Use In Medical Rehabilitation Research Articles

Analysis of legislative basis for medical rehabilitation in Russia

Background. In recent years, there have been significant changes in the regulatory documentation related to medical rehabilitation, caused by the need to consolidate the principles for rehabilitation of patients in post-COVID period and standardize the procedures used for it. Therefore, it is important to analyze the existing regulatory framework and the proposed changes that will come into force in the near future.Objective: to assess the regulatory legal acts governing the provision of medical rehabilitation in Russia.Material and methods. Regulatory legal acts and their drafts were obtained through the reference and legal systems “Kontur Standard”, “ConsultantPlus”, and the Federal Portal of Draft Regulatory Legal Acts. The following electronic libraries, databases and other sources were used to collect secondary information: eLibrary, Google Scholar, PubMed/MEDLINE, Yandex and social networks.Results. Article 41 of the Constitution of the Russian Federation guarantees the right to health protection and medical care. Within the latter the use of medical rehabilitation can be considered. Going down to the next level, the term “medical rehabilitation” is found in Federal Law dated November 27, 2011 No. 323-FZ “On the fundamentals of health protection of citizens in the Russian Federation”. However, the requirements in the field under consideration are specifically described in Orders of the Ministry of Health of Russia No. 788n and 878n, which establish a three-stage provision of medical rehabilitation and give specific time instructions for the frequency and duration of care prcedures. The conditions for the transition of patients between the stages of medical rehabilitation are presented, and creating interdisciplinary rehabilitation teams is specified.Conclusion. The analysis of innovations in the regulatory framework showed no fundamental changes in the regulation of medical rehabilitation. At the moment, there is a need to expand it by regulating the activities of multidisciplinary rehabilitation teams. A more detailed elaboration of normative documentation regulating the provision of medical rehabilitation to children is necessary.

Magnetic therapy as an effective technology for medical rehabilitation

Objective. Provide a scientific overview of world research works on the study of the influence of magnetic fields on the human body under various pathological conditions. Materials and methods. The literature review was conducted using the PubMed, Medline, Google Scholar, and Elsevier databases over the past 14 years (2010–2024); only full-text articles were included in the review. Key words used to conduct the search: “Magnetic therapy”, “Magnetic therapy pain”, “Magnetic stimulation”, “Pulsed magnetic therapy”. The criteria for inclusion of articles in the review were: year of publication of the scientific work from 2010 to 2024, full-text articles, papers, systematic reviews, meta-analyses and experimental studies. Exclusion criteria: coincidence of identical works in different databases. Results. This review combines data from 9 modern systematic reviews and meta-analyses for 2010-2024, which consider the use of magnetic fields in clinical practice and 4 experimental studies studying the mechanisms of action of magnetic fields on tissues and metabolic regulatory systems. Conclusion. Based on the results of the analysis of the data obtained, the role of the most significant techniques that are appropriate for use in medical rehabilitation and have a wide range of prescriptions was determined.

- Penerapan Sanksi Rehabilitasi Terhadap Pelaku Tindak Pidana Penyalahgunaan Narkotika Golongan I (Putusan Nomor 1016/Pid.Sus/2022/PN.Jkt.Brt)

Narcotics abusers are said to be victims of narcotics crimes and are placed into rehabilitation, but based on Decision No. 1016/Pid.Sus/2022/PN.Jkt.Brt. the defendant has been proven and determined as a narcotics abuser based on the results of the assessment and evidence which leads to rehabilitation. The formulation of the problem in this article is how the application of rehabilitation sanctions to the perpetrators of class I narcotics abuse in Decision No.1016/Pid.Sus/2022/PN.Jkt.Brt., and the obstacles and efforts in applying rehabilitation sanctions to perpetrators of class I narcotics abuse. This article uses normative juridical research methods, descriptive research nature, data used Secondary data and primary data, data collection using literature study, data analysis using qualitative, drawing conclusions using the deductive method. In the results of this study, Law Number 35 of 2009 concerning Narcotics has regulated the mandatory use of medical rehabilitation, but in practice it does not run according to the Law. The conclusion is that the implementation of rehabilitation for addicts and victims of narcotics abuse by the National Narcotics Board has followed the existing provisions. However, the possibility of shortcomings in the application of these rules remains open

Increasing the use of medical rehabilitation by children and adolescents with migrant background through a multimodal information campaign: protocol of a trend study and accompanying process evaluation (MiMi-Reha-Kids, DRKS00019090).

