[Development of Practice Guidelines for Psychological Interventions in the Rehabilitation of Patients with Type 2 Diabetes: Methods and Results]. / Entwicklung von Praxisempfehlungen für psychologische Interventionen in der Rehabilitation von Patienten mit Typ-2-Diabetes: Methoden und Ergebnisse.

Purpose: The goal of the project was to develop evidence- and consensus-based practice guidelines for psychological interventions in the rehabilitation of patients with type 2 diabetes. Method: The practice guidelines were developed in several steps including a literature search, surveys of clinicians (psychologists and head physicians from rehabilitation centres) and an expert workshop. National experts from scientific departments, rehabilitation centres and patients were engaged in the development of the practice guidelines. Results: The recommendations refer to problems in the field of mental functions, body functions, environmental and personal factors. It is described (a) how specific problem areas can be detected (e. g., using screening-instruments), and (b) which psychological interventions are indicated when a specific problem area has been identified. Conclusions: The practice guidelines offer a practical decision support for psychological interventions in the rehabilitation of patients with type 2 diabetes.

[Current Practice of Dealing with Comorbid Problematic Substance Use in Non-Specialized Rehabilitation Settings: A Survey in German Somatic and Psychosomatic Rehabilitation Centres]. / Gegenwärtige Praxis des Umgangs mit komorbidem problematischem Suchtmittelkonsum in nicht auf Sucht spezialisierten Rehabilitationseinrichtungen--Ergebnisse einer deutschlandweiten Befragung.

STUDY OBJECTIVE: The current practice of dealing with comorbid problematic substance use in non-specialized somatic and psychosomatic rehabilitation centres is described. METHODS: A nationwide survey of rehabilitation centres across all indications was conducted. RESULTS: Incidents related to substance use within the past 12 months were reported by every centre participating in the survey. Even though these incidents occurred rather infrequently, 85% of the respondents stated that the opportunity should be used to address the topic of problematic substance use with all patients. At the same time the issue is discussed controversially by staff members in 42% of the centres, and 29% of the respondents state that there is a need to change the way this issue is dealt with. CONCLUSION: It seems necessary to strengthen the awareness of the problem as well as the professional confidence in dealing with it. In order to support identification of and dealing with problematic substance use, appropriate practice guidelines for the somatic and psychosomatic rehabilitation settings are needed. The present survey constitutes a basis for developing such practice guidelines.

[Structures and Practice of Psychological Services in Oncological and Diabetological Rehabilitation: Results of a Nationwide Survey]. / Strukturen und Praxis der psychologischen Abteilungen in der onkologischen und diabetologischen Rehabilitation: Ergebnisse einer bundesweiten Befragung.

OBJECTIVE: To study the structural frame conditions and the contents of psychological activity in oncological rehabilitation as well as in rehabilitation of patients with type 2 diabetes. METHODS: We conducted a nationwide survey of psychological services in rehabilitation facilities treating oncological patients and patients with type 2 diabetes. RESULTS: 71 (of 145) oncological and 21 (of 63) diabetological rehabilitation facilities participated in the survey. In both indication areas an average of 1.1 psychologists is in charge of 100 patients. Between some rehabilitation facilities, however, there are considerable differences concerning the psychologist/patient ratio (in oncological rehabilitation facilities: standard deviation (SD)=0.52; in diabetological rehabilitation facilities: SD=0.35). Moreover, there is large heterogeneity among rehabilitation facilities as to the percentages of patients obtaining psychological interventions and the way in which psychological services allocate their working time. CONCLUSION: The general set-up of psychological services in oncological and diabetological rehabilitation facilities (especially the low psychologist/patient ratio in many facilities) can partly be considered insufficient. The heterogeneity with respect to the structural frame conditions and practice of psychological services reveals the low degree of standardization of psychological activity in both indication areas.

[Collaborative Goal Setting in Rehabilitation (ParZivar II): Evaluation of an Intervention in Patients with Chronic Back Pain]. / Partizipative Zielvereinbarung in der Rehabilitation (ParZivar II): Evaluation einer Intervention bei Patienten mit chronischen Rückenschmerzen.

