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PubMed2003

Substance use disorder comorbidity among inpatient youths with psychiatric disorder.

OBJECTIVE: Substance abuse/dependence has been reported to show significant association with psychopathology, and is likely to influence the course and outcome of psychiatric illness. The aim of this study was to determine the rate of substance use disorders (other than alcohol) comorbidity among inpatient adolescents with severe Axis 1 psychiatric disorder. METHOD: A retrospective analysis of systematically collected data was carried out. The subjects were 16-18-year-old youths, admitted to an inpatient unit for severe psychiatric disorder. The data collection process utilized the DSM-IV criteria for diagnostic categorization of psychiatric disorder and substance use disorder. Demographic data, and data on suicide attempts were also collected. RESULTS: Over a period of one year (March 2001-March 2002), 62 patients were admitted to the Christchurch Youth Inpatient Unit; 40 (64.5%) had a comorbid Substance Abuse Disorder (SAD) according to DSM-IV criteria and none had a Substance Dependence Disorder. The vast majority involved cannabis and stimulants. Sixty per cent of those with mood disorder, 63% of those with anxiety disorder and 80% of those with schizophrenia spectrum disorder had a comorbid SAD. Internalizing problems, especially mood disorders, pre-dominated among those with SAD reflecting the Unit's admission criteria. There were no differences in attempted suicide rates between those with SAD and those without SAD, but those with SAD were more likely to have unstable accommodation/living arrangements than those without SAD. CONCLUSIONS: Our findings confirm previous reports suggestive of high rates of SAD comorbidity among youth with severe psychiatric illness. There are clinical and process implications for these findings particularly identification of substance use disorders and their treatment as well as resource availability and staff training.

Adolescent↗
PubMed1998

Analyzing the time and value of housestaff inpatient work.

OBJECTIVE: To determine time allocation and the perceived value to education and patient care of the weekday activities of internal medicine housestaff on inpatient rotations and to compare the work activities of interns and residents. DESIGN: An observational study. We classified activities along five dimensions (association, location, activity, time, and value), developed a computer-assisted self-interview survey, and demonstrated its face and content validity, internal consistency, and interrater reliability. Subjects were assigned survey computers for 5 consecutive weekdays over a 24-week period, into which they entered data when prompted several times a day. SETTING: The medical service of a university-affiliated Veterans Administration Medical Center. PARTICIPANTS: Sixty housestaff (36 interns, 24 residents) rotating on the inpatient wards. MEASUREMENTS AND MAIN RESULTS: We analyzed activities according to content (direct patient care, indirect patient care, education), association, and location. Likert-scale ratings of perceived value to education and patient care were also obtained. Housestaff provided complete responses to 3,812 (95%) of 3,992 prompts by a median of 11 seconds; 93% of responses were logically consistent across the measured dimensions. Housestaff spent more time in indirect patient care (56%) than in direct patient care (14%) or educational activities (45%). Formal educational activities had the highest educational value (66 on 0-100 scale), and direct care had the highest value to patient care (81). Over 30% of time was spent in administrative activities, which had low educational value(40). Compared with residents, interns allocated significantly less time to educational activities (38% vs 57%) and more time to lower-value activities such as documentation (19% vs 12%). CONCLUSIONS: Improved data collection methods demonstrate that housestaff in our program, particularly interns, spend much of their workday in activities that are low in educational and patient care value. Selective elimination or delegation of such activities would preserve higher-value experiences during reductions in overall inpatient training time. Planners can use automated random sampling to guide the rational redesign of housestaff work.

Confidence Intervals↗
PubMed2001

Inpatient interdisciplinary rehabilitation after total hip arthroplasty surgery: a comparison of revision and primary total hip arthroplasty.