Chronic illnesses can have an unfavorable impact on the participation opportunities of children and adolescents. The German health care system offers medical rehabilitation in order to prevent negative effects, however, migrant children and adolescents make use of this option less frequently than their peers without a migrant background. A multimodal information campaign was developed to increase the use of medical rehabilitation by children and adolescents with a migrant background, and to reduce disparities in health care. The process evaluation will examine the implementation of a multimodal information campaign intended to increase the use of medical rehabilitation by migrant children and adolescents. The information campaign follows a low-threshold participatory approach. In a first step, persons from different migrant communities in Berlin and Hamburg are trained to become transcultural health mediators. These mediators then share their knowledge about chronic illnesses and medical rehabilitation with other families at information events held in their native language. The transcultural mediators also support migrant families in applying for medical rehabilitation. The effectiveness of the intervention will be tested by a trend study with repeated cross-sectional surveys. For this purpose, all families in the project regions of Berlin and Hamburg whose child has received medical rehabilitation are surveyed annually in order to be able to map changes in the proportions of children and adolescents with a migrant background over the course of the project. The study protocol describes a complex intervention to increase the use of medical rehabilitation by migrant children and adolescents, and the accompanying process evaluation and trend study. The intervention is intended to contribute to reducing health inequalities in Germany. The study described in this protocol will provide extensive data on the multimodal information campaign and can thus help organizations and institutions adapt or further develop similar measures for other regions. German Clinical Trials Register (DRKS00019090).

Method for correcting somatic dysfunctions

The development of methods for timely and effective correction of the body somatic dysfunctions is currently one of the urgent tasks of medicine. The article, presented in the form of a lecture, summarizes the results of previous studies of the human connective tissue adaptive reactions to external influences. There are considered histological and biochemical mechanisms of formation of structural and functional adaptation of connective tissue, main cells and intercellular matrix, underlying in particular in the formation of somatic dysfunction. Markers of venous circulatory disorders in the form of hypercapnia, a marker of arterial circulation in the form of hypoxia and a marker of functional disorders of innervation and mobility in the form of compression were selected as environmental factors in the study. As an example, based on the laboratory studies results, a method of somatic dysfunctions correction is proposed. It includes a certain order of osteopathic, manual actions on the body or body parts aimed at eliminating the effects of compression, hypercapnia (excess carbon dioxide) and hypoxia (oxygen deficiency). Also the justification of this method use in medical rehabilitation is proposed.

Application of Physical Factors at the First Stage of Medical Rehabilitation after Radical Surgical Treatment of Breast Cancer

There are a large number of publications confirming the clinical safety of the of physiotherapy application in patients with malignant neoplasms of the breast, but scientific studies on the physical factors complex use in medical rehabilitation of this group of patients in the early postoperative period have not been published yet. Aim. To determine the effectiveness of fluctuating currents in combination with pneumocompression, general magnetotherapy, local magnetotherapy, low-temperature argon plasma applied for patients after radical surgical treatment of breast cancer in the early postoperative period. Material and methods. A prospective, simple, randomized study involving 190 women diagnosed with breast cancer in the early postoperative period after radical Madden mastectomy or radical breast resection (2–4 days) was performed, the average age was 58±10.61 years. The control group consisted of patients included in the course of rehabilitation (exercise therapy, balance therapy and classes with a medical psychologist) fluctuating currents. Low-temperature argon plasma, intermittent pneumocompression, general and local magnetotherapy were added to fluctuations for patients in the main groups. Results and discussion. The analysis of the clinical and functional data showed that in the early postoperative period for breast cancer against the background of the standard drug therapy and the course of medical rehabilitation, the combination of fluctuating currents with intermittent pneumocompression, general and local magnetotherapy significantly reduced the degree of the upper limb edema and the volume of lymphorrhea. The addition of general and local magnetotherapy affects the decrease in the indicators of the shoulder girdle and forearm muscles electrical excitability. Low temperature argon plasma improves the regeneration of the postoperative suture and reduces swelling and inflammation in this area. The dynamics of the decrease in the level of anxiety and depression, pain syndrome and the general condition of cancer patients are most pronounced in the groups that additionally received magnetotherapy. The volume and quality of movements, muscle strength significantly increased in all groups without differences in results. The action of magnetic fields contributes to the increase of tissue oxygenation, due to which an anti-inflammatory and decongestant effect is realized. Fluctuation of the shoulder girdle and forearm muscles leads to normalization of the functional electrical excitability of the muscles by surgical treatment, which allows to restore the motor stereotype of the limb in a short time, and intermittent pneumocompression affecting the skin and tissue structures of the lower extremities and trunk improves the overall lymph flow, which does not lead to stagnation of lymph in the operated area. Conclusion. Thus, the combined application of physical factors against the background of the standard drug therapy and the course of medical rehabilitation significantly improves the result and recovery time after surgical treatment of the breast cancer in the early postoperative period. A comprehensive approach to medical rehabilitation at the I stage led to the preservation of results in the long-term period 1.5 and 6 months after the operation without adverse events.

