Evaluated prognosis based on somatic, psychological and social factors related to the treatments approved by the statutory accident insurance

Status:

completed 04/2010

Aims:

A new integrated concept, based on medical, psychological and social factors shall realize scientifically proofed evaluation, prognosis and quality assurance within the treatments approved by the statutory accident insurance.

Activities/Methods:

Five modules:
- Preparation and coordination of the start phase
- Data collection and evaluation
- Data collection: catamnesis
- Analysis of data and model-construction of prognosis
- Documentation of results

Results:

The study - taken from 09/2006 to 04/2010 at BG Unfallklinik Ludwigshafen - has been designed to build up an integrated and evaluated pool of results of medical, psychological and social factors which could be the forecasting-basis of success or failure of treatments approved by statutory accident insurance. This should deliver an optimal monitoring of the medical treatments by steering and regulating the rehabilitation process timely according to its forecasted results. A successful handling of rehabilitation has been strived being accompanied by a reduction of financial expenditure.
The investigated sample came to N=108 patients. Medical, ergotherapeutic, physiotherapeutic, psychological and social experts of a clarifying rehabilitation-team established large variable lists containing extensive detailed information about the status quo of the patients. In combination with standardized self-estimated psychological scales a broad view on multiple aspects has been implemented. The extended pool of features called for a reduction geared to criteria of content, psychometrical, epistemological and practical matter to guarantee an acceptable ratio of number of patients to number of studied features which could be useful to enlarged statistical multivariate analysis. Indices and total scores allowed concentration on most meaningful variables.
Prognoses increase their value reducing random effects in favour to systematic factors. Using computer-supported disaggregation of the entire sample (via cluster analysis) into three patient groups - "unobtrusive persons","highly psycho-social stressed persons" and "persons, able to resist" - the value of forecasting the success of rehabilitation could be increased significantly, but the second group had to be dropped because its number of patients was insufficiently small.
Catamnestic data provided information on contentment concerning the suggested rehabilitation and its success (via indices) estimated by rehabilitation managers and patients. It arose two judgement levels (objective criteria) for the construction of formal forecasting models, which led to six forecasting models by separating the entire sample into three plots (all patients, group one and group two). A pool of features being selected from these volumes included medical, psychological and social components like: intensity of pain, tendency for depression, motivation and performance, favourable work environment, extent of restrictions during occupation and private life. Also having used discriminant analysis pools of variables were found which distinguished between not successful versus successful rehabilitation processes. Positive results were obtained forecasting the separate criterion "?regaining the ability to work?" by predictors which have been proved themselves in formal forecasting models.
Not all the objectives of the research project could be realized according to significantly reduced number of patients (N = 108) despite many efforts of acquisition. Particularly the area of applicability results has to be considered as limited, therefore, the study has been structured yet but did not yield direct transfer of the consequences of action concerning the trauma rehabilitation because there is still lack of empirical data. But the findings from the research study were sufficient to show paths for approaches for further studies and possible monitoring strategies.

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