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PubMedDate not supplied

[Current trends in medical rehabilitation and their significance for the field of psychosomatic rehabilitation].

At present the process of serious restructuring can be observed in the system of medical rehabilitation in Germany. This paper focuses on recently initiated innovations and their consequences for psychosomatic rehabilitation. The patient's access to a psychosomatic rehabilitation system is analysed and examined to what extent innovations increase early detection of patients with psychosomatic disorders. Regarding the structure of psychosomatic rehabilitative offers, the initiated innovations such as an increase of flexibility, better transition and improvement of inpatient rehabilitative offers are described and discussed. Finally, the development of quality improvement programs and rehabilitation research in the field of psychosomatic rehabilitation is presented. Although many changes have taken place up to now, further relevant modifications in psychosomatic rehabilitation are predicted by the authors.

Ambulatory Care↗
PubMed1981

[Vocational rehabilitation of heart patients. An analysis of "vocational rehabilitation cases" closed by the federal employment institute (author's transl)].

The number of heart/circulatory disease rehabilitation cases closed annually by the Federal Employment Institute has remained almost the same over the 1972-1978 period. In 1978 the national total of closed heart/circulatory disease cases amounted to 6,325, with 945 of the clients having attended vocational rehabilitation measures/courses. Some 25 percent of the cases are classified as "condition following myocardial infarction"; in male clients, this applies to about one third. Compared to the number of male clients, women are strongly under-represented in vocational rehabilitation of heart/circulatory disease patients. In relation to the structure of the gainfully employed population total, the frequency of vocational rehabilitation measures on heart/circulatory disease diagnoses varies strongly among the individual Laender employment office districts. Considerable differences are apparent when the age structure of heart/circulatory disease rehabilitation cases is compared with that of any other disability group. In case of the first, the number of cases increases with age, while the trend is the very opposite in the latter case. This fact shows that vocational rehabilitation measures for heart/circulatory disease patients need come up to special conditions, and that they have to be determined on different criteria. The rate of integrational solutions considered a positive outcome is considerably lower for heart/coronary disease rehabilitees than for the total of rehabilitees. The participation in vocational rehabilitation programmes of 14.9 percent equally is considerably lower than the corresponding percentage of the total number of rehabilitation cases (26.2 percent).

Female↗
PubMed1998

[Rehabilitation management categories. A new approach to case mix in medical rehabilitation].

Creating typical treatment case groups in medical rehabilitation, in short: Rehabilitee Management Categories (RMKs, Rehabilitanden-Management-Kategorien), is a key issue for quality assurance within the frame of modern concepts of Total Quality Management (TQM), not least utilizing current organization and management concepts (Managed Care). So far, the problem of creating highly homogeneous case groups has remained unsolved on the basis of the present methodological framework. Critical prerequisites for any further scientific work on this problem are being established in the field of medical rehabilitation with the help of the Classification of Therapeutic Services (CTS) as well as development of instruments documenting therapy plans for typical rehabilitation case groups, process-relevant quality features and definitions of therapy goals as a basis for quality screening under the Pension Insurance quality assurance programme in medical rehabilitation. These developments have clearly contributed to expanding the theoretical foundations as well as the prerequisites for empirical grounding of Rehabilitee Management Categories in medical rehabilitation under the Pension Insurance scheme. A project for determination of rehabilitation case groups which is based on these developments, is due to start at the Humboldt University and Technical University, Berlin in the near future within a rehab promotion initiative of the German Pension Insurance system in cooperation with the Federal Ministry of Research and Technology. Conceptually, the determination of Rehabilitee Management Categories by far exceeds all previous approaches as (1) it will be generated by an iterative process of empirical service descriptions and theoretical consensus building among experts, (2) not only static parameters but also process-related details will be recorded, and (3) quality requirements will be defined for the rehabilitation process and outcome. As a result, rehabilitation-relevant case groups are to be created, which will include a definition of process- and outcome-oriented quality standards. Unlike previous case group concepts, the new approach encompasses quality management issues as an integral part of its development. Since this concept for determination of Rehabilitee Management Categories incorporates the definition of quality standards, i.e., guidelines, prerequisites will be created for integrating these standards into quality management concepts, as well as service management across the interfaces of the German service delivery system (Managed Care).

