Inpatient Medical Rehabilitation Research Articles

Predicting Functional Independence Measure Scores During Rehabilitation with Wearable Inertial Sensors.

Evaluating patient progress and making discharge decisions regarding inpatient medical rehabilitation rely upon standard clinical assessments administered by trained clinicians. Wearable inertial sensors can offer more objective measures of patient movement and progress. We undertook a study to investigate the contribution of wearable sensor data to predict discharge functional independence measure (FIM) scores for 20 patients at an inpatient rehabilitation facility. The FIM utilizes a 7-point ordinal scale to measure patient independence while performing several activities of daily living, such as walking, grooming, and bathing. Wearable inertial sensor data were collected from ecological ambulatory tasks at two time points mid-stay during inpatient rehabilitation. Machine learning algorithms were trained with sensor-derived features and clinical information obtained from medical records at admission to the inpatient facility. While models trained only with clinical features predicted discharge scores well, we were able to achieve an even higher level of prediction accuracy when also including the wearable sensor-derived features. Correlations as high as 0.97 for leave-one-out cross validation predicting discharge FIM motor scores are reported.

Assessment of Patient Participation in Physical Rehabilitation Activities: An Integrative Review

In addition to the amount and intensity of rehabilitation interventions and the number of therapies, the degree of patient participation in physical rehabilitation activities is key. For this reason, adequate information regarding participation is necessary to evaluate patient performance. This article reviews instruments designed to assess participation in physical rehabilitation activities. Integrative review. Pubmed, CINAHL, PsycInfo, Embase, and Cochrane Library database were searched for publications between January 1976 and July 2012. Secondary searches were also conducted and reference lists scanned for relevant publications. Fourteen articles reporting on three instruments were found. They differ with regard to their underlying theoretical concepts. Each instrument was tested in medical inpatient rehabilitation settings. Each instrument appears to be useful for assessing specific aspects of patient participation in rehabilitation activities. More theoretical work is needed to clarify the underlying concepts as these instruments are not yet ready for clinical application.

The Uniform Data System for Medical Rehabilitation

The aim of this study was to present yearly aggregated summaries of rehabilitation outcomes at admission, discharge, and follow-up from a national sample of patients receiving inpatient medical rehabilitation for stroke, traumatic brain injury, lower extremity fracture, lower extremity joint replacement, traumatic spinal cord injury, or debility. This is an analysis of secondary data from more than 300 inpatient rehabilitation facilities in the United States that contributed inpatient and follow-up data to the Uniform Data System for Medical Rehabilitation during the period January 2002 through December 2010. Aggregate variables reported include demographic information, social situation, and functional status (Functional Independence Measure instrument ratings at admission, discharge, and follow-up). Follow-up data were obtained 80-180 days after discharge through telephone interviews by trained clinical staff. The final sample included 287,104 patients with follow-up information. The median time to follow-up was 95 days. Overall, more than 90% of the patients within each impairment group were living in the community at follow-up. Follow-up Functional Independence Measure total ratings were stable to slightly increased over time. Change scores (discharge to follow-up) increased in all six groups. The mean Functional Independence Measure gains from discharge to follow-up, as a percentage of mean gains from admission to discharge, varied by impairment category: 46% for spinal cord injury to 71% for lower extremity fracture. Locomotion yielded the lowest ratings at all three assessments within each of the six impairment groups. The follow-up data from the national sample of patients discharged from inpatient rehabilitation indicate that gains in mean functional independence scores from both admission to discharge and discharge to follow-up gradually increased from 2002 to 2010. At follow-up, more than nine of ten patients in all six groups are living in the community.

