Telerehabilitation

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In a first approximation, telerehabilitation can generally be understood as the implementation of medical rehabilitation measures using ICT (Information and Communications Technology). This means that rehabilitation services can also be offered over existing spatial and / or temporal distances. A Telereha does not have the task of replacing a full-day rehabilitation service according to § 15 SGB VI. Tele-rehab aftercare can be used as an alternative z. B. to the IRENA procedure , following an inpatient or all-day outpatient service for medical rehabilitation. In addition to the conventional face-to-face rehab aftercare, telematically assisted rehab aftercare is available. The rehabilitation aftercare is intended to consolidate the rehabilitation success. The institutions of the German pension insurance have developed special aftercare programs for this. The rehabilitation candidates should be able to transfer what they have learned in rehabilitation into everyday life, stabilize and develop them further through aftercare. Rehabilitation aftercare offers can help to anchor the positive effects of medical rehabilitation after the end of rehabilitation in the everyday life of the patient by strengthening self-responsibility and self-management skills of those affected. Research projects for the further development of rehabilitation aftercare break new ground, which already start during rehabilitation and increasingly use media such as telephone, cell phone and internet. From 2019 tele-follow-up care offers must comply with the admission and implementation conditions of the German pension insurance. The minimum requirements for tele-follow-up care do not have to be fully met for newly initiated model projects, but a data protection concept is required in any case. Model projects are limited in time or regionally, in contrast to this, there are nationwide recognized and offered aftercare programs for the standard care of all pension insurance institutions and insured persons. The rehab statistics database (RSD) differentiates between the type of aftercare service, and a distinction is made between conventional (face-to-face) and tele-rehab aftercare offers. In Austria, the TeleReha is used to extend the recovery phase after the rehabilitation stay right up to the patient's home; it has been anchored in the law there since a social security reform, it is intended to facilitate therapies, increase adherence to therapy and fill in gaps in treatment following hospital treatment.

General

The first research approaches for computer-aided telerehabilitation systems were made by the Enzensberg Clinic Group , at the Herzogenaurach Specialist Clinic, under the direction of Bernd Kladny, before 2000 . In the treatment of multimorbid patients, multimodal treatment approaches of teletherapy could be an effective rehabilitative as well as post-rehabilitative aftercare offer to support successful rehabilitation. In 2016, the results of a feasibility study on EvoCare teletherapy as an aftercare offer from the Aggertalklinik, the rehabilitation clinic of the DRV Rheinland, were presented. "It is a model that can be used as a supplement - if IRENA is not possible on-site, as an alternative to the aftercare offer of a RV wearer." "In orthopedics as well as in cardiology, secondary prevention after rehabilitation is inadequate. The very good therapeutic success of rehabilitation has so far not been sustainable enough in the long term. That is why there are intensive efforts to find appropriate aftercare programs, whereby long-term (more than 2 years) measures are necessary to stabilize the therapeutic success. Internet-based programs appear promising here. The Deutsche Rentenversicherung is particularly interested in the sustainability of the rehab success. ”In 2018 a study was published that looked at the integration of a telerehabilitative system to support in-patient orthopedic measures. The digital training is at least as successful as the conventional training plan and shows positive trends in training frequency. It was stated that the number of cases was too small.

Standard supply

Those insured with Deutsche Rentenversicherung Bayern Süd (DRV) can, according to a doctor's prescription, continue the exercises they learned during rehabilitation at home with TeleRehabilitation for the first six weeks after their stay in a rehabilitation clinic. DRV Bayern Süd is the first statutory pension insurance institution to introduce this type of aftercare.This first regular approval enables other pension insurance institutions across Germany to make this form of telerehabilitation available to their patients as an extension of their existing range of care, provided the following requirements are met. In 2017, the Deutsche Rentenversicherung published the "DRV Requirements for Tele-Rehabilitation Follow-Up Care" for the first time. “This is followed by a chapter on remuneration for tele-follow-up services, followed by explanations on the implementation of uni- and multimodal tele-follow-up care. The regulations for the conventional face-to-face aftercare forms IRENA , RENA, T-RENA, Psy-RENA and addiction aftercare are taken into account. ”The EvoCare treatment process is possible for medical rehabilitation facilities approved by the German Pension Insurance. After a full-day rehabilitation measure, EvoCare can be included in the standard care of the rehabilitation aftercare of the pension insurance as a unimodal treatment offer in the orthopedics indication, for diseases of the musculoskeletal system. The remuneration rates for the EvoCare treatment procedure are regulated for the rehabilitation facilities providing aftercare services as unimodal training therapeutic tele-follow-up care (based on T-RENA) in individual provision. EvoCare can only be carried out under the responsibility of a medical rehabilitation facility approved by the DRV. In their treatment concept, the facilities must explain how EvoCare should actually be used. The institutions should also state for which group of people they would like to use EvoCare. The principle of the priority of conventional face-to-face aftercare over tele-aftercare applies. On the other hand, tele-care is a useful addition to the range of after-care services provided by the pension insurance. It is particularly appropriate when the possibilities of conventional rehab after-care do not work. Tele-follow-up care can thus include a group of rehabilitants who would otherwise not use rehabilitation follow-up care. TeleNachorge complements the traditional rehabilitation aftercare offer. For multimodal tele-care (based on IRENA ) or in other indications, EvoCare can be used as a model in rehabilitation facilities approved by the German Pension Insurance, these are diseases of the cardiovascular system, neurological diseases, metabolic diseases as well as mental and psychosomatic ones Disruptions. In times of the corona pandemic (March 2020), approved tele-rehab aftercare can be continued.