Diagnosis-Related Groups↗
PubMed2000

Current issues in rehabilitation outcome measurement: implications for audiological rehabilitation.

OBJECTIVE: This paper will describe several key issues current in rehabilitation outcome measurement that should be considered in the establishment or choice of any new outcome measurement system or tools. DESIGN: The paper is a concept piece based on a review of literature rather than on experimental design. RESULTS: Social and political forces of the 1990s are affecting the need for outcome measurement and management: consumerism, or empowerment of the end user of services; the global Internet and information age; and the pervasiveness of the concept of quality improvement. In this context, several underlying concepts are important in effective outcome management approaches. Rehabilitation's focus on the person served provides a frame for measurement. Measurement in terms of the domains of the World Health Organization's International Classification of Impairments, Activities and Participation reflects meaningful dimensions of rehabilitation for people with hearing loss. Activities in the arena of rehabilitation performance indicator development are summarized and challenges in developing outcome management systems are discussed. CONCLUSIONS: The paper proposes that choice is a key outcome of interest in rehabilitation. Persons served in audiological rehabilitation and providers alike can benefit from systematic outcome measurement, but more can be learned about outcomes. Attention to consistent and uniform outcome measurement in audiological rehabilitation is consistent with the trends in the rehabilitation community at large.

Community Health Services↗
PubMedDate not supplied

Long-term effects of cardiac rehabilitation and the paradigms of cardiac rehabilitation.

BACKGROUND: The benefits of exercise training for postmyocardial infarction and postcoronary artery bypass surgery patients are well established, but little is known about the effects of rehabilitation in the months or years following the program. The purpose of this study was to assess exercise capacity, blood lipids, and physical activity patterns 2 years after completing a concentrated residential rehabilitation program in Switzerland. METHODS: Seventy-eight patients (86% males, mean age = 56 +/- 10, mean ejection fraction = 64% +/- 12%) were referred to a residential rehabilitation program after a myocardial infarction or coronary artery bypass surgery between January 2001 and June 2001. Patients lived at the center for 1 month, during which time they underwent educational sessions, consumed a low-fat diet, and exercised 2 hours daily. Two years after completing the program, patients returned to the hospital and underwent a maximal exercise test, an assessment of recent and adulthood physical activity patterns, and evaluation of blood lipids. RESULTS: During the 2-year follow-up period, there were 5 deaths, and 70 of the remaining 73 patients returned for repeat testing. Mean exercise capacity increased 27% during the rehabilitation program (P < .01). Gains in exercise capacity during rehabilitation were maintained after the follow-up period; mean exercise capacity after 2 years was 34% higher compared with that at baseline (P < .01). At the 2-year evaluation, patients were expending a mean of 3127 +/- 1689 kcals/wk during recreational activities compared with 977 +/- 842 kcals/wk during adulthood prior to their cardiac event (P < .001). Between the completion of rehabilitation and the 2-year follow-up, total cholesterol, total cholesterol/high-density lipoprotein ratio, and triglycerides increased significantly. CONCLUSIONS: Two years after a cardiac event and participation in a concentrated residential rehabilitation program, patients maintained their exercise capacity and engaged in physical activities that exceed the levels recommended by guidelines for cardiovascular health. These observations suggest that a relatively intensive rehabilitation program provided a catalyst to maintain physical activity patterns and exercise tolerance in the 2 years following a cardiac event.

Coronary Artery Bypass↗
PubMed1998

Nursing home rehabilitation after acute rehabilitation: predictors and outcomes.

