PubMed Health⌕ Search

Biomedical subjects

W H Jäckel

Publications and source records attributed to W H Jäckel.

At least 19 recordsLinked to original sources
PubMed2006

[Comparison of three outpatient therapy forms for treatment of chronic low back pain-- findings of a multicentre, cluster randomized study].

The AOK Baden-Württemberg health insurance fund initiated a study on the outpatient rehabilitation of patients with chronic low back pain, aimed at improving the treatment concept for its insurees with chronic low back pain (START). This model project was scientifically guided by the Hochrhein-Institute in Bad Säckingen. The paper compares the effectiveness of Enhanced Outpatient Physiotherapy (Erweiterte Ambulante Physiotherapie, EAP), Outpatient Rehabilitation (Ambulante Rehabilitation, AR) and Medical Training Therapy (Medizinische Trainingstherapie, MTT) in patients with low back pain. In seven regions in Baden-Württemberg, one of these three intervention forms was provided to the patients. A total of 1,274 patients were included in the study. The AOK Baden-Württemberg patients receiving treatment in one of the three intervention forms were seriously restricted in both the physical dimension of their health status and in their physical mobility in everyday life and at the workplace. Besides, they frequently reported considerable psychosocial strain. The three interventions led to significant and relevant decreases in pain intensity and to an improved health-related quality of life. There were no significant differences between the various treatments in terms of effectiveness. The patients shared an equally high satisfaction with the treatment received. In MTT, the total therapy length of 15 weeks was by far longer than in AR and EAP (about 5 and 8 weeks). Unlike AR and, in parts, EAP, patients may continue to work while participating in MTT. Therefore an immediate therapy start within a week was more likely possible in MTT (59 %) than in AR (10 %) or EAP (23 %). In evaluating the results a number of restrictions have to be considered. Nevertheless, based on our research findings, the following can be concluded: MTT is a suitable therapy concept in patients with low back pain characterized by a rapid start and-- compared to the other two concepts-- by lower therapy costs. MTT might represent a meaningful therapy element also in new forms of provision such as integrated services. Patients showing severe psychosocial strain should be assigned to an interdisciplinary therapy as it is provided by inpatient and outpatient rehabilitation facilities. For effective differential assignment to the various programmes, realization of a standardized rehab assessment is an important precondition.

Activities of Daily Living↗
PubMed2005

[Structural quality of neurologic rehabilitation clinics].

BACKGROUND: In 2003, criteria for assessing the structural quality of rehabilitation units for inpatient treatment were developed in cooperation with the German statutory pension insurance and health insurance. The aim of this study was to assess this quality using predefined valuation criteria and to test their applicability. METHODS: In the context of the Quality Assurance Programme for Rehabilitation provided by the German statutory health insurance, the structural quality of 18 neurological rehabilitation units was assessed applying the criteria for the first time. RESULTS: On average, the 18 rehabilitation units fulfilled 93.9% of the basic criteria. Despite this high proportion, variability in the degree of realisation in the individual rehabilitation units could be demonstrated. The basic criteria are realistic in respect to the structural requirements, without leveling out the differences between the centres. CONCLUSION: Assessing the structural quality of rehabilitation units on the basis of defined standards allows for a benchmark between units as well as for improvements within the individual units.

Germany↗
PubMed2005

[Routine report on the medical rehabilitation of patients with musculoskeletal diseases].

The commission "Rehabilitation" of the German Society of Rheumatology compiled a data set for a routine report of the rehabilitation system for muskuloskeletal diseases. More than 250 rehabilitation hospitals offer inpatient rehabilitation for patients with musculoskeletal diseases. The prevalence of inpatient rehabilitation decreased due to new legislative rules in 1997, increased again thereafter but has not reached the former level. The prevalence of inpatient rehabilitation during the preceding year in patients with inflammatory rheumatic diseases treated by rheumatologists amounts to 12% with higher figures in men than in women and lower figures in the area of the former German Democratic Republic. The prevalence of outpatient rehabilitation increased during the last few years but, currently, does not exceed 5% of the entire rehabilitation procedures.

Ambulatory Care↗
PubMed2005

[Development and psychometric testing of a patient questionnaire for medical rehabilitation (IRES-3)].

