Purpose The aim of the present study was to develop and test a mobile and outpatient rehabilitation program for individuals with cognitive and/or multiple impairments as part of a feasibility study. The therapies were delivered both in the clinic and in the social environment (e.g., residential settings, sheltered workshops, public swimming pools). The objective of this qualitative analysis was to examine barriers to accessing rehabilitation that participants generally encounter, how they experienced their participation in the newly piloted mobile outpatient rehabilitation program, which factors contributed to goal achievement, and how participants assessed the sustainability of the intervention. Methods Semi-structured face-to-face interviews were conducted with all 15 project participants at the end of their participation. The interviews were transcribed and analyzed using structured qualitative content analysis according to Kuckartz and R & auml;diker. Results Participants reported numerous barriers to accessing medical rehabilitation, including rejected rehabilitation applications and structural barriers within facilities. The SIMRE intervention was evaluated positively. Factors supporting goal achievement included sufficient therapy time, adequate staff resources, and the combination of mobile and outpatient therapy. A comprehensive needs assessment within participants' living and working environments was found to be essential for individualized planning of rehabilitation measures. Concurrently, participants articulated concerns regarding the sustainability of achieved improvements, citing the lack of appropriate follow-up options as well as personnel and structural resources in routine care. Conclusion The findings indicate that a mobile and outpatient rehabilitation approach for individuals with cognitive and/or multiple impairments is both feasible and capable of contributing to improved participation. Additionally, the findings highlight the necessity for individualized rehabilitation and subsequent follow-up care to ensure the stability of the achieved outcomes.
Purpose Racial discrimination directed at employees can significantly affect their well-being, job satisfaction, and professional development. In the German healthcare system, there is a lack of systematic research on the experiences of staff members who are affected by racism, particularly in rehabilitation facilities, where collaboration among staff and patients poses social challenges. This study aims to examine the extent and nature of such experiences and to assess existing complaint and prevention structures. Methods Between October and November 2024, 1,322 inpatient rehabilitation facilities were invited to participate in an online survey, to which 144 facilities responded. The survey addressed managers as well as quality and complaints officers. It assessed the frequency and context of racial discrimination by supervisors, colleagues, patients, or relatives, as well as existing institutional measures for prevention and intervention. Data were analyzed descriptively. Results Around one tenth of the reported complaints were related to racial discrimination. Most frequently, incidents were reported involving patients or their relatives; less commonly, incidents among colleagues were described. In 86.1% of the facilities, racist complaints were investigated immediately. 76.4% of the facilities provided support services for affected employees. Only a few of the surveyed institutions reported cooperating with external counseling services or legal advisors. Preventive measures varied in terms of their implementation: reporting systems for discrimination incidents were in place in 42.4% of the facilities, and regular trainings on cultural sensitivity were conducted in 35.4% of the facilities. Conclusions Racial discrimination against staff is a relevant issue in inpatient rehabilitation facilities. Institutional structures for complaint management and prevention are in place but are not yet comprehensively established. The findings indicate a potential need to further develop cooperations with external counselling services and to strengthen the sensitization of managerial staff. The study thus provides initial empirical evidence to inform the further development of institutional complaint and prevention structures.
Purpose The aims of the study were to explore the subjective experiences of patients and healthcare professionals regarding the implementation of the principle of autonomy in inpatient medical rehabilitation in Germany, as well as to identify factors that hinder or promote this implementation. Methods An exploratory qualitative interview study was conducted. The study surveyed patients undergoing rehabilitation for various conditions (orthopedics, psychosomatics/psychotherapy, oncology, cardiology, neurology, internal medicine) and members of various professions (physicians, dietitians/nutritionists, occupational therapists, physical therapists, social workers, psychologists, nurses) in eight rehabilitation clinics. The problem-centered interviews took place between February 2025 and January 2026 and were analyzed using content analysis. Results Interviews were conducted with 37 patients and 19 healthcare professionals. From the perspective of the patients, aspects related to autonomy were present throughout the entire rehabilitation process and included, among other things, the need for information. Healthcare professionals predominantly viewed respecting the autonomy of patients as part of their professional responsibilities. Structural and personal factors, such as resource constraints, standardization, or external influences, were identified that could make it difficult to maintain implement patient autonomy. Conclusion Respect for the autonomy of patients is recognized by both patients and healthcare professionals as a core value in inpatient medical rehabilitation. Challenges in implementing patient autonomy should be addressed to uphold this principle.
