title: Inpatient or outpatient rehabilitation after herniated disc surgery? - Setting-specific preferences, participation and outcome of rehabilitation.
abstract: OBJECTIVE
  To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes.
  
  
  METHODS
  The longitudinal observational study referred to 534 consecutive disc surgery patients (18-55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days.
  
  
  RESULTS
  The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001).
  
  
  CONCLUSIONS
  The results suggest a "pre-selection" of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and improve rehabilitation effects such as return to work.
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors.forename: Margrit
authors.initials: M
authors.lastname: Löbner
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Luppa
authors.affiliation: Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Konnopka
authors.affiliation: Department of Neurosurgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Saale), Germany.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Meisel
authors.affiliation: Department of Neurosurgery, Klinikum St. Georg gGmbH, Leipzig, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Günther
authors.affiliation: Department of Neurosurgery, University of Leipzig, Leipzig, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Meixensberger
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
authors.forename: Katarina
authors.initials: K
authors.lastname: Stengler
authors.affiliation: Center for Public Mental Health, Gösing am Wagram, Austria; Department of Public Health, University of Cagliary, Cagliary, Italy.
authors.forename: Matthias C
authors.initials: MC
authors.lastname: Angermeyer
authors.affiliation: Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007405:Intervertebral Disc Displacement / Q000523:psychology / Q000534:rehabilitation* / Q000601:surgery; D008875:Middle Aged; D010358:Patient Participation; D011446:Prospective Studies; D011788:Quality of Life; D062707:Return to Work; D016896:Treatment Outcome; D055815:Young Adult