RehabilitationPub Date : 2024-06-01Epub Date: 2024-06-12DOI: 10.1055/a-2148-7035
Wilfried Mau, Matthias Bethge, Max Emanuel Liebl
{"title":"[The National Competency-Based Catalogue of Learning Objectives for Medicine 2.0 for the subject Physical and Rehabilitative Medicine, Naturopathic Medicine. Consensus of Scientific Medical Societies].","authors":"Wilfried Mau, Matthias Bethge, Max Emanuel Liebl","doi":"10.1055/a-2148-7035","DOIUrl":"https://doi.org/10.1055/a-2148-7035","url":null,"abstract":"<p><strong>Background: </strong>The learning objectives in the current cross-sectional subject \"Rehabilitation, Physical Medicine, Naturopathic Medicine\" have been revised as part of the further development of the National Competency-Based Catalogue of Learning Objectives for Medicine (NKLM) to its new version 2.0. Since the NKLM is designed as an interdisciplinary catalogue, a subject assignment seemed necessary from the point of view of various stakeholders. Thus, the German Association of Scientific Medical Societies (AWMF) and the German medical faculties initiated a subject assignment process. The assignment process for the subject \"Physical and Rehabilitative Medicine, Naturopathic Medicine\" (PRM-NHV; according to the subject list of the first draft of the planned novel medical license regulations from 2020) is presented in this paper.</p><p><strong>Material and methods: </strong>The AWMF invited its member societies to participate in the assignment of learning objectives of chapters VI, VII, and VIII of the NKLM 2.0 to the individual subjects to which they consider to contribute in teaching. For \"PRM-NHV\", representatives of the societies for rehabilitation sciences (DGRW), physical and rehabilitation medicine (DGPRM), orthopaedics and traumatology (DGOU), as well as for naturopathy (DGNHK) participated. In a structured consensus process according to the DELPHI methodology, the learning objectives were selected and consented. Subsequently, subject recommendations were made by the AWMF for each learning objective.</p><p><strong>Results: </strong>From the NKLM 2.0, a total of 100 competency-based learning objectives of chapters VII and VIII for the subject \"PRM-NHV\" were consented by the representatives of the involved societies for presentation on the NKLM 2.0 online platform.</p><p><strong>Conclusions: </strong>In the context of the revision process of medical studies in Germany and under the umbrella of the AWMF and the German medical faculties, a broad consensus of competency-based learning objectives in the subject \"PRM-NHV\" could be achieved. This provides an important orientation for all medical faculties both for the further development of teaching in the cross-sectional subject \"Rehabilitation, Physical Medicine, Naturopathic Medicine\" according to the 9th revision of the medical license regulations, which has been valid for twenty years, and for the preparation of the corresponding subjects in the draft bill of the novel license regulations.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":"63 3","pages":"189-196"},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312330","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}
RehabilitationPub Date : 2024-04-01Epub Date: 2024-01-20DOI: 10.1055/a-2192-3377
Franziska Ebert, Nikolaus Ballenberger, Markus C Hayden, Dirk Möller, Matthias Limbach, Michael Schuler, Dennis Nowak, Konrad Schultz
{"title":"[Effects of pulmonary rehabilitation on dysfunctional respiratory patterns in patients with uncontrolled asthma].","authors":"Franziska Ebert, Nikolaus Ballenberger, Markus C Hayden, Dirk Möller, Matthias Limbach, Michael Schuler, Dennis Nowak, Konrad Schultz","doi":"10.1055/a-2192-3377","DOIUrl":"10.1055/a-2192-3377","url":null,"abstract":"<p><strong>Purpose: </strong>Dysfunctional breathing patterns (DAM) are deviations from physiologic breathing patterns. DAM seem to be associated with lower asthma control. To date, it is unclear what effect inpatient rehabilitation can have on this problem. The aim of this work is to investigate the effect of pulmonary rehabilitation (PR) on DAM.</p><p><strong>Methods: </strong>The data are based on a randomized controlled trial with a waiting control group. The intervention group (IG) received PR 4 weeks after application approval and the control group (KG) after 5 months. Dysfunctional breathing was assessed by Nijmegen-Questionnaire (NQ). Values ≥ 23 points indicate an existing DAM. Values at the end of rehabilitation (T2) and after three months (T3) were compared (analysis of covariance). Supplemental moderator analysis was performed to examine whether the effect of PR was related to baseline NQ scores.</p><p><strong>Results: </strong>Significant differences in NQ score are found between IG (n=202) and KG (n=210) at T2 (AMD=10.5; 95%CI [9; 12]; d=1.4; p<0.001) and at T3 (AMD=5.8; 95%CI [4.3; 7.3]; d=0.8; p<0.001). There is an interaction effect between the difference in NQ score between the groups at T2 and baseline at T0 (b=5.6; 95%CI [2.2; 11.9]; p<0.001). At T3, this interaction effect was no longer detectable (b=4.5; 95%CI [-3.1; 14.1]; p=807).</p><p><strong>Conclusion: </strong>Inpatient, multimodality, and interdisciplinary PR is associated with significant and clinically relevant improvement in DAM both at discharge and 3 months later. In the short term, patients with existing DAM benefit more from PR than patients without DAM.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"100-106"},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514200","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}