Applying the International Classification of Functioning, Disability and Health in establishing a rehabilitation diagnosis for patients with juvenile myoclonic epilepsy

The International Classification of Functioning, Disability and Health (ICF) is a globally recognized classification for health components and health-related factors, which has been recommended by the World Health Organization for use in medical rehabilitation. In the practice of a rehabilitation doctor dealing with patients suffering from juvenile myoclonic epilepsy (JME), the ICF is used to establish a rehabilitation diagnosis and formulate the goal of rehabilitation, as well as to implement its basic principles. It provides better insight into a range of difficulties patients with JME might face at the level of personal health and in everyday life.

Nonpharmacological interventions in patients with cognitive impairment: a comparison of residential and nursing homes in Poland.

Availability of nonpharmacological interventions to manage neuropsychiatric symptoms is important to reduce the use of psychotropic drugs in residents with dementia in long‑term care facilities (LTCFs). We aimed to assess prevalence of nonpharmacological interventions in residents with cognitive impairment in LTCFs, and to find factors associated with their participation in cognitive therapy (CT). A cross‑sectional analysis of a country‑representative sample of 23 LTCFs in Poland was conducted between 2015 and 2016. We used the InterRAI‑LTCF tool to collect data from 455 residents with cognitive impairment. Most of the residents were involved in occupational therapy activities (73.4%) and medical rehabilitation (67.2%); however, less than half participated in CT (44.8%) and physical activity group (41.2%), and only 24.2% of individuals received psychological therapy (PT) and only 22.7% of residents were encouraged to enhance their ability with activities of daily living (ADL). We found a positive correlation between participation in enhancing ADL and CT (rho = 0.677; P <0.001), and a considerable variation between the LTCFs in prevalence of PT, CT, and encouraging maintaining ADL. The chance of participating in CT was higher in women (odds ratio [OR], 1.87; 95% CI, 1.15-3.04), residents of nursing homes (OR, 2.79; 95% CI, 1.69-4.60), of larger facilities (OR, 4.09; 95% CI, 2.45-6.81), and among residents having moderate cognitive impairment (OR, 2.27; 95% CI, 1.27-4.08), delusion (OR, 2.31; 95% CI, 1.34-3.98), diagnosis of depression (OR, 5.07; 95% CI, 2.31-11.14), or Alzheimer disease accompanied by behavioral disorders (OR for interaction, 5.25; 95% CI, 1.28-21.58). We found a relatively high use of medical rehabilitation and occupational therapy and significant diversity between facilities in use of CT, PT, and maintaining/enhancing ADL.

Inanspruchnahme medizinischer Rehabilitation und Zugangsbarrieren bei Personen mit Migrationshintergrund – Ergebnisse der lidA-Kohortenstudie

