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Carl V. Granger - One of the best experts on this subject based on the ideXlab platform.
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Satisfaction with Medical Rehabilitation after Spinal Cord Injury
Spine, 2004Co-Authors: Leigh Tooth, Kenneth J. Ottenbacher, Pamela M. Smith, Sandra B. Illig, Richard T. Linn, Carl V. GrangerAbstract:Study Design. Retrospective Objective. To predict satisfaction with Medical Rehabilitation. Summary of Background Data. While spinal cord injury (SCI) patient satisfaction with life and community services has been investigated, satisfaction with Medical Rehabilitation has not. Methods. Information submitted to the Uniform Data System for Medical Rehabilitation ( 1998 - 2001) by 134 hospitals/Rehabilitation facilities in the United States (n = 6,205 patients with SCI) was examined. Predictors were sociodemographic variables, Case Mix Groupings (CMG) ( 401 - 505, 5001), length of stay, rehospitalization, followup therapy, and health maintenance. Satisfaction was assessed at a mean of 92.2 days (SD 11.9 days) postdischarge. Data were analyzed according to who reported the outcome ( patient, n = 3,858 or family/other, n = 1,869). Statistical modeling was conducted using logistic regression. Results. High overall satisfaction was reported (94%). Significant predictors for the patient report data were CMG and rehospitalization. Compared with CMG 5001 ( short stay,
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The Uniform Data System for Medical Rehabilitation report of patients discharged from comprehensive Medical Rehabilitation programs in 1999.
American journal of physical medicine & rehabilitation, 2002Co-Authors: Anne Deutsch, Carl V. Granger, Roger C Fiedler, Carol F. RussellAbstract:This is the 10th annual report describing patients discharged from comprehensive Medical Rehabilitation programs in the United States that subscribe to the Uniform Data System for Medical Rehabilitation. The analysis included 298,973 complete records of first admission cases discharged alive from 676 facilities in 1999. The data show that patients receiving care in comprehensive Rehabilitation programs show measurable functional improvement and that a high percentage of patients are discharged to community-based settings.
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Satisfaction with Medical Rehabilitation in patients with cerebrovascular impairment.
American journal of physical medicine & rehabilitation, 2001Co-Authors: Kenneth J. Ottenbacher, Roger C Fiedler, Vera A. Gonzales, Pamela M. Smith, Sandra B. Illig, Carl V. GrangerAbstract:Objective: Overall satisfaction has important social and economic implications for patients who have received inpatient Medical Rehabilitation. We conducted this study to examine the overall satisfaction level at 3- to 6-mo follow-up for inpatients with cerebrovascular impairments discharged from Medical Rehabilitation. Design: The study was retrospective using information from a national database representative of Medical Rehabilitation patients across the United States. Information submitted in 1997 and 1998 to the Uniform Data System for Medical Rehabilitation by 177 hospital and Rehabilitation facilities from 40 states was examined. The final sample included 8,900 patient records. The main outcome measure was the level of satisfaction with Medical Rehabilitation at 80-180 days postdischarge follow-up. Results: A logistic regression model including ten independent variables was used to predict satisfied vs. dissatisfied at follow-up. Three statistically significant variables were included in the final model and correctly classified 95.1 % of the patients. Higher FIM TM instrument discharge scores were associated with increased satisfaction. Further analysis of the FIM instrument subscales indicated that higher ratings in transfers, social cognition, and locomotion were significantly associated with increased satisfaction. Conclusion: We identified several functional variables associated with increased satisfaction after Medical Rehabilitation in persons with stroke. The ability to objectively assess patient satisfaction is important as consumer-based outcome measures are integrated in accreditation and healthcare evaluation.