RehabilitationPub Date : 2024-04-01Epub Date: 2023-12-08DOI: 10.1055/a-2192-3476
David Fauser, Pia Zollmann, Marco Streibelt, Matthias Bethge
{"title":"[Work Participation after Multimodal Rehabilitation due to Cancer: Representative Analyses using Routine Data of the German Pension Insurance].","authors":"David Fauser, Pia Zollmann, Marco Streibelt, Matthias Bethge","doi":"10.1055/a-2192-3476","DOIUrl":"10.1055/a-2192-3476","url":null,"abstract":"<p><strong>Purpose: </strong>Cancer diseases are associated with multiple physical, psychosocial, and occupational burdens that jeopardize work participation and must be specifically addressed with rehabilitative interventions. This study addressed the following questions regarding cancer patients whose rehabilitation was covered by German Pension Insurance (GPI): (a) What socio-medical risks existed prior to rehabilitation, (b) how well persons were able to return to work after rehabilitation, and (c) what conditions determined work participation?</p><p><strong>Methods: </strong>We used the rehabilitation statistics database of the German Pension Insurance and included patients with completed medical rehabilitation due to cancer in 2017. Analyses were carried out for the entire group as well as for those differentiated according to their tumor sites (breast, prostate, colon and lung). Work participation was operationalized both via a monthly state up to 24 months after rehabilitation discharge and as a rate of all persons who were employed 12 or 24 months and the 3 preceding months (stable work participation). For the analysis of the influencing factors on stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months.</p><p><strong>Results: </strong>A total of 63,587 data sets were included in the analysis (breast cancer: n=20,545, 32%; prostate: n=6,434, 10%; colon: n=4,727, 7%; lung: n=2,866, 5%). Of the rehabilitation participants 55% (lung), 49% (colon), 46% (breast), and 13% (prostate) had sickness absences of six or more months in the year before rehabilitation. Two years after rehabilitation, return-to-work rates were 66% (breast), 54% (prostate), 50% (colon), and 24% (lung). The strongest factors influencing stable work participation were time of sick leave, wage before rehabilitation and age.</p><p><strong>Conclusion: </strong>Two years after cancer rehabilitation, 5 to 6 out of 10 persons returned to stable work participation. Relevant influencing factors were the length of sick leave and wages prior to cancer rehabilitation. The results suggest inclusion of more work-related aspects in cancer rehabilitation and greater suppor, especially in the first year post-rehabilitation.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"107-118"},"PeriodicalIF":0.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812281","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}
RehabilitationPub Date : 2024-02-01Epub Date: 2024-02-09DOI: 10.1055/a-2126-7431
Rebecca Abel, Nora Zoth, Christiane Wilke, Thomas Schmidt
{"title":"[Exercise-Based Prehabilitation In Orthopaedics, Cardiology And Oncology].","authors":"Rebecca Abel, Nora Zoth, Christiane Wilke, Thomas Schmidt","doi":"10.1055/a-2126-7431","DOIUrl":"10.1055/a-2126-7431","url":null,"abstract":"<p><p>Prehabilitation (prehab) aims to prepare patients for surgery, to reduce perioperative complications and to improve postoperative recovery. Pre-operative interventions depend on the indication and the specific patient characteristics and life circumstances. In orthopaedics, the focus is on preoperative improvement of physical performance, function and muscle strength through specific strength, mobility and sensomotoric training. In cardiology, endurance training and respiratory therapy are used in the preoperative phase, as well as coordination and strengthening exercises and occupational therapy to improve physical fitness and performance and reduce cardiovascular risk factors. In oncology, prehab is used preoperatively and also in addition to chemotherapy or radiotherapy to reduce medical side effects and to increase tolerance to cancer therapies (e. g. surgery, chemotherapy, radiotherapy). Exercise interventions in oncology differ according to the type of cancer (e. g. combined strength and endurance training, respiratory therapy, high-intensity interval training and walking). Study results often show positive effects on health resources using prehab. However, further high-quality clinical intervention studies are needed to confirm the clinical benefits of prehab for implementation in routine care.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":"63 1","pages":"51-64"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713427","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}
RehabilitationPub Date : 2024-02-01Epub Date: 2024-02-09DOI: 10.1055/a-2204-3952
Catherine Rothacher, Joachim Liepert
