[Work-Related Medical Rehabilitation (WMR) Care in Psychosomatic Medicine in Comparison with Other Indications]. / Medizinisch-berufliche Orientierung (MBOR) in der Psychosomatischen Rehabilitation im Vergleich zu somatischen Indikationen.

BACKGROUND: So far, there is little data on the quality of work-related medical rehabilitation (WMR)-care in the routine, including from a user perspective. The best data are still available for orthopedic rehabilitation. For psychosomatic rehabilitation, a special need for WMR is known due to the long periods of inability to work and the frequent early retirements. It is unclear how precisely and to what extent WMR services are provided in routine care. METHODS: In 2019, a representative sample (N=34.887) of employed insured persons up to 65 years old, stratified by indication, was surveyed by the German Pension Insurance fund six months after their rehabilitation with the self-assessment tool MBOR-R. In addition, standard data of the rehabilitation provider (RSD) were collected, from which WMR-related therapeutic offer data (KTL) could be taken. Rehabilitants were asked about their return to work as part of the catamnesis. RESULTS: The participation rate in the survey is 29%, complete survey and RSD data are available after exclusion of addiction rehabilitation and post-operative-procedures from a total of 6.128 rehabilitants, of which N=1.460 after psychosomatic rehabilitation. The comparison of indications shows that 37% of the rehabilitation patients need WMR, which is by far the highest rate. WMR care in psychosomatic rehabilitation is still the best developed and most targeted, but still far from the standards required by the pension insurance. More than 50% of the rehabilitants, even after WMR, rate their employment-related treatment offer as too low. These subjective rehabilitation assessments in the MBOR-R questionnaire prove to be a relevant factor for the prognosis of the return to work quotes, in contrast to the documented KTL services, in addition to the need indicators of WMR and the implementation of WMR. DISCUSSION: The results suggest that in the field of psychosomatic rehabilitation, too, increased efforts should be made in the future to offer and expand basic WMR services for all rehabilitants and core and special services for rehabilitants with poor work ability and an increased risk of permanent work disability (BBPL) in routine care. The scope and design of MBOR measures should also be quality-optimized from the user's perspective in order to achieve the greatest possible effects.Limitations of the results result from the restriction to rehabilitants of the German Federal Pension Insurance, to limited participation rates, Limitations of the interpretability of the therapy documentations and due to the study design with a one-point measurement and remembered pre-values.

[Questionnaire to Assess the Work-Related Orientation of Medical Rehabilitation from the Perspective of the Rehabilitants (WMR-R): Cross-Sectional Study Comparing the Short and Long Versions]. / Fragebogen zur Erfassung der medizinisch-beruflichen Orientierung der Rehabilitation aus der Perspektive der Rehabilitanden (MBOR-R): Querschnittsstudie zum Vergleich der Kurz- und Langversion.

BACKGROUND: The user perception of the work-related treatment is of great importance for the further development and success of work-related medical rehabilitation (WMR). The German Pension Insurance Fund (Deutsche Rentenversicherung DRV Bund) has therefore supported the development of the questionnaire WMR-R that can be used to assess the quality of the structure, process and results of work-related rehabilitation treatment from the patient's point of view. This paper presents a short version and compares it with the long version. METHODS: Based on a representative sample stratified by indication, employed rehabilitants up to the age of 65 were randomly selected to be questioned 6 months after their rehabilitation with a long version (N=28276) or a short version (N=6611) of WMR-R. In addition, routine data of the German Pension Insurance Fund were included. 27 items each of the long version and 8 items of the short version are added up to a total score and compared with regard to test statistical quality criteria and sample sensitivity. RESULTS: Participation rates were slightly higher in the short version (31%, N=2115) than in the long version (28%, N=8019). The processing quality in both versions is comparable. The short and long versions correlate with each other at r=0.96 (p<0.01). Both versions have similar validity characteristics and separate well between WMR and standard rehabilitation. Both versions are robust to demographic, disease-related and socio-medical risk factors. Rehabilitants with addiction and psychosomatic as well as neurological diseases rate their rehabilitation as significantly more work-oriented compared to other indications, especially pneumology. DISCUSSION: Due to the low survey effort and the simple evaluation and interpretation, the short version is particularly suitable for routine surveys of WMR care quality. The long version allows a differentiated recording of the WMR offer of rehabilitation facilities in the sense of strength/weakness analyses.

[Who Benefits in Graded Return to Work on Behalf of the German Pension Insurance? Results of a Cohort Study]. / Wer profitiert von Stufenweisen Wiedereingliederungen zu Lasten der Deutschen Rentenversicherung? ­ Ergebnisse einer Kohortenstudie.

