Occupational factors in rheumatic diseases as a principle of rehabilitation--analysis of patients of the pension insurance administration for workers in Austria

The study evaluates unselected "blue-collar" patients (n = 642) included under the social insurance law guidelines of rehabilitation. Rehabilitation measures had become necessary in these patients because of existing or impending invalidity in diseases of rheumatic origin. In 421 patients (= 66%), a connection with the place of work appeared possible. This entailed adaptation or change of the place of work in 297 patients (= 71%), the result of these measures after a period of two to three years being described. General aspects of occupational rehabilitation measures are discussed.     

Functional and occupational characteristics associated with very early return to work after stroke in Japan

Tanaka H, Toyonaga T, Hashimoto H. Functional and occupational characteristics associated with very early return to work after stroke in Japan.

Objectives

To examine clinical, functional, and occupational factors associated with very early return to work after stroke, and to identify factors manageable through occupational arrangements, patient education, and other welfare programs.

Design

Prospective cohort study.

Setting

Acute care of the first stroke event in 21 acute care hospitals specializing in clinical and occupational health.

Participants

Consecutive patients with stroke in working age (N=335).

Interventions

Not applicable.

Main Outcome Measures

Data pertaining to demographic, clinical, functional, and occupational factors were collected from hospital records. Multiple logistic regression analysis with backward stepwise selection was used to obtain a final model to predict the likelihood of patients returning very early to work.

Results

The sample was predominantly men (80%) with a mean age ± SD of 55.2±7.2 years; 30% succeeded in very early return to work. After adjusting for age, sex, and modified Rankin scale at discharge, white-collar versus blue-collar occupation (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.00–4.21), Barthel Index at onset (OR, 1.02; 95% CI, 1.01–1.03), and employment status at discharge (OR, 17.36; 95% CI, 3.15–95.72) were selected in the final model as significant predictors of very early return to work. Patients with mild physical disability and higher cortical dysfunction found it more difficult to return to work very early compared with those without these conditions.

Conclusions

We found that patients with stroke who had mild disability at onset, were in a white collar occupation, and were employed at discharge were more likely to return to work very early, even after adjusting for functional levels at discharge. Cognitive rehabilitation is needed for those with mild physical disability and higher cortical dysfunction.     

Vocational rehabilitation in German vocational retraining centres and results of Berufsförderungswerk Heidelberg gGmbH

The article focuses on the results of vocational integration over the last two decades and on actual results from client-surveys as presented by the Arbeitsgemeinschaft Deutscher Berufsf?rderungswerke (ADB) (working group of the German vocational retraining centres) and the Berufsf?rderungswerk Heidelberg (BFW Heidelberg, the vocational retraining centre in Heidelberg). Process quality of vocational rehabilitation can be indicated by data like the number of persons dropping out of their training - the ratio to be found in the vocational retraining centres is on a lower level than in other institutions of vocational training. Clients have changed: during the last decade the average age of the clients in the BFW Heidelberg has increased by 3 years, there is a higher proportion of women, but there also are more clients with psychological disorders. A new group of clients is growing - non-handicapped persons who pay for their training themselves. Process quality has improved, with graduates of the BFW Heidelberg saying significantly more often that they can use much or very much of the training courses' contents within their later occupational activities -- the proportion increases with the level of training they had undergone. Additionally the proportion of those is growing who see themselves in an -- according to their training -- adequate occupational situation. These are certainly positive results referring to the indicators of process quality. Concerning outcome quality one has to take the levels of occupational integration into account. Compared with the results of German vocational retraining centres overall, graduates of the Heidelberg centre constantly had a higher level of vocational integration over the last 20 years, one of the reasons being that the vocational training offered in Heidelberg reaches up to the level of degree of a university of applied sciences. The situation on the job market strongly influences occupational integration: it is evident that a high rate of unemployment will extend the time span necessary for placement. But in the long run occupational integration proves to be amazingly high. Variables that influence the results are: level of disability, sex, age and marital status. The level of vocational qualification is a characteristic with high evidence: integration of graduates at the level of "Fachschule" (highly skilled technician or the like) is 10 % higher and that of graduates at the level of "Fachhochschule" (university of applied sciences) another 10 %. Participation in vocational rehabilitation generally is highly estimated -- estimation as given two years after the training increases with the level of qualification. In the Heidelberg centre progress is seen in expanding the proportions of special target groups (which of course is politically aimed at): women now account for some 30 %, there are more elderly clients and for example also more clients with psychological disorders. The vocational integration of these various groups has to be regarded under different aspects. For example, the situation of severely disabled clients is quite ambivalent: their proportion is falling and their rate of occupational integration is relatively low -- yet there are effects that may compensate. So the importance of the disability decreases with a rising level of vocational training. The data presented may permit the conclusion that vocational rehabilitation at the Heidelberg centre has become more successful over the last decade.     

