QUALITY REPORT 2017/18
“THE THERAPY MADE SENSE. MY KNEE IS BACK IN SHAPE FOR MY SHOW GIPFELTREFFEN – AND MY FINGERS FOR MUSIC.”
WERNER SCHMIDBAUER WERNER SCHMIDBAUER PRESENTER AND SINGER-SONGWRITER
YOU WERE LOOKING AROUND FOR A SUITABLE REHABILITATION CLINIC BEFORE YOUR CRUCIAL KNEE OPERATION. YOU QUICKLY CHOSE THE MEDICAL PARK CHIEMSEE REHABILITATION CLINIC IN BERNAU- FELDEN. WHY? The facility exudes great calm; this is wonderful and was absolutely the right decision. Everybody, from the head doctor to the cleaning staff, was incredibly nice. To this day, I only have the best memories of my stay.
WAS THE DECISION ALSO STRAIGHTFORWARD BECAUSE, ALONGSIDE ORTHOPAEDICS, THE CLINIC SPECIALISES IN SPORTS MEDICINE – A VERY IMPORTANT AREA FOR YOU? Yes. I was a triple jumper and skier during my youth. To this day I present a programme for Bavarian TV in which I climb a mountain with celebrities. It is good to know that the doctors and therapists there are also specialists in this area. And what is equally important is that the Medical Park Chiemsee rehabilitation clinic also employs psychologists. Until my stay there, I had no clue that they could be important. I have a foreign object in my body – a so-called bicon- dylar sledge prosthesis – which has stabilised my knee, but which caused me mental stress. I immediately received psychological support, which helped me enormously.
FOLLOWING YOUR FIVE-WEEK STAY, YOU WERE AN OUT PATIENT OF THE MEDICAL PARK CHIEMSEE REHABILITATION CLINIC FOR SEVERAL MONTHS. To begin with, I travelled to Bernau two to three times a week to restrengthen my muscles and to make the ligaments in my knee more resilient. At the moment, I only manage if there are one or more free days during a tour. But I am very glad that the therapists have shown me practical exercises that I can do both on the tour bus and during concert breaks. MEDICAL PARK IN FIGURES
91PERCENT RECOMMENDATION RATE
by our patients – testimony to our acceptance levels.
70PERCENT 2,500ROOMS EQUITY RATIO
offering hotel comfort shows that Medical Park and the highest standards to is a crisis-proof employer that assist in your recovery. is able to innovate. > 3,000EMPLOYEES 90PERCENT BED OCCUPANCY RATE
make up a team of highly qualified doctors, therapists, demonstrates demand nurses and service staff. among patients. MEDICAL PARK LOCATIONS IN GERMANY
Lower C Saxony Berlin
Brandenburg
Saxony- Anhalt North Rhine- Westphalia O
Saxony
Thuringia
Hesse
A B
Hof Rhineland- Coburg Palatinate Würzburg Czech Republic
N
Nuremberg
Regensburg
Baden- France Württemberg Bavaria Passau
M Munich K G, H I, J D, E, F L
Switzerland Austria WHAT MEDICAL PARK CLINICS OFFER
Internal Psycho Orthopaedics Neurology Oncology medicine somatics
A Bad Camberg
B Bad Rodach
Berlin C Humboldtmühle
Bad Wiessee am D Kirschbaumhügel Private Clinic
Bad Wiessee E St. Hubertus
Bad Wiessee am F Kirschbaumhügel Specialist Clinic
Bad Feilnbach G Blumenhof
Bad Feilnbach H Reithofpark
Chiemsee I (Bernau-Felden)
Chiemseeblick J (Bernau-Felden)
K Prien Kronprinz
L Loipl
MEDICAL CENTRES OUTPATIENT CENTRES
STROKE CENTRE BERLIN ( C ) CITY MED, MUNICH ( M )
ST. THERESIEN, NUREMBERG ( N )
BORUSSIA MÖNCHENGLADBACH ( O ) CONTENTS