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The Functional Independence Measure: A Measurement of Disability and Medical Rehabilitation
Functional Evaluation of Stroke Patients, 1996Co-Authors: Roger C Fiedler, Carl V. GrangerAbstract:Measuring outcomes in Medical Rehabilitation must begin with an understanding of what is to be measured, and this understanding must be grounded in theory and connected to a comprehensive model for meeting the needs of the patient. Measurement tools for outcomes must then be designed and tested with respect to their purpose, practicality, construction, standardization, reliability, and validity. This chapter proposes a conceptual model called Challenges to the Quality of Daily Living that is based on the work of Abraham Maslow. The model describes the goal of fulfillment as achieving a balance between one’s choices, options, and expectations on the one hand (functional opportunities), with one’s physical, cognitive, and emotional constraints (functional demands/barriers) on the other. While these opportunities and demands are not directly measurable in qualitative or quantitative terms, the underlying factors supporting or forming barriers to health and function are measurable. The Functional Independence Measure (FIM) and the Uniform Data System for Medical Rehabilitation (UDSmr) are examined from the perspectives described above, and are found to provide practical measurement for patients undergoing Medical Rehabilitation for conditions that render them dependent on others for assistance in activities of daily living. The FIM has been shown to be reliable, valid, feasible, practical, and sensitive to clinical change in functional independence at admission, discharge, and follow-up. Use of the FIM and the UDSmr characterizes disability and change in severity through the use of a uniform language, and has important implications for national and international exchange of comparable information concerning outcomes.
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Outcome Measurement in Medical Rehabilitation
International journal of technology assessment in health care, 1995Co-Authors: Carl V. Granger, Carol M. BrownscheidleAbstract:The Uniform Data System for Medical Rehabilitation (UDSmr) provides a method for uniform assessment of the severity of patient disability and the outcomes of Medical rehabilitative care. The effectiveness and efficiency of Medical Rehabilitation services may be analyzed using the Functional Independence Measure (FIM), the functional assessment component of the UDS, and other data. Program evaluation models based on the UDSMR and the FIM are useful for measuring resource cost of disability.
Matthias Bethge - One of the best experts on this subject based on the ideXlab platform.
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Work-Related Medical Rehabilitation in Patients with Musculoskeletal Disorders: a Propensity-Score-Analysis
Die Rehabilitation, 2020Co-Authors: David Fauser, Martin Vogel, Matthias BethgeAbstract:Work-related Medical Rehabilitation is a multimodal interdisciplinary approach to reduce health-related discrepancies between work capacity and job demands in order to achieve work participation, especially for patients with severely more restricted work ability. The study tested the effects of a work-related Medical Rehabilitation program, implemented in routine care, compared with common Medical Rehabilitation in patients with musculoskeletal disorders. Data were assessed in 2014 and 2015 and were analyzed by an as-treated analysis. By means of propensity-score-matching, participants of work-related Medical Rehabilitation (intervention group, IG) were compared with similar participants of common Medical Rehabilitation (control group, CG). The primary outcome was a positive work status one year after discharge of Rehabilitation. Treatment effects were analyzed by logistic regressions and absolute risk reductions (ARR) were calculated. 312 patients (156 in the IG) were included in the analysis one year after Rehabilitation. Propensity-score-matching achieved balanced sample characteristics. Work-related Medical Rehabilitation increased a positive work status by 11 points (ARR=0.11; 95% CI: 0.02, 0.20; p=0.020) compared to common Medical Rehabilitation. Work-related Medical Rehabilitation leads to better work participation outcomes after one year compared with common Medical Rehabilitation. Thieme. All rights reserved.