Vocational integration after a two-year retraining measure in vocational retraining centres--a prognostic model

BACKGROUND: Vocational rehabilitation aims at occupational reintegration of the clients. This article focuses on several key results of an evaluation study on rehabilitative vocational training programmes. A central research goal was to identify prognostic factors for successful vocational integration. METHOD: Three vocational retraining centres (Berufsf?rderungswerke) participated in this cohort study with five waves of measurement. Data gathering on process and outcome quality of the two-year training programmes was based on client-surveys (questionnaires). A prognostic model for occupational integration one year after the training measure was developed, based on questionnaire data gathered at the beginning of the training courses. RESULTS: One year after completion of their training 55% of the participants had returned to a job (dependent or self-employed). The logistic regression model for prognosis of return to work showed six relevant variables, and occupational integration as well as nonintegration 12 months after training could be predicted in 77%. Regional unemployment rates revealed to be the most important predictive variable for job reintegration. Other significant variables were: control beliefs, educational level, pain, perceived social support, and occupational field. Neither marital status nor level of disability (GdB) proved predictive for return to work. The variables age and gender were significant only in the univariate analysis. DISCUSSION AND CONCLUSION: A set of variables could be identified as predictive for return to work after a two-year vocational training measure. Some variables, such as control beliefs or perceived social support, may indicate possibilities for specific supportive interventions.     

Violence towards personnel in out-of-hours primary care: a cross-sectional study

Objective

To investigate (1) the prevalence of occupational violence in out-of-hours (OOH) primary care, (2) the perceived cause of violence, and (3) the associations between occupation, gender, age, years of work, and occupational violence.

Design

A cross-sectional study using a self-administered postal questionnaire.

Setting

Twenty Norwegian OOH primary care centres.

Subjects

Physicians, nurses, and others with patient contact at OOH primary care centres, 536 responders (75% response rate).

Main outcome measures

Verbal abuse, threats, physical abuse, sexual harassment.

Results

In total, 78% had been verbally abused, 44% had been exposed to threats, 13% physically abused, and 9% sexually harassed during the last 12 months. Significantly more nurses were associated with verbal abuse (OR 3.85, 95% confidence interval 2.17–6.67) after adjusting for gender, age, and years in OOH primary care. Males had a higher risk for physical abuse (OR 2.36, CI 1.11–5.05) and higher age was associated with lower risk for sexual harassment (OR 0.28, CI 0.14–0.59), when adjusted for background variables. Drug influence and mental illness were the most frequently perceived causes for the last occurring episode of physical abuse, threats, and verbal abuse.

Conclusion

This first study on occupational violence in Norwegian OOH primary care found that a substantial number of health care workers experience occupational violence from patients or visitors. The employer should take action to prevent occupational violence in OOH primary care.Key Words: Cross-sectional studies, general practice, nurses, out-of-hours, physicians, prevalence, violenceThis study describes the prevalence of occupational violence among health workers in Norwegian out-of-hours primary care.

• One in three has been exposed to physical abuse during their working career in out-of-hours primary care.
• Nurses experience more verbal abuse than the other occupational groups.
• The perceived main causes of occupational violence are drug influence and mental illness.

     

Predictors of return to work after inpatient cardiac rehabilitation under workers' compensation plan

Vocational reintegration is one of the major goals of cardiac rehabilitation. 70 % of blue-collar workers under 50 years of age resume their job after in-patient cardiac rehabilitation. 10 % are hindered to do so by cardiac problems. Specific measures exist that may facilitate work resumption. As these measures should be started as soon as possible there is a need for predictors of return to work which can be obtained easily and at an early stage. Subjects of this prospective study were 650 patients (10 % female) under 50 years of age who participated in an in-patient cardiac rehabilitation programme under the workers' pension insurance scheme. At the beginning of programme participation, problems in work resumption as expected by the patient and by his physician were obtained, as well as depression and anxiety scores (HADS-D). Physicians' and patients' expectations concerning problems in resuming work turn out to be significant predictors of the vocational situation of the male patients six months following medical rehabilitation. The depression score obtained at the outset of the programme is the only predictor of return to work in female patients.     

