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PubMed2000

[Outcome quality in oncologic rehabilitation. Viewpoint of the Professional Committee of Rehabilitation, After-Care and Social Medicine of the German Cancer Society].

The article is concerned with the basic ideas of outcome quality within the field of oncological rehabilitation and expresses the position which is held by the Section for Rehabilitation, Aftercare and Social Medicine within the German Cancer Society. The authors explicitly express the necessity of rehabilitation-specific goals and corresponding outcome criteria as opposed to the goals and criteria of acute oncological treatment. In the formulation of goals and criteria, the medical-somatic, occupational-rehabilitative, social and psychological levels are considered. The consequences which arise from these outcome criteria with regard to the rehabilitative health care system for cancer patients are discussed.

Aftercare↗
PubMed2000

[Process quality in oncologic rehabilitation. Viewpoint of the Professional Committee of Rehabilitation, After-care and Social Medicine of the German Cancer Society].

The article concerns itself with the issue of process quality in inpatient institutions for oncological rehabilitation and expresses the viewpoint of the German Cancer Society's Section for Rehabilitation, Aftercare and Social Medicine (ARNS). Standards for the organization of patients' access to the rehabilitation clinic, for the design of oncological-rehabilitational diagnostics, for the formation of therapeutic strategies and the rehabilitative services offered will be described.

Aftercare↗
PubMed2005

[Transfer of research findings into the practice of rehabilitation and effects on the development and stabilization of the infrastructure of rehabilitation sciences--the pension insurance perspective].

The programme for research in rehabilitation has been established by the Federal Ministry of Education and Research and the German Pension Insurance scheme in 1998 to further develop the methodology in this field. In addition to other effects, the large number of projects has strengthened the research structure in Germany. An important aim of the programme is the transfer of the research findings into the practice of rehabilitation. The initiators also organize this transformation process in terms of a long-term task. The paper describes the transfer of findings in the topics selected by the Pension Insurance scheme: patient education, access to rehabilitation, and vocational orientation in medical rehabilitation. Furthermore, additional activities concerning the transfer are outlined. To improve the practice of rehabilitation by transferring research findings is of great importance for the Pension Insurance scheme.

Biomedical Research↗
PubMedDate not supplied

Systematic review of measures and their concepts used in published studies focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities.

PURPOSE: To identify outcome measures cited in published studies focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities, and to identify and quantify the concepts contained in these measures using the ICF as a reference. METHODS: Electronic searches of Medline, Embase, CINAHL, Pedro and the Cochrane Library from 1997 to March 2002 were carried out. In a first step, abstracts of the retrieved studies were checked and data on the outcome measures and certain characteristics of the included studies were extracted. In a second step, the items of the questionnaires and their underlying concepts were specified. These concepts were then linked to ICF categories using standardized linkage rules. RESULTS: From the 1,657 abstracts retrieved, 259 studies met the inclusion criteria. In a second step, 277 formal assessment instruments and 351 single clinical measures were retrieved. A total of 1,353 concepts were extracted from the clinical and technical measures. Ninety-six percent of these concepts could be linked to ICF categories. Fifty-six second-level ICF categories representing the concepts contained in the measures. Twenty-six (46%) of the 56 categories belong to the component Body Functions, five (9%) to the component Body Structures, and 25 (45%) to the component Activities and Participation. CONCLUSIONS: The ICF provides a valuable reference to identify and quantify the concepts of outcome measures focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities. Our findings indicate a need to define and to agree on 'what should be measured' in rehabilitation care to allow for a comparison of patient populations.

Activities of Daily Living↗
PubMed1995

Rehabilitation technology assessment practices in vocational rehabilitation agencies.

A rehabilitation technology assessment is an essential element in the array of rehabilitation technology services provided for vocational rehabilitation (VR) clients. As a part of a comprehensive survey of rehabilitation technology services in VR agencies, information was collected on current practices in rehabilitation technology assessment. Some variation in length, components included, and professionals involved were found among agencies. A complete description of these assessments as reported by VR agencies is discussed and commonalities in current practice are described.

Consultants↗
PubMed2002

The Come Back Programme: a rehabilitation programme for patients with brain injury with psychosocial problems despite previous rehabilitation.

