Self-employment index for neurological and geriatric rehabilitation

from Wikipedia, the free encyclopedia

The Independence Index for Neurological and Geriatric Rehabilitation (SINGER) is a German-language classification for recording the independence and need for care of patients in the context of outpatient or inpatient neurological rehabilitation . The survey is carried out by doctors or other therapists (such as nurses or speech therapists ) as an external assessment. A point value is collected using a standardized list of questions. The SINGER is derived from the International Classification of Functioning, Disability and Health (ICF). There are similarities with the Barthel Index and the Functional Independence Measure (FIM). According to the company, the SINGER is used in around 40 rehabilitation facilities. (As of 2019)

background

The instrument was developed from rehabilitation practice in Germany. Scientific support and evaluation was carried out by the Upper Rhine Institute for Rehabilitation Research.

In terms of content, the SINGER is based on the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization (ICF 2004; German version) as well as on existing and tried-and-tested instruments (especially the Barthel Index and FIM), although these instruments have certain weaknesses were compensated (e.g. the lack of separation between verbal and written communication or between hearing and reading comprehension in the FIM or the high ceiling effects in phase D patients in the Barthel index). Of the nine domains of the ICF in the area of ​​'Activities and Participation', seven are represented in SINGER with one or more indicators. With the exception of the ICF domains “important areas of life” (e.g. education, occupation, economic aspects) and “life in community and society” (e.g. leisure, religion, political life), all domains of the ICF are at least included represented by a leading indicator in the SINGER. The SINGER comprises 20 items from the areas of self-sufficiency, mobility, communication, cognition, social behavior and housekeeping

The most important innovation compared to the instruments already available concerns the basic principle of the gradations for the 20 items: The SINGER levels are not based on the extent of the need for help (such as "25 - 50% self-employed" in the FIM), but rather on the type the need for assistance, which was divided into three basic categories:

  • professional help during therapy
  • Contact assistance, which is also affordable outside of therapy
  • independent; no external help required.

Each of the basic categories was divided into two sub-categories, resulting in the following six levels:

  • 0 total dependence on professional help;
  • 1 professional contact assistance required if the patient is able to cooperate;
  • 2 Contact help is also sufficient outside of therapy;
  • 3 supervision or preparation by instructed persons sufficient; no contact help required;
  • 4 independently with aids or slowed down;
  • 5 independently without aids.

Differentiation from other assessment procedures

In comparison with the Barthel-Index or FIM processes, the SINGER is particularly characterized by the following properties:

  1. ICF - orientation and practicality: The SINGER was developed from 2001 to 2008 from rehabilitation practice in Germany. It depicts the seven particularly reha-relevant domains of the ICF with a few items each, without being oversized. In addition, it shows a medium level of detail and is therefore manageable in the daily routine. Additional document tasks support the user with the specific level assignment.
  2. No significant floor and ceiling effects: Since the SINGER maps all essential reha-relevant areas with sufficient sensitivity to change, it does not generate any noticeable floor and ceiling effects compared to the Barthel Index.
  3. Suitability for the rehab process display and assessment: The SINGER shows a very good change sensitivity and can therefore represent the rehab process meaningfully. Due to the six levels per item, up to five "improvements" can be mapped. In this way, essential and everyday improvements in the rehabilitation process are recorded. B. fails with the Barthel index.
  4. The SINGER is suitable for planning rehabilitation goals: Due to the SINGER's very good sensitivity to change, it can be used for planning rehabilitation goals. The result is that the SINGER, as required by assessment procedures, is at the center of rehabilitation and can be used to formulate everyday-relevant and verifiable rehabilitation goals and to monitor success.
  5. Can be used immediately - other areas of application: In contrast to the FIM, the SINGER can be used immediately without charge by granting a free license (see link). It is suitable for use in quality assurance programs and offers interesting perspectives in rehabilitation research, e.g. B. in the preparation of rehabilitation prognosis after a stroke.

