Rainer Kaluscha

A prospective randomized controlled trial comparing occupational therapy with home-based exercises in conservative treatment of rotator cuff tears

BACKGROUND This pilot study evaluates the outcome after occupational therapy, compared to home-based exercises in the conservative treatment of patients with full thickness rotator cuff tears. METHODS Forty-three adult subjects (range, 18-75 years), who had a full thickness rupture of the rotator cuff which was verified by magnetic imaging tomography, with clinical signs of a chronic rotator cuff impingement, and who were available for follow-up, were randomized to occupational therapy or to independent home-based exercises using a booklet. After drop-out, 38 patients were available for full examination at follow-up. Before therapy and after 2 months of conservative treatment, pain intensity, the Constant-Murley score, isokinetic strength testing in abduction and external rotation, functional limitation, clinical shoulder tests and health-related quality of life (EQ-5D) were evaluated. RESULTS Two-thirds of the patients improved in clinical shoulder tests, regardless of the therapy group. There were no significant differences between the groups with reference to pain, range of motion, maximum peak force (abduction, external rotation), the Constant-Murley score, and the EQ-5D index. The only significant difference observed was the improvement in the self-assessed health- related quality of life (EQ-5D VAS) favoring home-based exercises. CONCLUSION Home-based exercise, on the basis of an illustrated booklet with exercises twice a day, supplies comparable results to formal occupational therapy in the conservative treatment of rotator cuff tears. The results of this pilot study suggest some potential advantages related to psychological benefits using home-based treatment.

Zusammenhänge zwischen dem Erwerbsstatus in den ersten 2 Jahren nach Rehabilitation und langfristigen Erwerbsverläufen: Implikationen für die Outcome-Messung

Study Objectives: The aim was to investigate the predictive value of the employment status measured in the 6th, 12th, 18th and 24th month after medical rehabilitation for long-term employment trajectories during 4 years. Methods: A retrospective study was conducted based on a 20%-sample of all patients receiving inpatient rehabilitation funded by the German pension fund. Patients aged <62 years who were treated due to musculoskeletal, cardiovascular or psychosomatic disorders during the years 2002-2005 were included and followed for 4 consecutive years. The predictive value of the employment status in 4 predefined months after discharge (6th, 12th, 18th and 24th month), for the total number of months in employment in 4 years following rehabilitative treatment was analyzed using multiple linear regression. Per time point, separate regression analyses were conducted, including the employment status (employed vs. unemployed) at the respective point in time as explanatory variable, besides a standard set of additional prognostic variables. Results: A total of 252 591 patients were eligible for study inclusion. The level of explained variance of the regression models increased with the point in time used to measure the employment status, included as explanatory variable. Overall the R²-measure increased by 30% from the regression model that included the employment status in the 6th month (R²=0.60) to the model that included the work status in the 24th month (R²=0.78). Conclusion: The degree of accuracy in the prognosis of long-term employment biographies increases with the point in time used to measure employment in the first 2 years following rehabilitation. These findings should be taken into consideration for the predefinition of time points used to measure the employment status in future studies.

Eine Fortschreibung des Rehabilitationsbedarfs in Deutschland bis 2040 anhand demografischer Faktoren

The demographic changes in Germany leads to a significant shift in the composition of the population and the workforce, this affecting the future need for medical rehabilitation. This paper estimates the future change in rehabilitation demand based on a forecast for demographic changes till 2040. First, the sensitivity of the rehabilitation demand with respect to demographic factors is estimated. Second, the demographic factors are projected by stochastic methods, resulting in forecasts for the future need for medical rehabilitation. The projections show that the short-term demand is likely to rise. Theoretically, yearly wage increases of about 2.2% are needed for covering the increasing medical rehabilitation costs from 2010 till 2017. For the mid-term demand, the model predicts a slight decline in rehabilitation cases. Considering all these facts, the budget for rehabilitation will probably not cover the future costs for rehabilitation. However, the long-term forecast is subject to considerable uncertainty.

Nachsorgeempfehlungen zur stufenweisen Wiedereingliederung: Inwieweit erklären Rehabilitandenmerkmale die bestehenden Unterschiede zwischen den Einrichtungen?

BACKGROUND The first step to initiate a stepwise occupational reintegration (SOR) is the recommendation of the rehabilitation centers. Therefore rehabilitation centers have a significant impact on the use of SOR. There is evidence that the recommendation rate between the rehabilitation centers differs clearly. The present survey therefore analyses in detail the differences of the recommendation rate and examines which patient-related factors could explain the differences. METHODS This study is based on analysis of routine data provided by the German pension insurance in Baden-Württemberg (Rehabilitationsstatistikdatenbasis 2013; RSD). In the analyses rehabilitation measures were included if they were conducted by employed patients (18-64 years) with a muscular-skeletal system disease or a disorder of the connective tissue. Logistic regression models were performed to explain the differences in the recommendation rate of the rehabilitation centers. RESULTS The data of 134 853 rehabilitation measures out of 32 rehabilitation centers were available. The recommendation rate differed between the rehabilitation centers from 1.36-18.53%. The logistic regression analysis showed that the period of working incapacity 12 month before the rehabilitation and the working capacity on the current job were the most important predictors for the recommendation of a SOR by the rehabilitation centers. Also the rehabilitation centers themselves have an important influence. DISCUSSION The results of this survey indicate that the characteristic of the patients is an important factor for the recommendation of SOR. Additionally the rehabilitation centers themselves have an influence on the recommendation of SOR. The results point to the fact that the rehabilitation centers use different criteria by making a recommendation.

