BACKGROUND:Early rehabilitation in acute hospitals aims to prevent immobilization-related complications and improve the functional capacity of patients with severe or critical illness. Early rehabilitation can be a useful concept to improve functioning in COVID-19 patients. However, literature concerning early in-hospital rehabilitation in COVID-19 patients is scarce. AIM:To analyze the utilization of in-hospital interdisciplinary early rehabilitation (IER) in COVID-19 patients and characterize the sample of IER patients. DESIGN:Prospective cohort study. SETTING:Hospitalized COVID-19 patient cases. POPULATION:This study used data from the National Pandemic Cohort Network (NAPKON) in Germany. METHODS:IER utilization rates were retrieved. Demographic and clinical data from hospitalized COVID-19 patients who had received IER during the course of their treatment were evaluated. RESULTS:Out of the 2,644 patients in the Cross-Sectoral Platform (German abbreviation: SUEP) cohort, 0.79% [95% CI: 0.51% to 1.22%] received IER during their stay in an acute care hospital. Among the subgroup of patients who had previously been treated in intensive care, 2.13% [95% CI: 1.16% to 3.63%] received IER. The most common comorbidities were cardiovascular diseases (66.7%) and neurological/psychiatric diseases (36.1%). The small sample size limited further analyses. CONCLUSION:The low rate of early rehabilitation in acute hospitals for COVID-19 patients indicates an unmet need, particularly in severe cases. Structural changes in the health system are needed to close this gap. The WHO and the German Medical Council have recently acknowledged the necessity of early in-hospital rehabilitation and have issued a call for its implementation in acute hospitals.

While total hip and knee replacement (THR/TKR) surgery are effective measures to restore functioning and reduce pain in patients with severe osteoarthritis (OA), long-term treatment effects vary among patients. Following behavioral economic theory, these differences may be partially attributed to the impact of personality traits on individual strategies to approach post-surgical challenges. This study explored the associations between self-efficacy, willingness to take risk regarding health (H-WTTR), and future orientation, and the 3-month course of health-related quality of life (HRQoL) and OA-specific health status. As part of the prospective and observational MobilE-TRA 2 cohort study, 147 patients aged 60 years and older were assessed by self-administered questionnaires before and three months after THR/TKR at a single German hospital. As indicators for the surgical outcome, HRQoL was assessed by the EuroQol Five-Dimensional Five-Level Questionnaire (EQ-5D-5L), including the visual analogue scale (EQ-VAS), and functioning was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) using the global score, function score, and pain score. All WOMAC scores were transformed into scales with 0 = worst health and 100 = best health. Self-efficacy was measured using the General Self-Efficacy Short Scale. H-WTTR and future orientation were assessed by single-item questions on 11-point Likert scales. The associations between these personality traits and the 3-month change in the outcome scores were analyzed using linear regression models for THR and TKR respectively. In THR patients a one-point-increase in self-efficacy was associated with improvements in EQ-5D-5L (β=0.0704; p=0.0099), WOMAC global (β=6.6337; p=0.0139), WOMAC function (β=8.2557; p=0.0046), and WOMAC pain (β=5.9994; p=0.0232). For TKR, only the association of self-efficacy with the EQ-VAS change-score was significant (β=5.8252; p=0.0482). Self-efficacy demonstrated weak positive, but not significant associations with all WOMAC scores and a negative association close to zero with the EQ-Index. H-WTTR and future orientation showed no significant associations to changes of the outcome scores. Self-efficacy appears to be a prognostic factor for better THR/TKR outcomes after three months. If these findings can be confirmed in further research, strategies to improve self-efficacy should be considered in prehabilitation programs. Not applicable.