OBJECTIVES: To describe outcomes of revision total hip arthroplasty (THA) patients who underwent interdisciplinary inpatient rehabilitation, and to compare them with primary THA patients. DESIGN: Descriptive and case-control study. SETTING: Forty-bed, community-based, freestanding rehabilitation hospital. PATIENTS: Thirty-nine revision THA subjects, gender- and age-matched with 39 primary THA controls. INTERVENTION: Inpatient interdisciplinary rehabilitation. MAIN OUTCOME MEASURES: FIM instrument, length of stay, hospital charges, and disposition location. RESULTS: The average revision THA patient stayed 10.5 days, improved from an admission FIM score of 89 to a discharge FIM score of 110, and incurred a hospital charge of $10,600. Of the revision THA patients, 98% were discharged home, and orthopedic-related complications were uncommon. No significant differences existed between revision and primary THA patients in any outcome measures. A trend toward higher rehabilitation charges ($12,400 vs $9500, p =.07) was found in revision THA patients who wore a hip orthosis. Otherwise, no differences were found in outcome measures based on the type of revision surgery, the presence of weight-bearing restrictions, or the presence of orthopedic complications. CONCLUSIONS: THA patients selected for inpatient rehabilitation have favorable short-term functional outcomes. The type of THA (primary vs revision) is not an independent differentiating factor.

Aged↗
PubMedDate not supplied

Treatment histories of borderline inpatients.

In this study, we describe the types and amounts of psychiatric treatment received by a well-defined sample of borderline personality disorder (BPD) inpatients, and compare these parameters with those of a group of carefully diagnosed personality-disordered controls. Finally, we assess the risk factors associated with a history of intensive, high-cost treatment, which we defined as having had two or more prior psychiatric hospitalizations. The treatment histories of 290 borderline inpatients and 72 axis II controls were assessed using a reliable semistructured interview. All nine forms of treatment studied except electroconvulsive therapy (ECT) were common among borderline patients (36% to 96%). In addition, a significantly higher percentage of borderline patients than axis II controls reported a history of individual and group therapy, day and residential treatment, psychiatric hospitalization, participating in self-help groups, and taking standing medications. They were also significantly younger when they first entered individual therapy and began to take standing medications. In addition, borderline patients spent more time than axis II controls in individual therapy and psychiatric hospitals, and were on standing medications for a significantly longer period of time. They also reported a significantly higher number of psychiatric hospitalizations, lifetime number of standing medications, and number of psychotropic medications taken at the same time. In addition, we found a highly significant multivariate predictive model for multiple prior hospitalizations. The six significant predictors were age 26 or older, a history of quasi psychotic thought, lifetime number of self-mutilative efforts and suicide attempts, a childhood history of reported sexual abuse, and an adult history of being physically and/or sexually assaulted. Taken together, these results confirm clinical impressions concerning the high rates of mental health services used by borderline patients. They also suggest that particularly high rates of costly inpatient treatment are associated with a complex admixture of older age, BPD symptoms in the cognitive and impulse realms, and traumatic life experiences occurring in both childhood and adulthood.

Adolescent↗
PubMedDate not supplied

Improvement of patient attitude toward treatment among inpatients with schizophrenia and its related factors: controlled study of a psychological approach.

A randomized controlled trial was conducted in an acute inpatient setting to test the effects of an intervention based on individual interviews, with the goal to improve patients' attitudes towards their psychiatric situation and understanding of illness and its treatment. In addition, the factors related to the improvement were explored. Fifty eligible male patients with DSM-IV schizophrenia recruited from consecutive admissions were allocated to two groups: weekly sessions plus routine inpatient treatment or routine inpatient treatment only. Assessment was conducted twice, before and after the maximum 8-week intervention period. The assessment included a self-report scale for measuring patients' psychological attitudes toward their treatment situation, scales of therapist perception and self-perception applying a semantic differential technique, and the Maudsley Personality Inventory (MPI), in addition to assessment of psychotic symptomatology. We found a modest but significant effect of the intervention on one domain of patient attitude: recognition of need for treatment. Trust of patients in their psychiatrist was a factor for improvement of the recognition domain. Neuroticism had some influence on the formation of personal relations in a psychiatric situation. This study lends support to the effectiveness of psychological treatment on patient attitude, and indicates some factors related to its development.

Adaptation, Psychological↗
PubMedDate not supplied

Self-harm behaviors across the life cycle: a pilot study of inpatients with borderline personality disorder.

The purpose of this study was to explore, throughout the life cycle, the prevalence of self-harm behaviors among psychiatric inpatients with and without borderline personality disorder (BPD). Psychiatric inpatients with BPD (n = 43) were compared to those without BPD (n = 40) with regard to self-reported self-harm behaviors during their lifetime. The mean number of self-harm behaviors, including high-lethal behaviors (i.e., suicide attempts, cutting oneself, overdosing), among those with BPD dramatically increased between the ages of 18 and 24 years and was sustained through ages 50 to 59 years. Non-BPD patients showed a similar pattern, but the means were notably less. These data suggest that the behavioral "burn out" theory of personality disorders does not necessarily occur among inpatients with BPD.

