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PubMed2005

Do systematic multiprofessional rehabilitation group meetings improve efficiency in vocational rehabilitation?

PURPOSE: The aim of the present study was to investigate differences in the effects on employment between clients whose rehabilitation was coordinated in systematic multiprofessional rehabilitation group meetings and clients whose rehabilitation was coordinated in the "conventional" way. METHOD: The study was based on a sample of 51 individuals who received systematic group meeting coordination. All individuals in the study group were unemployed before the rehabilitation intervention. Two different comparison groups were chosen: one at a local level and another at a national level. The groups were matched on an individual level based on records obtained from The National Labour Market Board (AMS) and The National Social Insurance Board (RFV). The data were analysed by an analysis of variance (ANOVA) for repeated measures for binary responses. RESULTS: 68.6% in the study group and 49% in both the local comparison group and national group had some form of employment 24 months after rehabilitation. The ANOVA analyses (in terms of odds ratio) found that when all measurement points (6, 12 and 24 months after the rehabilitation) were included in the calculations that there was twice as high a chance of becoming employed after having received rehabilitation services through the multiprofessional group than for both comparison groups. The majority of employment in all the groups was associated with some form of subsidy or sheltered employment.

Adolescent↗
PubMed1994

[Women in occupational rehabilitation--findings of a Federal Rehabilitation Council conference].

The working programme of the Federal Rehabilitation Council includes the subject of reducing participation disincentives for women in the field of vocational rehabilitation. A working conference in 1990 had already dealt with this topic, and its findings were further scrutinized and substantiated in a second conference in 1993, in order to develop concepts more appropriate than hitherto to meeting the specific requirements present in women-oriented vocational rehabilitation measures. In-depth counselling and the possibility of pre-vocational orientation services were considered particularly important. Both concerning their range of occupational options and their timing as well as organizational specifics, the vocational rehabilitation programmes should to a greater extent be geared to the life situation and life planning of women. Consequently, the issue of community-based, and hence family-friendly, provision of vocational rehabilitation services is an increasing focus of discussion. Model projects have already been drafted or started relative to certain aspects in this field of women-focussed further development of vocational rehabilitation, but an overall concept capable of uniting the various approaches and requirements continues to be out of sight. A project group to help remedy this situation has hence been established by the Federal Rehabilitation Council.

Persons with Disabilities↗
PubMed1996

[Sports therapy and rehabilitation sports--a health policy responsibility of rehabilitation].

From a demographic and health policy perspective, movement and sports are gaining increased importance in terms of their preventive, therapeutic and rehabilitative potential. Successful use of sports therapy and rehabilitation sports in rehabilitating paraplegics, breast cancer patients, and patients with total hip replacement have provided convincing proof of their positive physical, mental and social impact, hence of the substantial contributions they are able to make towards enhancing specific parameters of the quality of life. It is assumed that movement and sports are conducive in particular in chronic conditions, in line with the principle of "rehabilitation taking priority over care". Whether reduced health care spending will ensue, will in the final analysis have to be determined through controlled longitudinal studies, which have not been embarked upon as yet. Successful rehabilitation in this domain presupposes adequately qualified staffing in movement therapy-focussed rehabilitation facilities, both in- and out-patient, availability of an uninterrupted rehabilitation chain as well as appropriate follow-up for evaluation.

Activities of Daily Living↗
PubMed1996

[Early neurologic-neurosurgical rehabilitation--on the epidemiology of the need for early rehabilitation beds by adult patients exemplified by the Bremen federal district].

Early neurological rehabilitation means starting rehabilitation of brain damaged patients already during the acute phase of the trauma or illness. It meanwhile is commonly accepted that early onset of specific neurological rehabilitation interventions will enhance medical improvement and social reintegration potential. On the other hand, the number of treatment places required for adequate early neurological rehabilitation remains a controversial, and as yet unresolved, issue in Germany. In the present study, an evaluation was undertaken for the first time to determine the local demand for early rehabilitation beds in the well-defined region of the federal state of Bremen, based on retrospective analysis of all adults treated for severe brain disease in the major Bremen clinics over a period of 22 months, i.e., between January 1992 and October 1993. A total of 146 early rehabilitation treatments was found, which is equivalent to 80 treatments a year. These results are compared with the figures and recommendations given by Kuratorium ZNS. Also, our findings document the apparent deficits in neurological rehabilitation at the time in the Land Bremen, which undoubtedly jeopardize our daily objectives, the progress and successes achieved in early intensive care.

