Aspects of rehabilitation, a journal article from 2017 by Michaela Frisch
When should one consider rehabilitation, and what conditions should be met?
If outpatient treatment options have been exhausted and persistent symptoms of illness remain, or if the ability to function in daily life is further reduced, thus jeopardizing independent living, then rehabilitation is required. This includes the need for an interdisciplinary therapeutic approach (e.g., nutrition, psychological support, exercise therapy, patient education, etc.) to improve and stabilize participation in daily life, provided that the therapies cannot be carried out to the necessary extent on an outpatient basis.
The need for rehabilitation can also be justified to avoid a more costly hospital stay due to a worsening of the condition or an impending need for long-term care that rehabilitation can prevent. It can also exist after a hospital stay, in which case it is referred to as AHB (follow-up treatment, with costs covered by the German Federal or State Pension Insurance) or AR (follow-up rehabilitation, with costs covered by the health insurance fund). Applications are submitted through the treating physician and the social services department.
Rehabilitation offers an opportunity to stabilize the course of an illness and prevent its deterioration, but it also requires the patient's willingness, motivation, and resilience. The patient's mental and physical condition is therefore essential for rehabilitation. Non-invasive ventilation (NIV) or long-term oxygen therapy (LTOT) are not exclusion criteria, but when choosing a clinic, one should pay attention to its specialization.
The treating physician should describe the rehabilitation prognosis as positive. Even though rehabilitation requires a certain degree of personal responsibility and willingness on the part of the patient, the rehabilitation goals should be realistic and defined in relation to the patient's individual circumstances and the improvement in quality of life resulting from the rehabilitation measures.
Special requirements and quality criteria of the payers for the clinics
When searching for a suitable rehabilitation clinic within the framework of the right to choose, in addition to one's own experiences, it is also advisable to look at the so-called special requirements and quality characteristics of the cost bearers for the clinics:
- Specialization, e.g. also in rare lung diseases
- Pulmonologists (lung specialists) available in-house all day (and not just for a few hours once a week)
- Other areas of specialization within the qualification: Internal medicine, allergology, sleep medicine
- Specialization also includes the provision, prescription, training, and monitoring of long-term oxygen therapy and non-invasive ventilation.
- Additional qualification in diabetology may be required due to comorbidity.
- Possibly specialized training in the field of obesity and allergology for the interdisciplinary team
- Possibly cooperation with the regional dialysis center, the regional radiology practice, as well as dermatologists and ophthalmologists or specialists in neurology and cardiology.
- Cooperation with a speech therapy practice
- Daily patient admission (including nursing and medical admissions)
- Doctors and qualified nurses are on duty at the clinic 24 hours a day, 365 days a year.
- Accommodation for accompanying persons is possible
- Individualized application plan
- The execution of tests and the evaluation of the outcome parameters will be published.
Good preparation is key.
As is often said, preparation is half the battle. You will need:
- All relevant documents
- The most recent examination results from the last 3-6 months from doctors or examinations in clinics.
- A reasoned statement from the treating pulmonologist regarding the need for rehabilitation, the rehabilitation prognosis, and the rehabilitation goals.
- Personal statement regarding the restriction of participation, the reduction of social and general mobility, reduced workload and performance in everyday life, etc.
- Personal statements regarding one's own rehabilitation goals: "What do I want to achieve in rehabilitation?", "What did I take away from the last rehabilitation and integrate or change in my everyday life?"„
- If available: a positive discharge report from the last rehabilitation measure regarding the improvement in physical resilience, adherence to therapy, stabilization of the disease course, increase in measurable parameters (walking test distance, lung function values, etc.), implemented behavioral recommendations.
What are the steps to take if a planned rehabilitation is rejected?
Should the rehabilitation application be rejected despite thorough preparation, it is very important to note the date of receipt on the letter in order to keep track of and comply with the applicable legal deadlines for objections or legal action.
If a preferred clinic has been named in the application, it is best to involve them as a partner and request a corresponding statement and support.
Please do not use pre-formulated letters, but instead provide individually justified and detailed information in your letter of objection and send it to the cost bearer by registered mail, taking into account the deadlines.
What is pulmonary rehabilitation?
Pulmonary rehabilitation is a comprehensive intervention that, based on the identification of each individual's specific problems, designs a specialized therapy program. In addition to physical training and education, this program primarily aims to change behavior. The goal is to improve the mental and physical well-being of patients with chronic respiratory diseases and to promote a long-term shift towards a more health-conscious lifestyle. This is also reflected in the corresponding evidence base, which is rated at level A.
- Increased physical performance
- Improvement of strength and endurance of the leg muscles (evidence level B for arm muscles)
- Reduction of hospital stays and sick days or hospital admissions
- Improving quality of life
- Improvement of psychological components such as anxiety and depression
- Reduction of shortness of breath
The need for rehabilitation can also be justified to avoid a more costly hospital stay due to a worsening of the condition or an impending need for long-term care that rehabilitation can prevent. It can also arise after a hospital stay, in which case it is referred to as AHB (follow-up treatment, with costs covered by the German Federal or State Pension Insurance) or AR (follow-up rehabilitation, with costs covered by the health insurance fund). Applications are submitted through the treating physician and the social services department.
Rehabilitation offers an opportunity to stabilize the course of an illness and prevent its deterioration, but it also requires the patient's willingness, motivation, and resilience. The patient's mental and physical condition is therefore essential for rehabilitation. Non-invasive ventilation (NIV) or long-term oxygen therapy (LTOT) are not exclusion criteria, but when choosing a clinic, one should pay attention to its specialization.
The treating physician should describe the rehabilitation prognosis as positive. Even though rehabilitation requires a certain degree of personal responsibility and willingness on the part of the patient, the rehabilitation goals should be realistic and defined in relation to the patient's individual circumstances and the improvement in quality of life resulting from the rehabilitation measures.
What would pulmonary rehabilitation be without guidance and transition to aftercare?
In addition to all the self-help instructions and home programs, there are other important recommendations:
- Participation in Pulmonary exercise
- Advice and information
- Prescription is possible at least for those insured by the German Pension Insurance (DRV) federal or state governments in the rehabilitation clinic.
- information
Referral to self-help groups
Because the overall package is what makes pulmonary rehabilitation sustainably effective. The patient, however, must be willing and actively participate in order to gain as much as possible for themselves and implement and integrate it into their daily life.
Michaela Frisch, as appeared in Alpha1 Journal 2/2017
