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PubMed1999

[Goal-oriented outcome measurement in inpatient or day care orthopedic-rheumatologic rehabilitation of patients with back pain].

The comparison of patient characteristics and effectiveness of inpatient rehabilitation (IPR) and outpatient rehabilitation (OPR) is of growing importance in terms of flexible and cost-effective structures in rehabilitation. The effectiveness of the treatment is measured applying a goaloriented approach based on the individual rehabilitation goals and the attainment of these goals at the end of the programme. The frequencies of rehabilitation goals chosen by patients in IPR and OPR are similar. Decrease of pain, improvement of muscular strength and improvement of the range of motion are the main goals of patients in IPR and OPR (92-56%). No relevant differences can be seen considering the effectiveness of IPR and OPR, except for the markedly higher improvement of vitality in IPR. Patients in need of rehabilitation whose primary rehabilitation goal is improvement of vitality should therefore preferentially be referred to an inpatient rehabilitation programme.

Adult↗
PubMed2000

[The formation and developmental outlook of medical rehabilitation in the Armed Forces of the Russian Federation].

In medical service system of AF RF rehabilitation means combination of medical, military and professional, social and economic and pedagogical measures directed to recovery of health, fighting efficiency (ability to work) which were disturbed or lost by servicemen because of disease or trauma. In the article the main landmarks of rehabilitation development in Russian military medicine are pointed out, today's state of system on the whole and stages in particular is analyzed, perspectives of development are determined. The authors have noted considerable contribution made by Central Military Clinical Hospital N 6 to development of medical rehabilitation. Arsenal of modern rehabilitation and restorative measures is indicated. Methodological principles of rehabilitation conduction are shown. The main ways in further improvement of medical rehabilitation are development of its specialization, rise in economic and social efficiency of rehabilitation measures at the expense of significant unloading of hospital urgent beds and decrease in periods of patient return to military service who will be ready to perform their duties in whole volume. Introduction of modern methodological and organizational principles of medical rehabilitation into the practice of medical support of the Armed Forces' personnel will contribute to achievement of success in this area.

Adult↗
PubMed1999

A uniform database of rehabilitation as a basis for evaluating the outcome quality.

To make it possible to benefit from patient data recorded in rehabilitation clinics, with regard to outcome quality and scientific investigation, the Rehabilitation Research Centre at the University of Ulm has created a rehabilitation register, a database based on ORACLE, into which the relevant patient data is transferred, having been made anonymous via an SQL archiving program. The archived data includes the clinical parameters, the running text of the discharge report, and the doctor's and patient's assessment of the rehabilitation outcome. It can be automatically searched for structured data, according to every conceivable criterion and in every conceivable combination, also in combination with a text search in the running text of the admission and discharge reports and the rehabilitation outcome. With the aid of the rehabilitation register and thanks to the possibilities of EDP (Electronic Data Processing), in future it will be possible to make much more differentiated comments on the rehabilitation outcome than would be the case if the search were restricted to structured data alone. This is essential in order to be able constantly to improve outcome quality and to verify the economic benefit of rehabilitation medicine.

Databases as Topic↗
PubMedDate not supplied

The structure and structural effects of VA rehabilitation bedservice care for stroke.

The purpose of this study was to: 1) examine the variation in organizational structure within rehabilitation bed-service units (RBU) in the Veterans Health Administration (VHA), and 2) evaluate the effects of RBU and parent hospital structure on stroke rehabilitation outcomes. Two VHA-wide surveys of acute and rehabilitation services for stroke were linked with 2 y of VHA rehabilitation outcomes for stroke patients. A random effects mixed model was used to adjust for patient level covariates, control for unique site effects, and test for facility level structural effects. After adjusting for patient covariates, four structural variables were associated with length of stay or patient functional gain. These results indicate that rehabilitation structure is important to rehabilitation outcome. The individual variables identified in this study, namely, diverse multidisciplinary staff, expert physician leadership, staff participation in team care, and richer rehabilitation equipment resources, may represent the distinct aspects of a successful, comprehensive rehabilitation unit.

Adult↗
PubMed2001

Medicare program; prospective payment system for inpatient rehabilitation facilities. Final rule.