Short-term goal attainment of in-patient rehabilitation in Germany and long-term risk of early retirement in patients with musculoskeletal diseases: results from a prospective 5-year follow-up study

Purpose: Occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies. The aim of this study was to evaluate the prognostic value of various short-term rehabilitation outcome parameters on early retirement in Germany. Method: In a prospective multi-centre cohort study of self-rated patient status, physician chosen therapy goals and attainment were measured by means of standardized questionnaires at the beginning and end of medical rehabilitation. Information with regard to disability was collected by self-report over a 5-year follow-up period. Results: We included 1268 MSD patients aged 45–57 who underwent a 3-week, multidisciplinary, in-patient rehabilitation programme in 10 rehabilitation centres in Southern Germany between January and December 2001. During follow-up (mean duration: 3.9 years) 117 (9%) patients received a disability pension. After adjustment for sex, age and patient outcomes, risk for early retirement was significantly increased for patients with only partial success with respect for the therapy goals pain reduction (HR 1.95), improvement in spine motility (HR 1.6) and improvement of muscle strength (HR 2.3). Patients who did not have the therapy goal were at the same risk as patients with full goal achievement. Conclusions: Clinicians’ rating of short-term therapy outcome might be of prognostic relevance of MSD patients’ long-term employment status. Implications for Rehabilitation Short-term therapy success in pain therapy, spine motility and improvement in muscle strength during in-patient rehabilitation can help preserve long-term working capacity. Clinician’s rating is an independent predictor for long-term working capacity. Assessment of rehabilitation outcome is a contribution to quality control.

Inanspruchnahme der Anschlussrehabilitation nach einer Bandscheibenoperation

The aim of this study was to identify relevant factors that influence utilization and interim period between hospitalization and postoperative rehabilitation after disk surgery. Logistic regression was performed for utilization of an early postoperative rehabilitation and for an interim period, when patients were going to a rehabilitation facility (directly after hospitalization or after a period at home) on claims data from statutory pension insurance and statutory health insurance. Increased utilization of postoperative rehabilitation was found in older and German patients. Moreover, adiposity and additional physiotherapy in hospital increased the utilization of postoperative rehabilitation, while blood transfusion during hospitalization was an inhibiting factor.Female gender, older age and additional physiotherapy in hospital decreased the probability for an interim period between hospitalization and postoperative rehabilitation. However, the probability for an interim period increased from 2005 to 2010. Utilization and interim period between hospitalization and postoperative rehabilitation meet patients needs and seem adequate. Nevertheless, there are indications for under-utilization of certain patient groups (foreign citizens, unemployed persons, male patients).

Erwerbsstatus nach einer Bandscheibenoperation: Was bewirkt eine Anschlussrehabilitation?

OBJECTIVE The aim of this study was a comparison of treatment results in the year after disk surgery between the following treatment groups: rehabilitation immediately after discharge from hospital, rehabilitation with a transition time (at home) up to twenty days after rehabilitation or no rehabilitation. METHODS On basis of claims data from a statutory health insurance and the German Federal Pension Fund the comparison of treatment results was performed. Therefore, duration of disability, return to work and early retirement are considered as treatment results and are analyzed using general linear models (GLM). Furthermore utilization of occupational rehabilitation was compared between the treatment groups with logistic regression. RESULTS Rehabilitants showed a lower risk of unemployment. Moreover, rehabilitants utilize more often occupational rehabilitation. Both rehabilitation treatment groups had a higher duration of disability (including duration of rehabilitation) in the first quarter after surgery. Afterwards the duration of disability decreased faster. Risk of early retirement was higher in patients that started rehabilitation immediately. CONCLUSION Rehabilitants tend to have better treatment results in the year following disc surgery.

Effekte einer Verbund-Rehabilitation Orthopädie-Psychosomatik

Ziel: Die Verbund-Rehabilitation Orthopadie-Psychosomatik (VOP) ist eine spezielle Form der verhaltensmedizinisch-orthopadischen Rehabilitation (VMO). Ziel der Studie ist ein Vergleich der Effekte der VOP mit denen der orthopadischen sowie psychosomatischen Rehabilitation. Methodik: In einer 3-armigen Fall-Kontroll-Studie wurden der psychische und korperliche Gesundheitszustand von Rehabilitanden einer VOP sowie einer orthopadischen und psychosomatischen Standardrehabilitation zu Beginn und Ende der Rehabilitation gegenubergestellt. Ergebnisse und Schlussfolgerung: Die psychische Belastung war in der VOP (N=511) und Psychosomatik (N=322) zu Rehabilitationsbeginn vergleichbar. Aus korperlicher Sicht waren VOP-Rehabilitanden zu beiden Messzeitpunkten vergleichbar mit orthopadischen Rehabilitanden (N=135). Durch die VOP konnte der psychische und korperliche Gesundheitszustand gleichermasen stark verbessert werden wie in den entsprechenden Standardrehabilitationen. Die VOP ist bei Patienten mit Doppeldiagnosen somit eine erfolgreiche Therapie.