Reha-Therapiestandards und medizinisch-beruflich orientierte Rehabilitation – Ist beides miteinander vereinbar? Eine Aufwandsanalyse der Therapieanforderungen

Abstract

Medical rehabilitation carried out by the German Pension Insurance aims at maintaining or restoring the ability to work taking into account individual problems of the insured population. To ensure high-quality rehabilitation the German Pension Insurance uses a variety of quality assurance instruments. It is indispensable that requirements from different instruments constitute a conclusive and hence reproducible overall concept. This article looks at the requirements imposed on work-related medical rehabilitation (MBOR) and from the standards for rehabilitative therapy. In an expenditure analysis we evaluated the extent to which the requirements from our standards for rehabilitative therapy in chronic back pain and work-related medical rehabilitation are compatible with each other, and their impact on the quantity of treatment to be delivered. In a first step the instruments were compared qualitatively. Next, we looked at the resulting cumulative duration of treatment. Finally, using an orthopaedic rehabilitation centre on the underlying assumptions as an example, we analysed whether existing staffing levels are sufficient to fulfil the requirements. MBOR and rehabilitation treatment standards both set requirements regarding vocational orientation; they, however, employ different methods and address different groups of rehabilitants. The duration of treatment for a rehabilitant who - owing to his work-related problems - is treated not only according to the rehabilitative treatment standards but also fulfilling the MBOR requirements profile increases on average from 10.4 to 14.2 h a week. Modelling of the staffing levels necessary to fulfil the requirements shows a possible shortage in the group of social workers only. The requirements from MBOR and rehabilitative treatment standards are compatible with each other regarding systematics, target group and scope of work-related treatment and are consistent with specifications for structural quality, especially with staffing levels. Rehabilitants are not exposed to undue strains, and staffing levels in rehabilitation centres are adequate - with the possible exception of social workers for MBOR. In future development of quality specifications for rehabilitation it remains pre-eminent to ensure an interlocking of the different requirements, in order to provide the rehabilitation centres with a comprehensible frame for the provision of care.