Im internationalen Kontext wird unter Rehabilitation eine Gesundheitsstrategie verstanden 1, die durch verschiedene Maßnahmen auf verbesserte Funktionsfähigkeit zielt, um Teilhabeeinschränkungen zu reduzieren, die Menschen mit gesundheitlichen Beeinträchtigungen in der gesellschaftlichen Interaktion erfahren 2. Die aktuelle Resolution der Weltgesundheitsversammlung „Strengthening rehabilitation in health systems” 3 fordert in Übereinstimmung mit der UN-Behindertenkonvention 4, dass für die medizinischen Belange von Menschen mit Beeinträchtigungen adäquate Rehabilitationsdienste und Rehabilitationsprogramme zur Verfügung stehen müssen. Dies entspricht dem Prinzip einer bedarfsorientierten Leistungserbringung ohne Limitierung durch den Grad der Beeinträchtigung einer Person. Darüber hinaus sollen in allen Phasen der Gesundheitsversorgung diese Rehabilitationsdienste verfügbar sein, also vom Akutkrankenhaus bis zur Langzeitversorgung.

Im internationalen Kontext wird unter Rehabilitation eine Gesundheitsstrategie verstanden 1 , die durch verschiedene Massnahmen auf verbesserte Funktionsfahigkeit zielt, um Teilhabeeinschrankungen zu reduzieren, die Menschen mit gesundheitlichen Beeintrachtigungen in der gesellschaftlichen Interaktion erfahren 2 . Die aktuelle Resolution der Weltgesundheitsversammlung ,,Strengthening rehabilitation in health systems" 3 fordert in ubereinstimmung mit der UN-Behindertenkonvention 4 , dass fur die medizinischen Belange von Menschen mit Beeintrachtigungen adaquate Rehabilitationsdienste und Rehabilitationsprogramme zur Verfugung stehen mussen. Dies entspricht dem Prinzip einer bedarfsorientierten Leistungserbringung ohne Limitierung durch den Grad der Beeintrachtigung einer Person. Daruber hinaus sollen in allen Phasen der Gesundheitsversorgung diese Rehabilitationsdienste verfugbar sein, also vom Akutkrankenhaus bis zur Langzeitversorgung.

Objectives To compare the effects of acupuncture and medical training therapy in combination or individually with usual care on quality of life, depression, and anxiety in patients with tension-type headache. Methods In this single-center, prospective, randomized, controlled, unblinded trial, 96 adults (38.7(+/−13.3) years of age; 75 females/20 males/one dropout) with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups (n = 24). The treatment groups received six weeks of either acupuncture or medical training therapy as monotherapies or in combination (12 interventions each), or usual care. We assessed depressiveness (PHQ-9), anxiety (GAD-7), and health-related quality of life (SF-12) as secondary outcome parameters at baseline, six weeks, three months, and six months after initiation of treatment. Linear mixed models were calculated. Results Both, acupuncture (baseline to six-weeks change scores: mean: −2(standard deviation: 2.5 points), three months: −2.4(2.4), six-months −2.7(3.6)) and the combination of acupuncture and medical training therapy (−2.7(4.9), −2.2(4.0), −2.2(4.2)) (each within-group p < .05) significantly reduced depressiveness-scores (PHQ-9) to a greater extent than medical training therapy (−0.3(2.0), −0.5(1.6), −0.9(2.6)) or usual care alone (−0.8(2.9), 0.1(2.8), 0.2(3.6)). We found similar results with anxiety scores and the physical sum scores of the SF-12. No severe adverse events occurred. Conclusions Acupuncture and the combination of acupuncture and medical training therapy elicit positive effects on depression, anxiety, quality of life, and symptom intensity in patients with episodic and chronic tension-type headache. Acupuncture appears to play a central role in mediating the therapeutic effects, underscoring the clinical relevance of this treatment. An additive benefit of the combination of both therapies does not appear to be relevant. Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.

