Leniger Tobias, Heßling Andrea
Dr. Becker Neurozentrum Niedersachsen Bad Essen.
Fortschr Neurol Psychiatr. 2019 Feb;87(2):92-102. doi: 10.1055/a-0695-9074. Epub 2019 Jan 7.
To increase the rate of successful return-to-work (RTW) after acute or chronic diseases, the German Pension Insurance established the concept of work-related medical rehabilitation (WMR) as a strategic advancement of conventional medical rehabilitation. Although in some indications, the WMR is demonstrably superior to conventional medical rehabilitation in terms of occupational reintegration, this has not yet been proven for neurology so far. Current studies on neurological WMR point to the complexity of clinical anamnestic characteristics of the target group, which makes it difficult to define severe restrictions of work ability (SRWA) as a prerequisite for access to the neurological WMR. In addition, the heterogeneous functional disabilities, multiple comorbidities and the different types of rehabilitation services (follow-up, medical treatment) significantly influence SRWA identification. Standardized SRWA screening instruments with a focus on socio-medical criteria identify SRWA less adequately than individual history taking. In neurology, an individualized SRWA screening is recommended at the beginning of WMR despite additional expense.
为提高急性或慢性疾病后成功重返工作岗位(RTW)的比率,德国养老保险机构确立了与工作相关的医学康复(WMR)概念,作为传统医学康复的一项战略推进措施。尽管在某些适应症方面,WMR在职业重新融入方面明显优于传统医学康复,但到目前为止,这在神经病学领域尚未得到证实。目前关于神经病学WMR的研究指出了目标群体临床病史特征的复杂性,这使得将工作能力严重受限(SRWA)定义为获得神经病学WMR的先决条件变得困难。此外,功能残疾的异质性、多种合并症以及不同类型的康复服务(随访、医疗治疗)对SRWA的识别有显著影响。侧重于社会医学标准的标准化SRWA筛查工具在识别SRWA方面不如个人病史采集充分。在神经病学领域,尽管费用较高,但建议在WMR开始时进行个体化的SRWA筛查。