Type of Project: Funded project Joint project Study
Comparison of Different Methods of Social Medicine Assessments Used for the Selection of Patients for In- patient Rehabilitation (multi-center-study)

Background In the German rehabilitation system, a social medicine assessment is carried out when deciding if a patient is suitable for in-patient medical rehabilitation. There are different assessment methods established. Some pension assurances use a work-up based on medical documents like comprehensive patient questionnaires and questionnaires for primary physicians (assessment type A). Other insurances have either employed medical specialists (assessment type B) or use specialists from outside (assessment type C) to make an individual personal assessment with the patient. These assessments are used although evidence-based knowledge about their different effectiveness in selecting rehabilitation needing people (sensitivity, specifity) has not been established by now. Aims and questions The goal of the project is to compare the different assessment procedures A, B and C. The chosen design is comparable to a validation study for diagnostic instruments. We want to examine how the three diagnostic assessment methods differ from each other and how they correlate with external criteria (rehabilitation needs assessed by the patients themselves and rehabilitation needs assessed by clinicians). Design This is the first study to apply a randomized experimental design to social medicine reviews of rehabilitation needs. After assessments on the basis of medical documents have been performed (assessment type A), the patients (n=400) are randomized to one form or the other of the assessments made by specialists (type B or C as described above). These assessments are realized independent of the result of the first assessments (type A). The results of the assessments are correlated with different external criteria. Patients are examined at five times (application for medical rehabilitation, beginning and end of rehabilitation, and follow-ups after 3 and 12 months). The assessments by the clinicians are taken at the beginning and at the end of the rehabilitation. Course In the first year of the project a feasability study was made with a sample of 130 patients. It allowed to optimize the protocol of the study and to implement it into the normal process of the application for medical rehabilitation in the social medicine services and the course of questionnaires at the beginning and at the end of the medical rehabilitation. The feasability study has shown, that the project C2 can be completed according to plan.