Rehabilitation In Germany Research Articles

Pulmonary rehabilitation in follow-up and inpatient rehabilitation for Long COVID: twelve months of follow-up.

Individuals with persistent impairments due to Coronavirus disease 2019 (COVID-19) can receive pulmonary rehabilitation in Germany. To date, there is no evidence of the medium- or long-term effects of pulmonary rehabilitation on Long COVID. This study examined changes in health and occupational outcomes over time and described the therapeutic content of pulmonary rehabilitation and aftercare. This analysis also compared two rehabilitation groups after COVID-19 who had different levels of access to rehabilitation. Longitudinal observational study with multicenter and prospective data collection. Pulmonary rehabilitation in four different rehabilitation facilities in Germany. Individuals with a mild course of disease and long-lasting impairments (inpatient rehabilitation, IR) and patients with a severe course after hospitalization (follow-up rehabilitation, FuR). Participants had to be between 18 and 65 years of age. Written questionnaires were administered at the beginning and end of rehabilitation, as well as six and twelve months after rehabilitation. Health-related quality of life (HrQoL), fatigue, participation restrictions, COVID-19 symptoms, mental and physical health were assessed, as well as occupational outcomes and questions about rehabilitation and aftercare. IR patients were predominantly female (68.0%) and 52 years of age on average, while 66.1% of Long COVID rehabilitees in FuR were male and three years older. Over the course of rehabilitation, most COVID-19 symptoms decreased with statistical significance. The subjective health scales showed improvements with medium to large effect sizes (ES) over time in IR (P<0.01; ES between 0.55 (cognitive fatigue) and 1.40 (physical fatigue)) and small to large effects in FuR (P<0.01; ES between 0.45 (anxiety) and 1.32 (physical fatigue)). One year after rehabilitation, most effects remained at a moderate level. After twelve months, an increase in neurocognitive symptoms was observed in FuR patients. More than 80% of employed people returned to work one year after rehabilitation, although FuR patients returned to work a median of four weeks later (P<0.01). The comparative analysis showed that rehabilitees in different forms of rehabilitation attended rehabilitation with different impairments and rehabilitation goals, which are partly considered in treatment and aftercare. To provide needs-based rehabilitation to different rehabilitation groups with Long COVID, knowledge of their health histories and preferences is necessary.

Sequences of vocational rehabilitation services in Germany: a cohort study

BackgroundThis study aimed to describe sequences of vocational rehabilitation services among individuals with approved vocational rehabilitation in Germany and to identify typical service sequences.MethodsWe used administrative data on vocational rehabilitation services and questionnaire data on health and work ability to describe frequencies and sequences of vocational rehabilitation services financed by the Federal German Pension Insurance. Through sequence analysis, we were able to map the service sequences. We did cluster analyses to identify typical different service sequences.ResultsOur sample included 1,652 individuals with 2,584 services. Integration services and two-year vocational retraining were the most common services. We could identify three different service clusters around integration services: shorter ones, followed by employer benefits and without employer benefits. We found two different clusters around two-year vocational retraining: shorter and longer clusters. Two-year vocational retraining was more often initiated by preparatory services and followed by employer benefits than integration services. Longer services in both clusters were associated with better baseline data for physical health, work ability, risk of future work disability, and younger age than shorter services. People in two-year-vocational retraining reported at baseline better general health, better work ability, low risk of future work disability, and less mental illness compared to people in integration services.ConclusionsMultiple services, that is, sequences of services, were more likely to occur among individuals with more complex services like two-year vocational retraining. Utilization of complex services and longer services was influenced by health, age, risk of future work disability, and education.Trial registrationGerman Clinical Trials Register DRKS00009910, registration 25/01/2016.

Use and attitudes towards digital technologies in addiction rehabilitation in the SARS-CoV-2 pandemic

