Rehabilitation最新文献

{"title":"[Exclusion risks of people with limited work capacity: \"The system is not designed for you to be ill so often.\"]","authors":"Betje Schwarz, Katja Nebe","doi":"10.1055/a-2858-9577","DOIUrl":"https://doi.org/10.1055/a-2858-9577","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic illnesses can significantly impair social participation and lead to disintegration, poverty and isolation. The aim is to trace the exclusion risks of people whose ability to work is at risk or already reduced due to illness.</p><p><strong>Methods: </strong>The study is based on problem-centered interviews with 50 people insured by the German Pension Insurance (GPI) Bund or Nord who, according to GPI routine data, have a high risk of premature retirement due to illness. Recruitment and sampling were conducted using a letter and a questionnaire, which wer sent to a total of 4,000 insured persons. The analysis followed a mix of sequential-narrative and category-based approach, supplemented by a systematic-contrastive case comparison.</p><p><strong>Results: </strong>People with reduced earning capacity are at risk of falling into a spiral of exclusion that can be accelerated or slowed down by various factors. Periods of incapacity to work, reductions in working hours and potential job loss and unemployment lead to financial losses, which can result in further restrictions on participation in the areas such as leisure, housing and consumption. Social participation can also suffer as a result. All of this, can further impair health and accelerate the spiral of exclusion.</p><p><strong>Conclusion: </strong>In order to counteract disease-related social exclusions, comprehensive strategies are required that focus in particular on care and work-related exclusion factors without losing sight of \"classic\" categories of inequality.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Potential of Machine Learning for Predicting Individual Treatment Success in Inpatient Psychosomatic Rehabilitation].","authors":"Paul-Gerrit Velthuysen, Christoph Kröger, Axel Kobelt-Poenicke","doi":"10.1055/a-2822-5523","DOIUrl":"https://doi.org/10.1055/a-2822-5523","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate prediction models of individual psychosomatic rehabilitation success based on patient characteristics might help to identify potential non-responders and to optimize the fit between patients and treatment. The aim of the present study was to investigate the potential of machine learning in this context.</p><p><strong>Methods: </strong>Random forest models were trained to predict treatment success in terms of the dimensions of symptom severity, health-related quality of life, interpersonal relationship building, and self-efficacy. In addition, relevant predictors were analyzed. Since random forest allows using both scale values and individual items as independent predictors, the present study utilized 555 potential predictors from 16 self-assessment instruments and 11 personal characteristics. This is a secondary data analysis of a dataset collected in a naturalistic single-group pre-post design. The random forest models were implemented using nested cross-validation. In the outer cross-validation, the final model was validated, and the included predictors were analyzed for their respective permutation importance.</p><p><strong>Results: </strong>Depending on the dimension, between 30.02% and 38.94% of the variance in individual treatment success could be explained. In external cross-validation, between 29.33% and 37.83% of the variance was explained. Across all dimensions, a total of 45 predictors - 17 scale scores and 28 single items - were included. Only two predictors were relevant for all dimensions.</p><p><strong>Conclusion: </strong>Using random forest models, large proportions of variance in individual treatment success could be explained for all investigated dimensions. In cross-validation, the large effect sizes and generalizability regarding new observations could be confirmed for all investigated dimensions. The analysis of relevant predictors provides additional evidence for predictors already associated with treatment success, while emphasizing the need of a nuanced consideration of psychosomatic rehabilitation success. A practical implementation of personalized treatments in the sense of personalized medicine does not seem feasible in the near future due to numerous limitations.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":"65 4","pages":"207-215"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Führung interprofessioneller Teams in der Rehabilitation – Das integrative kollaborative Führungsmodell.","authors":"Mirjam Körner","doi":"10.1055/a-2840-3022","DOIUrl":"https://doi.org/10.1055/a-2840-3022","url":null,"abstract":"","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":"65 4","pages":"203-206"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"How is my body going to cope with it? How should I go on with my life?