“LEARNING TO WALK AGAIN AT 84 YEARS OLD – THE SAME JOY I FELT WHEN MY SON TOOK HIS FIRST STEPS.” NEUROLOGY PAGE 24
“I WANT TO BE HEALTHY AND I WILL GET BETTER. I PROMISED MYSELF THAT.” NURSING PAGE 82
2 “ALL OF MY HOPES HAVE BEEN WONDERFULLY FULFILLED HERE.” ORTHOPAEDICS PAGE 6
“WHO KNOWS? MAYBE I’LL GO KITE SURFING IN HOLLAND AGAIN ON E DAY.” INTERNAL MEDICINE PAGE 48
“THE LAKE AND THE MOUNTAINS EXUDE SUCH IMMENSE CALM THAT THEY ALREADY REDUCE STRESS.” PSYCHOSOMATICS PAGE 70 CONTENTS
MEDICAL PARK LOCATIONS COVER FLAP
MEDICAL PARK IN FIGURES PAGE 1
EDITORIAL PAGE 4
ORTHOPAEDICS CORONARY HEART DISEASE PAGE 62 REPORT PAGE 6 MITRAL VALVE DISEASE PAGE 64 HIP REPLACEMENT AFTER OSTEOARTHROSIS CHRONIC HEART FAILURE PAGE 16 PAGE 66
KNEE REPLACEMENT ARTERIAL OCCLUSIVE DISEASE AFTER OSTEOARTHROSIS PAGE 67 PAGE 18 INTESTINAL SURGERY AFTERCARE BACK TREATMENT PAGE 68 AFTER SPINE OPERATION PAGE 20
CONSERVATIVE BACK TREATMENT PAGE 22 PSYCHOSOMATICS
REPORT PAGE 70
DEPRESSION NEUROLOGY PAGE 78 3 REPORT ANXIETY AND SOMATOFORM PAGE 24 DISORDERS THERAPY 4.0 PAGE 80 PAGE 35 POST-TRAUMATIC AND PHASE B ADAPTATION DISORDERS PAGE 40 PAGE 81
PHASE B: STROKE PAGE 42
PHASE C PAGE 44 NURSING
PHASE D REPORT PAGE 46 PAGE 82
INTERNAL MEDICINE PATIENT RATING
REPORT RECOMMENDATION AND PAGE 48 SATISFACTION PAGE 92 GENERAL CARDIOLOGY PAGE 60
AORTIC VALVE DISEASE PAGE 61
PUBLICATION DETAILS PAGE 96
MEDICAL PARK QUALITY REPORT 2017/18 EDITORIAL
DEAR READERS,
Thank you for picking up our latest quality report.
In this edition, we would like to show you once again how we pursue our require- ments concerning quality leadership with no ifs and buts. Our motivated employees work with state-of-the-art facilities to achieve the best possible rehabilitation success with our patients. This is a high demand, whose success we want to make quantifiable as far as possible – by means of objective medical findings, but also through the evaluation of feedback from our guests and patients.
Using graphical reports, we will tell you about real patients and their therapies at our facilities – and all the intensive rehabilitation phases. It is sometimes a roller coaster of emotion, but all of the stories are emboldening. And, last but not least, informative insights are revealed into the typical experiences of our patients. Because even if each treatment is personal: you, a relative, a friend or an acquaint- ance could have the same experience or similar during a rehabilitation stay. 4
It is not only clear from these stories that we place particular emphasis on viewing our work from the point of view of our patients, but also when it comes to the assessment of the success of our therapy. This is why we have used new question- naires on health-related quality of life for the first time. You can find these important results transparently reproduced in the chapter on facts and figures. Furthermore, we present you with new nursing and therapy concepts that can result in higher patient motivation and, in turn, greater therapeutic success.
No matter whether you are affiliated with us as a cooperating professional colleague, a patient, family member or in another way, we are delighted to have been able to win you over with our first quality report, and we hope for the same with the second edition. We wish you an inspirational read.