In 1994 the Come Back Programme (CBP) started in the rehabilitation centre, Groot Klimmendaal, in Arnhem, The Netherlands. The CBP is a rehabilitation programme for (young) adults with brain injury (BI) having problems with their psychosocial functioning despite having undergone a rehabilitation programme previously. The main goal of the CBP is to regain maximal independence in psychosocial functioning. The objectives of the study were to assess problems experienced after BI, despite having undergone a rehabilitation programme previously, and whether the CBP can improve psychosocial functioning. The study was retrospective, through investigating medical records and via a structured questionnaire sent to patients who participated in the CBP between 1994 and 1998 (n = 25). Follow-up was at least 1 year after the CBP. There was an 80% response (n = 20). The mean age at BI was 22 years. The patients had severe BI (mean duration of coma 4.7 weeks) and 17 had traumatic BI. Prior to the CBP negative consequences were seen on independence of living, employability, relationships and contact with friends. No or little effect was seen on contact with family and leisure activities. After the CBP, positive effects were found on employability and independence of living but not on premorbid levels. The effect on the other aspects were absent or not clear. Most patients wanted support at follow-up. The authors concluded that the CBP had a positive effect on independence of living and employability. A 'second' rehabilitation programme can be useful if psychosocial problems are present. Long-lasting support and structural control seem necessary and are recommended.

Activities of Daily Living↗
PubMed1998

Improvement scaling (rehabilitation version). A new approach to measuring progress of patients in achieving their individual rehabilitation goals.

OBJECTIVES: Accurate measurement of clinically relevant change in individual patients undergoing rehabilitation has been an elusive goal. Simple, clinically meaningful, patient-centered measures of individual patient change are urgently needed. The purpose of this research was the development and testing of Improvement Scaling (Rehabilitation Version)(IMS), a new approach to measuring the progress that rehabilitation patients make during treatment. METHODS: Research and clinical staff developed the 65 IMS scales and applied them to all admissions to an an inpatient rehabilitation unit. Date were collected on 292 consecutively admitted rehabilitation patients who were aged 50 or older. An Improvement Score indicates the degree to which each patient achieves the expected level of outcome on his or her unique set of IMS goals. Improvement scores were compared to Goal Attainment Scores and to scores from more traditional measures. Interrater reliability was assessed. RESULTS: IMS scores correlated r = .78 with comparable Goal Attainment Scores. IMS and Goal Attainment Scores had the same pattern of correlations with other measures. Interrater reliability of IMS scores was r = .91. CONCLUSIONS: IMS appears to be a practical, reliable, valid, and clinically useful technique for measuring individual patient change. What is needed now is replication and more information on factors which may influence IMS scores. Versions of IMS are being developed for home health care and mental health. Applications of IMS for quality assurance, quality improvement, and documentation of patient change for third parties is discussed.

Activities of Daily Living↗
PubMedDate not supplied

Vocational Rehabilitation Index assessment of rehabilitation medicine service patients.

Only a minority of working-age patients referred to rehabilitation medicine services return to work, but could more be helped? A first step is identifying those potentially able to do so. This paper describes the retrospective application of the Vocational Rehabilitation Index (VRI) to 223 patients of working age and with various diagnoses referred to one rehabilitation medicine service. The VRI discriminates between patients who return to work and those who do not, as well as between groups with apparently differing degrees of need for vocational rehabilitation assistance. It also has good face validity. Results suggest that it is feasible to apply the VRI in rehabilitation medicine settings and that further prospective evaluation and practical applications should be undertaken.

Abstracting and Indexing↗
PubMed2005

[ISYDE-Psi first step of the implementation of guidelines for psychology activities in cardiac rehabilitation and prevention. Italian SurveY on CarDiac REhabilitation-Psychology].

The Italian SurveY on CarDiac REhabilitation-Psychology (ISYDE-Psi) was developed, in line with the indications of the Italian National Guidelines Program, as part of a project to implement and apply the guidelines for psychology interventions in cardiac rehabilitation and prevention published in 2003. The Task Force on Psychological Interventions in Cardiac Rehabilitation conducted this pilot survey of the existing situation of Psychology in order to prepare the ground for implementation of the guidelines through interactive training. As part of the evaluation of training requirements a questionnaire was elaborated to gather information on the models of organization of and activities carried out by psychologists working in the surveyed cardiac rehabilitation facilities. Data collection for ISYDE-Psi terminated at the end of March 2005, with replies from 68/107 (63.6%) structures. In the light of this response, the Task Force has developed a training project for psychologists working in cardiac rehabilitation, sponsored by the Italian Council of Psychologists, that will be implemented in different regions of the country with the aim of disseminating the guidelines and promoting their correct application despite the existing regional disparities in organization.