This final rule establishes a prospective payment system for Medicare payment of inpatient hospital services provided by a rehabilitation hospital or by a rehabilitation unit of a hospital. It implements section 1886(j)of the Social Security Act (the Act), as added by section 4421 of the Balanced Budget Act of 1997 and as amended by section 125 of the Medicare, Medicaid, and SCHIP [State Children's Health Insurance Program] Balanced Budget Refinement Act of 1999 and by section 305 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000. Section 1886(j) of the Act authorizes the implementation of a prospective payment system for inpatient rehabilitation hospitals and rehabilitation units of hospitals. This section also authorizes the Secretary to require rehabilitation hospitals and rehabilitation units to submit data as the Secretary deems necessary to establish and administer the prospective payment system. The prospective payment system described in this final rule replaces the reasonable cost-based payment system under which rehabilitation hospitals and rehabilitation units of hospitals are paid under Medicare.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1975

[State and perspectives of development of rehabilitation trends in cardiology].

On the basis of the experience of rehabilitation of 500 myocardial infarction patients recommendations are given for the development of rehabilitation in cardiology. It is indicated that the problems of rehabilitation should be solved with the participation of the existing medical establishments, i. e. hospitals, sanatoriums and out-patient clinics, that should function as successive stages of rehabilitation. The main person responsible for the rehabilitative measures at each particular stage should be the attending pyhsician who had mastered the appropriate methodological principles. In choosing the rehabilitation program the attending physician should be assisted by a special rehabilitation team (commission that brings together at the patient's bedside the necessary specialists--kinesitherapy physician, psychologist, functionalist, sociologist. These organizational principles permit to arrange an extensive rehabilitative work within the existing pattern of medical institutions, without any significant changes in its structure.

Humans↗
PubMedDate not supplied

Rehabilitation following stroke in patients aged 85 and above.

To assess the course and results of rehabilitation following stroke in the oldest old, we conducted a prospective study to compare 45 patients 85 years and above and 220 consecutive patients aged 75 to 84 years who were hospitalized for rehabilitation following stroke. Functional status was measured and compared by the Functional Independence Measuretrade mark(FIM) scale and successful rehabilitation was defined as FIM > 80 at discharge. Eighteen patients in the 85+ group (40%) underwent successful rehabilitation compared with 115 (52%) in the 75 to 84 group (not significant). No significant differences were found between the groups in any other parameters that measure success and/or efficacy of rehabilitation, but in all these parameters, without exception, there were lower values in the 85+ group. No differences in the length of rehabilitation and complications rates were found between groups. We conclude that although the success rate for rehabilitation following stroke is lower in the oldest old, it appears that the effort invested in rehabilitating patients in this group is no less justified than in younger elderly patients.

Age Factors↗
PubMed2005

[Evidence-based rehabilitation and health care in view of social law].

The explicit requirement for rehabilitation to be based on sound scientific evidence is only sporadically encountered among statutory provisions. Nevertheless, such requirement may be implicitly concluded from regulations for effective and high-quality service provision. Evidence-based rehabilitation medicine differs from evidence-based clinical medicine in that rehabilitation is obliged to aim at more therapeutic goals than just maintenance, recovery, or improvement of health. Furthermore, among statutory pension funds the granting of rehabilitation measures depends on an individual's probability to improve his or her earning capacity by rehabilitation. This point particularly denotes the need for a sound scientific evidence base. Care, as defined by Social Code Book XI (SGB XI), is mainly directed towards the support of daily living activities--therefore a scientific evidence base does not play a specific role. In sick-nursing, the role of evidence-based practice has not yet achieved a clear significance. Aside from service provision, evidence-based decisions may play a role in planning of facilities and services for rehabilitation. In rehabilitation medicine, the responsibilities for the production and financing of scientific evidence, aside from educational and research purposes, may be seen in compatibility with the responsibilities after and 19, Para. 1 Social Code Book IX for the provision of adequate services: The federation, the states, and providers/payers of rehabilitation.

Evidence-Based Medicine↗
PubMed2005

[Rehabilitation results of persons with severe traumatic brain injury].

