Biomedical subjects

B Maier-Riehle

Publications and source records attributed to B Maier-Riehle.

10 recordsLinked to original sources

PubMed2004

[Further development of peer-review-procedures in medical rehabilitation].

In 2002, the peer review for the somatic indications of medical rehabilitation was further developed. This process was aimed at adjusting the peer review checklist to the "Guide for the Uniform Medical Report of the Statutory German Pension Insurance Scheme" ("Leitfaden zum einheitlichen Entlassungsbericht der Rentenversicherung"), at harmonising the peer review with the version used in the quality assurance programme of the German health insurance and at reducing requirements by focusing on criteria relevant in the individual case. This paper reports on the consensus process carried out and outlines the modifications of the peer review procedure.

Germany↗

PubMed2003

[Evaluating the rehabilitation process by means of peer review: examination of the methods used and findings of the 2000/2001 data collection in the somatic indications].

This paper reports the results of a peer review system that was implemented in the context of the quality assurance programme of the statutory German Pension Insurance scheme. The data reported refer to the 2000/2001 data collection period for medical rehabilitation in the somatic indications. Examination of inter-rater reliability for judgements of individual raters shows satisfactory results only in orthopaedics. In the quality assurance programme, rehabilitation centres are usually evaluated by the mean of 20 rater judgements. The reliability of this aggregated measure is satisfactory in all indications. The results of 561 rehabilitation centres show that those quality criteria are in particular need of improvement that refer to subjective concepts of patients (e. g., subjective theories of illness). Between peer review procedures in 1998 and 1999, the quality scores of rehabilitation centres had improved whereas between 1999 and 2000/2001, no further improvement can be shown. However, those rehabilitation centres with a low quality score in 1999 (lowest quartile of the distribution) underwent a positive development between 1999 and 2000/2001. Reasons for this trend and possibilities for improving interrater reliability of the peer review process as an element of the quality assurance programme of the German Pension Insurance scheme are discussed.

Chronic Disease↗

PubMed2001

The effects of back schools--a meta-analysis.

Back schools are educational programmes for the prevention and rehabilitation of back pain. A quantitative review (meta-analysis) was performed to synthesize the existing evidence on their effectiveness, for different outcome criteria and time categories. On the basis of a systematic literature research, 18 controlled back school studies with a total of 1682 participants could be included in the meta-analysis. Effect sizes that compared back school patients with patients in a control group were calculated for 14 outcome criteria and four time categories. Effectiveness of back schools was shown for the time period within 6 months of intervention. However, effects for the 14 examined criteria revealed large differences: in contrast to the strong effects on correct back posture and movements and on knowledge of back school contents, the intervention had only small effects on health economic variables (e.g. utilization of the health care system) and no effects on clinical variables (e.g. pain intensity). With regard to the time period following the 6 months after intervention, the analysed data does not strongly support the effectiveness of back schools. It is concluded that the effectiveness of back school intervention depends on the outcome criterion and time of measurement. The results suggest that the concept of back school programmes should be improved and systematically re-evaluated.

Adolescent↗

PubMed2000

[Effect strength variation in the single group pre-post study design: a critical review].

In Germany, studies in rehabilitation research--in particular evaluation studies and examinations of quality of outcome--have so far mostly been executed according to the uncontrolled one-group pre-post design. Assessment of outcome is usually made by comparing the pre- and post-treatment means of the outcome variables. The pre-post differences are checked, and in case of significance, the results are increasingly presented in form of effect sizes. For this reason, this contribution presents different effect size indices used for the one-group pre-post design--in spite of fundamental doubts which exist in relation to that design due to its limited internal validity. The numerator concerning all effect size indices of the one-group pre-post design is defined as difference between the pre- and post-treatment means, whereas there are different possibilities and recommendations with regard to the denominator and hence the standard deviation that serves as the basis for standardizing the difference of the means. Used above all are standardization oriented towards the standard deviation of the pre-treatment scores, standardization oriented towards the pooled standard deviation of the pre- and post-treatment scores, and standardization oriented towards the standard deviation of the pre-post differences. Two examples are given to demonstrate that the different modes of calculating effect size indices in the one-group pre-post design may lead to very different outcome patterns. Additionally, it is pointed out that effect sizes from the uncontrolled one-group pre-post design generally tend to be higher than effect sizes from studies conducted with control groups. Finally, the pros and cons of the different effect size indices are discussed and recommendations are given.

Case-Control Studies↗

PubMed1999

[Current developments in ambulatory rehabilitation].

Up to now, the majority of rehabilitative measures in Germany has been performed in inpatient programmes. In the past 10 years discussions have increased about extending a flexible scheme involving outpatient, inpatient and partially inpatient rehabilitation benefits. Some concepts in outpatient rehabilitation were already developed as well by the Federal Rehabilitation Council as by various rehabilitation providers. Concept requirements include the principles of holism, interdisciplinarity, goal-oriented rehabilitation and team-work of rehabilitation staff. The arguments in favour of extended outpatient rehabilitation are being faced with many questions and uncertainty about future needs, differential indication criteria and effectiveness. In order to answer these questions pilot projects accompanied by scientists are being conducted for different indication fields. Preliminary findings of the scientific studies indicate that the inpatient rehabilitation model gains more acceptance than the partially inpatient type. The studies on the whole show that partially inpatient populations differ from inpatient ones on various variables. Considering these limitations in comparability, there is a tendency for partially inpatient rehabilitation to yield similar results as inpatient measures. Additionally, it is important to accurately identify the indication.