Adolescent↗
PubMed1997

[Geriatric rehabilitation needs in Cologne: the concept of "integrated geriatric rehabilitation"].

Given a growing number of elderly people and the related consequences for the health care system, such as increasing numbers of persons with chronic diseases or in need of long-term nursing care, the present rehabilitation system must be extended and new services be introduced. Hospitals in Cologne report that an average 48% of their geriatric patients are in need of rehabilitation measures. Taking into account the patients' willingness and capacity to undergo rehabilitation treatment, the figure reduces to 30%. Based on the number of geriatric patients treated in hospital each year, rehabilitation facilities for 15416 geriatric patients a year have to be provided. About two thirds of the patients require continued hospital treatment after the acute phase. Obviously, these treatments are not only performed in the geriatric departments of the hospitals, as only 161 geriatric beds are available in Cologne. One third of the patients could be taken care of on a partial hospitalization or outpatient basis after the acute phase. Thus, limiting a patient's length of stay in hospital could have a cost-containment effect. As partial hospitalization and outpatient rehabilitation facilities are lacking, the Cologne "Geriatrics" study group has developed a concept of "integrated geriatric rehabilitation", suggesting the establishment of mobile rehabilitation teams. The concept aims at developing a cooperative network linking outpatient with partial hospitalization and inpatient services, and including the physicians at community level.

Aged↗
PubMed2004

The Pittsburgh Rehabilitation Participation Scale: reliability and validity of a clinician-rated measure of participation in acute rehabilitation.

OBJECTIVE: To demonstrate interrater reliability and predictive validity of the Pittsburgh Rehabilitation Participation Scale (PRPS), a clinician-rated 6-point Likert-type item measuring patient participation in inpatient rehabilitation sessions. DESIGN: Prospective measurement of patient participation in physical and occupational therapy sessions during inpatient rehabilitation. SETTING: University-based, freestanding acute rehabilitation hospital. PARTICIPANTS: Two hundred forty-two inpatients, primarily elderly, with a variety of impairment diagnoses (eg, stroke), who were admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Change in the 13 motor items from the FIM trade mark instrument, from admission to discharge. RESULTS: The PRPS had high interrater reliability (intraclass correlation coefficient [ICC]=.91 for occupational therapists; ICC=.96 for physical therapists). The subjects had mean PRPS scores +/- standard deviation of 4.73+/-0.76. Mean PRPS scores predicted rehabilitation outcome (N=242, r=.32, P<.0001), as measured by change in motor FIM. The strength of this association did not change in a multivariate model that controlled for age, gender, race, impairment group, medical comorbidity count, length of stay, and admission FIM. CONCLUSIONS: Patient participation during acute inpatient rehabilitation can be easily and reliably measured, and PRPS scores predict functional outcome. The PRPS may have applicability in clinical and research outcome measurement.

Adult↗
PubMed2001

Evaluation of medical rehabilitation in community based rehabilitation.

Almost all governments and non-governmental organisations in developing countries use a community-based rehabilitation (CBR) approach to work with disabled people. Although disabled people's organisations reject the categorisation of disability in individual terms, 'medical rehabilitation' is still regarded as an important but time limited process within rehabilitation. The paper lists measures and methods used in a comprehensive evaluation, and presents a practical method to examine the quality of medical rehabilitation. The method was developed and applied in an evaluation of service needs and service provision for disabled people in low-income communities, for the Ministry of Welfare, Government of India. The method described is a tracer approach. It assesses quality in three aspects of medical rehabilitation: (i) Technical quality, based on application of minimum technical standards for each impairment. (ii) Interpersonal quality, by observation of service sessions and interviews with service users. (iii) Management (structural) quality, by comparing the rehabilitation goals of service users and service providers. The method differs from most others in that it is process oriented, as opposed to output oriented. The method meets the challenges of providing low-cost assessment of a difficult outcome measure (the quality of medical rehabilitation), within a complex process (CBR). It is anticipated that the tracer method will be useful to the objective evaluation of disability services throughout the developing world.