OBJECTIVE: There is a significant improvement in acute treatment and rehabilitation of patients with severe traumatic brain injury in the last 20 years. PURPOSE: Introduction of the rehabilitation result of patients with severe traumatic brain injury treated at Neurorehabilitation unit of the National Institute for Medical Rehabilitation. METHOD: Retrospective analysis of patients' data treated in the Neurorehabilitation unit 2002. year. RESULTS: Data of 53 patients from the 165 severe traumatic brain injured patients treated in 2002. year were complete enough for analysis. The mean age of the patients was 30.6 (8-65) years. The interval between the time of injury and admission was 53 (21-120) days. The majority of patients injured in vehicular accidents (42/53). The length of stay in rehabilitation unit was 41 (8-92) days, but 20 patients were readmitted for further therapy (1-6 times) in these cases the hospitalization was 70 (8-206) days. The functional status of these patients was scored with Barthel Index (0-100). At the time of admission the mean score was: 25, at the time of discharge 50, one year after injury: 75. Twenty-two patients were independent one year after injury in performing daily activities. 35 patients became ambulatory at the time of discharge. 45 patients were discharged to their home, 6 patients had to be send back to the acute ward for observation serious complication. CONCLUSION: Rehabilitation treatment of patients with severe traumatic brain injury is suggested in centers, where special team is available for the patients with multifunctional impairments. Nowadays, only one third of these patients are treated by rehabilitation centers in Hungary. Establishing new centers, development of the existing units, improvement the outpatient or community based rehabilitation facilities are suggested in order to improve the rehabilitation outcome of patients with severe traumatic brain injury.

Activities of Daily Living↗
PubMed1991

Characteristics of hospital patients receiving medical rehabilitation: an exploratory outcome comparison.

This study classified consecutive hospital admissions to acute medical and surgical wards (n = 3,170) into clinical subgroups based on diagnostic, prognostic, and functional criteria. The groups were (1) independent, (2) terminal, (3) medical, (4) dementia, and (5) rehabilitation candidate. Medical record data from hospital admission, discharge, and nine-month follow-up were collected. The groups had unique patterns of survival, residence, and use of health care services during follow-up. Rehabilitation participants were compared with a group similar in age, major diagnostic category, and functional ability, who did not receive rehabilitation. Only 21% of persons meeting the study criteria for rehabilitation actually received rehabilitation services. At follow-up, participants in rehabilitation had lower mortality, spent less time in skilled nursing care, and were less frequently hospitalized. Although exploratory in nature, this study supports previously observed benefits of rehabilitation. In combination with clinical assessment, the process of identifying patient subgroups may be useful in planning interventions more uniformly and in developing measures to reduce selection bias in rehabilitation admission decisions.

Aged↗
PubMed1989

[Medical rehabilitation from the viewpoint of the established physician].

In view of the not inconsiderable numbers of pension insured who have undergone no medical rehabilitation prior to their being pensioned prematurely, the principle of "rehabilitation comes before pensioning" hence not being implemented for this population, it is deemed justified to inquire into the causes of this situation. In the framework of the present study of 902 questionnaires returned by office practice physicians, it is presumed that the office practice physician is the controlling agent in inducing appropriate patients at the right time to participate in a rehabilitation measure. The following indicators are presumed to decisively influence this steering function: Attitude towards medical rehabilitation; Disease/disability-specific experience with medical rehabilitation measures; Satisfaction with the rehabilitation clinic selected by the pension insurance administration; Awareness of the rehabilitation clinics' range of rehabilitative services and the various treatment modalities available; Awareness of pertinent legal provisions; Cooperation between office-practice physician and pension insurance administration.

Attitude of Health Personnel↗
PubMedDate not supplied

[Organization and implementation of clinical rehabilitation at a special hospital].

