K. Spyra

Risikoindex Erwerbsminderungsrente (RI-EMR)

The aim of our study was to identify variables of prognostic relevance for disability pensions (DP) in the register data of the German Pension Fund (GPF) and to use the identified variables to construct a risk index. The study was designed as a case-control study of insurants of the GPF Bund using disability pensioners from 2004-2008 as cases and active insurants as controls. Independent variables were selected from the accumulated register data from 2001-2003. Data of 8,500 men and 8,405 women were analyzed. The strongest predictor of future DP were days of sickness benefits. Men with short-term benefits had 6.1 times higher odds of receiving a DP, while men receiving long-term benefits had even 66.3 times higher odds of receiving a DP. For women, the odds were increased 3.8 and 38.4 times, respectively. The risk index score was calculated by transforming the linear combination of parameter estimators and personal characteristics to values ranging from 0-100. ROC analyses and survival analyses confirmed the prognostic relevance of the index score. Independent samples were used to validate our models. Our results show that the GPF has information which could enable an active strategy to enhance the provision of medical rehabilitation.

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.

Psychometrische Testung eines generischen Assessments zur Erfassung bio-psycho-sozialer Beeinträchtigungen bei Versicherten mit Bewilligung einer medizinischen Rehabilitation

BACKGROUND In Germany, different rehabilitation measures were developed for patients with problems due to their specific chronic disease. The aim of the study was to test a generic assessment tool for a valid identification of disability patterns. This tool can effectively display the demand of specific rehabilitation measures in the medical rehabilitation. METHODS The generic assessment tool was tested in a representative sample of individuals who have been granted a medical rehabilitation by the German Federal Pension Insurance. With this sample, we performed a cross-sectional study. RESULTS Full data were available for 2 530 persons. Our analyses showed good psychometric properties of the integrated instruments concerning missing rate, ceiling and floor effects, reliability and factorial validity. We could identify a 3-dimensional structure of the assessment tool according to the biopsychosocial model. CONCLUSION The presented assessment tool is suitable for the identification of biopsychosocial impairments and resources. This can help to allocate patients with chronic diseases in appropriate rehabilitation facilities and therapeutic modules.

Bedeutung von Arbeitsbelastungen bei Rehabilitanden – Anwendung eines Index für Berufstätigkeiten

OBJECTIVE To investigate the importance of job demands for rehabilitation patients. METHODS A secondary data analysis of 2,089 rehabilitation patients of the Federal German Pension Insurance was conducted. The job exposure index of Kroll was used based on occupations. RESULTS The prevalence of high job demands was 11.2%. The index correlated significantly with reha-relevant impairments. Furthermore, there was a significant association between high job demands and an unfavorable return-to-work prognosis at discharge from rehabilitation, also independently of the presence of self-reported severe restrictions of work ability. CONCLUSION The job exposure index reflects occupation-specific job demands of rehabilitation patients. The construction of the index based on the relevant occupation classifications enables its broad application in analyses using routinely collected health data.

[Validation of the Patient Classification System Rehabilitee-Management-Categories (RMK) in Patients with Chronic Back Pain in Regular Medical Treatment].

BACKGROUND AND OBJECTIVE The Rehabilitee-Management-Categories (RMK) have been developed by the Charite - University Medicine Berlin for 10 years. A content- and time-stable classification approach should support health care providers to offer therapy standards that are better adjusted to the needs of patients. At the same time, stability means for healthcare payers that the admission management to clinics with specialised services could be optimized. METHODS The stability of the RMK classification was tested with the help of latent class analysis (LCA) in independent samples. The data sets are taken from 3 different studies carried out from 2006 to 2011. Only patients with chronic back pain (M40-M54) who were in regular medical treatment provided by the German Pension Fund were included. RESULTS A statistically stable 4-class solution was found in all samples. Kappa-coefficients from 0.605 to 0.72 showed a good consistence of the RMK-algorithm from the first LCA with the respective latent class analyses. CONCLUSION The RMK-approach offers possible uses for both healthcare providers and healthcare payers by assessing the need of treatments according to the ICF approach. Among other things, this approach can be used to fulfil the quality guideline in a differing way.

[Risk Index Disability Pension (RI-DP). A register-based case-control study with 8,500 men and 8,405 women].

The aim of our study was to identify variables of prognostic relevance for disability pensions (DP) in the register data of the German Pension Fund (GPF) and to use the identified variables to construct a risk index. The study was designed as a case-control study of insurants of the GPF Bund using disability pensioners from 2004-2008 as cases and active insurants as controls. Independent variables were selected from the accumulated register data from 2001-2003. Data of 8,500 men and 8,405 women were analyzed. The strongest predictor of future DP were days of sickness benefits. Men with short-term benefits had 6.1 times higher odds of receiving a DP, while men receiving long-term benefits had even 66.3 times higher odds of receiving a DP. For women, the odds were increased 3.8 and 38.4 times, respectively. The risk index score was calculated by transforming the linear combination of parameter estimators and personal characteristics to values ranging from 0-100. ROC analyses and survival analyses confirmed the prognostic relevance of the index score. Independent samples were used to validate our models. Our results show that the GPF has information which could enable an active strategy to enhance the provision of medical rehabilitation.

Risikoindex Erwerbsminderungsrente (RI-EMR)@@@Risk Index Disability Pension (RI-DP): Eine prozessdatenbasierte Fall-Kontroll-Studie mit 8500 Männern und 8405 Frauen@@@A register-based case–control study with 8,500 men and 8,405 women

The aim of our study was to identify variables of prognostic relevance for disability pensions (DP) in the register data of the German Pension Fund (GPF) and to use the identified variables to construct a risk index. The study was designed as a case-control study of insurants of the GPF Bund using disability pensioners from 2004-2008 as cases and active insurants as controls. Independent variables were selected from the accumulated register data from 2001-2003. Data of 8,500 men and 8,405 women were analyzed. The strongest predictor of future DP were days of sickness benefits. Men with short-term benefits had 6.1 times higher odds of receiving a DP, while men receiving long-term benefits had even 66.3 times higher odds of receiving a DP. For women, the odds were increased 3.8 and 38.4 times, respectively. The risk index score was calculated by transforming the linear combination of parameter estimators and personal characteristics to values ranging from 0-100. ROC analyses and survival analyses confirmed the prognostic relevance of the index score. Independent samples were used to validate our models. Our results show that the GPF has information which could enable an active strategy to enhance the provision of medical rehabilitation.

Rehabilitation als Gegenstand der Versorgungsforschung

Since the mid-1990s, the lack of proper development in health services research in the healthcare system of the Federal Republic of Germany has been repeatedly criticised by healthcare policy-makers and experts alike, whilst also being the subject of a number of reform initiatives. Rehabilitation sciences, which were established in Germany as an autonomous scientific discipline in the early 1990s, could benefit in terms of conception, methodology and organisation from these activities and the new interest bestowed on healthcare sector research. At the same time, the converse also holds true since from the very beginning health services research has played a particular role in the development of rehabilitation sciences-unlike the role it has played in the overall healthcare system. The complex nature of the areas of research covered by rehabilitation, together with the theoretical plurality and methodological diversity associated with it, may be ascribed to the fact that (up to the present) this sector has lacked a broader framework connecting together health research concerns and issues. This article presents a comprehensive overview of current concerns and issues as evidenced in publications of the past 15 years that make an explicit contribution to health services research. It highlights the rehabilitation system research undertaken in the past decade as a central plank of health services research. Furthermore, it also investigates the backdrop to health services research in rehabilitation in terms of its development, its research concerns, its methodology, its organisation and its infrastructural embeddedness.