Assessment, education and placement: an integrated approach to vocational rehabilitation

Taking into account that a great number of people in the Netherlands are considered incapacitated for work, reintegration activities are becoming increasingly important. Thus far, no studies have been conducted in the Netherlands to investigate the long-term effectiveness of vocational rehabilitation programmes. This study assessed the long-term effectiveness of the programmes of three vocational rehabilitation centres. The centres relate their success to the proportion of trainees participating in the competitive labour market. The centres provide integrated programmes in certified occupational training and personal skills training. After five years, 80% of the trainees are working in the competitive labour market. In addition, their personal skills have improved. Within 4 to 7 years the decrease in social security costs of reintegrated employees will outweigh the total costs of the vocational training programme.     

Medical rehabilitation in long-term disability

Based on data from a prospective observational cohort study the following article attempts to answer two key questions of rehabilitation research in Germany: (1) What are the utilization rates of rehabilitation measures in patients with long-term work-incapacity due to low-back pain? (2) In this group of patients: does participation in rehabilitation programs correlate with return to work? Patients with long-term work-incapacity due to low-back pain report a severely impaired health status (measured by FFbH, SF-36, numeric rating scale for pain intensity) which calls for comprehensive medical treatment and rehabilitation. 40.5% of study patients received first time medical rehabilitation between three months and one year after the beginning of long-term work-incapacity, 20.5% between one year and two years after the beginning of long-term work-incapacity. These figures were not influenced by age. Considering the severity of impairment we judge these rates as being quite low. There was no positive correlation found between utilization of medical rehabilitation measures or any other medical treatment and return to work. A positive correlation was observed for utilization of first time medical rehabilitation between three months to one year after the beginning of long-term work-incapacity and functional capacity. This effect was demonstrable for patients 50 years of age or younger. CONCLUSIONS: (1) In our cohort utilization of medical rehabilitation measures in patients with low-back pain and long-term work-incapacity is quite low. This suggests a considerable amount of underutilization. (2) In order to avoid underutilization the process of accessing medical rehabilitation within the German health care system should be critically reviewed. (3) In the given context of high unemployment rates and the German early pensioning system the use of "return to work" as the main criterion to judge effectiveness of rehabilitation measures remains debatable.     

Therapy goal setting in patients with psychological stress in orthopaedic and cardiac rehabilitation

OBJECTIVES: To study goal-setting for patients with psychological stress in orthopaedic and cardiac rehabilitation centres. DESIGN: A questionnaire assessing patients' somatic, functional and psychosocial status ("IRES"-questionnaire) was administered to 3109 patients with musculoskeletal diseases and 1670 patients with cardiovascular diseases from a total of 26 rehabilitation centres at their admission and discharge. For all patients, physicians filled in the "Physician's Sheet" ("Arztbogen") that assesses patient-specific goals of therapy. RESULTS: Nearly 50 % of the patients suffered from psychological stress at their admission. Of the patients with high psychological stress (higher than in 90 % of the general population) only 11.1 % (musculoskeletal diseases) and 3.4 % (cardiovascular diseases) were diagnosed as having a mental disorder (ICD-10 diagnosis in the range of F00 - F99). High psychological stress reported by patients themselves is associated with only a small increase of goal setting in psychological therapy documented in the "Physician's Sheet". The most important factors that influence the predefinition of psychological goals of therapy are high multimorbidity, an ICD-10 diagnosis in the range of F00 - F99, low age, high motivation for rehabilitation and being a woman. However, statistically significant differences between rehabilitation centres in the predefinition of psychological goals of therapy were detected. It can be assumed that differences in concepts of therapy are responsible for this finding. CONCLUSION: The results show that physicians use the patient's self-assessments of their psychological stress only to a small extent while planning psychosocial interventions and care. The predefinition of goals in a context of "forced" consideration of patients self-assessments leads to a higher degree of consistency between patients' judgements and goal settings. It also shows a slightly higher predictive power for rehabilitation effects than the predefinition of goals of therapy without noticing patients' self-assessments. This demonstrates the usefulness of a patient-centred screening instrument for psychological stress in orthopaedic and cardiac rehabilitation.     

