[Participation after stroke: the influence of depression in outpatient neurological rehabilitation]. / Teilhabe nach Schlaganfall: Einfluss von Depressivität in der ambulanten Neurorehabilitation.

BACKGROUND: Depressiveness is a known and common problem after stroke, which puts a great burden on those affected. The main goal for stroke rehabilitation is to achieve the maximum possible self-determination and participation in the community. This research study examined how depressive symptoms influence the course of participation in outpatient neurological rehabilitation. METHODS: Stroke rehabilitants from 17 German outpatient neurological rehabilitation centers were interviewed in a multicentric observational study. Within the current work, data on participation and depressive symptoms recorded at the beginning and at the end of rehabilitation by self-assessment questionnaires, were evaluated. RESULTS: Data of 342 rehabilitants were considered. Results of a multinomial logistic regression analysis indicated that the depression value at the end of rehabilitation, in particular, proved to be a good predictor for the improvement in participation. The lower the depressiveness, the more likely an improvement in participation. At the beginning of the rehabilitation program there were no significant differences between mean depression scores of patients who improved and patients who deteriorated. DISCUSSION: A relationship between depressiveness and participation was shown. The treatment of depressive symptoms through timely administered psychotherapeutic and medicinal care and general activity promotion could influence the participation in a beneficial way.

[Current Developments of the Interdisciplinary Subject Rehabilitation, Physical Medicine, Naturopathic Treatment in the German Medical Faculties: Results of the DGRW Faculty Survey in 2015]. / Aktuelle Entwicklungen der rehabilitationsbezogenen Lehre in den humanmedizinischen Studiengängen in Deutschland: Ergebnisse der DGRW-Fakultätenbefragung 2015.

To ascertain the current development of the rehabilitation-related medical teaching in the interdisciplinary subject Rehabilitation, Physical Medicine, Naturopathic Treatment (Q12) regarding its execution, content, exams and evaluation of teaching at the Medical Faculties the German Society of Rehabilitation Science conducted another faculty survey in 2015. Representatives of all degree courses of human medicine in German Universities (n=41) received a pseudonymised standardised questionnaire in summer 2015. The response rate was 76% (n=31). Half of the faculties (48%) stated that they had a teaching and research unit for at least 1 of the 3 subjects of the interdisciplinary Q12. The Q12-teaching of faculties including these units partially differed from the other faculties. Model medical education programmes provide on average 2 semesters more for Q12-teaching in comparison to the traditional programmes. More than 3 quarters of the traditional programmes and all other courses include other medical professionals besides physicians as lecturers. Multiple choice questions still constitute the most common examination type (94%). Nearly all Medical Faculties evaluate the rehabilitation-related teaching but only half of all them have implemented a financial gratification based on the evaluation results. Even 10 years after the implementation of Q12, major variations were demonstrated regarding the execution, content and methods of medical education in rehabilitation. In the future the influence of the National Competence Based Catalogues of Learning Objectives for Undergraduate Medical Education on the Q12-development and the Q12-teaching in medical university education in Germany with foreign qualification will be of particular interest.

[Social Inequalities and Rehabilitation Among Patients with Mental Illness]. / Soziale Ungleichheit und Rehabilitation bei psychischen Erkrankungen.

Objectives: The concept of social position ("soziale Lagen") includes horizontal (gender, age) and vertical (occupation, education) indicators of social inequalities. For the first time, this concept is used to identify health and health care inequalities among rehabilitation patients with mental illness. Methods: Analyses are based on a survey of 327 patients with mental illness in rehabilitation clinics in northern Germany. Social inequalities are analyzed according to psychosocial health at baseline, utilization of therapies during the stay and psychosocial health 4 month after discharge by applying bi- and multivariate statistical procedures. Results: Vertical inequalities were found in psychosocial health at baseline and 4 months later. In contrast, no inequalities were found in the utilization of therapies during the stay. Conclusion: Health inequalities can be identified by vertical indicators, whereas horizontal indicators are not significantly associated with health outcomes in this study.

[Rehabilitation Application Rejected - What Happens Then?]. / Reha abgelehnt - und dann?