This contribution offers guidance in the planning, organization, and operation of a clinical gerontological rehabilitation unit. The first part outlines the important requirements of a geriatric rehabilitation clinic and considerations for medical and non-medical staffs (with recommendations showing keynumbers), as well as the structure and equipment for the clinical buildings and recommendations for room area and amount of beds. The general requirement for clinical geriatric rehabilitation beds in Germany is mentioned and training for geriatric rehabilitation is considered. The second part deals with the organization and operation of clinical rehabilitation, in particular, regarding directions and responses of rehabilitation teams, and especially their priority to use collected data as a management function. The contribution concludes with an example of an inpatient rehabilitation at the Klinik für medizinische Rehabilitation und Geriatrie, Henriettenstiftung Hannover, FRG.

Activities of Daily Living↗
PubMed1988

Inpatient arthritis rehabilitation programs in the US: results from a national survey.

The implementation of prospective payment systems has severely limited the traditional practice of providing rehabilitation services to arthritis patients on rheumatic disease units; however, the admission of these patients to a designated rehabilitation unit may be appropriate. This paper presents data on the provision of inpatient rehabilitation services to patients with arthritis. Two surveys were developed for this study. The first survey sample consisted of 502 hospitals; 163 (52%) of the 313 respondents were identified as facilities providing inpatient arthritis rehabilitation. A second survey regarding patient and program characteristics was completed by 146 of the 313 facilities. The data from rehabilitation units serving arthritis patients are presented with regard to utilization, discharge disposition, sources of payment, patient demographic and diagnostic information, and specialization of the rehabilitation program. The data indicate that persons with arthritis are underrepresented in the rehabilitation population, although the diagnosis is approved for admission under rehabilitation guidelines. This underutilization is attributed to problems of reimbursement, inappropriate admission criteria, inadequately trained staff, and lack of referrals.

Arthritis↗
PubMed1981

Rehabilitation service needs: physicians' perceptions and referrals.

A descriptive sample survey of physicians showed that 75% of physicians in an urban area had seen at least 1 patient in the past 6 months who was perceived as needing some type of rehabilitation service, whereas only 8% to 17% of physicians saw more than 25 such patients. Of those physicians who saw such patients, about 15% offered some type of rehabilitation service with their own staff. The great majority of physicians referred of rehabilitation service with their own staff. The great majority of physicians referred such patients elsewhere. Some physicians neither offered rehabilitation services nor referred their patients. A descriptive survey of all hospitals and all health/mental health/rehabilitation/vocational rehabilitation clinics showed that 70% of hospitals and 55% of the clinics offered some outpatient rehabilitation services. Home rehabilitation services were offered by very few organizations. It is concluded that physicians probably do not recognize the extent to which their patients need rehabilitation services and, in addition, may not adequately refer their patients for such services.

Ambulatory Care↗
PubMed1994

Social supports as a determinant of community-based care utilization among rehabilitation patients.

OBJECTIVE: We determine the extent to which noninstitutionalized long-term care patients receive assistance from family members and friends, and evaluate the effect of this assistance on use of outpatient rehabilitative and personal care services. DATA SOURCES AND STUDY SETTING: Over 12 months, primary data were collected from 289 patients in noninstitutional settings after inpatient rehabilitation at three Boston-area rehabilitation hospitals. Data on patients' acute and rehabilitative stays were obtained from medical record reviews. Patients provided primary data on sociodemographics, living arrangements, social supports, functional status, health behaviors, life events, and use of outpatient services during the study period. The latter was verified and service charge data obtained from the care providers. STUDY DESIGN: The study was longitudinal and observational. Patient-provided information was obtained at one, six, and twelve months postdischarge. ANALYTIC METHODS: Multivariate Tobit regression was used to evaluate the effect of social supports on patients' use of rehabilitative and personal care services, controlling for sociodemographics and functional status. Service use was measured as charges incurred during the 12-month study period. PRINCIPAL FINDINGS: Results confirm the primary role of family and friends in providing daily personal care and identify the availability of that support as a key determinant of expenditures on community-based personal care services. Social supports do not predict outpatient rehabilitative service use. CONCLUSIONS: Differing eligibility criteria seem appropriate for outpatient rehabilitative and personal care services. The current emphasis on functional status in determining rehabilitative service eligibility appears appropriate; but we find that considering patients' social supports would be both meaningful and appropriate in determining personal care service eligibility. This approach would avert the expense of making personal care services universally available, while facilitating assistance for patients whose functional and social status put them at increased risk of institutional placement.

