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PubMed2004

[Neuropsychological testing in vocational rehabilitation for subjects with schizophrenia].

Until now it is difficult to predict the success of vocational rehabilitation programs for subjects with severe mental illnesses. The growing knowledge about the neuropsychological mechanisms of psychiatric disorders has not been fully integrated into psychiatric rehabilitation research. We reviewed the literature how to use neuropsychological parameters for predicting outcome of vocational rehabilitation programs in subjects with schizophrenia and schizoaffective disorders. Twenty studies were reviewed, which evaluated neuropsychological variables to predict dimensions of rehabilitation success. As a result of this review, we suggest implementing neurocognitive tests, which assess executive functions, working memory, and attention deficits in routine rehabilitation to better plan and coordinate rehabilitation, and to predict rehabilitation outcome.

Cognition↗
PubMed2005

[Capability to work in vocational rehabilitation of the severe mentally ill: initial predictors and change after six months].

OBJECTIVE: Persons with severe mental illnesses often need additional vocational rehabilitation in order to gain or regain an adequate capability to work. The objective of this paper is the assessment of work capability and its development throughout the rehabilitation process, as well as clarification of its correlating variables, and predictors. METHOD: We present data obtained at two different points in time (at rehabilitation program intake and at the six month mark of being in the program) from a sample of 117 rehabilitants. Capability to work was assessed by using the adapted German version of the Work Personality Profile (WPP), called the Arbeitsfähigkeitenprofil (AFP). Additionally, sociodemographic, intellectual, psychopathological, and subjective quality of life measures were examined. RESULTS: The AFP sum score revealed a significant change after six months' participation in the rehabilitation program. More precisely, for the subscales "capability to learn" and "communication skills", a significant increase was obtained, whereas "social adaptation" showed a non-significant improvement. CONCLUSION: Our results show that the rehabilitants' "capability to work" had improved at the six month mark of the rehabilitation program. It appears that baseline variables of the AFP subscales at program intake were largely related to psychopathology and subjective quality of life measures. Sociodemographic parameters, educational level, and attention measures were associated with work capability improvement after six months.

Adult↗
PubMed2005

[Efficacy of inpatient rehabilitation for chronic back pain in Germany: update of a systematic review].

BACKGROUND: The ninth book of the German social code, SGB IX, has intensified questions on the effectiveness and usefulness of medical rehabilitation, a multimodal multidisciplinary team care model, especially but not exclusively for chronic back pain. In 2002 back pain was the reported leading cause for 29 % of all medical and other rehabilitative services provided by German statutory pension funds. A previous systematic review of all available German studies (January 1980 to June 2001) analysed the effectiveness of inpatient rehabilitation for chronic back pain. The present report provides an update and critical appraisal of the review. METHOD: Again we conducted a systematic search for relevant German studies from between July 2001 and December 2003 using electronic data bases, hand-searching of congress abstracts and postal questionnaires. The quality of relevant studies was assessed according to the recommendations of the Cochrane Back Review Group. For each study effect sizes for up to six central outcome parameters were calculated using pre-post comparisons from short and medium term follow-ups, they were correlated with prognostically relevant characteristics of the studies and samples. The combined weighted intra-group effect sizes were compared with results from international studies. RESULTS: 16 studies, both controlled and uncontrolled, were included. Again we could not identify any study confirming the effectiveness of medical rehabilitation in chronic back pain compared to no treatment or usual care. The methodological quality of the new studies did not seem to exceed that of the earlier ones. Depending on the outcome variable, small effects (e. g. on functional ability) to relevant effects (e. g. vitality) can be observed at or immediately after the end of rehabilitation. Now the effects after three to 12 months seem to be smaller than previously observed. DISCUSSION AND CONCLUSIONS: The small size of medium term effects indicates a basic problem of inpatient rehabilitation for chronic back pain in Germany. This becomes even greater when the results of international controlled studies are used as reference. Possible reasons for the disappointing situation (weak methodology, inappropriate selection of patients, weak intervention) are to be discussed. At present, we have no convincing evidence for a general effectiveness of Germany's system of inpatient rehabilitation for chronic back pain.