The Post COVID-19 condition (PCC) is a complex disease affecting health and everyday functioning. This is well reflected by a patient's inability to work (ITW). In this study, we aimed to investigate factors associated with ITW (1) and to design a machine learning-based model for predicting ITW (2) twelve months after baseline. We selected patients from the post COVID care study (PCC-study) with data on their ability to work. To identify factors associated with ITW, we compared PCC patients with and without ITW. For constructing a predictive model, we selected nine clinical parameters: hospitalization during the acute SARS-CoV-2 infection, WHO severity of acute infection, presence of somatic comorbidities, presence of psychiatric comorbidities, age, height, weight, Karnofsky index, and symptoms. The model was trained to predict ITW twelve months after baseline using TensorFlow Decision Forests. Its performance was investigated using cross-validation and an independent testing dataset. In total, 259 PCC patients were included in this analysis. We observed that ITW was associated with dyslipidemia, worse patient reported outcomes (FSS, WHOQOL-BREF, PHQ-9), a higher rate of preexisting psychiatric conditions, and a more extensive medical work-up. The predictive model exhibited a mean AUC of 0.83 (95% CI: 0.78; 0.88) in the 10-fold cross-validation. In the testing dataset, the AUC was 0.76 (95% CI: 0.58; 0.93). In conclusion, we identified several factors associated with ITW. The predictive model performed very well. It could guide management decisions and help setting mid- to long-term treatment goals by aiding the identification of patients at risk of extended ITW.

The objective examination of the Post-COVID syndrome (PCS) remains difficult due to heterogeneous definitions and clinical phenotypes. The aim of the study was to verify the functionality and correlates of a recently developed PCS score. The PCS score was applied to the prospective, multi-center cross-sectoral cohort (in- and outpatients with SARS-CoV-2 infection) of the "National Pandemic Cohort Network (NAPKON, Germany)". Symptom assessment and patient-reported outcome measure questionnaires were analyzed at 3 and 12 months (3/12MFU) after diagnosis. Scores indicative of PCS severity were compared and correlated to demographic and clinical characteristics as well as quality of life (QoL, EQ-5D-5L). Six hundred three patients (mean 54.0 years, 60.6 www.clinicaltrials.gov under NCT04768998.

ObjectiveEvidence of geographical variation in total hip replacement (THR) and deviations from treatment guidelines persists. In this exploratory study, we aim to gain an in-depth understanding of patients’ healthcare trajectories by identifying and visualising medication use patterns in coxarthrosis patients before surgery. We examine their association with patient characteristics and THR, and compare them with recommendations on mild analgesics, opioid prescription and exhaustion of conservative therapy.MethodsIn this exploratory study, we apply State Sequence Analysis (SSA) on German health insurance data (2012–2015). We analyse a cohort of coxarthrosis patients, half of whom underwent THR after a 1 year observation period and half of whom did not undergo surgery until at least 1 year after the observation period. Hierarchical states are defined based on prescriptions. We construct sequences, calculate sequence similarity using optimal matching and identify medication use patterns via clustering. Patterns are visualised, descriptive statistics are presented and logistic regression is employed to investigate the association of medication patterns with subsequent THR.ResultsSeven distinct medication use patterns are identified, correlating strongly with patient characteristics and subsequent THR. Two patterns leading to THR demonstrate exhaustion of pharmacological therapy. Opioid use is concentrated in two small patterns with low odds for THR. The most frequent pattern lacks significant pharmacological therapy.ConclusionsThis SSA uncovers heterogeneity in medication use patterns before surgery in coxarthrosis patients. Cautious opioid handling and adherence to a stepped prescription approach are observed, but many patients display low medication therapy usage and lack evidence of exhausting conservative options before surgery.

There is a lack of interventions that treat the Post-Covid-19 Condition (PCC) itself. Accordingly, treatment guidelines recommend physiotherapy interventions to alleviate symptoms and enhance functioning. In cases where unimodal treatments prove ineffective, non-organ-specific multidisciplinary bio-psycho-social rehabilitation (MBR) programs are a suitable option. In a pilot observational study with assessments at the entry and end of treatment we aimed to evaluate the feasibility of a 3-week day clinic MBR program and explore its effects on physical functioning in PCC patients with fatigue and reduced physical capacity. Patient selection was based on an interdisciplinary assessment involving a physician, a psychologist and a physiotherapist. Feasibility was determined based on full participation (≥ 8 of 9 days) and maintenance of stable endurance in the 6-Minute Walk Test (6MWT). From 37 patients included in the study, 33 completed the MBR (mean age: 43 ± 12 years, 73% female). Four patients discontinued the MBR, with two of them having reported deterioration of PCC symptoms. The 6MWT showed a numerical improvement from 501 ± 97 m to 512 ± 87 m, although it did not reach statistical significance. These results support the feasibility of outpatient MBR with a focus on active physiotherapy interventions in PCC patients with fatigue. This study aligns with previous research supporting the effectiveness of physiotherapy and rehabilitation in PCC patients. However, further research is needed to address possible different treatment responses and varying treatment approaches in subgroups of PCC patients.

