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From the perspective of patients with rheumatic diseases, the reduction of inflammatory disease activity alone is not a sufficient treatment goal. In addition the functional health and participation also have to be improved. Starting with the first symptoms the empowerment for the self-management of the disease is important for the patients; therefore, the established treat to target-strategy has to be expanded by the functional dimension to treat to participation. The position paper of the German Society for Rheumatology (GSR) summarizes the relevant fields of the multiprofessional action that is frequently necessary. This includes the acquirement of function-related competencies during training, further education and advanced training as well as implementation in the everyday practice of patient care. Furthermore, the GSR acknowledges the need for research related to functional and sociomedical consequences of rheumatic diseases and to individual and combined function-related programs in outpatient and inpatient care in rheumatology.

Objective: Reconciling informal caregiving and gainful employment is a challenge for many informal caregivers. The goals of this paper are to identify factors influencing care-related employment reduction, and to record work-related wishes for improving the compatibility of informal caregiving and being employed., Methods: Analyses were based on the cross-sectional Benefits of Being a Caregiver Study of 426 employed caregivers of an older person in need of care. Data were collected on characteristics of the care receivers and caregivers, and aspects of the caregiving and employment situation. Potential influencing factors of care-related employment reduction (n=426) were analyzed using binary logistic regression. The wishes regarding the compatibility of informal care at home and employment were examined descriptively using structured content analysis according to Mayring., Results: One quarter of the employed informal caregivers (n=108) reduced their hours of employment due to the demands of caregiving. The profile of influencing factors of a care-related employment reduction was composed of a higher number of working hours, higher effort for activities of daily living, and co-residence with the care receiver. Employed caregivers primarily expressed a desire for flexibility in working hours, a reduction in working hours, and some concessions with regard to absenteeism., Conclusions: Relieving the burden on caregivers in the activities of daily living in form of formal and informal support services can probably reduce the likelihood of a care-related reduction in gainful employment., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

This article deals with the study "Competencies in later life" (CiLL), a parallel study to the German program for the international assessment of adult competencies (PIAAC) survey which assesses the level and distribution of skills of the adult population in a representative study. Assuming the growing importance of learning and education in a society challenged by demographic changes, the first section of the paper outlines the qualitative research of learning activities of focus groups in the daily life of elderly people. The second section of the paper presents the survey design and exemplary findings of the quantitative CiLL study. Initial results show that basic skills of the elderly are highly influenced by personal and sociodemographic variables, particularly by educational background. The data available indicate that the participation of the elderly in adult education and the options available for competence development have to be increased.

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Background and Objectives: The German health interview and examination survey for adults (DEGS1) with the mental health module (DEGS1-MH) is the successor to the last survey of mental disorders in the general German population 15 years ago (GHS-MHS). This paper reports the basic findings on the 12-month prevalence of mental disorders, associated disabilities and self-reported healthcare utilization., Methods: A representative national cohort (age range 18-79 years, n = 5,317) was selected and individuals were personally examined (87.5 % face to face and 12.5 % via telephone) by a comprehensive clinical interview using the composite international diagnostic interview (CIDI) questionnaire., Results: The overall 12-month prevalence of mental disorders was 27.7 % with substantial differences between subgroups (e.g. sex, age, socioeconomic status). Mental disorders were found to be particularly impairing (elevated number of disability days). Less than 50 % of those affected reported to be in contact with health services due to mental health problems within the last 12 months (range 10-40 % depending on the number of diagnoses)., Conclusions: Mental disorders were found to be commonplace with a prevalence level comparable to that found in the 1998 predecessor study but several further adjustments will have to be made for a sound methodological comparison between the studies. Apart from individual distress, elevated self-reported disability indicated a high societal disease burden of mental disorders (also in comparison with many somatic diseases). Despite a relatively comprehensive and well developed mental healthcare system in Germany there are still optimisation needs for treatment rates.

This paper suggests an operationalization of the items of the early rehabilitation Barthel-index (ERBI). In addition, it presents a modification of this instrument, called lower-saxony ERBI (lsERBI). In order to validate the lsERBI, it has been used in 273 neurological rehabilitants. Findings suggest that the lsERBI has a higher specificity but lower sensitivity than the conventional ERBI. Inter-rater-reliability was high (r=0.84). Further studies are welcome to validate the lsERBI., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim of the Study: The aim of the study was to examine the direct and the indirect change measurement; previous studies comparing the 2 methods demonstrated that they agree only to a limited extent. Analyses of the factorial structure have shown that indicators of direct change measurement were assigned regardless of the content of a dimension common to them. This paper examined whether previous results obtained on scale level were also valid on item level., Methods: Empirical data were obtained from 3 rehabilitation patient samples (n=466, n=194, n=610). The factorial structures of the direct and indirect measurements of change were assessed and compared using principal components analysis with oblique rotation. Additionally, analyses were performed stratified across clinical indications and only for items of the direct change measurement., Results: The factorial structure of 3 data sets showed that the previously published scale-level results were also valid on item level. Analyses demonstrated only low to medium agreement between the 2 methods of change measurement. The indicators of direct change measurement loaded regardless of their content on one or a few common dimensions, which did not agree with those of the indirect change measurement., Conclusion: In considering the 2 methods of measuring change, it is apparent that the standard method of change measurement (indirect change measurement) is suitable to reflect a comprehensive and multi-dimensional representation of changes within the field of medical rehabilitation evaluation., (© Georg Thieme Verlag KG Stuttgart · New York.)

