Orthopedic Rehabilitation Patients Research Articles

The social class of orthopedic rehabilitation patients: Are there differences in subjective health, return to work motivation, and participation in aftercare interventions?

This longitudinal quasi-experimental study examines the relationship between social class, subjective health, motivation to return to work (RTW) following medical rehabilitation, and participation in aftercare interventions, utilizing the Social Cognitive Theory of Social Class. To do so, a prospective multicentric study was conducted. The analysis was based on data from N = 1044 orthopedic rehabilitation patients in three clinics in Germany. Latent growth curve models, fixed-effect linear regression models, and multilevel binomial logistic regression were employed for data analysis. As hypothesized, the findings demonstrate that lower social class is associated with poorer subjective health, while higher social class is linked to increased solipsistic motives, characterized by pursuing personal goals in the context of RTW. Conversely, individuals from lower social classes exhibit contextualist motives, which indicate a focus on social and environmental threats influencing their motivation to RTW. Surprisingly, social class does not significantly impact participation in aftercare interventions, probably due to low variance and potentially the successful inclusion within the German healthcare system. These findings emphasize the importance of considering diverse motivation profiles derived from the Social Cognitive Theory of Social Class. The study contributes to our understanding of the social determinants of health and has implications for reducing health disparities by highlighting the motivational aspects, including solipsistic and contextualist motives, associated with social class.

A cross-sectoral approach to utilizing health claims data for quality assurance in medical rehabilitation: study protocol of a combined prospective longitudinal and retrospective cohort study

BackgroundMeasuring the quality of provided healthcare presents many challenges, especially in the context of medical rehabilitation. Rehabilitation is based on a holistic biopsychosocial model of health that includes a person’s long-term functioning; hence, outcome domains are very diverse. In Germany, rehabilitation outcomes are currently assessed via patient and physician surveys. Health insurance claims data has the potential to simplify current quality assurance procedures in Germany, since its comprehensive collection is federally mandated from every healthcare provider. By using a cross-sectoral approach, quality assessments in rehabilitation can be adjusted for the quality provided in previous sectors and individual patient risk factors.MethodsSEQUAR combines two studies: In a prospective longitudinal study, 600 orthopedic rehabilitation patients and their physicians are surveyed at 4 and 2 time points, respectively, throughout rehabilitation and a follow-up period of 6 months. The questionnaires include validated instruments used in the current best-practice quality assurance procedures. In a retrospective cohort study, a nationwide claims database with more than 312,000 orthopedic rehabilitation patients will be used to perform exploratory analysis for the identification of quality indicators. The identified SEQUAR claims data quality indicators will be calculated for our prospective study participants and tested for their ability to approximate or replace the currently used, best-practice quality indicators based on primary data.DiscussionThe identified SEQUAR quality indicators will be used to draft a novel, state-of-the-art quality assurance procedure that reduces the administrative burden of current procedures. Further research into the applicability to other indications of rehabilitation is required.Trial registrationWHO UTN: U1111-1276-7141; DRKS-ID: DRKS00028747 (Date of Registration in DRKS: 2022/08/10).

A process to foster pathology-related effects of design primes - how orthopedic patients might benefit from design features that influence health behaviour intention.

A growing body of literature mainly in the context of consumer research indicates that the formal-aesthetic and conceptual design of objects can influence users' thoughts, emotions and even behavioural patterns. While there is strong evidence regarding these effects on actual purchasing decisions, evidence on the effect of aesthetic design features (e.g., haptics, colour) on health-related mental concepts and intentions for health behaviour change is scarce. Based on insights from material and conceptual priming, this article illustrates the research-driven and evidence-based design process of two design primes and comprises pre-tests and an experiment in two settings on the effect of design on health behaviour focusing i.a. on intention for health behaviour change. In an evidence-based and research-driven process, two lecterns were designed to work as primes, i.e., to have a positive vs. negative influence on several mental constructs (sense of control, sense of coherence, resiliency, self-efficacy) and health-related intention. The lecterns differed mainly in terms of aesthetic appearance (e.g., material, colour, proportion, steadiness). They were tested in (a.) a university setting with students (n = 83) and (b.) a clinical setting with orthopaedic rehabilitation patients (n = 38). Participants were asked to perform an unrelated task (evaluation of an unrelated product) while standing at and using the lecterns. Overall, t-tests and Mann-Whitney-U tests show no significant differences but differing tendencies in a mentioning task. When asked to name health-promoting activities, in the clinical setting, participants using the "positive" prime (i.e., the steady lectern, n = 13) mentioned more sport-related aspects on average and a higher portion of sport-related aspects of their answers than participants using the "negative" prime (n = 11). In the university setting (positive: n = 36; negative n = 38), no such differences emerged. This finding gives reason to believe that the prime might be specifically effective in the clinical setting as it relates to physical activity being the most relevant topic of the patients' pathology.

