Akzeptanz und Praktikabilität der Reha-Therapiestandards für die Rehabilitation nach Hüft- und Kniegelenks-Totalendoprothese (TEP) - Ergebnisse einer Anwenderbefragung zur Pilotversion

Abstract

Implementation of the pilot version of the rehab therapy standards for rehabilitation following total hip or knee replacement was accompanied by a user survey. This survey allowed rehab centres to comment on the standards and suggest changes.Early 2010 a total of 160 rehab centres that had treated at least 50 German Pension Fund insurees following total hip or knee replacement in 2008 received a written survey together with an overview of performance data according to KTL (Classification of Therapeutic Procedures), data that reflect the degree to which the centres had complied with the requirements of the therapy standards.69% of the centres returned the questionnaire. The centres included predominantly agreed that the rehab standards fulfil the quality attributes "scientific foundation (evidence)", "relevance for day-to-day work", "up-to-dateness", and "inter- and multidisciplinary development". There were no statistically significant differences between centres with previously high or low compliance with the requirements of the standards relative to the ratings given for these global quality criteria. Almost all responders considered comprehensiveness and structure of the standards adequate. Between 55 and 94% found that therapeutic procedures were sufficiently represented by the treatment modules. Minimum percentages of patients requiring the respective treatment were considered adequate for 8 out of 13 modules. Responders suggested restricting continuous passive motion to knee replacement. Psychological interventions were considered less important. Among the main reasons for non-adherence to therapy standards in 2008 were: coding problems, too high demands, contraindications, and shortage of staff. Implementation of the standards was associated with both positive and negative expectations on the part of the rehab centres; an issue raised in addition was the effort involved in internal restructuring.The results of the user survey show that the concept of the rehab standards and its implementation basically are accepted. Criticism had mainly concerned continuous passive motion and the need for psychological interventions. Coding problems should not be overrated since the underlying performance data referred to a period of time before the standards were implemented. General appraisal of the rehab standards was independent of previous performance. This emphasizes the weight of user feedback. The rehab standards already have been revised in light of the results of the user survey.