[Outcome quality in rehabilitation of children and adolescents: results of project aiming at the development of a quality assurance programme]. / Ergebnisqualität in der Kinder-Jugend-Rehabilitation: Resultate eines Projekts zur Entwicklung eines Qualitätssicherungsverfahrens.

OBJECTIVES: This study reports on the results of a project that was initiated by the German pension fund and the statutory health insurers and conducted in 2009 to 2010 with the goal of developing, arranging and testing instruments for quality assurance for the outcome (including patient satisfaction) in inpatient medical rehabilitation centres for children and adolescents. METHOD: After a 6-month concept phase in which instruments were developed using value benefit analyses, expert consensus procedures, surveys of centres, and qualitative (cognitive interviews) and quantitative (psychometric tests) pre-studies, data were collected in 23 child and adolescent rehabilitation centres using the instruments that had been developed. The project was limited to the following 4 main diagnoses: obesity, bronchial asthma, atopic eczema, and hyperkinetic disorders as well as related disorders (ICD: F90-F94). Children and adolescents over the age of 12 years were interviewed themselves, for younger children, the parents were interviewed. It was decided to include 7 constructs that can be considered as indicators of the quality of the outcome or of patient satisfaction: generic and disease-specific quality of life, perceived change in health, body function parameters (e. g., blood pressure), disease-related self-management, satisfaction of the children/adolescents with rehabilitation, and parent satisfaction. RESULTS: With respect to quality of life, blood pressure, Munich fitness test and lung function parameters, low to medium effects were achieved; with respect to body mass index, SCORAD score and disease-related self-management, the effects were strong. The results can be summarised to the effect that rehabilitation generally achieves noticeable effects in the areas where the impairment is pronounced. In both the parent and the rehabilitation patient survey, there was a high level of satisfaction. The parents of rehab patients under the age of 12 years gave the centres an average assessment of 1.6 to 1.8; rehab patients over the age of 12 years gave the centres an average grade of 2.0 (1=very good to 5=very bad). The differences among the centres were very low after risk adjustment, especially for outcome quality. CONCLUSIONS: The strengths of the instruments that were developed are that a scientifically demanding quality measurement was conducted (e. g., combination of indirect and direct measurement of change, several methodological approaches to measuring results, wide range of endpoints analysed, homogeneous comparison groups, elaborate risk adjustment process). There are limitations, especially with respect to the rather great effort needed and not particularly high power for the comparison of centres. The German pension fund and the statutory health insurers are now discussing on the basis of the results of the project the routine implementation of quality assurance in children/adolescent rehabilitation and concrete steps that can be taken to implement it in routine health care.

[Disease-related self-management of obese children and children with bronchial asthma: changes and predictors during inpatient rehabilitation]. / Das Krankheitsmanagement von Kindern und Jugendlichen mit Adipositas und Asthma bronchiale: Veränderungen und Prädiktoren im Rahmen stationärer Rehabilitation.

BACKGROUND AND SIGNIFICANCE: There is growing interest in disease-related self-management as a means of coping with chronic disease. Improving disease-related self-management has thus become a key aim of inpatient medical rehabilitation of children and adolescents. We conducted this study in the framework of the project entitled "Outcome quality in medical inpatient rehabilitation of children and adolescents" initiated and financed by the German statutory pension and statutory health insurance programmes. STUDY AIM: Our study aim was to examine any changes following inpatient medical rehabilitation in the diagnosis-specific disease self-management of children suffering from obesity and from bronchial asthma. In addition we sought to identify any personal characteristics of the rehabilitants that might predict changes in self-management. METHODS: We collected data from 17 inpatient medical rehabilitation centres on disease-related self-management in children with obesity (n=706) and bronchial asthma (n=162) at the start of rehabilitation and 6 weeks after rehabilitation. The age of the diagnostic group "obesity" averaged 14.3 years, with a male percentage of 39.3%. The average age in the diagnostic group "bronchial asthma" was 14.0 years, with a male percentage of 54.2%. A questionnaire was used addressing the self-management of chronically ill young people. To compare the results from both measurement occasions, we employed t-tests for dependent samples and calculated effect-sizes. Using hierarchical regression analyses, we determined predictors of change in disease-related self-management. The predictor variables were included into the hierarchical regression analyses within 6 topical blocks (baseline disease management, sociodemography, body functions, baseline quality of life, motivation for rehabilitation, and duration of rehabilitation). RESULTS: We observed significant post-rehabilitation improvement of disease-related self-management in both the obese (T=-22.423; p<0.001) and the bronchial asthma group (T=-5.349; p<0.001). This improvement revealed a strong effect in the obese group (SRM=0.84) and a moderate effect in the bronchial asthma group (SRM=0.42). Regression analyses explained 3.4% of the variance in the obese group and 31.3% in the bronchial asthma group. In the latter group, self-management 6 weeks after the end of rehabilitation can be predicted by good self-management at the start of rehabilitation (ß=0.516; p<0.001) as well as primary school attendance (ß=0.201; p<0.01). DISCUSSION: Our results show that the disease-related self-management of obese youngsters and those with bronchial asthma benefits from inpatient rehabilitation. Changes in self-management are only poorly predicted by the variables included in the regression analysis in the diagnostic group "obesity". Other factors than those considered in this study seem to influence the success of treatment. In the diagnostic group "bronchial asthma" a significantly higher proportion of incremental variance can be explained, the extent of disease management at the beginning of rehabilitation being the most important predictor.

[Goal setting in inpatient medical rehabilitation: exploring the current practice]. / Reha-Zielvereinbarungen - gegenwärtige Praxis in der stationären medizinischen Rehabilitation.

OBJECTIVE: Goal setting is regarded as a key element in the rehabilitation process. Information about current goal setting practice is limited. However, there is potential for further improvement, e. g. as far as patient participation in the goal setting process is concerned. The study reports results of a survey on the current practice of goal setting in medical rehabilitation, focusing on development potential. The study examines acceptance and requirements for goal setting as well as patients' and professionals' experiences regarding goal setting during the rehabilitation process, with an emphasis on patient participation. METHODS: A total of n=40 rehabilitation professionals and n=210 inpatients with a diagnosis of chronic back pain, diabetes mellitus type 2 or coronary heart disease were surveyed at six rehabilitation centres using a questionnaire. Questionnaires contained predominantly closed-ended items regarding the current practice of goal setting. Several items were identical for both groups. In addition to the quantitative evaluation by means of frequency analyses free text data were evaluated. RESULTS: Rehabilitation professionals saw various benefits in goal setting with patients. Many professionals experienced patients to have personal goals for their rehabilitation, and most of them believed that patient participation in goal setting is possible. Also, barriers and requirements for goal setting were identified. A consistent concept for goal setting, involvement of and exchange between the different occupational groups and an elaborate handling of information in the context of goal setting seem to be realised at least partially. Professionals and patients reported similar frequencies of talks on goal setting at different times during the rehabilitation course. Patient participation seems to be realised to some extent but not comprehensively. The results show slight discrepancies between patients' and professionals' statements. DISCUSSION: Current practice of goal setting in inpatient rehabilitation of patients with the diagnoses named above is altogether on a relatively advanced level in the rehabilitation centres taking part in the study. The study identifies potential for development concerning a comprehensive implementation of goal setting, the realisation of patient participation, goal documentation and their integration into rehabilitation. Moreover, deeper involvement of the rehabilitation team and a stronger conceptual integration of the subject within the centres seem desirable. This can be taken up within the scope of interventions.