Rapid nutritional assessment and intervention in orthopedic rehabilitation patients

ObjectivesThe aim of this study was to identify the effect of early nutritional assessment and nutritional intervention on outcomes of older adult patients after discharge from an acute care hospital following fall related fracture. MethodsThis was a feasibility pilot study with post intervention data. One group pretest-posttest study design was implemented. All participants were admitted to a rehabilitation facility in the Southwestern US after a fall related fracture. MeasuresDischarge destination, Functional Independence Measure (FIM), and length of stay (LOS). ResultsA total of 69% of the participants were discharged home. Total FIM scores improved (p<0.01). No significant association was identified between prealbumin change and total FIM change. Patients who had improved prealbumin experienced improved FIM and shorter LOS; however, no significant correlations were determined between LOS and prealbumin change. ConclusionNutritional interventions are important for recovery during rehabilitation of a fall-related fracture. SummaryThis project supports early nutritional evaluation and intervention for older adult patients after major orthopedic procedure. Participants who received early intervention had improved outcomes. (194 characters).

Cardiopulmonary capacity and psychological factors are related to return to work in orthopedic rehabilitation patients.

Health psychology sheds light on the process of returning to work after sick leave and subsequent medical rehabilitation. A 15-month longitudinal study with N = 201 orthopedic rehabilitation patients is reported. It examined whether and how both physiological health (e.g. body mass index and oxygen reabsorption) and psychological/social-cognitive factors (e.g. self-efficacy and social support) are related to returning to work. It was found that social-cognitive and physiological variables, such as oxygen consumption at anaerobic threshold, are important for returning to work. While physical activity was significantly correlated with social-cognitive variables, it was not significantly correlated directly with returning to work. Results suggest that self-efficacy and oxygen consumption at anaerobic threshold should be improved during medical rehabilitation.

Calibration of an item bank in 474 orthopedic patients using Rasch analysis for computer-adaptive assessment of anxiety

Objective: To calibrate an item bank of anxiety-related questions for use in orthopedic patients within a computer-adaptive test. Design: This is a psychometric study. Setting: The sample of orthopedic patients was recruited in two orthopedic rehabilitation clinics in Germany. Subjects: A total of 474 orthopedic rehabilitation patients were recruited for this study. Interventions: Not applicable. Main measures: The main measure is an adapted version of an existing anxiety item pool for cardiovascular rehabilitation patients. Results: The results of the confirmatory factor analysis and Mokken analysis confirmed a one-factor structure and double monotonicity. An anxiety item bank (48 items) could be developed and calibrated using Rasch analysis. It fitted to the Rasch model with a non-significant item–trait interaction (χ2(203) = 172.59; P = .94) and was free of differential item functioning. Unidimensionality could be verified and the person separation reliability was .96. The category threshold parameters varied between 4.72 and 3.16 (7.88 logits). Conclusion: The unidimensional anxiety item bank provides the basis for a computer-adaptive test to assess a wide range of anxiety in rehabilitation patients with orthopedic diseases with very good psychometric characteristics.

Frailty and resilience in an older population. The role of resilience during rehabilitation after orthopedic surgery in geriatric patients with multiple comorbidities.

Hip fracture is common in the elderly and it is usually associated with comorbidities and physiological changes which may have an impact on functioning and quality of life. The concept of resilience may explain why this impact varies among patients. The aim of this open, prospective cohort study was to explore the relationships between resilience, frailty and quality of life in orthopedic rehabilitation patients, and also to assess whether these factors might affect rehabilitation outcome. Eighty-one patients, older than 60 years, underwent a multidisciplinary assessment at the beginning and at the end of the rehabilitation period following orthopedic surgery to the lower limb. The assessments were performed using the Resilience Scale, the Multidimensional Prognostic Index (as a measure of frailty), the WHO Quality of Life-BRIEF, the Geriatric Depression Scale, and the Functional Independence Frailty and resilience in an older population. The role of resilience during rehabilitation after orthopedic surgery in geriatric patients with multiple comorbidities Measure (as a measure of the rehabilitation outcome). A negative correlation between disability and resilience emerged and this association interacted with frailty level. We also found that resilience and quality of life are positive predictors of functional status at discharge.