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Effects of nationwide implementation of work-related Medical Rehabilitation in Germany: propensity score matched analysis
Occupational and environmental medicine, 2019Co-Authors: Matthias Bethge, Miriam Markus, Marco Streibelt, C. Gerlich, Michael SchulerAbstract:Objectives Since 2014, the Federal German Pension Insurance has approved several departments to implement work-related Medical Rehabilitation programmes across Germany. Our cohort study was launched to assess the effects of work-related Medical Rehabilitation under real-life conditions. Methods Participants received either a common or a work-related Medical Rehabilitation programme. Propensity score matching was used to identify controls that were comparable to work-related Medical Rehabilitation patients. The effects were assessed by patient-reported outcome measures 10 months after completing the Rehabilitation programme. Results We compared 641 patients who were treated in work-related Medical Rehabilitation with 641 matched controls. Only half of the treated patients had high initial work disability risk scores and were intended to be reached by the new programmes. The dose of work-related components was on average in accordance with the guideline; however, the heterogeneity was high. Work-related Medical Rehabilitation increased the proportion of patients returning to work by 5.8 percentage points (95% CI 0.005 to 0.110), decreased the median time to return to work by 9.46 days (95% CI -18.14 to -0.79), and improved self-rated work ability by 0.38 points (95% CI 0.05 to 0.72) compared with common Medical Rehabilitation. A per-protocol analysis revealed that work-related Medical Rehabilitation was more effective if patients were assigned according to the guideline and the minimal mandatory treatment dose was actually delivered. Conclusions The implementation of work-related Medical Rehabilitation in German Rehabilitation centres affected work participation outcomes. Improving guideline fidelity (reach and dose delivered) will probably improve the outcomes in real-world care. Trial Registration Number DRKS00009780
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work related Medical Rehabilitation in patients with musculoskeletal disorders the protocol of a propensity score matched effectiveness study eva wmr drks00009780
BMC Public Health, 2016Co-Authors: S Neuderth, Miriam Markus, C. Gerlich, Betje Schwarz, M Schuler, Matthias BethgeAbstract:Background Musculoskeletal disorders are one of the most important causes of work disability. Various Rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. As the effects of conventional Medical Rehabilitation programs on sickness absence duration were shown to be slight, work-related Medical Rehabilitation programs have been developed and tested. While such studies proved the efficacy of work-related Medical Rehabilitation compared with conventional Medical Rehabilitation in well-conducted randomized controlled trials, its effectiveness under real-life conditions has yet to be proved.
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Motivational and Volitional Processes in the Context of Applying for Medical Rehabilitation Services
Psychotherapie Psychosomatik medizinische Psychologie, 2016Co-Authors: Katja Spanier, Inka Mohnberg, Elke Peters, Elliot Michel, Michael Radoschewski, Matthias BethgeAbstract:We analyzed if intention and planning of an application for Medical Rehabilitation can be described using the health action process approach. Data were used from the "Third German SocioMedical Panel of Employees". A questionnaire comprising 8 scales was developed. The scales assess outcome expectancies (3 scales), support by family and physicians (2 scales), self-efficacy, intention and action planning (1 scale each). A confirmatory factor analysis was performed to examine the factorial validity of the questionnaire. Structural equation modeling was used to explain intention and planning of an application for Medical Rehabilitation. 3 294 persons participated in the survey. The average age was 47.9 years (range 40-54 years, SD=4.1). 53% of the participants were women. Further analyses included data of 2 911 (listwise deletion) and 3 288 participants (estimated missing values), respectively. The anticipated 8-factor structure of the questionnaire was confirmed. The model fit of the structural equation model was good. Intention was explained by family-related negative outcome expectancies, self-efficacy, and support by family and physicians. Intention and support by physicians directly affected planning. Additionally, family-related negative outcome expectancies, family and physician support, and self-efficacy were indirectly associated with planning. This indirect effect was mediated by intention. 51% of the variance of intention and 65% of the variance of planning were explained. The findings of the structural equation model indicate that the health action process approach is useful to describe the process of applying for Medical Rehabilitation. A validation of the model needs longitudinal data on actual applications. The health action process approach supports our understanding of motivational and volitional determinants of an application for Medical Rehabilitation. Our results underline the important role that family doctors and occupational physicians have if an application for Medical Rehabilitation is needed. © Georg Thieme Verlag KG Stuttgart · New York.