Major amputation of the lower limb is a stressful and mementous procedure with high challenges for personal, social and occupational reintegration. The complex management of the rehabilitation process of patients after lower limb amputation (LLA) needs extensive knowledge in terms of medical issues, therapeutical strategies and social law. Even more, since sectoral structures clearly differ depending on the region and its population density. An innovative project, funded by the German Federal Joint Committee within a program to support innovations in medical supply (Innovationsfonds-Projekt) is evaluating and implementing a new model in the rehabilitation of patients with LLA. The key is to implement a medical care-manager who is helping the patients to get along with the new situation after LLA by offering different options and managing medical issues. Furthermore, the main goal of the project is to implement an outpatient interim rehabilitation in a university hospital for physical and rehabilitation medicine (PRM) directly after amputation and discharge from the surgical ward. The aim of this paper is to present the experiences, the obstacles as well as the challenges and possibilities of this new approach to postoperative rehabilitation after LLA. Furthermore, first results will be demonstrated.

Background: It has already been shown that it is feasible to use International Classification of Functioning, Disability and Health (ICF) Sets as self-assessment instruments. We used this idea to design an ICF-based screening tool to assess patients of a broadly based rehabilitation department. It was developed for the purpose of having a screening tool before taking the anamnesis, as well as for rehabilitation planning and follow-up. Methods and Materials: The Rehabilitation Goal Screening (ReGoS) instrument is a self-report questionnaire which was developed based on the most relevant domains from the ICF Core Sets for chronic pain and rehabilitation. The ICF categories were translated into plain language and 0–10 Likert scales were used. A retrospective analysis of routine clinical data using the ReGoS tool, Work Ability Index (WAI) and Hospital Anxiety and Depression Scale (HADS) in paper- or tablet-based form was performed. Results: The average age of the N = 1.008 respondents was 53.9 years (SD = 16.2). Of the respondents, 66% (n = 665) were female. At the time of the survey, 48.3% (n = 487) of the patients were employed. ReGoS results demonstrated that the highest restrictions on a scale from 0 to 10 were found in the areas of energy and drive (M = 5.79, SD = 2.575) and activities of daily living (M = 5.54, SD = 2.778). More than a third of the respondents rated their work ability as critical. Conclusion: The use of the ReGoS instrument as an ICF-based screening tool based on a self-report questionnaire provides relevant information for clinical diagnosis, participative goal setting and a detailed functional capacity profile.

Zusammenfassung Eine Majoramputation ist für die Betroffenen ein äußerst belastender Eingriff und mit großen Herausforderungen für die gesellschaftliche und berufliche Wiedereingliederung verbunden. Bei der Versorgung von Amputationspatient*innen besteht ein hoher Bedarf an ärztlicher und therapeutischer Behandlung sowie sozialmedizinischer Steuerung. Die sektoralen Versorgungsstrukturen sind regional sehr unterschiedlich aufgestellt und decken häufig den Bedarf nicht adäquat ab. Dem Entlassmanagement kommt hierbei eine Schlüsselposition zu. Ein Innovationsfondsprojekt des Gemeinsamen Bundesausschusses (G-BA) implementiert und evaluiert gegenwärtig modellhaft eine optimierte Versorgung für Menschen nach Majoramputation durch Einführung eines sektorenübergreifenden Caremanagement und der Einführung einer ambulanten Interimsphase in einer Hochschulambulanz für Physikalische und Rehabilitative Medizin (PRM) und Therapie. Der Beitrag berichtet über die Umsetzung, die gemachten Erfahrungen und über erste Ergebnisse.

Objectives The aim of this study was to compare the effects of acupuncture and medical training therapy alone and in combination with those of usual care on the pain sensation of patients with frequent episodic and chronic tension-type headache. Design This was a prospective single-centre randomised controlled trial with four balanced treatment arms. The allocation was carried out by pre-generated randomisation lists in the ratio 1:1:1:1 with different permutation block sizes. Setting The study was undertaken in the outpatient clinic of Rehabilitation Medicine of the Hannover Medical School. Participants and interventions: Ninety-six adult patients with tension-type headache were included and randomised into usual care (n = 24), acupuncture (n = 24), medical training (n = 24), and combination of acupuncture and medical training (n = 24). One patient was excluded from analysis because of withdrawing her/his consent, leaving 95 patients for intention to treat analysis. Each therapy arm consisted of 6 weeks of treatment with 12 interventions. Follow-up was at 3 and 6 months. Main outcome measures Pain intensity (average, maximum and minimum), frequency of headache, responder rate (50% frequency reduction), duration of headache and use of headache medication. Clinical results: The combination of acupuncture and medical training therapy significantly reduced mean pain intensity compared to usual care (mean = −38%, standard deviation = 25%, p = 0.012). Comparable reductions were observed for maximal pain intensity (−25%, standard deviation = 20%, 0.014) and for minimal pain intensity (−35%, standard deviation = 31%, 0.03). In contrast, neither acupuncture nor medical training therapy differed significantly from usual care. No between-group differences were found in headache frequency, mean duration of headache episodes, and pain medication intake. At 3 months, the majority of all patients showed a reduction of at least 50% in headache frequency. At 6 months, significantly higher responder rates were found in all intervention groups compared to usual care. Conclusions In contrast to monotherapy, only the combination of acupuncture and medical training therapy was significantly superior in reduction of pain intensity compared to usual care. Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.