Adolescent↗
PubMed2003

Benefit of inpatient multidisciplinary rehabilitation up to 1 year after stroke.

OBJECTIVE: To analyze the benefit of inpatient multidisciplinary rehabilitation up to 1 year after stroke. DESIGN: Retrospective cohort study. SETTING: Inpatient rehabilitation hospital in Japan. PARTICIPANTS: A total of 1056 patients with stroke were divided into 3 groups based on the interval between stroke onset and admission to the rehabilitation hospital: group I, within 90 days (n=507, 48%); group II, 91 to 180 days (n=377, 36%); and group III, more than 180 days (n=172, 16%). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcome (A to D; independent to totally dependent) in walking, affected upper extremity, and activities of daily living (ADLs) and discharge disposition. RESULTS: Walking status improved in 70.9% of nonambulatory patients in group I, in 54.8% in group II, and in 43.9% in group III. Similarly, ADLs improved in 66.7% of the totally dependent patients in group I and in approximately 50% in groups II and III. Functional gain in those with a totally nonfunctional upper extremity at admission was poor (29.7%). Initial functional categories affected each outcome (P<.0001). On discharge, 73.8% in group I and approximately 60% in groups II and III went home. CONCLUSION: Approximately half of all patients regained their abilities in walking and ADLs after inpatient multidisciplinary rehabilitation up to 1 year after stroke. However, there was considerable limitation in functional recovery of the affected upper extremity.

Activities of Daily Living↗
PubMed2000

[Partial inpatient oncologic rehabilitation--results of a model project].

Medical rehabilitation in Germany is traditionally performed primarily in the inpatient setting. It was not until recent years that model forms of outpatient offers were first tested. In this article we will present the results of a comparative evaluation of inpatient and outpatient/partially outpatient oncological rehabilitation measures. Within the framework of a retrospective questionnaire study, oncological rehabilitants from both settings will be compared with regard to questions concerning the process of participation, rehabilitative goals, oncological interventions and perceived outcome from the perspective of the patient. An overall result is that persons who were treated in the outpatient setting, when compared with those treated in the inpatient setting, show more congruency than discrepancy with regard to all of these key topics. The results will be discussed with respect to further development of the rehabilitative health care system.

Adult↗
PubMed2001

[Varicose vein operation under inpatient conditions].

The change of surgical operations from inpatient to outpatient conditions as a method of lowering costs in health care has lead to a significant rise in the number of outpatient operations, especially in varicose vein surgery. Hospitalisation is still required in special cases. The criteria of 146 patients with varicose veins for admittance to inpatient treatment were retrospectively reviewed. The clinical findings, the designated operation and the specific personal factors were assessed. We found in just under 70% of the patients the indication for hospital admittance whereas in slightly over 30% the outpatient management was ascertained. Through this selection the total number of inpatients could be reduced, leading on the other hand to a relative increase in the number of difficult cases with more severe conditions requiring more complex management.

Adult↗
PubMed2001

[Inpatient violence: frequency, risk factors, preventive strategies].

In contrast to Angloamerican and Scandinavian countries inpatient violence was not regarded as a problem in German-speaking countries for a long time. Only recently it has become a topic of increasing interest for clinical practice and research, whereby the present data exhibit significant parallels to the international development. After the discussion of methodological problems (e. g. varying definitions, sources of information, ways of registration) the paper presents the current state of knowledge about inpatient violence:Underestimation in general, mainly with respect to female patients; only a few patients are responsible for the majority of assaults; victims are rather staff members than fellow patients; discrepancy between the mostly minor physical, though major emotional consequences for victims; considerably negative effects on patient-staff interactions and ward climate. Aside from patient-related actuarial and dynamic risk factors (social origin, previous history of aggressive behaviour, dissocial personality traits and - partly - diagnoses, acute intoxication, substance abuse, lack of insight and compliance, psychotic symptoms) external/contextual factors as patient-staff ratio, ward size, structure and climate, staff-attitudes, recognition of early warning signs and handling of risk situations are of major importance for the frequency and severity of incidents. Intervention and prevention strategies are focussing - aside from medication - on the aforementioned staff-related factors and patient-staff interactions. They are the principal basis for sufficient inpatient treatment beyond the problem of violence.

