[Current Developments of the Interdisciplinary Subject Rehabilitation, Physical Medicine, Naturopathic Treatment in the German Medical Faculties: Results of the DGRW Faculty Survey in 2015]. / Aktuelle Entwicklungen der rehabilitationsbezogenen Lehre in den humanmedizinischen Studiengängen in Deutschland: Ergebnisse der DGRW-Fakultätenbefragung 2015.

To ascertain the current development of the rehabilitation-related medical teaching in the interdisciplinary subject Rehabilitation, Physical Medicine, Naturopathic Treatment (Q12) regarding its execution, content, exams and evaluation of teaching at the Medical Faculties the German Society of Rehabilitation Science conducted another faculty survey in 2015. Representatives of all degree courses of human medicine in German Universities (n=41) received a pseudonymised standardised questionnaire in summer 2015. The response rate was 76% (n=31). Half of the faculties (48%) stated that they had a teaching and research unit for at least 1 of the 3 subjects of the interdisciplinary Q12. The Q12-teaching of faculties including these units partially differed from the other faculties. Model medical education programmes provide on average 2 semesters more for Q12-teaching in comparison to the traditional programmes. More than 3 quarters of the traditional programmes and all other courses include other medical professionals besides physicians as lecturers. Multiple choice questions still constitute the most common examination type (94%). Nearly all Medical Faculties evaluate the rehabilitation-related teaching but only half of all them have implemented a financial gratification based on the evaluation results. Even 10 years after the implementation of Q12, major variations were demonstrated regarding the execution, content and methods of medical education in rehabilitation. In the future the influence of the National Competence Based Catalogues of Learning Objectives for Undergraduate Medical Education on the Q12-development and the Q12-teaching in medical university education in Germany with foreign qualification will be of particular interest.

[Education, advanced and further training in the field "psychology in rehabilitation"]. / Aus-, Fort- und Weiterbildung "Psychologie in der Rehabilitation"

The commission for vocational training, training and further education of the German Society of Rehabilitation Science tends to discuss and to give recommendations for various professions in rehabilitation. The working group, which is led by J. Bengel/Freiburg and M. Morfeld/Magdeburg-Stendal created an inventory of Rehabilitation Psychology. The training programs for Rehabilitation Psychology at universities and universities of applied science in Germany are based on a job profile of psychologists in medical and vocational rehabilitation. The different universities have diverse priorities focusing on Rehabilitation Psychology. The offer changes because of the adaption of requirements and implementation of Bologna Reform. The training and further education offers are specific and available for large indication areas. Finally outstanding issues and problems are pointed out.

[Anxiety and depression in the elderly: results of a regional examination]. / Angst und Depression bei Älteren - Ergebnisse einer regionalen Untersuchung.

AIM: The aim of this study was to determine the point prevalence of anxiety, depression and a mixed form of anxiety and depression in people older than 54 years. METHOD: A cross-section study by postal questioning using HADS-D was carried out. RESULTS: In total, 24.8% of the examined population group reported about having anxiety, depression or a mixed form of both - depression: 12.7% (men: 5.1%, women: 7.6%), anxiety: 4% (men: 1.5%, women: 2.5%), mixed form: 8.1% (men: 2.5%, women: 5.5%). There was no significant statistical difference between men and women in severity of the examined psychological disorders. However, the mean scores in men as well as in women were higher with multiple psychological stress factors than with single psychological stress. Women were significantly more affected by the mixed form than men (χ (2)=5.2; p=0.02). There were positive correlations between age and seriousness of depression in the mixed form in women (r=0.62; p=0.001). CONCLUSION: In comparison, depression in older people develops 3 times and anxiety 2 times more often than in the general population; the sex ratio (men:women) in the general population is 1:2 for depression and anxiety; in the present study the ratio is almost 2:3.

[Psychological comorbidity. Diagnosis and indications for further treatment in medical rehabilitation]. / Psychische Komorbidität. Befunde zur Diagnostik und Hinweise auf Möglichkeiten der Weiterversorgung in der medizinischen Rehabilitation.