BACKGROUND: Re-analyses of extensive datasets as well as theoretical considerations have led to the conclusion that the patient questionnaire "Indicators of Rehabilitation Status" (IRES) should be revised in several respects. The new version IRES-3 was developed on the basis of a theoretical model of rehabilitation following the ICF (International Classification of Functioning, Disability and Health) as well as of elements of the earlier version IRES-2. In addition, we included the results of expert panels on the definition of treatment goals in medical rehabilitation. METHODS: The IRES-3 was tested in 453 patients in rehabilitation clinics of seven diagnostic areas. To compare the IRES-3 with other generic instruments, the SF-36 and the HADS were employed at the same time. For purposes of cross-validation, an external sample could be used. The dimensional structure was tested in confirmatory factor analyses. RESULTS: With rare exceptions, the tests showed good values for item difficulties, ceiling and floor effects, internal consistencies and test-retest-reliability. Convergent validity could be established for the IRES-3 when compared to relevant scales of the SF-36 and the HADS. Indices of sensitivity to change were comparable, if not somewhat superior to the effects on comparable scales of the SF-36. The assessment of the construct validity and the dimensional structure of the questionnaire led to the definition of eight dimensions which can be interpreted as somatic, emotional, functional, occupational, social, pain, coping, as well as health information and behaviour. The dimensional structure of the IRES-3 can be regarded as theoretically meaningful as well as empirically proven. STANDARDIZATION: For purposes of standardization, data were collected on a sample representative of the population aged 30-75 years in Germany. These data allow a norm-oriented interpretation of scales and dimensions of the IRES-3 for patients in rehabilitation. APPLICATION: The questionnaire is ready for application, including a computer programme for data entry and analysis.

Activities of Daily Living↗
PubMed2004

Quality assessment in rehabilitation centres: the indicator system 'Quality Profile'.

PURPOSE: An indicator system for measuring the quality of rehabilitation centres ('Quality Profile' of rehabilitation centres) is presented. The implementation of the concept is explained with the aid of results regarding structural, process and outcome quality in 26 cardiac and orthopaedic rehabilitation centres. METHOD: In each centre, structural, process and outcome quality, including patient and employee satisfaction, are measured. Process quality is determined by means of a peer review procedure that includes examination of 20 randomly selected cases on the basis of discharge reports and therapy plans. The medical outcome is measured by a prospective study with three measurement time points and a sample of approx. N=200 patients per centre. RESULTS: Overall, the level of quality of the medical rehabilitation in the institutions participating in the study must be considered high. However, on almost all quality dimensions, even after a risk adjustment there are clear differences between centres, which point to the usefulness of benchmarking analyses and the need for improvements in quality in some centres. CONCLUSIONS: The indicator system presented is a starting-point for comprehensive, comparative measurement of the quality of in-patient rehabilitation centres that, with regard to its principles, also appears applicable to other areas of health care.

Cardiac Rehabilitation↗
PubMed2004

[Criteria of quality of structure in rehabilitation units with inpatient treatment].

The structure of a rehabilitation unit is an important feature of the quality of care. Adequate and qualitatively good structures provide the basis for appropriate therapy offers and treatment and eventually, a better health for rehabilitants. The quality of structures is generally recorded without any evaluation of the aspects in particular. The definition of standards is the basis for such an evaluation. The project presented is aimed at the definition of relevant structural standards for rehab units with inpatient treatment for musculoskeletal, cardiac, neurological, gastroenterological, oncological, pneumological and dermatological diseases. Here, the distinction between basal criteria which have to be fulfilled by every rehab unit with inpatient treatment and criteria important for a well-aimed assignment of patients with specific needs ("assignment criteria") should be made. Apart from the documentation of structural attributes, the structural quality of a rehab unit can be described individually as well as in comparison with other units. Relevant structural criteria were defined in expert meetings by means of a modified Delphi-technique with five inquiries. Overall, 199 "basal criteria" and "assignment criteria" were defined. All criteria can be assigned to the two domains general structural characteristics (general characteristics and equipment of rooms; medical/technical equipment; therapy, education, care; staff) and process-related structures (conceptual frames; internal quality management; internal communication and personnel development). The structural standards are applicable to units for musculoskeletal, cardiac, neurological, oncological, gastroenterological, dermatological and pneumological rehabilitation financed by the two main providers of rehabilitation, the statutory pension insurance scheme and the statutory health insurance scheme for all other five indications. The definition of structural standards agreed by experts in a formal consensus process, provides comprehensive and concrete requirements for German rehab units with inpatient medical rehabilitation. If the two main providers of rehabilitation both use the standards this can be regarded as a hallmark on the path to a unitary programme for quality management. The results enable units to analyse their weak points not just on an individual basis but allow also for a comparison between units, along with contributing to optimizing the structural quality of rehab units.

Germany↗
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↗
PubMed2004

[Evolution of a quality assurance programme for physiotherapy schools - results of the first quality inspections].