Health Care Surveys↗
PubMed2001

Rehabilitation that works--vocational outcomes following rehabilitation for occupational musculoskeletal pain.

AIMS: To describe the short term vocational outcome for accident compensation claimaints with disabling musculoskeletal pain following a comprehensive, interdisciplinary rehabilitation programme. METHODS: A telephone follow-up audit of clients who had undertaken a rehabilitation programme characterised by a cognitive-behavioural approach with self-management, reconditioning, vocational rehabilitation and psychological pain management. RESULTS: Of 62 clients who had undergone a rehabilitation programme, we obtained follow-up information on 49 (79%). These were predominantly male, aged in their mid 30s, manual workers with low back pain and a median sick leave of twelve months. At a median of five months a vocational success was achieved in 75%: working full time (47%), part time (12%) or actively looking for work (16%). Of those in work, 48% went back to the same job, 7% went back to the same job but with a different employer and 15% went to a different job that used the same skills. Logistic regression analysis showed that duration of work disability was the major predictor of vocational success (OR 0.36, 95% CI 0.18 to 0.78, for a difference of twelve months). CONCLUSION: Despite the uncontrolled nature of these results, it is likely that the rehabilitation programme had a significant impact in getting compensation claimants back to work. Only a minority require substantive retraining and early intervention is associated with a better outcome.

Adult↗
PubMed2005

[Rehabilitation guidelines as tool of quality assurance in rehabilitation].

The rehabilitation guideline program initiated by the German Federal Pension Insurance for Salaried Employees (BfA) can be regarded as the introduction of evidence- and consensus-based guidelines with direct relevance to rehabilitation practice in this specific sector of care. After successful implementation of the program, a substantial reduction of practice variation among rehabilitation institutions may be expected, hereby promoting the quality assurance in rehabilitation care. The program will also support the legitimization of medical rehabilitation as offered by the pension funds. So far, this is the first and only health care sector that has included the use of evidence-based practice guidelines routinely and ubiquitously into quality assurance activities.

Germany↗
PubMed1990

Cardiovascular, pulmonary, and cancer rehabilitation. 2. Cardiovascular considerations in the rehabilitation of the disabled.

This self-directed learning module addresses core concepts in the application of principles of cardiac rehabilitation for the physically disabled population. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section contains general and athletic conditioning programs for the disabled, rehabilitation of the disabled with coexisting cardiac disease (including modified exercise tolerance testing, cardiac demands of rehabilitation programs, and cardiac precautions), and peripheral circulatory dysfunction (arterial, venous, and lymphatic).

Bibliographies as Topic↗
PubMed1990

Cardiovascular, pulmonary, and cancer rehabilitation. 1. General principles of cardiovascular rehabilitation.

This self-directed learning module highlights advances in this topic area. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in Physical Medicine and Rehabilitation. This section reviews the anatomy of the heart, physiology of exercise training, pathophysiology and clinical aspects of cardiac conditions frequently encountered in rehabilitation, cardiac evaluation techniques, physical conditioning for normal persons, and rehabilitation of the patient with heart disease. Advances that are covered in this section include indications for cardiac rehabilitation following coronary artery bypass graft compared with percutaneous transluminal coronary angioplasty and exercise testing and physical conditioning of patients on long-term beta-adrenergic blockade or with severe left ventricular dysfunction.

Bibliographies as Topic↗
PubMed1990

Cardiovascular, pulmonary, and cancer rehabilitation. 4. Cancer rehabilitation: principles and psychosocial aspects.

This self-directed learning module highlights advances in alternative treatment settings, nutrition, and sexuality in cancer rehabilitation. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section discusses principles of clinical oncology for rehabilitation, and psychosocial aspects of cancer rehabilitation management.

