Zabar Omar, Lichtenberg Dieter, Groneberg David A, Ohlendorf Daniela
Institut für Arbeits‑, Sozial- und Umweltmedizin, Goethe-Universität Frankfurt, 60596, Frankfurt am Main, Deutschland.
Asklepios Katharina-Schroth-Klinik, Orthopädie, Bad Sobernheim, Deutschland.
Wien Med Wochenschr. 2023 Oct;173(13-14):319-328. doi: 10.1007/s10354-021-00911-0. Epub 2022 Feb 15.
Mental comorbidity plays an increasingly important role in determining the specific rehabilitation needs of patients in Germany in the context of other personal, social and occupational factors. In order to make the DRV's list of criteria more meaningful when assigning patients to one type of rehabilitation, this retrospective analysis is intended to determine from which of the two rehabilitation concepts examined (orthopedic rehabilitation or healing procedures (HV)/behavioral-medical orthopedic rehabilitation (BMOR)) patients with mental comorbidity (taking into account gender, employment status of the main orthopedic diagnosis) benefit more.
Using the screening questionnaires HADS‑A, HADS‑D, SIMBO and BPI as well as a hospital questionnaire at the beginning of rehabilitation, data from 913 subjects (529 m/384 w) were collected and evaluated. Of these, 43% were assigned to HV and 57% to BMOR. Thus, in addition to the main orthopedic diagnosis, the frequency distribution of the factors psychological comorbidity, sex and, employment status (in the sense of unemployment) was determined. Using HADS, the benefit was determined at the end of the therapy by comparing the score medians.
Frequency distributions and the development of HADS scores show that the prior classification according to psychological comorbidity was correct. Women were more often affected by mental comorbidity and women achieved greater success in BMOR. Regarding the main orthopedic diagnosis, a high prevalence of cervical and lumbar spine complaints was found. According to logistic regression with model decomposition, the variables gender, HADS‑A and -D at the beginning of rehabilitation and the psychological comorbidity (yes/no) are suitable to correctly allocate the patients with 76.86% to one of the two types of therapy.
The presence of mental comorbidity appears to be a useful indicator that should be retained in the DRV's criteria catalog as one of the main criteria for allocation to BMOR. Female gender in connection with the presence of mental co-morbidity can also be considered a conclusive criterion. With regard to the main orthopedic diagnosis, cervical spine complaints may be particularly suitable as an allocation criterion.
在德国，精神共病在结合其他个人、社会和职业因素确定患者的具体康复需求方面发挥着越来越重要的作用。为了使德国康复协会（DRV）的标准清单在将患者分配到一种康复类型时更有意义，这项回顾性分析旨在确定患有精神共病的患者（考虑性别、主要骨科诊断的就业状况）从所研究的两种康复概念（骨科康复或治疗程序（HV）/行为医学骨科康复（BMOR））中的哪一种中获益更多。
使用筛查问卷HADS - A、HADS - D、SIMBO和BPI以及康复开始时的医院问卷，收集并评估了913名受试者（529名男性/384名女性）的数据。其中，43%被分配到HV，57%被分配到BMOR。因此，除了主要骨科诊断外，还确定了心理共病、性别和就业状况（从失业角度）等因素的频率分布。使用HADS，通过比较分数中位数在治疗结束时确定获益情况。
频率分布和HADS分数的变化表明，根据心理共病进行的先前分类是正确的。女性更常受到精神共病的影响，并且女性在BMOR中取得了更大的成功。关于主要骨科诊断，发现颈椎和腰椎疾病的患病率很高。根据带有模型分解的逻辑回归，康复开始时的变量性别、HADS - A和 - D以及心理共病（是/否）适合将76.86%的患者正确分配到两种治疗类型之一。
精神共病的存在似乎是一个有用的指标，应作为分配到BMOR的主要标准之一保留在DRV的标准目录中。与精神共病相关的女性性别也可被视为一个决定性标准。关于主要骨科诊断，颈椎疾病可能特别适合作为分配标准。