MEDICAL PARK QUALITY REPORT 2017/18 EDITORIAL 5
DR. MED. ULRICH R. MAUERER JOHANNES KNEISSL CHIEF EXECUTIVE OFFICER DIRECTOR OF CENTRAL (CEO) QUALITY MANAGEMENT
MEDICAL PARK QUALITY REPORT 2017/18 LEG AXIS TRAINING The red ball, called a jumper, is filled with air and is therefore rocky. Johannes Rieger, the physiotherapist, stabilises Schmidbauer’s thigh with a Thera-Band to bring the hip, knee and foot into one axis. ORTHOPAEDICS
“ALL OF MY HOPES HAVE BEEN WONDERFULLY FULFILLED HERE.” Werner Schmidbauer, 56, had three fingers oper- ated on. Just three weeks later, he was fitted with a new prosthetic knee and came for so-called follow-up treatment at Medical Park Chiemsee in Bernau-Felden. That was absolutely the right decision, he says. Everybody, from the head doctor to the cleaning staff, was incredibly nice. 7
A MATTER OF PRACTICE Stretching, flexing, bending, exerting – rubber slings, in which the therapist hangs Schmidbauer’s feet or hands, also help with regaining fitness in everyday life.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
THE PUSH OF A BUTTON During regular ultrasound scans, Dr. Christina Valle reviews the healing process following the operation. For example, how resilient Schmidbauer’s knee has become.
FINDINGS While the doctor examines Werner Schmidbauer’s knee with the probe, he can see what Dr. Christina Valle is explaining to him on the screen at the same time.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
MEDICAL ROUNDS On a daily basis, the doctor visits the patient in his room. They can then discuss the results of the examination together, like Werner Schmid- bauer and Medical Director Prof. Dr. Marcus Schmitt-Sody here, and determine the therapy for the next few days. 9
“HERE THE PATIENT ISN’T JUST A NUMBER, BUT A PERSON WHO SHOULD BE CONSID- ERED AS A WHOLE.”
PROF. DR. MED. MARCUS SCHMITT-SODY, RESULTS MONITORING HEAD OF ORTHOPAEDICS AT CHIEMSEE Prof. Dr. Marcus Schmitt-Sody runs two Medical Park rehabilitation clinics on Lake Chiemsee, the one in Bernau-Felden and the Kronprinz in Prien. This almost always means 400 ortho paedic patients. If time allows, he personally checks whether the automatic leg splints are having the desired effect.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
FINE MOTOR SKILLS Because Schmidbauer also had surgery on three of his fingers, he is relearn- ing fine motor movement during ergo therapy with Christiane Starnecker, whereby he attaches clothes pegs to the therapy tree and takes them off again. 10
“WITHOUT THE KNEE OPERA- TION AND SUBSEQUENT REHABILITATION, I WOULDN’T HAVE BEEN ABLE TO PRESENT MY SHOW GIPFELTREFFEN ANY MORE.”