OBJECTIVE: To determine the predictive factors and functional outcomes of patients who were discharged from an acute rehabilitation unit to a nursing home care unit (NHCU) at a Veterans Affairs (VA) hospital. DESIGN: Cohort descriptive study. SETTING: An academically affiliated urban VA Medical Center. PATIENTS: All patients (n = 81, median age 68 years) admitted to a VA rehabilitation unit over a 1-year period. OUTCOME MEASURES: Discharge locations, predictors for NHCU transfer, and functional status as determined by Functional Independence Measure (FIM) scores. RESULTS: Patients discharged to the NHCU (17%) were compared with those discharged to the community (80%). Multiple logistic regression analysis showed that acute rehabilitation length of stay (LOS), admission, and discharge FIM scores were the only independent variables that predicted discharge to the VA NHCU. Although overall FIM gains in both groups during acute rehabilitation were similar, the NHCU group had significantly lower admission FIM scores and lower LOS efficiency because of longer acute rehabilitation LOS. Postacute NHCU rehabilitation resulted in significant gains in FIM scores at a slower rate. Sixty-four percent of these nursing home patients eventually returned to the community. CONCLUSION: Nursing home rehabilitation can result in favorable functional and community outcomes for selected patients.

Activities of Daily Living↗
PubMed2005

[The application of hierarchical linear modelling for rehabilitation center comparisons in quality assurance and rehabilitation research].

For a fair comparison of rehabilitation centres with respect to the effects of the treatment provided (e. g. for the purpose of quality assurance programmes), it is essential that those factors which influence the outcome of rehabilitation treatment and over which the rehabilitation centres have no control (the so-called "confounders", such as co-morbidity and age of the patients on commencement of treatment) are included in the statistical analysis. Simple linear regression models without random effects and without interaction terms are frequently used for this purpose. However, this method has certain limitations which can be avoided if hierarchical linear modelling (HLM) is employed. HLM has the advantage over standard regression analysis methods in that it can be used to take into account the multi-level structure of a comparison problem, allows predictors to be introduced at the level of the centres and also makes it possible to model variations of regression coefficients for the centres. When the HLM technique is used, separate linear models can be produced for the various hierarchically structured data levels of the question (e. g. the levels "patients" and "centres" for rehabilitation centres, for example). Moreover, it can be empirically tested with HLMs whether the rehabilitation coefficients (e. g. effects of mean age of patients on the outcome of rehabilitation) differ significantly between the centres. In this article, we describe the use of hierarchical linear modelling on the basis of data obtained from the quality assurance programme of the statutory health insurance schemes in the field of medical rehabilitation ("QS-Reha").

Benchmarking↗
PubMed1991

Characteristics of pediatric rehabilitation training offered by physical medicine and rehabilitation residencies.

Pediatric physiatry is a growing subspecialty. A survey was designed to determine the nature of pediatric rehabilitation training in physical medicine and rehabilitation residency programs in the United States. Sixty-five programs (93%) responded. More than three quarters of the programs required three months or more in pediatric rehabilitation, usually in the HO-III or HO-IV year. Forty-two percent of the programs had an even balance of inpatient and outpatient clinical opportunities. Approximately half offered exposure to a separate pediatric rehabilitation ward, and 82% placed residents in a general pediatric rehabilitation clinic. Advanced training has become more widespread in pediatric rehabilitation, with 46% of the residency programs having preceptors with board certification in pediatrics and physiatry or fellowship training, and 42% of the programs responding offering advanced training opportunities in pediatric rehabilitation.

Child↗
PubMed1999

[Ambulatory cardiac phase II rehabilitation--"the Cologne model"--including 3-year-outcome after termination of rehabilitation].