OBJECTIVE: The "ParZivar II" project had 2 aims: optimization of the "ParZivar I" intervention by individual coaching of physicians, and evaluation of the optimized intervention. METHODS: The intervention was evaluated in a sequential control group design in 4 rehabilitation facilities with 3 measurement points. A total of n=279 patients with chronic low back pain participated in the study. RESULTS: The optimized intervention shows the potential to statistically significantly improve proximal outcomes (e. g. goal-centric processes or patient-physician interaction). Regarding distal outcomes, no statistically significant differences were found. CONCLUSION: The "ParZivar" intervention is a suitable approach to increase participative goal setting. Due to the complexity of the intervention, problems of dissemination and the potential for improvement in study design, there is a need for further research.

[(Neuro)psychological Rehabilitation after Stroke: a National Survey of Structures and Practice in Inpatient and Outpatient Neurological Rehabilitation]. / Die (neuro-)psychologische Rehabilitation nach Schlaganfall: Eine bundesweite Befragung zu Strukturen und Praxis in der stationären und ambulanten neurologischen Rehabilitation.

STUDY OBJECTIVE: Structures and practice of psychological units in neurological rehabilitation centres treating post-stroke patients are described. METHODS: A nationwide survey of psychological services in neurological rehabilitation centres was conducted. RESULTS: Psychologist-patient ratios differed greatly among rehabilitation centres. Post-stroke patients showed a variety of complex problems. Psychological interventions mainly comprised diagnostic evaluation as well as individual interventions and cognitive training. CONCLUSION: The complex and manifold problems of patients in neurological rehabilitation require a comprehensive knowledge of (neuro)psychological functioning. In order to support appropriate and individual treatment decisions, practice guidelines for psychological interventions in the rehabilitation of post-stroke patients are necessary. The present survey constitutes the basis for developing such practice guidelines.

[Feasibility and benefit of an active screening for rehab need and subsequent written advice to file an application for rehab treatment in AOK-insurants enrolled in the disease management program diabetes type 2 (PARTID-trial)]. / Praktikabilität und Nutzen eines aktiven Screenings auf Rehabedarf mit anschließender schriftlicher Beratung zur Rehaantragstellung bei AOK-Versicherten im Disease-Management-Programm Diabetes Typ 2 (PARTID-Studie).

BACKGROUND AND STUDY AIMS: Type 2 diabetes (DM II) is the world's most widespread metabolic disease. Numerous investigations have demonstrated that intensive, multimodal interventions can reduce the occurrence of DM-associated comobidities and mortality. Medical rehabilitation could offer such an alternative, albeit one with an obvious time limit. There is currently no active program in Germany designed to screen for pa-tients' need for rehab. Here, we investigated -whether screening for rehab need in DMII pa-tients accompanied by written advice to file an application for rehab treatment would generate a relevant number of rehab measures, whether -inpatient rehab results in improved mid-term prognoses, and which patients demonstrate a particular benefit from such a program. METHODS: We screened 5 500 employed individuals aged 18-54 years for their need for rehab via an extensive questionnaire based on the "Lübeck Algorithm". The patients were registered in the DMP (disease management program) Diabetes mellitus Type 2 in the AOK Rheinland/-Hamburg health insurance division, and payed into DRV (German statutory pension insurance -scheme) Rheinland retirement insurance. Pa-tients needing rehab who presented no exclusion criteria (i. e., for a rehab intervention far from their place of residence) were randomized to a control or intervention group at a ratio of 3:1. Patients in the intervention group received a letter from the AOK advising them to fill out an application for rehab. A very short, simple application form was included in the mailing. 12 months after randomization we conducted a query to determine the effects of rehab. Our primary endpoint was a cardiovascular risk score specifically devised for diabetics. Multi-level models were applied to measure changes in cardiovascular risk. RESULTS: 850 patients (rate of return=16%) returned completed screening forms to us. After having excluded those with faulty diagnoses and/or those who had refused to participate, 829 patients remained. 94% of them presented a need for rehab according to specific criteria (39% with a simple and 55% with complex problem profiles). 266 patients stated in the questionnaire that a rehab program was impossible for them for personal reasons. Of those patients who remained, we randomized 299 to the intervention cohort and 102 to the control group. Almost 70% of the intervention group completed an application for rehab, and our follow-up revealed that most of them participated in a rehab intervention. Return rate after one year was 82%. Analysis on the intention-to-treat (ITT) principle revealed no significant effect on cardiovascular risk (p=0.68); however, per-protocol analysis demonstrated a significant effect in the intervention cohort (p=0.025). Males, and patients with an uncomplicated problem profile profited from the intervention. DISCUSSION: We discovered that a proactive procedure leads to the identification of a highly relevant group of insured individuals, and that it is suited to generating a large number of medically -justified rehab applications. ITT analysis on the effi-cacy of inpatient rehabilitation for type 2 diabetes mellitus in terms of the cardiovascular 5-year risk, however, failed to display a significant statistical effect in this study population (insurees of generally lower socioeconomic status having no intention to apply for rehab treatment). Rehab treatment for type 2 diabetes does not seem to be universally effective. This of course does not apply to rehab in general, as patients usually participate in rehab of their own volition. More research is needed on this issue.

