Clinical practice guidelines are relevant to all parties involved in the health system. For rehabilitation under the German pension insurance scheme, there are two main aspects: the integration of rehabilitation into the curative guidelines in terms of "local tailoring" on the one hand and the development of guidelines for rehabilitative processes, demand-oriented control of rehabilitation access, and rehabilitative aftercare on the other hand. The elaboration of effective standards is aimed at avoiding over-provision, under-provision or misdirected provision of care and, simultaneously, at ensuring that quality assured treatment is offered to the rehabilitees. Also, it is intended to increasingly implement evidence-based medicine in a sector of the health system in which research has so far been underrepresented. Implementation of guidelines in the rehabilitative sector will allow to disseminate existing knowledge in targeted manner, to systematically fill the gaps and to broaden the knowledge base as a whole. Furthermore, guidelines can facilitate integration of the different sectors in health care provision by operationalising the interfaces both with curative medicine and primary prevention. Throughout the process of guideline development for rehabilitation the specific characteristics of this sector must be kept in mind. Since therapeutic interventions are multidisciplinary and multimodal in nature guidelines have to be comprehensible and applicable for all members of the multiprofessional team. Corresponding to the relative paucity in rehabilitation research there is no sufficient evidence base for numerous therapeutic interventions. Accordingly, guidelines in rehabilitation will--initially--consist of a mixture of evidence- and consensus-based recommendations. Also, the specific goal of rehabilitation under the German pension insurance scheme, namely maintenance or recovery of the capacity at work, has to be borne in mind. There are many initiatives by the providers of rehabilitation as well as the scientific medical societies to develop and implement rehabilitative clinical practice guidelines, e. g. the guidelines programme of the BfA (Federal Insurance Institute for Salaried Employees), which is aimed at developing rehabilitation process guidelines for selected indications, the guidelines activities of the VDR (Federation of German Pension Insurance Institutes), and the input of the "Guidelines" commission of the DGRW (German Society of Rehabilitation Science). It is hoped that in the years to come the parties involved in German health care provision will be open to the advantages of clinical practice guidelines. Rehabilitation under the German pension insurance scheme, with respect to its experience with quality assurance, its responsibilities for structure and concept and a growing acceptance on the part of care providers, already holds a well-founded starting position.

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.

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Zusammenfassung Der folgende ?berblick ?ber die Implementation der ICF setzt die Bestandsaufnahme von 2006 fort. Die Ausf?hrungen berichten prim?r ?ber die Anwendung der ICF in der Rehabilitation in Deutschland. Es wird aber auch auf internationale Entwicklungen Bezug genommen. Die Bestandsaufnahme beruht auf zug?nglichen Quellen unterschiedlicher Art, wie z.?B. Dokumenten, Tagungsberichten, Ver?ffentlichungen, und ist als Orientierungshilfe zu verstehen. Sie gibt keinen vollst?ndigen ?berblick ?ber die ICF-bezogene Literatur. Dies gilt ebenso f?r die vielf?ltigen Aktivit?ten im Zusammenhang mit der Anwendung der ICF. Themenzentrierte, tiefergehende Analysen sind deshalb w?nschenswert, die hier nicht geleistet werden k?nnen. Dies gilt auch f?r die Untersuchung von konkreten Entwicklungen in der Versorgung im Zusammenhang mit dem ICF-Modell.

With the International Classification of Functioning, Disability and Health, ICF and its adoption by the World Health Organization in May 2001, the concept of "functional health" reached a new dimension. Prepared and developed further over many years, the concept of a comprehensive and internationally consented classification system completed the shifting of paradigm in our notion of disease and disablement, bringing along far-reaching consequences for theory and practice in particular in rehabilitation. Symbolizing this paradigmatic shift, destigmatization, resource orientation, context factors, and participation are among the central notions of the concept. The ICF is a foundation for seeking international agreement across the bounds of disciplines and is amidst an intensive transfer and implementation process, also in Germany. Due to the multitude of actors and activities involved, it has become almost impossible even for those taking a strong interest in the matter to keep up with developments and fields of applications, let alone to achieve consensus in these respects. The German Society of Rehabilitation Sciences therefore initiated a problem-oriented stocktaking of the present situation. This article seeks to point out a number of important developments and trends in order to provide initial orientation and overview. The stocktaking is intended to contribute to further disseminating the ICF, at the same time however to outline several crucial fields of application and development. To be continued and deepened, this preliminary stocktaking underlines several core developments along with a number of conceptual issues still unresolved for the time being. Notwithstanding a high degree of acceptance of the concepts underlying the ICF, continued and, as far as possible, coordinated efforts toward implementation will be required at all levels.