Abstract Background Before the start of the pandemic, digital technologies were hardly used in addiction rehabilitation in Germany - also due to the lack of a legal framework. During the SARS-CoV-2 pandemic, the funding agencies enabled their use. The aim of the study is to describe the use of and attitudes towards digital technologies in addiction rehabilitation from the perspective of both clinic management and rehabilitation patients. Methods Clinic management of all 1044 outpatient and inpatient addiction rehabilitation clinics in Germany were asked in summer 2022 to complete an online questionnaire on the use of and attitudes towards digital technologies in addiction treatment. 415 clinics provided answers (response rate 40%). In addition, 460 rehabilitation patients from 34 different clinics were questioned in written form (mean age 46.0 years (SD: 13.3), 73% male; 81% alcohol addiction). Results According to the clinic management, digitally conducted therapies were carried out in individual therapy (inpatient: 22% vs. outpatient 62%), group therapy (4% vs. 37%), family-oriented interventions (55% vs. 51%), and pre-admission interviews (45% vs. 45%). Among the rehabilitation patients, 10% in inpatient and 37% in outpatient rehabilitation stated that they had used digitally conducted therapies. 87% of the clinic management felt that digital therapy offers were useful during the pandemic, and 84% were in favour of using them beyond the pandemic. Among rehabilitation patients, the approval rate was 85% and 59% respectively. Conclusions Digital technologies were used for different therapy services in addiction rehabilitation. The majority of both clinic management and rehabilitation patients were in favour of this, even beyond the pandemic. For further use after the pandemic, the establishment of a legal, financial and organisational framework is required. Non-inferiority studies (comparing digital to face-to-face) could add to the evidence. Key messages • Digital technologies were used for therapeutic purposes (e.g. individual therapy, group therapy, family-oriented interventions) by a large proportion of addiction clinics during the pandemic. • The majority of clinic management and rehabilitation patients are in favour of the use of digital technologies in addiction rehabilitation even beyond the pandemic.

Milieu-specific differences in symptom severity and treatment outcome in psychosomatic rehabilitation in Germany.

Previous studies that focused on socioeconomic differences did not comprehensively explain existing inequalities in psychosomatic rehabilitation in Germany. We applied a social milieu approach, which additionally includes sociocultural factors such as lifestyles, attitudes and values, to investigate differences among patients in symptom severity, psychosocial impairment and improvement over the course of the intervention. As a model for social milieus, the empirical Sinus milieus were used. 2,000 patients of two psychosomatic rehabilitation clinics in Germany were included and their milieu was assessed with the Sinus milieu indicator for Germany 10/2018 questionnaire. BDI-II (N = 1,832) and HEALTH-49 (N = 1,829) questionnaires were used to measure depressiveness and psychosocial impairment at admission (T0) and discharge after 5 weeks of treatment (T1). Milieu differences in severity and improvement were analyzed by mixed-model ANOVAs. Milieu distribution was not representative of the overall population of Germany. We found significant differences between patients from different milieus in both BDI-II and HEALTH-49 (p < 0.001). Patients from the Precarious Milieu had the highest burden of depressive symptoms in BDI-II and the highest impairment on all HEALTH-49 scales at T0 and T1. Over the course of rehabilitation, patients from all milieus improved significantly in all domains (p < 0.001). Significant interaction effects showed milieu-dependent differences in improvement for depressiveness on the BDI-II [F(9, 1822) = 2.50, p = 0.008] and for three HEALTH-49 scales, namely Psychological well-being [F(9, 1819) = 3.30, padj = 0.005], Interactional difficulties [F(9, 1819) = 2.74, padj = 0.036] and Activity and Participation [F(9, 1819) = 4.94, padj < 0.001], while post-hoc tests only revealed two significant group differences for the last scale. In all domains, patients from the Precarious Milieu retained higher symptoms and impairment at T1 than patients from better-off milieus had at T0. Social milieu was associated with symptom severity, treatment access and outcome of psychosomatic rehabilitation patients. Milieu-specific sociocultural habits, psychosocial needs and therapeutic demands may help describe differences and should be considered in therapy planning and implementation, to improve equal access, quality and effectiveness of rehabilitation. Therefore, further research on milieu-specific differences and needs is necessary.

A living lab approach to define patients needs and expectations for eHealth-based cardiac rehabilitation in Germany and Spain: the TIMELY study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020. Background eHealth solutions may be used for personalized care and to provide assistance for disease control to CAD patients over the compendium of the disease. TIMELY is the first artificial intelligence-driven eHealth approach based on cardiac rehabilitation (CR) components connected with internet of things devices. For usability and acceptance of the TIMELY eHealth solution, patients are actively involved in development through a Living Lab approach. Purpose To define patients’ needs for an eHealth-based self-care support CR maintenance program. Methods The Living Lab used a guided survey among CAD patients at CR centers in Germany and Spain during inpatient or outpatient CR, respectively. Questions referred to use of technology and patients’ opinion on usefulness of suggested eHealth features. Importance/usefulness was rated on a 5-point Likert scale (median score). Results 79 CAD patients (20% female) participated (Spain, n=30; Germany, n=49). Patients’ mean age was 57 years (range 37–79), educational level was 87% ≤high school. All patients owned a smartphone also used for information (76%) and documentation (43%). Patients rated the importance of CR components (diet, stress management, regular exercise, risk factor reduction, smoking cessation) along the continuum of care as "very high" (5/5), with no difference between the two centers. Individual support for regular exercise after structured CR was rated "high" (4/5). Renewal of recommended training intensity (heart rate), evaluation of training progress, and suggestions on activities were rated "useful" (4/5) to "very useful" (5/5). The importance of support for stress management, risk factor management, diet, and medication adherence was rated 3/5. Usefulness of an education platform was rated 4/5, motivational messages scored 3/5. Individual feedback by a person was rated over feedback by a virtual agent (4/5 vs. 3/5). The availability of electronic health records was evaluated as "very useful" (5/5) remote blood pressure management and ECG monitoring were rated as "useful" (4/5). All items ranged between 1-5, indicating large interindividual differences. No differences between nationalities were detected for exercise-/medical-related features. For other CR features, overall progression documentation was significantly rated as more useful by German patients compared to Spanish patients (5/5 vs. 4/5, p&amp;lt;0.001) and German patients rated individual feedback of a real person higher than Spanish patients (5/5 vs. 4/5, p=0.005). No differences existed between women and men. Conclusions Patients expressed a strong need for individual support of physical exercise and updated training recommendations during CR maintenance. The observed inter-individual differences regarding usefulness and acceptance indicate the need for an adaptive system to reduce barriers for eHealth access. Patients from Germany and Spain showed equally high acceptance of eHealth components for the management of CAD.

