Anzeige
Erschienen in:
01.12.2006 | Original Article
Rehabilitation medicine-Efficacy and effectiveness in the German health care system exemplified for persons with musculoskeletal diseases
Erschienen in: Journal of Public Health | Ausgabe 6/2006
Einloggen, um Zugang zu erhaltenAbstract
This article summarizes studies published during the past 4 years from different areas of research considering the efficacy or effectiveness of medical rehabilitation for persons with musculoskeletal diseases (MSD) in Germany. Efficacy refers to data generated under experimental conditions in controlled studies of interventions including one or more components. Various aspects of efficacy were investigated in randomized controlled studies of multidisciplinary patient education programs, psychological interventions, rehabilitation measures adjusted to psychological or somatic risk profiles and workplace-related medical interventions. Effectiveness studies concerning rehabilitation are performed under routine conditions, i.e., the interventions under study are applied to populations/groups that are usually not or are less selected compared to efficacy studies. This type of study comprises comparisons between outpatient and inpatient settings and, considering a broad definition of effectiveness, non-comparative cohort studies, metaanalyses including long-term cohort studies, analyses from the pension insurance follow-up database and outcome benchmarking of rehabilitation centers. Cross-sectional studies of physicians’ and patients’ judgments of rehabilitation elucidate the issue of effectiveness from different perspectives, which may have a significant impact on the demand and application for medical rehabilitation. In several efficacy studies high levels of evidence have been demonstrated for different components of medical rehabilitation. Even though effectiveness studies frequently lack randomization or even control groups, they give some orientation. This is indispensable for decision makers as long as higher level evidence is not available under the conditions of the German legislation and social security system. Finally, priorities for future research in rehabilitation medicine are summarized.