WERNER SCHMIDBAUER
FLUID MOVEMENT The machine that Schmidbauer uses to stabilise his torso and raise his thoracic spine with the aid of therapist Michaela Kreitmair is called Gyro- tonic. The aim is that movement should become fluid again.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
VITAL No extras. No actors milling about. But 120 employees in nursing and therapy who slog away, toil, work, It finally caught up with him at some point. Not just a measure, massage, balance out, hold, test, examine, little, but intensely: Werner Schmidbauer, presenter, carry, support, advise, help, listen day in, day out, until musician, mountaineer, native of Munich, a popular patients are back where they want to be and ought to figure even into the far north, has a long history of be following knee, foot, hip, shoulder, spinal or hand suffering. First his knee snapped; that was many years surgery: pain-free, at home, at work, with friends. ago. It was very painful. He then suffered two torn This is the aim that they all work towards with the ligaments and four meniscus operations. He received patient, always with cutting-edge science in mind. an implant, but that didn’t last forever. Last February And they almost always succeed. he was therefore fitted with a prosthetic knee in hos- pital – a so-called bicondylar sledge prosthesis – it was Medical Director and Head Doctor Prof. Dr. Marcus desperately needed. At last, you could almost say. Schmitt-Sody is proud of this. And rightly so. “Our facility is always at full capacity,” he says. It has a repu- In March 2017 he travelled to Bernau am Chiemsee – tation. This is not just because of the fact that the more precisely, to the Medical Park Chiemsee rehabili- “patient isn’t a number here”, as Schmitt-Sody ex- tation clinic for orthopaedics, traumatology and plains – although it certainly helps – but a person who sports medicine in Bernau-Felden. For five weeks. He should be taken seriously and considered as a whole. learned to walk again. He wanted to build his muscles. “This is our calling card.” The rehabilitation clinic in He needed to exert his knee, squat, stand up, strengthen Bernau should be somewhere where a patient feels his condition. This was vital for someone who has at home. been presenting the show Gipfeltreffen on Bavarian TV for 14 years. Indeed, the conversations that Schmid bauer has with the celebrities take centre stage. The climbing up and down should seem easy, incidental.
WITH OUR 11 But now the supposedly incidental activity, the walk- ing and climbing, was pushed to the foreground. It SUPPORT needed to be that straightforward again, so no viewers were left thinking: Is he limping? Is he in pain?
Of course, Werner Schmidbauer was best-placed to understand all this. This is why he researched various possible orthopaedic rehabilitation clinics before his crucial knee operation. He chose the Medical Park facility in Bernau-Felden on Lake Chiemsee. To this day, he only has the best memories because “The facil- ity exudes great calm,” he says. “This is wonderful and was absolutely the right decision. Everyone, including the cleaning staff, was incredibly nice.”
You should perhaps know that Werner Schmidbauer PROF. ( DHFPG) DR. MED. THOMAS WESSINGHAGE lives in Bad Aibling, and there, Bavaria is exactly how HEAD OF ORTHOPAEDICS you imagine it to be: with mountaintops, covered in AT BAD WIESSEE snow, with roast pork at the inn and May dancing in dirndls. It came as no surprise to him to see how idyllic “We always say: here you are more than it looked just a few kilometres down the road. Where ‘just’ our patient. We see you as an the buildings of the Medical Park Chiemsee ortho- independent and autonomous partner of paedic rehabilitation clinic lie between the mountains our doctors and therapists.” and Lake Chiemsee, neither flat nor purpose-built structures, but buildings with gable roofs, like you find everywhere here. Maybe a bit bigger. Direct ac- cess to the lake guaranteed. But patients who come from the west, north or east of Germany could easily imagine that several episodes of the TV series Der Bergdoktor were set here. But everything here is real.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
He has been head doctor and medical director of the Medical Park specialist orthopaedic clinic for ten THREE QUESTIONS years now; not just the one in Bernau am Chiemsee, REGARDING THE ARM STUDIO but also Prien Kronprinz, which has two specialist fields: internal medicine and orthopaedics. Prien is the somewhat better-known location, also on Lake Chiemsee, from where the ships depart to Herren chiemsee Castle, which was commissioned by the Bavarian fairy tale king Ludwig II. Before Prof. Dr. Schmitt-Sody arrived at Chiemsee, he worked in orthopaedics at the university clinic in Grosshadern, Munich. Now, he continues to teach as a professor at the Ludwig-Maximilians-Universität Munich, and is also responsible for around 400 orthopaedic patients. You trust someone like him. Not just because of his CV, but also because of his demeanour and charisma: friendly, clear, competent. Sometimes a little strict – DR. MED. HANS-JÜRGEN MEES but that is necessary from time to time. HEAD OF ORTHOPAEDICS AT BAD RODACH PSYCHOLOGICAL CARE