BACKGROUND: The German statutory pension insurance (Deutsche Rentenversicherung) rejects about a third of applications for medical rehabilitation. It is assumed that the health and occupational situation of people whose applications are rejected will become unsatisfactory. So far, there are no publications investigating the group of people with rejected applications. METHOD: Of 2 075 included applicants, 345 persons were rejected. Patients whose applications were rejected were matched with those whose applications were approved (Propensity-Score-Matching). At the end of the study, evaluable data sets including all 3 time points of measurement (application, 4 and 10 months thereafter) were available for 173 applicants with rejected applications and for 223 applicants approved for rehabilitation. The course of development of both groups was analysed using variance analysis with repeated measurements. The study was conducted for 27 months (January 2012-March 2014). RESULTS: At the time of application, there were no differences in health and occupational situation between the 2 groups. Also, there were no differences between groups in their utilization of outpatient therapies in the year before their application. 4 months later, a small advantage for those with an approved application was observed, and occasionally there were even significant differences. Both groups used medical and other healthcare offers comparably frequently. 10 months after application, both groups showed further improvements. There were no differences in the number of physician or non-physician patient consultations. DISCUSSION AND CONCLUSION: Our study could not confirm the assumption that the health or occupational situation of people with rejected application for rehabilitation suffers as a result of this rejection. Rather, the opposite seems to be the case. The factors that are responsible for the improvement, however, could not be identified by our study.

[Limitations of Social Participation in General Population - Normative Data of the IMET based on a Population-Based Survey in Northern Germany]. / Einschränkungen der Teilhabe in der Bevölkerung - Normdaten für den IMET auf der Basis eines Bevölkerungssurveys in Norddeutschland.

BACKGROUND: Medical rehabilitation in Germany is characterized by the biopsychosocial model of the ICF. Its complexity makes it less suitable for studies in rehabilitation sciences. For an implementation of the ICF, specific assessment instruments that are able to measure activity and participation efficiently in rehabilitation are needed. Instruments measuring social participation are rarely available in German language and have been employed only in a handful of empirical works. The "Index zur Messung von Einschränkungen der Teilhabe" (IMET) was developed in 2005 and measures participation of people with different chronic diseases as described in the ICF. The IMET has been applied in many studies in rehabilitation science, but as reference values were not available so far, the results could not be classified. METHOD: In a population survey, 5 004 residents in Luebeck were randomly selected by the registration office and sent a short questionnaire. The questionnaire contained questions on the overall state of health, quality of life, prevalence of chronic diseases and limitations of participation (IMET). RESULTS: The completed questionnaire was returned by 2 755 of 4 692 eligible people (58.7%). 731 residents declined participation. Therefore, the participation quota is 43.1%. The mean age of participants was 53 years (SD: 17.1), 53% were women.Limitations of participation varied according to sex and age. Men tended to be more limited in their participation. As expected, limitations in participation increased with age. Participants with a low level of education showed a significantly higher rate of participation restrictions than people with a higher level of education. The IMET correlated significantly with the health status and quality of life as well as with the prevalence of various chronic diseases. DISCUSSION: The random sample of Luebeck inhabitants comprised people between 19 and 79 years of age. The age distribution of our sample deviated from the German population with younger people being underrepresented, and older people being overrepresented. With respect to the educational level, the random sample of the Hanseatic city showed a larger proportion of people with higher education.In this population sample, there was a sex and age-related variation in restriction in participation and this correlated highly with content-related constructs. Norm values for the IMET enable classification of limitations of participation for people undergoing rehabilitation or patients suffering from chronic diseases.

[Informative Texts for Rehabilitation Patients are Difficult to Understand]. / Informationstexte für Rehabilitanden sind schwer verständlich.

OBJECTIVE: To check the intelligibility of informational texts written for rehabilitation patients. METHOD: Most investigated texts came from rehabilitation providers, patient organizations and health portals (8 texts), and from 50 rehabilitation facilities for musculoskeletal conditions (145 texts). We added a self-written booklet in plain language. All texts dealt with the goals and substance of rehabilitation. Readability formulas were computed for each text, and the Hamburg approach to intelligibility was applied. RESULTS: Only highly educated people will find the documents easily to understand, except for our self-written booklet, which is also comprehensible to lower secondary school leavers. CONCLUSION: The informational texts are of little help for people who are undecided whether or not to participate in rehabilitative measures and for rehab patients in preparatory stages. Issuing organizations are overburdened with the task of wording in a comprehensible manner, and should consider seeking assistance by professional writers or providing training for their staff.

[Suitability of the SINGER as a tool for assessment in outpatient neurological rehabilitation]. / Eignung des SINGER als Assessmentinstrument in der ambulanten neurologischen Rehabilitation.

