Rehabilitative und ambulante physikalisch-medizinische Versorgung von Rheumakranken

Abstract

Rehabilitation and outpatient physiotherapy were investigated from the perspectives of patients suffering from rheumatoid arthritis (RA) or ankylosing spondylitis (AS) and of rheumatologists. In 2007, 204 outpatients with RA and 47 with AS at the Arthritis Center in Halle, Germany, and 117 rheumatologists from all over the country participated in two questionnaire surveys. Patients and rheumatologists gave predominantly positive judgements of physiotherapy, psychological interventions, and patient education programs. However, outpatient care including these interventions was judged to be mainly limited by fixed budgets and other formal restrictions. Even though these therapeutic options are part of (primarily inpatient) rehabilitation programs, the estimate of the need for multidisciplinary rehabilitation programs varied widely among the rheumatologists. Significant objections against rehabilitation include reluctance of the patients, administrative burden for the physicians, payers' rejections, and limited choice of rehabilitation clinic. Despite major functional limitations, a substantial portion of the patients received no multidisciplinary medical rehabilitation, outpatient physiotherapy, psychological interventions, or patient education. Recommendations for the improvement of care are derived from these data.

Utilisation of rheumatology care services in Germany: the case of physical therapy and self-help groups

“…Additionally, we then included 4 studies that were known to us [33], [34], [35], [36] but had not been identified through the MEDLINE search. A total of 8 studies were, therefore, included in the review [10], [25], [33], [34], [35], [36], [37], [38]. All studies were carried out exclusively in Germany, with the exception of one study that included a mixed population from the Netherlands and Germany [38].…”

“…Six studies used a longitudinal approach and two studies used a cross-sectional approach [35], [38]. Utilisation was assessed using questionnaire surveys [33], [37], [38], routine data [25], [35], [36] and health insurance records (10, 34). Further methodological issues are described in Table 1 (Tab.…”

“…Seven studies analysed the utilisation or prescription rates of PT services in patients with RA and found that between 25 percent [34], [37] and 55 percent [33] of patients had either used PT services or had had PT prescribed to them. Studies that only investigated the use of outpatient PT [34], [37] found lower prescription rates than studies that investigated overall PT use [35], [36], [25]. Two studies included patients with FM.…”

Defizite der ergotherapeutischen Routineversorgung bei rheumatischen Erkrankungen

“…Einer Befragung von Rheumatologen und Patienten aus dem Jahre 2007 zufolge, erhielten in den letzten 12 Monaten vor der Befragung rund 11% der funktionell am meisten und 2-4% der weniger ausgeprägt beeinträchtigten Patienten mit RA Ergotherapie und/oder Funktionstraining/Rehabilitationssport [12]. Zink et al [18] erfassten im Rahmen der Kerndokumentation fast 9000 Patienten mit rheumatischen Erkrankungen.…”

Physiotherapeutische Routineversorgung von Patienten mit rheumatischen Erkrankungen – Auswirkungen auf Schmerz, Funktionsfähigkeit und Lebensqualität

“…Nach welchen Faktoren werden derzeit die Patienten physiotherapeutisch versorgt, gibt es bestimmte Determinanten oder welche Faktoren sind f ü r die Verteilung der Leistungen verantwortlich? Mau und M ü ller [24] zeigen in ihrer Untersuchung, dass bei einem gro ß en Teil der Patienten trotz erheblicher Funktionseinschr ä nkung keine ambulanten physikalisch-medizinischen Interventionen verordnet werden. Als eine wichtige Ursache nennen die Autoren geringe Heilmittelrichtgr ö ß en.…”