FROM HOSPITAL REHABILITATION INTO THE COMMUNITY LESSONS FROM AFAR - - PowerPoint PPT Presentation

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FROM HOSPITAL REHABILITATION INTO THE COMMUNITY LESSONS FROM AFAR - - PowerPoint PPT Presentation

Dec 15, 2022 219 likes •566 views

FROM HOSPITAL REHABILITATION INTO THE COMMUNITY LESSONS FROM AFAR Dr. Peter Wright CONTENT 1. Exercise the miracle cure 2. Why rehab and exercise means a return of investment? 3. Comparison of international rehabilitation systems 4.

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FROM HOSPITAL REHABILITATION INTO THE COMMUNITY – LESSONS FROM AFAR

  • Dr. Peter Wright
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  • 1. Exercise – the miracle cure
  • 2. Why rehab and exercise means a return of

investment?

  • 3. Comparison of international rehabilitation

systems

  • 4. Disease management programmes [DMPs]

CONTENT

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EXERCISE - THE MIRACLE CURE

THE KEY DOCUMENT WAS PRODUCED BY THE ACADEMY OF MEDICAL ROYAL COLLEGES IN 2015

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CAD-MORTALITY AND FITNESS IN QUARTILES

(NORWAY, 1960 MEN, 40-59 YEARS, 16 FOLLOWING YEARS)

[years] SANDVIK et al. (1993) Cumulation [%] 2 4 6 8 1 1 2 1 4 1 6 2 4 6 8 1 1 4 3 2

1 = highest fitness 4 = lowest fitness

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EFFECTS OF AN ENDURANCE TRAINING ON THE O2-CONSUMPTION OF THE MYOCARDIUM IN CARDIAC PATIENTS

Schulz 2005

. .

Angina Pectoris Threshold in CHF 25 50 75 100 125 150

workload (Watt)

10 20 30 40

  • myok. VO2 (ml min-1 100g-1)

0.0 0.5 1.0 1.5 2.0 2.5 3.0

VO2 (l min-1 )

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STRENGTH TRAINING AFTER CARDIAC TRANSPLANTATION: EFFECT ON MUSCLE MASS

(BRAITH, MSSE 30:483-89 1998)

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EFFECTS OF A STRENGTH TRAINING ON THE KNEE EXTENSORS IN 85-97 YEAR OLDS

Harridge et al., Muscle Nerv 22, 831-839, 1999

11 Subjects (8 w, 3 m) 12 weeks strength training Dynamic maximal strength

  • f the knee extensor +134%

Muscle cross section +10% before after

+ 44%

92 J. male

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REDUCTION OF MORTALITY RISK

Type Intervention Reduction of relative Risk Author

Mamma- Ca. Minimum 3x 1 hr moderate activity per week (9 MET s) 26-40% Holmes et al. 2005 Colon-Ca. Minimum 6x 1 hr moderate activity per week (18 MET s) 40-50% Meyerhardt et al. 2006, 2007 Prostate- Ca. Minimum 3x 1hr intense physical activity per week 61% Kenfield et al. 2011

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WHY REHAB & EXERCISE MEANS A RETURN OF INVESTMENT

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DIFFERENT REHAB SETTINGS

Definition of different rehabilitation measures

  • Ambulatory rehabilitation is a form of medical care provided on an
  • utpatient basis.
  • Stationary or inpatient rehabilitation is a form of medical care for

patients whose condition requires admission to a hospital or rehabilitation clinic.

  • Vocational rehabilitation measures are used to overcome barriers to

maintaining or obtaining an employment relationship.

International Social Security Association 2017

Average duration of interventions Ambulatory rehabilitation 14.3 days (stdev. 7.4) Stationary rehabilitation 26.5 days (stdev.9.2)

Average duration of interventions

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OVERVIEW OF COUNTRY SPECIFIC SOCIAL SECURITY PARAMETERS (PERCENTAGE)

Country Social security contribution rate on income1 Temporary disability insurance benefit rate2 Permanent disability insurance benefit rate3 Austria 42.35 60 35 Canada 15.38 75 35 Chile 22.14 100 35 Finland 30.60 70 35 Germany 40.75 75 35 Indonesia 10.50 75 35 Italy 42.87 62.5 35 Malaysia 26.75 80 35 New Zealand 0.00 80 35 Poland 42.09 90 35 United States 15.90 66 35 Zimbabwe 7.00 51 35

Notes:

1.Retrieved from Retrieved from SSA and ISSA (2014a, 2014b, 2015a, 2015b); New Zealand is a special case without

contribution collection since its programme is financed through general taxes.

2.See note 1. For Germany, Indonesia, Italy and Poland, the average of the two given values for the different providers of

compensation payments was used.