What do patients do in the arm studio? At times he is amazed by how early patients are re Train, train, train. Depending on the located from the acute care hospital to the rehabilita- requirements, they work on the motor and tion clinic following an operation; often they are still sensory function of the shoulder, arm, so weak that they have to lie in bed, and it is not un usual for them to have a high painkiller requirement,
12 hand and fingers. We use state-of-the-art therapeutic robotics and computer-assisted says the head doctor, and: “They get phase-dependent exercise equipment. But we don’t focus therapy.” This of course starts out gently. They are exclusively on technology; we are primarily given lymphatic drainage, manual therapy such as interested in the effectiveness of an exer- massages or physiotherapy until they are able to walk cise. It is also possible for patients to exer- independently to the therapy rooms. Health insur- cise the fine motor skills in their fingers by ance providers approve three weeks of rehabilitation hanging up and taking down laundry. for their members. But one-third of all patients stay longer because medical reasons make this necessary. What is so special about equipment-based training? Just like Werner Schmidbauer. He stayed for five The advantage is that we can put the weeks. “I’m a bad healer,” he says. “The doctors were amazed that it went so slowly for me.” And when he patients on the equipment at a very early was not in good shape ‘mentally’ because he had a stage of rehabilitation, even if they are still foreign object in his body, the bicondylar sledge pros- very limited in terms of movement. It can thesis in his knee, he was of course given psycho be that motors move the joints, or the arm logical support. He is still pleased about this. Since is supported by a sling. The training is also being discharged, he has been an outpatient. To begin varied. We want to inspire our patients. with, he travelled to the rehabilitation clinic in Ber- nau two to three times a week to restrengthen his Is modern technology now replacing muscles and to make the ligaments in his knee more the therapist? resilient. But currently only when his tour schedule No. The equipment can only be used by allows time for this. trained therapists. They adjust the weight relief or active support for patients and evaluate the computer-aided feedback with them.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
WERNER SCHMIDBAUER rough terrain. The patients first go there with crutches, HAS INVESTED A LOT later at a self-selected tempo. Schmidbauer says: “I have noticed that I ask a little too much of myself OF TIME IN ORDER TO because I have the desire for things that seem a hin- BE ABLE TO BEND HIS drance to me to be over quickly. Also, people aren’t used to having people milling about them.” Here, the KNEE AGAIN. WITHOUT Bavarian speaks – just as the Schmidbauer we know – HELP AND GUIDANCE, straightforwardly, amiably, clearly, unpretentiously. HE WOULD NOT BE His therapists also praise the fact that he never wanted special treatment, did not consider himself to be spe- WHERE HE IS TODAY. cial, and is just as friendly and approachable as he seems on the TV.
To start with, he performed exercises in bed using a Anyone who wants to understand Schmidbauer’s CPM machine, a device that also exists for operated desire needs to know that he was a track-and-field shoulders and damaged elbows, ankles or even, as in athlete in his youth, focusing on the triple jump – a Schmidbauer’s case, knees. The CPM machine can be discipline that places a heavy demand on the knee. placed in the bed and both the inclination angle and He was also a skier who enjoyed skiing in deep snow. speed can be adjusted. The patient lies the operated Following a fall in 1993, he tore his cruciate ligament arm or leg on it and, without having to do much on for the first time, beginning a long medical saga with one’s own, the device gently starts moving back and four meniscus operations until, in spring 2017, he forth and thus trains joint flexibility – an exercise that was fitted with his prosthetic knee, which finally each patient dreads a little as it targets the part of the brought him to the Medical Park Chiemsee rehabili body that is the most sensitive at that point in time. tation clinic in Bernau. This suited him especially well Later on, Schmidbauer would go to the fitness room, given that the focus there is not only on the rehabili which patients call the ‘muscle factory’, lie