WG 2: Demand-oriented rehabilitation

The aim of this working group is to accompany the development of (clinical-practical) therapy and quality standards for special indications, but also to identify cross-indication rehabilitation processes that can be defined by similar rehabilitation medical courses of different clinical pictures.

The primary goal of this working group is the evaluation of current therapy and quality standards from the point of view of the practicing rehabilitation physician and the assessment of current rehabilitation science evidence for everyday rehabilitation medicine, but not the development of rehabilitation guidelines or the scientific evaluation of rehabilitation processes. This is the primary task of the professional societies, service providers and rehabilitation scientists who are members of the Alliance.

Therapy and quality standards for indication-specific rehabilitation measures 

Indication-specific rehabilitation measures are clinical pictures of rehabilitation medicine that can be assigned to certain specialist indications. The classification of clinical pictures is based on outpatient and acute inpatient specialist care, which is reflected in specialist medical training, specialist medical care and the scope of activities of specialist medical societies.

The first goal of the working group is to identify indications relevant to rehabilitation medicine among the members (professional societies) of the Alliance, for which there is a need to update rehabilitation medicine therapy and quality standards.

The second goal of the working group is to review and evaluate the current evidence of rehabilitation medicine interventions for individual indications within the specialties. This may include current (evidence-based) treatment guidelines for individual conditions as well as systematic reviews, meta-analyses, etc. from the literature. In addition, existing recommendations and quality standards of service providers for the individual indications are reviewed and evaluated.

These may be standards for rehabilitation therapy, but also publications in the form of textbooks, especially if they originate from the service providers themselves or from associated working groups. It is assessed whether and to what extent sufficient therapy and quality standards exist for the individual clinical pictures or whether there is a need for further scientific action.

In particular, this indication-specific review will clarify evidence-based quality in the following areas

• Access to Rehabilitation

• Documenting the Rehabilitation Process

• Evidence for rehabilitation interventions

• Evidence base for socio-medical prognosis

• Requirements for the equipment of facilities for medical and occupational rehabilitation (structural quality [personnel, space/equipment] and process quality [diagnostics and therapy/interventions])

• Identification of vulnerable patient groups, e.g. with cross-indication clinical pictures, and the consequences for the course of rehabilitation.

Position papers on individual indications have already been published by members of the Alliance (Meyer-Olson et al. 2019).

Quality assurance of cross-indication rehabilitation structures

The rehabilitation process basically consists of the occurrence of an illness that leads to the occurrence of a participation restriction, the indication and application for a rehabilitation medical measure, the implementation of the rehabilitation medical measure, and the rehabilitation medical follow-up care (Egen et al. 2021).

In medical rehabilitation in Germany, this process is accompanied by different service providers located in different sectors of the health care system (especially acute inpatient care and rehabilitation medical care as well as rehabilitation medical follow-up care).

While complex and well-structured processes have been established for some diseases (e.g. neurological rehabilitation after stroke), they do not exist for many indications in rehabilitation medicine. This is true for rehabilitation indications that are defined by an acute medical event with an initial maximum loss of function, as in the case of a cerebral stroke, but also for rehabilitation indications that manifest themselves in the context of chronic diseases, in which there is usually no persistent loss of function during the initial manifestation, but in which the indication for a rehabilitation measure only arises in the course of the disease in some patients. Especially for the latter groups of patients, no adequate structural rehabilitation processes have been defined, although these groups represent a large part of rehabilitation measures and services.

The aim of the working group is to define rehabilitation structures for different cross-indication disease patterns (e.g. acute versus chronic diseases) and to identify barriers between health care sectors that can be evaluated by rehabilitation science measures.

In addition, the working group is investigating the extent to which existing legal frameworks, such as the definition of "phases of acute need for treatment of an illness" according to § 13 (2) and § 15 (2) Social Code, Book VI, can be usefully integrated into a rehabilitation process, especially for chronic illnesses.

A further point is the evaluation of the quality and efficiency of intersectoral rehabilitation services (e.g. SHI-funded rehabilitation services for long-term care and rehabilitation services provided by specialists in physical medicine and rehabilitation).

References