Controlled Clinical Trials as Topic↗
PubMed2005

[Predicting improvement in work status of patients with chronic mental illness after vocational and integrative rehabilitation measurements].

PURPOSE: Chronically mentally ill patients often need special rehabilitation to be able to re-enter competitive employment. We know only very little about predicting favourable or unfavourable rehabilitation courses. The present study seeks to examine the relationship between successful rehabilitation -- as defined by a progress in professional ability -- and individual parameters obtained at initiation off-take. METHOD: Data of 101 subjects who had completed a rehabilitation programme serve as the basis. At the beginning of rehabilitation, sociodemographic, intellectual, psychopathological and quality of life measures were obtained. Each participant was assigned to one of two rehabilitation outcome groups: progress vs. stagnation, determined by the vocational status after programme termination. Both groups were then compared regarding the aforementioned parameters at programme onset to identify substantial predictors for rehabilitation success via regression analysis. RESULTS: High level of functioning, fewer periods of unemployment, a high level of work-related adaptation, and young age at programme onset were found to be predictive of progress in vocational status. CONCLUSIONS: Objective parameters have a higher predictive potential regarding vocational reintegration of psychologically ill people compared to subjective criteria. Psychiatric diagnoses as defined by DSM-IV do not reveal relevant connections with subsequent vocational successful reintegration, whereas the initial level of functioning has a definite predictive value.

Adult↗
PubMed2006

[Early termination of vocational rehabilitation for the severe mentally ill].

OBJECTIVE: To determine the conditional factors underlying a premature termination of vocational rehabilitation programs. METHODS: 123 rehabilitation participants were assessed prospectively regarding sociodemographic and psychopathological variables, level of functioning, subjective health, intellectual and work capacity. RESULTS: 23 persons terminated rehabilitation prematurely. Drop-outs differed regarding sociodemographic and illness-related variables, in subjective physical health, level of functioning, intelligence and work capacity. Three types of "drop-outs" could be identified: Termination due to exacerbation (of a functional psychosis), due to reluctance to show-up (mainly men with antisocial personality disorders) and a non-specific group. CONCLUSION: Vocational rehabilitation of subjects with severe mental illness should take account of each rehabilitant's individual capacities and abilities as well as individual concepts of the disorder. Moreover, integrated concepts of medical treatment and vocational rehabilitation are needed to ensure rehabilitation success.

Adult↗
PubMed2006

[Improvement of anxiety and depression in women with breast cancer during inpatient oncological rehabilitation-- results of a prospective study].

PURPOSE: Investigation of the influence of an oncological inpatient rehabilitation programme on anxiety and depression in women with breast cancer. PATIENTS AND METHOD: 198 women with breast cancer, aged 25 to 75 years, filled in the Hospital Anxiety and Depression Scale (HADS) German version at the beginning and end of inpatient rehabilitation. Focus was set on the frequency of anxiety and depression. Therefore proportions with 95 % confidence intervals (CI) were built. The before-after comparison of HADS-scores was made using the signed rank test with two-sided level of significance of alpha = 5 %. In addition effect sizes were calculated. Possible relations between the scores at the beginning of rehabilitation and the patients' age or the interval since diagnosis were analysed by calculating correlation coefficients. RESULTS: At the beginning of rehabilitation a state of anxiety was probable in 23.2 % (CI [17.3 %; 29.1 %] of the women and one of depression in 9.1 % (CI [5.8 %; 13.9 %]). In other words, they reached a level of >or= 11 score points on each scale. No correlation was found with the age of the patients or the time interval since diagnosis (|r| <or= 0.192). At the end of rehabilitation 67.5 % (CI [61.0 %; 74.0 %]) and 60.9 % (CI [54.1 %; 67.7 %]), respectively, of the women showed an improvement of anxiety and depression. The before-after difference was a median + 2 points (anxiety) and + 1 point (depression), resp., with a positive value representing an improvement. The changes after rehabilitation were statistically significant with p < 0.0001. The effect sizes ranged from 0.37 to 0.50. CONCLUSIONS: After the end of primary therapy, women with breast cancer frequently suffer from anxiety or depressive disorders, with no correlation to the patients' age or time since diagnosis. By an inpatient oncological rehabilitation programme both anxiety and depression can be improved very successfully. Whether these results represent a long-term effect is currently being evaluated in a randomised prospective study.