3.Set by authors at 35 per cent, as most countries calculate benefits based on a variety of factors via a formula and do

not provide average values. A survey of the empirical literature has shown, however, that permanent disability insurance usually recovers around 30–40 per cent of past earnings on average.

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WHY REHAB WORKS FROM AN ECONOMICAL POINT OF VIEW

Employer benefits Employer costs Increased productivity Decreased productivity (lost time) Reduced overtime costs Increased overtime costs Reduced recruitment costs Social security benefits Social security costs Reduced work compensation expenditure short term Intervention costs (from questionnaire) Reduced work compensation expenditure long term Increased overtime costs Increased contributions

Societal benefits Societal costs Increased productivity Decreased productivity (lost time)

Societal balance sheet Employer balance sheet Social security balance sheet

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COST EFFECTIIVENESS

International Social Security Association 2017

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COMPARISON OF INTERNATIONAL REHABILITATION SYSTEMS

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THE GERMAN REHABILITION PROCESS

Schüle, K. (2013): Thirty years of physical activity in oncology in Germany— from the birth of the first rehabilitative cancer sports group until today. European Group for Research into Elderly and Physical Activity (EGREPA)

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Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit COMMUNITY BASED POLY CLINIC/REHAB CENTRE

  • ONE OF 1500 NATIONAL REHABILITATION CLINICS/HOSPITALS
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Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit A MULTI-DISCIPLINARY PRIMARY HEALTH AND REHAB APPROACH

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Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit

XYZ

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Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit

XYZ

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Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit

XYZ

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Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit

XYZ

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REHABILITATION – NORWEGIAN STYLE

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AN EXAMLE OF REHAB FOR CHILDREN AND YOUNG ADULTS – NORWEGIAN STYLE

Beitostolen-rehab hospital/Norway: https://www.youtube.com/watch?v=2MnwUQ2rfW4

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Rehabilitation in Norway

Structure of the Norwegian Health System:

  • Around 50 rehabilitation-hospitals in Norway

(6 Nord; 8 Midt; 6 Vest; 30 Sør-Øst)

  • Every one has contracts with one or several

Health-regions

  • Pathway of rehabilitation varies between the

regions

  • Every institution is specialised on specific

groups of diagnoses

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REHAB – NORWEGIAN STYLE: ABILITY , NOT DISABILITY FOCUSED

  • In general groups are mixed
  • Specialist groups:

– Active in the wheelchair (both for children and adults) – Children with MS – Muscular dystrophy (both for children and adults) – Blind – Children with dysmelia – Children with spina bifida

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INTERDISCIPLINARY TEAMS

Basic structure of the interdisciplinary team

Overarching rehabilitation-team

Medical specialists; nurses; riding instructors + assistants

Children-section

Section leader/coordinator; 1 Occupational therapist; teachers 3 interdisciplinary teams that consist of (8-9 children per group):

  • 1 physiotherapist
  • 1 sports pedagogue/-therapist
  • 1 teamassitant or first year

physiotherapist

  • 2-3 students in practical training

Adult-section

Section leader/coordinator; 1 Occupational therapist 2 interdisciplinary teams that consist of (15 clients per group):

  • 1 physiotherapist
  • 1 sports pedagogue/-therapist
  • 1 teamassitant or first year

physiotherapist

  • 2-3 students in practical training
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DISEASE MANAGEMENT PROGRAMMES

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WHAT ARE DISEASE MANAGEMENT PROGRAMMES?

Disease management programmes (DMPs) are coordinated health care intervention programmes using interdisciplinary clinical teams, continuous analysis of relevant data, and cost‐effective technology to improve the health status of patients with treatable chronic diseases (e. g. asthma, diabetes, etc.). The design of a DMPs involves typically a certain number of disease management activities. According to the Disease Management Association of America (DMAA), these activities comprise “population identification processes, evidence-based practice guidelines; collaborative practice models, patient self-care management education as well as process and outcomes measurement”.

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DO DMP WORK?

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HOSPITALISATION RATE OF ALL TRAINING GROUPS

  • VS. THE DIETARY AND THE CONTROL GROUPS

5 10 15 20 25 30 weeks 20 40 60 80 100 Non hospitalisation rate [%]

Control group Non training group Training group

Hospitalisation Control Group 36% NTG (Dietary) 33.3% Training Group 15.4%

Wright, 2012

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5 10 15 20 25 30 weeks 20 40 60 80 100 Survival rate [%]

Training group Non training group Control group

Mortality Control Group 28% NTG (Dietary) 5.6% Training Group 3.1%

SURVIVAL RATE OF ALL TRAINING GROUPS VS. THE DIETARY AND THE CONTROL GROUPS

Wright, 2012

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DMP – AN EXAMPLE Disease Management: a multi- or interdisciplinary model?

Wright, 2012

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REHAB INFRASTRUCTURE

  • EXAMPLE FOR A SMALL SIZE SOLUTION

www.huruk.co.uk

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