Predicting return to work after brain injury using occupational therapy assessments

Purpose: The aim of this study was to evaluate the value of occupational therapy assessments used in an outreach rehabilitation programme to predict return to work after brain injury. The assessments represent the ICIDH-2 levels of body function and activity. Method: Fifty-six persons in a late phase after brain injury who had been admitted to the rehabilitation programme during 2 years were followed up according to work status. The follow up was made at a minimum of 2 years after injury. Demographic data and scores from the occupational therapy assessments were compared for the two groups who were back to work or studies (BTW) and not back to work or studies (NBTW). Results: Assessments of memory, visual perception and apraxia separated between the two groups BTW and NBTW. Logistic regression showed that memory score in combination with data on PADL made up the best predictive model. In a subgroup with 21 persons where data on IADL were added to memory and PADL the predictive value was even stronger. Conclusions: In this study we found that occupational therapy assessments were valuable in predicting failure to return to work or studies after brain injury.     

Occupationally Orientated Medical Rehabilitation (BOR) for disabilities caused by orthopedic diseases

Low back pain and arthrosis are influencing the quality of life of people concerned and are leading to high expenses for the health and social system. A merely medical rehabilitation is often insufficient in case the person concerned is unable to fulfil the requirement at work. But vocational rehabilitation is often connected with long processing and waiting times. To counteract these, cooperative approaches have been developed between rehabilitation clinics and vocational retraining centres (Berufsf?rderungswerke, BFW) over the last few years. The Bad Eilsen rehabilitation centre of the LVA Hannover has worked with the Bad Pyrmont BFW since 1998. According to this project, "Occupationally Orientated Medical Rehabilitation" (Berufsorientierte medizinische Rehabilitation, BOR), the participants are extensively informed and tested in the retraining centre, they can also perform occupation-specific tasks. The aim of the study was to compare processing and waiting times with and without BOR. The results available so far show that a majority of the participants of the BOR measures could be occupationally reintegrated. In many cases work promotion measures were introduced earlier. BOR measures not only lead to a considerable acceleration of procedures, they also improve the occupational reintegration of the insured to a high degree.     

The application of hierarchical linear modelling for rehabilitation center comparisons in quality assurance and rehabilitation research

For a fair comparison of rehabilitation centres with respect to the effects of the treatment provided (e. g. for the purpose of quality assurance programmes), it is essential that those factors which influence the outcome of rehabilitation treatment and over which the rehabilitation centres have no control (the so-called "confounders", such as co-morbidity and age of the patients on commencement of treatment) are included in the statistical analysis. Simple linear regression models without random effects and without interaction terms are frequently used for this purpose. However, this method has certain limitations which can be avoided if hierarchical linear modelling (HLM) is employed. HLM has the advantage over standard regression analysis methods in that it can be used to take into account the multi-level structure of a comparison problem, allows predictors to be introduced at the level of the centres and also makes it possible to model variations of regression coefficients for the centres. When the HLM technique is used, separate linear models can be produced for the various hierarchically structured data levels of the question (e. g. the levels "patients" and "centres" for rehabilitation centres, for example). Moreover, it can be empirically tested with HLMs whether the rehabilitation coefficients (e. g. effects of mean age of patients on the outcome of rehabilitation) differ significantly between the centres. In this article, we describe the use of hierarchical linear modelling on the basis of data obtained from the quality assurance programme of the statutory health insurance schemes in the field of medical rehabilitation ("QS-Reha").     

Medical and social medicine correlates of serum cholesterol value during and after inpatient cardiologic rehabilitation--a prospective study]

The connection between changes in the serum cholesterol value during and after in-patient cardiological rehabilitation on the one hand and medical and sociomedical variables on the other is investigated. In 162 male and female patients up to 60 years of age undergoing inpatient cardiological rehabilitation under the pension insurance scheme for workers, a significant decrease of serum cholesterol values could be observed between the beginning and the end of cardiological rehabilitation of 24.5 mg% (10.6%), with a subsequent increase of 12.5 mg% (6%) seven months later. Independent of a possible medical antilipemic therapy the group of patients with a positive occupational perspective was found to have better controlled serum cholesterol values than pensioners or those patients with a negative occupational perspective such as unemployment or dismissal. It can be assumed that those patients having a positive occupational perspective are more likely to follow dietetic and/or medical therapeutic regimes.     