Cancer-related fatigue (CRF) is a highly prevalent and the most distressing symptom during and after treatment for cancer. It is characterized by feelings of physical and mental tiredness, weakness, and lack of energy and is not influenced by rest or sleep. Approximately 40% of patients suffer from CRF at diagnosis and nearly all patients experience fatigue during the course of cancer therapy. The impact of CRF on daily living and patient quality of life (QoL) is substantial. It profoundly affects patient quality of life and limits personal, social and occupational roles. The fatigue is also associated with significant levels of distress and it imposes a financial burden by limiting the ability to work. The underlying causes of CRF are poorly understood as are the relationship between fatigue and psychosocial distress, depression or anxiety. This paper seeks to give an overview of cancer-related fatigue and its psychosocial burden.

Cancer-related fatigue (CRF) is a highly prevalent and the most distressing symptom during and after treatment for cancer. It is characterized by feelings of physical and mental tiredness, weakness, and lack of energy and is not influenced by rest or sleep. Approximately 40% of patients suffer from CRF at diagnosis and nearly all patients experience fatigue during the course of cancer therapy. The impact of CRF on daily living and patient quality of life (QoL) is substantial. It profoundly affects patient quality of life and limits personal, social and occupational roles. The fatigue is also associated with significant levels of distress and it imposes a financial burden by limiting the ability to work. The underlying causes of CRF are poorly understood as are the relationship between fatigue and psychosocial distress, depression or anxiety. This paper seeks to give an overview of cancer-related fatigue and its psychosocial burden.

During recent years, a discussion on work activity of retirees has commenced also in Germany. First, this contribution presents a survey of the North American phenomenon of bridge employment and, second, complements leadoff empirical results on individual motives and favored basic conditions in Germany. Individual and structural preconditions for work activity during retirement are presented as well as possible manifestations of retirement activities. This paper quantifies the extent of work activity of retirees in Germany into their upper seventies. Potential follow-up actions for the three levels individuals, organizations, as well as politics and society are recommended.

Siegrists concept of effort-reward imbalance (ERI) had been shown to be associated with a broad range of health impairments, in particular cardiovascular diseases and depression. The original questionnaire was designed to assess ERI in the field of occupational work. This paper reports on a newly developed questionnaire for the assessment of ERI in household and family work. Analogous to the original version, it is divided into two components: (i) dysbalance of effort and reward (extrinsic component), and (ii) over-commitment (intrinsic components). The questionnaire was tested with data drawn from a clinical sample of mothers (n = 567) in rehabilitation clinics. Factor analyses have reproduced the two main dimensions "effort" and "reward". Relevant aspects of reward at home were (i) meaningfulness, (ii) social gratification, (iii) appreciation from the spouse, and (iv) affection for the child. Finally a 19-item questionnaire for assessing ERI in household and family work (ERI-M) and a four-item measure for measuring parental over-commitment (Over-M) are available. The psychometric properties of both instruments are good to satisfactory.

Even years after having sustained multiple injuries patients often suffer from its sequelae. These comprise restrictions in physical function, but also pain, social and psychological impairments. Although the Meran Consensus Conference in 1990 defined the contents of "quality of life" (QoL) measures in surgery, still no instrument is available for the valid assessment of all relevant QoL domains in multiple injured patients. This paper describes the systematic development of a modular instrument for the assessment of health related QoL. Within three phases (phase I: generation of items, phase II: item reduction, phase III: pre-testing in 70 multiple injured and control patients) a questionnaire of 57 items was developed, which measures all relevant trauma-related aspects of QoL after acute hospital care. In combination with the Glascow Outcome Scale (GOS), the EUROQOL and the SF-36, the newly developed instrument builds the Polytrauma Outcome Chart (POLO-Chart) which will also be used as "Part E" for outcome assessment within the "Trauma registry" of the German Society for Trauma Surgery. In phase IV, the POLO-Chart will finally be validated in five trauma centres (Celle, Essen, Hanover, Cologne und Munich).

This paper addresses two important issues of oldest old research. First, we try to answer the question whether differences between extremely old persons are based on enduring aging processes of physical, social and psychological functions, or whether they are the result of selective survival weeding out the frail. Both trajectories predict low variability, but on different levels. Second, we investigate to which extent the variability of extremely old persons can be assessed by traditional psychosocial instruments. One hundred and fifty six centenarians were contacted, of whom 91 centenarians and 86 proxies participated in this study. The distribution of the cognitive status reveals a high amount of variability. In contrast, with respect to functional capacity 83% receive support from the German Statutory Insurance System for Long-Term Care. The higher variability in the psychological variable points to adaptive potential. We assume that in extreme old age various resources are used to maintain physical functioning above a critical threshold.