Rehabilitation services are considerably less used by persons with a migration background of working age in Germany than by persons without migration background. One reason could be access barriers. They can arise both from the structures of the health/rehabilitation system as well as from influences of the personal environment, e. g. financial burdens incurred through the use of rehabilitation or cultural expectations. In addition to the migration status, other factors such as country of origin, reasons for immigration, length of stay as well as the religious affiliation and social status could influence the utilization of medical rehabilitation. It was examined to what extent differences in utilisation are due to the migration background and to migration-independent personal barriers to access. The lidA-study is a nationwide, representative prospective cohort study among employees with insurable employment born in 1959 and 1965 with a focus on work, age, health and employment. Data from the first (2011) and the second wave (2014) were combined for the analyses. In addition to bivariate analyses to describe the sample according to migration status, logistic regression analyses were carried out to estimate the odds ratios for the influence of migration background or nationality and other factors on the use of a medical rehabilitation measure. The chance of receiving medical rehabilitation is increased for migrants of the 1st generation (odds ratio (OR) 1.56, 95% confidence interval (CI): 1.09-2.25). If predominantly or exclusively no German is spoken at home, this could be associated with a comparatively much lower chance of utilisation (OR: 0.56, 95% CI: 0.28-1.15). Because only nationality is often available in routine data to determine the status of migration, another model only considers migrants and 2nd generation nationals and examines the influence of nationality on utilisation. A foreign nationality was not associated with a higher utilisation (OR: 1.07, 95% CI: 0.55-2.08). Results of previous studies on the use of medical rehabilitation for people with a migration background are inconsistent. This could be due to different examined population groups, different indications for rehabilitation, a temporal change in utilisation and the various study designs as well as data sources. We found a higher use of medical rehabilitation services by persons with a migrant background (1st generation) compared to non-migrant persons. One reason could be our more precise definition of the migration background compared to analyses of routine data. If predominantly or exclusively another language than German is spoken at home, the utilisation tends to be lower. The finding coincides with a lack of German language skills described as an access barrier in the literature.

Rehabilitation access and effectiveness for persons with back pain: the protocol of a cohort study (REHAB-BP, DRKS00011554)

BackgroundBack pain is one of the most common chronic diseases in Germany and has a major impact on work ability and social participation. The German Pension Insurance (GPI) is the main provider of medical rehabilitation to improve work ability and prevent disability pensions in Germany. However, over half of the persons granted a disability pension have never used a medical rehabilitation service. Furthermore, evidence on the effects of medical rehabilitation in Germany is inconclusive. Consequently, this study has two aims: first, to determine barriers to using rehabilitation services, and second, to examine the effectiveness of medical rehabilitation in German residents with chronic back pain.MethodsIn 2017 a postal questionnaire will be sent to 45,000 persons aged 45 to 59 years whose pension insurance contributions are managed by the GPI North or the GPI Central Germany. In 2019 respondents who report back pain in the first survey (n = 5760 expected) will be sent a second questionnaire. Individuals will be eligible for the first survey if they are employed, have neither used nor applied for a rehabilitation programme during the last 4 years and neither received nor applied for a disability pension. The sample will be drawn randomly from the registers of the GPI North (n = 22,500) and the GPI Central Germany (n = 22,500) and stratified by sex and duration of sickness absence benefits. Barriers to rehabilitation services will be related to socio-demographic and social characteristics, pain and attitudes to pain, health and health behaviour, healthcare utilisation, experiences and cognitions about rehabilitation services and job conditions. Propensity score matched analyses will be used to examine the effectiveness of rehabilitation services. Data on use of medical rehabilitation will be extracted from administrative records. The primary outcome is pain disability. Secondary outcomes are pain intensity and days of disability, pain self-efficacy, fear avoidance beliefs, self-rated health, depression, healthcare utilisation, self-rated work ability and subjective prognosis of employability, sickness absence benefits, and disability pensions.DiscussionThis study identifies barriers to use of rehabilitation services and determines the effectiveness of medical rehabilitation for patients with chronic back pain.Trial registrationGerman Clinical Trials Register (DRKS00011554, January 26, 2017).

Development and validation of the Diabetes Knowledge Assessment Test for use in medical rehabilitation

Purpose: To develop and validate the Diabetes Knowledge Assessment Test (DKAT), an assessment designed to measure diabetes knowledge of medical rehabilitation patients with or without diabetes. Methods: Content validity methods were used to develop the DKAT, which was administered to rehabilitation patients to examine psychometric properties. Results: Subjects were 75 inpatients (56% with diabetes; 45% male), and 75 outpatients (49% with diabetes; 69% male). The initial DKAT consisted of 49 items, which was reduced to 32 items based on psychometric criteria. Point-biserial item discrimination indices ranged from 0.26 to 0.61. Item difficulty indices ranged from 27 to 96%. Cronbach’s alpha was 0.82. Known groups construct validity comparisons revealed that patients with diabetes obtained significantly higher DKAT scores than patients without diabetes (p = 0.01), supporting construct validity. Scores did not differ significantly by gender, educational attainment, age, or outpatient versus inpatient (all p > 0.05), further supporting construct validity. Confirmatory factor analysis identified two factors: “Complications” and “Risks-Symptoms-Management”. Conclusions: Findings support claims that DKAT scores are valid and reliable for diabetes knowledge assessment across a range of rehabilitation conditions. It is appropriate for use with persons with or without diabetes engaging in rehabilitation services as an inpatient or outpatient.Implications for RehabilitationMedical rehabilitation patients represent an important population in which to assess core diabetes knowledge due to the extremely high prevalence of diabetes.We were unable to identify instruments with validity evidence aimed at assessing diabetes knowledge in rehabilitation populations, therefore undertook development of the DKAT.The DKAT represents a psychometrically promising assessment that can inform individuals at risk with the signs and symptoms of diabetes, as well as behavioral actions to reduce risk.The DKAT can also be used to identify those with a diagnosis of diabetes in need of formal diabetes education.