\" Reflections on occupational future: interview study with cardiac rehabilitation patients with vocational reintegration risk.","authors":"Lara Luisa Wolff, Machteld Luizink-Dogan, Christine Holmberg, Heinz Völler, Annett Salzwedel","doi":"10.1055/a-2645-2652","DOIUrl":"10.1055/a-2645-2652","url":null,"abstract":"<p><strong>Purpose: </strong>Patients in cardiac rehabilitation (CR) with subjectively impaired occupational prognosis are at risk of not returning to work (RTW) in the medium term. This study aimed to explore, describe and summarise the aspects relevant in CR patients' reflections on their occupational future.</p><p><strong>Methods: </strong>A qualitative study was conducted in CR in 2021/22; 25 patients (median age 52 years; 9 women, 16 men; working in different physically demanding occupations; 20 with risk of non-RTW and 5 without by the Würzburger Screening) were interviewed and asked to reflect on their occupational future.About 6-8 months post-CR, 8 patients were re-interviewed to check the relevance of the factors identified during CR. All interviews were recorded, transcribed and thematically analysed.</p><p><strong>Results: </strong>Aspects relevant for the reflection on subjectively perceived occupational future could be summarised into internal factors: personal aspects, health perception, heart-focused anxiety, and external factors: social circle and adjustments in work conditions. Two further themes were time-related: prior health/illness-related experiences and intended work and lifestyle changes. Especially participants with a risk of non-RTW experienced heart-focused anxiety, contemplated previous health/illness experiences and expressed a desire to RTW in the distant future, although they had no clear plan of action. Greater emphasis was placed on prioritising health and taking time for RTW, and participants often felt supported in this by their social environment. Themes were overlapping between participants with and without risk of non-RTW, yet different in relevance and detail.</p><p><strong>Conclusion: </strong>Overall, patients at different risk of non-RTW reflecting on their subjective perception of occupational future show similarities regarding relevant aspects and themes. However, especially patients at risk of non-RTW reflected on perceived heart-focused anxiety and the lack of concrete RTW plans for their occupational future. These aspects should be considered in individual, holistic and goal-oriented approaches to support patients on their RTW journey.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"216-224"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Promotion of Work Participation in Outpatient vs. Inpatient Work-Related Medical Rehabilitation (WMR) in Patients with Musculoskeletal Disorders: Analyses Using Administrative Data].","authors":"David Bühne, Christian Hetzel, Mathis Elling, Torsten Alles","doi":"10.1055/a-2679-7982","DOIUrl":"10.1055/a-2679-7982","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of the present study was to compare outpatient vs. inpatient work-related medical rehabilitation (WMR) with regard to treatment dose of work-related interventions and promotion of work participation.</p><p><strong>Methods: </strong>The rehabilitation statistics database of the German Pension Insurance was used. Patients were included if they had completed WMR for musculoskeletal disorders in 2018 or 2019 and were aged up to 63 years. The implementation of WMR was measured based on work-related interventions documented in the discharge report.</p><p><strong>Results: </strong>The sample consisted of 46,276 rehabilitants. Work-related interventions were documented with an average total duration of 8.2 (outpatient WMR) and 9.3 (inpatient WMR) hours. In 25.7% of the outpatient and 37.1% of the inpatient rehabilitants, the minimum total duration of 11 hours was met. With regard to the promotion of occupational participation, no significant difference was observed between inpatient and outpatient WMR (OR=0.96, 95% CI [0.90, 1.03], reference: inpatient WMR), suggesting a potentially comparable benefit.</p><p><strong>Conclusions: </strong>The need for WMR measures was not consistently met in either outpatient or inpatient rehabilitation. In both settings, people assigned to WMR predominantly received less work-related interventions than intended. The promotion of return to work was achieved with comparable effectiveness in both outpatient and inpatient WMR.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"243-251"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Medical rehabilitation for gastrointestinal disorders].","authors":"Kerstin Herzer","doi":"10.1055/a-2872-1177","DOIUrl":"https://doi.org/10.1055/a-2872-1177","url":null,"abstract":"","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":"65 4","pages":"252-264"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Potential and challenges of an outpatient rehabilitation programme for children and adolescents with obesity - Interviews with professionals from rehabilitation centres].","authors":"Judith Stumm, Lucie Schröder, Meta Herrmann, Jennifer Marie Burchardi, Sandra Fahrenkrog","doi":"10.1055/a-2724-3558","DOIUrl":"10.1055/a-2724-3558","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of the study was to explore the goals, achievements and challenges of an outpatient rehabilitation program for obese children and adolescents from the perspective of specialist staff at rehabilitation centres.