Objective The objective of this study was to determine the impact of obtaining a second opinion consultation on time to knee arthroplasty (KA). We further examined the frequency of KA and the determinants of KA following the second opinion.Design Prospective cohort study.Setting The second opinion programme was implemented at the Ludwig Maximilian University Hospital in Munich.Participants Participants comprised patients with knee osteoarthritis who were insured with one of the largest statutory health insurance Allgemeine Ortskrankenkasse Bayern (mean age 64.3±9.6 years). Patients participated in a second-opinion programme and completed questionnaires on site before and after personal presentation for the second opinion consultation. Follow-up questionnaires were delivered by post at 3 and 12 months after the second opinion consultation. Of the 142 patients included in the study, 47 (33.1%) underwent KA within 12 months after obtaining the second opinion.Primary outcome measures Primary outcome measure was time until patients received KA. Cox proportional hazard modelling was used to calculate the associations between the selected predictors and time that elapsed between receipt of the second opinion to KA.Results Mean time until KA was 17 weeks. Kaplan-Meier curves showed significant differences in time to KA according to the recommendation given at second opinion consultation, knee-related quality of life and Kellgren-Lawrence grade. In multivariate Cox proportional hazard modelling, second opinion recommendation (HR 5.33, 95% CI 1.16, 24.41) and knee-related quality of life (HR 1.03, 95% CI 1.01, 1.06) were significant predictors of time from second opinion to KA.Conclusions Obtaining a second opinion had significant impact on time to knee replacement. Those who were recommended immediate surgery also underwent surgery more quickly after the second opinion. The effect of knee-related quality of life supports the importance of patient-reported outcome measures in the decision for or against KA.

Einleitung Sekundäre Ursachen der Osteoporose stellen im klinischen Alltag in Bezug auf Diagnostik und effektive Therapie eine besondere Herausforderung dar. Die Mastozytose ist eine seltene Erkrankung der hämatopoetischen Stammzelle mit breiten klinischen und morphologischen Erscheinungsbild. In 10-30 % der systemischen Fälle kommt es zu einer Knochendichteminderung bis zur manifesten Osteoporose.

Background Multidisciplinary biopsychosocial rehabilitation (MBR) in patients with chronic low back pain (CLBP) is superior to less intensive treatments for at least one year, but the long-term course of the disease is largely unknown. The primary aim of this study was to describe the long-term course of an MBR in relation to pain, disability, and quality of life from the beginning of an MBR to between 4 to 15 years after participation. The secondary aim was to explore the long-term course of an MBR in relation to physiological outcomes of functioning. Methods This was a observational study conducted at a university hospital. The cohort consisted of participants of a 3-week, CLBP-specific MBR program between August 2001 and January 2013. The North American Spine Society questionnaire (NASS) pain and disability scale was the primary patient -reported outcome measure (PROM). The NASS neurogenic symptoms scale and the Short-Form 36 (SF-36) health survey were secondary PROMs. Patients were assessed before entry to the MBR (T0), at entry (T1), at discharge (T2) and 4 to 15 years after discharge (T3). Effects were quantified by effect size (ES). Score differences were tested for significance using parametric or non-parametric tests and linear mixed models. Results Of 299 consecutive patients from the MBR program, 229 could be contacted. Of these, 84 declined participation, five did not meet the inclusion criteria, and 26 had incomplete data. Thus, 114 patients were included. The mean follow-up time was 9.2 years. At T3, patients exhibited beneficial effects for NASS pain and disability with a moderate ES (ES = 0.63; p < 0.001). The NASS neurogenic symptoms scale was stable. The SF-36 scales showed an improvement in the bodily pain domain (ES = 1.02; p < 0.001), but no significant changes for physical functioning, physical role, general health, vitality, social functioning, emotional role, or mental health. The physical health component summary was improved (ES = 0.40, p = 0.002), and the mental health summary was unchanged. The linear mixed model analysis confirmed improvements in pain and disability between T1 and T3 (p = 0.010). Conclusions The results of this study suggest that there is a long-term benefit of MBR participation in patients with CLBP.