Adult↗
PubMed1992

[Social costs of visual handicap and blindness. Rehabilitation resources for blind patients].

UNLABELLED: The number of blind and partially sighted persons in Germany is growing. Increasing social cost and human suffering are related. Measures to counteract this development (e.g. prevention, rehabilitation) are needed. This work gives an overview of the social cost of visual impairment; rehabilitation efforts and needs for eye diseases are considered. MATERIALS AND METHODS: Data from several sources have been analysed in regard to social cost of blindness and rehabilitation efforts for eye diseases: e.g. from the Bavarian and Federal statistical agencies (number of blind and partially sighted), form the German veterans administrations (number of early retired) etc. The results relate to the former Federal Republic of Germany before unification; data from the five new states are not yet available. RESULTS: 1. social cost: The funds needed for blindness compensation payments increased steadily; new figures from Bavaria indicate that in Germany a total of 1,000,000 DM is needed. As a trend the yearly rise over the last 10 years was 6% in Bavaria. Indirect social cost ist caused by early retirement of blind or visually handicapped people; yearly 1% (2000 cases) of all early retirement is due to eye diseases. 2. rehabilitation efforts: For the annual incidence of blind and partially sighted--an estimated 17,000 blind and 50,000 partially sighted--only 12,000 rehabilitation measures are provided in Germany. For the age group over 65 years (which makes up to 60% of all visually impaired) only 800 rehabilitation measures are being completed yearly. In the ophthalmology sector the provision of low vision aids to visually handicapped people is incomplete. A maximum of 60% of all practising ophthalmologists in Bavaria provide this service. On the basis of own data (and from the medical service of medical assistance insurances) it is obvious that 20-50% of the prescribed low vision aids do not fit the requirements of the visually handicapped. In general too high a magnification is prescribed. CONCLUSIONS: More visual rehabilitation services are needed to cope with the growing demand, especially for low vision aids. A prerequisit for a higher coverage with low vision aids is a better reimbursement of the prescribing ophthalmologist by medical assistance insurances.

Blindness↗
PubMed2006

Rehabilitation service utilization and determinants among people with an intellectual disability: preliminary findings in Taiwan.

Improving rehabilitation services for people with intellectual disabilities (ID) remains an ongoing challenge in the public health system. The purpose of this article was to investigate the types of rehabilitation services used by people with ID and determine what factors predict resource utilization in Taiwan. Samples of 957 people with ID were recruited from the Taiwan National Disability Register in a cross-sectional study in 2001. The findings indicated that 24.5% of individuals with ID had received rehabilitation services in the past 7 months. The main types of services used were speech and communication therapy (50%), psychotherapy (32.1%), occupational therapy (30.3%) and physiotherapy (25.2%). Stepwise logistic regression was carried out for the utilization of rehabilitation services (yes/no). The model revealed that the following factors: (i) Major Illness Card holder, (ii) time spent in medical care, (iii) having a family physician, (iv) having illnesses, (v) age of ID individual, and (vi) gender of the main carer, were all significantly associated with the utilization of rehabilitation services. We should reorient the healthcare system to respond adequately to the health needs of rehabilitation service users and its determinants, and further research should focus on the effectiveness and efficiency of rehabilitation for people with ID in Taiwan.

Adolescent↗
PubMed1999

The effect of vocational rehabilitation on later sick leave.