Return to work after medical rehabilitation in Germany: influence of individual factors and regional labour market based on administrative data

BackgroundThe influence of both individual factors and, in particular, the regional labour market on the return to work after medical rehabilitation is to be analyzed based on comprehensive administrative data from the German Pension Insurance and Employment Agencies.MethodFor rehabilitation in 2016, pre- and post-rehabilitation employment was determined from German Pension Insurance data for 305,980 patients in 589 orthopaedic rehabilitation departments and 117,386 patients in 202 psychosomatic rehabilitation departments. Labour market data was linked to the district of residence and categorized into 257 labour market regions. RTW was operationalized as the number of employment days in the calendar year after medical rehabilitation. Predictors are individual data (socio-demographics, rehabilitation biography, employment biography) and contextual data (regional unemployment rate, rehabilitation department level: percentage of patients employed before). The estimation method used was fractional logit regression in a cross-classified multilevel model.ResultsThe effect of the regional unemployment rate on RTW is significant yet small. It is even smaller (orthopaedics) or not significant (psychosomatics) when individual employment biographies (i.e., pre-rehabilitation employment status) are inserted into the model as the most important predictors. The interaction with pre-rehabilitation employment status is not substantial.ConclusionsDatabase and methods are of high quality, however due to the nonexperimental design, omitted variables could lead to bias and limit causal interpretation. The influence of the labour market on RTW is small and proxied to a large extent by individual employment biographies. However, if no (valid) employment biographies are available, the labour market should be included in RTW analyses.

Defining patients needs and expectations for eHealth-based cardiac rehabilitation in Germany and Spain: living lab data from the TIMELY study

Abstract Background eHealth innovations have set the stage to optimize personalized care and provide assistance for disease control to patients with CAD. TIMELY is the first artificial intelligence (AI)-driven eHealth approach that employs internet of things devices and is based on cardiac rehabilitation (CR) components. To guarantee acceptance and usability of eHealth solutions, patients are actively participating in development through a Living Lab approach. Purpose To define patients' needs for an eHealth-based lifestyle intervention and self-care support. Methods The Living Lab approach included a guided survey conducted among CAD patients at CR centers in Germany and Spain during inpatient or outpatient CR, respectively. Questions referred to current use of technology and patients' opinion on the usefulness of suggested features of a future eHealth application. Ratings for usefulness/importance were recorded on a 5-point Likert scale reported as median score. Results 79 patients (20% female) were interviewed (DE, n=49; ES, n=30). Patients' mean age was 57 years (range 37–79), educational level was 87% ≤ high school and 13% &amp;gt; high school. All patients owned a smartphone that they also used for information (76%) and documentation (43%). Patients rated the importance of all CR components (regular exercise, healthy diet, stress management, smoking cessation, risk factor reduction) along the continuum of care as “very high” (5/5). Individual need for regular exercise support after structured CR was rated “high” (4/5). Exercise reminders, suggestions on activities, update of recommended training heart rate, evaluation of training progress, and achieved goals were rated “useful” (4/5) to “very useful” (5/5). The importance of support for diet, stress management, overall risk factor management, and medication was rated 3/5. Usefulness of a learning/education tool was rated 4/5, while motivational messages scored 3/5 and individual feedback of a person or virtual agent scored 4/5 and 3/5, respectively. The availability of electronic health records was evaluated as “very useful” (5/5) remote ECG monitoring and blood pressure management were rated as “useful” (4/5). The range of all items accessed was 1–5, indicating large interindividual differences. No significant differences existed between female and male patients or German and Spanish patients, though the importance of sharing training progress with family/ friends was rated higher by men (3/5) compared to women (1/5) and higher by Spanish (4/5) compared to German patients (2/5). Conclusions CR patients expressed a strong need for individual support of regular physical exercise and updated training recommendations. The observed inter-individual differences regarding usefulness and acceptance indicate the need for a highly adaptive system to prevent exclusion from eHealth access. CR patients from Germany and Spain showed equally high acceptance of eHealth components for the management of CAD. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Commission Horizon 2020

