[Whole-body cryotherapy in rehabilitation of patients with rheumatoid diseases--pilot study]. / Die Bedeutung der Ganzkörperkältetherapie im Rahmen der Rehabilitation bei Patienten mit rheumatischen Erkrankungen.--Ergebnisse einer Pilotstudie.

UNLABELLED: Cryotherapy as a whole-body cold therapy (with cold air cooled by addition of nitrogen blown on the patients in an open cabin) for treatment of inflammatory rheumatic diseases already started in Bad Säckingen in 1986. In 1996, a new cold chamber (this time a closed chamber without any addition of nitrogen) based on compressor technology was introduced. The aim of our study was to test whether significant pain relief could be achieved by means of this cold therapy. Furthermore, we were interested in the practicability and acceptance of this new technique. Wellbeing during the treatment application and pain level were assessed using verbal and numerical rating scales. The sample consisted of 120 consecutive patients (75% women, age: 30-67 yrs, M = 52.6 yrs). These patients were suffering from primary fibromyalgia (40.7%), rheumatoid arthritis (17.3%), chronic low back pain (16.4%), ankylosing spondylitis (10.9%), osteoarthritis (9.1%), secondary fibromyalgia (3.6%) and other autoimmune diseases (1.8%) (mean duration of symptoms: 4 yrs). The patients were treated 2.5 minutes on average in the main chamber (mean temperature: -105 degrees C). The patients' statements concerning their pain level were analyzed by means of analyses of variance with repeated measures and paired-sample t-tests. RESULTS: The pain level after application of the cold therapy decreases significantly. The pain reduction lasts about 90 minutes. The initial pain level decreases during the whole time of treatment, no significant improvement, though, can be shown from the middle to the end of the four-weeks treatment. According to the results of our study, there is evidence that the whole-body cold therapy generates important short-term effects and somewhat weaker effects over the treatment period as a whole. Short-term pain reduction facilitates intensive application of physiotherapy and Occupational Therapy. The treatment procedure is practicable, and all in all well tolerated. From the patients' point of view, whole-body cold therapy is an essential part of the rehabilitation programme.

[Therapy goals in medical rehabilitation]. / Therapieziele in der medizinischen Rehabilitation.

The definition of appropriate and measurable goals for treatment is a fundamental quality feature of medical practice. In co-operation with experts, we developed a catalogue of therapy goals for medical rehabilitation. In a two-stage procedure we first analyzed the target definitions that are currently used in medical rehabilitation. In a second step we used these targets as input for expert panels. Based on a modified model of the WHO classification ICIDH, the goals were defined on four dimensions: somatic, functional, psychosocial and educative. The established goals are relevant and measurable. Nevertheless, there is still a lack of adequate and sound measurement procedures for many goals. Therefore, there is an urgent need for further research in this field.

[Agreement and differences between reviewers in a peer review procedure]. / Ubereinstimmung und Unterschiede zwischen Beurteilern bei einem Peer-Review-Verfahren.

In Germany the statutory pension insurance institutions have started a quality assurance programme. Our institute developed a peer review procedure for screening the process quality of rehabilitation care. The peer review was tested in a pilot study. Our article refers to the examination of interrater reliability, intrarater reliability and reviewer bias. First of all, experienced doctors were trained in reviewing reports routinely written by rehabilitation doctors at discharge of their patients. The peers had to judge on 56 process criteria belonging to six categories (e.g. case history). The reliability coefficients were calculated for the overall judgement of each category and the overall judgement of the process quality of rehabilitation care. The coefficients of interrater reliability and the coefficients of average intrarater reliability range from sufficient to good. Only few reviewers showed a general tendency to harsh or lenient rating. The objectivity of the tested peer review procedure seems definitely higher than in American studies of peer review of hospital charts.

[Peer review: a method for the analysis of the quality of processing in-patient rehabilitation methods]. / Peer Review: Ein Verfahren zur Analyse der Prozessqualität stationärer Rehabilitations-massnahmen.

In order to evaluate the process quality of inpatient rehabilitation we established a peer-review system. In our approach, measurement of process quality is based on the report written by rehabilitation doctors at discharge of their patients. First of all, a list of 52 criteria relevant to process quality was defined by experienced clinicians using the Delphi technique. These criteria may be divided into six dimensions: anamnesis, diagnostic interventions, goals of therapy and therapy, judgement on vocational abilities, recommendations for further treatment and epicrisis. Thereafter, the experts in a manual defined specific requirements for each of the 52 criteria. In a pilot study, we were able to demonstrate reliability and practicability of the peer review system. Using this approach shortcomings in present rehabilitation practice may be detected. Nearly 400 reports from 20 rehabilitation hospitals were reviewed by thoroughly trained peers. Most frequently shortcomings were found in the description of patient's disabilities and in the definition of specific rehabilitation goals. Furthermore, this procedure enables comparison of process quality in different rehabilitation hospitals. In our pilot study we found marked differences in the process quality of the 20 rehabilitation hospitals.