PURPOSE: The aim of this study was to examine the effect of vocational rehabilitation on later sick leave for employed and unemployed people on long-term sick leave. METHOD: The study was based on long-term sick-leave cases initiated during 1992-1994 in Stockholm, Sweden. Of 1704 cases, 383 (321 employed and 62 unemployed) underwent vocational rehabilitation. These were individually matched with sick-leave cases not undergoing rehabilitation, using the variables age, sex, diagnoses and employment status. RESULTS: The hypotheses were (1) that people who underwent rehabilitation, both employed and unemployed, would have less later sick leave than those who did not, and (2) that rehabilitation would affect employed people more than unemployed people. These hypotheses were only partly supported. CONCLUSIONS: The results indicate that vocational rehabilitation has a positive effect regarding later sick leave only for unemployed men. For unemployed women the effect is negative and for those employed, both men and women, rehabilitation has no demonstrable effect.

Adult↗
PubMed2003

Surveillance with duplex ultrasound in traumatic spinal cord injury on initial admission to rehabilitation.

OBJECTIVE: To determine the prevalence of deep vein thrombosis (DVT) by surveillance duplex ultrasound in the traumatic spinal cord injury (SCI) population on admission to rehabilitation. DESIGN: Retrospective sequential case series. SETTING: Midwest regional, university-based, Commission on Accreditation of Rehabilitation Facilities-accredited acute rehabilitation center. METHODS: Charts of all patients with traumatic SCI admitted and discharged from January 1, 1996 through December 31, 1998 were reviewed. Preadmission data were collected on demographics, severity of injury, and DVT prophylaxis information, along with rehabilitation duplex ultrasound results and incidence of thromboembolic events. RESULTS: Ninety-two participants met the inclusion criteria. There were 68 men and 24 women with a mean age on admission of 32.4 years. On admission, 45 participants (49%) were classified as tetraplegic and 47 (51%) were classified as paraplegic; 63 (69%) had motor-complete lesions and 29 (31%) had motor-incomplete lesions. Of all the participants, 8 (8.7%) were found to have DVT on admission to rehabilitation. There were no statistically significant differences among participants with regard to age, sex, level of injury, or completeness of injury, when comparing those participants with DVT on admission, those without DVT on admission, and those with thromboembolic events diagnosed later in their hospitalization. Of the 84 participants who had negative duplex ultrasounds on admission, 4 individuals (4.8%) were found to have DVT and 4 (4.8%) had pulmonary emboli subsequently. In these 84 participants, DVT prophylaxis with low-molecular-weight heparin was found to be more effective than was adjusted-dose heparin in preventing thromboembolic phenomenon. CONCLUSION: Incidence of DVT remains high despite prophylaxis in traumatic SCI patients. Two thirds of DVT diagnosed in rehabilitation was identified on admission and one third was diagnosed later. Duplex ultrasound is an effective and valuable tool that assists in the diagnosis of asymptomatic DVT in patients with traumatic SCI who are initiating in-patient rehabilitation.

Adolescent↗
PubMed2005

Effects on sick leave of an inpatient rehabilitation programme for asthmatics in a randomized trial.

AIM: Among adult asthmatics a major proportion of the cost of illness is attributed to productivity losses and societal costs in connection with sick leave compensation. The aim of the study was to evaluate an extensive structured four-week inpatient rehabilitation programme for asthmatics. METHODS: A diagnosis of asthma was made in a structured way among people on sick leave due to a respiratory disorder. In total, 197 persons were randomized to either a rehabilitation programme, or to usual care. The main components of the rehabilitation programme were education, pharmacological optimization, physical training, and coping skill acquisition. RESULTS: At the three-year follow-up, the median number of sick leave days in the rehabilitation group was 104, and in the usual care group 167 (p = 0.12). An analysis of a subgroup consisting of persons not currently smoking with a previous diagnosis of asthma by a physician (n = 57) showed a significant effect on sick leave at three years (median number of days 63 in the rehabilitation group vs 361 in the control group, p = 0.02). All analyses were based on intention to treat. CONCLUSIONS: The long-term effects on sick leave of an extensive inpatient asthma rehabilitation programme are most evident for non-smokers and ex-smokers with a previous asthma diagnosis. It is therefore recommended that persons with asthma who are current smokers should be offered participation in smoking cessation programmes instead of asthma rehabilitation programmes.