Trauma rehabilitation : Implementation and challenges

The current state of posttraumatic rehabilitation in Germany is on the one hand shaped by the efforts of the primary care providers in the acute setting to transfer patients as soon as possible to rehabilitation in accordance with the requirement for acontinuous chain of rehabilitation. On the other hand, there are still important treatment gaps due to a lack of options, specialized structures and financing. This has the consequence that severely injured patients sometimes experience substantial difficulties, setbacks and delays on their way back to social participation. This article presents the various phases of rehabilitation and the existing challenges in order to guarantee the universally acknowledged demand for acontinuous rehabilitation chain. Reference is made to the missing structures and simultaneously to the necessary continuity of the processes, the quality assurance and the financial prerequisites for new forms of care. This is exemplified by how the continuum of posttraumatic rehabilitation of the German statutory accident insurance with the successful reintegration of trauma victims in work and social life could be amodel for insured persons of the statutory health insurance and the German pension fund. The scientific societies of trauma surgery and rehabilitation medicine also promote the model of a differentiated trauma rehabilitation and sustain the idea of atrauma rehabilitation network to increase the chances of the severely injured for the best possible quality of life and social participation.

Work Participation after Multimodal Rehabilitation due to Diseases of the Digestive System. Representative Analyses using Routine Data of the German Pension Insurance

Diseases of the digestive system such as Crohn's disease (CD) or ulcerative colitis (UC) are associated with problems in occupational participation, but they only make up a very small part of all rehabilitation services provided by the German Pension Insurance. Rehabilitation is a very good treatment option, but its effectiveness is largely unclear. So far, several studies exist on the return to work after medical rehabilitation. However, representative findings and the relevant influencing factors are still lacking. This is the aim of the present analysis. We used the rehabilitation statistics database of the German Pension Insurance. Patients were included with completed medical rehabilitation due to a disease of the digestive system in 2017. The analyses were carried out for the entire group as well as differentiated according to the diagnosis groups CD, UC, diverticular diseases (DI) as well as pancreatic diseases (PA). Occupational participation was operationalised both via a monthly information up to 24 months after rehabilitation and as a rate of all persons who were employed after 12 or 24 months in the survey month and the 3 preceding months. For the analysis of the influencing factors on stable occupational participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. A total of 8,795 data sets were included in the analysis (CD: n=1,779, 20%; UC: n=1,438, 16%; DI: 1,282, 15%; PA: n=761, 9%). The average age in the groups ranged from 44 (CD) to 54 (DI) years; the proportion of women ranged from 28% (PA) to 57% (CD). Between 16% (DI) and 32% (PA) of the rehabilitation participants had sickness absences of 6 or more months in the year before rehabilitation. Two years after rehabilitation, the return-to-work rates were 69% (CD), 71% (UC), 68% (DI) and 58% (PA). The strongest influencing factors on stable occupational participation were time of sick leave and wage before rehabilitations well as work ability at admission. Two years after gastroenterological rehabilitation in Germany, 6 to 7 out of 10 affected persons return to stable work participation. Relevant influencing factors are the time of sick leave and the level of remuneration. The results support an expansion of rehabilitation concept to include work-related aspects.

Impact of the SARS-CoV-2 Pandemic on the Utilization of Cancer Rehabilitation: a Difference-in-Differences Analysis

