[Evaluation of ambulatory orthopedic-traumatologic rehabilitation by compensation insurance. A comparison with inpatient rehabilitation].

In 1994, "Ambulant Orthopaedic-Traumatologic Rehabilitation" (AOTR) was introduced by the Ersatzkassen health insurance funds. This study investigated structural, process and outcome quality. One of the study questions asked is whether AOTR is as effective for (1) patients with low back pain and clinical signs of disc problems and (2) patients with cruciate ligament injury as the routinely practised inpatient rehabilitation. In a quasi-experimental cohort study patients from five AOTR centers were compared to patients from five orthopedic rehabilitation clinics with regard to their rehabilitation outcome measured on the clinical, disability and handicap level. At the beginning (t0) and the end (t1) of the rehabilitation, data were collected from patients and therapists and 6 months later (t2) only from patients by means of questionnaires. The inclusion criteria for patients with back problems had to be broadened ("patients with low back pain") because of difficulties with patient sampling. Sample sizes were n = 166 (AOTR: 100, inpatient: 66) for t0 and t1 and n = 101 (AOTR: 47, inpatient: 54) for t0, t1 and t2. At baseline, ambulant patients with low back pain were younger (43 vs. 49 years) and better off with regard to disabilities and handicaps than patients from rehabilitation clinics. Clinical signs (e.g., neurological signs, Lasègue sign, flexibility of the spine) showed smaller differences. At t1 clinical, disability and handicaps variables had improved considerably in both groups. At t2 the improvements had stabilized or had become greater. Analyses of variance showed that improvements in the ambulant group were not much greater after accounting for the different baseline status. The sample size of patients with knee ligament injury was n = 66 (AOTR: 50, inpatient: 16). Ambulant patients considerably improved with regard to knee function and handicaps. Despite of small sample sizes this study provides some evidence that (1) AOTR and inpatient rehabilitation both are effective for treating subgroups of patients with low back pain and (2) AOTR is effective for treating patients with cruciate ligament injury.