Psychosocial comorbidity in somatic disorders is considered an important problem from the epidemiological point of view as well as from the perspective of care. Therefore, the different origins or development are etiologically discussed. In this article, an overview of the prevalence of psychiatric comorbidity of musculoskeletal disorders, using chronic back pain in somatic medical rehabilitation as an example, is given. According to the statistics of the German pension insurance fund, musculoskeletal diseases are the most common indication. In this article, the opportunities and the challenges for medical rehabilitation in managing psychosocial comorbidity are discussed. Starting with the description of medical rehabilitation in Germany, the significance of psychosocial comorbidity in medical rehabilitation and the resulting opportunities arising from this special setting to screen for psychological comorbidity are examined. These aspects are discussed based on articles from 2000-2010 in the field of orthopedic inpatient medical rehabilitation. A total of ten studies, focusing on the medical rehabilitation of chronic back pain, were identified. It was found that three papers reported data on the prevalence of psychological comorbidity and addressed diagnostic screening. This is discussed from a perspective that addresses potential barriers on the part of therapists as well as the patients. More attention should be directed to implementing the appropriate screening and follow-up care.

[Outpatient rehabilitation in Germany. Interim results and prospects for further development]. / Ambulante Rehabilitation in Deutschland. Eine Zwischenbilanz und Perspektiven der Weiterentwicklung.

The offer and development of outpatient medical rehabilitation in Germany represents a substantial component of rehabilitative care. In consideration of demographic change and the increase of chronic illnesses, outpatient rehabilitation facilities, on account of their flexibility, can close care gaps for those who find stationary rehabilitation less attractive or not possible for other reasons. With the implementation of the "Sozialgesetzbuch" (SGB) V and SGB VI as well as the introduction of the SGB IX regarding the rehabilitation principle "outpatient before inpatient," outpatient rehabilitation was social juridically established. Today outpatient rehabilitation means an equal setting, which can substitute inpatient rehabilitation, thus, shortening inpatient rehabilitation or it can follow inpatient rehabilitation. In 2008, outpatient services constituted 11% of all rehabilitation services. Illnesses of the muscle system, skeletal system, and connective tissue system, which are the most frequent rehabilitation indications in Germany, are treated in an outpatient setting in 17% of cases. The outpatient rehabilitation process is characterized by the close proximity to a patient's residence and job, flexibility, and individual participation. These characteristics enable the implementation of innovative possibilities, e.g., stepwise occupational reintegration into the rehabilitation process in order to optimize rehabilitation outcome.

[Chronic low back pain : Replication of different reaction groups]. / Chronischer Rückenschmerz : Replikation reaktionsdifferenter Gruppen.

BACKGROUND: The aim of the study was to replicate the different reaction groups: "Fröhlicher Durchhalter (FD)" who are characterised by a positive mood and endurance strategies, "Depressiver Durchhalter (DD)" with depressive mood and cognitions to hold on and "Depressiver Vermeider (DV)" who are depressed with social and physical avoidance strategies. The replication was conducted with more feasible methods than the Kiel Pain Inventory (KPI), which had been frequently used in former research. This might effectuate a superior intervention outcome. PATIENTS/METHODS: The sample (n=290) consisted of patients after their first nucleotomy at the beginning of the inpatient medical rehabilitation. Selection of the scales was based on cognitive-emotional and behavioural pain characteristics. Therefore 14 scales of generic standardised questionnaires were investigated RESULTS: The cluster analysis revealed two heterogeneous groups: the FD (n=203, 75.7%) and DV (n=65, 24.3%). MANOVA showed significant differences between both groups (Wilks' lambda: F (14,253)=30.97; p<.001); especially the emotional pain characteristics were relevant. CONCLUSION: The study contributes to the methodological stability of two postulated groups. Thus further research should foster the development of risk-based interventions to evaluate if these groups offer an appropriate differentiation in rehabilitation.

[A comparison of multimodal programmes of patient education in the rehabilitation of chronic low back pain]. / Multimodale Interventionsprogramme in der Rehabilitation von Patienten mit chronischen Rückenschmerzen--Ein Vergleich.

