Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2006; 16(2): 82-91
DOI: 10.1055/s-2005-915387
Wissenschaft und Forschung
© Georg Thieme Verlag KG Stuttgart · New York

Prädiktoren des Rehabilitationsergebnisses bei Patienten nach Hüft- und Knieendoprothetik - Eine Multiebenenanalyse

Predictors of Rehabilitation Outcome in Patients after Total Hip and Total Knee Arthroplasty - A Multilevel AnalysisE.  Farin1 , M.  Glattacker1 , W.  H.  Jäckel1 , 2
  • 1Abt. Qualitätsmanagement und Sozialmedizin, Universitätsklinikum Freiburg
  • 2Hochrhein-Institut für Rehabilitationsforschung, Bad Säckingen
Further Information

Publication History

Eingegangen: 2. August 2005

Angenommen: 16. Dezember 2005

Publication Date:
07 April 2006 (online)

Zusammenfassung

Studienziel: Die Bestimmung von patientenbezogenen und klinikbezogenen Prädiktoren des kurz- und mittelfristigen Outcomes einer Rehabilitationsmaßnahme nach Hüftendoprothese (HTEP) und Knieendoprothese (KTEP). Methode: In 32 orthopädischen Rehabilitationskliniken wurden Patienten konsekutiv in die Studie eingeschlossen, bis eine Fallzahl von ca. 200 Patienten pro Klinik erreicht war. Insgesamt waren darunter n = 1954 HTEP-/KTEP-Patienten. Eingesetzt wurden ein Patientenfragebogen zur Selbsteinschätzung des somatischen, funktionalen und psychosozialen Status sowie ein Arztbogen, der u. a. der Erfassung von Komorbidität, Diagnose und Reha-Motivation dient. Als Outcomeparameter werden Mobilität, Schmerzen und vitale Erschöpfung betrachtet. Ergebnisse: Kurzfristig werden geringe bis mittelhohe Effekte erzielt. 6 Monate nach Beendigung der Rehabilitationsmaßnahme sind nur die Verbesserungen bezüglich Mobilität deutlich ausgeprägt. Bedeutsame patientenbezogene Prädiktoren des Outcomes sind der jeweilige Aufnahmewert des Outcomeparameters, die funktionale und psychische Belastung bei Reha-Beginn, Komorbidität, Geschlecht, Alter und soziale Probleme. Klinikbezogene Einflussfaktoren erweisen sich als relevant für die Rehabilitationseffekte bezüglich Mobilität und vitaler Erschöpfung, nicht aber für die Schmerzreduktion. Umfangreiche Erfahrungen einer Einrichtung mit somatisch und funktional stark belasteten Patienten wirken sich förderlich aus auf die Reha-Effekte im funktionalen und psychosozialen Bereich. Schlussfolgerung: Neben patientenbezogenen Prädiktoren des Rehabilitationsoutcomes existieren auch medizinisch relevante, klinikbezogene Einflussfaktoren, die mit Hilfe von Multiebenenanalysen identifiziert werden können.

Abstract

Aim: The determination of patient-related and clinic-related predictors of the short- and medium-term outcome of rehabilitation after total hip arthroplasties (THA) and total knee arthroplasties (TKA). Method: N = 1.954 THA/TKA patients were included in the study. Use was made of a patient questionnaire for self-assessment of somatic, functional and psychosocial status. Additionally we applied a documentation sheet completed by the physicians. Multilevel analysis using hierarchical linear modelling was employed. Results: In the short-term slight to medium effects are achieved. Six months after the end of rehabilitation only the improvements with regard to mobility are clearly obvious. Significant patient-related predictors of outcome are the value of the outcome parameter at admission, the functional restrictions and psychological stress at the start of rehabilitation, comorbidity, gender, age and social support. Centre-related influencing factors prove to be relevant for the effects of rehabilitation with regard to mobility and vital exhaustion, but not for the reduction in pain. Extensive experiences of a centre with somatically and functionally greatly affected patients have a beneficial effect on the results of rehabilitation in the functional and psychosocial area. Conclusion: In addition to patient-related predictors of outcome of rehabilitation there are also medically relevant, centre-related influencing factors that can be identified with the aid of multi-level analyses.

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1 Falls das jeweils betrachtete Kriterium als Skala der jeweiligen Unterdimension zugeordnet ist (wie z. B. beim Kriterium „Vitale Erschöpfung”, das eine Skala der Unterdimension „Psychische Belastung” bildet), wurde aus dem Prädiktor der Einfluss des Kriteriums zuvor regressionsanalytisch eliminiert.

Dr. phil. Dipl.-Psych. Erik Farin

Universitätsklinikum Freiburg · Abt. Qualitätsmanagement und Sozialmedizin

Breisacher Straße 62/Haus 4

79106 Freiburg

Email: erik.farin@uniklinik-freiburg.de

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