Development of a guideline for rehabilitation of patients with low back pain-- phase 2: analysis of data of the classification of therapeutic procedures

Initiated by the Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte), the project is aimed at developing an evidence-based guideline for rehabilitation of patients with low back pain (LBP). Guideline development will be based on a systematic review of the literature, an analysis of the treatment procedures currently employed in rehabilitation, inclusion of the patients' perspectives as well as consultation of experts' panels of clinically experienced physicians and therapists. Formulation of the guideline will then be carried out in a structured consensus building process. This article is focused on analysing the present situation with regard to the treatments received by patients insured by the BfA, using data from routine documentation according to the Classification of Therapeutic Procedures (KTL, Klassifikation Therapeutischer Leistungen). The analysis is intended to provide indications of a basic need to implement a common guideline as well as, simultaneously, to explore possible deficits in present treatment practices, hence to define priorities requiring special attention in the framework of guideline development. As a result of a systematic literature review, the KTL-defined therapeutic procedures that had emerged as relevant in the rehabilitation of LBP patients were aggregated into so-called therapeutic modules which then formed the basis of the analysis. In all, more than 46,000 KTL-data of 2438 patients with a diagnosis of "low back pain" (M54.5 ICD-10) were included. In the rehab centres investigated, rehabilitation of patients with LBP follows a multidimensional, multiprofessional therapeutic strategy. More than 90 % of all patients receive treatments from the modules "medical training therapy", "health education", "physiotherapy", and "physical therapy". Treatments provided to a majority of the patients are massage (78 %), electrotherapy (67 %) as well as psychotherapy (68 %). Women more frequently than men receive therapies belonging to the "psychological treatments" and "occupational therapies" modules; younger patients receive more of the "training therapies", and more often. When treatments are compared across centres, a large variability in the therapeutic procedures provided becomes apparent. This high degree of variability suggests that development and implementation of a common clinical practice guideline for rehabilitation of patients with chronic low back pain should receive priority attention.     

Predicting return to work after brain injury using occupational therapy assessments

Purpose: The aim of this study was to evaluate the value of occupational therapy assessments used in an outreach rehabilitation programme to predict return to work after brain injury. The assessments represent the ICIDH-2 levels of body function and activity. Method: Fifty-six persons in a late phase after brain injury who had been admitted to the rehabilitation programme during 2 years were followed up according to work status. The follow up was made at a minimum of 2 years after injury. Demographic data and scores from the occupational therapy assessments were compared for the two groups who were back to work or studies (BTW) and not back to work or studies (NBTW). Results: Assessments of memory, visual perception and apraxia separated between the two groups BTW and NBTW. Logistic regression showed that memory score in combination with data on PADL made up the best predictive model. In a subgroup with 21 persons where data on IADL were added to memory and PADL the predictive value was even stronger. Conclusions: In this study we found that occupational therapy assessments were valuable in predicting failure to return to work or studies after brain injury.     

Outpatient and inpatient orthopaedic rehabilitation--results of a study comparing outcome and costs

This article presents main results of a study comparing outcome and costs of various all-day outpatient and inpatient orthopaedic rehabilitation forms. The results were obtained within the scope of a comprehensive evaluation programme commissioned by the federation of health (VdAK) and pension insurance institutes (VDR). The purpose of this evaluation was to examine the quality of different types of various rehabilitation care. The outcome comparison comprises a longitudinal follow-up of various somatic, psychosocial und occupational reintegration parameters up to one year after rehabilitation as well as outcome assessments from the perspective of patients and physicians in rehabilitation centres and general practice. The costs are estimated on the basis of data from health and pension insurance funds. The results show extensive corresponding of results und assessments in the different forms of rehabilitation care for comparable patient groups. There are no indications of poorer care quality in outpatient rehabilitation, while economic analyses show better cost effectiveness in outpatient treatment by comparability of treatment, patients, and results. Results suggest that outpatient care, offered in the same quality as in the examined rehabilitation centres, is an alternative or complement to inpatient care at least for those patients, who can be treated in both the outpatient and inpatient setting.     

Abstract 24: Occupational categories and return to work after traumatic brain injury.