Bibliographies as Topic↗
PubMed1995

Stroke rehabilitation in south Auckland; the value of an effective rehabilitation unit.

AIM: To assess the validity of Barthel based poststroke triage, the effectiveness of a rehabilitation unit in minimising poststroke institutionalisation, and medical resource utilisation for stroke management. METHODS: A prospective study of stroke outcome for 115 consecutive patients admitted to Middlemore Hospital, Auckland, between March and September 1993, based on Barthel functional assessments at 1 week and 3 months poststroke, postdischarge domicile and duration of inpatient stay in both acute medical and rehabilitation units. RESULTS: For the 73 patients offered rehabilitation, 48 (76%) of the survivors were able to return home after a mean period of 6 weeks. Of 24 subjects with 1 week Barthel scores of five or less, 15 of 19 (84%) survivors returned to their original domicile. Of eight patients with 1 week Barthel scores of two or less, all survived and five returned home. The median delay between admission by the acute medical service and transfer to the rehabilitation unit was only four days for the 70 patients involved. CONCLUSION: Our data provides local confirmation of internationally increasing acceptance of the effectiveness of rehabilitation units in reducing expensive long term institutionalisation and freeing up stressed acute medical resources.

Aged↗
PubMed1997

[Attitude of established physicians to medical rehabilitation: an empirical study of the access to rehabilitation problem].

Office-practice physicians' attitudes towards and knowledge of available medical rehabilitation benefits are crucial influences concerning the manner and extent to which they pursue their patients' access to rehabilitation. Covering some 1200 office-practice physicians in the catchment area of a workers pension insurance agency, LVA Oldenburg-Bremen, the present questionnaire study is directed at a closer analysis of these influences. The findings, for one, indicate great diversity of overall approval of rehabilitation measures, for the other they however also reveal varying judgements of the relevancy of rehabilitation benefits for the various disease groups. Suggestions are set out on the basis of our findings on how access to rehabilitation could be upgraded.

Adult↗
PubMed2002

Neuro-rehabilitation--a challenge for neurosurgeons in the century 21st concepts and visions of the WFNS-Committee on neurosurgical rehabilitation.

OBJECTIVES: Patients with severe brain, spinal cord and peripheral nerve lesions today survive surgery. This, however, is quite often achieved at the burden of disabilities. Neuro-rehabilitation could improve significantly patient's quality of life (QoL). METHODS: Formed in 1997, the WFNS Committee supports all efforts regarding personal and regional activities, teaching, research, recommendations, guidelines, and practical application to improve neurosurgeon's quality management within the spectrum of rehabilitation around the world. RESULTS: Neuro-rehabilitation became part of the scientific programmes at the 11th EANS, 10th AANS, ICRAN 1999, and now 12th WFNS congresses. The first international conference on Neurosurgical Rehabilitation took place in D--Münster, 2000. CONCLUSIONS: The WFNS Committee can influence neurosurgeons to take over the challenge of neuro-rehabilitation to improve patient's outcome in respect to ICIDH-2 WHO classification. Delegates of all neurosurgical societies are kindly invited to join us.

Advisory Committees↗
PubMed1998

[Ambulatory vs. inpatient rehabilitation after established myocardial infarct--contra ambulatory rehabilitation].

Outpatient cardiac rehabilitation, as compared to inpatient rehabilitation, has substantial disadvantages for several patient groups. These drawbacks may lead to insufficient results in long term secondary prevention and to inadequate quality of life in patients with chronic heart disease. As outpatients, they remain in life circumstances which were, at least in part, causative for their heart diseases. Especially in elderly patients, those with a complicated course of disease, those who find adjusting their life style to the chronic disease state a daunting task, and those who find coping with the fact of being chronically ill as surpassing their psychological skills will find only in an inpatient setting all the relevant support delivered by a team of experts complementing each other for the benefit of the patient. A flexible system for inpatient or/and subsequent outpatient cardiac rehabilitation should be adopted which can be tailored to the individual patient's needs. It remains to be seen whether outpatient cardiac rehabilitation will really lower costs in the long run. This can be expected at best for a small group of relatively young patients with reasonably good physical fitness and no major problems in coping behaviour. The majority of patients needing cardiac rehabilitation does not fall into this group.

Aftercare↗