Deutsche Rentenversicherung (Germany)

The aim of this study was to examine the prognostic validity of the risk index for predicting the effectiveness of medical-psychosomatic rehabilitation treatments. Specifically, it was investigated whether the risk index contributes additional explanatory value beyond sick leave duration in the year preceding rehabilitation. Sociodemographic, clinical, and motivational differences between risk groups were also analyzed.This retrospective study was based on data from 725 patients treated at a rehabilitation center between September 2022 and December 2023. Participants were categorized by risk level (high, medium, low). Measures included depression severity (PHQ-9), work motivation (DIAMO), subjective return-to-work expectations (SPE), and social-medical assessments. Statistical analyses included ANOVAs, multiple and logistic regressions, and the Reliable Change Index.The high-risk group was older, more frequently female, and more likely to have been on extended sick leave. They reported poorer subjective and social-medical return-to-work expectations, lower work motivation, more avoidant behavior, and reduced participation capabilities. The risk index significantly predicted depression severity at discharge, though less strongly than prior depression levels and sick leave duration. It did not significantly predict return-to-work status at discharge.The risk index provides additional value in predicting psychological treatment outcomes, but not in forecasting work ability. Clinically relevant differences in motivation, participation assessment, and return-to-work expectations in the high-risk group underline the need for targeted early interventions. Conclusion While useful for identifying vulnerable groups, the risk index does not replace individualized assessments of occupational and psychological burdens. Early recognition and promotion of motivational and functional resources are essential for successful rehabilitation.

Since the publication of Professor Reinhard Graf's work in 1980, Graf's technique has become the gold standard forscreening Developmental Dysplasia of the Hip (DDH) in many European and non-European countries. Despite the fact thatit is supported by robust literature evidence, there is criticism about its reliability and reproducibility, questioning severalaspects of the diagnostic procedure. There is, however, concern, based on recent literature, about the quality and reliability ofthe published data, which may, in many cases, be based on inadequate scans, and therefore any conclusions drawn have to bequestioned. The aim of this review is to demonstrate the most important aspects of Graf's technique, to clarify the potentialsources of confusion and to flag up the most common errors and mistakes made, either during the ultrasound examination, orduring the reporting procedure. Furthermore, this review can be used as a guide for reviewers and editors and should help toenhance the quality control of publications on this subject.

Einleitung Medizinische Gutachten (GA) mit einer sozialmedizinischen Beurteilung des Leistungsvermögens (LV) sind häufig bei der Deutschen Rentenversicherung (DRV) ein zentraler Aspekt bei der Bearbeitung von Anträgen auf Erwerbsminderungsrente. Die Qualität dieser GA prüft die DRV über ein bundesweites Peer Review-Verfahren. Zentrales Prüfkriterium ist die (sozial-)medizinische Nachvollziehbarkeit der Beurteilung des LV: In der sog. „Ampelfrage“ votieren die Peers, ob im jeweiligen GA die Argumentationskette hinsichtlich der Beurteilung des LV a) nachvollziehbar („grün“), b) lückenhaft, aber überbrückbar („gelb“), oder c) unterbrochen und nicht überbrückbar („rot“) ist. Ist die Argumentationskette des GA lückenhaft oder nicht überbrückbar, so sind die Peers aufgefordert, ihre Voten in Freitextkommentaren weiter zu begründen.

The quality of socio-medical expert opinions, which are prepared for the German Pension Insurance (GPI) in the context of applications for reduced earning capacity pension due to mental disorder, has hardly been investigated so far. The aim of the present study was to investigate to what extent expert medical reports on post-traumatic stress disorder (PTSD) comply with the guideline of the GPI on socio-medical reports for mental and behavioral disorders. To examine the quality of expert opinions, 52 socio-medical expert opinions in which a diagnosis of post-traumatic stress disorder (PTSD) was assigned and a performance capacity of less than three hours was determined were analyzed. The quality of the expert opinions was assessed both quantitatively by calculating quality points and qualitatively by analyzing the content. Percent agreement and Cohen's kappa were calculated for two raters to examine rater agreement based on a subsample (n=11). The analyzed appraisals scored an average of 36.1 (SD=7.4) out of a possible 92 quality points (range 22/56). In most of the expert opinions, the descriptions of participation limitations, epicrisis, and sociomedical conclusion were unsatisfactory. The inadequate presentation of the functional and participation limitations in the expert opinions may not do justice to the actual facts of the case, so that the evidence of a health disorder with the corresponding participation limitations cannot be provided beyond doubt. Accordingly, measures to improve the quality of expert opinions such as training and regular quality reviews are necessary.