{"title":"[Factors Modulating Motor Function Changes in Stroke Patients During Inpatient Neurological Rehabilitation].","authors":"Catherine Rothacher, Joachim Liepert","doi":"10.1055/a-2204-3952","DOIUrl":"10.1055/a-2204-3952","url":null,"abstract":"<p><strong>Purpose: </strong>To identify factors that have an impact on the degree of functional improvements in stroke patients during inpatient neurological rehabilitation.</p><p><strong>Methods: </strong>Retrospective analysis of 398 stroke patients who participated in an inpatient Phase C rehabilitation (Barthel index between 30 and 70 points). We correlated changes in 3 physiotherapeutic assessments (transfer from sitting to standing; transfer from bed to (wheel)chair; climbing stairs) and 3 occupational therapeutic assessments (eating/drinking; dressing of the upper part of the body; object manipulation) with the factors age, gender, Barthel-Index at admission, time since stroke, length of stay in inpatient rehab, number and extent of therapies and ischemic versus hemorrhagic stroke. In addition, a stepwise regression analysis was performed.</p><p><strong>Results: </strong>The patient group showed significant improvements in all assessments. Length of stay in inpatient rehab and number/extent of therapies correlated with improvements of transfer from sitting to standing, transfer from bed to (wheel)chair, climbing stairs, and dressing of the upper part of the body. Number/extent of therapies also correlated with eating/drinking. Barthel-Index at admission was negatively correlated with transfer from sitting to standing, transfer from bed to (wheel)chair, and dressing of the upper part of the body. No correlation between changes of motor functions and age or gender or type of stroke (ischemic versus hemorrhagic) was found. Patients<3 months after stroke showed stronger improvements of transfer from sitting to standing, transfer from bed to (wheel)chair, climbing stairs, dressing of the upper part of the body, and object manipulation than patients>6 months after stroke. However, patients<3 months after stroke also stayed 10 days longer in inpatient rehab. The stepwise regression analysis identified the number of physiotherapies and Barthel-Index at admission as the most important factors for changes in transfer from sitting to standing and transfer from bed to (wheel)chair, number of physiotherapies and time since stroke for climbing stairs, number of occupational therapies for eating/drinking, number of occupational therapies and time since stroke for dressing the upper part of the body and number of occupational therapies and length of inpatient rehab for object manipulation.</p><p><strong>Conclusion: </strong>In stroke patients, a higher number of therapies is associated with greater improvements of motor functions. Age, gender and type of stroke have no relevant impact on changes of motor functions during inpatient rehabilitation.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":"63 1","pages":"31-38"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713428","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}
RehabilitationPub Date : 2024-02-01Epub Date: 2023-09-18DOI: 10.1055/a-2138-9199
Tuğba Aksakal, Maria Mader, Fabian Erdsiek, Kübra Annac, Dennis Padberg, Yüce Yılmaz-Aslan, Oliver Razum, Patrick Brzoska
{"title":"[Supporting rehabilitation facilities in implementing diversity-sensitive care: Development of the DiversityKAT manual].","authors":"Tuğba Aksakal, Maria Mader, Fabian Erdsiek, Kübra Annac, Dennis Padberg, Yüce Yılmaz-Aslan, Oliver Razum, Patrick Brzoska","doi":"10.1055/a-2138-9199","DOIUrl":"10.1055/a-2138-9199","url":null,"abstract":"<p><strong>Background: </strong>Expectations regarding health care including rehabilitation differ depending on age, gender, and also the migration history of the patient population. To meet the diverse expectations, health care needs to be diversity-sensitive, which can have a positive effect on the utilization and outcomes of care. Diversity-sensitive care, however, should take into consideration not only the expectations of diverse patient groups but also the opportunities and challenges offered by diversity of staff. Managers of health care facilities and health care staff in Germany are well aware of the need for diversity-sensitive care, but corresponding measures, so far, have been applied rarely and only unsystematically. The aim of the study was to develop a manual consisting of a catalogue of instruments and a guideline that can support rehabilitation facilities in implementing diversity-sensitive care.</p><p><strong>Methods: </strong>A mixed methods approach was used for the study. Based on a scoping review, suitable instruments (n=34) were identified that can be used for the implementation of diversity-sensitive health care. Consensus on a draft of the manual was then reached in seven focus group discussions with health care staff (n=44) and a discussion circle consisting of n=5 representatives of the rehabilitation providers.</p><p><strong>Results: </strong>The <i>DiversityKAT</i> manual, which was developed in a participatory manner, presents diversity-sensitive tools, including instructions, questionnaires, checklists and concepts that can be used to take into account the diversity of needs and expectations in everyday health care. In line with the feedback from health care staff, the manual includes information that can be used as a step-by-step guide to select and implement appropriate tools. At the request of the staff and the rehabilitation providers, exemplary case descriptions were added to present the use of selected instruments in specific situations. A matrix was developed for purposes of quick orientation and pre-selection of suitable instruments.