From January 1992 until December 1994 the Cologne model of ambulant cardiac rehabilitation (ACR) in the greater area of Cologne, Germany, was performed and is still in progress. In Germany until 1992 the cardiac rehabilitation was exclusively performed stationary. The objective of the "Cologne model" was to evaluate, whether the transfer of the stationary cardiac rehabilitation programs into the ambulatory setting is achievable without deficits in efficiency, safety and overall quality. The results obtained are intended to serve for standardization and quality control of future ambulatory cardiac rehabilitation programs in Germany. From 1992 to 1994 108 patients (94 men, 14 women; 52.3 +/- 8.0 years old) with coronary artery disease (CAD) which were compatible with the criteria of the "Cologne model" (Table 1) participated in the 4-week ACR. The indications for inclusion into the ACR were in 74 cases a myocardial infarction (MI), in 34 cases CAD without MI, but with PTCA/stent-procedure (Table 3). Seven patients discontinued the ACR prematurely, 2 patients because of cardiovascular reasons. Reasons for the preference of the ambulatory over a stationary cardiac rehabilitation program were in 40.6% of the patients refusal of "hospital ambience", in 43.6% familiar or in 12.9% professional reasons. During the 4-week ACR patients participated in a mean of 72.9 +/- 6.7 hours of therapy (Table 4). As a result of the ACR exercise tolerance increased highly significantly (**) from 116.4 +/- 28.8 to 129.9 +/- 34.6 watt). This improvement was maintained at the 1- and 3-year control (128.7 +/- 35.8**) examinations (Tables 5 and 7). One year after ACR 77% of the patients stated to be physically active in ambulatory heart groups (AHG) (27.6%) or on their own (49.4%). Three years after ACR the rate of regularly physically active patients still was 59.2%. Furthermore, as a result of ACR the dietary behavior was changed significantly. There was a reduction in the consumption of lipids by 20.8%, saturated fatty acids by 30.7% and of cholesterol by 30.5%. The plasma concentrations of cholesterol decreased from 231 +/- 49.8 to 213.2 +/- 35.9 mg%**. Six (and 12) months after ACR they increased again to 225.6 +/- 39.4 mg%. Three years after ACR the mean cholesterol level was 219.1 +/- 39.3 mg%. In the high risk group (cholesterol at the initial visit > 220 mg%) cholesterol levels were reduced from 266 +/- 44 to 232 +/- 31.9 mg%**. Six and 12 months after ACR they were 239.7 +/- 35.8 mg% and 245.8 +/- 32.6 mg%, respectively, (Tables 6 and 7) and still significantly lower than before ACR, though only 19% of the patients were treated with lipid lowering agents. Three years after ACR cholesterol were 234.6 +/- 37.7 mg%** in the high-risk group. 34.2% of the patients received lipid lowering agents. Mean body weight remained unaltered over the 3-year period. Smoking behavior was not altered significantly during the 4-week ACR. However, before the cardiovascular event 67.3% of the patients had smoked cigarettes. At the beginning and at the end of ACR 20.8% of the patients still smoked. During the ACR the number of smoked cigarettes was reduced significantly from 32.4 +/- 15.2 to 6.9 +/- 5.2 cigarettes per day. One year after ACR 23% of the patients were smokers, 3 years after ACR the percentage of smokers increased to 30.3%. Before ACR 73.3% of the patients were still working. During the first 6 months after ACR 68.2% returned to work and the percentage increased to 73% in the following 6 months. The results demonstrate that it is achievable to transfer the contents of the established stationary cardiac rehabilitation programs into the ambulatory setting without loss of efficiency, safety and overall quality. It is further confirmed, that it is necessary to continuously evaluate the results of the cardiac rehabilitation program on a long-term basis. (ABSTRACT TRUNCATED)

Adult↗
PubMed1999

[Ambulatory/partial inpatient phase II rehabilitation of heart patients in a Rhine-Main district rehabilitation clinic].

According to the guidelines and standards for a comprehensive phase II rehabilitation a new outpatient/part-time outpatient program was developed and started at an existing rehabilitation center in January 1997. All patients of the new program were included in a follow-up study and compared with patients of the same center, who met the inclusion and exclusion criteria for the outpatient mode, but wanted to perform their rehabilitation in the full-time residential mode. Both groups were examined before, at the end and 6 months after the program. Until December 1998 118 patients after an acute cardiac event such as myocardial infarction, PTCA or heart surgery were rehabilitated in the outpatient/part-time outpatient mode. The short- and medium-term results concerning somatic outcomes, e.g. the risk factor profile or the improvement of the maximum work capacity, were equal in both groups. Comparing the direct costs for a 4-week rehabilitation, the part-time outpatient program was 26%, the outpatient program even 52% cheaper than the standard full-time residential program. The new program is as effective as the residential rehabilitation, but it is cheaper. Because of the in- and exclusion criteria it is suitable for only a subgroup of cardiac patients, because of the demands and standards the new program it can be offered only in special rehabilitation centers.