Begleitete Eigeninitiative nach der Reha („Neues Credo“) – Langzeitergebnisse der quasiexperimentellen Interventionsstudie

Our project is closely related to the previous study "Rehabilitation aftercare - a new credo for rehabilitation clinics"; the intensified aftercare-strategy was developed by an interdisciplinary group of health professionals and scientists for patients with chronic back pain. Main objective is the resumption and maintenance of regular physical activity in everyday life of pa-tients undergoing rehabilitation. The aim of our present study was to evaluate the long-term (24-month-follow-up) efficacy of the "New Credo" (inpatient medical rehabilitation+intensified aftercare=IG) as compared with usual care (inpatient medical rehabilitation=CG). We conducted a prospective controlled multicentre trial (IG: 3 clinics vs. CG: 3 clinics) with 4 points of measurement (T0: before and T1: after rehabilitation as well as T3: 12 and T4: 24 month after discharge). We enrolled rehabilitants with a primary diagnosis of chronic back pain (ICD-10: M51-54) who had given their consent. Exclusion criteria were mental and/or psychological impairments as well as surgery in the past 6 months. Primary Outcomes included restriction of social participation (IMET) and functional capacity (FFbH-R). Treatment effects were evaluated using analyses of variance and adjusting for differences between baseline -values; furthermore we calculated effect sizes (SMDInter, SMDIntra, ORs). Complete data were available for 123 IG-rehabilitants and 299 CG-participants (Completer-Analysis, response: 52%). Regarding restriction in functional capacity in everyday life (FFbH-R) multivariate analysis confirmed a treatment*time interaction, the appropriate effect-sizes showed no significant effects (SMDInter and SMDIntra). With respect to long-term effects 24 months after discharge no significant effects were found for social participation, however. With respect to secondary outcomes there are no significant differences between the groups (SMDInter, ORs); in fact rehabilitants of both groups showed similar effects (SMDIntra) in most cases. In summary our results doesn't confirm that the intensified aftercare-programme is able to improve longer-term effectiveness of inpatient orthopaedic rehabilitation up to 24 month.

The role of medical staff in providing patients rights.

ABSTRACTAmong the priority basic human rights, without a doubt, are the right to life and health-social protection. The process of implementation of human rights in the everyday life of an ordinary citizen in the post-war recovery of Bosnia and Herzegovina faces huge objective and subjective difficulties. Citizens need to be affordable adequate healthcare facilities that will be open to all on equal terms. The term hospital activity implies a set of measures, activities and procedures that are undertaken for the purpose of treatment, diagnosis and medical rehabilitation of patients in the respective health institutions. Principles of hospital care should include Comprehensiveness (Hospital care is available to all citizens equally); Continuity (Provided is continuous medical care to all users); Availability (Provided approximately equal protection of rights for all citizens). Education of health professionals: The usual threats to patient safety include medical errors, infections occurred in the hospital, unnecessary exposure to high doses of radiation and the use of the wrong drug. Everyday continuing education in the profession of a doctor is lifelong.

Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation.

The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4) and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days) and lowest functional rating at discharge (average 79.4). Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25) generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research.

Patientenschulungen mit arbeits- und berufsbezogener Thematik – Ergebnisse einer bundesweiten Befragung deutscher Reha-Einrichtungen

Psychosocial patient education programs focusing on work-related issues are a core element in the German statutory pension insurance's profile of requirements (POR) regarding inpatient vocationally oriented medical rehabilitation (VOMR). This study aims at analyzing the prevalence of patient education programs focusing on work-related issues in German rehabilitation centers with regard to their content and quality.Data were collected in a national survey on the current state of patient education within medical rehabilitation programs in Germany in 1473 inpatient and outpatient medical rehabilitation centers. Data were analyzed both quantitatively and qualitatively, with free text responses being assigned to categories, drawing upon criteria developed by the German Center of Patient Education and the pension insurance's POR. 283 of the 908 institutions participating in the survey provided information on 454 psychosocial patient education programs focusing on work-related issues. "Unemployment and job training", "work hardening", "stress"/"relaxation" were named most frequently. The criteria derived from the POR regarding group content and from the Center of Patient Education regarding group size and education methods were largely fulfilled. There is a need for existing group programs in VOMR to be further manualized, evaluated and published. More patient education programs focusing on work-related issues should be developed specifically for relevant indications.