down on a tation and healing of damaged bones, but also sports 13 mat – sometimes on his back, sometimes on his stom- medicine. For a former sportsman like Schmidbauer, ach – but at least one foot or one hand was always in a this was certainly an additional incentive to choose sling. All of these exercises strengthen flexibility and this clinic. But this is still not his entire medical his supporting muscles. tory. In Bernau, they could also help him to move his fingers better again. For him, this is just as important Schmidbauer describes his daily routine as follows: as his knee. “Sometimes there would be therapy before breakfast, after breakfast there were medical rounds, and at lunchtime you would already be really hungry be- cause you had done so much.” Therefore: he has invested a lot of time in order to be able to bend his knee again; an important exercise for anyone, but vital for someone like Werner Schmidbauer, whose job is climbing mountains and asking questions, even if it isn’t the only thing he does. 900THERAPISTS FINGER EXERCISES SUPPORT OUR He therefore received leg axis training whereby he PATIENTS FOLLOWING would stand on a so-called ‘jumper’, which is filled THEIR OPERATION. with air and therefore rocky – it should however help the patient to bring the hip, knee and foot into one axis with the help of a therapist; in Schmidbauer’s case, it was Johannes Rieger. The operated knee wants to give way to the left or to the right. When it no longer does this, a significant step towards healing has been accomplished. He took part in gait training in the specially created therapy garden in which there are gentle slopes, but also larger stones that simulate
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
Ultimately, Schmidbauer is also a musician, guitarist and singer. And at some point, being someone who plays and practises the guitar so much, his fingers stopped playing along. He suffered from trigger fin- ger, a type of tenosynovitis; he could no longer extend three of his fingers, or only painfully. So he under- went an operation on two of the affected fingers three weeks before his knee surgery so that the tendons and 88PERCENT muscles were once again able to stretch – because how else was he going to be able to continue to play the OF KNEE PATIENTS FEEL guitar? The third finger followed six months later. A SIGNIFICANT IMPROVEMENT IN JOINT MOBILITY. He thus stood in the orthopaedic rehabilitation clinic at a therapy tree and practised, along with ergother- apist Christiane Starnecker, pinching clothes pegs together, pegging them at various heights on the wooden branches and taking them off again. These So is it good luck or bad luck that the operations have kinds of exercises promote fine motor movements. fallen precisely in the year that he has taken his sab- They look easy for someone who has never experi- batical? Let’s just say it was rather lucky, because he enced pain in their fingers and are practically essen- could then concentrate on healing; he didn’t have to tial for a person for whom playing the guitar is both a cancel any concerts. He is now back on tour – he is career and a calling. Like Werner Schmidbauer. playing 60 concerts in five months in Bavaria, Austria and Switzerland. This kind of thing is always tremen- dously exhausting, but especially difficult if you are not yet feeling one hundred percent sure of yourself. Often, he is unable to fully extend his operated leg. 14 CERTAINTY On the tour bus or on stage he notices that he isn’t GUARANTEED quite his old self yet. He always carries with him a golf ball that he rolls under his feet to relieve tension and an acupuncture pen that he uses on the connective tissue on his operated hand during breaks in order to ‘stretch the fascias’. His colleagues often laugh at him when they see him like that and jokingly refer to it as ‘painting by numbers’.
But everyday life also teaches him: “I have noticed that I’m getting sloppy,” says the Bavarian singer– songwriter. It is then all the more important that he attend the therapy sessions again in Bernau. He knows full well that without help and guidance, he would not be where he is today. DR. MED. NADINE DREYER HEAD OF ORTHOPAEDICS AT BAD WIESSEE ST. HUBERTUS “Nowadays, joints are treated minimally invasively. The patient can usually exert themselves earlier. We ensure targeted, painless training without the risk of over- loading.”
MEDICAL PARK QUALITY REPORT 2017/18 FOCUS ON THE PATIENT
PROF. DR. MED. KARSTEN DREINHÖFER HEAD OF ORTHOPAEDICS AT BERLIN HUMBOLDTMÜHLE “Quality of life, the perceived state of health and treatment satisfaction are important criteria that ultimately only the patients themselves can assess. For this 15 reason, we include their perspectives in the evaluation of rehabilitation success and, in the process, rely on indicators from recog- nised measurement methods.”