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multiprofessional teamwork in work related Medical Rehabilitation for patients with chronic musculoskeletal disorders
Journal of Rehabilitation Medicine, 2015Co-Authors: Betje Schwarz, S Neuderth, Christoph Gutenbrunner, Matthias BethgeAbstract:OBJECTIVE Systematic reviews indicate the effectiveness of multimodal Rehabilitation. In Germany this has been shown, in particular, for work-related Medical Rehabilitation. A recently published guideline on work-related Medical Rehabilitation supports the dissemination of these programmes. The feasibility of this guideline was examined in a multicentre study. This paper presents findings on the relevance of multiprofessional teamwork for the implementation of successful work-related Medical Rehabilitation. METHODS Focus groups were conducted with 7 inpatient orthopaedic Rehabilitation teams and examined using qualitative content analysis. RESULTS Multiprofessional teamwork emerged inductively as a meaningful theme. All teams described multiprofessional teamwork as a work-related Medical Rehabilitation success factor, referring to its relevance for holistic treatment of multifactorially impaired patients. Although similar indicators of successful multiprofessional teamwork were named, the teams realized multiprofessional teamwork differently. We found 3 team types, corresponding to multidisciplinary, interdisciplinary and transdisciplinary team models. These types and models constitute a continuum of collaborative practice, which seems to be affected by context-related factors. CONCLUSION The significance of multiprofessional teamwork for successful multimodal Rehabilitation was underlined. Indicators of ideal multiprofessional teamwork and contextual facilitators were specified. The contingency approach to teamwork, as well as the assumption of multiprofessional teamwork as a continuum of collaborative practice, is supported. Stronger consideration of multiprofessional teamwork in the work-related Medical Rehabilitation guideline is indicated.
Marcus J. Fuhrer - One of the best experts on this subject based on the ideXlab platform.
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Facilitating patient learning during Medical Rehabilitation: a research agenda.
American Journal of Physical Medicine & Rehabilitation, 1998Co-Authors: Marcus J. Fuhrer, Robert Allen KeithAbstract:: Although patient learning is widely acknowledged to be an integral part of many Medical Rehabilitation practices, it has been the subject of little systematic research. A workshop conducted August 18 to 19, 1997, was organized by the National Center for Medical Rehabilitation Research (National Institute of Child Health and Human Development, National Institutes of Health) and several co-sponsoring organizations to formulate recommendations concerning learning-oriented Rehabilitation practices. The recommendations and their supporting rationale are summarized in the topic areas of motor learning and control, cognitive learning, recovery of functioning, generalization and transfer of training, and applications for patients with strokes, traumatic brain injury, amputations, and infants and children.
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Conference report: an agenda for Medical Rehabilitation outcomes research.
American journal of physical medicine & rehabilitation, 1995Co-Authors: Marcus J. FuhrerAbstract:On August 29 to 31, 1994, a conference was conducted to develop recommendations for needed initiatives in Medical Rehabilitation outcomes research. Organized by the National Center for Medical Rehabilitation Research and cosponsored with the Agency for Health Care Policy and Research, the conference was entitled "An Agenda for Medical Rehabilitation Outcome Research." The resulting recommendations are presented in four areas: philosophic issues; strategy and design issues; measurement of disability and handicap; and measurement of quality-of-life and of health status.
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Conference report: an agenda for Medical Rehabilitation outcomes research.
Journal of allied health, 1995Co-Authors: Marcus J. FuhrerAbstract:In August 1994, a conference was organized by the National Center for Medical Rehabilitation Research (National Institute of Child Health and Human Development, National Institutes of Health) and cosponsored by the Agency for Health Care Policy and Research to formulate recommendations for outcomes research in Medical Rehabilitation. Recommendations are presented in the areas of philosophical issues, strategy and design issues, measurement of disability and handicap, and measurement of quality of life and health status.
Michael Schuler - One of the best experts on this subject based on the ideXlab platform.