Dietary intakes in geriatric orthopaedic rehabilitation patients: Need to look at food consumption not just provision

Elderly orthopaedic rehabilitation patients are potentially at high nutritional risk and thus nutrition provision is a fundamental component of the multidisciplinary care to optimise physical rehabilitation. Hospital food service (catering) is internationally recognised as a key component of good clinical care of patients and has the potential to provide a population approach to managing under-nutrition. Within Scotland, there have been significant developments with regards to food, fluid and nutritional care within clinical settings including the setting of clinical standards. However audits to date have focused on processes being in place and not patient outcomes. Therefore, this study aimed to evaluate food provision and consumption in elderly orthopaedic rehabilitation settings to determine whether nutrition standards are being met. A service evaluation of food provision and consumption to inpatients 65 years and older in post-acute geriatric orthopaedic wards over 24h in National Health Service (NHS) hospitals in Scotland, UK was conducted. Food provision from each meal, in-between meal snacks from the trolley service and also on ward provisions were measured by weighing all items prior to being served to the patient. Any leftover food items were also weighed to allow the amount of food consumed to be determined. Estimated energy and protein contents of foods provided and consumed were compared against nutrient standards for hospital foods. Food provision to n=175 patients, across seven wards and three hospitals was significantly less than standards set for energy and protein provision for 'nutritionally well' patients; (Hospital B mean diff - 549 kcals,-19g p<0.01; and Hospital C mean diff-250 kcals,-12g, p<0.001). Patients consumed approximately three quarters (74%) of the food they were provided. Higher provision of both energy and protein was associated with higher levels of consumption (r=0.77 and r=0.79, p<0.001), respectively. Significant work has been undertaken to improve the nutritional care of patients in hospitals. However, at a time where inefficiencies in clinical services must be reduced along side improvements in patient outcomes, there is a need for greater monitoring of patient food intakes to enable improvements in food production and food service systems to this end.

A study of fluid provision and consumption in elderly patients in a long-stay rehabilitation hospital.

Adequate hydration is key to good clinical care and essential for preventing problems in elderly patients such as constipation, pressure sores and confusion. The present study aimed to evaluate fluid provision and consumption in elderly patients against current standards for Scottish hospitals. A service evaluation, of fluid provision and consumption over 24 h by elderly orthopaedic rehabilitation patients in a long-stay hospital in Scotland was conducted. Fluids provided and consumed from trolley services, those at meal times and beverages from jugs of water were measured. The average fluid content of a jug, cup and glass on each ward was determined. Each jug of water provided was recorded, as was the acceptance of hot and cold drinks offered. Intake was determined by measuring the leftover water in each jug when these were refreshed and any leftover liquid in patients' cups deducted from that provided. Observations were made with respect to the presentation and encouragement of fluids. Fifty-eight patients (12 males, 46 female, aged ≥65 years) were monitored, of whom 56 were provided with more than the recommended minimum fluid per day [mean (SEM) = 2379 (82) mL]; however, mean intake was lower than recommended [mean (SEM) = 1302 (60) mL; P = 0.002]. Provision of drinks from a trolley service [mean (SEM) = 956 (44) mL] was less than fluid from jugs [mean (SEM) = 1398 (54) mL; P = 0.002]; however, the consumption of drinks from the trolley was greater [77% consumed, mean (SEM) = 770 (46) mL] than from jugs [41% mean (SEM) = 514 (36) mL; P < 0.001]. Patients consumed significantly more fluid from individual beverages than jugs. Consideration of the method of fluid provision is important with respect to influencing fluid intakes.

Patients' perceived involvement in vocationally oriented medical rehabilitation and its associations with satisfaction and motivation to deal with work-related issues during rehabilitation

Little is known about the degree of involvement in treatment-related decision-making experienced by patients in work-related medical rehabilitative programs. It was investigated whether subgroups of patients in vocationally oriented medical rehabilitation (VOMR) can be distinguished regarding their degree of perceived participatory involvement and whether different degrees of perceived involvement during the consultation were associated with the motivation to deal with work-related problems and the satisfaction with treatment decision-making, the doctor-patient interaction and overall treatment. Data from a previous study including 283 orthopaedic rehabilitation patients were re-analysed. Latent class analysis yielded four types of perceived involvement (shared decision-making; patient-centred interaction with vs. without involvement in decision-making; no involvement). Higher involvement was associated with higher satisfaction, but not with the motivation to deal with work-related issues. Perceived involvement can be regarded as a helpful tool in promoting patient-centeredness in work-related medical rehabilitation. The lack of associations with motivation necessitates further research.