Abstract Background In 2019, Germany had the highest rate of hip replacement surgery and the fourth highest rate of knee replacement surgery among more than 30 OECD countries. The age-standardised rates were estimated at 174 hip joint and 137 knee joint replacements per 100,000 population. Against this background, the contrast between financial incentives for surgery and missing incentives for non-surgical treatment options is repeatedly discussed. Quality indicators (QIs) can serve to measure and transparently present the quality of evidence-based care. Comparing results in the form of audit and feedback has been shown to improve e.g. guideline-compliant ambulatory care. Existing QIs targeting the care of gon- and coxarthrosis mainly focus on discharge management after joint replacement surgery and/or require additional data collection. Therefore, as part of the MobilE-ARTH project, a set of QIs for ambulatory care prior to joint replacement surgery calculable based on routine data is being developed. The present study’s aim is to evaluate the impact of this QI set in terms of providing feedback on the quality of care. Methods The MobilE-ARTH project comprises (Phase 1) developing a QI set following the RAND/UCLA Appropriateness Method, (Phase 2) implementing the QIs in established physician networks of a German statutory health insurance (SHI) within a prospective, non-blinded, cluster-randomised pilot study, and (Phase 3) evaluating the QI set’s effectiveness. The physicians in the intervention networks will (a) receive feedback reports providing information about the routine data-based QIs of their gon- and/or coxarthrosis patients and aggregated results for their network, and (b) be invited to two voluntary, facilitated network meetings. In these network meetings, the physicians can use the information provided on the feedback reports to discuss multiprofessional care pathways for patients with gon- and/or coxarthrosis. Selected indicators of the QI set will serve as primary and secondary outcome measures. Routine data will be analysed within multi-level models using an intention-to-treat approach. Discussion Feedback reports help maintaining clinical standards and closing the gap between evidence and medical practice, thus enabling an overall improvement in health care. Providing physicians with QI-based information on quality of care promotes identifying strengths and weaknesses in medical treatments. Trial registration German Clinical Trials Register, number DRKS00027516 , Registered 25th January 2022 – Prospectively registered.

Background Recent clinical studies have demonstrated the effectiveness of specific, multidisciplinary, bio-psychosocial, rehabilitation programmes for chronic neck pain. However, prognostic factors for the improvement of pain and disability are mostly unknown. Therefore, the aim of this study was to explore prognostic factors associated with improvements in chronic neck pain following participation in a three-week, multidisciplinary, bio-psychosocial, rehabilitation programme. Methods In this observational, prospective cohort study, a total of 112 patients were assessed at the beginning, end, and 6 months following the completion of a multidisciplinary, bio-psychosocial, rehabilitation programme. Inclusion for participation in the rehabilitation programme depended upon an interdisciplinary pain assessment. The primary outcome was neck pain and disability, which was measured using the Northern American Spine Society questionnaire for pain+disability and was quantified with effect sizes (ES). Multivariable linear regression analyses were used to explore potential prognostic factors associated with improvements in pain and disability scores at discharge and at the 6-month follow-up period. Results The mean age of the patients was 59.7 years (standard deviation = 10.8), and 70.5% were female. Patients showed improvement in pain+disability at discharge (ES = 0.56; p < 0.001), which was sustained at the 6-month follow-up (ES = 0.56; p < 0.001). Prognostic factors associated with improvement in pain+disability scores at discharge included poor pain+disability baseline scores (partial, adjusted correlation r = 0.414, p < 0.001), older age (r = 0.223, p = 0.024), a good baseline cervical active range-of-motion (ROM) (r = 0.210, p < 0.033), and improvements in the Short-form 36 mental health scale (r = 0.197; p = 0.047) and cervical ROMs (r = 0.195, p = 0.048) from baseline values. Prognostic factors associated with improvements in pain+disability at the 6-month follow-up were similar and included poor pain+disability baseline scores (partial, adjusted correlation r = 0.364, p < 0.001), improvements in the Short-form 36 mental health scale (r = 0.232; p = 0.002), cervical ROMs (r = 0.247, p = 0.011), and better cervical ROM baseline scores. However, older age was not a factor (r = 0.134, p = 0.172). Conclusions Future prognostic models for treatment outcomes in chronic neck pain patients should consider cervical ROM and mental health status. Knowledge of prognostic factors may help in the adoption of individualized treatment for patients who are less likely to respond to multidisciplinary rehabilitation.