Purpose Improving out-of-home walking-related participation after stroke involves multiple stakeholders. Interprofessional diagnostics should constitute a prerequisite for outpatient therapeutic and assistive device provision. The overarching aim of this multi-methods study is the bottom-up development of a toolkit for this field. The aims of this sub-study were to identify challenges and co-creatively develop solution strategies for gaps in interprofessional collaboration. Methods A future workshop was conducted as a method of participatory action research in the Upper Bavaria District. Data analysis followed Mayring's qualitative content analysis and was guided by a model of interprofessional collaboration including interactional, organizational, and systemic determinants. Results Participants included people after stroke (n=5), relatives (n=1), and health professionals (n=17) from occupational and physical therapy, orthopaedic technology, general medicine, neuropsychology, nursing, statutory health insurance funds, counselling services, and foundations. They identified challenges extending beyond interprofessional diagnostics of out-of-home walking-related participation but related to it. Four action plans were developed for main points of criticism: (1) assessment toolbox, (2) interprofessional home visits, (3) digital communication, and (4) a participation roadmap. Shared core elements included participation-oriented person-centred care, the International Classification of Functioning, Disability and Health, and empowerment of people after stroke and their relatives. Conclusion The future workshop enabled the bottom-up development of solution strategies, which will be integrated into the design of a toolkit to support collaboration. Further development, evaluation, and sustainable implementation require reforms of legal frameworks, stronger cooperation between academia, service providers, and municipalities, improved digital infrastructure, and funding models for interprofessional collaboration.
Purpose The treatment of sensorimotor disorders is a central component of neurological and neurosurgical early rehabilitation (NNER). To date, a comprehensive sensorimotor assessment for severely affected patients is not available. Therefore, the Sensorimotor Assessment Physiotherapie (SeMo-P) was developed at the Lurija Institut (Kliniken Schmieder in Germany). It comprises four independent components assessing different aspects of sensorimotor function: SeMo_Sensibility (sensitivity of the legs), SeMo_PM (passive joint mobility of the legs), SeMo_AM (active joint mobility of the legs), and SeMo_Mobility (patient mobility). The aim of this study was the systematic evaluation of the quality criteria reliability, validity, and responsiveness. Methods The sample consisted of 50 patients who completed the SeMo-P shortly after admission to the NNER (t1) and again four weeks later (t2). Appropriate psychometric methods were used to test reliability (internal consistency, inter-rater reliability), validity (convergent validity and concurrent/predictive criterion validity), responsiveness and the occurrence of floor or ceiling effects for each part. Results All parts of the SeMo-P showed overall good internal consistency (Cronbach's alpha: 0.72 - 0.97). In terms of inter-rater reliability, SeMo_Sensitivity, SeMo_AM, and SeMo_Mobility achieved excellent values (ICC (2,1 ): 0.98 - 0.99, p<0.001), while SeMo_PM fell within the moderate range (ICC 2,1 : 0.71, p<0.001). Validity was only examined for the SeMo_Mobility, which had good construct (r(s) : 0.91 - 0.95, p<0.001) and criterion validity (r( s) : 0.68 - 0.73, p<0.001). All parts of the assessment record change over time (responsiveness), whereby the SeMo_Sensitivity could detect changes in fewer patients, which was presumably due to a ceiling effect at t1. The SeMo_PM also showed a ceiling effect. The SeMo_Mobility and the SeMo_AM showed very good results in terms of responsiveness and there were neither floor nor ceiling effects. Conclusion The study shows that the quality criteria of the SeMo-P items range from moderate to excellent. For clinical practice, the use of SeMo_AB and SeMo_Mobility is recommended. It should be noted that no investigation of validity has yet been conducted for the SeMo_AB. The other parts can be used optionally depending on the specific question.