Adult↗
PubMed2003

Rehabilitation care for patients with ALS in The Netherlands.

BACKGROUND: In the Netherlands, rehabilitation medicine plays an important role in the symptomatic and palliative treatment of ALS patients. Detailed information about the actual care of ALS patients in the Netherlands and about the attitude of consultants in rehabilitation medicine towards the management of this disease was lacking. OBJECTIVE: To obtain detailed information about the rehabilitation care for patients with ALS in the Netherlands. METHODS: We have performed a survey among all consultants in rehabilitation medicine in the Netherlands, using a questionnaire about the organisation of care and the care management of ALS patients. RESULTS: Two hundred eighty one questionnaires were gathered with a response rate of 98%. There were 14 specialised ALS centres spread throughout the country, except in the northwest and southwest. Most consultants worked with an ALS multidisciplinary team and most patients were treated in an outpatient rehabilitation clinic. Follow up visits were performed in most cases 5-6 times per year. The majority of the patients were followed up until death. The Dutch protocol for rehabilitative management in ALS was used in 89% of all treated ALS patients. Follow up and care management was not different in the specialised centres compared with the non-specialised centres. CONCLUSION: In conclusion, this study indicated that the actual care for ALS patients was reasonably well organised in the Netherlands, based on the results and reactions of the consultants in rehabilitation medicine.

Amyotrophic Lateral Sclerosis↗
PubMed2004

Vocational rehabilitation in psychiatry: a re-evaluation.

OBJECTIVE: To highlight the vocational gap in the provision of psychiatric rehabilitation, to outline the goals and conceptual framework of psychiatric rehabilitation, and to discuss rehabilitation interventions with specific reference to vocational rehabilitation and the evidence base for supported employment. CONCLUSIONS AND SERVICE IMPLICATIONS: Vocational psychiatric rehabilitation has been a neglected area of practice in Australian psychiatry. Psychiatric treatment needs to adopt a more balanced approach in the provision of a range of services, including vocational rehabilitation, in order to improve long-term outcomes for people suffering from psychiatric disability. A vocational focus should be included in psychiatric rehabilitation and better integration between mental health services and vocational services needs to take place. Supported employment is an evidence-based practice that is designed to help people with psychiatric disabilities participate as much as possible in the competitive job market.

Australia↗
PubMedDate not supplied

Participation as an outcome of traumatic brain injury rehabilitation.

OBJECTIVES: Participation in meaningful life situations is an important aspect of functioning after traumatic brain injury (TBI). However, to date, few studies have included measures of social participation or community integration as outcome measures after TBI rehabilitation. This paper is a selective review of the literature that examines the effects of TBI rehabilitation on measures of participation or community integration. It also addresses the related questions of clinically significant improvements in community integration, variability in patterns of community functioning, and the relationship of participation and quality of life after TBI. DESIGN: Literature review. CONCLUSIONS: A small number of studies suggest that postacute TBI rehabilitation can produce improvements in participation and community integration. However, a considerable amount of variability in rehabilitation outcomes may be apparent. Analysis of clinically significant changes in individual's functioning suggests that rehabilitation may exert its benefits not only by facilitating improvements, but also by preventing declines in community functioning. Subjective well-being and quality of life have generally been ignored as TBI rehabilitation outcomes. There is considerable evidence that participation and subjective well-being represent distinct and dissociable outcomes after TBI, which may reflect the importance of patients' preferences and values in evaluating the effectiveness of rehabilitation.

Adult↗
PubMed1993

Allocating health care resources. The vexing case of rehabilitation.