Sources and literature

  • Birgit Hibbeler: Rehabilitation: Payment after success. In: Deutsches Ärzteblatt. October 20, 2006.
  • Adelbert Zehnder: Rehabilitation - Remuneration Light in the black box. In: Kma . 01/2007.
  • N. Gerdes, UN Funke, U. Schüwer, H. Kunze, E. Walle, WH Jäckel: Outcome-oriented remuneration in rehabilitation after stroke - results of a trial of the procedure in 13 specialist neurological clinics. In: 16th Rehabilitation Scientific Colloquium of the German Pension Insurance from March 26th to 28th, 2007 in Berlin. Proceedings, pp. 337–339.
  • Polly Schmincke: Pay for Performance - money against healing. In: kma. 03/2008.
  • Ludwig Boltzmann Institute: Differentiation of severity in neurological and trauma rehabilitation. Final report, part 2, p. 17, Vienna 2009.
  • UN Funke, U. Schüwer, P. Themann, N. Gerdes: SINGER manual for level assignment. S. Roderer Verlag, Regensburg 2009, ISBN 978-3-89783-655-6 .
  • UN Funke, U. Schüwer, P. Themann, N. Gerdes: SINGER manual for level assignment. 2nd, revised and expanded edition. S. Roderer Verlag, Regensburg 2017, ISBN 978-3-89783-865-9 .
  • N. Gerdes and others: Result-oriented remuneration for rehabilitation after a stroke. In: The rehabilitation. 48, Thieme Verlag, Stuttgart 2009, pp. 190-201.
  • N. Gerdes, UN Funke, B. Claus, U. Schüwer, P. Themann: Self-employment index for neurological and geriatric rehabilitation (SINGER) development and validation of an assessment instrument. In: Verband Deutscher Rentenversicherungträger (Ed.): 14th Rehabilitation Science Colloquium 2005. (= DRV Schriften. Volume 59). Bad Homburg 2005, ISBN 3-926181-95-8 , pp. 341-343.
  • Kathrin Pauline Spendl: Success-oriented remuneration in rehabilitation. Dissertation. Ulm University, 2010, DNB 1010440535 .
  • Nikolaus Gerdes, Ulf-Norbert Funke, Ursula Schüwer, Peter Themann, Gustav Pfeiffer, Cornelia Meffert: Independence Index for Neurological and Geriatric Rehabilitation (SINGER) - Development of a new assessment instrument. In: The rehabilitation. 51 (5), Thieme Verlag, Stuttgart 2012.
  • K. Freidel, M. Leisse: How much FIM corresponds to so much SINGER? In: Proceedings of the 20th Rehabilitation Science Colloquium 2011. Berlin 2011, ISBN 978-3-00-033981-3 , pp. 90–92.
  • N. Gerdes, I. Funke: Sample-based versus individual prognosis of the rehabilitation result after a stroke, conference volume 21st Rehabilitation Science Colloquium 2012. Berlin 2012, ISBN 978-3-00-037354-1 , pp. 374-375.
  • G. Zieres, U. Weibler: Quality perspectives in medical rehabilitation. Iatros Verlag, 2012, ISBN 978-3-86963-300-8 .
  • CH Veit among others: Pay-for-Performance in the healthcare sector. An opinion on behalf of the Federal Ministry of Health, BQS Institute for Quality & Patient Safety, 2012. ( online , PDF, 4.4 MB)
  • Federal Working Group for Rehabilitation: Phase E of Neurological Rehabilitation - Recommendations. BAR, Frankfurt am Main, December 2013.
  • K. Freidel, M. Leisse: Measurement of functional independence: Correspondence of the assessments SINGER and FIM and consequences for the user . In: The rehabilitation . tape 53 , no. 01 , January 28, 2014, ISSN  0034-3536 , p. 43-48 , doi : 10.1055 / s-0033-1341456 .

Web links

Individual evidence

  1. ↑ SINGER - Questions and Answers. In: singer-assessment.de. Accessed July 31, 2019 .