Leitlinien in der Rehabilitation: Einschränkung der Therapiefreiheit oder Grundlage für bessere Ergebnisse?

Abstract

Clinical practice guidelines - seen as an aggregation of scientific evidence - and evidence based medicine are of relevance and importance for everybody involved in health care. Nevertheless, the discussion of their pros and cons is controversial. Major criticisms concern methodological aspects, a disregard of the patients' perspective, potentially increasing costs and the limitation of doctors' autonomy possibly caused by streamlining therapy. Supporters emphasize the improvement of care that comes with using proven therapies, patients' empowerment, cost reduction and equity in the distribution of resources. Following medical practice guidelines the liability for medical malpractice may be limited, but non-adherence to guidelines does not entail liability per se. Clinical practice guidelines in the rehabilitative sector differ from those in curative medicine by being required to achieve more complex goals than maintenance, recovery and improvement of health. Activities in the rehabilitation sector address two main topics: The integration of rehabilitation into curative guidelines, e. g. by participating in the German clearing process for guidelines, and the development of guidelines specific to rehabilitation. There are a number of guideline initiatives, e. g. with the Association of the Scientific Medical Societies (AWMF), the Federation of German Pension Insurance Institutes (VDR) and the Federal Insurance Institute for Salaried Employees (BfA). The BfA project is the first to allow integration of evidence based medicine into the quality assurance programme of the German Pension Insurance complementing it with differentiated criteria for the assessment of therapeutic processes. Taking evidence based medicine increasingly into consideration and the continuous process of introducing rehabilitative clinical practice guidelines are going to improve health care for people with chronic diseases.

Paediatric Rehabilitation Treatment Standards: A Method for Quality Assurance in Germany

“…In the context of a rehabilitation standards program, it has funded several research projects focusing on the development of rehabilitation treatment standards since 1998. 12 These standards constitute an important element of quality assurance in rehabilitation. While guidelines of medical professional associations address the treatment of individual patients (see above), 10 the rehabilitation treatment standards (RTS) of the German Pension Insurance focus on the processes of rehabilitative treatment in rehabilitation centres.…”

Akzeptanz und Praktikabilität der Leitlinie für die Rehabilitation bei koronarer Herzkrankheit

“…Vor diesem Hintergrund wurde für die Erstellung der Leitlinien innerhalb des Leitlinienprogramms ein einheitliches Vorgehen entwickelt, dass mehrere aufeinander aufbauende Phasen vor− sieht und Elemente beinhaltet, die für die Akzeptanz und Umset− zung von Leitlinien in die klinisch−rehabilitative Praxis von Rele− vanz sind (u. a. systematische Analyse der wissenschaftlichen Li− teratur, Analyse des aktuellen therapeutischen Geschehens in der medizinischen Rehabilitation, strukturierter Konsensprozess unter Einbeziehung der wichtigsten an der Rehabilitation betei− ligten Berufsgruppen) [2,8,9].…”

Introducing a feedback training system for guided home rehabilitation

“…The addressed patients require adequate and individualized therapy according to their needs to improve the chances of continuing to live independently and to quickly regain a good and efficient quality of life [1]. Medical rehabilitation is usually done in a hospital setting but to an increasing degree ambulatory [2-5]. …”