[Development and psychometric testing of a patient questionnaire for medical rehabilitation (IRES-3)]. / Entwicklung und psychometrische Testung eines Patientenfragebogens für die medizinische Rehabilitation (IRES-3).

BACKGROUND: Re-analyses of extensive datasets as well as theoretical considerations have led to the conclusion that the patient questionnaire "Indicators of Rehabilitation Status" (IRES) should be revised in several respects. The new version IRES-3 was developed on the basis of a theoretical model of rehabilitation following the ICF (International Classification of Functioning, Disability and Health) as well as of elements of the earlier version IRES-2. In addition, we included the results of expert panels on the definition of treatment goals in medical rehabilitation. METHODS: The IRES-3 was tested in 453 patients in rehabilitation clinics of seven diagnostic areas. To compare the IRES-3 with other generic instruments, the SF-36 and the HADS were employed at the same time. For purposes of cross-validation, an external sample could be used. The dimensional structure was tested in confirmatory factor analyses. RESULTS: With rare exceptions, the tests showed good values for item difficulties, ceiling and floor effects, internal consistencies and test-retest-reliability. Convergent validity could be established for the IRES-3 when compared to relevant scales of the SF-36 and the HADS. Indices of sensitivity to change were comparable, if not somewhat superior to the effects on comparable scales of the SF-36. The assessment of the construct validity and the dimensional structure of the questionnaire led to the definition of eight dimensions which can be interpreted as somatic, emotional, functional, occupational, social, pain, coping, as well as health information and behaviour. The dimensional structure of the IRES-3 can be regarded as theoretically meaningful as well as empirically proven. STANDARDIZATION: For purposes of standardization, data were collected on a sample representative of the population aged 30-75 years in Germany. These data allow a norm-oriented interpretation of scales and dimensions of the IRES-3 for patients in rehabilitation. APPLICATION: The questionnaire is ready for application, including a computer programme for data entry and analysis.

[Outpatient orthopaedic rehabilitation: treatment, outcomes and costs as compared to inpatient rehabilitation]. / Teilstationäre orthopädische Rehabilitation: Therapeutische Leistungen, Behandlungsergebnis und Kosten im Vergleich zur stationären Rehabilitation1.

In a parallel design the study examined an outpatient rehabilitation model project for patients of the pension insurance scheme of Rhineland-Palatinate (LVA Rheinland-Pfalz). In 6 centers for the rehabilitation of musculoskeletal diseases patients were assessed at the beginning and at the end of rehabilitation as well as six and twelve months after discharge. In this article the final results concerning therapeutic measures as well as health-related and economic outcomes are presented. Not included are aspects of differential utilization and the perception of the rehabilitation by the clients, which will be published in a separate article. No large differences were found concerning participation in the various therapeutic measures. As measured by the main score and the sub-dimensions of the IRES patient questionnaire, effects of the same magnitude were found for the parallelized samples. Equally, no differences in outcome quality were found concerning the great majority of medical parameters documented in a doctors' questionnaire, the rate of applications for pension, occupational status twelve months after rehabilitation, as well as the reduction of sick-leave. The economic evaluation was carried out only from the perspective of the pension insurance agency. Considerable differences were found in the net costs of rehabilitation: although there are no user charges for patients in outpatient rehabilitation, mean expenditure was about 970 EURO lower than in inpatient rehabilitation. The study findings demonstrate that the concept of interdisciplinary rehabilitation has been realized in the outpatient centers as well and that the centers have reached an effectiveness comparable to that of inpatient rehabilitation. At least those patients who actively choose the outpatient setting gain as much as patients in inpatient rehabilitation.

[Reconditioning in groups: an effective programme for the rehabilitation of patients with low back pain?]. / "Rekonditionierung in Gruppen" - Ein wirksames Rehabilitationsprogramm bei chronischen Rückenschmerzen?

The article reports on a study in which elements of a group-oriented reconditioning programme for patients with low back pain were incorporated into the routine of an in-patient orthopaedic rehabilitation clinic. The specific elements of the new programme consisted of stable group structures during the whole stay of 3 to 4 weeks, and of 3 to 7 hrs. walks in hilly ground three times a week. The effects of this programme were tested against a standard programme with a mix of passive and active elements using a controlled study design. 92 persons participated in an experimental group and 81 persons in a control group with no significant differences found between the two groups at admission. Effects were measured by means of a physicians' questionnaire and a multidimensional patients' questionnaire (IRES) answered at admission, at discharge, and at six- and twelve-month follow-up. The results of a two-factorial analysis of variance with repeated measures showed that the interaction between group and time on the summary score of the IRES was not significant, although the experimental group showed somewhat better effects at all times of measurement. The discussion focuses on the reasons for this result, among which the unexpectedly good effects in the control group are named, as well as certain difficulties with the implementation of a strongly activity-oriented programme into the course of a "normal" rehabilitation clinic.

[LVA Rheinland-Pfalz Model Project of day care rehabilitation: initial results]. / Modellprojekt der LVA Rheinland-Pfalz zur teilstationären Rehabilitation: erste Ergebnisse.

A study is carried out to examine a demonstration project for partial hospitalization rehabilitation of patients of the pension insurance scheme of Rhineland-Palatinate (LVA Rheinland-Pfalz) using a parallel design. In four centers for the rehabilitation of musculoskeletal diseases the patients are assessed at the beginning and at the end of rehabilitation as well as six and twelve months post using the IRES questionnaire, a phycisians' questionnaire for the documentation of medical parameters, an instrument for client satisfaction and additional questionnaires. In addition the treatment and the costs on the side of the pension insurance agency are examined. Partial hospitalization rehabilitation clients are compared to inpatient ones from three rehabilitation hospitals. Preliminary analyses of patient self-report data show a strong similarity of inpatient and partial hospitalization clients as far as admission parameters, rehabilitation treatment, perception of rehabilitation and its effects are concerned. These results indicate that the pension insurance schemes' concept of interdisciplinary rehabilitation can be realized in partial hospitalization rehabilitation centers as well, achieving an outcome very similar to inpatient rehabilitation.