BACKGROUND: In contrast to the broad evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) in chronic low back pain (CLBP) patients of working age, little is known about the benefit in patients aged ≥65 years.AIM: To quantify the short-term and 12-month effects of a 3-week CLBP specific MBR program in patients ≥65 years of age; to compare the effects in patients ≥65 years of age to the effects in younger patients.DESIGN: Observational prospective cohort study.SETTING: Outpatient clinic at a tertiary physical medicine and rehabilitation center.POPULATION: Consecutive patients with CLBP who participated in a CLBP specific MBR program.METHODS: The 3-week MBR program included 44 hours of treatment. The primary outcomes pain and disability were measured by the North American Spine Society Questionnaire (NASS). Secondary outcome measures were the Short-Form 36 (SF-36) and the numerical rating scale for pain. Effects were quantified using effect sizes (ES).RESULTS: From 203 included patients, 104 patients older than 65 years (mean: 70.7; SD=4.0) were compared to 99 patients younger than 65 years (mean: 56.4; SD=6.7). The older patients had more comorbidities (two or more comorbidities: 49.5% versus 23.5%; P<0.001). Both groups showed significant improvements in pain and disability at discharge (both groups: P<0.001) and at the 12 months' follow-up (old: P<0.001; young: 0.039) with slightly higher effects for the older patients compared to the younger patients (discharge: ES=0.67 versus ES=0.53; 12 months: ES=0.42 versus ES=0.29). Both groups also improved in the SF-36 Physical Component Summary with slightly lower effects for the older patients (discharge: ES =0.31, P<0.001 versus ES=0.43, P<0.001; 12 months: ES=0.27, P=0.025 versus ES=0.39, P=0.001). The group differences of the change scores were not significant in any of the outcome measures.CONCLUSIONS: MBR shows similar improvements in pain and disability in patients aged ≥ 65 compared to younger patients for at least 12 months.CLINICAL REHABILITATION IMPACT: The findings support the concept of MBR in the growing population of CLBP patients older than 65 years of age.

Introduction Vertigo, dizziness and balance problems (VDB) as well as osteoarthritis (OA) are among the health conditions with the greatest impact on mobility and social participation in older adults. Patients with VDB and OA were shown to benefit from specialised care such as vestibular rehabilitation therapy or joint replacement. However, these effects are not permanent and seem to disappear over time. One important reason might be a decreasing adherence to therapy recommendations. Findings from behavioural economics (BE) can help to shed light on individual effects on adherence behaviour and long-term outcomes of VDB and OA. Objective Based on insights from BE concepts (ie, self-efficacy, intention, and time and risk preferences), MobilE-TRA 2 investigates the determinants of functioning and health-related quality of life (HRQoL) 3 and 12 months after discharge from total hip replacement (THR)/total knee replacement (TKR) in patients with OA and after interdisciplinary evaluation for VDB. Methods and analysis MobilE-TRA 2 is a longitudinal observational study with data collection in two specialised tertiary care centres at the university hospital in Munich, Germany between 2020 and 2023. Patients aged 60 and older presenting for their first THR/TKR or interdisciplinary evaluation of VDB at Ludwig Maximilians University (LMU) hospital will be recruited for study participation. Three and twelve months after baseline assessment, all patients will receive a follow-up questionnaire. Mixed-effect regression models will be used to examine BE concepts as determinants of adherence, HRQoL and functioning. Ethics and dissemination The study was approved by the ethics committee at the medical faculty of the LMU Munich under the number 20-727. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Findings will also be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.