Since mid-2014, the Bad Schallerbach health facility of the Insurance Company for Railways and Mining (VAEB) has been offering outpatient TeleReha in an initial test phase in Austria . Participation in TeleReha is voluntary and free of charge for those insured with VAEB. Patients have the option of receiving telemedicine support in their recovery six weeks after the rehabilitation stay at the health facility. It enables rehabilitation to continue within your own four walls. The indication groups are predominantly from the orthopedic area. Therapy compliance was over 70 percent. According to the SV-holder, a well-structured and sustainable rehabilitation phase is very important, especially for injuries that fall into the orthopedic field. Results of a study published in 2018: “96% of the patients in the intervention group are satisfied or very satisfied with the handling. 2% of the intervention group were not satisfied with the way they communicated with the physiotherapist. After 6 months, the participants in the intervention group are significantly more satisfied with the overall course of treatment than the patients in the comparison group. ”On December 13, 2018, the National Council in Austria decided that the General Social Insurance Act (ASVG) would be amended. It is made clear that telerehabilitation also counts as an outpatient medical rehabilitation measure; this serves the expansion of digitization and telemedicine as planned in the government program.

Web links

Individual evidence

  1. ↑ Fraunhofer Focus (Ed.): Report Telerehabilitation 2015 . October 15, 2015 ( Download [PDF]).
  2. ↑ Requirements of the German pension insurance for tele-rehabilitation aftercare, Internet access: June 18, 2020 ( [1] ) /
  3. ↑ German pension insurance. Accessed on the Internet on July 17, 2018: Framework concept for rehabilitation aftercare including facilities
  4. ↑ Rupp, E., Sünderhauf, S., Tesak, J .: Teletherapy in the treatment of aphasia. Aphasia and allied areas, No. 2, 2008, accessed on the Internet: July 17, 2018 ( [2] ) /
  5. ↑ Widera, T., Volke, E., Buschmann-Steinhage, R .: Rehabilitation Aftercare in Transition - Current Framework Conditions and Challenges for Pension Insurance Institutions and Service Providers Rehabilitation Report of the German Pension Insurance, accessed on June 18, 2020 ( [3] ) /
  6. ^ U. Eisermann, I. Haase, B. Kladny: Computer-aided multimedia training in orthopedic rehabilitation. In: American journal of physical medicine & rehabilitation / Association of Academic Physiatrists. Volume 83, Number 9, September 2004, pp. 670-680, PMID 15314531 .
  7. ↑ Leitner, M., TeleTherapie for multimorbid patients, poster no. 4, poster abstracts p. 6., published at the 11th Rehabilitation Symposium Network Rehabilitation Research in Bavaria eV (NRFB), Multimorbidity in Medical Rehabilitation, 9-10 . November 2017, Bad Reichenhall Clinic. [4]
  8. ↑ Hein, A., Hekler, J., Telemedicine in orthopedic rehabilitation - Feasibility study for EvoCare teletherapy as an aftercare offer of the Aggertalklinik, rehabilitation clinic for orthopedic diseases of the DRV Rhineland, poster no. 4, poster abstracts p. 6, published on the 1st Rehabilitation Symposium Network Rehabilitation Research in Bavaria eV (NRFB), Sustainable Lifestyle Change. A task for rehab., 17.-18. November 2016, Frankenland Clinic Bad Windsheim. [5]
  9. ↑ Tele-Assist - Results of the feasibility study of a telemedical care offer for cardiological and orthopedic rehabilitation in the Roderbirken Clinic and the Aggertalklinik
  10. ↑ Telematic training to promote motivation and activity level during inpatient rehabilitation for low back pain. In: DRV writings. Volume 113, 2018, pp. 296-298. ( [6] )
  11. ^ German pension insurance from April 16, 2014 With rehabilitation from home fit for the job again
  12. ↑ German Federal Pension Insurance, nationwide recognition, remuneration rates for EvoCare, October 11, 2017 ( [7] ) /
  13. ↑ New therapy offer for patients after rehabilitation !, October 26, 2017, E-HEALTH-COM, Internet access: June 28, 2018 ( [8] ) /
  14. ↑ German Federal Pension Insurance, circular to rehabilitation facilities, Internet access June 18, 2020 [9] /
  15. ↑ Outpatient TeleRehabilitation, Annual Report of the Institute for Health Promotion and Prevention 2014, pages 14–16, Internet access: June 18, 2020 ( [10] ) /
  16. ↑ Modern technology for your health further developed, Insurance Company for Railways and Mining, VAEB Annual Report 2017, page 38, Internet access June 18, 2020 ( [11] ) /
  17. ↑ GE Bad Schallerbach - TeleMedizin, Internet access vielgesundheit.at: December 12, 2017 ( [12] ) /
  18. ↑ Tele-physiotherapy: sustainable or short-lived hype? Georg Thieme Verlag, 2018, accessed on July 20, 2018 .