ORTHOPAEDIC LOCATIONS Medical Park offers orthopaedic rehabilitation at nine locations.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
HIP REPLACEMENT AFTER OSTEOARTHROSIS
PATIENTS HAVE SPACE WITH US: MORE THAN 11,500 SQUARE METRES FOR TRAINING THERAPY.
PATIENTS WITH - HIP REPLACEMENTS AFTER TEN METRE WALKING TEST OSTEOARTHROSIS IN 2017 Upon admission Upon discharge
Bad Wiessee 14.5 Bad Wiessee St. Hubertus 962 St. Hubertus 10.8 Bad Wiessee 1 7. 8 Bad Wiessee am Kirschbaumhügel Spec. Clinic 12.6 Specialist Clinic 316 Bad Wiessee 1 7. 4 Bad Wiessee am Kirschbaumhügel Private Clinic 13.5 Private Clinic 176 14.8 Chiemsee 10.8
Chiemsee 860 Prien 15.8 Kronprinz 12.2 Prien Kronprinz 629 14.8 Bad Rodach Bad Rodach 712 11. 5 Berlin Hum- 14.4 Berlin Humboldtmühle 958 boldtmühle 11. 4
Bad Feilnbach 15.4 Bad Feilnbach Blumenhof 185 Blumenhof 11. 3
Bad Feilnbach Reithofpark 337 Bad Feilnbach 16.6 Reithofpark 13.0 16
In seconds 5 10 15 20
In this test, the time a patient takes to walk ten metres is measured in seconds. Patients improve by an average of 3.8 seconds – in other words, their walking speed increases by 24 percent.
STAIR CLIMBING STAIR CLIMBING Upon admission Upon discharge
Bad Wiessee 1.2 The ability to measure stair climbing is a St. Hubertus 2.7 simple but reliable evaluation of therapeutic Bad Wiessee 1.0 Spec. Clinic 2.3 progress following the implantation of an
Bad Wiessee 1.0 artificial hip. A patient’s ability to walk is Private Clinic 2.8 assessed by a therapist on a scale of 0 to 4. 1.1 Chiemsee 2.2 A score of 0 means that the patient cannot climb any steps. 1 means that patients can Prien 1.1 Kronprinz 2.4 move up the levels by bringing one foot to 1.2 meet the other and with their hand on the Bad Rodach 2.4 handrail. At 2, climbing is possible without the Berlin Hum- 1.1 boldtmühle 2.8 handrail. 3 represents climbing by moving the lower foot up and past the standing foot Bad Feilnbach 0.8 Blumenhof 1.5 using the handrail. A 4 is for climbing by Bad Feilnbach 1.1 moving the lower foot up and past the stand- Reithofpark 2.0 ing foot without support. 0 1 2 3
Climbing stairs gets easier: patients improve by more than one level on the scale, achieving an average of 2.3. This corresponds to climbing stairs by bringing one foot to meet the other without support. Upon admission, they are still dependent on the handrail.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
PAIN SCALE PAIN MEDICATION NEEDED UPON DISCHARGE Upon admission Upon discharge None / occasional pain medication Improvement in pain medication dose
Bad Wiessee 3.1 Bad Wiessee 61.0 1 7. 7 St. Hubertus 1.5 St. Hubertus 78.7
Bad Wiessee 3.6 Bad Wiessee 54.7 22.6 Spec. Clinic 1.7 Spec. Clinic 77.3
Bad Wiessee 3.2 Bad Wiessee 55.1 23.5 Private Clinic 1.2 Private Clinic 78.6 3.2 56.4 24.2 Chiemsee 1.1 Chiemsee 80.6
Prien 3.6 Prien 46.4 23.6 Kronprinz 1.7 Kronprinz 70.0 3.7 71.2 13.5 Bad Rodach 1.2 Bad Rodach 84.7
Berlin Hum- 3.4 Berlin Hum- 62.8 25.7 boldtmühle 1.3 boldtmühle 88.5
Bad Feilnbach 3.9 Bad Feilnbach 51.9 22.1 Blumenhof 1.4 Blumenhof 74.0
Bad Feilnbach 3.6 Bad Feilnbach 51.0 22.0 17 Reithofpark 1.6 Reithofpark 73.0
0 1 2 3 4 In percent 0 10 20 30 40 50 60 70 80 90 100
Therapeutic success can also be viewed objectively according to the A hip operation is usually accompanied by post-operative pain. reduction of pain medication administered over the course of therapy. An We can relieve our patients of much of it: on a scale of 1 to 10, most average of 56.7 percent of all patients can do entirely or largely without of them rate their pain at less than 1.4 by the time they leave us. painkillers just four weeks after a hip joint operation. A further 21.4 percent That means only a light pain. can have their pain medication dose drastically reduced.