Aggression↗
PubMedDate not supplied

[Outpatient orthopaedic rehabilitation: treatment, outcomes and costs as compared to inpatient rehabilitation].

In a parallel design the study examined an outpatient rehabilitation model project for patients of the pension insurance scheme of Rhineland-Palatinate (LVA Rheinland-Pfalz). In 6 centers for the rehabilitation of musculoskeletal diseases patients were assessed at the beginning and at the end of rehabilitation as well as six and twelve months after discharge. In this article the final results concerning therapeutic measures as well as health-related and economic outcomes are presented. Not included are aspects of differential utilization and the perception of the rehabilitation by the clients, which will be published in a separate article. No large differences were found concerning participation in the various therapeutic measures. As measured by the main score and the sub-dimensions of the IRES patient questionnaire, effects of the same magnitude were found for the parallelized samples. Equally, no differences in outcome quality were found concerning the great majority of medical parameters documented in a doctors' questionnaire, the rate of applications for pension, occupational status twelve months after rehabilitation, as well as the reduction of sick-leave. The economic evaluation was carried out only from the perspective of the pension insurance agency. Considerable differences were found in the net costs of rehabilitation: although there are no user charges for patients in outpatient rehabilitation, mean expenditure was about 970 EURO lower than in inpatient rehabilitation. The study findings demonstrate that the concept of interdisciplinary rehabilitation has been realized in the outpatient centers as well and that the centers have reached an effectiveness comparable to that of inpatient rehabilitation. At least those patients who actively choose the outpatient setting gain as much as patients in inpatient rehabilitation.

Adult↗
PubMedDate not supplied

[Outpatient and inpatient orthopaedic rehabilitation--results of a study comparing outcome and costs].

This article presents main results of a study comparing outcome and costs of various all-day outpatient and inpatient orthopaedic rehabilitation forms. The results were obtained within the scope of a comprehensive evaluation programme commissioned by the federation of health (VdAK) and pension insurance institutes (VDR). The purpose of this evaluation was to examine the quality of different types of various rehabilitation care. The outcome comparison comprises a longitudinal follow-up of various somatic, psychosocial und occupational reintegration parameters up to one year after rehabilitation as well as outcome assessments from the perspective of patients and physicians in rehabilitation centres and general practice. The costs are estimated on the basis of data from health and pension insurance funds. The results show extensive corresponding of results und assessments in the different forms of rehabilitation care for comparable patient groups. There are no indications of poorer care quality in outpatient rehabilitation, while economic analyses show better cost effectiveness in outpatient treatment by comparability of treatment, patients, and results. Results suggest that outpatient care, offered in the same quality as in the examined rehabilitation centres, is an alternative or complement to inpatient care at least for those patients, who can be treated in both the outpatient and inpatient setting.

Ambulatory Care↗
PubMedDate not supplied

[Outpatient and inpatient neurological rehabilitation--a follow-up comparison].

Since the mid-90s outpatient rehabilitation has been developed by public health insurance companies and pension funds. Outpatient rehabilitation is defined as comprehensive multidisciplinary and medically supervised service which in neurological rehabilitation mostly follows inpatient rehabilitation. In the present paper partial results of a larger study (by Schoenle and Leyhe, 2000) are reported with respect to the follow-up of the effects of outpatient versus inpatient rehabilitation 6 month after termination of the treatment. Major results are the endurance of the effects over the observed time interval and the equivalent effectiveness of the two forms of rehabilitation. Distinct effects were observed for the two patient groups (more progress in the body related functional disturbances for inpatients versus cognitively related progress for the outpatients). The results reflect intrinsic features of neurological rehabilitation and the current organizational status of neurological rehabilitation in Germany.

Activities of Daily Living↗
PubMedDate not supplied

[Short term results of outpatient vs. inpatient rehabilitation after stroke].