There is growing evidence for the effectiveness of multimodal intervention concepts for chronic low back pain in the international literature, and accordingly several German rehabilitation programmes for the treatment of chronic low back pain patients have been developed. Focus of this paper is to describe and compare frequently used German multimodal intervention programmes for in- and outpatient rehabilitation of patients with chronic low back pain. Programmes were chosen by searching the most relevant online resources as well as the online pages of Deutsche Rentenversicherung and Zentrum Patientenschulung during September 2008. Keywords guiding the search were: Patientenschulung, Rückenschmerzen, Manual, psychologische multimodale Interventionskonzepte, Rehabilitationsprogramm, psychology, intervention, low back pain, manual and therapy. By this means, six manually supported multimodal rehabilitation programmes for the in- and outpatient therapy of patients with chronic back pain could be identified: Göttinger Rücken-Intensiv-Programm (GRIP), the psychological programme for chronic head- and low back pain, the Münchner Rücken-Intensiv-Programm (MRIP), Back to Balance, Arbeiten und Leben--Back to Balance (ALEBABA) und Rückenfit: Lebenslust statt Krankheitsfrust. These programmes are depicted and compared with regard to their potentials and limitations in supporting the rehabilitation process of patients with chronic low back pain. While comparing the programmes, a number of similarities between them can be detected, as well as pronounced differences, e. g., regarding settings and complexity. In most programmes, lack of appropriate evaluation studies and lack of aftercare turn out to be critical aspects.

[Pain staging, gender, and rehabilitation outcome in chronic low back pain. A pilot study]. / Schmerzchronifizierung, Geschlecht und Rehabilitationserfolg bei chronischem Rückenschmerz. Eine Pilotstudie.

BACKGROUND: Current biopsychosocial models of the etiology and chronicity of back pain postulate a major impact of psychological factors in the process of back pain chronicity. PARTICIPANTS AND METHODS: Effects of gender and pain staging on rehabilitation outcome were examined immediately after and 3 and 6 months after rehabilitation in 121 patients with chronic low back pain (43 women, 78 men; M=48 years; ICD-10 diagnoses M54.4/M54.5). Pain was staged using the Mainz Pain Staging System. RESULTS: In the short and mid term, patients in stage I and women benefited from rehabilitation. Rehabilitation outcomes tended not to be improved for men in stage III. CONCLUSIONS: Results support the notion that rehabilitation outcome is significantly influenced by pain staging and gender. Thus, clinical-psychological and gender-specific interventions should be incorporated in future therapeutic regimens to increase the rehabilitation outcomes in patients with higher chronicity of back pain.

[Social inequality as a predictor of occupational reintegration of chronic back pain patients following medical rehabilitation]. / Die Bedeutung sozialer Ungleichheit als Prädiktor für die berufliche Wiedereingliederung von chronischen Rückenschmerzpatienten nach medizinischer Rehabilitation.

BACKGROUND: The question of which factors influence return to work following medical rehabilitative measures in the case of chronic back pain is, in a social political context, of international significance. While psychosocial, socio-economic and demographic factors as well as subjective perceptions of working conditions are individually discussed, the role of social inequality has thus far received little attention. OBJECTIVE: The present paper focuses on the occupational reintegration of patients with chronic dorsopathies following a medical rehabilitative intervention and aims to investigate the influence of predictor variables on successful reintegration. METHODS: The re-analysis conducted was based on a three-year prospective controlled intervention study with three measurement sessions. The study comprised a sample of 289 patients aged 20 to 64 years who had undergone first-time intervertebral disc operations in the lumbar spine region. Data were collected between March 2002 and February 2005 using a standardized written questionnaire. Winkler's (1998) composite index comprising indicators of occupational position, income and education was employed as a measure of social inequality. Age and sex were also included as independent variables in a binary logistic regression analysis. RESULTS: Of individuals undergoing rehabilitation, those from lower social classes returned to work later than those from higher social classes. Age and sex did not prove to be significant predictors of successful return to work. DISCUSSION: The probability of successful reintegration into working life increases according to the position within the vertical structure of social class. In light of this result, it can be assumed that not only differential allocation of patients to rehabilitation interventions but also the specific contents of these interventions should be modeled on the basis of economic criteria.