Adult↗
PubMedDate not supplied

[Outcomes of cardiac rehabilitation treatment and cost-effectiveness relations--A comparison between inpatient and outpatient rehabilitation programmes].

Regarding the dominance of inpatient medical rehabilitation programmes efforts have emerged over the last few years to strengthen outpatient medical rehabilitation programmes in Germany. The goal of cardiac rehabilitation is the recovery of physical, psychic and social wellbeing in people with a severe heart condition. For this contribution the central outcomes of cardiac rehabilitation were compared between different rehabilitation programmes (inpatient and outpatient) and cost-effectiveness analyses were made. These results were obtained within the scope of an evaluation study commissioned by the statutory health and pension insurance agency. In summary, the different rehabilitation programmes can be regarded as comparable concerning effectiveness and costs following rehabilitation.

Activities of Daily Living↗
PubMed2005

[Criteria for assessing the need for rehabilitation and for sanctioning refund claims -- Würzburg rating scale for sociomedical expertising on the need for rehabilitation and on the justification of refund demands on statutory insurance].

The essential criteria governing the assessment of the need for rehabilitation must be reviewed before making a sociomedical decision on claims to the German Statutory Pension Insurance (GRV) for refunding expenditure on rehabilitation. For an objective view of such a sociomedical decision, one must specify more clearly the fundamental assessment criteria. The study presented here was based on an exploratory analysis using a specific rating scale (the "Würzburg Checklist") for the various aspects of necessary rehabilitation according to sociomedical assessment of the medical records and medical examination of the patient. The aim of such an analysis is to pinpoint the various necessary decisions one by one before arriving at a final sociomedical expertise enabling the insurance body to decide to meet the cost of rehabilitating a particular patient. Three Bavarian Statutory Sickness Insurance bodies conducted medical random checks by selecting a sample of applicants with musculo-skeletal disease (n = 483) and examining the medical records and the results of a personal examination of the applicant by the medical expert. Completion of the rating scale was done after the experts had made their decision. The rating was subsequently repeated by the clinicians when the patient was admitted to the rehabilitation hospital. Although there were significant differences between these three groups of physicians in the evaluation of the applicants in respect of requirement criteria, it was not possible to identify any particular tendency to a verdict. Assessing the criteria according to the records is limited to some extent. Factor analysis yields five subscales in the rating list with good internal consistency: overall impediment, forecasting the ability to being motivated for rehabilitation, professional efficiency rating, psychosocial stress, risk factors. These subscales, while fairly consistent, are discriminatively valid in respect of rehabilitation recommendations by the sociomedical experts. The results of this survey are a first approach to the development of a practically relevant structural tool for sociomedical assessment.

Adult↗
PubMed2006

[Regional quality assurance in medical rehabilitation. The Schleswig-Holstein medical rehabilitation quality community--initiative and testing].

In light of the growing age of the population in Germany and worldwide as well as the increasing of chronic diseases, there can be no doubt about the importance of medical rehabilitation. Yet the unbalanced proportions of treatment (costs), effectiveness and efficiency have been discussed critically in the past. The Statutory Pension Insurance scheme responded to this imbalance with a comprehensive quality assurance programme. Furthermore, a nation-wide Rehabilitation Research Funding Programme was established. Still missing, however, are transfer of scientific results into practice and a quality assurance programme that focuses on outcomes and effectiveness. In 2001, in Schleswig-Holstein, a "Medical Rehabilitation Quality Community" was initiated. The Community aims are a higher level of transparency of rehabilitation treatment procedures, providing proof of effects on patient outcomes, and comparison of effects achieved in different rehabilitation clinics, based on patient surveys. After completion of funded pre- and main phases, the Medical Rehabilitation Quality Community will be continued on a self-initiative and self-financing basis. In this paper, procedures and feasibility of the project are described. The main empirical results (outcomes, patient satisfaction, treatment after rehabilitation, n = 2026, and indication related benchmarking) will be presented in a subsequent article.