Fifty stroke patients who had already regained basic ADL-functions were investigated at the beginning and end of either inpatient or outpatient rehabilitation of similar therapeutic intensity in the same institution. For geographic reasons, outpatient treatment could only be offered to a subgroup of patients. Neurological deficits, extended ADL-functions and quality of life (SF-36) were assessed. Patients who chose outpatient rehabilitation exhibited milder neurological deficits and better ADL-function at onset. On average, outpatient rehabilitation took about 8 days more than inpatient treatment. Under rehabilitation, gains with respect to ADL-functions and the QoL-dimensions "physical role function" and "physical functional ability" were realized. The magnitude of changes did not depend on setting. A decrease in "general health perception" may be related to the inpatient treatment of patients who would have preferred an outpatient setting. Brief periods between stroke and onset of rehabilitation and longer duration of rehabilitation treatment were significantly associated with better outcome with respect to ADL-functions.

Activities of Daily Living↗
PubMedDate not supplied

[Rehabilitation outcomes of a psychosomatic clinic integrating fully inpatient and partial hospitalization rehabilitation approaches: a comparison].

As publications from the domain of psychosomatic rehabilitation pertaining to the conceptual approaches and effects of partial-hospitalization rehabilitation have so far relied on very small case numbers, the effectiveness of partial-hospitalization rehabilitation was analysed in 318 patients in comparison to a large sample of rehabilitants who had participated in fully inpatient rehabilitation. No relevant differences were found among the groups studied in sociodemographic respects or range of diagnoses. The same was true concerning the level of complaints present at the onset of rehabilitation. Good rehabilitation outcomes were achieved in both groups, however, the effect sizes found for changes in depressiveness and indulgence to complaining ("Klagsamkeit") (GSI from the SCL-90) were lower in the partial-hospitalization group than in the patients in fully inpatient rehabilitation. Also, the relatively high share of partial-hospitalization patients discharged unable to return to work might be clinically significant. While our findings confirm the good results reported from other disciplines, they nevertheless are a reminder of the need for very careful selection of patients for partial-hospitalization rehabilitation, in order not to withhold "better" rehabilitation than could be provided on a partial-hospitalization basis from patients with special sociomedical problems. The best rehabilitation outcomes seem to be achieved by those patients who, towards the end of fully inpatient rehabilitation, were granted transition to the partial-hospitalization programme.

Adult↗
PubMed2003

[Inpatient medical rehabilitation in diabetes mellitus in light of evidence based practice guidelines: an evaluation on the basis of BfA routine data].

OBJECTIVE: Multidisciplinary team care is an opportunity to improve the long-term metabolic situation of patients with diabetes mellitus, hence can help reduce the individual and financial burden of diabetes-related complications. The aim of this study is to evaluate the extent to which patients undergoing rehabilitation carried by the German Federal Insurance Institute for Salaried Employees (BfA) were treated in accordance with recent evidence-based clinical practice guidelines on diabetes mellitus. METHODS: We extracted specific treatment recommendations relevant to inpatient rehabilitation from national and international evidence-based guidelines and allocated them to general subjects of diabetes care (e. g. [disease specific] education, physical activity, psychosocial interventions). In the "Classification of Therapeutic Procedures (KTL)", an instrument used to classify therapeutic procedures in rehabilitation, we then identified those procedures that represented the recommendations of the guidelines. The coded procedures were allocated to the general aspects of diabetes care, too. In total, 9 "therapeutic modules" were designed, each containing guideline-recommendations and coded procedures. Using the KTL codes documented as a routine in discharge reports, we were able to describe, analyse and evaluate the procedures performed during rehabilitation. The data set we used contained KTL codes and medical information from 9,456 patients whose rehabilitation was carried by the BfA diagnosed with either diabetes mellitus type 1 or 2, who received an inpatient rehabilitation procedure during the years 2000 and 2001. RESULTS: The number of patients who received at least one procedure out of the particular therapeutic module is as follows (numbers in brackets represent the total number of KTL codes in that therapeutic module): Therapeutic module "Education (3)" - 98.66 %, "Exercise Training (63)" - 92.42 %, "Nutrition Training (14)" - 96.44 %, "Stress (18)" - 35.33 %, "Motivation (15)" - 82.87 %, "Coping Skills (15)" - 27.42 %, "Social Work (26)" - 11.44 %, "Alcohol and Nicotine (24)" - 3.69 %, "Diabetic Complications (81)" - 75.42 %. On average patients received procedures out of 5.2 different therapeutic modules. The results were consistent over subgroups (type 1/type 2 diabetes, men/women) but varied considerably between clinics. The care provided in clinics with higher numbers of diabetic patients is more in line with guideline specifications. DISCUSSION: A substantial number of patients received procedures out of the therapeutic modules "Education", "Exercise Training", "Nutrition Training" and "Motivation". In other therapeutic modules (e. g. "Alcohol and Nicotine") deficits were noted. These deficits as well as the substantial variation between clinics demonstrate the need to develop clinical practice guidelines for rehabilitation of patients with diabetes. In principle, the results of this study have to be interpreted carefully because we did not examine to which extent the documented processes are in accordance with the realities. CONCLUSIONS: Inpatient rehabilitation of diabetic patients carried by the BfA can be characterised as multidisciplinary and in accordance with the recommendations of recent evidence-based guidelines. Certain problematic aspects should be put into focus. A guideline taking into account all rehabilitative aspects, including the preparation for and the care after the rehabilitation process, can be instrumental in reducing deficits in rehabilitative care as well as differences between clinics. To gain wide acceptance, guideline development should be coordinated by a scientific institute and involve members of all groups concerned (e. g. the rehabilitative team, GPs, patients). Within certain limits the "KTL" instrument permits evaluation of process quality in rehabilitation of patients with diabetes mellitus.