[The new curriculum for surgery in Hamburg, Germany]. / Integrierte operative Medizin: Die studentische Ausbildung in der Chirurgie in Hamburg.

In October 2004, the medical faculty of Hamburg University started a program to restructure completely clinical teaching according to new state regulations of June 2002. In this new curriculum design, the surgical disciplines were horizontally and vertically interconnected and integrated, with a focus on practical training and problem-based teaching. This study describes the concept of clinical teaching and presents the student evaluation results of the first four blocks with a focus on performance in surgical disciplines. There was high student satisfaction with the new program, compared with results before October 2004 and also with respect to other disciplines within the new curriculum. This was especially true for the practical courses in the newly established skills lab. Future developments in e-learning and practical teaching in the skills lab are necessary to overcome restrictions on medical education due to changes in the German health care system.

[Changes of teaching in the interdisciplinary subject "rehabilitation, physical medicine, naturopathic treatment" in the German medical faculties 2004 to 2006/07]. / Entwicklung der Lehre im Querschnittsbereich "Rehabilitation, Physikalische Medizin, Naturheilverfahren" an den medizinischen Fakultäten 2004-2006/07.

BACKGROUND: Rehabilitation, Physical Medicine, Naturopathic Treatment (Querschnittsbereich Q-12) was introduced as a compulsory interdisciplinary subject in the revised Federal Medical Licensing Regulations (Approbationsordnung für Arzte) in October 2003. This offered the opportunity to increase the students' interest in rehabilitation-related issues and to integrate current evidence of rehabilitation research. The implementation of the Q-12 in the German medical faculties was investigated by yearly questionnaires during a three-year-period. METHODS: In 2004, 2005, and 2006/07 anonymous postal questionnaires concerning the teaching in Q-12 were sent to the 36 medical faculties in Germany. Non-responders were reminded at least once by a repeat postal questionnaire. RESULTS: The response rates were 67% in 2004, 72% in 2005, 50% in 2006/07, respectively. Of the 36 faculties 34 responded at least once. Ten faculties responded to all questionnaires. In a considerable number of faculties, Q-12 is being coordinated by university institutions which are not denominated as one of the subjects designated in the Q-12 title. Major differences regarding the implementation of Q-12 were found between the faculties. Further development of Q-12 faces several limitations of resources. Almost all faculties provide curricula for teaching Q 12, some of which are still incomplete. During all three examinations lecturer-centered teaching methods (lectures, seminars, other presentations) were used most frequently. POL-cases and other structured patient oriented teaching were also reported less frequently. E-learning was very rarely offered to the students. Musculoskeletal and neurological disorders were the most frequent specific indications for practice-related integration of Q-12 issues. Compulsory election subjects (Wahlpflichtfächer) related to Q-12 issues before and during the final year of the medical students, are not being offered by all faculties. The vast majority of the faculties advocate an exchange of materials for teaching and examinations. CONCLUSIONS: During the three examinations, major differences concerning the implementation of Q-12 were found between the faculties. Therefore, it is recommended that all faculties verify whether they adequately cover the joint educational objectives recommended for Q-12 by two German scientific societies. Furthermore, the more frequent application of up-to-date practice-oriented teaching and examination methods, an intensified implementation of Q-12-related issues in teaching specific indications, the completion of curricula, enhanced offer of compulsory election subjects related to Q-12 issues, continued scientific investigations and symposia/workshops concerning the promotion of Q-12-related teaching as well as the generation and exchange of teaching and examination materials are recommended.

[Organization of methodological support and cross-project research activities in multicenter research programmes - experiences of the centers for methodological support within the "rehabilitation science" research network]. / Organisation methodischer Beratung und projektübergreifender Forschungsaktivitäten in multizentrischen Forschungsprogrammen - Erfahrungen der Methodenzentren im Verbundforschungsprogramm Rehabilitationswissenschaften.