Ambulatory Care↗

PubMed1999

[Need for rehabilitation and application behavior].

The need for rehabilitation is not absolute and given quality. Determination of the need for rehabilitation depends on various criteria, e.g., the case history and certain legally standardized medical prerequisites. Both the regulation of rehabilitation expenditures and different types of personal excess coverage may be interpreted as efforts on the part of social policy to introduce additional controls (i.e., alongside the medical prerequisites) of the need for rehabilitation. Since rehabilitation benefits are only granted in case the insured has applied for, the demand for personal excess coverage might cause a certain selection of financially powerful rehabilitees. Recent cost-cutting legislation, which inter alia included strict budgeting of rehabilitation expenditures and increased personal excess coverage, had entailed a considerable decline in the number of applications for rehabilitation in 1996 and 1997. Several pension insurance funds started questioning their insured to examine the general interest in using rehabilitation services. The results show a strong need for rehabilitation in the group of the older insured (aged 40 and over), however, only 35% to 40% of the insured in subjective need for rehabilitation intend to file an application for rehabilitation and an even smaller number of insured actually apply for rehabilitation. Major impediments to applying for rehabilitation mentioned are job uncertainty as well as the increased personal excess coverage under the recent austerity legislation.

Adult↗

PubMed1998

[Agreement and differences between reviewers in a peer review procedure].

In Germany the statutory pension insurance institutions have started a quality assurance programme. Our institute developed a peer review procedure for screening the process quality of rehabilitation care. The peer review was tested in a pilot study. Our article refers to the examination of interrater reliability, intrarater reliability and reviewer bias. First of all, experienced doctors were trained in reviewing reports routinely written by rehabilitation doctors at discharge of their patients. The peers had to judge on 56 process criteria belonging to six categories (e.g. case history). The reliability coefficients were calculated for the overall judgement of each category and the overall judgement of the process quality of rehabilitation care. The coefficients of interrater reliability and the coefficients of average intrarater reliability range from sufficient to good. Only few reviewers showed a general tendency to harsh or lenient rating. The objectivity of the tested peer review procedure seems definitely higher than in American studies of peer review of hospital charts.

Bias↗

PubMed1998

[Therapy goals in medical rehabilitation].

The definition of appropriate and measurable goals for treatment is a fundamental quality feature of medical practice. In co-operation with experts, we developed a catalogue of therapy goals for medical rehabilitation. In a two-stage procedure we first analyzed the target definitions that are currently used in medical rehabilitation. In a second step we used these targets as input for expert panels. Based on a modified model of the WHO classification ICIDH, the goals were defined on four dimensions: somatic, functional, psychosocial and educative. The established goals are relevant and measurable. Nevertheless, there is still a lack of adequate and sound measurement procedures for many goals. Therefore, there is an urgent need for further research in this field.

Combined Modality Therapy↗

PubMed1997

[Peer review: a method for the analysis of the quality of processing in-patient rehabilitation methods].

In order to evaluate the process quality of inpatient rehabilitation we established a peer-review system. In our approach, measurement of process quality is based on the report written by rehabilitation doctors at discharge of their patients. First of all, a list of 52 criteria relevant to process quality was defined by experienced clinicians using the Delphi technique. These criteria may be divided into six dimensions: anamnesis, diagnostic interventions, goals of therapy and therapy, judgement on vocational abilities, recommendations for further treatment and epicrisis. Thereafter, the experts in a manual defined specific requirements for each of the 52 criteria. In a pilot study, we were able to demonstrate reliability and practicability of the peer review system. Using this approach shortcomings in present rehabilitation practice may be detected. Nearly 400 reports from 20 rehabilitation hospitals were reviewed by thoroughly trained peers. Most frequently shortcomings were found in the description of patient's disabilities and in the definition of specific rehabilitation goals. Furthermore, this procedure enables comparison of process quality in different rehabilitation hospitals. In our pilot study we found marked differences in the process quality of the 20 rehabilitation hospitals.

Germany↗

PubMedDate not supplied

[Expanding outpatient rehabilitation].

Up to now, the majority of rehabilitative measures in Germany has been performed in inpatient programmes. In the past 10 years an extension of outpatient rehabilitation can be noted. Because of new social welfare legislation the legal disadvantages for participants in outpatient rehabilitation have been eliminated on the 1st July 2001. In the past year, the Federal Rehabilitation Council as well as various rehabilitation providers have developed further and specified their concepts in outpatient rehabilitation. Concept requirements include still the principles of holism, interdisciplinarity, goal-oriented rehabilitation and team-work of rehabilitation staff. The extension of outpatient rehabilitation in the sphere of German pension insurance scheme is documented by the increase in models respectively regular services and rehabilitative measures. The results of the evaluation suggest, that the outpatient realisation of a comprehensive rehabilitation concept yields comparable results as the inpatient realisation. In some regions there is a strong cooperation between pension insurance institutes and corresponding health insurance companies in order to extend outpatient rehabilitation. A quality assurance program for outpatient rehabilitation will be developed. It can be expected, that the extension of outpatient rehabilitation goes on and that thereby the possibilities of a more flexible medical rehabilitation grow.

Ambulatory Care↗