Calibration of an item bank for work capacity in cardiological rehabilitation patients

Prevention of work loss is a core objective of cardiovascular rehabilitation. However, comprehensive and economic diagnostic instruments on work limitation are missing. The present study describes the calibration of an item bank for work capacity in cardiovascular rehabilitation patients. This study was based on an item pool (166 items) for assessing work capacity in orthopaedic rehabilitation patients. A total of 349 cardiovascular rehabilitation patients were recruited from 14 German rehabilitation inpatient centres. Exploratory factor analysis was used to determine underlying dimensions of work capacity. Rasch analysis was applied to test for fit of the model, item fit, unidimensionality, particularly local independence and differential item functioning using RUMM2030. Two independent factors (cognitive work capacity/physical work capacity) were found. Fitting of the data to the Rasch model was initially poor (significant item-trait interaction for both factors; p < 0.001). After rescoring disordered categories, excluding misfitting items and items with differential item functioning, 20 and 18 items remained for cognitive work capacity and physical work capacity. Item-trait interaction (cognitive work capacity p = 0.24; physical work capacity p = 0.95) and person separation index (cognitive work capacity = 0.81; physical work capacity = 0.85) were satisfactory. Unidimensionality was given for both factors. The calibrated item bank provides the basis to assess work capacity in cardiovascular rehabilitation patients, fulfilling high psychometric standards. Further, the item bank could be either used to develop a computer adaptive test or an economic short-form questionnaire.

Depressive symptoms interfere with post-rehabilitation exercise: Outcome expectancies and experience as mediators

The aim of the study was to examine the relationship between depressive symptoms and physical exercise by unveiling how outcome expectancies regarding exercise and positive exercise experience could mediate between depressive symptoms and exercise. A longitudinal study included 178 cardiac and orthopedic rehabilitation patients in Germany. Patients responded to psychometric scales at two points in time with a six-week interval, assessing depressive symptoms (Time 1), outcome expectancies regarding exercise (Time 1), exercise experiences (Time 2), and exercise behavior (Times 1 and 2). Depressive symptoms were negatively related to physical exercise (r =− 0.18), to positive outcome expectancies (r =− 0.23), and to positive exercise experiences (r =− 0.26). In a multiple-step mediation model, expectancies and experiences mediated between depressive symptoms and exercise. In total, 15% of the exercise variance was accounted for. Outcome expectancies and a lack of positive experience seem to partly explain why depressed individuals are less likely to exercise.

Body composition in older orthopaedic rehabilitation inpatients: Are field methods valid?

AbstractAim: The assessment of body composition is an important aspect of the determination of nutritional health. This cross‐sectional measurement study aimed to assess the relative validity of a range of field techniques for the measurement of body composition in a sample of older orthopaedic inpatients participating in rehabilitation.Methods: Assessment of percent fat‐free mass of 31 adults, aged 65 years and over, was conducted under fasting conditions by two types of bioelectrical impedance analysis (multi‐frequency and single frequency—using manufacturer's pre‐programmed prediction equation) and compared with percent fat‐free mass estimated by dual energy X‐ray absorptiometry, a reference technique. Data from multi‐frequency bioelectrical impedance analysis were also used to calculate percent fat‐free mass from the prediction equation of Dey et al. for comparison. Skeletal muscle mass was derived from assessment of corrected arm muscle area and compared with skeletal muscle mass from dual energy X‐ray absorptiometry analysis. Bland‐Altman analysis was performed to determine the level of agreement between each field technique and dual energy X‐ray absorptiometry.Results: Mean bias and limits of agreement between single frequency bioelectrical impedance analysis and dual energy X‐ray absorptiometry were −5.7% (−24.0, 12.6), between multi‐frequency bioelectrical impedance analysis (manufacturer's pre‐programmed prediction equation) and dual energy X‐ray absorptiometry were 1.4% (−13.4, 16.1), between multi‐frequency bioelectrical impedance analysis (Dey et al. prediction equation) and dual energy X‐ray absorptiometry were −5.0% (−16.6, 6.6) and between skeletal muscle mass as derived from assessment of corrected arm muscle area and skeletal muscle mass from dual energy X‐ray absorptiometry analysis −0.97 kg (−8.37, 6.43).Conclusion: None of the methods assessed are clinically acceptable for assessment of body composition in older orthopaedic rehabilitation patients; however, estimation of skeletal muscle mass, as derived from corrected arm muscle area, is likely to be of more use in the clinical setting as there is no requirement for patients to be fasted.