Activities of Daily Living↗
PubMed1998

Recovery and rehabilitation following subarachnoid haemorrhage. Part I: Outcome after inpatient rehabilitation.

BACKGROUND AND PURPOSE: Although subarachnoid haemorrhage (SAH) is a subtype of stroke, functional outcome following rehabilitation for SAH must be considered distinct from that of cerebral infarction because of the younger age and the difference in pathology and resultant neurologic deficits. The purposes of this study were to: (1) describe the demographic and clinical characteristics of SAH patients receiving rehabilitation; (2) describe functional outcomes following inpatient rehabilitation; and (3) investigate possible relationships between patient characteristics and functional outcomes. METHODS: Retrospective chart review of SAH patients admitted to inpatient rehabilitation. Functional Outcomes rated by the Functional Independence Measures (FIM). Analysis with descriptive and nonparametric statistics. RESULTS: Eighty patients with SAH admitted to a rehabilitation unit with a mean age of 54 years. Fifty-seven had identified aneurysms as a cause of SAH. Seventy-four subjects (93%) presented with Hunt and Hess grades of 3-5. The median length of stay was 26 days in acute care and 49 days in rehabilitation. Seventy patients (88%) were discharged home. The mean admission FIM was 59.5 and mean discharge FIM 91.0. The FIM efficiency (aggregate change in FIM/day) was 0.62/day and the average rate of FIM gain 0.97 points/day. Hydrocephalus negatively influenced outcome (p = 0.05). There was a trend for subjects with worse Hunt and Hess scores at onset to have poorer discharge FIM scores. CONCLUSION: SAH patients receiving inpatient rehabilitation make functional gains, although the rate of gain is less than for TBI or stroke. These SAH patients represent a subgroup with more severe SAH at onset than the total population of SAH survivors. The presence of hydrocephalus negatively impacts on outcome. Further detailed study of functional and neuropsychological outcome in SAH survivors is needed.

Activities of Daily Living↗
PubMed1995

[The Early Rehabilitation Barthel Index--an early rehabilitation-oriented extension of the Barthel Index].

The Barthel Index has been shown to be a good measure of reduced activities of daily living which can be applied in routine clinical practice in a valid and reliable manner. However, patients with severe brain damage cannot be differentiated appropriately as floor effects show up with increasing severity of neurological impairment, e.g. in comatose and near- or post-comatose patients in early rehabilitation. Aspects of functional deficits relevant in early rehabilitation patients have been introduced to the Barthel Index in a separate section, the Early Reha Barthel Index (ERI). These aspects are: state requiring temporary intensive medical monitoring, tracheostoma requiring special treatment (suctioning), intermittent artificial respiration, confusional state requiring special care, behavioural disturbances requiring special care, swallowing disorders requiring special care, and severe communication deficits. Experience with the ERI gathered with 210 early rehabilitation patients and 312 patients with severe brain damage demonstrate that the extended scale permits differentiation of patients according to severity and to avoid floor effects. Patients can be allocated appropriately to different phases of rehabilitation, i.e., early rehabilitation of patients with very severe brain damage or rehabilitation of patients with severe brain damage. The ERI is quick, economical, and reliable. Given the high cost of early rehabilitation it is expected to be of special interest also to health care providers to ensure that the right patient is looked after in the right bed.

Activities of Daily Living↗
PubMed1997

Industrial rehabilitation medicine. 1. Why is industrial rehabilitation medicine unique?

This self-directed learning module is part of the chapter on industrial rehabilitation medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Industrial rehabilitation medicine encompasses injuries and illnesses that occur in the workplace and are covered under workers' compensation. The central thesis of this article is that industrial rehabilitation medicine is a unique area because the workers' compensation system influences the behavior of injured workers. The article is divided into three sections. The first briefly reviews the history of workers' compensation in the United States, and describes eight key features of compensation systems. The second explores several hypotheses to explain why injured workers frequently have less favorable outcomes than noncompensation patients with similar medical conditions. Some explanations focus on dysfunctional psychologic reactions such as "compensation neurosis" and "disability syndrome." Others focus on contextual factors, including return to work policies by employers and financial incentives or disincentives for return to work. The third section outlines reasons why the physiatrist is often the "preferred provider" in industrial rehabilitation medicine. One crucial consideration is that many of the most important disabling work injuries are those with which physiatrists are familiar. Also, physiatric training and philosophy prepare the physician to focus on function, to work with a rehabilitation team, and to be sensitive to psychologic factors that might impede an injured worker's recovery. All of these skills are important in the treatment of injured workers.