Restricted access to rehabilitative care due to the SARS-CoV-2 pandemic may affect the participation of cancer survivors and risks progression of the underlying disease. The aim of our analyses was to examined the extent to which cancer rehabilitations in Germany decreased due to the SARS-CoV-2 pandemic. Data were retrieved from the German Pension Insurance which is the main provider for medical rehabilitation in Germany. We used monthly cross-sectional data on the utilization of cancer rehabilitation (Ca-rehab-services according to section 15 for working-aged people or section 31 social security code VI for pensioners) in 2019 and 2020. We used a difference-in-differences model to determine the reduction in rehabilitation utilization attributable to the pandemic and reported incidence rate ratios (IRR). We included 146,924 cancer rehabilitations in 2019 and 113,117 cancer rehabilitations in 2020. Compared to the previous year, the nationwide decline in cancer rehabilitations was greatest in April 2020 (63.2%). Utilization of cancer rehabilitation was reduced by 11.5% for benefits according to section 15 social security code VI (IRR=0.885; 95% CI: 0.864 to 0.906) and by 26.5% for benefits according to section 31 (IRR=0.735; 95% CI: 0.717 to 0.754) due to the pandemic. For pensioners the decline in utilization was more pronounced in Western Germany than in Eastern Germany and greater for non-post-acute rehabilitations than for post-acute rehabilitations. The analyses show a pandemic-related decline in cancer rehabilitations, especially in cancer rehabilitation services for pensioners. Failure to seek medical rehabilitation, through which physical and psychological recovery and relief from disease and treatment side effects can be achieved, will have a lasting impact on the participation for many cancer survivors. Repeated monitoring of work ability and health of chronically ill people could generate necessary data to clarify why people in need of rehabilitation have avoided seeking medical rehabilitation and how they can be supported.

Socio-demographic and socio-economic disparities in medical rehabilitation in Germany in 2019

Abstract Medical rehabilitation is a valuable component to restore physical and mental health, to prevent social isolation and to ensure a return to work. Due to the demographic change and the still increasing number of Post-Covid-19 patients, the demand for rehabilitation is still increasing. Latest, the COVID-19 pandemic elucidated that especially people from lower socio-economic backgrounds are disproportionally affected by health crisis. The aim of this study was to determine the influence of socio-demographic and socio-economic factors on quantitative exercise therapy in medical rehabilitation and to clarify the divergence of existing research findings. In our study we used data from 824.606 rehabilitation cases (German Federal Pension Insurance) and investigated the role of age and gender, marital status, social status and location towards inequalities in access to medical rehabilitation. Multiple linear regression and effect size calculation were used to show associations and to discuss the relation to clinical relevance. We were able to show a highly significant difference (P &amp;lt; 0.001) in access to exercise therapy in our study group. Patients aged 65+, women, single or widowed people, rehabilitants of low socioeconomic status or people located in the new federal states in Germany received shorter and less frequent exercise therapy. There are differences of up to 3.5 hours of treatment duration and 4.25 treatments per week, when disadvantaged social factors accumulate. However, despite the presented differences, the received treatments for the disadvantaged groups are still in the range of suggested minimum therapeutic requirements by the German Federal Pension Insurance. We could show a significant difference in rehabilitative therapy, which is solely based on social factors. There is an urgent need to draw special attention to the here discussed inequalities in access to medical rehabilitation for socially disadvantaged population and the overarching impact on society. Key messages • The social inequality in medical rehabilitation to the detriment of the socially disadvantaged population that we have identified must give rise to clear changes in order to establish social justice. • Equal opportunities and health quality assurance that address the individual needs of each patient should be the focus of socio-medical, policy development.

Defining patients needs and expectations for eHealth-based cardiac rehabilitation in Germany and Spain: living lab data from the TIMELY study

Abstract Background eHealth innovations have set the stage to optimize personalized care and provide assistance for disease control to patients with CAD. TIMELY is the first artificial intelligence (AI)-driven eHealth approach that employs internet of things devices and is based on cardiac rehabilitation (CR) components. To guarantee acceptance and usability of eHealth solutions, patients are actively participating in development through a Living Lab approach. Purpose To define patients' needs for an eHealth-based lifestyle intervention and self-care support. Methods The Living Lab approach included a guided survey conducted among CAD patients at CR centers in Germany and Spain during inpatient or outpatient CR, respectively. Questions referred to current use of technology and patients' opinion on the usefulness of suggested features of a future eHealth application. Ratings for usefulness/importance were recorded on a 5-point Likert scale reported as median score. Results 79 patients (20% female) were interviewed (DE, n=49; ES, n=30). Patients' mean age was 57 years (range 37–79), educational level was 87% ≤ high school and 13% &amp;gt; high school. All patients owned a smartphone that they also used for information (76%) and documentation (43%). Patients rated the importance of all CR components (regular exercise, healthy diet, stress management, smoking cessation, risk factor reduction) along the continuum of care as “very high” (5/5). Individual need for regular exercise support after structured CR was rated “high” (4/5). Exercise reminders, suggestions on activities, update of recommended training heart rate, evaluation of training progress, and achieved goals were rated “useful” (4/5) to “very useful” (5/5). The importance of support for diet, stress management, overall risk factor management, and medication was rated 3/5. Usefulness of a learning/education tool was rated 4/5, while motivational messages scored 3/5 and individual feedback of a person or virtual agent scored 4/5 and 3/5, respectively. The availability of electronic health records was evaluated as “very useful” (5/5) remote ECG monitoring and blood pressure management were rated as “useful” (4/5). The range of all items accessed was 1–5, indicating large interindividual differences. No significant differences existed between female and male patients or German and Spanish patients, though the importance of sharing training progress with family/ friends was rated higher by men (3/5) compared to women (1/5) and higher by Spanish (4/5) compared to German patients (2/5). Conclusions CR patients expressed a strong need for individual support of regular physical exercise and updated training recommendations. The observed inter-individual differences regarding usefulness and acceptance indicate the need for a highly adaptive system to prevent exclusion from eHealth access. CR patients from Germany and Spain showed equally high acceptance of eHealth components for the management of CAD. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Commission Horizon 2020