Objectives: To further evaluate determinants of return to work (RTW) after traumatic brain injury (TBI) by examining the relationship between preinjury occupational category and RTW outcome. Design: Prospective collaborative cohort study. Setting: To be eligible for this study, patients had to have been hospitalized with a diagnosis of TBI and have received both acute neurotrauma services and inpatient rehabilitation services at any of the 17 Traumatic Brain Injury Model Systems centers. Participants: Consecutive sample of 1173 patients with TBI who consented to participate, were employed prior to injury, and had completed 1-year follow-up assessment. Intervention: Included an inpatient interdisciplinary brain injury rehabilitation program. Main Outcome Measure: Competitive employment 1 year after rehabilitation. Results: Participants (N=1173) were categorized into 1 of 3 groups, depending on preinjury occupational title: high decision making (n=170), service related (n=622), or manual labor (n=381). Chi-square analysis showed an association between these categories and RTW at 1 year (P<.005). The chance of successful RTW was greatest for high decision making (58.8%), less for service related (42.8%), and lowest for manual labor (32.5%). Of those with successful RTW, the majority did so within the same occupational category grouping. Preinjury manual labor jobs were most likely to shift to a different category postinjury (39.1%), whereas service-related jobs were least likely to shift (25.5%). Conclusions: Prior research has shown that preinjury employment status (employed vs unemployed) greatly influences the odds of successful RTW after TBI. The current study convincingly demonstrates that the type of occupation also influences RTW outcome, with the best prospect for RTW being among persons with high decision-making jobs. Occupational category should be examined in the future development of predictive models for RTW after TBI.     

Occupational therapy needs of patients with thoracic cancer at the time of diagnosis: findings of a dedicated rehabilitation service

Purpose

Guidelines recommend screening patients with cancer to identify their rehabilitation needs. To help quantify this area of need and associated workload from an occupational therapy perspective in patients with thoracic cancer, we report the experiences of a dedicated rehabilitation service.

Methods

Consecutive patients were screened soon after diagnosis using items associated with occupational performance in the Sheffield Profile for Assessment and Referral for Care questionnaire. Those reporting predetermined levels of distress underwent a full occupational therapy evaluation; this generated a problem list from which individualised goals and interventions were instigated.

Results

Of 540 patients screened, 273 (51 %) reported levels of distress which warranted a full occupational therapy assessment. Of these, 260 (95 %) reported a total of 681 problems (median of 4 [2–5] per patient). Mostly these lay within the domain of self care (553, 78 %) in the categories of transfers, functional mobility and bathing/showering. A total of 646 goals (median of 2 [1–3] per patient) were formulated, resulting in 652 individual interventions, most frequently the provision of equipment (79 %) or advice (32 %) and referral to another professional/agency (23 %). Patients considered that most goals were achieved (98 %) and that the provision of equipment was useful (97 %).

Conclusions

About half of patients with thoracic cancer screened have occupational therapy needs around the time of diagnosis. Problems are mostly in the area of self-care, with equipment provision the most frequent intervention provided. Future work should examine the efficacy of occupational therapy interventions further.     

Outpatient rehabilitation of alcohol dependent patients in a day clinic: initial results of a comparative follow-up study of day clinic and inpatient treatment

This article describes the development of an outpatient concept for the day-clinic withdrawal treatment of alcohol dependent persons in a Hamburg institution for addiction aid. It reports the initial, selected results of a comparative follow-up study of patients discharged during the years 1998-2000, who either receive ambulatory treatment in the day clinic (n = 270) or inpatient treatment in the institution's special clinic (n = 462). Assessable questionnaires are available from 131 outpatients of the day-clinic treatment and 173 patients of the inpatient treatment form. The response rate - with reference to the group of those who were reachable - was 57.2 % for patients of the day clinic and 53.2 % for patients of the special clinic. The results of the study arrive at the conclusion that both treatment forms can be seen as thoroughly comparable with regard to primary outcome measurements (for example reduction of psychological stress, abstinence rates, reintegration into occupational life). Rehabilitants treated in the inpatient setting more frequently report that they had already contacted centres for further treatment and self-help groups during the rehabilitation phase, which however doesn't lead to a change of participation behaviour following the rehabilitation phase. This serves to confirm the assumption that an additional offer of a day-clinic service in the area of addiction rehabilitation provides a further, effective treatment concept that sensibly supplements the otherwise inpatient-oriented treatment landscape. The results indicate the quality of the work performed in the day clinic studied (as well as in the inpatient clinic) and should encourage the funding agencies and employees of other day clinic institutions in the field of addiction rehabilitation to participate in evaluation and quality assurance measures, thus continuing to bridge the gap between the (theoretical) state of knowledge concerning outpatient rehabilitation and the degree to which it can be successfully realized.