中德康复技术培训课件)25.06康复技术培训 职业康复.ppt

Christoph Korallus Innovation in Vocational Rehabilitation 职业康复中的创新 by Hanover Medical School Department of Rehabilitation Medicine Contents JobRehab VW/Post 复工康复 Need-based rehabilitation 基础康复需求 Fit for Work and Life 适应工作及生活 Hanover medical schools health management program 汉诺威医学院健康管理项目 JobFit 适岗（对工作的岗位的适应及回归） 1 week intensive vocational rehabilitation 1周集中职业康复 Occupational physicians perspective Projects of PRM Department: 康复科项目 Background Standard“ medical Rehabilitation is in many cases not sufficient to achieve return-to work. 标准-医疗康复很多情况下不足以实现回归工作的目的 Problems: Rehabilitation programs are not adapted to the actual workplace, the patient should return to.康复内容与实际将回归的工作不能对接 Occupational physician is not involved in rehabilitation process 操作医师在康复进程中墨守成规 Ideas for solution:解决方法 Occupational Rehabilitation measures 开展职业康复措施 Need-based Rehabilitation 1-6 weeks, inpatient/oupatient基础康复 Providing workplace information to the rehab向康复中心提供工作场所信息 Providing rehab information to the company/physicians向公司/医生提供康复信息内容 Performing FCE and adapting training on the results在前基础上提供对接训练 Doing one day of Rehab AT the company 公司内一日康复训练 Challenges 挑战 Muskuloskeletal Pain tends to chronification, when not treated appropriately and early.若治疗不适当或未尽早，肌肉骨骼疼痛会 转变成慢性损伤 Former healthy workers get an effective treatment, when work ability is heavily affected.当工作能力受到严重影响时，工作者应 得到有效治疗 German health insurance system is complicated and different agencies can be in charge for funding a rehab measure. 德国健康保险系统可以完美覆盖，并且不同机构对 康复措所需费用负责 Employee with complaints Information of employees Company Health insurance Pension insurance Prevention Level 1 1 week Rehabilitation Level 2-outpatient 3 weeks Rehabilitation Level 2-inpatient 3 weeks Workplace informationShort discharge report Employee with complaints Information of employees Company Health insurance Pension insurance Prevention Level 1 1 week Rehabilitation Level 2-outpatient 3 weeks Rehabilitation Level 2-inpatient 3 weeks Workplace informationShort discharge report Employee with complaints Information of employees Company Health insurance Pension insurance Prevention Level 1 1 week Rehabilitation Level 2-outpatient 3 weeks Rehabilitation Level 2-inpatient 3 weeks Workplace informationShort discharge report Occupational physician Rehabilitation physician Employee with complaints Information of employees Company Health insurance Pension insurance Prevention Level 1 1 week Rehabilitation Level 2-outpatient 3 weeks Rehabilitation Level 2-inpatient 3 weeks Workplace informationShort discharge report Occupational physician Rehabilitation physician Employee with complaints Information of employees Company Health insurance Pension insurance Prevention Level 1 1 week Rehabilitation Level 2-outpatient 3 weeks Rehabilitation Level 2-inpatient 3 weeks Workplace informationShort discharge report Occupational physician 专职专职医师师 Rehabilitation physician 康复医师师 Employee with complaints 被投诉诉雇员员 Information of employees 雇员员信息 Company 公司 Health insurance 健康保险险 Pension insurance 养老保险险 Prevention预预防 Level 1 1 week Rehabilitation Level 2-outpatient 3 weeks Rehabilitation Level 2-inpatient 3 weeks Workplace information 工作地信息 Short discharge report 短期执执行报报告 Difference in days Arithmetic mean Median Begin of JobRehabEnd of JobRehab 7,4 0 0,5 0Rehabilitation Rehabilitation physicians perspective Introducing employee Feedback from funding agency Transmission of workplace information Receipt of short discharge report Vocational integration -0,5 0 12,0 6 1,4 1 0,3 0 Rehabilitation Recommendation ofJobRehab Difference in days Arithmetic mean Median Begin of JobRehabEnd of JobRehab 7,4 0 0,5 0Rehabilitation Rehabilitation physicians perspective Introducing employee Feedback from funding agency Transmission of workplace information Receipt of short discharge report Vocational integration -0,5 0 12,0 6 1,4 1 0,3 0 Rehabilitation Recommendation ofJobRehab Difference in days Arithmetic mean Median Begin of JobRehabEnd of JobRehab 7,4 0 0,5 0Rehabilitation Rehabilitation physicians perspective Introducing employee Feedback from funding agency Transmission of workplace information Receipt of short discharge report Vocational integration -0,5 0 12,0 6 1,4 1 0,3 0 Rehabilitation Recommendation ofJobRehab Difference in days Arithmetic mean Median Begin of JobRehab 