Tailored GuideLine Implementation in STrokE Rehabilitation (GLISTER) in Germany. Protocol of a Mixed Methods Study Using the Behavior Change Wheel and the Theoretical Domains Framework.

ObjectiveEvidence-based guidelines are important for informing clinical decision-making and improving patient outcomes. There is inconsistent usage of guidelines among physical therapists involved in stroke rehabilitation, suggesting the existence of a gap between theory and practice. Addressing the German guideline “evidence-based rehabilitation of mobility after stroke (ReMoS),” the aims of this project are (1) to describe the current physical therapy practice within the context of stroke rehabilitation in Germany, (2) to evaluate barriers and facilitators of guideline usage, (3) to develop, and (4) to pilot test a theory-based, tailored implementation intervention for the benefit of guideline recommendations.Materials and MethodsThis study uses a stepwise mixed methods approach for implementing a local guideline. A self-reported online questionnaire will be used to survey the current physical therapy practice in stroke rehabilitation. The same survey and systematic-mixed methods review will be used to evaluate the barriers and facilitators of guideline usage quantitatively. Semi-structured interviews will add a qualitative perspective on factors that influence ReMoS guideline implementation. The Behavior Change Wheel and Theoretical Domains Framework will be used to support the development of a tailored implementation intervention which will be pilot tested in a controlled study. Patient and physical therapy-related outcomes, as well as the appropriateness, such as acceptance and feasibility of the tailored implementation intervention, will be analyzed.ConclusionThis will be the first endeavor to implement a guideline in German stroke rehabilitation with a focus on changing care provider behavior based on the knowledge of current practice and determining factors using a tailored and theory-based intervention.

Wie stark hat die COVID-19-Pandemie die kardiologische Rehabilitation im ersten Jahr der Pandemie beeinflusst? Ein Vergleich der Leistungszahlen aus 2019 mit 2020 in Deutschland

IntroductionIn Germany, the COVID-19 pandemic led to substantial changes in outpatient and acute clinical cardiac care and rehabilitation. To estimate the influence of the COVID-19 pandemic on cardiac rehabilitation in 2020, institutional performance was compared to the pre-pandemic year 2019. MethodsThe performance numbers from rehabilitation institutions were compared. These data were provided in 2019 and 2020 as part of an online survey that the German Society for the Prevention and Rehabilitation of Cardiovascular Diseases (DGPR) performs annually. ResultsComplete data for 2019 and 2020 were available from 60 institutions. The overall number of patients treated was reduced by 14.3%, with substantial differences between institutions. Women were more affected (–16.4%) than men (–13.4%) and retirees (–14.5%) significantly more than people still in the workforce (–7.5%). In 25 institutions (42.4%) there was a COVID-19 outbreak resulting in a partial or complete shutdown in 15.7%. In total, 34.5% of the institutions treated patients with COVID-19 infection, 30.5% after such an infection. A large majority of these institutions (72.1%) had to bear the costs for testing suspected cases of SARS-CoV-2-infection alone. ConclusionThe economic and logistic burden of the COVID-19 pandemic has posed a threat to cardiac rehabilitation in Germany.

Barriers to applying for medical rehabilitation: a time-to-event analysis of employees with severe back pain in Germany.