Chronic Disease↗
PubMed1997

[The future of vocational rehabilitation--vocational rehabilitation for the future. An explanation with the federal government's austerity measures].

Under the law on enhancing growth and employment (Wachstums- und Beschäftigungsförderungsgesetz-WFG), the legal entitlement to vocational rehabilitation hitherto stipulated in the employment promotion act (Arbeitsförderungsgesetz-AFG), has been restricted to a narrowly defined population; and pension insurance scheme spending in the entire rehabilitation field been "capped" to the 1993 level minus some 600 million DM. Moreover, the transitional allowance applicable for pension insurance rehabilitees will be lowered. In addition, economies amounting to some 500 million DM have been imposed on the federal employment service Bundesanstalt für Arbeit. These measures are placing persons with disability at a disadvantage, accept exclusion of entire groups of disabled persons, and endanger the very existence of numerous rehabilitation facilities previously established with significant amounts of public funding. A blind eye is being turned on the high level of demand for qualification measures, on the overall economic benefits of rehabilitation measures, and on the fact that measures of this kind are disabled persons' only chance to hold their own in the face of labour market competitiveness. Also, poor awareness seems to exist of the fact that, in the longer run, meaningful contributions to greater economy will more likely be generated by structural adjustment, increased effectiveness, and greater flexibility. The future of vocational rehabilitation is being placed at risk--notwithstanding that vocational rehabilitation for the future is imperative.

Cost Control↗
PubMed1992

[Evaluating the independence of paraplegic patients at the end of the first rehabilitation--a multicenter project of computer-assisted quality control in rehabilitation].

Rehabilitation of patients who became handicapped due to illness or trauma is a difficult process, involving many therapeutic sections. The necessity to document the results of different rehabilitation programs led to the development of numerous scoring systems in the USA within the last 25 years, considering mainly functional results. The present functional assessment score (DMGP-Selbständigkeitserfassung für Tetraplegiker) for the documentation of self-sufficiency in tetraplegic patients after primary rehabilitation has been designed to record the quality of rehabilitation programs and has been exclusively designed for patients with quadriplegia, it there fore has the advantage of a better and more precise documentation over other general functional scoring systems, especially for the interests of different sections (occupational therapy, physiotherapy) being involved in this special rehabilitation program. The aim of the documentation is to record the degree of independence of tetraplegic patients after primary rehabilitation, considering the individual requirements of aids and the assumption of circumstances suitable for wheel-chairs. Since all data are collected on a computer-readable form each participating clinic has the opportunity for an individual analysis of the own results, as well as the opportunity of comparing it with the collective results.

Activities of Daily Living↗
PubMed2006

[Rehabilitation processes and sustainability: first results of a rehabilitation study of geriatric stroke patients].

A rehabilitation care management oriented towards the severity of the disease, the individual competence and the patient's needs essentially improves the effectivity and the sustainability of inpatient rehabilitation. The Institute of Gerontology of the University of Heidelberg is developing an assessment for elderly stroke patients to optimize placement decision by an early rehabilitation prognosis. Data concerning functional, cognitive and psychological status were collected in 267 patients participating in a postacute rehabilitation program on admission, after two weeks and on discharge and six weeks later. In this article are presented the study design and patients' characteristics during the rehabilitation process. The first assessment at admission gives important information about the sustainability of the ADL-competence after discharge. Severe stroke, premorbid ADL-competence, cognitive impairment, communication problems, depression and higher age were found to be predictors for the outcome of the rehabilitation process.

Aged↗
PubMed2004

Toward a taxonomy of rehabilitation interventions: Using an inductive approach to examine the "black box" of rehabilitation.

