Oncological rehabilitation: evaluation of the efficiency of inpatient rehabilitation

BACKGROUND: There are only few studies on the evaluation of the efficiency of oncologic rehabilitation. The objective of this study was to determine the efficiency of a complex rehabilitation programme consisting of medical care, physical therapy, sports therapy, psychological support and health care seminars. Therefore the rehabilitation requirement at admission and the rehabilitation result at discharge were assessed in a patient sample. METHODS: To determine the rehabilitation requirement and the rehabilitation result, a self-assessment patient questionnaire was used (IRES, Indicators of Reha Status). This questionnaire allows establishing essential patient's parameters, which, besides the medical reports and the doctors' and therapists' opinions, are relevant for the Reha aims and important for the treatment strategy. The IRES instrument is a reliable, valid, sensitive and standardized multidimensional test instrument for assessment and outcome measurement in rehabilitation comprising parameters of somatic, functional and psychosocial issues. With the questionnaire the rehabilitation requirement was determined at the various measuring points as "Reha-status" with the three main dimensions "somatic status", "functional status" and "psychosocial status" or as distress scales (score values 0 - 10). The data were collected at admission to inpatient rehabilitation (T0) and at discharge (T1). RESULTS: At T0 967 patients with various oncologic diseases (breast cancer, gastrointestinal cancer, urogenital cancer, haematological and lymphatic systemic diseases, and various other types of cancer) were included into the study. At discharge (T1) 900 patients were included; subject to evaluation at T0 and T1 were n = 883 patients. Average age was 55,7 +/- 11,9 years; 55,7 % were female, 44,3 % male. According to "Reha-status" 44 % were "extremely suspect" (IRES-score 5,4 +/- 0,8), 26 % "suspect" (6,8 +/- 0,4), and 30 % "normal" (7,9 +/- 0,6) in comparison to a norm-reference test. Pre/post analysis (T0/T1) of the sample revealed a significant improvement of "Reha-status" (T0 = 6,6 +/- 1,2/T1 = 6,81 +/- 1,3; p < 0,001). Significant improvements were also noticed for the subdimensions "somatic status" (T0 = 5,9 +/- 1,5/T1 = 6,1 +/- 1,6; p < 0,001) and "psychosocial status" (T0 = 6,9 +/- 1,5/T1 = 7,2 +/- 1,5; p < 0,001), whereas "functional status" had not changed significantly (T0 = 7,1 +/- 1,6/T1 = 7,2 +/- 1,5; p > 0,05). Especially distinct improvements were observed in "psychosocial status" and in the distress scales, which are particular relevant in oncological patients. CONCLUSIONS: This investigation demonstrates that use of the IRES instrument is feasible also in clinical routine, hence supporting the determination of the patient's individual rehabilitation requirement and his or her individual rehabilitation aims. The findings confirm that during rehabilitation measurable and statistically significant positive effects are achieved in the somatic and psychosocial fields. In summary, this study shows that the complex programme of oncological inpatient rehabilitation achieves relevant changes within important distress issues of the patients.