Научное обоснование использования средств медицинской реабилитации и ботулинотерапии на этапе восстановительного лечения постинсультной спастичности

Among the factors contributing to disability after stroke is the most important movement disorder, major clinical manifestation of which is the central spastic paresis. Spasticity is revealed in the study of passive movements of the limbs as increased resistance to muscle in response to its rapid stretching. Once developed spastic paresis usually persists throughout the life of the patient. The treatment of spastic paresis is intractable problem. In recent years the treatment of post-stroke spasticity started using botulinum toxin type A. In comparison with the existing methods of treating muscle hyper local administration of botulinum toxin has a number of obvious advantages. According to the latest recommendations in all cases after botulinum therapy require active physical therapy and physical rehabilitation. Botulinum therapy is not a substitute for physical therapy and exercise therapy, which is the basis of the rehabilitation program and is an integrated part of a comprehensive treatment to improve motor functions. Using a special additional treatment measures such as physical therapy and exercise therapy is often part of the overall treatment but their formal evaluation was carried out in only a few studies. The article presents the author&amp;#180;s concept of rehabilitation post-stroke spastic muscle hypertonus in neuro-rehabilitation with the use of medical rehabilitation and botulinum therapy.

Entwicklung und kurzfristige Effektivität eines standardisierten Schulungsprogramms für die Rehabilitation bei koronarer Herzkrankheit

Patient education is an essential part in the treatment of coronary heart disease in medical rehabilitation. In the German-speaking area, no standardized and evaluated patient education program for coronary heart disease is available so far. In this paper, we demonstrate the development of a quality assured patient education program based on a health-education program of the German statutory pension insurance scheme. In a multi-level approach, an existing program was modified concerning treatment evidence, practical guidelines, theories of health and illness behavior and quality criteria for patient education as well as clinical experience and thereafter manualized. In a formative evaluation, feasibility and patient acceptance of this modified program were assessed using evaluation questionnaires of patients and trainers. Afterwards, effects of the patient education program as compared to a traditional education program were assessed on a short-term (at discharge), medium-term (6-month follow-up) and long-term (12-month follow-up) basis in a multicenter quasi-experimental control group study of patients with coronary heart disease (n=434). Results of the formative evaluation demonstrate an overall good acceptance and a good feasibility of the manualized program. Short-term results show a significant small treatment effect in the primary outcome variable patients' knowledge (p=0.001, η2 =0.028). Furthermore, small effects were also observed among some secondary outcomes, such as attitude towards medication, planning of physical activity, psychological quality of life and satisfaction with the education program. A standardized education program for patients with coronary heart disease has been developed in a systematic process based on established quality standards. Depending on the outstanding medium and long-term effects, the program may be recommended for general use in medical rehabilitation. The manual provides the prerequisites allowing for a successful transfer into clinical practice.

Rehabilitationserfolg bei Menschen mit türkischem Migrationshintergrund – Eine Auswertung von Routinedaten der Deutschen Rentenversicherungen Rheinland und Westfalen