</p><p><strong>Methods: </strong>As part of a multi-stage research project, 19 semi-structured, guideline-based telephone interviews were conducted with the medical and therapeutic staff of four rehabilitation centres and analysed using Framework Analysis.</p><p><strong>Results: </strong>The interviewees agreed that the goal was a long-term and sustainable change in lifestyle. Furthermore, weight loss played an important role in both the goal and success of the rehabilitation program. Implementation of lessons learned into everyday life on a long-term basis, lower motivation of parents and various difficulties encountered by rehabilitants and staff when concomitant measures of the program were carried out during weeks of school term posed a challenge. The (active) role of parents in the outpatient rehabilitation program was shaped by different expectations on the part of all stakeholders and influenced by resources available to the families to different extents. The low number of participants was probably due to the low level of awareness and the small number of outpatient rehabilitation programs in Germany.</p><p><strong>Conclusion: </strong>The outpatient rehabilitation program for obese children and adolescents has potential for success in individual cases. However, the goals of the rehabilitation program should be communicated more transparently, especially with regard to possible weight reduction, which in turn influences the expectations and motivation of children and adolescents and their parents. By involving parents more specifically, various challenges can be addressed and the lessons learned can be implemented more effectively into everyday life.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"234-242"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Sustainable Return to Work for Individuals with Mental Health Conditions: Effects of Job Protection Aftercare].","authors":"Elena Andreeva, Tatjana Levin, Christian Sturm","doi":"10.1055/a-2654-6017","DOIUrl":"10.1055/a-2654-6017","url":null,"abstract":"<p><strong>Purpose: </strong>Mental health disorders increase the risk of early retirement and occupational exclusion. Individualized, needs-oriented aftercare that includes measures to stabilize employment following vocational rehabilitation can support affected individuals in transitioning into the workforce and mitigate these risks. Drawing on the JobProtection model project, this study investigated the impact of aftercare on sustainable workforce reintegration and the factors influencing long-term employment among individuals with mental health conditions.</p><p><strong>Methods: </strong>Anonymized routine data from the German Pension Insurance Braunschweig-Hannover (n=1464) were analyzed using logistic regression. Among the sample, 113 individuals in the intervention group participated in up to 24 months of JobProtection aftercare (2019-2023) following vocational rehabilitation. The control groups, which received standard aftercare, comprised a historical group (n=688; vocational rehabilitation measures completed between 2015 and 2017) and a parallel group (n=663; vocational rehabilitation measures completed between 2019 and 2021). Sustainable workforce reintegration was defined as at least 24 months of employment, based on data from social security contributions.</p><p><strong>Results: </strong>The intervention group showed significantly higher chances of achieving sustainable employment. Other positive predictors of long-term workforce reintegration included older age, a longer duration of vocational rehabilitation, and the approval of a partial disability pension. In contrast, individuals granted a full disability pension or those whose pension applications were rejected had significantly lower chances of remaining employed for at least two years after vocational rehabilitation. Belonging to the parallel control group was associated with reduced chances of stable employment.</p><p><strong>Conclusion: </strong>The vocational reintegration of JobProtection participants was successfully supported in the long term. Accordingly, needs-oriented aftercare may serve not only as a meaningful complement to vocational rehabilitation for individuals with mental health conditions, but also as a means of addressing a previously unmet need in care provision.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"225-233"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effectiveness of Therapeutic Interventions (KTL) in Post-Acute Rehabilitation of Hip and Knee Arthroplasty Patients Based on the Staffelstein Score and Identification of Optimized Therapy Pathways].","authors":"Johannes Schröter, Johanna Feucht, Natascha Raisig, Philipp Drees","doi":"10.1055/a-2880-8199","DOIUrl":"https://doi.org/10.1055/a-2880-8199","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to analyze and optimize therapeutic interventions (according to KTL codes) in post-acute rehabilitation of patients following hip or knee total arthroplasty (TEP). While evidence exists for the effectiveness of individual measures, data on optimal therapy pathways in three-week inpatient TEP rehabilitation setting are lacking.