The consensus-based SARS-CoV-2, COVID-19, and Rehabilitation Practice Guideline provides recommendations that take both infection prevention and the pursuit of therapeutic goals in rehabilitation settings during the coronavirus pandemic into account. The Practice Guideline provides guidance how to prevent SARS-CoV-2 infections in rehabilitation settings in a first part. The guideline's second part addresses rehabilitation for patients affected by COVID-19 starting with interventions on intensive care units, during early rehabilitation, post-acute rehabilitation, in outpatient and community rehabilitation settings, as well as long-term care, e. g. for COVID-19 survivors with Long- or Post-COVID.The updated second version of the Practice Guideline (dating from 01.11.2021) is a consensus-based guideline developed by a representative panel of healthcare professionals from 15 medical societies covering various rehabilitation disciplines, infectious diseases, hospital hygiene, and epidemiology. The abbreviated version provides an overview of all recommendations given.

The user perception of the work-related treatment is of great importance for the further development and success of work-related medical rehabilitation (WMR). The German Pension Insurance Fund (Deutsche Rentenversicherung DRV Bund) has therefore supported the development of the questionnaire WMR-R that can be used to assess the quality of the structure, process and results of work-related rehabilitation treatment from the patient's point of view. This paper presents a short version and compares it with the long version. Based on a representative sample stratified by indication, employed rehabilitants up to the age of 65 were randomly selected to be questioned 6 months after their rehabilitation with a long version (N=28276) or a short version (N=6611) of WMR-R. In addition, routine data of the German Pension Insurance Fund were included. 27 items each of the long version and 8 items of the short version are added up to a total score and compared with regard to test statistical quality criteria and sample sensitivity. Participation rates were slightly higher in the short version (31%, N=2115) than in the long version (28%, N=8019). The processing quality in both versions is comparable. The short and long versions correlate with each other at r=0.96 (p<0.01). Both versions have similar validity characteristics and separate well between WMR and standard rehabilitation. Both versions are robust to demographic, disease-related and socio-medical risk factors. Rehabilitants with addiction and psychosomatic as well as neurological diseases rate their rehabilitation as significantly more work-oriented compared to other indications, especially pneumology. Due to the low survey effort and the simple evaluation and interpretation, the short version is particularly suitable for routine surveys of WMR care quality. The long version allows a differentiated recording of the WMR offer of rehabilitation facilities in the sense of strength/weakness analyses.

Abstract. Background: The efficacy of inpatient psychosomatic rehabilitation in Germany can be considered proven. However, a significant number of patients with mental disorders remain unsatisfied with rehabilitation or being non-responders. Illness beliefs, as the core element of the Common-Sense Model of Self-Regulation (CSM), are widely known as predictors of various health outcomes. Yet, little is known about treatment beliefs as an extension of the CSM and their impact on health outcomes. Aim: As treatment beliefs differ in relation to the treatment, this study aimed to explore rehabilitation-related treatment beliefs in psychosomatic rehabilitation patients with mental disorders before inpatient admission. Thus, knowledge of the concept of rehabilitation-related treatment beliefs will be added. Methods: N = 10 semi-structured telephone interviews were conducted in September/October 2018. A purposive sampling approach was chosen based on the criteria gender, age, and diagnosis. Participants were asked about their rehabilitation expectations starting with an open narrative question. Interviews were analyzed using qualitative content analysis. Results: Participants had a mean age of 48.3 years ( SD = 9.42); five participants were female and five male. 9 main themes with 32 subthemes as components of the rehabilitation-related treatment beliefs were identified: reasons for rehabilitation, conditions within the clinic, rehabilitation planning, organization of the rehabilitation, the content of the rehabilitation, results of the rehabilitation, concerns, expectations toward one’s behavior, and contact to other patients. Limitation: Our sample was too small to analyze the data for different subgroups. Conclusion: Results show that rehabilitation-related treatment beliefs are multidimensional, addressing different aspects of psychosomatic rehabilitation.