The allocation of resources to rehabilitation is beset with many difficulties. Among them are the general crisis in the American health care system and the problem of how to make a case for the role of rehabilitation. Rehabilitation must be prepared to show how and why it is a good medical and social investment in relation to other needs. Rehabilitation has played a secondary role in the American health care system because of overemphasis on curative and life-extending medicine. Rehabilitation must work to show that money invested in caring is as well spent as money aiming at the extension of life. It must also establish a fresh new vision of health care in general as well as illustrate where rehabilitation stands in a more integrated and coherent health care system. Improved quality of life, which rehabilitation can provide, is as important as saving and extending life.

Delivery of Health Care↗
PubMed2001

Satisfaction with medical rehabilitation in patients with cerebrovascular impairment.

OBJECTIVE: Overall satisfaction has important social and economic implications for patients who have received inpatient medical rehabilitation. We conducted this study to examine the overall satisfaction level at 3- to 6-mo follow-up for inpatients with cerebrovascular impairments discharged from medical rehabilitation. DESIGN: The study was retrospective using information from a national database representative of medical rehabilitation patients across the United States. Information submitted in 1997 and 1998 to the Uniform Data System for Medical Rehabilitation by 177 hospital and rehabilitation facilities from 40 states was examined. The final sample included 8,900 patient records. The main outcome measure was the level of satisfaction with medical rehabilitation at 80-180 days postdischarge follow-up. RESULTS: A logistic regression model including ten independent variables was used to predict satisfied vs. dissatisfied at follow-up. Three statistically significant variables were included in the final model and correctly classified 95.1% of the patients. Higher FIM instrument discharge scores were associated with increased satisfaction. Further analysis of the FIM instrument subscales indicated that higher ratings in transfers, social cognition, and locomotion were significantly associated with increased satisfaction. CONCLUSION: We identified several functional variables associated with increased satisfaction after medical rehabilitation in persons with stroke. The ability to objectively assess patient satisfaction is important as consumer-based outcome measures are integrated in accreditation and healthcare evaluation.

Activities of Daily Living↗
PubMed1983

A networking approach to rehabilitation service delivery in the developing nation/states of Micronesia.

The people of Micronesia , those inhabitants of a collection of over 2,000 islands and atolls encompassing three million square miles of Western Pacific Ocean, have developed by the establishment of three political entities, compacts of Free Association with the United States (United Nations Administrators of the area under the designation of the U.S. Trust Territory of the Pacific Islands). These emerging nations aim for self-sufficiency in all areas of national endeavor within specified periods of time. The University of Guam's Vocational Rehabilitation Training Program has addressed itself to the issue confronting not only these newly emerging nation/states of Micronesia , but indeed, those developing nations which currently struggle with the social, cultural and economic issues of providing for its citizenry , appropriate rehabilitation programming which meets criteria of high quality services to the largest number of people within an attainable cost structure. Initial findings suggest this Third World Rehabilitation community refrain from adopting a polarity of thinking approach in the design and delivery of Rehabilitation services. The logical extension of such either/or planning attempts seems only to limit current and future Rehabilitation programming effort. Rather, a comparative cost analysis of selected rehabilitation services and accompanying travel expenses related to providers from both sides and throughout the Pacific, demonstrates that an admixture approach, which includes all available sources of services, warrants further investigation as a viable programming model for the nation/states of Micronesia to utilize as they develop locally based Vocational Rehabilitation Service programs of their own.

Delivery of Health Care↗
PubMed1987

The rehabilitation of disabled Native Americans.

The Native American population remains a special ethnic group in the United States that is overrepresented at the lower end of the socioeconomic scale, with a suspected greater than average rate of disabling conditions. Utilization of rehabilitation services by adult Native Americans was studied. Three years of Rehabilitation Services Administration (RSA) data were analyzed to compare the rehabilitation success rate of Native Americans with that of all other population groups. Native Americans were significantly less likely to be rehabilitated than clients from the general population. Factors contributing to the poor rehabilitation of Native Americans were analyzed. Three factors identified as significant were the socioeconomic characteristics of the clients, the type of disabilities presented by the clients, and the inability of the counselors to locate clients and complete the rehabilitation plan. Recommendations for improving the rehabilitation of Native Americans are discussed.

Adult↗