On completion of the funding period of six years within the federal programme for research in medical rehabilitation, an evaluative summary is given of the work performed and the experiences made in the cross-sectional projects offering methodological support. While specific research profiles had prevailed in each of the eight regional research networks, two institutions had been implemented with similar task assignments within all networks; i. e., (i) a central office, and (ii) a center for methodological support (CMS) had been available in order to enhance methodological research infrastructure and research quality of the clinical projects. This article outlines the support offered as well as further tasks of the CMS. Further, it is argued that organized, scientifically based methodological support and consultation should be part of any research network. Finally, a number of important aspects are discussed which should be taken into account to enhance research quality in medical rehabilitation in the future.

[Problem oriented learning (POL) in rehabilitation on the example of a patient with ankylosing spondylitis]. / Problemorientiertes Lernen (POL) in der Rehabilitation am Beispiel eines Patienten mit Spondylitis ankylosans.

Through innovative teaching and learning methods relevant topics in rehabilitation can be conveyed effectively. Therefore, in this paper a papercase for problem-oriented learning (POL) is presented concerning rehabilitation in rheumatology, exemplified by a patient with ankylosing spondylitis. This papercase can be applied in the integrated course Rehabilitation, Physical Medicine and Naturopathic Treatment, the curricular part of teaching rehabilitation during the medical training according to the 9 (th) revision of the Federal Medical Licensing Regulations (Approbationsordnung). In addition the teaching material presented can be used in other courses, such as elective courses for non-medical professionals of the interdisciplinary rehabilitation team. First experiences gathered with the papercase in the Health and Nursing Sciences study programme of the Faculty of Medicine of Martin-Luther-University Halle-Wittenberg are reported.

[Current teaching, learning and examination methods in medical education and potential applications in rehabilitative issues]. / Aktuelle Lehr-, Lern- und Prüfungsmethoden in der medizinischen Ausbildung und ihre Anwendungsmöglichkeiten für die Rehabilitation.

With introduction of the new Federal Medical Licensing Regulations (Approbationsordnung) in Germany, integrated teaching in "Rehabilitation, Physical Medicine, Naturopathic Treatment" (Querschnittsbereich Q12) has become obligatory for the first time. Furthermore, the new Regulations require the medical faculties in Germany to realize an innovative didactic orientation in teaching. This paper provides an overview of recent applications of teaching techniques and examination methods in medical education with special consideration of the new integrated course Q12 and further teaching methods related to rehabilitative issues. Problem-oriented learning (POL), problem-based learning (PBL), bedside teaching, eLearning, and the examination methods Objective Structured Clinical Examination (OSCE) and Triple Jump are in the focus. This overview is intended as the basis for subsequent publications of the Commission for Undergraduate and Postgraduate Training of the German Society of Rehabilitation Science (DGRW), which will present examples of innovative teaching material.

[Methods in health services research. The example of the evaluation of the German disease management programmes]. / Methodische Ansätze in der Versorgungsforschung. Das Beispiel Evaluation der Disease-Management-Programme.

According to the established definition of Pfaff, health services research analyses patients' path through the institutions of the health care system. The focus is on development, evaluation and implementation of innovative measures of health care. By increasing its quality health services research strives for an improvement of efficacy and efficiency of the health care system. In order to allow for an appropriate evaluation it is essential to differentiate between structure, process and outcome quality referring to (1) the health care system in its entirety, (2) specific health care units as well as (3) processes of communication in different settings. Health services research comprises a large array of scientific disciplines like public health, medicine, social sciences and social care. For the purpose of managing its tasks adequately a special combination of instruments and methodological procedures is needed. Thus, diverse techniques of evaluation research as well as special requirements for study designs and assessment procedures are of vital importance. The example of the German disease management programmes illustrates the methodical requirements for a scientific evaluation.

[Chances for advancement of outpatient rehabilitation in Germany]. / Weiterentwicklungsmöglichkeiten der ambulanten Rehabilitation in Deutschland.