[Professional self-perception, resources, stress and job satisfaction of psychologists in rehabilitation centres]. / Berufliches Selbstverständnis, Ressourcen, Belastungen und berufliche Zufriedenheit von Psychologen in rehabilitativen Einrichtungen.

OBJECTIVE: Psychologists from rehabilitation centres were surveyed about their current job situation. Following areas were included: (a) professional self-perception, (b) occupational resources and stress, (c) job satisfaction. METHODS: A nationwide survey of psychologists of all rehabilitation centres in Germany was conducted. Overall, 1,461 rehabilitation centres of all specialties were contacted in writing, of which 623 psychologists participated in the survey. Some of the results can be compared with reference data from previous surveys. RESULTS: The professional self-perception has hardly changed over the last 10 years. Counselling and psychotherapy in one-to-one sessions and group interventions still play an essential role. Overall, job satisfaction and resources are high. General job satisfaction can be best predicted by career opportunities and opportunities for qualification. CONCLUSIONS: The results of the study indicate which resources should be strengthened in order to enhance job satisfaction of psychologists in medical rehabilitation. Particular thought should be given to improving career opportunities for psychologists in rehabilitation centres.

[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.

[Proactive screening for rehabilitation need in type 2 diabetics from an AOK Disease Management Programe: which patients will be identified?]. / Proaktives Screening nach Rehabilitationsbedarf bei Typ-2-Diabetikern im Disease-Management-Programm einer AOK: Welche Patienten können identifiziert werden?

BACKGROUND: Medical rehabilitation seems suitable for implementing multimodal interventions for the treatment of type 2 diabetes. Rehabilitation in Germany on principle requires that insurees file an application. Proactive screening for rehabilitation need has only been explored in pilot projects so far. It seems a promising attempt to assess rehab need by questionnaire especially in patients with type 2 diabetes. We do not know though how patients who have been screened positive for rehab need differ from other patients with type 2 diabetes as to their health and risk profiles. This could provide an indication of the validity of the proactive approach. METHODS: Members of an Allgemeine Ortskrankenkasse (AOK) Disease Management Program (DMP) for type 2 diabetes were screened for rehab need by questionnaire. 13 diabetes-specific problem areas were assessed. Problems were assigned to 10 specific treatments (problem-treatment-pairs). Rehab need was presumed if patients needed 3 or more treatments. Patients were then compared to regular rehab patients as well as patients with type 2 diabetes from primary care medical offices. RESULTS: From 5500 DMP-patients 829 returned the questionnaire (return rate: 15.5%). From these 94% met the criteria for rehab need; of these 55% needed 6 or more treatments (complex problems). Patients who screened positive for rehab suffered from more health problems and had worse risk profiles as compared to patients from medical offices, and disease burden was comparable or worse as compared to regular rehab patients. CONCLUSIONS: This indicates that proactive screening for rehab need in patients with type 2 diabetes leads to reasonable (valid) results. The very low return rate suggests that the sample may be considerably biased, though. Possibly, mainly patients with greater impairment to health responded to the screening.

[Work place health promotion programmes of the statutory German Pension Insurance]. / Betriebsnahe Präventionsprogramme der Deutschen Rentenversicherung.