BACKGROUND: In view of growing numbers and large expenditures Graded Return to work (GRTW) gained in importance for the German Pension insurance in the last decade. Therefore, the questions were whether GRTW is effective in the German rehabilitation system and if there are any criteria for or against the assignment to GRTW following medical rehabilitation. METHODS: In a large cohort study 40,262 persons were asked to fill out questionnaires at the start of and 15 months after medical rehabilitation. The control group consisted of persons without GRTW after rehabilitation. Propensity Score Matching was used to balance the groups. Primary outcomes were the rate of employment, the rate of invalidity pension k and the time of sick leave in the follow-up. The role function of the SF-36 and mental health (PHQ-4) were defined as secondary outcomes. RESULTS: The matching resulted in 1,009 pairs. The GRTW group had a higher rate of return to work, a lower rate of disability pensions and less weeks of sick leave in the follow-up. Moreover, a higher role function and mental health was observed in the intervention group. The effects were particularly pronounced for patients with a high initial risk of permanent disability as well as higher sick leave prior rehabilitation. CONCLUSION: Following these results there is a clear evidence for the effectiveness of GRTW following medical rehabilitation. GRTW is indicated for persons with prior sick leave of more than 3 months or a high risk of permanent disability (>8 points on the SIBAR scale, Screening Instrument for the Assessment of Need for Occupation Related Treatment in Medical Rehabilitation). For persons with only few weeks of sick leave or at most 5 points on the SIBAR scale there is a clear contraindication.

Effectiveness of Graded Return to Work After Multimodal Rehabilitation in Patients with Mental Disorders: A Propensity Score Analysis.

Purpose Graded return to work (GRTW) is a strategy aimed at bringing people gradually back to coping with a full workload after an extended period of sick leave. This study aims to determine the effect of GRTW in addition to a multimodal rehabilitation on longer-term work participation in people with chronic mental disorders (CMDs). Methods Patients filled out questionnaires at the start of a multimodal rehabilitation and 15 months later. Balanced groups (GRTW, no GRTW) were formed by propensity score matching based on 27 covariates. The primary outcome measures were the return to work (RTW) status at follow-up and the number of days on sick leave during follow-up. Results From 1062 data sets (GRTW 508, no GRTW 554), 381 pairs were matched (age: 47.8 years; 78% female; 65% affective disorders, 28% neurotic or somatic disorders). At follow-up, 88% of the GRTW group had returned to work compared to only 73% of the controls (RR = 1.22, 1.13-1.31). The mean sick leave duration during the follow-up period was 7.0 weeks in the GRTW group compared to 13.4 weeks in the control group (p < 0.001). Additional explorative analyses showed that these effects were only observed in patients with an unsure or negative subjective RTW prognosis. Conclusions Based on this analysis, GRTW in addition to a multimodal rehabilitation is effective in enhancing successful work participation in people with CMDs. Earlier studies showing larger effects in people with a higher risk of a non-RTW were confirmed.

Towards open-source, low-cost haptics for surgery simulation.

In minimally invasive surgery (MIS), virtual reality (VR) training systems have become a promising education tool. However, the adoption of these systems in research and clinical settings is still limited by the high costs of dedicated haptics hardware for MIS. In this paper, we present ongoing research towards an open-source, low-cost haptic interface for MIS simulation. We demonstrate the basic mechanical design of the device, the sensor setup as well as its software integration.

[Experiences of a working group about linking inpatient psychosomatic rehabilitation and outpatient psychotherapy]. / Aus der psychosomatischen Rehabilitation in die ambulante Psychotherapie: Erfahrungen eines Qualitätszirkels zur Vernetzung zwischen Klinik und niedergelassenen Therapeuten.

UNLABELLED: Long waiting times and other reasons make it difficult to carry on outpatient psychotherapy after completion of inpatient psychosomatic rehabilitation. Therefore instant linking between the both settings was provided by a working group. METHODS: Rate of patients taking part, kind of performed outpatient psychotherapy, working state and its change and therapeutic experiences were assessed. RESULTS: 43 patients were referred directly from inpatient psychosomatic rehabilitation to outpatient psychotherapy. 79% came to briefings, 63% started treatment, during which the rate of patients able to work increased from 42% to 67%. Especially in the beginning of therapies structure centered techniques were necessary. DISCUSSION: Results are encouraging, but need to be confirmed by a prospective control group design.

Osseointegration of alumina with a bioactive coating under load-bearing and unloaded conditions.

The aim of the study was to evaluate the osseointegration of Al(2)O(3) coated with a bioactive glass ceramic (BioveritI), in a load-bearing implant model in sheep in comparison to uncoated Al(2)O(3) and to a minimally loaded situation. Both types of implants were inserted into the proximal tibia (load-bearing model) and in a drill hole defect into the tibia diaphysis (minimally loaded model). Under load-bearing conditions, the coating resulted in significantly higher interfacial shear strength and a high amount of mineralized bone in direct contact to the implant surface. In contrast, the uncoated Al(2)O(3) was surrounded by a thick connective tissue layer corresponding to low interfacial shear strength. In the minimally loaded model, however, there was rather a tendency of lower interfacial shear strength in the case of the coated implants. This finding corresponds to the histological results, which showed mineralized bone in the interface of uncoated Al(2)O(3), whereas in the case of the coated implants a thin layer of osteoid was observed. It was suggested that the osseointegration of Al(2)O(3) could be improved by the coating under load-bearing conditions, under which uncoated Al(2)O(3) ceramics cannot directly bind to bone.

Covalent DNA-Streptavidin Conjugates as Building Blocks for Novel Biometallic Nanostructures.

Supramolecular aggregates of DNA, RNA, streptavidin, immunoglobulin, and nanocrystalline metal clusters can be generated by self-assembly on the basis of oligonucleotide hybridization (shown schematically). Following selective immunosorption on surface-immobilized antigen, the biometallic hybrid is detectable by electron microscopy.