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Effects of nationwide implementation of work-related Medical Rehabilitation in Germany: propensity score matched analysis
Occupational and environmental medicine, 2019Co-Authors: Matthias Bethge, Miriam Markus, Marco Streibelt, C. Gerlich, Michael SchulerAbstract:Objectives Since 2014, the Federal German Pension Insurance has approved several departments to implement work-related Medical Rehabilitation programmes across Germany. Our cohort study was launched to assess the effects of work-related Medical Rehabilitation under real-life conditions. Methods Participants received either a common or a work-related Medical Rehabilitation programme. Propensity score matching was used to identify controls that were comparable to work-related Medical Rehabilitation patients. The effects were assessed by patient-reported outcome measures 10 months after completing the Rehabilitation programme. Results We compared 641 patients who were treated in work-related Medical Rehabilitation with 641 matched controls. Only half of the treated patients had high initial work disability risk scores and were intended to be reached by the new programmes. The dose of work-related components was on average in accordance with the guideline; however, the heterogeneity was high. Work-related Medical Rehabilitation increased the proportion of patients returning to work by 5.8 percentage points (95% CI 0.005 to 0.110), decreased the median time to return to work by 9.46 days (95% CI -18.14 to -0.79), and improved self-rated work ability by 0.38 points (95% CI 0.05 to 0.72) compared with common Medical Rehabilitation. A per-protocol analysis revealed that work-related Medical Rehabilitation was more effective if patients were assigned according to the guideline and the minimal mandatory treatment dose was actually delivered. Conclusions The implementation of work-related Medical Rehabilitation in German Rehabilitation centres affected work participation outcomes. Improving guideline fidelity (reach and dose delivered) will probably improve the outcomes in real-world care. Trial Registration Number DRKS00009780
C. Gerlich - One of the best experts on this subject based on the ideXlab platform.
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Effects of nationwide implementation of work-related Medical Rehabilitation in Germany: propensity score matched analysis
Occupational and environmental medicine, 2019Co-Authors: Matthias Bethge, Miriam Markus, Marco Streibelt, C. Gerlich, Michael SchulerAbstract:Objectives Since 2014, the Federal German Pension Insurance has approved several departments to implement work-related Medical Rehabilitation programmes across Germany. Our cohort study was launched to assess the effects of work-related Medical Rehabilitation under real-life conditions. Methods Participants received either a common or a work-related Medical Rehabilitation programme. Propensity score matching was used to identify controls that were comparable to work-related Medical Rehabilitation patients. The effects were assessed by patient-reported outcome measures 10 months after completing the Rehabilitation programme. Results We compared 641 patients who were treated in work-related Medical Rehabilitation with 641 matched controls. Only half of the treated patients had high initial work disability risk scores and were intended to be reached by the new programmes. The dose of work-related components was on average in accordance with the guideline; however, the heterogeneity was high. Work-related Medical Rehabilitation increased the proportion of patients returning to work by 5.8 percentage points (95% CI 0.005 to 0.110), decreased the median time to return to work by 9.46 days (95% CI -18.14 to -0.79), and improved self-rated work ability by 0.38 points (95% CI 0.05 to 0.72) compared with common Medical Rehabilitation. A per-protocol analysis revealed that work-related Medical Rehabilitation was more effective if patients were assigned according to the guideline and the minimal mandatory treatment dose was actually delivered. Conclusions The implementation of work-related Medical Rehabilitation in German Rehabilitation centres affected work participation outcomes. Improving guideline fidelity (reach and dose delivered) will probably improve the outcomes in real-world care. Trial Registration Number DRKS00009780
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work related Medical Rehabilitation in patients with musculoskeletal disorders the protocol of a propensity score matched effectiveness study eva wmr drks00009780
BMC Public Health, 2016Co-Authors: S Neuderth, Miriam Markus, C. Gerlich, Betje Schwarz, M Schuler, Matthias BethgeAbstract:Background Musculoskeletal disorders are one of the most important causes of work disability. Various Rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. As the effects of conventional Medical Rehabilitation programs on sickness absence duration were shown to be slight, work-related Medical Rehabilitation programs have been developed and tested. While such studies proved the efficacy of work-related Medical Rehabilitation compared with conventional Medical Rehabilitation in well-conducted randomized controlled trials, its effectiveness under real-life conditions has yet to be proved.