Activities of Daily Living↗
PubMedDate not supplied

Rehabilitation in the nursing home: how much, why, and with what results.

Although rehabilitation is considered an important component of long-term care, few studies have looked at the factors associated with the provision of rehabilitation in this setting. The authors examined one State's skilled nursing homes to gain information on their rehabilitation practices. Data for this study came from a mail survey and from the licensing applications filed with the State Division of Facility Services. Sixty-nine percent of the State's nursing homes responded to the survey. All reported that they provided specialized physical therapy, occupational therapy, or speech therapy, or all three, but the numbers of patients reported to be enrolled in such therapies on a daily basis varied from 0 to 64 percent of the facility's census. Factors positively associated with the provision of rehabilitation included the number of full-time registered nurses on the staff and the belief of the facility administrator that the purpose of rehabilitation is to restore function so that patients can be discharged. Facilities that employed their own therapists rather than contract for these services reported significantly more patients enrolled in daily therapies. And a significant positive correlation was observed between the provision of daily rehabilitation services and discharge of patients in those facilities that hired their own rehabilitation staff. These findings suggest that the provision of rehabilitation in nursing homes has different goals and outcomes and that there are facilities with identifiable characteristics that appear more successful in returning patients to their homes.

Aged↗
PubMed1993

[Requirements for a "rehabilitation law" manual within social regulations from the viewpoint of the administrative practice].

Rehabilitation in Germany falls within the purview of the various branches of the social security and public welfare system, a decentralized approach which has stood the test of time. Notwithstanding, deficits exist primarily due to a lack of up-to-date intersectoral alignment a shortcoming to be remedied by comprising rehabilitation in a separate book of the Social Code. The various social security schemes responsible for rehabilitation are attaching much importance in this context to the linkages with their specific fields of competence as well as their programming latitude being maintained. The demands to be made from an overall perspective relative to a "rehabilitation" book are set out inter alia on the example of social assistance and youth services, on terminological issues, benefit scope, needs coverage, rehabilitation principles and procedures, as well as on cooperation aspects, also clarifying differing views among the branches of our social security and welfare system. A Social Code book on "rehabilitation" should essentially be aimed at focussing the variety of rehabilitative measures in terms of a holistic rehabilitation approach, i.e., to respond to the person's overall needs by overall service provision.

Disability Evaluation↗
PubMed1996

Life-cycle analysis of depot versus rehabilitation manual wheelchairs.

The proper selection of a wheelchair requires making several critical decisions, not the least of which is what type of wheelchair is appropriate. The International Organization for Standards (ISO) continues to develop and refine wheelchair standards. Standards allow the objective comparison of products from various sources, permitting consumers or clinicians to assess wheelchairs with which they are not familiar by comparing test results. This study consisted of three components: 1) the comparison of fatigue test results with a planar ANSI/RESNA test dummy to a HERL contoured test dummy; 2) the comparison of fatigue test results for common depot versus common rehabilitation manual wheelchairs; and 3) the comparison of fatigue test results for manual rehabilitation wheelchairs with solid 8-inch casters versus those with pneumatic 8-inch casters. Rehabilitation wheelchairs lasted on average 13.2 times longer than the depot wheelchairs. Both types, tested with the standard ISO-ANSI/RESNA dummy, lasted on average 2.1 times longer than those wheelchairs tested using the contoured dummy. The three rehabilitation wheelchairs equipped with 8-inch pneumatic casters lasted on average 3.2 times longer than the 6 rehabilitation wheelchairs equipped with solid 8-inch casters. The depot wheelchairs cost about 3.4 times as much to operate per cycle or per meter than the rehabilitation wheelchairs. The rehabilitation wheelchairs tended to experience component failures, while the depot wheelchairs tended to experience frame failures. Our testing indicates that the tests in the ISO-ANSI/RESNA standards can relate design features to fatigue test results and durability. Rehabilitation wheelchairs tend to use higher quality materials and better manufacturing practices, and they provide greater mobility for wheelchair users. Purchasers and prescribers of wheelchairs should consider the life-cycle cost and not just the purchase price for wheelchairs.

Analysis of Variance↗