According to data from World Health Organization (WHO), the number of people with needs for rehabilitation is continuously increasing worldwide. Physical and Rehabilitation Medicine (PRM) is nationally and internationally an independent medical specialty and scientific research field. At Present, in Germany only three medical faculties have academic chairs for Physical and Rehabilitation Medicine (PRM). The need for integrating PMR at university level is supported by a number of arguments: PRM is recognised as an independent medical specialty and since 1996 interated into the (model) training regulations of the German Medical Association as a specialist group. The PRM is a defined research field and scientific area. It comprises the areas of biological and genetic basic research, biomedical and technological rehabilitation research, clinical rehabilitation research, integrative rehabilitation research and the sciences of the functioning of the person The PRM is a defined part of the curriculum for medical studies and is firmly anchored in the licensing regulations for doctors with the cross-sectional area "Rehabilitation Medicine, Physical Medicine, Naturopathic Treatment". This dimension rates that acedemic chairs of PRM have a broad spectrum of tasks, teaching and patient care as shown above, the PRM meets all the criteria for an academic field, the tasks of which at universities are outlined. This is also important for the further development of the health and social system. Based on these facts, the German Society of Physical and Rehabilitation Medicine (DGPRM) demands that chairs or other independent professorships for Physical and Rehabilitation Medicine be established at every medical faculty.

Background German social legislation gives patients the right to obtain a second opinion before elective surgery and defines quality criteria for reimbursement by statutory health insurances. However, the effects of second opinions before elective surgery are largely unknown. The aim of this study was to evaluate the effects of a second opinion programme in patients recommended for knee arthroplasty. Methods The largest statutory health insurance funds in Bavaria offered patients who had been recommended to have knee arthroplasty the opportunity to partake in a second opinion programme which consisted of an in person presentation to an experienced knee surgeon. In this cohort study, consecutive patients from this second opinion programme who signed informed consent were included from 07/10/2016 to 14/02/2020. Data were collected before and after the second opinion visit. Results A total of 141 (66%) of 215 patients who presented for a second opinion participated in the evaluation study. The second opinion physician recommended knee arthroplasty to 40% of the patients, later knee arthroplasty if the conditions worsened to 40%, and no knee arthroplasty to 20%. After receiving the second opinion 28 of 56 (41%) undecided patients preferred knee arthroplasty, 14 no knee arthroplasty, 14 remained undecided. Four of 46 patients with a preference for “arthroplasty” changed their decision to “no arthroplasty”, five of 35 patients from “no arthroplasty” to “arthroplasty”. The patients were more confident in their decision according to the decision confidence scale (before: 5.4 ± 3.0; after: 7.8 ± 2.5; p < 0.001). They rated their satisfaction with the second opinion programme with a mean grade of 1.35 (± 0.60) (best:1; worst:6). Logistic regression analyses showed that the recommendation of the second opinion physician for joint arthroplasty was associated with the guideline criteria radiological severity of osteoarthritis ( p = 0.001) and knee-joint-specific quality of life ( p = 0.041). Conclusion The second opinion of an experienced knee surgeon frequently deviates from the initial recommendation for knee arthroplasty. The association of guideline criteria to the second recommendation suggests a high quality of the second opinion. From the patient perspective, the second opinion reduces uncertainties in their treatment decision.

Dear Prof. Wade, We have read with great interest the paper titled “Efficacy of microcurrent therapy (MCT) for treatment of acute knee pain: A randomized doubleblinded controlled clinical trial” by Daryl Lawson et al.1 This will indeed enhance the understanding of this new treatment method. Microcurrent therapy has the potential to become an internationally recognized newer modality in electrotherapy. A lot of interesting questions are still unanswered and further high quality studies akin to Lawson et al.’s work are required. Impetus to further studies on this topic need disclosure of all the parameters that have been used (e.g. amplitude, intensity, frequency, shape, electric charge, the length and width of the electrodes, etc.). This will allow comparability of different RCTs. Therefore, we would like to emphasize on the precise reporting of the parameters in this paper.1 Electrode placement, electrode size, intensity, frequency, and currency have been explained. Unfortunately, this is not a self-sufficiency according to published RCTs.2–4 Although the modalities of the current have been clarified by Lawson et al., the duration of treatment and impulse is unfortunately missing or clouded. The authors describe that the patients wore the electrodes for 3 hours per day. But, it would be great if authors could describe the duration of continuous microcurrent treatment with 0.2 Hz? Were there any kinds of defined pulsetrains followed by interpulse-breaks or other changes like it is usual in microcurrent therapy? Was it really a continuous current over 3 hours without any inter-pulse intervals? How long was the duration of the single impulse that was generated every 5 seconds (=0.2 Hz)? A point of minor criticism of ours is that Lawson et al. state that this “was the first double-blinded randomized clinical trial using microtens device with people that have acute knee pain” (Discussion, page 7). Recently we have also published a double blinded RCT on patients with knee pain due to osteoarthritis treated with microcurrent therapy with different intensities.5 Additionally, in our published RCT we have added one more group with no Microcurrent therapy – more transparency is needed in used parameters