OBJECTIVE: The scales Barthel-Index (BI) and Functional Independence Measure (FIM) are the most frequently used instruments for measurement of outcome in neurological rehabilitation. Both instruments show appropriate psychometric characteristics but there are some limitations for their use in outpatient neurorehabilitation. The "Score of Independence for Neurologic and Geriatric Rehabilitation (SINGER)" was developed to compensate the weaknesses of the established instruments and to facilitate a direct connection to the ICF. The results of the original validation study of the SINGER in an inpatient setting recommended a test of the SINGER also in an outpatient setting. METHOD: The SINGER has been applied in a multicentric validation study. Patients of 17 outpatient rehabilitation centres were included consecutively. In this study patients with stroke or TBI were asked to fill in a questionnaire at 4 points of measurement. Additionally, medical staff were asked to rate the patients' status at admission and discharge. RESULTS AND CONCLUSIONS: SINGER-data could be collected of 429 patients. In sum, results recommend to use the SINGER in outpatient neurorehabilitation, though with some restrictions. In comparison to BI and FIM, the SINGER results show in any case considerably less ceiling effects. The further exclusive use of FIM and, above all, BI cannot be recommended. But for very weak affected patients SINGER is poor sensitive for change and because SINGER is not covering all relevant aspects of rehabilitation a combined clinical use of SINGER and other assessment instruments seems to be a constructive solution.

[Different Health Impairments at the Beginning of Medical Rehab: Possibilities of more Flexibility using the Example of Rehab Aftercare]. / Unterschiedliche Ausgangsbelastungen in der medizinischen Rehabilitation: Möglichkeiten der Flexibilisierung am Beispiel der Reha-Nachsorge.

BACKGROUND: The aftercare-program new credo was developed interdisciplinary and with practical orientation for rehabilitation patients with chronic back pain. The concept focuses on rehabilitation aftercare from the beginning of rehabilitation treatment and includes a long-term support of rehabilitation patients after inpatient rehabilitation. A multi-center, controlled longitudinal study demonstrated that participants in the intervention group (IG) implemented significantly better rehabilitation contents and objectives in everyday life and had significant better long-term effects. Anyway, there are participants who don't benefit from the new credo as they begin rehabilitation treatment with low impairments. Assuming that rehabilitation patients with lower impairments need a less comprehensive rehabilitation aftercare compared to those with higher impairments, a follow-up study including a flexible aftercare strategy was conducted. Thereby it is investigated whether the IG achieves more sustainable effects despite of less aftercare compared to the control group (CG) without the aftercare program. METHOD: A prospective controlled longitudinal study in 2 rehabilitation clinics with 3 points of measurement was conducted. The flexibilization of the aftercare program was based on the level of impairment in the main outcome variable functional limitation in activities of daily living (FFbH-R) and restriction in participation (IMET) at the beginning of rehabilitation. Both questionnaires have been used in numerous studies successfully. Rehabilitation patients with low impairments received only the elements of the new credo during inpatient rehabilitation, rehabilitation patients with relevant impairments received the entire new credo over a period of 12 month after inpatient rehabilitation. The effects were evaluated with data from the CG of the primary study [Deck et al., 2012]. This sample was also divided according to their impairments. Rehabilitation patients with no relevant impairments were included in the analysis (IG N=81, KG N=157). RESULT: Regarding the long-term effects for the primary outcome variable FFbH-R a significant positive intragroup-effect was detected for the IG, the CG reached the initial value 12 month after inpatient rehabilitation. For the IMET a significant intragroup-effect is also visible in the IG, the CG does not change over the period of time. For both primary outcomes, there are no significant interaction effects to be observed. With respect to the secondary outcomes, in the IG significant small to moderate intragroup-effects were determined in all outcomes, the CG achieved for half of those outcomes significant small intragroup-effects. CONCLUSION: Rehabilitation patients, who begin rehabilitation with rather low impairments perpetuate their rehabilitation effects with an even reduced aftercare. Aftercare-programs should therefore be adapted to the individual needs. Rehabilitation patient, who start the rehabilitation with relative good health, seem not to have an added value from an intensive aftercare-program.

[Reha Aftercare--One Size Fits All? Analyses of Rehab Patients which do not Benefit from Reha Aftercare]. / Reha-Nachsorge - one size fits all? Analyse der Rehabilitanden, die nicht vom Reha-Nachsorgekonzept "neues Credo" profitieren.