BACKGROUND: In 2009, the amendment of § 31 Abs. 1 Nr. 2 SGB VI gave the German Pension Insurance the opportunity to provide outpatient medical treatments for insured people who have an occupation with particularly high risk of health. Ever since, the German Pension Insurance has developed various work place prevention programmes, which have been implemented as pilot projects. This article aims at systematically recording and comparatively analyzing these programmes in a synopsis which meets the current state of knowledge. METHODS: We developed an 8 page questionnaire focusing on work place prevention programmes by the German Pension Insurance. This questionnaire was sent to people in charge of all programmes known to us. RESULTS: All programmes have been drafted -across indications. They are aiming at insured people who already suffer from first health disorders but who are not in imminent need of rehabilitation. However, the concrete target groups at which the specific programmes are aimed differ (shift workers, nurses, elderly employees). Another difference between the various programmes is the setting (in- or outpatients) as well as the duration. CONCLUSION: All programmes are using existing structures offered by the German Pension Insurance. They provide measures in pension insurance owned rehabilitation centers. It would be desirable to link these performances with internal work place health promotion and offers of other social insurances.

[Development of practice guidelines for psychological interventions in the rehabilitation of patients with chronic low back pain: methods and results]. / Entwicklung von Praxisempfehlungen für psychologische Interventionen in der Rehabilitation von Patienten mit chronischen Rückenschmerzen: Methoden und Ergebnisse.

PURPOSE: The aim of this study was to develop evidence- and consensus-based practice guidelines for psychological interventions in the rehabilitation of patients with chronic low back pain. METHOD: The practice guidelines have been developed systematically in several steps. Experts from scientific departments and rehabilitation centres as well as rehabilitation patients participated in the development of the practice guidelines. In addition, a draft of the practice guidelines was circulated among head psychologists and chief physicians of somatic orthopaedic rehabilitation centres for their comments and approval. RESULTS: The final practice guidelines comprise recommendations regarding systematic screening and diagnostics of psychologically relevant problems. Furthermore, they include suggestions for the organisation of psychological interventions addressing specific problems. CONCLUSIONS: The detailed, evidence- and consensus-based practice guidelines offer an orientation for psychological practice in the somatic rehabilitation of patients with chronic low back pain.

[Empirically derived recommendations for measuring patient-reported change in rehabilitation studies]. / Empirisch gestützte Empfehlungen für die patientenberichtete Veränderungsmessung in der medizinischen Rehabilitation.

Diverse methods are available for evaluation of (medical) interventions. In each case one has to decide on a specific method. Our aim was to analyze typical problems involved in the measurement of change. Different methods are delineated, and their specific pros and cons are set out. Subsequently, empirically derived recommendations are outlined on which method should be employed for which problem and under which circumstances. A characteristic of rehab treatment is that as a rule a multitude of problems are addressed, and accordingly, treatment goals are heterogenic. Straightforward recommendations for one or the other method cannot be given.

[The development of practice guidelines for psychological interventions in the rehabilitation of patients with coronary heart disease: methods and results]. / Die Entwicklung von Praxisempfehlungen für psychologische Interventionen in der Rehabilitation von Patienten mit koronarer Herzkrankheit: Methoden und Ergebnisse.

Available guidelines and treatment standards are not sufficiently detailed to give practical guidance for psychological interventions in the rehabilitation of patients with coronary heart disease. We therefore aimed at developing evidence- and consensus-based practice guidelines for psychological interventions in the rehabilitation of individual patients with coronary heart disease. The following steps were taken: (1) A systematic search for guidelines and reviews, and a survey of rehabilitation centres concerning present structures and the practice of psychological services, (2) development of a first draft of the practice guidelines in an expert workshop, (3) a survey of all senior psychologists and chief physicians of the rehab centres for their approval, as well as focus groups with rehab patients, and (4) revision of the recommendations and final consensus development in an expert workshop. Significant aspects of the guidelines that go beyond present practice are routine screening for psychological comorbidity, neuropsychological screening for cognitive dysfunction in particular patients, and employment of defined psychologically grounded interventions by the entire rehab team. So far, the practice guidelines have been widely accepted by professionals in the field of rehabilitation.

[Psychological interventions in the rehabilitation of patients with coronary heart disease: summary of evidence and recommendations from systematic reviews and guidelines]. / Psychologische Interventionen in der Rehabilitation von Patienten mit koronarer Herzerkrankung: Zusammenfassung der Evidenz und der Empfehlungen aus systematischen Übersichtsarbeiten und Leitlinien.