Rehabilitation vor Pflegebedürftigkeit im Alter: eine Analyse anhand von Routinedaten

Medical rehabilitation of statutory health insurance (SHI) in Germany aims at prevention of (increasing) disability and thus the need for long-term care. The paper examines the inpatient rehabilitation care utilization in the elderly based on claims data, taking into account the need of pre-existing long-term care (LTC) in according to the German Long-Term Care Insurance and further changes (survival, LTC level). Anonymous data from inpatient medical rehabilitation of AOK-insured patients ≥ 65 years (2008/2009) following different treatment pathways were evaluated: early rehabilitation while hospital treatment (FR), combined treatment with early and subsequent rehabilitation (F-/AR), subsequent rehabilitation after hospital treatment (AR); rehabilitation without previous hospital treatment (SR). Survival and LTC-Level (higher level=higher care demands) were tracked for 12 months after utilization of rehabilitation. The extent of pre-existing levels of LTC ≥ 1 was in FR 44.1%, in F-/AR 19.1%, in AR 10.1% and in SR 15.9%. Above-average shares of geriatric indications and below-average shares of orthopaedic indications were observed for all 4 groups. LTC levels remained unchanged for varying percentages of patients in the treatment groups (FR 57%, F-/AR 46%, AR 85%, SR 92%). Higher LTC-Levels were observed for 42% of cases in the FR group, 54% in the F-/AR group, and only 14% and 7% in the AR and the SR group respectively. Lower LTC-Levels could be found in less than 1% of the cases in all groups. Survival rates varied significantly (72% FR, F-/AR 84%, AR 92% and 96% SR). Cases with a pre-existing care level had significantly reduced survival rates. The results could be confirmed after standardization for age and gender. The current application of the legal principle "rehabilitation before LTC" for older insurants is in SHI mainly segmented afterwards or integrated into hospital treatment but rarely combined intersectoral or conducted without immediately preceding hospital-treatment.

Regional Variation in Stroke Rehabilitation Outcomes

ObjectiveTo examine and describe regional variation in outcomes for persons with stroke receiving inpatient medical rehabilitation. DesignRetrospective cohort design. SettingInpatient rehabilitation units and facilities contributing to the Uniform Data System for Medical Rehabilitation from the United States. ParticipantsPatients (N=143,036) with stroke discharged from inpatient rehabilitation during 2006 and 2007. InterventionsNot applicable. Main Outcome MeasuresCommunity discharge, length of stay (LOS), and discharge functional status ratings (motor, cognitive) across 10 geographic service regions defined by the Centers for Medicare and Medicaid Services (CMS). ResultsApproximately 71% of the sample was discharged to the community. After adjusting for covariates, the percentage discharged to the community varied from 79.1% in the Southwest (CMS region 9) to 59.4% in the Northeast (CMS region 2). Adjusted LOS varied by 2.1 days, with CMS region 1 having the longest LOS at 18.3 days and CMS regions 5 and 9 having the shortest at 16.2 days. ConclusionsRehabilitation outcomes for persons with stroke varied across CMS regions. Substantial variation in discharge destination and LOS remained after adjusting for demographic and clinical characteristics.

Liveonline-Nachbetreuung bei Patienten mit abdominaler Adipositas in der kardio-diabetologischen Rehabilitation: Ergebnisse einer randomisierten, kontrollierten Studie

Obese patients were coached after inpatient medical rehabilitation with a 6 units comprehensive multimodal Liveonline aftercare program. In the randomized controlled study design, significant improvements in all outcome criteria were found both in treatment and control group. The improvements in the treatment group, however, were only partially superior to the control group, especially in the area of food habits. A statistically significant superiority of the treatment group concerning the primary targets waist circumference and body mass index could not be determined. The Liveonline aftercare was evaluated positively by the participants. Future research is discussed.