BACKGROUND: In an own research project fund-ed by this program rehabilitation aftercare as part of a revised rehabilitation philosophy ("new credo") was tested and evaluated in a controlled longitudinal trial. Rehabilitation patients from the intervention group reported significantly better implementation of rehabilitation contents and objectives in everyday life during 12 months after their rehabilitation stay. Better long-term effects were also detectable. Anyway, not all rehabilitation patients seemed to benefit from the intervention. The present analysis focuses on this subgroup: How do rehabilitation patients that do not benefit from the "new credo" differ from rehabilitation patients that draw advantage from it? METHOD: Data from a controlled study were used for secondary analysis. 3 clinics implemented the "new credo". Primary outcomes were: participation constraints (IMET) and functional disabilities in everyday life (FFbH-R). The intervention clinics recruited a total of 166 rehabilitation patients. Data from 163 cases could be analyzed using quantitative methods. In addition, interview data from 7 unsuccessful rehabilitation patients was analyzed qualitatively. RESULTS: 102 (63%) rehabilitation patients improved their values in FFbH-R or IMET by at least 0.3 effect sizes (successful group). Among the 61 unsuccessful rehabilitation patients, 17 (10%) started rehabilitation with initial values that high that they could not reach the fixed minimal improvement criteria ("low burdened" group). They were excluded from further analysis. The remain-ing 44 (27%) rehabilitation patients constitute the "unsuccessful" group.Both groups have comparable levels of impairment concerning somatic and psychosocial parameters.At the end of the rehabilitation stay the "unsuccessful" group reached improvements of moderate to large effect sizes concerning the recorded health parameters. One year after rehabilitation "unsuccessful" rehabilitation patients fall back to their baseline levels of impairment, while the successful maintain their achieved effects after rehabilita-tion. The 2 groups rated several aspects of the intervention differently and the "unsuccessful" group rated the preparation for the time after the rehabilitation worse.The number of perceived aftercare elements proves to be the strongest predictor of failure in multivariate evaluation; "clinic facilities" is the only other independent predictor.During the interviews, "unsuccessful" patients reported different individual barriers for implementation of physical activity in daily life. CONCLUSIONS: Rehabilitation patients, who did not benefit from the new rehabilitation and aftercare concept, did neither differ in sociodemographic nor in disease-specific characteristics from the successful rehabilitation patients. However, differences in the implementation of the new rehabilitation philosophy and its individual components in the rehabilitation clinics are significantly associated with the occurrence of success or failure. Ov-er-all, the results of our study indicate a need for more flexible design of rehabilitation and aftercare adjusted to individual needs.

[Need for information concerning medical rehabilitation of the federal german pension fund--findings of an online survey of general practitioners]. / Informationsbedarf zur medizinischen Rehabilitation der Deutschen Rentenversicherung--Ergebnisse eines Online-Surveys mit niedergelassenen Ärzten.

AIM: General practitioners complain about information deficits, uncertainties and unclear requirements associated with medical rehabilitation. In this study General practitioners' specific information needs are identified and the preferred form for the presentation of information is determined. METHODS: In a secondary analysis of several focus groups with different stakeholders, rehabilitation specific aspects were identified for which General practitioners could have further information needs. Those were transferred into an online-questionnaire. GPs in Schleswig-Holstein were invited to the online-survey via E-Mail by different medical associations. RESULTS: A total of 194 questionnaires were available for analysis. In general, high information needs covering all rehabilitation topics in the questionnaire are evident. The highest information need is recognised for the following aspects: in which cases it makes sense to file an objection, which measures have to take place before it makes sense to file an objection and what the term "ambulant measures have been exhausted" exactly means. GPs clearly prefer a website as a means of informational source. Under the option of multiple replies 74.2% prefer a website, followed by the option of a brochure (44.8%) and further education (22.2%). CONCLUSION: General practitioners have high information needs regarding different aspects of rehabilitation which are not satisfied with existing sources of information. The development of a user-friendly website with comprehensible information on the required aspects seems necessary to increase the acceptance and understanding of medical rehabilitation among practitioners and therefore to optimise rehabilitation processes.

[Supported aftercare into psychosomatic rehabilitation - transfer of "new credo"]. / Begleitete Nachsorge in der Psychosomatik - Transfer des neuen Credo.

