[Rehabilitation for Post-COVID Syndrome covered by the German Pension Insurance in 2021]. / Rehabilitationen bei Post-COVID-Syndrom der Deutschen Rentenversicherung 2021.

AIM OF THE STUDY: The present work is intended to give an overview of rehabilitation of patients with post COVID-19 condition covered by the German Pension Insurance in 2021. METHODS: Cross-sectional analysis of medical rehabilitation completed in 2021, in which COVID-19 sequelae were coded in first or second place in the uniform discharge report according to the International Statistical Classification of Diseases and Related Health Problems was carried out. The codes U08(.9), U09(.9) and U10(.9) as well as the corresponding codes from 2020 were taken into the evaluation as COVID-19-related diseases. Children's rehabilitation and oncological rehabilitation for pensioners and their relatives were excluded. Statistically, relative and absolute frequencies are given for nominal and ordinal variables, and median and quartiles for continuous, skewed distributed variables. RESULTS: 9,666 rehabilitations with one of the codes mentioned in first or second place remained. 54.8% of the patients were women and 43.2% men. The median age was 54 and 55 years (women/men). In all, 64.4% of the rehabilitations were carried out in the pulmonary medicine department. Owing to somatic indications, almost 50% of these patients in rehabilitation remained in the clinic beyond the regular approval period. The most common other diagnoses were diseases of the respiratory system. In 80.7% of those affected, the treating physicians considered the post-COVID-19 condition-associated symptoms as improved through rehabilitation. Furthermore, employment was subject to social security contributions for 88.0% of these patients, and 30.5% were employed in the fields of health, social affairs, teaching, and education. Of those affected, 63.8% were on sick leave when they were admitted, 63.0% when they were discharged. With regard to performance in the last job or on the general job market, over 90.0% received a prognosis for 6 hours and more. CONCLUSION: The importance of post-COVID-19 condition in the context of medical rehabilitation increased significantly over the course of 2021. The disease causes long periods of disability. With regard to performance, the available analyses give a positive picture; only 6.5% of those individuals undergoing rehabilitation were assessed as having a reduced capacity to earn of less than 3 hours on the general labor market.

[Personal Factors of the Bio-Psycho-Social Model (WHO): A Revised Classification by the German Society for Social Medicine and Prevention (DGSMP)]. / Personbezogene Faktoren im bio-psycho-sozialen Modell der WHO: Systematik der Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP).

BACKGROUND: In 2010, the ICF working group of Faculty II "Applied Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP proposed a classification of personal factors (PF) for the German-speaking area. Meanwhile, the International Classification of Functioning, Disability and Health (ICF) and WHO's bio-psycho-social model were increasingly integrated into the German Social Code (Book IX for Rehabilitation and Participation). It was a legislative decision that the needs assessment for the rehabilitation process must be "comprehensive". AIM: This publication aims to present an updated classification of PF to support the socio-medical assessment. For this purpose other published papers proposing a classification of PF were analyzed, especially the publication of Geyh et al. METHODS: The multiprofessional working group re-examined the basic structure, consistency and selection of factors of the 2010 classification using a qualitative approach and modified them if meaningful and necessary. The principles for the selection of factors were the same as in the 2010 publication (comprehensive, manageable, universal, impartial, relevant, unambiguous, focusing on finality, not regarding causality and non-discriminatory). RESULTS: A fundamental revision was not necessary; the basic structure remained primarily unchanged. Some items were included, excluded, summarized, shifted and editorially or content-related altered. Legal expertise shows that the classification of PF and their individual use for the socio-medical assessment, if necessary for the individual rehabilitation allocation, incur no problems with regard to data-protection regulations. PERSPECTIVES: The revised classification is ready to support users to describe and document relevant influences of the life background of individuals in a structured manner. Thus, influences on functioning and participation can be described comprehensively and transparently based on the bio-psycho-social model. A justiciable allocation of benefits for persons with disabilities is facilitated.

[Exercise Therapy in German Medical Rehabilitation - an Analysis based on Quantitative Routine Data]. / Bewegungstherapeutische Versorgung in der medizinischen Rehabilitation der Rentenversicherung ­ eine Analyse auf Basis quantitativer Routinedaten.

AIM OF THIS STUDY: This study describes the quantitative importance of exercise therapy in German medical rehabilitation based on 2014 routine data of the German Pension Insurance. It also shows changes in comparison with data from 2007. METHODS: Data from 710012 rehabilitation discharge letters comprising 83677802 treatments from central indications in medical rehabilitation were analysed descriptively. RESULTS: Overall 35.4% of treatments could be classified as exercise therapy. Total and relative duration, percentage of individual treatment and kind of exercise treatment varied between indications in 2007 as well as in 2014. There were also differences between sexes, age groups and settings. CONCLUSION: During the period examined the high importance of exercise therapy in German medical rehabilitation has increased. The results point at a meaningful concept behind the composition of exercise therapy taking indications and disease related factors into account.