Gruppenprogramme der Gesundheitsbildung, Patienten­schulung und Psychoedukation in der medizinischen Rehabilitation 2010 - Eine Bestandsaufnahme

High quality demands are being placed on concepts of educational group programmes in medical rehabilitation as well as the related trainer qualifications. A nationwide survey of German medical rehabilitation clinics in 2005 had revealed a need for improving educational practice according to these quality criteria. An updated investigation was performed in 2010 aiming at describing group programmes used in medical rehabilitation. 1 473 inpatient and outpatient medical rehabilitation clinics were invited to participate. 908 clinics reported on their training programmes. Data from clinics caring for patients with somatic disorders could be compared to the 2005 survey. Data from clinics for both psychosomatic and substance abuse disorders was collected for the first time in 2010. Overall, psychologists and physicians were reported to be the most frequent conductors of educative programmes. In somatic clinics, psychologists, dieticians and occupational therapists or physiotherapists were the most common conductors. Two-thirds of the institutions reported no training prerequisites for staff members to perform patient education. 80% of the education programmes were categorized post hoc into 3 classes: "generic health education", "disorder-specific patient education", and "psychoeducational group programmes". Almost two-thirds of all programmes were carried out with 8-15 participants, and many used several interactive didactic methods. Programmes conducted in small groups (<8 participants) used significantly more interactive methods than those conducted in larger groups did (>15 participants). Only half of the programmes were manualized. Significantly more interactive methods were used in completely manualized programmes. Only about half of the programmes were evaluated, and only very few evaluation studies were published. The institutions wished additional support by workshops especially concerning qualification of their staff and concerning educational concepts. A need for further improvement and support exists relative to the training of educators and the development of manuals as well as evaluation and publication of the programmes.

In-patient Rehabilitation Outcomes Following Lower Extremity Fracture in Patients with Pneumonia

Pneumonia is a common comorbidity among hospitalized older adults and may impede functional restoration and increase medical cost. Medicare reimbursement rates for patients receiving in-patient medical rehabilitation services are higher for individuals who have comorbid pneumonia. We examined the impact of comorbid pneumonia on outcomes for patients with lower extremity fracture receiving in-patient medical rehabilitation services. Secondary data analysis of medical records obtained from 919 in-patient rehabilitation facilities in the United States. The sample included 153,241 subjects who received in-patient rehabilitation services following lower extremity fracture in 2005-2007. We used multivariable linear regression to evaluate the independent effects of pneumonia on stay and discharge functional status (Functional Independence Measure instrument), and logistic regression models to explore discharge to home versus not home. Pneumonia was a comorbidity for 4,265 (2.8%) of the subjects with lower extremity fracture. The multivariable models indicated that subjects with no payment-eligible comorbidity experienced shorter stay (regression coefficient -0.44, 95% CI -0.60 to -0.28 d), higher discharge functional status ratings (regression coefficient 1.84, 95% CI 1.42-2.25 points), and higher odds of home discharge (odds ratio 1.19, 95% CI 1.09-1.29), compared to subjects with pneumonia. Our findings suggest that comorbid pneumonia is associated with poorer rehabilitation outcomes (stay, discharge functional status, and discharge setting) among subjects receiving in-patient rehabilitation services for lower extremity fracture.

Methodological issues in the organization and implementation of outpatient rehabilitation exercise programs in patients with different forms of coronary heart disease

The paper presents a review of the main features of a program of the exercises used in the medical rehabilitation of patients with acute and chronic coronary heart disease, including conditions after operations on the heart and vessels. Based on his and literature information, the author states that it is now accepted to use low - to moderate-intensity training exercises. They do not differ from high-intensity exercises in their effectiveness. Furthermore, they are safe, more economical, and convenient. The author gives particular attention to the organizational issues of physical rehabilitation, particularly to multi-sessional trainings using the computerized trainer system.