Physiotherapie/Physikalische Therapie bei tiefer Beinvenenthrombose und Lungenembolie in der orthopädischen Rehabilitation

Hintergrund: In der orthopädischen Rehabilitation werden häufig Patienten behandelt, bei denen eine tiefe Beinvenenthrombose und/oder eine Lungenembolie festgestellt wurde. Es liegt Evidenz dahingehend vor, dass die frühzeitige Mobilisation optimal antikoagulierter Patienten mit tiefer Beinvenenthrombose weder die Häufigkeit des Auftretens noch den Schweregrad von Lungenembolien erhöht. Gleiches gilt für Patienten mit Lungenembolie ohne Rechtsherzbelastungszeichen. Zu der Frage, ob der Einsatz von Physiotherapie – z. B. Krankengymnastik im Bewegungsbad oder Manuelle Lymphdrainage – zu vermehrten oder schwereren Lungenembolien, führt gibt es keine Studien.

Entwicklung eines Fragebogens zur Erfassung des subjektiven Behandlungskonzepts von Rehabilitanden

The purpose of the study was to develop a generic questionnaire for assessing the patients' rehabilitation treatment representations on the theoretical basis of the Common Sense Model of self-regulation and analogous with established assessment instruments for illness representations and medication-related treatment representations. Using theory-based and empirical patient and provider input, a pool of 115 items on the patients' rehabilitation treatment representations was generated. The items were first pre-tested on n=182 rehabilitation patients in nine rehabilitation centres for the indications musculoskeletal diseases and psychosomatic illnesses. The next step was the factor analytical reduction of the item pool. The resulting factors were analyzed for unidimensionality, and the remaining items were analyzed for distribution of values. Internal consistency and the "known groups validity" were used to determine reliability and validity, respectively. Finally, patient acceptance of the questionnaire was assessed. The item pool was considerably reduced by factor analysis and the remaining items were grouped under four factors. After eliminating other single items on the basis of modification indices and indicator reliability, the unidimensionality of these factors was assessed as good. The majority of the remaining 23 items showed an asymmetrical distribution, which was also reflected by low item difficulty. The contents of the scales can be interpreted as "somatic outcome expectation", "psychological outcome expectation", "process expectations", and "concerns". The internal consistency of the scales (Cronbach's alpha) lies between 0.80 and 0.84 for the entire sample. The treatment representations for psychosomatic patients differ in the anticipated direction from those of orthopaedic rehabilitation patients. Patient acceptance of the questionnaire was very positive. The questionnaire developed allows aspects of the patients' rehabilitation treatment representations to be measured, the features of which are highly relevant for providers as a basis for providing individualized patient information. However, the results of the pretest have to be tested confirmatory and also indicate that there is still potential for improving the instrument and making it more precise.

Intervention Effects on Cognitive Antecedents of Physical Exercise: A 1‐Year Follow‐Up Study

We developed and evaluated a theory‐based intervention programme (MoVo‐LISA) that encompasses motivational and volitional strategies aiming to prepare orthopaedic rehabilitation patients to perform physical exercise on a regular basis after discharge. The intervention consists of six units: two group sessions, one one‐to‐one interview, and three after‐care contacts. Two hundred and twenty inactive patients were subsequently assigned to an intervention group (standard care plus MoVo‐LISA) and a control group (standard care). Participants filled out questionnaires assessing cognitive antecedents of physical exercise. Measurement took place before and after rehabilitation, 6 weeks and 6 months after discharge, and 1 year after discharge. A 2 × 5 repeated measurement design was applied. Results revealed significant main and interaction effects with regard to cognitive variables; the intervention group reported enhanced self‐efficacy and more positive balance of outcome expectations at 6 months as well as stronger goal intentions, more elaborated implementation intentions, and optimised strategies of intention shielding at 12 months after discharge compared to patients of the control group. Our findings demonstrate that a short and inexpensive cognitive‐behavioural training programme is an effective tool to enable rehabilitation patients to follow treatment recommendations after discharge. The standardised intervention can be conducted by personnel other than psychologists.