</p><p><strong>Discussion: </strong>Through practice-oriented advice and low-threshold guidance, the <i>DiversityKAT</i>-manual can increase user orientation in rehabilitation but needs to be further examined in future evaluation studies.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"23-30"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10308029","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":"Evaluation of an Innovative Case Management Strategy to Improve Rehabilitation Coverage for People at High Risk of Permanent Work Disability: a Feasibility Study.","authors":"Lea Remus, Marei Grope, Stella Lemke, Matthias Bethge","doi":"10.1055/a-2158-3212","DOIUrl":"10.1055/a-2158-3212","url":null,"abstract":"<p><strong>Purpose: </strong>Our process evaluation (trial registration: DRKS00022468) monitored the implementation of a multi-component strategy including case management aiming to improve rehabilitation coverage and work participation of people with a high risk of permanent work disability.</p><p><strong>Methods: </strong>A risk score using administrative data, particularly on employment and welfare benefits, was employed to identify individuals with higher probability of receiving disability pension and therefore potentially needing support. These individuals were contacted by post and encouraged to phone their regional case manager if they needed assistance. Content for the intervention components was developed collaboratively with the case managers. We examined the sample reached, dose delivered, fidelity, dose received and satisfaction with the intervention.</p><p><strong>Results: </strong>Out of 1074 individuals with high-risk scores were contacted, there were 57 case managements. The participants reached were in poor health, and 42.1% reported at least four diagnosed conditions, mostly musculoskeletal and mental disorders. About two-thirds (63.0%) reported poor work ability at baseline. On average, 72.5% of the content of the initial telephone contacts, 88.7% of the content of the face-to-face interviews and 45.2% of the content of the case management were delivered. The participants were highly satisfied with the various components and content of the intervention. Knowledge about rehabilitation improved significantly, with 43 of the 57 participants (75.4%) applying for rehabilitation, mainly medical rehabilitation. At the end of the case management intervention, most participants (91.7%) were still employed.</p><p><strong>Conclusion: </strong>The risk score offers an opportunity to screen for people with a high risk of permanent work disability. Case management participants found participation worthwhile and were significantly better informed about participation services after completing case management. More than every second participant received medical or vocational rehabilitation.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"13-22"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61566128","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}
RehabilitationPub Date : 2024-02-01Epub Date: 2023-08-21DOI: 10.1055/a-2129-2731
Betje Schwarz, Hannes Banaschak, Rebekka Heyme, Ernst von Kardorff, Nancy Reims, Marco Streibelt, Matthias Bethge
{"title":"A Mega-Ethnography of Qualitative Meta-Syntheses on Return to Work in People with Chronic Health Conditions.","authors":"Betje Schwarz, Hannes Banaschak, Rebekka Heyme, Ernst von Kardorff, Nancy Reims, Marco Streibelt, Matthias Bethge","doi":"10.1055/a-2129-2731","DOIUrl":"10.1055/a-2129-2731","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies.</p><p><strong>Methods: </strong>We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings.</p><p><strong>Results: </strong>Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model.</p><p><strong>Conclusions: </strong>RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual's life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one's own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person's working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"39-50"},"PeriodicalIF":1.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10857889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10039983","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}
RehabilitationPub Date : 2023-12-01Epub Date: 2023-10-31DOI: 10.1055/a-2134-2142
Markus C Hayden, Michael Schuler, Matthias Limbach, Gabriele Schwarzl, Nikola Stenzel, Dennis Nowak, Konrad Schultz