Combined Modality Therapy↗
PubMed2004

[Efficacy and therapeutic factors of interpersonal psychotherapy for depressed inpatients - results of a pilot study].

BACKGROUND: Despite the common use of combined therapy programs for the treatment of depression among inpatients, very few evaluations have been reported. OBJECTIVE: Evaluation of the efficacy and efficacy factors of a 6 week treatment program of IPT in combination with standard pharmacotherapy of depressed inpatients (IPT-S). METHOD: 28 inpatients with a major depression were treated with IPT-S. The first eight cases were evaluated regarding the therapy process using the cubus analysis. RESULTS: The treatment showed significant and stable changes on depression-specific and interpersonal measures. The most successful IPT therapies showed a pattern of intensive clarification - especially of interpersonal issues - in the first half of therapy followed by coping strategies. CONCLUSIONS: The preliminary results suggest that IPT-S is a useful and effective therapy concept that warrants further investigation.

Adolescent↗
PubMed2004

[Comparison of costs-of-illness in a year before and after inpatient and outpatient rehabilitation in persons with spinal disorders].

The present economic analyses of orthopaedic inpatient and outpatient rehabilitation (IPR resp. OPR) focus but on the evaluation of the expenses from the cost carrier's perspective. Lower intervention costs were related to OPR, whereas comparable social and clinical outcome was achieved. Comprehensive assessment of the economic consequences (resource utilization and lost productivity) of low back pain have not been performed up to now. Therefore, as part of a prospective follow-up study (1) a comparison of overall cost-of-illness and cost components 12 months prior and after IPR and OPR, respectively, was carried out in patients with low back pain and (2) the relative changes of these cost components were compared in a full-cost-analysis from a societal perspective. A total of 150 matched pairs (SR and AR) were followed prospectively over 12 months. Disease related costs in the year prior to the intervention were evaluated retrospectively. Prior to IPR and OPR overall costs amounted to 7010 and 7710 Euro, respectively, per person and year in patients with low back pain. As the main cost component of overall costs, sick leave (SL) periods account for 74% (IPR) and 76% (OPR), respectively. Inpatient costs represent the main component of direct costs. In the year after the intervention the costs due to sick leave periods still represent the major cost component (46 and 52%, resp.) of overall costs (3370 and 3600 Euro, resp.). Disease related cessation of work including work disability accounts for about 10% of productivity costs after IPR and OPR. Indirect costs still make up for the major part of overall costs (58 and 62%, resp.). No differences of cost components and their relative changes can be seen between patients participating in IPR and OPR, respectively, within both time frames. The comparison of overall costs in the 12 months before and after IPR and OPR reveals a cost reduction of 52% (IPR) and 53% (OPR), resp. This decrease of costs is mainly related to the reduction of SL periods, though costs due to inpatient treatment decrease as well. Summarizing, the present full-cost-analysis from a societal perspective shows no differences of cost components and cost changes between orthopaedic IPR and OPR in the 12 months prior to and after the intervention. Comprehensive cost-analyses reveal no obstacles for further implementation of OPR in the treatment of low back pain. Future development and diversification of rehabilitation measures should aim at evaluating real resource consumption during the intervention in detail as a basis for further allocational decision making.

Ambulatory Care↗