BACKGROUND: In recent years the prevalence of psychosomatic illnesses increased considerably, therefore the relevance of medical rehabilitation is also increasing. The effectiveness of psychosomatic medical rehabilitation has been demonstrated, but only a small proportion of rehabilita-tion patients manage to transfer the rehabilita-tion success into the daily routine. Numerous -aftercare offers should stabilize the effects of -rehabilitation. Against this background, a new -rehabilitation aftercare strategy ("New Credo"), initially developed and evaluated with good -results for orthopedic indications, was tested for psychosomatic indications. The aim of the present study was to test the concept in a psychosomatic rehabilitation clinic in terms of feasibility (feasibility-study). Further an evaluation of the results of the new credo can be made by the use of a "historical" control group. METHOD: In a longitudinal feasibility study with 3 points of measurement (before and after rehab as well as after 4 months) the feasibility and acceptance of the new credo was examined. One psychosomatic rehabilitation clinic in Schleswig-Holstein participated in the study, included were rehabilitation patients with depressive disorders (F32.x, F33.x und F40; ICD-10). The new credo philosophy was implemented in the clinical routine as well as the supporting materials were -applied during the project duration. During the study period the clinic was provided with a person in charge for the aftercare program. Psychological symptom severity (BSI) was defined as primary outcome variable. Secondary outcome variables were the subjective health, restriction in participation as well as health-related quality of life. Complete data were available for 91 rehabilitation patients. They were compared with matched data in terms of age, gender and school education from the "Qualitätsgemeinschaft medizinische Rehabilitation in Schleswig-Holstein". RESULTS: The new credo is also in psychosomatic rehabilitation well-accepted by all persons involved. The rehabilitation pa-tients used their rehabilitation stay to find a suitable activity for themselves for the time after rehabilitation. The majority evaluated the keeping of the diary as positive. In the primary and secondary outcome variables are medium to big effects visible in regard of short- to fairly long-term improvements. In the comparison with the "historical" control group on the level of intra-group effects remains an advantage in favor of the new credo. DISCUSSION AND CONCLUSION: The new credo proved to be also feasible for rehabilitation patients with depressive disorders, the rehabilitation- and aftercare strategy was well-accepted by the clinic and the rehabilitants. Most of the rehabilitation patients evaluated the new rehabilitation philosophy and the accompanied aftercare positively. First promising results indicate an increased sustainability of rehabilitation success using the new credo. Their validation in a multicenter controlled study design remain to be seen.

[Structures and processes in outpatient neurorehabilitation]. / Strukturen und Prozesse in der ambulanten Neurorehabilitation.

OBJECTIVE: Quality of structures, processes and outcome are commonly accepted as dimensions of quality management and quality assurance. Data of structures and processes are not published to date for German outpatient neurorehabilitation. Rehabilitative care and service providers are legally bound to apply concepts of quality management and quality assurance. The service providers pass recommendations, which have to be implemented by outpatient neurorehabilitation centres. Data analysis of existing structures and processes in outpatient neurorehabilitation centres are embedded as a part of a long-term multicentres outcome study. METHOD: 22 outpatient neurorehabilitation centres participated in an online survey with 227 items using the google tool "Docs" between September and December 2011. Following issues were asked: general information about the centres (e. g. date of establishment, number of therapy places, kind of patients, responsible organization), utility supply contracts with service providers, local cooperation and networking, staff and equipment and appliances, treatment concepts, processes of therapy (e. g. individual and group therapy, frequency, concentration, planning), team processes, goals and team development, quality management and documentation. RESULTS AND CONCLUSIONS: In the meantime outpatient centres of neurorehabilitation are well-established as care providers and commonly accepted by service providers. However a comprehensive availability does not exist. The results show comparable structures of the centres, what is mostly determined by the service provider audited regulatory framework. Different concepts result in different processes. There are a lot of hints with respect to different concepts in form and content to implement the legally obligated mandate. In general their work with context -factors is still a frequently unused potential. It can be countered by the therapeutic inclusion of the social and environmental living conditions of the patients.

[Supported own initiative of rehabilitation patients ("new credo") - longterm effects of the nonrandomized trial]. / Begleitete Eigeninitiative nach der Reha ("Neues Credo") - Langzeitergebnisse der quasiexperimentellen Interventionsstudie.