In Germany too, the reactions to the pandemic with the SARS coronavirus-2 has led to significant cuts in almost all areas of society and the priorities of health and social policy shifted dramatically. This also applies to rehabilitative care in practically all its dimensions. The following statement of the German Society for Physical and Rehabilitative Medicine (DGPRM) would like to discuss some aspects of these developments and derive recommendations.

Zusammenfassung Nach Daten der Weltgesundheitsorganisation (WHO) nimmt die Zahl der Menschen mit Bedarf an rehabilitativer Versorgung weltweit kontinuierlich zu. Die Physikalische und Rehabilitative Medizin (PRM) ist national und international ein eigenständiges ärztliches Fachgebiet und wissenschaftliches Forschungsfeld, das in Deutschland derzeit lediglich durch 3 universitäre Professuren bzw. Lehrstühle für PRM an staatlichen Universitäten verankert ist. Die Notwendigkeit einer entsprechenden universitären Verankerung wird durch eine Reihe von Argumenten gestützt: ▪ Die Physikalische und Rehabilitative Medizin (PRM) ist als eigenständiges ärztliches Fachgebiet seit 1996 fest in der (Muster-)Weiterbildungsordnung der Bundesärztekammer als Facharztgruppe verankert. ▪ Die PRM ist ein definiertes Forschungsfeld bzw. Wissenschaftsgebiet und umfasst die Bereiche biologische und genetische Grundlagenforschung, biomedizinische und technologische Rehabilitationsforschung, klinische Rehabilitationsforschung, integrative Rehabilitationsforschung und die Wissenschaften der Funktionsfähigkeit der Person. ▪ Die PRM ist ein definierter Teil des Curriculums für das Medizinstudium und mit dem Querschnittsbereich „Rehabilitationsmedizin, Physikalische Medizin, Naturheilverfahren“ in der Approbationsordnung für Ärzte fest verankert. Hieraus ergeben sich umfangreiche Aufgaben, von Lehrstühlen für Physikalische und Rehabilitative Medizin in Forschung, Lehre und Krankenversorgung. Wie oben gezeigt, erfüllt die PRM alle Kriterien für ein akademisches Fachgebiet, deren Aufgaben an den Universitäten im Folgenden skizziert werden. Es ist auch für die Weiterentwicklung des Gesundheits- und Sozialsystems von Bedeutung. Fußend auf diesen Aufgaben fordert die Deutsche Gesellschaft für Physikalische und Rehabilitative Medizin (DGPRM), dass an allen medizinischen Fakultäten Lehrstühle oder andere unabhängige Professuren für Physikalische und Rehabilitative Medizin eingerichtet werden.

Zusammenfassung Auch in Deutschland haben die Reaktionen auf die Pandemie mit dem SARS-Coronavirus-2 zu erheblichen Einschnitten in fast allen gesellschaftlichen Bereichen geführt und die Prioritäten der Gesundheits- und Sozialpolitik dramatisch verschoben. Dies betrifft auch die rehabilitative Versorgung in praktisch allen ihren Dimensionen. Das folgende Statement der Deutschen Gesellschaft für Physikalische und Rehabilitative Medizin (DGPRM) möchte einige Aspekte dieser Entwicklungen aufzeigen und Empfehlungen ableiten.