OBJECTIVE: To summarize national and international evidence and recommendations for psychological interventions in the rehabilitation of patients with coronary heart disease. Background is a project for the development of evidence-based practice guidelines for psychological interventions in the rehabilitation of patients with coronary heart disease. METHODS: A systematic literature search in several databases and on the websites of professional associations was conducted in order to identify relevant reviews and guidelines. A handsearch was conducted in addition to the electronic search. Eligible publications were selected, and evidence for psychological interventions was extracted as well as recommendations relative to psychological diagnostics or interventions. RESULTS: 5 systematic reviews and 34 guidelines were included. Recommendations and (partially restricted) evidence from systematic reviews was found for the following psychological interventions: patient counselling and health education; screening and treatment of comorbid psychological disorders; occupational counselling; stress management; relaxation training; interventions for smoking cessation; interventions promoting appropriate nutrition and weight management; interventions enhancing sufficient, regular physical activity; interventions enhancing social support; specific interventions for women; involvement of family members or partners; discussion of sexual activity. DISCUSSION/CONCLUSION: For several psychological interventions in the treatment of patients with coronary heart disease we found empirical evidence from systematic reviews. For other psychological interventions, no empirical evidence from systematic reviews was found. The summary of guidelines shows that both in Germany and abroad, a number of psychologically grounded interventions are an inherent part of cardiac rehabilitation. However, many recommendations which refer to psychological diagnostics and interventions are not precise enough to guide psychological care of individual patients. In particular, there are no statements in many guidelines on which (psychological) treatments should be considered for which problems. Moreover, hardly any evidence or recommendations were found for specific interventions referring to special groups of patients (e.g., women, patients with low socio-economic status or migration background). Further research is needed in these respects in order to answer questions concerning the indication and effectiveness of such tailored interventions.

[Use of trajectories for measuring change in medical rehabilitation: a contribution toward comparison of different methods of outcome measurement]. / Verwendung von Verlaufstypen zur Veränderungsmessung in der medizinischen Rehabilitation: Ein Beitrag zum Vergleich verschiedener Methoden der Ergebnismessung.

OBJECTIVE: The question of which methods should be used to assess the effects of medical rehabilitation has a long and controversial history. With regard to this background the project "Outcome measurement in medical rehabilitation" aimed at developing a better understanding of the process of change and its assessment. We also looked into possible causes for discrepancies between the results of direct and indirect measures of change. Aims of our study were: (1) to picture trajectories of change in a simple and descriptive way, (2) to compare the resulting solutions, (3) to highlight relations with direct measurement of change and/or global estimation of effects, (4) to compare the predictive value of different measurements of change. METHODS: We used available data from rehabilitation research which covered direct and indirect measurement of change as well as global measurement of effects and which therefore enabled us to compare different methods of outcome measurements. The well documented record includes data from n=466 patients with chronic back pain. Different trajectories (3 and 5 groups) were defined using their pre/post data. RESULTS: Depending on limits chosen for positive or negative courses and chosen outcome 20% to almost 40% of the patients showed improvements over the follow-up period. About the same percentages changed for the worse. However, two-thirds of the patients improved at least in one outcome. Compared with those, who did not experience improvements in any outcome, this group indicated better global rehabilitation effects. The different types of trajectories (3 and 5 groups) substantially contribute to the explained variance of catamnestic status at 12 months beyond other predictors as well as beyond initial status. The same applies to the prediction of disability days. CONCLUSION: The description of trajectories of change yields useful results. In contrast to complex statistical methods we were able to identify groups of patients that can easily be described.

[Structures and practice of psychology departments in orthopaedic and cardiac rehabilitation: a comparison of outpatient and inpatient clinics in Germany]. / Strukturen und Praxis der Psychologischen Abteilungen in der orthopädischen und kardiologischen Rehabilitation: Vergleich zwischen ambulanten und stationären Einrichtungen in Deutschland.