Evaluation of an internet-based aftercare program to improve vocational reintegration after inpatient medical rehabilitation: study protocol for a cluster-randomized controlled trial

BackgroundMental disorders are the main reasons for rising proportions of premature pension in most high-income countries. Although inpatient medical rehabilitation has increasingly targeted work-related stress, there is still a lack of studies on the transfer of work-specific interventions into work contexts. Therefore, we plan to evaluate an online aftercare program aiming to improve vocational reintegration after medical rehabilitation.MethodsVocationally strained patients (n = 800) aged between 18 and 59 years with private internet access are recruited in psychosomatic, orthopedic and cardiovascular rehabilitation clinics in Germany. During inpatient rehabilitation, participants in stress management group training are cluster-randomized to the intervention or control group. The intervention group (n = 400) is offered an internet-based aftercare with weekly writing tasks and therapeutic feedback, a patient forum, a self-test and relaxation exercises. The control group (n = 400) obtains regular e-mail reminders with links to publicly accessible information about stress management and coping. Assessments are conducted at the beginning of inpatient rehabilitation, the end of inpatient rehabilitation, the end of aftercare, and 9 months later. The primary outcome is a risk score for premature pension, measured by a screening questionnaire at follow-up. Secondary outcome measures include level of vocational stress, physical and mental health, and work capacity at follow-up.DiscussionWe expect the intervention group to stabilize the improvements achieved during inpatient rehabilitation concerning stress management and coping, resulting in an improved vocational reintegration. The study protocol demonstrates the features of internet-based aftercare in rehabilitation.Trial registrationInternational Standard Randomised Controlled Trial Number Register (ISRCTN:ISRCTN33957202)

Predictors of Discharge to Acute Care after Inpatient Rehabilitation in Severely Affected Stroke Patients

This study aimed to determine the predictors of discharge to acute care after inpatient rehabilitation in severely affected stroke patients. This was a retrospective study using data from the Uniform Data System for Medical Rehabilitation (UDSMR) between 2008 and 2009. The main outcome variable was discharge location, which included discharge to acute care or discharge to the community after inpatient rehabilitation. The study sample included 223 of the most severely affected stroke patients (Case-Mix Group 0110 of Medicare reimbursement classification), of whom 86 were discharged to acute care from after the inpatient medical rehabilitation setting; 137 similarly classified stroke patients were discharged to the community after inpatient medical rehabilitation. The variables examined were Functional Independence Measure ratings, co-morbid medical conditions, and four groups of stroke-related neurologic deficits (hemiparesis, dysphagia, language deficits, and other stroke-related neurologic deficits). The groups were devised based on International Classification of Diseases, 9th Revision codes. There were no significant demographic differences between the two groups-those discharged to the acute care hospital and those discharged to the community. There was a difference in admission Functional Independence Measure ratings, whereby patients discharged to acute care were significantly lower (P < 0.05) on admission motor and cognitive function than were patients discharged to the community. When controlling for 19 groups of co-morbid medical conditions and 4 groups of stroke-related neurologic deficits, there was no significant difference between patients being discharged to an acute care hospital and those discharged to the community. In the current study, controlling for impairment (stroke), severity of condition, demographic variables, inpatient rehabilitation admission day of the week and discharge day of the week, prehospitalization living setting, prehospitalization living with (alone, family, other), payer (secondary insurance coverage), onset days, co-morbid medical conditions, and classification of stroke-related neurologic deficits, the only variable predictive of discharge to the acute care hospital from an inpatient rehabilitation facility is function at admission, mainly the admission motor Functional Independence Measure rating. If clinicians routinely assess the functional status of patients during the preadmission screening process, it may aid in identifying whether the patient is at an increased risk of being readmitted to the acute care hospital.