Community Health Services↗
PubMed2003

Community rehabilitation, or rehabilitation in the community?

PURPOSE: Political and other considerations are increasing the profile of 'community rehabilitation' but there is little agreement on the nature of community rehabilitation or its benefits and disadvantages. This paper clarifies some of the underlying conceptual and evidential matters in the context of the WHO International Classification of Functioning model of disablement. CLASSIFICATIONS: Rehabilitation services can be classified by their specialist skills (e.g. spinal injury services, wheelchair services), by the geographic location of the service (e.g. inpatient stroke service), by the organization managing the service (e.g. social services rehabilitation service), or by location of service delivery. There is no useful consistent comprehensive classificatory system, and all classificatory labels may carry hidden implications. EVIDENCE: The evidence suggests that rehabilitation is more effective when given in the patient's own environment. It also suggests that most so-called community rehabilitation teams are relatively short-lived and are not multi-disciplinary and not expert. SOLUTION: We should work towards a network of rehabilitation teams, some specialized in specific diseases or interventions, and some in longer-term involvement with patients in the community with special emphasis on increasing social participation and ensuring good support. At all times we should balance the advantages of delivering the service in the patient's home against the obvious problems concerning practicality and the equitable use of scarce specialist staff time.

Community Health Services↗
PubMed2002

Current status of rehabilitation medicine in Asia: a report from New Millennium Asian Symposium on Rehabilitation Medicine.

With the aim of promoting rehabilitation medicine in Asian countries, where the number of persons with disability occupies a significant proportion in the world, New Millennium Asian Symposium on Rehabilitation Medicine was held in February 2001 in Tokyo, under the sponsorship of the Japanese Association of Rehabilitation Medicine. Twenty-three guest speakers from 14 Asian countries and regions participated in the 2-day meeting. With a structured questionnaire that was sent to the participants beforehand, demographic data related to rehabilitation practice and information on training and certification in rehabilitation medicine in the participating countries were collected, and presented at the meeting. Based on these data, the current status of rehabilitation medicine in Asia was summarized. The symposium marked an important step forward for the promotion of rehabilitation medicine in Asia.

Asia↗
PubMed2006

Rehabilitation outcomes in patients with brain tumors and acute stroke: comparative study of inpatient rehabilitation.

OBJECTIVES: To investigate functional outcomes after hospital rehabilitation of patients surviving craniotomy for primary brain tumor excision compared with post-stroke patients. DESIGN: The database of the Neurological Rehabilitation Department "C" of Loewenstein Rehabilitation Center was used to investigate primary brain tumors and first ischemic and hemorrhagic stroke patients admitted for hospital rehabilitation during an 11-yr period, between January 1993 and August 2004. Particular attention was paid to age and sex distribution, onset-to-admission interval, length of stay, functional status at admission and discharge, functional gain (DeltaFI change) as measured by the FIM instrument. RESULTS: A total of 168 patients with craniotomy for primary brain tumor excision (128 intracranial meningiomas and 40 cerebral gliomas) and 1660 first-stroke patients were admitted to the department for rehabilitation during the study period. Mean patient age was 59.9 yrs in meningioma group, 54.1 yrs in the glioma group, and 60.4 yrs in the stroke group. In the meningioma and stroke groups, male patients were in the majority (62 and 70%); in the glioma group, there was equal sex distribution. On average, patients were admitted to rehabilitation treatment 13 days after meningioma excision, 34 days after glioma operation, and 21.6 days after stroke. Functional variables during inpatient rehabilitation were found to be similar in the all groups. Average FIM rating at admission was 80.07 in the meningioma group, 68.2 in the glioma group, and 70.4 in the stroke group. Average discharge FIM rating was 90.3 for patients with meningiomas, 80.7 for patients with gliomas, and 87.8 for stroke patients. Functional gain was 17.9 for meningioma patients, 17.2 for glioma patients, and 21.8 for stroke patients. Average length of stay was 24 days for the meningioma group, 23 days for the glioma group, and 75.4 days for stroke patients; 88.1% of stroke patients, 91.7% of meningioma patients, and 82.7% of glioma patients were discharged to their homes, and 5.4, 3.4, and 8.6%, respectively, were discharged to nursing homes. CONCLUSIONS: Patients with brain tumors can achieve good functional outcomes with a shorter length of stay.

