[Utilization of Rehabilitation After Orthopedic Operation - Does Severity of Case Influence the Setting of Rehabilitation (Out- Vs. Inpatient)?] / Inanspruchnahme einer Anschlussrehabilitation nach orthopädischer Operation ­ Beeinflusst die Fallschwere das Rehabilitationssetting (ambulant vs. stationär)?

OBJECTIVE: The aim of this study was to examine which factors predict rehabilitation setting (inpatient vs. outpatient) after hospitalization in order to indicate the meaning of severity for access to a certain kind of rehabilitation. METHODS: All patients with surgery for hip or knee (joint) endoprosthesis or disc surgery between 2005 and 2010 were selected for analysis from anonymized data from statutory health insurance (AOK Baden-Württemberg) and German Pension Fund (Bund as well as Baden-Württemberg). Logistic regression was performed for outpatient vs. inpatient rehabilitation. RESULTS: Patients from all surgery groups utilize more often inpatient rehabilitation, if they started treatment immediately after hospitalization than patients that start treatment after a period at home. With increasing age as well as comorbidities patients use more inpatient rehabilitation. The probability for inpatient rehabilitation decreased between 2005 and 2009. CONCLUSION: Beneath severity also context factors seem to be issues for the choice of inpatient or outpatient rehabilitation. For a demand-orientated access to a certain kind of rehabilitation, environmental conditions like support by family or accessibility to therapeutic, nursing or medical assistance and medical parameters like severity should be weighed against each other.

[Return to Work after Disk Surgery - Influenced by Rehabilitation?] / Erwerbsstatus nach einer Bandscheibenoperation: Was bewirkt eine Anschlussrehabilitation?

OBJECTIVE: The aim of this study was a comparison of treatment results in the year after disk surgery between the following treatment groups: rehabilitation immediately after discharge from hospital, rehabilitation with a transition time (at home) up to twenty days after rehabilitation or no rehabilitation. METHODS: On basis of claims data from a statutory health insurance and the German Federal Pension Fund the comparison of treatment results was performed. Therefore, duration of disability, return to work and early retirement are considered as treatment results and are analyzed using general linear models (GLM). Furthermore utilization of occupational rehabilitation was compared between the treatment groups with logistic regression. RESULTS: Rehabilitants showed a lower risk of unemployment. Moreover, rehabilitants utilize more often occupational rehabilitation. Both rehabilitation treatment groups had a higher duration of disability (including duration of rehabilitation) in the first quarter after surgery. Afterwards the duration of disability decreased faster. Risk of early retirement was higher in patients that started rehabilitation immediately. CONCLUSION: Rehabilitants tend to have better treatment results in the year following disc surgery.

[Utilization of Rehabilitation after Disk Surgery - A Cross-Sectoral Analysis of Claims Data from Statutory Health Insurance and German Federal Pension Fund]. / Inanspruchnahme der Anschlussrehabilitation nach einer Bandscheibenoperation.

The aim of this study was to identify relevant factors that influence utilization and interim period between hospitalization and postoperative rehabilitation after disk surgery. Logistic regression was performed for utilization of an early postoperative rehabilitation and for an interim period, when patients were going to a rehabilitation facility (directly after hospitalization or after a period at home) on claims data from statutory pension insurance and statutory health insurance. Increased utilization of postoperative rehabilitation was found in older and German patients. Moreover, adiposity and additional physiotherapy in hospital increased the utilization of postoperative rehabilitation, while blood transfusion during hospitalization was an inhibiting factor.Female gender, older age and additional physiotherapy in hospital decreased the probability for an interim period between hospitalization and postoperative rehabilitation. However, the probability for an interim period increased from 2005 to 2010. Utilization and interim period between hospitalization and postoperative rehabilitation meet patient's needs and seem adequate. Nevertheless, there are indications for under-utilization of certain patient groups (foreign citizens, unemployed persons, male patients).