[Medical Rehabilitation as an Attractive Field of Work for Medical Doctors? - A Qualitative Survey]. / Die medizinische Rehabilitation als attraktives Arbeitsfeld für Ärztinnen und Ärzte? ­ Eine qualitative Befragung.

In the German Health system there is an increasing competition in the recruitment of specialised staff, especially for rehabilitation centres, which are deemed less attractive. Therefore, this study examines the attractiveness of the field of medical rehabilitation from the point of view of medical professionals. We conducted 16 semi-structured interviews with doctors from 7 rehabilitation centres with different medical specialisations. The interviews were digitized and transcribed. A structured content analysis was carried out using the software MAXQDA 11. 745 codes were identified and assigned to the categories "attractiveness", "unfavourable aspects" and "special features" of rehabilitation. Regarding medical rehabilitation, the interviewees appreciated especially the predictable, flexible working environment with little time pressure. Other than working with rehabilitative patients working as part of an interdisciplinary team was of high importance for the interviewees. Among the special features of rehabilitation in comparison with acute care were the higher relevance of the bio-psycho-social model of health and illness as well as the higher proportion of communication and organisation. Medical rehabilitation in Germany is an attractive field of work for medical doctors. This fact should be considered more with regards to rehabilitation's public image.

Paediatric rehabilitation treatment standards: a method for quality assurance in Germany.

OVER THE LAST FEW YEARS, THE GERMAN PENSION INSURANCE HAS IMPLEMENTED A NEW METHOD OF QUALITY ASSURANCE FOR INPATIENT REHABILITATION OF CHILDREN AND ADOLESCENTS DIAGNOSED WITH BRONCHIAL ASTHMA, OBESITY, OR ATOPIC DERMATITIS: the so-called rehabilitation treatment standards (RTS). They aim at promoting a comprehensive and evidence-based care in rehabilitation. Furthermore, they are intended to make the therapeutic processes in medical rehabilitation as well as potential deficits more transparent. The development of RTS was composed of five phases during which current scientific evidence, expert knowledge, and patient expectations were included. Their core element is the specification of evidence-based treatment modules that describe a good rehabilitation standard for children diagnosed with bronchial asthma, obesity, or atopic dermatitis. Opportunities and limitations of the RTS as a tool for quality assurance are discussed. Significance for public healthThe German pension insurance's rehabilitation treatment standards (RTS) for inpatient rehabilitation of children and adolescents aim at contributing to a comprehensive and evidence-based care in paediatric rehabilitation. As a core element, they comprise evidence-based treatment modules that describe a good rehabilitation standard for children diagnosed with bronchial asthma, obesity, or atopic dermatitis. Although the RTS have been developed for the specific context of the German health care system, they may be referred to as a more general starting point regarding the development of health care and quality assurance standards in child/adolescent medical rehabilitative care.

[The Rehabilitation Guideline Program of the BfA]. / Das Reha-Leitlinienprogramm der BfA.

UNLABELLED: Since 1998, the German Federal Pension Insurance for Salaried Employees (BfA) has funded several research projects aimed at developing clinical practice guidelines for medical rehabilitation. Using a standardized protocol, therapeutic processes for individual disorders were evaluated as to whether they were evidence-based. The projects covered about half of all rehabilitation cases handled by the BfA. Effective therapeutic procedures were identified in a systematic literature review. Clusters of therapies--so called evidence-based therapeutic modules (ETM)--were formed, outlining the frame of an ideal rehabilitation. A target/actual comparison was carried out to determine the need to develop rehabilitation guidelines. Routine data of the Classification of Therapeutic Performances derived from discharge letters were compared with the ETM, allowing comparison of the actual provision of treatment with the scientifically-defined target. The variance in therapies between the ETM on one hand, and among rehabilitation centers on the other hand, made the necessity for the development of rehabilitation clinical practice guidelines clear. The ETM were finalized after a written survey including all professions and a subsequent multi-professional expert workshop. The guidelines are now integrated into the BfA's quality assurance system. The process of implementation is accompanied by research teams. CONCLUSION: By developing clinical practice guidelines specific to rehabilitation, the pension insurance is the only sector of the German health system in which quality evaluation is carried out on the basis of clinical practice guidelines. This will improve the treatment of chronically ill patients on a scientific and quality-assured basis.