A barrier in outcomes and effectiveness research is the ability to characterize the interventions under review. This has been the case especially in rehabilitation in which interventions are commonly multidisciplinary, customized to the patient, and lack standardization in definition and measurement. This commentary describes how investigators and clinicians, working together, in a major multisite stroke rehabilitation outcome study were able to define and characterize diverse stroke rehabilitation interventions in a comprehensive, yet parsimonious, fashion and thus capture what actually transpires in a hospital-based stroke rehabilitation program. We consider the implications of the study's classification system for a more comprehensive taxonomy of rehabilitation interventions and the potential utility of such a taxonomy in operationalizing practice standards, medical record keeping, and rehabilitation research.

Documentation↗
PubMed2005

Opening the black box of post-stroke rehabilitation: stroke rehabilitation patients, processes, and outcomes.

DeJong G, Horn SD, Conroy B, Nichols D, Healton EB. Opening the black box of post-stroke rehabilitation: stroke rehabilitation patients, processes, and outcomes. This article introduces the journal's supplement devoted to the methods and findings of the 7-site Post-Stroke Rehabilitation Outcomes Project (PSROP), a study designed to provide a very granular in-depth understanding of stroke rehabilitation practice and how practice is related to outcomes. The article summarizes current knowledge about the effectiveness of post-stroke rehabilitation, outlines where the PSROP fits into the broader traditions of stroke rehabilitation outcomes research, underscores the study's methodologic innovations, and summarizes the scope of the articles that follow.

Clinical Trials as Topic↗
PubMed1996

Cardiovascular, pulmonary, and cancer rehabilitation. 3. Cancer rehabilitation.

This self-directed learning module highlights several important rehabilitation aspects in the care of persons with cancer. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses the organization of a cancer rehabilitation team, unique rehabilitation issues presented by specific common tumors, and the impact of common complications on successful rehabilitation outcomes.

Aged↗
PubMed2005

[Health economic evaluation of rehabilitation programmes in the "rehabilitation sciences" research funding programme in Germany].

A main problem of the German rehabilitation sector is to meet the increasing demand for rehabilitation treatment while available resources are scarce. Thus, health economic evaluation is gaining more importance for decision making in the rehab system. In the "Rehabilitation Sciences" research funding programme the relevance of health economic analyses was recognised from the outset. In nearly all regional networks health economic analyses were conducted - though with different scope. In the first funding period the main focus of health economic evaluation was on (1) patient education programmes and (2) the comparison of inpatient versus outpatient rehabilitation. The projects of the research funding programme have initialised health economic evaluation of rehabilitation in Germany. It was shown that health economics can contribute relevant results for designing rehabilitation concepts. The article concludes with an outlook on the main future questions of rehab economic evaluation.

Biomedical Research↗
PubMedDate not supplied

The effect of pulmonary rehabilitation on healthcare utilization in chronic obstructive pulmonary disease: The Northeast Pulmonary Rehabilitation Consortium.

Although pulmonary rehabilitation results in improvement in multiple outcome areas, relatively few studies in the United States have evaluated its effect on healthcare utilization. This study compared aspects of healthcare utilization during the year before to the year after outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease referred to 11 hospital-based centers in Connecticut and New York. Utilization data from 128 of 132 patients who originally gave informed consent were evaluated; their mean age was 69 years and their forced expiratory volume in 1 second was 44% of predicted. Forty-five percent had 1 or more hospitalizations in the year before beginning pulmonary rehabilitation. In the year after pulmonary rehabilitation, there were 0.25 fewer total hospitalizations (P = .017) and 2.18 fewer hospital days (P = .015) per patient and 271 fewer hospital days for the group. Hospitalizations for respiratory reasons also decreased significantly. Most of the reduction in hospital utilization was due to a decrease in intensive care unit days. The number of physician visits decreased by 2.4 in the year after pulmonary rehabilitation (P < .0001); most of this reduction was due to decreased visits to primary care providers. The estimated costs/charges for the aspects of healthcare utilization that we studied decreased by a mean of 4,694 dollars and a median of 390 dollars (P = .0002). This study suggests that pulmonary rehabilitation leads to a reduction in healthcare utilization.

Aged↗