[Trajectory analysis of participation in a sample of stroke patients in German neurological outpatient rehabilitation centres]. / Teilhabebezogene Verlaufstypen in der Schlaganfallrehabilitation ­ Subgruppenanalyse der Daten einer multizentrischen Beobachtungsstudie zur ambulanten Rehabilitation nach Schlaganfall.

Objective We used a trajectory analysis to evaluate the course of participation in a sample of stroke patients in German neurological outpatient rehabilitation centres. Among other benefits, the method of trajectory analysis enables exploration of variables that influence the course of rehabilitation. Method In a multicentric observational study, patients at 17 outpatient neurorehabilitation centres were asked to fill in a questionnaire four times: at the time of admission to the rehabilitation center, on discharge and on month 4 and 12 post rehab. Additionally, clinical experts were asked to rate the patients' status at admission and discharge. Results and conclusions We obtained data on 364 stroke patients. There was deterioration in the social participation of 36 (9.9 %) patients, no change was observed in the participation of 173 (47.5 %) patients, and there was improvement in the participation of 155 (42.6 %) patients. 99 patients among the 173 patients that did not show changes in participation had already started with good participation scores. This questions the need for rehabilitation for this group. According to the sociodemographic variables, we could show that only sex and income are important for the course of rehabilitation. Further research is necessary about context factors that influence trajectories.

[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.