OBJECTIVE: Our project is closely related to the previous study "Rehabilitation aftercare - a new credo for rehabilitation clinics"; the intensified aftercare-strategy was developed by an interdisciplinary group of health professionals and scientists for patients with chronic back pain. Main objective is the resumption and maintenance of regular physical activity in everyday life of pa-tients undergoing rehabilitation. The aim of our present study was to evaluate the long-term (24-month-follow-up) efficacy of the "New Credo" (inpatient medical rehabilitation+intensified aftercare=IG) as compared with usual care (inpatient medical rehabilitation=CG). METHODOLOGY: We conducted a prospective controlled multicentre trial (IG: 3 clinics vs. CG: 3 clinics) with 4 points of measurement (T0: before and T1: after rehabilitation as well as T3: 12 and T4: 24 month after discharge). We enrolled rehabilitants with a primary diagnosis of chronic back pain (ICD-10: M51-54) who had given their consent. Exclusion criteria were mental and/or psychological impairments as well as surgery in the past 6 months. Primary Outcomes included restriction of social participation (IMET) and functional capacity (FFbH-R). Treatment effects were evaluated using analyses of variance and adjusting for differences between baseline -values; furthermore we calculated effect sizes (SMDInter, SMDIntra, ORs). RESULTS: Complete data were available for 123 IG-rehabilitants and 299 CG-participants (Completer-Analysis, response: 52%). Regarding restriction in functional capacity in everyday life (FFbH-R) multivariate analysis confirmed a treatment*time interaction, the appropriate effect-sizes showed no significant effects (SMDInter and SMDIntra). With respect to long-term effects 24 months after discharge no significant effects were found for social participation, however. With respect to secondary outcomes there are no significant differences between the groups (SMDInter, ORs); in fact rehabilitants of both groups showed similar effects (SMDIntra) in most cases. CONCLUSION: In summary our results doesn't confirm that the intensified aftercare-programme is able to improve longer-term effectiveness of inpatient orthopaedic rehabilitation up to 24 month.

[Measurement of participation in outpatient neurorehabilitation--a pilot study]. / Messung von Teilhabe in der wohnortnahen ambulanten Neurorehabilitation--eine Pilotstudie.

OBJECTIVE: To date there is a lack of tools to measure participation and the already existing measures are not properly used as yet. In 2005 the IMET (Index zur Messung von Einschränkungen der Teilhabe) was developed and is able to measure the ICF associated construct participation as a generic instrument in chronic diseases. IMET and numerous instruments were applied in our own study and results were compared with results of an unpublished study. In addition, to test IMET for its use in neurorehabilitation the effects of outpatient neurorehabilitation were investigated and compared with results obtained in an inpatient setting. METHOD: In a multicentric observational study, consecutively treated patients of 6 outpatient neurorehabilitation centres were asked to fill in a questionnaire at three time points (admission and discharge in the course of rehabilitation and at 4 months follow-up). Additionally, clinical experts were asked to rate the patients' status at admission and discharge. The data were compared with results of a sample of inpatients of an unpublished study. RESULTS: The IMET seems to be the to date best instrument to measure participation in a global, ICF-defined and economic way. Especially participation, general health status and capacity in leisure time and daily routine show the biggest improvements. In comparison, the outpatients show improvements in their participation status. Participation-oriented outpatient neurorehabilitation seems to have a considerable impact on participation status in neurological patients through the course of rehabilitation.

[Liveonline aftercare in patients with abdominal obesity in cardio-diabetological rehabilitation: findings of a randomized controlled study]. / Liveonline-Nachbetreuung bei Patienten mit abdominaler Adipositas in der kardio-diabetologischen Rehabilitation: Ergebnisse einer randomisierten, kontrollierten Studie.

Obese patients were coached after inpatient medical rehabilitation with a 6 units comprehensive multimodal Liveonline aftercare program. In the randomized controlled study design, significant improvements in all outcome criteria were found both in treatment and control group. The improvements in the treatment group, however, were only partially superior to the control group, especially in the area of food habits. A statistically significant superiority of the treatment group concerning the primary targets waist circumference and body mass index could not be determined. The Liveonline aftercare was evaluated positively by the participants. Future research is discussed.

[Recommendations for overcoming interface problems in medical rehabilitation of federal pension funds and statutory health insurance]. / Empfehlungen zur Überwindung von Schnittstellenproblemen in der medizinischen Rehabilitation der gesetzlichen Renten- und Krankenversicherung.

