Phasenmodell der Traumarehabilitation

Abstract

Advances in the rescue chain and first aid of polytrauma patients, which have consequently increased their chance of survival, have led to an increase in demands for rehabilitation. However, there is still a large hole in the continuity of rehabilitation between acute patient care and in-patient rehabilitation, the so-called "rehab-hole". The consequences are untapped rehabilitation potential, loss of strength, endurance and motivation as well as impairment of function of the patient.Based on the phase model of neurological/neurosurgical rehabilitation, we propose a step model for the rehabilitation of polytrauma patients that ensures an uninterrupted chain of rehabilitation. After acute patient care (phase a) and a potentially required early patient rehabilitation (phase b), trauma rehabilitation should seamlessly continue on to phase c. The implementation of phase c after acute patient rehabilitation requires changes in the structure of "orthopaedic" rehabilitation clinics and financial support due the large consumption of resources by more complexly injured patients in this phase. The subsequent rehabilitation in phase d is well established and complies with current rehabilitation measures (AHB, BGSW). Further rehabilitation measures may be essential for social and occupational reintegration of the patient (phase e), depending on the complexity of their injuries after the accident. For patients with long-lasting results after an accident, it is crucial to implement continuous follow-ups (phase f) to ensure a better long-term outcome.In order to implement this phase model it is necessary to establish specialized facilities that meet the particular requirements needed for phase c. This tri-phased treatment model in trauma centres can therefore be used in trauma rehabilitation. In addition to the already established local and regional rehabilitation centres, nationwide trauma rehabilitation centres have adopted phase c rehabilitation.

Versorgungslücken in der medizinischen Rehabilitation – die postakute Komplexrehabilitation

“…Besonders weit fortgeschritten ist die Diskussion zu Versorgungslücken in der medizinischen Rehabilitation in der Traumatologie, also nach schweren und schwersten Verletzungen. Simmel et al 3 beklagten ein „Reha-Loch“ und Simmel et al 4 legten Anforderungen an Einrichtungen der postakuten Rehabilitation (Phase C) vor. Müller et al 5 beschrieben die Einbindung von Reha-Einrichtungen in die Traumanetzwerke als praktische Umsetzungsmöglichkeit eines der neurologischen Rehabilitation analogen Phasenmodells der Traumarehabilitation, hier entsprechend der Phase C.…”

Stationäre und ambulante Heilverfahren der Deutschen Gesetzlichen Unfallversicherung

“…Die moderne Traumarehabilitation orientiert sich an dem erfolgreichen Modell der neurologischen Rehabilitation, in der die einzelnen Phasen der Rehabilitation fließend ineinander übergehen können (s. Abb. 1 ) 13 14 . Im aktuellen Weißbuch Schwerverletztenversorgung der Deutschen Gesellschaft für Unfallchirurgie (2019) wird dieses Phasenmodell für die Behandlung Schwerverletzter übernommen.…”

Rehabilitation of Patients with Osseointegrated Prosthesis after Transfemoral Amputation – Literature-based Recommendation for Postoperative Rehabilitative Procedure

“…Rehabilitation after osseointegrated prosthetics is complex and requires particularly close interdisciplinary cooperation among doctors, physiotherapists and orthopaedic technicians considering the high demands on functionality and load-bearing capacity of the prosthetic fitting [7]. Multi-level and fracture-free connection is essential to ensure successful long-term rehabilitation and must be adapted to the patientʼs needs considering the alternation between rehabilitation phases to prevent a 'rehab hole' [17]. Based on the published data and currently available information, this study aimed to provide the readers with the most reliable post-treatment routine by critically assessing their benefits and limitations and ensuring the best possible treatment outcome.…”

“…Interventionen gefordert. Eine Einstufung gemäß Phasenmodell der Rehabilitation nach Trauma in die Phase E wäre hier möglich, was wiederkehrende Nachsorge mit Intervention im Bedarfsfall bedeuten würde[17].SchlussfolgerungenRezidivierende Weichgewebskomplikationen sind bei schaftgeführten Prothesen häufig und beeinflussen das funktionelle Ergebnis und die Lebensqualität negativ. Osseointegrierte Prothesen stellen vor allem bei jungen Patienten und traumatologischer Amputationsursache bei problembehafteter, schaftgeführter Prothesenversorgung eine Behandlungsalternative dar.…”