ObjectiveLongitudinal studies on barriers to applying for rehabilitation in Germany are lacking in light of the suspected underutilization of rehabilitation services. The aim of this study was to examine application behaviour in persons with disabling back pain and to identify relevant predictors for making an application.DesignA prospective cohort study with randomized sampling of insurants in the German Pension Insurance, using a questionnaire at baseline and followup with linked administrative data for 1.5 years.Subjects/patientsEmployed persons (age range 45–59 years) with a high degree of limitations due to back pain and a self-reported risk of permanent work disability (not applied for disability pension, no medical rehabilitation within the last 4 years).MethodsMultivariable Cox regression was used to examine the influence of pre-selected variables on making an application in the follow-up period.ResultsOf 690 persons, only 12% applied for rehabilitation. Predictors for making an application were: support from physicians (hazard ratio (HR)=2.24; 95% confidence interval (95% CI) 1.32–3.80), family, and friends (HR=1.67; 95% CI 1.02–2.73), more pain-related disability days (HR=1.02; 95% CI 1.01–1.03), and worse work ability (HR=0.86; 95% CI 0.75–0.97). An intention to apply at baseline mediated the effect of family and physician support on the application.ConclusionThe low number of applications for rehabilitation despite disabling back pain indicates access barriers to, and underuse of, medical rehabilitation.LAY ABSTRACTMedical rehabilitation in Germany aims to enable participation and work ability in persons with chronic conditions, but requires an active decision to apply. This study included 690 persons with severe back pain and followed them for 1.5 years. The aim was to analyse applications for medical rehabilitation in this group and to determine the influencing factors. Only 12% of persons included in the study applied for rehabilitation, mostly after approximately 1 year. Factors making an application more likely were: more disability days and support of the application by their physician, family, and friends. Factors that made an application less likely were: better work ability and being more strained by household chores. The results show that only 1 out of 10 persons in need because of back pain actually end up in rehabilitation, and that possible barriers must be addressed.

Work Participation after Multimodal Rehabilitation due to Neurological Diseases - Representative Analyses Using Routine Data of the German Pension Insurance

There is little representative evidence for the German rehabilitation system on occupational reintegration after medical rehabilitation. For persons who have undergone rehabilitation on behalf of the German Pension Insurance (GPI) due to a neurological disease, it is therefore important to determine (a) what socio-medical risks exist prior to rehabilitation, (b) how well persons were able to participate in working life after rehabilitation, and (c) what conditions determine the work participation. The study is conducted on the basis of the GPI's database of rehabilitation statistics. Included were all persons, who completed medical rehabilitation in 2016 due to a neurological disease. The analyses were carried out for the entire group and also in a differentiated manner for the 2 main diseases, cerebrovascular diseases (CD) and multiple sclerosis (MS). Work participation was operationalized both via a monthly status variable until 24 months after rehabilitation and as a rate of all persons who were employed at the 12 and 24 months follow up and in the 3 months before, respectively. To analyse the factors influencing stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. A total of 42,230 data sets were included in the analysis (CD: n=18,368, 44%; MS: n=6,343, 15%). Patients with neurological diseases were 50 years old on average, 43% were female. We found that approximately15% of patients reported no absenteeism, whereas 17% stated an absence leave of six months or more in the year prior to rehabilitation. Mental and cardiovascular comorbidity was documented in 31 and 44% of the cases respectively. Nearly 48% of patients with CD returned to work two years after rehabilitation. For MS patients, the percentage was slightly higher at 54%. The amount of sick leave of the rehabilitated individual, their gross/net income prior to rehabilitation as well their work capacity prior to admission were the three strongest influencing factors on their return to the labour market. About half of all persons with neurological diseases return to sustainable work after medical rehabilitation in Germany. The amount of sick leave and the income before rehabilitation are determining factors as to whether the person will return to work. The analysis provides representative data on occupational reintegration after medical rehabilitation due to a neurological disease for the first time.

Challenges and Adaptation Strategies of Service Providers of Occupational Rehabilitation in Germany – Results of a Mixed Method Analysis

Challenges and Adaptation Strategies of Service Providers of Occupational Rehabilitation in Germany – Results of a Mixed Method Analysis

Satisfaction of Rehabilitation Patients on Social Media Websites and Online Rating Portals

Patients increasingly express themselves about their medical rehabilitation stay, evaluate health service providers with star ratings, and write reviews on the internet. So far, no results are available regarding online patient satisfaction for inpatient medical rehabilitation in Germany. For the first time, this study conducted a systematic analysis of rehabilitation patient satisfaction on social media websites and hospital rating portals. We collected reviews of medical rehabilitation on the portal Klinikbewertungen.de and the social network Facebook for 8 indication groups (orthopedics, psychosomatics/psychotherapy, oncology, cardiology, neurology, internal medicine, pulmonology/dermatology, gastroenterology) with a full data extraction over 3 survey years (October 2014-September 2017) and for rehabilitation clinics with main bed occupancy of retirement insurance (N=497). The star ratings, aggregated according to indication groups, were evaluated to determine patient satisfaction (Pearson's chi-square test, Fisher's exact test, Phi coefficient). A total of 97.2% of the rehabilitation clinics were represented, with 24,806 ratings on Klinikbewertungen.de. The most frequently evaluated indication groups were orthopedics (38.5%) and psychosomatics/psychotherapy (27.1%). Facebook ratings (N=4,127) were collected for rehabilitation clinics with one department (38.6%) in order to ensure an indication group assignment. Almost the same number of ratings were determined on official (48.7%) and unofficial Facebook pages (51.3%), with no significant correlation between website management and overall satisfaction (p>0.05). On the Facebook pages of the rehabilitation clinics, 49.1% of the ratings were written by women (38.5% by men; 12.4% not assignable). Sociodemographic information on Klinikbewertungen.de was based solely on the status of the insured (89.1% of those with statutory insurance). Overall, 95.4% of the reviews were written by patients and 4.0% by relatives, with 77.5% of patients recommending the clinic to other users (relatives: 37.2%). Most patient ratings were positive. However, there were differences in overall satisfaction between the indication groups. Patients in oncology (77.9%) were more satisfied than those in neurology (59.0%). Online ratings of inpatient medical rehabilitation were collected to a considerable extent. These were mostly positive. The results are comparable to standardized surveys. Despite restrictions in the use of social media data, the results indicated that the publicly available real-time online feedback from patients can provide useful information for the quality management of clinics as well as for patients in exercising their right to choose a rehabilitation clinic.