Schmerzempfinden und -verhalten während der orthopädischen Rehabilitation

Problems concerning the sustainability of medical rehabilitation are well known. Persistent avoidance behavior might be a potential cause. The present study is designed to determine the relationship between pain and pain-related behavior (resignation, distraction, avoidance) during the rehabilitation process. In addition, the impact of gender, age, level of chronicity, and location of ailments are investigated. Pain (German pain perception scale, SES) and pain-related behavior (German pain control questionnaire, FSR) were measured in 309 orthopedic rehabilitation patients. Affective pain, resignation and distraction are more pronounced in women than in men. Participants with highly increased levels of chronicity have more affective and sensory pain and higher values of avoidance and resignation. During the rehabilitation process, there was a decrease in affective pain, sensory pain and resignation. The difference values correlate significantly. Rehabilitation is effective for pain reduction. However, only limited changes in pain-related behavior were detected.

Gestandaardiseerde patiënten follow-up

Over the years an increasing number of orthopaedic rehabilitation patients were admitted to nursing home de Riethorst in Geertruidenberg (the Netherlands). For efficiency reasons we developed a standardised rehabilitation follow-up plan for orthopaedic inpatients, which is presented in this article. De laatste jaren is het aantal orthopedische revalidanten dat opgenomen werd in verpleeghuis de Riethorst te Geertruidenberg fors toegenomen. Om het revalidatieproces zo doelmatig te kunnen volgen, werd voor de orthopedische revalidanten een gestandaardiseerd follow-up plan ontwikkeld. Trefwoorden Orthopedie, revalidant, gestandaardiseerd follow-up plan

Behavioral Intentions and Action Plans Promote Physical Exercise: A Longitudinal Study with Orthopedic Rehabilitation Patients

Patients in rehabilitation settings often face difficulties in complying with physical exercise regimens. To examine social-cognitive determinants in the adoption and maintenance of exercise, a study with four points in time was launched, scrutinizing beliefs and behaviors of 509 orthopedic patients. Although exercise levels increased over time, a sizable number of patients remained inactive. Perceived self-efficacy and outcome expectancies predicted levels of intention and action plans. The latter two in turn were proximal predictors of subsequent exercise. In light of the findings, it is argued that planning helps to bridge the intention-behavior gap. Planning is an alterable variable and is therefore suitable for effective intervention.

Recognition of psychiatric disorders in musculoskeletal and cardiovascular rehabilitation patients

Härter M, Woll S, Reuter K, Wunsch A, Bengel J. Recognition of psychiatric disorders in musculoskeletal and cardiovascular rehabilitation patients. Arch Phys Med Rehabil 2004;85:1192–7. Objective To investigate the detection rate of psychiatric disorders in rehabilitation inpatients with musculoskeletal and cardiovascular diseases (CVDs). Design Cross-sectional survey; analysis of medical charts and discharge reports, combined with standardized diagnostic interviews. Setting Four orthopedic and 6 cardiovascular rehabilitation hospitals in southwest Germany. Participants More than 1700 inpatients with different musculoskeletal disorders and CVDs participated in the survey. On the basis of their General Health Questionnaire score, 205 patients with musculoskeletal diseases and 164 patients with CVDs were selected randomly for standardized interviews. Discharge reports of interviewed patients were analyzed. Interventions Not applicable. Main outcome measures Clinical interview (Composite International Diagnostic Interview [CIDI]) to obtain diagnoses of psychiatric disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Assessment of psychosocial burden and diagnoses of mental disorders, as well as admission to psychologic treatments, based on discharge reports of the attending physicians. Results The detection rate (sensitivity) of mental disorders was 48% in the orthopedic rehabilitation patients and 32% in the cardiovascular patients. Specificity was 80% in musculoskeletal patients and 87% in cardiovascular patients. Differential diagnostic competencies were lacking, and only half of the physicians’ diagnoses corresponded to the CIDI diagnoses. Conclusions The results showed a need for current DSM-IV or International Classification of Diseases, 10th edition, psychodiagnostics in medical rehabilitation to detect mental disorders in patients in the rehabilitation process at an earlier stage and to refer patients with comorbid mental disorders to adequate treatment.