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Copyright of Ergotherapie & Rehabilitation is the property of Schulz-Kirchner Verlag Gmbh and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sentha is an interdisciplinary research team involving the Technical University Berlin, the Berlin Institute for Social Research GmbH (BIS), the German Centre for Research on Ageing at the University of Heidelberg (DZFA), the School of Fine Arts Berlin (HdK), and the Brandenburg Technical University Cottbus (BTU). Building on empirical investigations of the role of everyday household products in the everyday life of older people, product-independent design and assessment guidelines and new products are being developed in an intensive interdisciplinary process in order to better meet the needs of older people and to enhance their autonomous living. The following paper describes the contributions from the participating disciplines and presents initial results of the social sciences subproject, describing the problems arising in living independently in old age and detecting the demands on new technological solutions. Data are based on a representative survey conducted in 1999 and including a stratified sample of 1417 men and women aged 55 and older.

The goal of this paper is to contribute to conceptual issues associated with the construct of everyday competence. After the description of reasons for the increased attention which everyday competence has found within gerontology, the first section of this work serves to shed light on six research traditions with relevance for everyday competence: (1) Research on everyday cognitive processes, (2) ADL/IADL research, (3) leisure time research, (4) coping research, (5) time budget research, and (6) ecological gerontology research. In the second section, two influential models of everyday competence, namely those of Margret Baltes and Sherry Willis, are discussed. Finally, an integrative conception of everyday competence, which is aimed to combine aspects of the six research traditions with elements of the two models of everyday competence, is suggested.

Quality of life and patient-centered health status has received increasing attention during the last decade. Simultaneously, there have been multiple instruments to assess quality of life in a standardized way. There are several possible approaches to assess health status in a more standardized way: (1) the judgement of a health professional, (2) performing standardized activities by the patient, and (3) self report of patients with standardized questionnaires. This paper presents a selection of health status instruments that have been used successfully to assess health-related quality of life in patients with musculoskeletal diseases. The description is restricted to instruments that have sound psychometric properties and that have been published in the scientific literature.

The study "Chances and Limits of Independent Living in Old Age" ("MUGSLA") interviewed 1092 frail people (60 years and older), as well as 406 of their primary caregivers. This paper examines the intensity of help provided, size and composition of task support networks, level of distress, and changes experienced by the primary caregiver as a result of taking care of the elderly. We also analyze which conditions support the inclusion of formal providers. The main results of the study are: the lower the functional status of the frail person the more likely they are taken care of by a primary caregiver. Assistance for the elderly is mainly provided by family members. Professional providers are part of the support system when the degree of need of care is extremely high and/or the primary caregiver reported extremely high levels of burden. We found that lack of information about services only partly explains the low rate of service utilization. Their role as caregiver affects virtually all areas of life.

This paper describes conceptual and clinimetric aspects as well as fields of application of the Hannover Functional Ability Questionnaire for measuring back pain-related disability (FFbH-R). The FFbH-R belongs to a series of short self-administered questionnaires for the assessment of functional limitations in activities of daily living among patients with musculoskeletal disorders. In addition to the FFbH-R, a specific version is available for patients with polyarticular diseases (the FFbH-P), as well as a combined version of both questionnaires. A new questionnaire for patients with osteoarthritis is currently being developed. Data from various studies indicate that the FFbH-R meets the relevant psychometric criteria of acceptability, reliability, validity, and sensitivity to change. It has been successfully applied in (observational and controlled) clinical studies, in epidemiologic surveys, and in compensation disability evaluation.

Objective and reliable rating of disability and functional dependence is of utmost importance for both medical and rehabilitation research and the practice of social medicine. The present paper provides an overview on internationally used disability scales and on studies that were carried out to determine their inter-rater reliability. Most of the scales were developed in the United States. The number and quality of inter-rater reliability studies strongly vary for various scales. In general, reliability was found to be high for summary scores of disability, whereas reliability strongly varied from extremely poor to excellent for single items of disability. This variation provides valuable suggestions for improving rating of disability.

The following article is a revised version of a paper read by the author at the Annual general Meeting of the federal Working Team for Rehabilitation in November 1990 in Hamburg. Basing on the increasing risk of elderly people being in need of care, the possibilities of rehabilitation also for elderly persons are discussed. The basic position of the paper is the axiom that rehabilitation should rank before caring for a person who lacks the ability to "pull himself together" and just remains passive. The paper deals with the structural features of genuine need for care and present-day medical and nursing care situation of the elderly and their relatives who look after them. Finally, the central components of an overall rehabilitation concept for elderly persons are presented.

1309 hospitalised parkinsonian patients were examined in respect of mental changes and the consequences for their participation in the life of the community. The paper expresses the association of their disability with the degree of rigidity, tremor, akinesis, and the gravity of the overall disorder.

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