Beyer Joachim, Seidel Egbert J
Abteilung Frührehabilitation und Altersmedizin, Krankenhaus Ludmillenstift, Meppen.
Zentrum für Physikalische und Rehabilitative Medizin des Sophien- und Hufeland-Klinikums Weimar.
Rehabilitation (Stuttg). 2017 Aug;56(4):272-285. doi: 10.1055/s-0043-112071. Epub 2017 Aug 24.
An early, intensive rehabilitative therapy accelerates the recovery of the functions of patients. It contributes to a reduction in the complication rate as well as an improvement in physical and social functioning/participation in the long-term follow-up. Early rehabilitation must be strengthened on the basis of the existing structures: the creation and maintenance of adequately qualified early-stage rehabilitation facilities, at least in hospitals with priority and maximum supply contracts. Patients with long-term intensive care and polytrauma must be rehabilitated as soon as possible (intensive medical rehabilitation).Specialists in physical and rehabilitative medicine, rehabilitative geriatrists, neurologists, orthopaedists and accident surgeons and other regional physicians must cooperate in a targeted manner. Exclusion criteria using corresponding OPS codes must be canceled. Additional specialist physician groups (anesthetists and intensive care physicians, general practitioners, accident and thoracic surgeons, internists) must be sensitized to the importance of early rehabilitation.In the case of more than 500,000 hospital beds, 25,000 beds should be identified as age- and diagnosis-independent early-care beds in the country-specific bed-care plans. A cost-covering financing of the different, personal and cost-intensive early rehabilitation must be ensured. A phase model similar to the BAR guidelines for neurological-neurosurgical early rehabilitation is to be considered for other disease entities.In order to make the rehabilitation process as successful as possible, medical (acute) treatment, medical rehabilitation, occupational integration and social integration have to be understood as a holistic event and are effectively interrelated, as a continuous process which accompanies the entire disease phase-wise. For this purpose, a continuous case management or a rehabilitation guidance has to be established.
早期强化康复治疗可加速患者功能恢复。从长期随访来看，它有助于降低并发症发生率，并改善身体和社会功能/参与度。必须在现有结构基础上加强早期康复：建立并维持具备足够资质的早期康复设施，至少在签订了优先和最大供应合同的医院要做到这一点。长期重症监护和多发伤患者必须尽快接受康复治疗（强化医疗康复）。物理与康复医学专家、康复老年病学家、神经科医生、骨科医生、事故外科医生及其他地区医生必须有针对性地开展合作。必须取消使用相应OPS编码的排除标准。其他专科医生群体（麻醉师和重症监护医生、全科医生、事故与胸外科医生、内科医生）必须认识到早期康复的重要性。在拥有超过50万张医院床位的情况下，应在各国特定的床位护理计划中确定25000张床位为与年龄和诊断无关的早期护理床位。必须确保为不同的、针对个人且成本高昂的早期康复提供成本覆盖型资金。对于其他疾病实体，应考虑采用类似于神经科 - 神经外科早期康复BAR指南的阶段模型。为了使康复过程尽可能成功，医疗（急性）治疗、医疗康复、职业融入和社会融入必须被视为一个整体事件，并且作为一个伴随整个疾病阶段的连续过程，它们之间存在着有效的相互关联。为此，必须建立持续的病例管理或康复指导。