</p><p><strong>Methods: </strong>A retrospective secondary use of clinical data was performed using anonymized patient data from 38 (hip TEP) and 29 (knee TEP) orthopedic MEDIAN clinics. A total of 11,628 hip TEP and 7,865 knee TEP patients (data collection: 2016-2019) were included. Based on the validated Staffelstein Score at admission, patients were classified into three groups (low, medium, high baseline value) using k-means clustering. Therapeutic interventions documented via KTL codes were clustered into 14 therapy pathways. Their effectiveness was assessed by the proportion of patients reaching a defined discharge score target in the Staffelstein Score. Optimized therapy modules were derived and compared with the rehabilitation standards (RTS) of the German Pension Insurance.</p><p><strong>Results: </strong>Significant differences in therapy outcomes were observed depending on group and therapy pathway. Patients with high baseline values particularly benefited from strength-based individual therapy (KTL A652) and electrotherapy (KTL K592). Patients with medium baseline values performers achieved best results with group-based physiotherapy (KTL B563), and - among hip TEP patients - with additional manual lymphatic drainage (KTL K672). Patients with low baseline values showed distinct needs: knee TEP patients responded well to coordination training (KTL A580) and assistive device-related occupational therapy (KTL E709), whereas hip TEP patients benefited most from endurance training (KTL A552) and motor-function-focused occupational therapy (KTL E653). Therapy success rates reached up to 97% depending on the appropriate therapy pathway.</p><p><strong>Conclusion: </strong>The study demonstrates that individualized rehabilitation strategies based on functional baseline status lead to significantly better outcomes. The identified therapy pathways provide an evidence-based foundation for refining rehabilitation standards. Prospective validation is recommended to ensure efficient, targeted post-TEP care and to avoid ineffective interventions.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Co-operation between self-help groups and rehabilitation facilities within the framework of the German Pension Insurance (DRV): Development, current status and perspectives].","authors":"Alf Trojan, Livia Gelsomino, Elâ Ziegler, Christopher Kofahl","doi":"10.1055/a-2892-2197","DOIUrl":"https://doi.org/10.1055/a-2892-2197","url":null,"abstract":"<p><strong>Purpose: </strong>Rehabilitation facilities are generally successful in their treatment goals, but cannot cover all aspects of coping with illness that everyday life after inpatient rehabilitation entails. The expertise of other patients and their relatives in the form of self-help groups (SHG) and peer counselling can help to stabilize the success of rehabilitation. Rehabilitation clinics occupy a strategically important position in the treatment pathway of patients when it comes to information about and referral to SHGs. This insight has been taken into account in recent years by numerous normative commitments of rehabilitation representatives to cooperate with organised self-help. The aim of the present study was to examine the normative statements of the German Pension Insurance (DRV) and the Federal Rehabilitation Association (BAR) on cooperation between self-help groups and the rehabilitation system and compare them with the relevant empirical data available.</p><p><strong>Methods: </strong>The balance of normative statements was based on an analysis of publicly available documents: DRV rehabilitation reports, practical aids, instructions and information on quality management systems of rehabilitation clinics as well as scientific literature. Secondary analytical answers to the empirical question of how many rehabilitants were referred to SHGs were provided by the DRV rehab reports and our own specific evaluations of DRV data from 2010 to 2022 provided to us.</p><p><strong>Results: </strong>The increasingly systematic intentions to cooperate with self-help groups and organisations were evident in all the documents analysed. Empirical results: Only a few of the annual rehab reports contained results from rehabilitant surveys. In a study published in 2010, 7-18% of former rehabilitants reported having received the \"suggestion of an SHG\". Suggestions for an SHG remained constant between 2010 and 2021 at a total of 9-10% in the somatic inpatient areas, but at 75% in the addiction area. Special evaluations of the service provision reported by clinics showed an increase in \"referral to an SHG\" from 4% to 8% of all rehabilitants between 2010 and 2015.</p><p><strong>Conclusion: </strong>With the exception of addiction clinics, the empirical reality of cooperation between the rehabilitation and self-help systems falls well short of the programmatic and normative statements. A current action research project with the DRV aims to achieve improvements.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}