The role of positive affect on social participation following stroke

Purpose: To examine the association between positive affect and social participation in adults with first-time stroke after in-patient medical rehabilitation. Methods: A prospective cohort design using information from the Stroke Recovery in Underserved Populations database (SRUP) for the years 2005–2006. Data were collected at discharge from in-patient medical rehabilitation and 3 months post-discharge. Participants were aged 50 and older with first-time stroke (n = 605) and admitted to 1 of 11 in-patient medical rehabilitation facilities across the United States. Primary measures included a positive affect scale and a home and community social participation instrument. Results: The mean age was 71.6 years, 50.3% were women, and 56.5% were married. Results of cumulative logit models showed each 1 point increase in positive affect was significantly associated with a 17% odds of higher social participation (OR: 1.17, 95% CI 1.10, 1.25), after adjusting for demographics, clinical characteristics, and negative affect. Conclusions: High positive affect at discharge from in-patient medical rehabilitation was associated with higher levels of social participation 3 months post-discharge. The significant association between higher positive affect and higher levels of social participation adds to accumulating evidence linking positive affect with beneficial physical and psychological outcomes after an acute event such as stroke.Implications for RehabilitationThis study shows positive affect associated with greater social participation 3 months post-discharge from in-patient medical rehabilitation.Positive affect may be a critical factor in the recovery trajectory of the stroke patient.The assessment of positive affect during in-patient medical rehabilitation may identify those at risk for poor social participation post-discharge and may lead to the design of innovative interventions aimed at the re-integration of stroke individuals into the community.

Recovery of Functional Status After Stroke in a Tri-Ethnic Population

To examine recovery of functional status for white, black, and Hispanic patients who have had a stroke from the time of admission to inpatient medical rehabilitation to 12 months after discharge. A longitudinal study that used information from the Stroke Recovery in Underserved Population database, a prospective observational study of persons with stroke who received inpatient medical rehabilitation services during 2005-2006. Eleven inpatient rehabilitation facilities located across diverse regions of the United States, including California, Florida, Iowa, Illinois, Kentucky, New Jersey, New York (2), Texas (2), and Washington, DC. A total of 990 adults aged 55 years or older who had a stroke and were admitted to 1 of 11 inpatient medical rehabilitation facilities in the United States were interviewed at 4 time points, including admission to and discharge from an inpatient medical rehabilitation facility and 3 and 12 months after discharge. Not applicable. Functional status as measured by the Functional Independence Measure (FIM). For the total sample, FIM ratings increased from admission to discharge and from discharge to 3-month follow-up, with little recovery occurring between 3 and 12 months. In random effects mixed models, at 3-month follow-up, both black and Hispanic patients had lower FIM ratings than did white patients. At 12-month follow-up, black and white patients were similar; however, Hispanic patients continued to have lower FIM ratings compare with white patients. Racial/ethnic group, age, length of stay, and medical comorbidities were significant predictors of total FIM ratings over the 4 time points. Persons 55 years and older who have had a stroke, regardless of race/ethnicity, appear to benefit from inpatient medical rehabilitation. Most functional status gains occur during inpatient medical rehabilitation and continue in the first few months after discharge, with little change afterward.

The Uniform Data System for Medical Rehabilitation

This study aimed to provide benchmarking information from a large national sample of patients receiving inpatient rehabilitation after a traumatic spinal cord injury. This was an analysis of secondary data from 891 inpatient medical rehabilitation facilities in the United States that contributed traumatic spinal cord injury data to the Uniform Data System for Medical Rehabilitation from January 2002 to December 2010. Variables analyzed included demographic information (age, sex, marital status, race/ethnicity, prehospital living setting, discharge setting), hospitalization information (length of stay, program interruptions, payer, onset date, rehabilitation impairment group, International Classification of Diseases 9 codes for admitting diagnosis, co-morbidities), and functional status (Functional Independence Measure [FIM] instrument ratings at admission and discharge, FIM efficiency, FIM gain). The final sample included 47,153 patients with traumatic spinal cord injury. Overall, the mean length of stay was 26.2 ± 23.2 days: yearly means ranged from 29.7 ± 25.4 in 2002 to 22.9 ± 18.9 in 2009. FIM total admission and discharge ratings also declined during the 8-yr study period; admission decreased from 60.5 ± 17.4 to 55.9 ± 16.3; discharge decreased from 86.1 ± 23.8 to 82.4 ± 23.4. Rehabilitation efficiency (FIM gain per day) remained relatively stable over time (1.6 ± 1.7 points per day). The percentage of all patients discharged to the community ranged from 75.8% to 71.5% per year. Wheelchair users stayed in rehabilitation longer than did persons who could walk (34.6 ± 217.4 vs. 17.4 ± 14.1 days) and also experienced less functional improvement (21.6 ± 15.8 vs. 29.6 ± 16.3 FIM points). National data from persons with traumatic spinal cord injury in 2002-2010 indicate that lengths of stay declined, but efficiency in functional independence was stable to slightly increased. More than 70% of patients were consistently discharged to community settings after inpatient rehabilitation.