OBJECTIVE: Interface problems in medical rehabilitation are a consequence of problems with communication and cooperation, lack of information and transparency. Different stakeholders are trying to solve these problems since many years or decades respectively. Following a series of deficit-oriented studies we tried to develop recommendations for possible solutions of important interface problems together with affected people based on a qualitative analysis of main problem areas. METHOD: 10 separate group discussions with rehabilitation patients, general practitioners and specialists in private practices, representatives of the federal pension fund and statutory health insurance as well as clinicians from rehabilitation clinics and 3 mixed group discussions (all before mentioned groups excluding rehabilitation patients) were conducted. These group discussions served to prepare a semidiurnal final conference. All meetings were recorded and content analyzed or summarized in protocols respectively. RESULTS: Results are recommendations on strategies to reduce interface problems in medical rehabilitation. Those are: development of a rehabilitation-information-website for insurees and general practitioners and specialists in private practices; changes in forms, applications, notifications; advanced training for general practitioners and specialists in private practices und support in detecting rehabilitation need. CONCLUSION: Due to divided structures of care provision and increasing specialization, overcoming interface problems is one of the main challenges in the provision of medical rehabilitation. It can be met if different stakeholder approach each other without prejudices, share instead of demarcate competencies and are willing to strike new paths. Our recommendations represent the first step to reaching this goal.

Laser profile reshaping in a Fabry-Perot thin film.

We report the observation of non-Gaussian reflected and transmitted laser spatial profiles resulting from the excitation of resonant modes below the critical angle for total reflection in a Fabry-Perot cavity formed by a thin ~7 um air film between two glass prisms. The observations of an interference minimum in the reflected profile and exponential decay in the transmitted profile are new and in excellent agreement with a complex pole theory. Extension of the theory to a larger ~0.7 m cavity at normal incidence predicts similar reshaped profiles.

[Supported own initiative of rehabilitation patients ("new credo") - a successful model?]. / Begleitete Eigeninitiative nach der Reha ("neues Credo") - ein Erfolgsmodell?

BACKGROUND: In recent years, rehabilitation aftercare has become an important topic in rehabilitation research and practice. This development was initiated by the lack of long-term effects after rehabilitation treatment and by the deficits identified in several reviews of aftercare recommendations and of actual practice of aftercare. Against this background, a new aftercare strategy was developed, the "New Credo", which focused aftercare from the beginning of rehabilitation treatment. A substantial element of the concept is the resumption and maintenance of physical activity in everyday life of the rehabilitation patient. The goal of the present study was the evaluation of this concept in a sample of patients with chronic back pain. METHOD: The "New Credo" was evaluated in a multi-centre, prospective controlled longitudinal study with 3 points of measurement (before and after rehab as well as after 12 months). 6 rehabilitation clinics in Schleswig-Holstein were included in the intervention arm (IG, 3 clinics) and in the control arm (CG, 3 clinics), participants were rehabilitants with chronic back pain. The clinics in the intervention arm implemented "the New Credo" in accordance with their local conditions. During the study period they were provided with a person who was responsible for managing aftercare activities for patients. Participants in the CG received standard rehabilitation treatment according to general guidelines. Restriction of social participation, disability days and restriction in functional capacity in everyday life were defined as primary outcomes. Complete data were available for 166 rehabilitants in the IG and 368 in the CG. RESULTS: At the end of rehabilitation rehabilitants in the IG reported significantly higher use of treatment offerings and more intensive preparation for the time after rehabilitation treatment than rehabilitants in the CG. Rehabilitants in the IG found recommendations for the time after treatment significantly better than those in the CG. As expected, both rehabilitants in the IG and in the CG showed similar outcomes directly after inpatient treatment. With respect to long-term effects 12 months later, significant differences with moderate effect sizes were observed in 2 of the 3 primary outcomes (function capacity and social participation) in favour of the IG. With respect to secondary outcomes, rehabilitants in the IG showed significantly better long-term results than those in the CG. DISCUSSION AND CONCLUSION: Our results show that the "New Credo" can successfully be implemented into rehabilitation practice. The "New Credo" was positively rated by clinicians and rehabilitants. Rehabilitants in the IG found offerings of supported aftercare very helpful. The intensity of actual use of aftercare by rehabilitants as well as the emphasis laid on aftercare by clinicians indicate that treatment was focused on aftercare over the whole time of rehabilitation and that the rehabilitants transferred these aspects into everyday life. For the rehabilitants in the IG higher long-term effects could be observed compared to those in the CG. This suggests an improved sustainability of rehabilitation effects and a successful transfer of acquired knowledge and self-efficacy in everyday life.