Rehabilitation has a long tradition in Germany compared to other countries and is based upon a differentiated, social law foundation. Rehabilitative offers are provided as standard benefits by different social insurance schemes (pension insurance, health insurance, accident insurance, etc.) and are an independent task of care not included in acute care. A high degree of institutionalisation and specialisation are specific characteristics of rehabilitation in Germany. A country-wide network of indication specific, mostly larger institutions is available for medical rehabilitation in Germany. This emergence of centres and the location of many institutions in more rural regions give rise to the fact that rehabilitation often cannot take place close to the places of residence of those who are in need of rehabilitative offers. Until the mid-nineties, rehabilitative benefits have been performed almost exclusively on an inpatient basis, which is another characteristic of medical rehabilitation in Germany. Since then the discussion about ambulant rehabilitation has been increasing. Several initiatives are aimed at supplementing the present in-patient offers through ambulant measures. This article describes and analyses the present efforts for the development of ambulant rehabilitation. In reference to the guidelines of the BAR (Federal Rehabilitation Council) concerning ambulant medical rehabilitation, adopted by all institutions involved in 2000, the current situation and the state of implementation are discussed, and advancements necessary in the authors' view are considered.

[Are there class-specific disadvantages in utilization of medical rehabilitation?]. / Gibt es schichtspezifische Benachteiligungen bei der Inanspruchnahme von medizinischen Reha-Massnahmen?

Many studies prove the fact that the risk for morbidity and mortality is increased in lower social classes. Most chronical diseases also accumulate in lower classes. However, data are missing as to whether this social disadvantage also affects the use of medical rehabilitation, which could supply support in dealing with the consequences of such diseases. On the basis of questionnaire data of 3021 insures of the LVA pension insurance fund for workers, it was examined whether there are class specific differences in the need for medical rehabilitation and in the intention of insures to apply for such a measure and which kind of class specific barriers and attitudes may hinder the application. The results first of all confirm that insured of lower social classes are specially health strained and have a particular demand for rehabilitative offers. The insured, however, quite rarely rate themselves as requiring rehabilitation, whereas there is no significant class specific difference in the intention to apply for rehabilitation. There are significant differences in the attitudes which influence application for medical rehabilitation. Above all, there are economic considerations and job-related fears which hinder lower class insurees to apply for medical rehabilitation. This calls for action regarding implementation of special screenings and counselling.

[Testing and validation of the German version of the Stroke Impact Scale]. / Fragebogen über die Folgen eines Schlaganfalls. Testung und Validierung der deutschen Version der "Stroke Impact Scale".

Suitable and psychometrically tested instruments to assess health-related quality of life in stroke patients are still lacking in German speaking countries. The current paper describes the translation and psychometric testing of the German version of the Stroke Impact Scale, which was developed as a self- and proxy- report measure in the United States to assess the consequences of a stroke. The instrument contains 64 Likert-scaled items and assesses eight dimensions of health-related quality of life ("strength", "memory and thinking", "emotion", "communication", "ADL/IADL", "mobility", "hand function", and "participation"). The questionnaire was used in a cross-sectional study of 137 persons with stroke and was psychometrically tested. The results of this psychometric testing show a good acceptance on part of the interviewees. Convergent validity of the SIS dimensions was assessed with correlation of the SIS subscales and subscales of the short form SF-36 and Nottingham Health Profile and criteria-related validity was examined by comparison of mean scores across groups defined by Rankin scores. The reliability of the questionnaire was determined through internal consistency (Cronbach's). The German version of the SIS is a reliable and valid instrument to assess health-related quality of life, but more studies are needed to make statements about sensitivity of the instrument, psychometric quality of the proxy version and suitability of the questionnaire for specific stroke subgroups.

The sick-building-syndrome--do women suffer more?

According to recent literature reviews, women seem to be especially prone to report symptoms of the so-called Sick-Building-Syndrome. In a large German study into the Sick-Building-Syndrome (the ProKlimA-project) 4596 persons from 14 buildings around Germany filled out a questionnaire regarding Sick-Building-symptoms and potential psychosocial determinants. The present article presents questionnaire results from 2517 female employees (as compared to 2079 male employees) which showed that women report higher scores in sensory irritation, a higher bodily complaint rate and more negative evaluation of the indoor climate. In addition most psychosocial variables showed less favourable scores for women as compared to men. Gender stratified logistic regression analysis suggests an effect of less favourable working conditions under which women are employed. Thus although women are more prone to express impairments in wellbeing, such expression has to be critically evaluated against the background of their living and working conditions.