Adult↗
PubMed1999

[Partial inpatient cardiologic rehabilitation in an urban satellite center of a rehabilitation clinic: the Munich model].

In April 1996 the Munich Rehabilitation Center was founded by the Social Security Agency as a "satellite center" of the "Klinik Höhenried for Cardiovascular Diseases", which is located 50 km south of Munich near the lake Starnberg and performs in-patient rehabilitation since 1967. The Munich Rehabilitation Center is exclusively designated for outpatient rehabilitation for patients in the Munich area. Monday to Friday from 9 a.m. to 4 p.m. up to 50 patients are treated according to the same standards as in residential centers. About 40% of patients treated are in WHO phase II, e.g. after coronary artery bypass grafting, acute myocardial infarction or a percutaneous transluminal coronary angioplasty. 60% have a chronic stable cardiac disease or risk factors for arteriosclerosis. After almost 3 years of experience we see some specific advantages in outpatient compared to the in-patient setting. Ambulatory treatment seems to be more than the residential center "minus a bed". For example: a "holiday feeling" can be avoided by the location in a city area, so the patients are focusing on medical rehabilitation. Outpatient rehabilitation makes an easy transition from a cardiological center to every day life possible. Some patients would refuse any further treatment far away from home because of personal or occupational reasons. Anxiety can be reduced and self-confidence increased by the outpatient setting. There is a daily feedback about the ability to transfer therapeutic advices home. We learned to appreciate outpatient rehabilitation as a cost-effective supplement to the proven in-patient setting for patients in municipal areas.

Ambulatory Care↗
PubMed1999

[Evaluation of ambulatory orthopedic-traumatologic rehabilitation by compensation insurance. A comparison with inpatient rehabilitation].

In 1994, "Ambulant Orthopaedic-Traumatologic Rehabilitation" (AOTR) was introduced by the Ersatzkassen health insurance funds. This study investigated structural, process and outcome quality. One of the study questions asked is whether AOTR is as effective for (1) patients with low back pain and clinical signs of disc problems and (2) patients with cruciate ligament injury as the routinely practised inpatient rehabilitation. In a quasi-experimental cohort study patients from five AOTR centers were compared to patients from five orthopedic rehabilitation clinics with regard to their rehabilitation outcome measured on the clinical, disability and handicap level. At the beginning (t0) and the end (t1) of the rehabilitation, data were collected from patients and therapists and 6 months later (t2) only from patients by means of questionnaires. The inclusion criteria for patients with back problems had to be broadened ("patients with low back pain") because of difficulties with patient sampling. Sample sizes were n = 166 (AOTR: 100, inpatient: 66) for t0 and t1 and n = 101 (AOTR: 47, inpatient: 54) for t0, t1 and t2. At baseline, ambulant patients with low back pain were younger (43 vs. 49 years) and better off with regard to disabilities and handicaps than patients from rehabilitation clinics. Clinical signs (e.g., neurological signs, Lasègue sign, flexibility of the spine) showed smaller differences. At t1 clinical, disability and handicaps variables had improved considerably in both groups. At t2 the improvements had stabilized or had become greater. Analyses of variance showed that improvements in the ambulant group were not much greater after accounting for the different baseline status. The sample size of patients with knee ligament injury was n = 66 (AOTR: 50, inpatient: 16). Ambulant patients considerably improved with regard to knee function and handicaps. Despite of small sample sizes this study provides some evidence that (1) AOTR and inpatient rehabilitation both are effective for treating subgroups of patients with low back pain and (2) AOTR is effective for treating patients with cruciate ligament injury.

Adult↗