[Medical rehabilitation of middle-aged insurants (55-plus): results of a qualitative study with rehab patients and rehab professionals]. / Medizinische Rehabilitation bei älteren Versicherten (55plus): Ergebnisse einer qualitativen Studie mit Rehabilitanden und Reha-Klinikern.

OBJECTIVE: Due to the demographic aging process of Germany's population, the development of morbidity and limited resources, a rethinking is needed in the fields of healthcare and social policy. The medical rehabilitation system will be of particular importance because of the increase of chronic and multiple illnesses in older age groups and the postponement of the retirement age. As the composition of rehabilitation patients will reflect broader demographic changes the question arises whether treatment plans of rehabilitation clinics will meet the demands and needs of older rehabilitation patients and which changes in rehabilitation processes might be required. METHODS: In 18 semi-structured focus groups, 62 rehabilitation patients with different indications aged over 55 years were asked about their needs, expectations and suggestions for improvement of the rehabilitation process. In contrast to previous quantitative research focusing on a comparison of rehabilitation needs and treatment offers of different age groups, only older rehabilitation patients were interviewed in this qualitative study. The results were discussed with health care experts in 3 multi-disciplinary focus groups. The conversations were recorded, transcribed and analysed using the content analysis approach. RESULTS: The study showed a wide range of needs of rehabilitation patients concerning the treatment process. The desire for more patient-centred care, especially through improved provision of information and patient participation rights in therapeutic decisions, was an important aspect. A detailed individual plan of aftercare and following-up patients regularly can facilitate the integration of rehabilitation-related aims into everyday life and therefore enhance the sustainability of rehabilitation. According to the experts, many of the needs mentioned were comprehensible and legitimate. Under the present circumstances (restrictions of time and personnel, guidelines), however, implementation of the proposals made by the rehabilitation patients was considered difficult to realize. Rehabilitation patients and experts ­agreed in that elements of occupational therapy should be expanded and transferred into real occupational setting and that intensified aftercare is needed. Contrary to our expectations, age-related aspects played a subordinate role according to both groups. Nevertheless, older rehabilitation patients saw a need for improvement in several areas of the rehabilitation process. Although the problems related to the rehabilitation process ­generally may not be directly age-related they might constitute a heavier burden for older patients. CONCLUSIONS: Optimizing various aspects of medical rehabilitation to reach sustainable outcomes in older rehabilitation patients appears to be necessary. Encouraging patients' individual responsibility for coping with the disease plays a key role in this process. Offering information tailored to patients' needs and provision of well-structured aftercare seem to be required especially for those older than 55.

[Quality of life and impact of incontinence in male patients with prostate carcinoma after radical retropubic prostatectomy]. / Die Lebensqualität und die Bedeutung der Inkontinenz bei Männern mit Prostatakarzinom nach radikaler retropubischer Prostatektomie.

BACKGROUND: To explore the effect of an interdisciplinary training programme on quality of life and impact of incontinence in male patients with urinary incontinence after radical retropubic prostatectomy for cancer of the prostate. PATIENTS AND METHODS: We conducted a controlled trial with two intervention groups. Both groups received an interdisciplinary training programme, with the first group (n=87) receiving the standard version, and the second group (n=72) receiving an additional tool 'BBS-trainer' to improve the perception of the pelvic floor muscles. Primary outcomes were quality of life (EORTC questionnaires) and impact of incontinence (modified questionnaire) evaluated up to six months after the treatment. The relationship between certain parameters such as incontinence was investigated. RESULTS: Mean age was 64 years; most of the participants were married and pensioned. Both groups improved significantly and to a relevant extent in most of the quality of life and incontinence variables during the three weeks of treatment, after six months they further improved significantly. Quality of life improved first, continence and impact on daily life followed. Some differences found between both groups refer to the time course. CONCLUSIONS: There is strong interaction between quality of life, incontinence and impact of incontinence. The interdisciplinary training programme shows quickly strong effects on quality of life and impact factors. It therefore is advisable that men with incontinence symptoms after prostatectomy should be offered such a treatment in a specialized rehabilitation clinic.