Zusammenfassung
Rehabilitationssport (RS) und Funktionstraining (FT) nach § 64 SGB IX bieten Menschen mit einer Osteoporose-Erkrankung die Möglichkeit, eigenverantwortlich Einfluss auf ihren gesundheitlichen Status zu nehmen. RS und FT sind nach ärztlicher Verordnung durch die Rehabilitationsträger zu bewilligen und werden in einer anerkannten Sportgruppe unter Leitung eines lizenzierten Übungsleiters durchgeführt. Der Leistungsumfang des RS und FT ist grundsätzlich nicht beschränkt. Beides kann bis zu 3-mal pro Woche verordnet werden, die Mindestdauer einer Übungseinheit (ÜE) liegt bei RS bei 45 min, bei FT bei 30 min bzw. 15 min. Die Teilnehmerobergrenze orthopädischer Indikationen liegt bei 15 Personen. RS- und FT-Gruppen sind zur Sicherung und Weiterentwicklung der Qualität der von ihnen erbrachten Leistung verpflichtet und müssen an Qualitätssicherungsprogrammen der Rehabilitationsträger teilnehmen. Betrachtet man neben den verbindlichen Regelungen die relativ hohe Dichte an Gruppen in Deutschland, so bietet sich der RS und FT als ideales Vehikel zur Sekundär- und Tertiärprävention der Osteoporose an. Allerdings ist die Effektivität von RS und FT auf indikationsspezifische Größen derzeit nicht nachgewiesen.
Abstract
The main application of exercise in the secondary and tertiary prevention of osteoporosis and other chronic diseases in Germany is based on Rehabilitationssport (RS) and Funktionstraining (FT) according to German law (§§ 2, 64 SGB IX). People with osteoporosis are entitled to prescribed medical rehabilitation sport supported (i. e. funded) by the statutory health insurance funds or pension insurances. Programmes are implemented in out-patient group sport settings guided and supervised by licensed instructors.
Apart from the specifications listed above, a mandatory guideline regulates other aspects including (a) aim, purpose and content, (b) responsibilities, (c) prescription period, (d) recognition and review of groups, (e) level of medical supervision, (f) regulation of funding and billing procedure of RS or FT. Further, other quality management aspects include the maximum number of participants per group (n = 15), the minimum duration of the sessions (RS: 45 min, FT: 30 / 15 min) and the obligation of the RS and FT groups to participate in a quality assurance programme of rehabilitation providers.
The setting of RS and FT is the local health sport groups usually recognised by the federal disabled and rehabilitation sport organisations using quite stringent criteria including accident insurance for participants. The latter associations are responsible for the sport groups’ compliance with all criteria and conditions of the guideline for RS and FT application. Violations of these guideline might lead to loss of recognition as a licensed RS or FT sport group and thus the ability to settle accounts with the statutory health insurance funds. Although there are slight differences between the federal states, funding of RS or FT by statutory health insurance funds or pension insurances in general is sufficient to run a corresponding group. To date, there are some 120,000 RS and FT groups in Germany, the vast majority focusing on orthopedic diseases. Although, unfortunately, not all people with osteoporosis were included in a dedicated RS or FT group and there are no reliable statistics on RS and FT with people with osteoporosis, we assume about 15,000 of such groups with about 150,000 participants are licensed in Germany to date.
Thus, the German approach with respect to exercise, as a secondary and tertiary prevention of osteoporosis, can be considered to be very advanced. However, there are also some weak points of RS and FT to date. Firstly, there is no clinical study that provided evidence for the effectiveness of dedicated RS and FT programmes, be it on osteoporosis or any other indication. Further, quality management (QM) in RS and FT focused exclusively on compliance with the RS and FT guideline and trainer education. However, no QM has been implemented to date with respect to process or results quality. In order to improve the effectiveness of RS and FT, this should be addressed in the nearest term, however.
Schlüsselwörter Rehabilitationssport - Funktionstraining - Osteoporose - körperliches Training
Key words exercise - osteoporosis - secondary and tertiary prevention - rehabilitation