This study aimed to compare, through Rasch analysis, the psychometric properties of the Locomotor Capabilities Index (LCI-5) and Prosthetic Mobility Questionnaire (PMQ 2.0) in German lower-limb prosthesis users. The questionnaires were concurrently administered to a convenience sample of 98 consecutively recruited individuals with lower limb amputation (LLA) (male/female = 61/37; mean age 57 ± 14 years). LCI-5 showed disordered rating scale thresholds (one response option in three items required collapsing); local dependence between two items (resolved by creating a testlet); underfit of one item (‘Get up from the floor’); and presence of a second weak dimension. PMQ 2.0 showed a correctly functioning rating scale; good fit of the data to the model (apart from some overfit); local dependence between two items (absorbed by creating a testlet); and essential unidimensionality. At scale co-calibration onto a common interval-scaled metric, PMQ 2.0 was better targeted than LCI-5 (i.e. the extent of item difficulty was more appropriate for the sample) and its operational range allowed a more precise measurement of higher locomotor abilities. The correlation between LCI-5 and PMQ 2.0 scores was rho =  0.78. In conclusion, LCI-5 revealed some drawbacks, confirming a previous Rasch study; refinement of its rating scale and item selection seems therefore warranted. The PMQ 2.0 demonstrated good overall measurement quality, in line with previous Italian and Slovene studies. The operational range of the PMQ 2.0 makes it more suitable than LCI-5 for assessing people with high locomotor abilities.

Amputationsrehabilitation ist eine Kernkompetenz in der Rehabilitationsmedizin. Sie zeigt mustergultig die notige Teamarbeit in der PRM auf, sowohl interprofessionell (Orthopadietechniker, Physiotherapeuten, Ergotherapeuten, Psychologen, Arzte, usw.) als auch medizinisch interdisziplinar (Rehabilitationsmedizin, Chirurgie, Angiologie, Diabetologie, usw.) sowie zwischen den Sektoren. Der Facharzt fur PRM kann dabei sowohl Bindeglied zwischen allen Professionen und Disziplinen als auch selbst wichtiger Teil der ICF-orientierten Therapie der Patient/innen mit Major-Amputation der unteren Extremitat sein. Ein grundlegendes Wissen zum Prothesenaufbau, Arten von Prothesenversorgungen, Amputationshohen, spezifischer klinischer Parameter sowie typischer Komplikationen ist dabei essenziell.

Amputationsrehabilitation ist eine Kernkompetenz in der Rehabilitationsmedizin. Sie zeigt mustergültig die nötige Teamarbeit in der PRM auf, sowohl interprofessionell (Orthopädietechniker, Physiotherapeuten, Ergotherapeuten, Psychologen, Ärzte, usw.) als auch medizinisch interdisziplinär (Rehabilitationsmedizin, Chirurgie, Angiologie, Diabetologie, usw.) sowie zwischen den Sektoren. Der Facharzt für PRM kann dabei sowohl Bindeglied zwischen allen Professionen und Disziplinen als auch selbst wichtiger Teil der ICF-orientierten Therapie der Patient/innen mit Major-Amputation der unteren Extremität sein. Ein grundlegendes Wissen zum Prothesenaufbau, Arten von Prothesenversorgungen, Amputationshöhen, spezifischer klinischer Parameter sowie typischer Komplikationen ist dabei essenziell.