In cooperation with the Hochrhein-Institute for Research in Rehabilitation (HRI), the Association for Assuring the Quality of Education in Physiotherapy Schools in Germany (ISQ) has developed a quality assurance programme for physiotherapy schools. It aims at assessing the quality of physiotherapy schools in Germany, and to award a quality seal based on compliance with defined criteria. First, a catalogue of quality features and criteria relevant for education in physiotherapy was developed. It is based on the analysis of questionnaires that had been sent to all German physiotherapy schools, to selected physiotherapists and leading physiotherapists in hospitals, to competent federal authorities, and to three school-classes with group discussions. The persons addressed named 360 different quality features. They were collected in a catalogue, revised in a multi-stage Delphi procedure, and approved consensually. The final criteria were transformed into basic quality requirements, and formulated as a check-list. Assessment of the quality features is carried out by trained visitors. In addition, the satisfaction of students is assessed with a questionnaire. The results of the interviews and the questionnaires are fed back to the schools in a quality report. Schools meeting all basic quality requirements are awarded the seal of quality. The seal is valid for three years. Since January 2003, this procedure is available for all schools in Germany. Until September 2002, a pretest of visitations and student questionnaires had been carried out with 31 member schools of the ISQ; according to the resulting quality reports, none of these schools would instantly be awarded the quality seal. In all, more than half of the schools do not meet 10 of the 42 basic criteria. Fundamental deficiencies have been found in the documentation pertaining to supervision of practical training. In terms of training, further training and professional development of their teachers and associated professors, needs for improvement could be shown in more than 66 % of all visited schools. Only 9 of 31 schools could produce a written syllabus. Additionally, the requirements of teachers conferences and equipment of libraries were not met by the majority. A general problem among the schools is inadequate documentation in many fields.

Clinical Competence↗
PubMed2004

[Quality assurance in rehabilitation: where do we stand today?].

In the sector of medical rehabilitation in Germany, a quality assurance programme has been established over the last decade. What distinguishes this programme in comparison to other sectors of the health care system is its comprehensive approach (including quality of structures, processes and outcomes), the special attention given to patients' needs, its scientific foundation, and its implementation throughout the sector. Participation in this programme is obligatory for all in-patient rehabilitation facilities. For out-patient rehabilitation, a specific programme is currently being developed. The feedback report to the facilities gives them concrete indications of existing strengths and weaknesses and thus offers them a start for developing their quality by means of internal quality management. The article begins with a presentation of the instruments and procedures applied as well as selected results of the previous surveys in the context of external quality assurance. Subsequently, the most important approaches to internal quality management are explained. The article ends with a description of the strengths and weaknesses of the existing quality assurance programmes and proposes steps to be taken for their further development.

Ambulatory Care↗
PubMed2003

[Development of a guideline for rehabilitation of patients with low back pain-- phase 2: analysis of data of the classification of therapeutic procedures].

Initiated by the Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte), the project is aimed at developing an evidence-based guideline for rehabilitation of patients with low back pain (LBP). Guideline development will be based on a systematic review of the literature, an analysis of the treatment procedures currently employed in rehabilitation, inclusion of the patients' perspectives as well as consultation of experts' panels of clinically experienced physicians and therapists. Formulation of the guideline will then be carried out in a structured consensus building process. This article is focused on analysing the present situation with regard to the treatments received by patients insured by the BfA, using data from routine documentation according to the Classification of Therapeutic Procedures (KTL, Klassifikation Therapeutischer Leistungen). The analysis is intended to provide indications of a basic need to implement a common guideline as well as, simultaneously, to explore possible deficits in present treatment practices, hence to define priorities requiring special attention in the framework of guideline development. As a result of a systematic literature review, the KTL-defined therapeutic procedures that had emerged as relevant in the rehabilitation of LBP patients were aggregated into so-called therapeutic modules which then formed the basis of the analysis. In all, more than 46,000 KTL-data of 2438 patients with a diagnosis of "low back pain" (M54.5 ICD-10) were included. In the rehab centres investigated, rehabilitation of patients with LBP follows a multidimensional, multiprofessional therapeutic strategy. More than 90 % of all patients receive treatments from the modules "medical training therapy", "health education", "physiotherapy", and "physical therapy". Treatments provided to a majority of the patients are massage (78 %), electrotherapy (67 %) as well as psychotherapy (68 %). Women more frequently than men receive therapies belonging to the "psychological treatments" and "occupational therapies" modules; younger patients receive more of the "training therapies", and more often. When treatments are compared across centres, a large variability in the therapeutic procedures provided becomes apparent. This high degree of variability suggests that development and implementation of a common clinical practice guideline for rehabilitation of patients with chronic low back pain should receive priority attention.

Combined Modality Therapy↗
PubMed2003

[Initial status of patients and effects of rehabilitation after stroke--analysis of a patients' and a physicians' questionnaire in three neurological rehabilitation centres with a follow-up after 6 months].