{"title":"[Patient-Reported Outcomes (PROs) 3 and 6 Months After Pulmonary Rehabilitation Following COVID-19].","authors":"Markus C Hayden, Michael Schuler, Matthias Limbach, Gabriele Schwarzl, Nikola Stenzel, Dennis Nowak, Konrad Schultz","doi":"10.1055/a-2134-2142","DOIUrl":"10.1055/a-2134-2142","url":null,"abstract":"<p><strong>Purpose: </strong>If COVID-19 disease sequelae also (co-)affect the respiratory organs, national and international guidelines recommend pulmonary rehabilitation (PR). So far, however, no studies are available from Germany on the course after PR, nor on possible course differences between the two Long COVID subgroups \"Ongoing symptomatic COVID-19\" and \"Post-COVID-19 syndrome\" (PCS).</p><p><strong>Methods: </strong> In a prospective observational study, patient-reported outcomes (PROs) regarding exertional dyspnea, quality of life, pain, fatigue, depression, and anxiety were assessed at the beginning of PR (T1), end of PR (T2), and after 3 (T3) and 6 months (T4). Statistical analyses were performed using latent difference models.</p><p><strong>Results: </strong> There were 224 rehabilitation patients (M<sub>Age</sub>=54.4; SD<sub>Age</sub>=10.4; 42.0% female) included in the study. During PR, all PROs improved significantly. After PR, improvements either persisted with large pre-post effect sizes (exertional dyspnea, quality of life), decreased slightly to small pre-post effect sizes (depression, fatigue), or decreased to baseline levels (anxiety, pain). PCS patients had greater burdens in depression, fatigue, and pain at baseline, but did not differ in trajectories. Indicators of the severity of the preceding acute phase (oxygen therapy, ICU treatment, ventilation) were associated with higher burdens at T0 in depression, fatigue, and pain, but not with the courses during and after PR. In contrast, female patients showed higher burdens in both depression and fatigue at T1 and higher pre-post effects than male patients.</p><p><strong>Conclusion: </strong> The fact that improvements in PROs occurred in both subgroups only during PR, but not during the follow-up period suggests that the changes are not due to the natural healing process but at least partly due to PR. Moreover, the results suggest that both patient groups may benefit from PR. Persisting improvements in exertional dyspnea and quality of life and, to a reduced extent, in depression and fatigue until 6 months after PR, but not in pain and anxiety warrant study of additional multimodal interventions that may be needed to maintain these effects.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"349-358"},"PeriodicalIF":0.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429235","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}
RehabilitationPub Date : 2023-12-01Epub Date: 2023-12-06DOI: 10.1055/a-2192-1969
Tanja Trefzer, Silke Brüggemann, Susanne Weinbrenner, Axel Schlitt
{"title":"[Rehabilitation for Post-COVID Syndrome covered by the German Pension Insurance in 2021].","authors":"Tanja Trefzer, Silke Brüggemann, Susanne Weinbrenner, Axel Schlitt","doi":"10.1055/a-2192-1969","DOIUrl":"10.1055/a-2192-1969","url":null,"abstract":"<p><strong>Aim of the study: </strong>The present work is intended to give an overview of rehabilitation of patients with post COVID-19 condition covered by the German Pension Insurance in 2021.</p><p><strong>Methods: </strong>Cross-sectional analysis of medical rehabilitation completed in 2021, in which COVID-19 sequelae were coded in first or second place in the uniform discharge report according to the International Statistical Classification of Diseases and Related Health Problems was carried out. The codes U08(.9), U09(.9) and U10(.9) as well as the corresponding codes from 2020 were taken into the evaluation as COVID-19-related diseases. Children's rehabilitation and oncological rehabilitation for pensioners and their relatives were excluded. Statistically, relative and absolute frequencies are given for nominal and ordinal variables, and median and quartiles for continuous, skewed distributed variables.</p><p><strong>Results: </strong>9,666 rehabilitations with one of the codes mentioned in first or second place remained. 54.8% of the patients were women and 43.2% men. The median age was 54 and 55 years (women/men). In all, 64.4% of the rehabilitations were carried out in the pulmonary medicine department. Owing to somatic indications, almost 50% of these patients in rehabilitation remained in the clinic beyond the regular approval period. The most common other diagnoses were diseases of the respiratory system. In 80.7% of those affected, the treating physicians considered the post-COVID-19 condition-associated symptoms as improved through rehabilitation. Furthermore, employment was subject to social security contributions for 88.0% of these patients, and 30.5% were employed in the fields of health, social affairs, teaching, and education. Of those affected, 63.8% were on sick leave when they were admitted, 63.0% when they were discharged. With regard to performance in the last job or on the general job market, over 90.0% received a prognosis for 6 hours and more.</p><p><strong>Conclusion: </strong>The importance of post-COVID-19 condition in the context of medical rehabilitation increased significantly over the course of 2021. The disease causes long periods of disability. With regard to performance, the available analyses give a positive picture; only 6.5% of those individuals undergoing rehabilitation were assessed as having a reduced capacity to earn of less than 3 hours on the general labor market.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":"62 6","pages":"339-348"},"PeriodicalIF":0.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500182","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}