Treatment Beliefs in Patients with Mental Disorders in Psychosomatic Rehabilitation

Abstract. Background: The efficacy of inpatient psychosomatic rehabilitation in Germany can be considered proven. However, a significant number of patients with mental disorders remain unsatisfied with rehabilitation or being non-responders. Illness beliefs, as the core element of the Common-Sense Model of Self-Regulation (CSM), are widely known as predictors of various health outcomes. Yet, little is known about treatment beliefs as an extension of the CSM and their impact on health outcomes. Aim: As treatment beliefs differ in relation to the treatment, this study aimed to explore rehabilitation-related treatment beliefs in psychosomatic rehabilitation patients with mental disorders before inpatient admission. Thus, knowledge of the concept of rehabilitation-related treatment beliefs will be added. Methods: N = 10 semi-structured telephone interviews were conducted in September/October 2018. A purposive sampling approach was chosen based on the criteria gender, age, and diagnosis. Participants were asked about their rehabilitation expectations starting with an open narrative question. Interviews were analyzed using qualitative content analysis. Results: Participants had a mean age of 48.3 years ( SD = 9.42); five participants were female and five male. 9 main themes with 32 subthemes as components of the rehabilitation-related treatment beliefs were identified: reasons for rehabilitation, conditions within the clinic, rehabilitation planning, organization of the rehabilitation, the content of the rehabilitation, results of the rehabilitation, concerns, expectations toward one’s behavior, and contact to other patients. Limitation: Our sample was too small to analyze the data for different subgroups. Conclusion: Results show that rehabilitation-related treatment beliefs are multidimensional, addressing different aspects of psychosomatic rehabilitation.

Smoking Cessation and Prescription of Ambulatory Exercise Training as Part of Pulmonary Rehabilitation in Germany

This survey was conducted on behalf of the German Respiratory Society (DGP) section 12. The aim was to assess the means of achieving tobacco cessation and prescription of exercise training on an outpatient basis after discharge from pulmonary rehabilitation clinic as part of aftercare of pulmonary rehabilitation programs in Germany. We contacted all pulmonary rehabilitation clinics in Germany. Of the 67 clinics we identified, 62 fulfilled the inclusion criteria; 39 clinics (62.9 %) agreed to participate and returned the completed questionnaires. Each clinic rated ambulatory exercise training sessions as effective aftercare. In each case, slightly above 50 % of the sample informed their patients via standardized talks or information brochures. In 38.5 % of the clinics, ambulatory exercise in groups was provided as aftercare. The number of patients who received prescription for aftercare at the end of the rehabilitation program ranged between 0 % and 100 %. Only a quarter of the clinics had ever been asked by the funding organizations regarding the success rate of the exercise program. All clinics assessed the smoking status of their patients and explained the importance of tobacco abstinence to them. The percentage of smokers was estimated to be 33 %; 69.7 % of the clinics stated that the rehabilitation program included standardized talks regarding tobacco cessation and 61.5 % reported having therapeutic group meetings on a regular basis. Further treatment options included psychological counselling (89.7 %), nicotine replacement therapy (61.5 %), or varenicline (15.4 %). Aftercare was offered only in 10.3 % of the clinics. On average, the percentage of smokers who achieved tobacco abstinence during the rehabilitation program was 32 %. Only one clinic (2.6 %) had ever been asked by the funding organization regarding the success rate of the tobacco cessation program. This survey emphasizes that most of the pulmonary rehabilitation clinics in Germany have already achieved a good standard regarding tobacco cessation and exercise training programs for their inpatients; however, there are still areas of improvement as far as providing care after discharge from a rehabilitation clinic is concerned with regard to smoking cessation and prescription of ambulatory exercise training.