Approximately 3 million Turkish immigrants are living in Germany, in North Rhine-Westfalia their share amounts to 4.7%. They use the same rehabilitation services as Germans, but their treatment usually shows less positive results - as other studies have shown. The aims of the research project "Immigration and Health Inequalities in Rehabilitation" were (a) to quantify the use of medical rehabilitation by Turkish immigrants in different diagnosis groups, (b) to compare outcomes in different diagnosis groups and (c) to find out whether the results will be explained by immigrant status, or by socio-economic factors accompanying immigrant status. An analysis of routine data from Deutsche Rentenversicherung Rheinland and Deutsche Rentenversicherung Westfalen (Rhineland and Westfalia Pension Insurances) was carried out, pertaining to 363 855 persons who had participated in at least one rehabilitation procedure between 2000 and 2006. 4.8% of all rehabilitees were identified as being of Turkish origin. A modified name-based algorithm was used to help to identify Turkish rehabilitees. The outcome of rehabilitation was measured by comparing the medical discharge assessments. Turkish people were in need of rehabilitation more often because of mental disorders/behavioural disturbances (Turkish men=22.0% vs. non-Turkish men=18.4% [p<0.001]; Turkish women=30.8% vs. non-Turkish women=21.6% [p<0.001]) and less often because of neoplasms (Turkish men=4.7% vs. non-Turkish men =7.8% [p<0.001]; Turkish women=6.4% vs. non-Turkish women=13.9% [p<0.001]). Concerning treatment results in several diagnosis groups Turkish rehabilitees benefitted less from treatment than non-Turkish rehabilitees did (musculoskeletal disorders: OR=2.08 [95%-CI=1.97-2.20]; mental disorders/behavioural disturbances: OR=1.70 [95%-CI=1.57-1.84]; respiratory diseases: OR=1.41 [95%-CI=1.14-1.75]; digestive disorders/metabolic diseases: OR=1.36 [95%-CI=1.11-1.66]). Non-Turkish rehabilitees had higher chances of success, even adjusted by social and performance-related factors. The differences were non-significant only in cardio-vascular disease and neoplasm treatment. Rehabilitation outcomes are significantly less favourable for Turkish people. The differences found can partially be traced to factors related to their migration background and not only to other social differences or performance-related factors of the health services. Immigrant status, hence, affects rehabilitation outcome and must receive attention in both rehabilitation plans and rehabilitation facilities.

Die Teilnehmerstruktur medizinischer Rehabilitationsmaßnahmen in Deutschland

Because of the diversity of institutions funding rehabilitative measures and the lack of a shared data base, little is known so far about how many people in all and what kind of people make use of medical rehabilitation. Starting out from this dilemma, the rehabilitant population of 2004 was described in greater detail with the help of the population-representative and not institution-oriented German Socio-Economic Panel (SOEP) and by means of health variables (subjective health, severe disability, periods of disability, health care utilisation) as well as of socio-demographic characteristics (sex, age, social status, region). In addition, the influence of these variables on the chances of taking part in rehabilitation was evaluated. In 2004, 4% of the respondents took part in rehabilitative measures, with women having a lower chance of participating as men have. A bivariate distinct age gradient leveled under multifactorial analysis. The strongest predictors, in contrast, were found to be subjective health, amount of visits to doctors' offices as well as hospitalizations. Contrary to our expectations, an influence of the social stratum could not be found. The analysis in addition shows a higher utilization of rehabilitative procedures in eastern Germany.

Efficiency pattern analysis for medical rehabilitation.

Efficiency pattern analysis (EPA) is a technique proposed for use in medical rehabilitation that links patient functional gain to resource use, as approximated by length of stay (LOS), after adjusting for initial severity. The Functional Independence Measure version of the Function Relation Groups (FIM-FRGs) is used to adjust for patient severity and to define the efficiency groups. The efficiency groups are based on LOS and functional gain cut point values in the statistical distribution that are above, below, or within the national interquartile range for each of 53 FRGs. Data from 32,494 patients discharged in 1990 from 123 rehabilitation facilities were used. EPA is a simple way to monitor change in functional gain in response to transformations in health care practices and resource availability. The technique could also provide individual facilities with a means to evaluate treatment efficiencies across time and to compare patterns of LOS and functional gain to national norms.

Analysis of Case Mix and the Prediction of Resource Use in Medical Rehabilitation

Case mix measures define broad clinical categories of patients who are homogeneous in the use of health care resources and in medical severity or complexity. Payment systems that are based on case mix measures link the level of payment to the complexity of patients treated, thereby enhancing equity in the provision of services. Although the medical rehabilitation literature documents a strong association between various patient characteristics and use of rehabilitation resources, there are no case mix measures suitable for medical rehabilitation. This article describes the conceptual basis underlying the development of a case mix measure called function-related groups.