LUMBAR OSTEOСHONDROSIS: DIAGNOSIS, TRЕАTMENT, MEDICAL REHABILITATION

The article presents the basic issues of diagnosis, treatment and medical rehabilitation of patients with neurological manifestations of lumbar osteochondrosis. The risk factors, pathogenesis of neurological syndromes, clinical and instrumental diagnosis methods of arising disturbances have been singled out. The approaches to the treatment have been given at different stages of the illness. The methods of medical rehabilitation of this cohort of the patients have been stated in detail. A particular attention is paid to physical methods of rehabilitation, being fundamental in the restoration of neurological deficiency.

Das Krankheitsmanagement von Kindern und Jugendlichen mit Adipositas und Asthma bronchiale: Veränderungen und Prädiktoren im Rahmen stationärer Rehabilitation

There is growing interest in disease-related self-management as a means of coping with chronic disease. Improving disease-related self-management has thus become a key aim of inpatient medical rehabilitation of children and adolescents. We conducted this study in the framework of the project entitled "Outcome quality in medical inpatient rehabilitation of children and adolescents" initiated and financed by the German statutory pension and statutory health insurance programmes. Our study aim was to examine any changes following inpatient medical rehabilitation in the diagnosis-specific disease self-management of children suffering from obesity and from bronchial asthma. In addition we sought to identify any personal characteristics of the rehabilitants that might predict changes in self-management. We collected data from 17 inpatient medical rehabilitation centres on disease-related self-management in children with obesity (n=706) and bronchial asthma (n=162) at the start of rehabilitation and 6 weeks after rehabilitation. The age of the diagnostic group "obesity" averaged 14.3 years, with a male percentage of 39.3%. The average age in the diagnostic group "bronchial asthma" was 14.0 years, with a male percentage of 54.2%. A questionnaire was used addressing the self-management of chronically ill young people. To compare the results from both measurement occasions, we employed t-tests for dependent samples and calculated effect-sizes. Using hierarchical regression analyses, we determined predictors of change in disease-related self-management. The predictor variables were included into the hierarchical regression analyses within 6 topical blocks (baseline disease management, sociodemography, body functions, baseline quality of life, motivation for rehabilitation, and duration of rehabilitation). We observed significant post-rehabilitation improvement of disease-related self-management in both the obese (T=-22.423; p<0.001) and the bronchial asthma group (T=-5.349; p<0.001). This improvement revealed a strong effect in the obese group (SRM=0.84) and a moderate effect in the bronchial asthma group (SRM=0.42). Regression analyses explained 3.4% of the variance in the obese group and 31.3% in the bronchial asthma group. In the latter group, self-management 6 weeks after the end of rehabilitation can be predicted by good self-management at the start of rehabilitation (ß=0.516; p<0.001) as well as primary school attendance (ß=0.201; p<0.01). Our results show that the disease-related self-management of obese youngsters and those with bronchial asthma benefits from inpatient rehabilitation. Changes in self-management are only poorly predicted by the variables included in the regression analysis in the diagnostic group "obesity". Other factors than those considered in this study seem to influence the success of treatment. In the diagnostic group "bronchial asthma" a significantly higher proportion of incremental variance can be explained, the extent of disease management at the beginning of rehabilitation being the most important predictor.