开始复工康复 End of JobRehab 复工康复结结束 7,4 0 0,5 0Rehabilitation Rehabilitation physicians perspective 康复医师师前景 Introducing Employee 介绍绍雇员员 Feedback from funding agency 经费经费机构反馈馈 Transmission of workplace information 传递传递工作地点信息 Receipt of short discharge Report 短期执执行报报告回执执 Vocational Integration 工作整合 -0,5 0 12,0 6 1,4 1 0,3 0 Rehabilitation Recommendation ofJobRehab 推荐 复工康复 Difference in days Arithmetic mean Median Begin of JobRehabEnd of JobRehab 7,4 0 0,5 0Rehabilitation Rehabilitation physicians perspective Introducing employee Feedback from funding agency Transmission of workplace information Receipt of short discharge report Vocational integration -0,5 0 12,0 6 1,4 1 0,3 0 Rehabilitation Recommendation ofJobRehab Receipt of workplace Information 工作地点信息回执执 Occupational physicians perspective Occupational physicians perspective 专职专职医师师前景 Primary outcome Pain Disability 主要结果-疼痛致残 7 家庭娱乐社会 活动 雇佣 性生活 自我 护理 日常生 活活动 8 Indirect costs JobRehab pre-post 间接花费 复工康复前后 IGCG Fit for Work and Life 适应工作生活 Governments recommendation for corporate health programs 政府推荐企业健康项目 Project for occupational health management by Hanover medical School. 汉诺威医学院专职健康管理项目 As established in JobRehab need-based health supporting offers. 将为复工康复所需的基础健康提供支持作为既定方针 Easy access to wheather preventive or rehabilitativ measures 便捷的连接预防与康复措施 Measures for workplace health promotion gain importance工作 地点推进健康的重要措施 Particular strains in an university hospital 大学医院内的特殊菌株 Development and implementation of Fit for Work and Life“ (FWaL) at Hannover Medical School (HMS) in order to: 改进并执行适应工作生活以达到如下目的： - restore, 恢复 - improve, 改善 - or preserve 或者维持 the employees work ability. 雇员的工作能力 . as established in JobRehab need-based health supporting offers. 作为复工康复基础健康支持的既定方针 Fit for Work and Life 适应工作生活 11 Payer: Public Health Insurance, Pension Funds Payer: HMS Registration & Questionnaire Physician Rehabilitative measures Preventive measures Diagnostic & Therapy Employees of HMS After completion According to indication voluntarily Sports medicine treatment Physical training JobFit (1 week + mTT) JobRehab IIa+s (3 Weeks) JobRehab III (Casemanagement) According to indication After completion continuation If indicated Stress-management training/ smoking cessation According to indication Evaluation Board of advisors 顾问 委员会 预 防 措 施 康 复 措 施 Methods 方法 Accompanying evaluation of FWaL 附带评估“适应生活工作” Data assessed by questionnaire before and at the end of the intervention as well as three, six and 12 months after beginning the intervention 在执行开始前、后、开始后三、六、十二个月分别进行调查问卷评估数据 Primary outcomes: Work Ability Index (WAI), duration of sick leave 主要结果-工作能力指数，病假时间 Secondary outcomes: Quality of Life (SF-36) 第二结果-生活质量 12 Sample characteristics 样本特征 nMean (SD) or % Age, mean (SD) 年龄20745.7 (8.7) Gender: female, % 性别20760.4 % Work ability (WAI), mean (SD) 工作能力20036.1 (7.2) Very low/ low work ability (WAI), % 极差/差工作能力百分比20048.0 % Sick leave (previous three months): yes, %病假（前 三个月） 20641.3 % Duration of sick leave (weeks), mean (SD)病假周数804.3 (4.1) Assigned intervention: preventive measures, % 进行干预：预防措施 20774.4 % 13 Primary Outcomes 主要结果 14 预防 康复 预防 康复 Results 结果 FWaL started in July 2013 适应工作生活项目开始于2013.7 550 employees registered for participation 550人注册参与 207 participated in the survey three months after beginning the intervention 207人于干预开始后3个月参与调查 Assignment to interventions needs-based 进行对基于需求的干预 Our idea of health management has effects on sick leave and workability even with in preventive interventions 我们关于健康管理的创意对病假和可操作性甚至对预防性干预 产生有效影响 First analysis shows, that its cost-effective! 前期分析表明-此 法经济有效 15 JobFit 1 week intensive rehabilitation 适岗-一周集中康复 Background Developing a rehab measure that is: 改进康复方法L： starting very early in the process of a disease 在疾病超早期开始 cost efficient 经济有效 adapted to the workplace 调整至工作地点 long-term follow-up (f.e training, physiotherapy) 长期随访 Giving feedback to occupational physician 给专职医师反馈 Making recommendations for ergonomic workplace adjustment (f.e. height adjustable desk, computer mouse) 给出符合人体工程学工作地点调整的建议 16 Schedule 时间表 17 Diagnostics 诊断 Ergonomic analysis 人体工 程学分析 FCE 履职能力评估 Training routine 常规训练 Psychological screening 心理筛查 Massage 按摩 Chiropractic 椎骨疗法 Stress reduction traininig 减压练习 Progressive Muscle Relaxation 逐步肌肉放松 Sauna 桑拿 Aqua 水疗 2x Team-Sessions 团队会 议 Functional capacity evaluation (FCE) 履职能力评估 18 Lifting Repetit