Rehabilitation after stroke has to face specific problems when treating patients with more or less severe disabilities in cognition and communication. Correspondingly, stroke rehabilitation takes a special position within the larger field of rehabilitation, and relatively little is known outside the neurological scientific community about the status of patients at admission, the case mix in the centres and the short- and medium-term effects of rehabilitation. The present study describes in some detail the initial status in unselected samples of consecutive patients (n = 768) from three neurological rehabilitation centres. The description shows a very inconsistent picture in all centres, ranging from patients with no neurological deficits to patients needing intensive care. Across the centres, we found remarkable differences in case mix. In order to measure the effects of rehabilitation after stroke, an instrument was developed that combines a physicians' questionnaire aiming at an assessment of the severely disabled cases with a patients' questionnaire for the less severe cases for which the physicians' questionnaire would show "ceiling effects" so that improvements could no longer be depicted. The application of the instrument showed that about 50 % of the sample were not capable of answering the patients' questionnaire. For the patients with neurological deficits, the functional parameters of the physicians' questionnaire showed significant improvements at discharge that can be interpreted as "strong" effects (effect sizes 1.0-1.3). For the patients with less severe deficits (and usually in later stages of the rehabilitation process), the patients' questionnaire showed "strong" improvements on the somatic and psychosocial scales both at discharge and 6 months later. On the functional scales, however, only small improvements were found. Finally, predictors could be identified that explain a large amount of the variance for length of stay (R(2) =.42) as well as for the effects of rehabilitation (R(2) =.74). When comparing effects across rehabilitation units with differences of case mix, these predictors should be statistically controlled in order to assure fair comparisons.

Adult↗
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↗
PubMed2002

[Job satisfaction in rehabilitation clinics--Development of the "MiZu-Reha" questionnaire and its use in quality assurance].

In this study, we report on the development and validation of a questionnaire measuring job satisfaction in rehabilitation centres. The questionnaire "Fragebogen zur Mitarbeiterzufriedenheit in Rehabilitationskliniken" ("MiZu-Reha") consists of 75 items. Three scales measure work climate, leadership and work organisation/communication. Further items assess weak points of work organisation and job satisfaction with several predefined aspects (e. g., career opportunities and salary). The scales have good internal consistency with Cronbach's alpha between 0.86 and 0.94. The dimensionality of the scales was established by confirmatory factor analyses. Correlations between the MiZu-Reha scales and independent satisfaction measures indicate the validity of the questionnaire. Correlations between the MiZu-Reha scales and indicators of patient satisfaction, process quality and outcome are in all cases positive (the higher the job satisfaction, the better the quality of rehabilitation), though weak and statistically not significant. Rehabilitation centres differ clearly from each other regarding job satisfaction of their employees. This shows the usefulness of clinic comparisons based on the MiZu-Reha. The questionnaire can be utilized in external quality assurance programmes, in the context of internal quality assurance measures (e. g. the Business Excellence Model of the European Foundation of Quality Management, EFQM) and in the use of management instruments such as the Balanced Scorecard.

Adult↗
PubMed2002

[Knowledge management in rehabilitation--proposal for a systematic development of clinical practice guidelines].

In the past ten years, the German pension scheme has launched several initiatives that can be regarded as milestones on the way to a scientifically founded rehabilitation system. These initiatives were: the Rehab Commission (1989 - 1991), the Quality Assurance Programme (since 1994), and the German Research Funding Programme "Rehabilitation Sciences" (in cooperation with the Federal Ministry for Education and Research, since 1996). As a next step on this way, we propose an initiative aiming at a systematic development and implementation of clinical practice guidelines for the main diagnostic groups in rehabilitation. Guidelines for diagnostic and therapeutic decisions are an instrument to sift through the abundance of fast changing knowledge in medicine, to assess the existing knowledge according to its scientific evidence, and to transform it into recommendations for clinical practice. In rehabilitation, guidelines seem to be particularly needed because specialized knowledge is mostly disseminated through an informal "training on the job". Our proposal intends to establish a reference centre for each of the main indications (cardiology, musculoskeletal diseases, etc.). These centres should cooperate with experts from clinical practice and research, as well as with representatives of the cost-carrying agencies and patient organisations, and should systematically analyse the processes of rehabilitation in the most important diagnostic groups. Guided by a "process matrix of rehabilitation", these analyses should identify the points at which far-reaching decisions are called for during the processes of rehabilitation. At these points, the knowledge base available for rational decisions should be examined. When there is no sufficient scientific knowledge, consensus conferences should be organized in order to collect and assess the available expertise of practitioners and to establish guidelines for clinical practice. Since compliance with such guidelines could be easily checked in the routine quality assurance programme, this proposal seems to be a promising way of improving the knowledge base in rehabilitation in a rather short time.

Diagnosis-Related Groups↗