Abstract Introduction Comprehensive cardiac rehabilitation (CR) programs based on the bio-psycho-social approach of the international classification of functioning and disease are carried out to achieve improved prognosis, superior health-related quality of life (HRQL) and social integration. We aimed to identify predictors of returning to work (RTW) and HRQL among cardiovascular risk factors and physical performance as well as patient-reported outcome measures (PROMs) modifiable during CR. Methods We designed a prospective observational multi-center study and enrolled 1,586 patients (2017/18) in 12 German rehabilitation centers regardless of their primary allocation diagnoses (e.g. acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), coronary artery disease (CAD), valvular disease). Besides general data (e.g. age, gender, diagnoses), parameters of risk factor management (e.g. smoking, lipid profile, hypertension, lifestyle change motivation), physical performance (e.g. maximum exercise capacity, endurance training load, 6-min walking distance), and PROMs (e.g. depression, heart-focused anxiety, HRQL, subjective well-being, somatic and mental health, pain, general self-efficacy, pension desire as well as self-assessment of occupational prognosis using several questionnaires) were documented at CR admission and discharge. 6 months after discharge, status of RTW and HRQL (SF-12) were captured by a follow-up (FU) survey and analyzed in multivariable regression models with multiple imputation of missing values. Results Out of the study participants, 1,262 patients (54±7 years, 77% men) responded to the follow-up survey and could be analyzed regarding the outcome parameters. Most of them were assigned to CR primarily due to AMI (40%) or CAD without myocardial infarction (18%), followed by heart valve diseases in 12% of patients and CABG (8%). 864 patients (69%) returned to work within the follow-up period. Pension desire, negative self-assessed occupational prognosis, heart-focussed anxiety, major life events, smoking and heart failure were negatively associated with RTW, while higher endurance training load, HRQL and work stress were positively associated (Figure 1). HRQL after 6 months was determined more by PROMs (e.g. pension desire, heart-focused anxiety, physical/mental HRQL in SF-12, physical/mental health in indicators of rehab-status questionnaire (IRES-24), stress, well-being in the World Health Organization well-being index and self-efficacy expectations) than by clinical parameters or physical performance. Conclusions Patient-reported outcome measures predominantly influenced RTW and HRQL in heart-disease patients, whereas patients' pension desire and heart-focussed anxiety had a dominant impact on all investigated endpoints. Therefore, the multi-component CR approach focussing on psychosocial support is crucial for subjective health prognosis and occupational resumption. Figure 1. Predictors of returning to work Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German pension insurance

Zusammenfassung Fragestellung Die sozialmedizinische Leistungsbeurteilung ist zentraler Bestandteil des Entlassungsberichts der medizinischen Rehabilitation und stellt die Basis weiterer wichtiger versicherungsrechtlicher Maßnahmen dar. Immer wieder sind PatientInnen mit dem Ergebnis ihrer sozialmedizinischen Leistungsbeurteilung nicht einverstanden. Diese Tatsache verkompliziert häufig den Return to Work. Untersucht wird, ob sich diese Patientengruppen hinsichtlich soziodemografischer Parameter, der Bewertung der therapeutischen Allianz und des Reha-Outcome unterscheiden. Material und Methoden KlinikmitarbeiterInnen werden dazu angehalten im Entlassungsbericht zu dokumentieren, ob ein Dissens bzgl. der sozialmedizinischen Leistungsbeurteilung vorliegt. Die Entlassungsberichte aller 2014 im Rehazentrum Oberharz behandelten PatientInnen wurden daraufhin gesichtet (n=1178). Mittels Chi-Quadrat-Tests und (multivariaten) Kovarianzanalysen wurden die Patientengruppen hinsichtlich soziodemographischer Parameter, Behandlungszufriedenheit, therapeutischer Allianz und psychosomatischen Veränderungen über die Rehabilitation analysiert. Ergebnisse PatientInnen im Dissens konnten auf Symptomebene von ihrer Reha-Behandlung weniger profitieren, waren mit dem Ergebnis ihrer Behandlung und mit der Therapeut-Patient-Interaktion unzufriedener. Diskussion Die sozialmedizinische Leistungsbeurteilung ist ein komplexer Prozess, der sowohl auf Beurteiler- wie auf Patientenseite durch zahlreiche Motive beeinflusst wird. Diese sind nur schwer zu erfassen und statistisch zu berücksichtigen. Schlussfolgerungen Um durch den Dissens entstehende Komplikationen zu vermeiden, sollten insbesondere bei stark psychosomatisch belasteten PatientInnen mit problematischer Erwerbsbiografie früh berufsbezogene Therapieangebote eingeleitet werden. In der Therapie sozialmedizinisch auffälliger PatientInnen sollte ein besonderer Wert auf eine gute Patient-Therapeut-Passung gelegt werden.