We aimed at comparing the present structural quality and practice of psychological services in ambulatory (outpatient) and inpatient rehabilitation in Germany.A nationwide survey of psychological services in orthopaedic and cardiac outpatient rehab centres was carried out. Results were compared to those of an identical study of inpatient services that was conducted simultaneously.Data were obtained from 81 ambulatory centres (return rate: 44%). Structures and practice (e. g., diagnostic procedures, psychological interventions) in ambulatory and inpatient rehabilitation only differed marginally. Differences concern the staff/patient ratio which is slightly better in ambulatory centres and some aspects of working conditions (e. g., less assisting staff or supervision).From its beginning, ambulatory rehabilitation in Germany has followed the standards of the inpatient model as far as structural quality and processes are concerned. Psychological practice in the ambulatory setting reflects that too. It is discussed whether the uniformity of ambulatory and inpatient rehabilitation services really is appropriate, or whether a more flexible model (e. g., regarding treatment duration) is needed in the German rehabilitation system.

[The factor structure of direct and indirect methods for measuring change in medical rehabilitation--analyses on item level]. / Die faktorielle Struktur der direkten und der indirekten Veränderungsmessung in der medizinischen Rehabilitation--Analysen auf Itemebene.

AIM OF THE STUDY: The aim of the study was to examine the direct and the indirect change measurement; previous studies comparing the 2 methods demonstrated that they agree only to a limited extent. Analyses of the factorial structure have shown that indicators of direct change measurement were assigned regardless of the content of a dimension common to them. This paper examined whether previous results obtained on scale level were also valid on item level. METHODS: Empirical data were obtained from 3 rehabilitation patient samples (n=466, n=194, n=610). The factorial structures of the direct and indirect measurements of change were assessed and compared using principal components analysis with oblique rotation. Additionally, analyses were performed stratified across clinical indications and only for items of the direct change measurement. RESULTS: The factorial structure of 3 data sets showed that the previously published scale-level results were also valid on item level. Analyses demonstrated only low to medium agreement between the 2 methods of change measurement. The indicators of direct change measurement loaded regardless of their content on one or a few common dimensions, which did not agree with those of the indirect change measurement. CONCLUSION: In considering the 2 methods of measuring change, it is apparent that the standard method of change measurement (indirect change measurement) is suitable to reflect a comprehensive and multi-dimensional representation of changes within the field of medical rehabilitation evaluation.

[Acceptance and practicability of the rehab therapy standards for rehabilitation after total hip and knee arthroplasty - findings of a user survey of the pilot version]. / Akzeptanz und Praktikabilität der Reha-Therapiestandards für die Rehabilitation nach Hüft- und Kniegelenks-Totalendoprothese (TEP) - Ergebnisse einer Anwenderbefragung zur Pilotversion.

Implementation of the pilot version of the rehab therapy standards for rehabilitation following total hip or knee replacement was accompanied by a user survey. This survey allowed rehab centres to comment on the standards and suggest changes.Early 2010 a total of 160 rehab centres that had treated at least 50 German Pension Fund insurees following total hip or knee replacement in 2008 received a written survey together with an overview of performance data according to KTL (Classification of Therapeutic Procedures), data that reflect the degree to which the centres had complied with the requirements of the therapy standards.69% of the centres returned the questionnaire. The centres included predominantly agreed that the rehab standards fulfil the quality attributes "scientific foundation (evidence)", "relevance for day-to-day work", "up-to-dateness", and "inter- and multidisciplinary development". There were no statistically significant differences between centres with previously high or low compliance with the requirements of the standards relative to the ratings given for these global quality criteria. Almost all responders considered comprehensiveness and structure of the standards adequate. Between 55 and 94% found that therapeutic procedures were sufficiently represented by the treatment modules. Minimum percentages of patients requiring the respective treatment were considered adequate for 8 out of 13 modules. Responders suggested restricting continuous passive motion to knee replacement. Psychological interventions were considered less important. Among the main reasons for non-adherence to therapy standards in 2008 were: coding problems, too high demands, contraindications, and shortage of staff. Implementation of the standards was associated with both positive and negative expectations on the part of the rehab centres; an issue raised in addition was the effort involved in internal restructuring.The results of the user survey show that the concept of the rehab standards and its implementation basically are accepted. Criticism had mainly concerned continuous passive motion and the need for psychological interventions. Coding problems should not be overrated since the underlying performance data referred to a period of time before the standards were implemented. General appraisal of the rehab standards was independent of previous performance. This emphasizes the weight of user feedback. The rehab standards already have been revised in light of the results of the user survey.