EQ-5D INDEX Upon admission Upon discharge
Bad Wiessee 63.9 St. Hubertus 77.6
Bad Wiessee 60.0 Spec. Clinic 74.0
Bad Wiessee 62.5 Private Clinic 89.5 62.5 Chiemsee 79.7
Prien 62.8 PROF. DR. MED. THOMAS HORSTMANN Kronprinz 77.8 57.5 HEAD OF ORTHOPAEDICS Bad Rodach AT BAD WIESSEE ST. HUBERTUS 78.0 Berlin Hum- 64.8 boldtmühle 76.3 “Being able to walk significantly better again is the Bad Feilnbach 65.2 Blumenhof 83.1 main goal that we want to achieve with the patient – Bad Feilnbach 61.3 using physiotherapeutic measures and targeted pain Reithofpark 82.7
therapy. For us, though, the success of treatment 40 50 60 70 80 90 consists of several indicators: from a reduction in pain, Quality of life is measured using five factors, including an improvement in mobility, an avoidance of independence, leisure activities, overcoming despondence. On average, subsequent complications and an increase in quality patients have 80 points upon discharge – with an improvement of of life.” 18 points. By comparison: more than 80 points corresponds to a distinctly high quality of life.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
KNEE REPLACEMENT AFTER OSTEOARTHROSIS
4,600 PATIENTS PER YEAR PLACE THEIR TRUST IN OUR EXPERTISE.
PATIENTS WITH KNEE REPLACEMENT AFTER PAIN SCALE OSTEOARTHROSIS IN 2017 Upon admission Upon discharge
Bad Wiessee 4.2 Bad Wiessee St. Hubertus 700 St. Hubertus 2.2 Bad Wiessee 4.5 Bad Wiessee am Kirschbaumhügel Spec. Clinic 2.6 Specialist Clinic 356 Bad Wiessee 4.3 Bad Wiessee am Kirschbaumhügel Private Clinic 2.2 Private Clinic 146 4.2 Chiemsee 1.8
Chiemsee 814 Prien 4.7 Kronprinz 2.4 Prien Kronprinz 654 4.5 Bad Rodach Bad Rodach 794 1.9 Berlin Hum- 4.1 Berlin Humboldtmühle 610 boldtmühle 1.9
Bad Feilnbach 4.9 Bad Feilnbach Blumenhof 143 Blumenhof 2.4
Bad Feilnbach Reithofpark 410 Bad Feilnbach 4.3 Reithofpark 2.3 18
0 1 2 3 4 5
It is important to us that post-operative pain is alleviated as quickly as possible. And the figures show that it is. Pain scale ratings drop by an average of around 2.2 points from admission to discharge, which is equivalent to a 50 percent average reduction in pain.
PAIN MEDICATION NEEDED UPON DISCHARGE None / occasional pain medication Improvement in pain medication dose
Bad Wiessee 41.4 23.4 St. Hubertus 64.8
Bad Wiessee 26.4 28.2 Spec. Clinic 54.6
Bad Wiessee 36.3 32.8 Private Clinic 69.1 34.3 32.7 Chiemsee 67.0
Prien 27.2 25.6 Kronprinz 52.8 DR. MED. KLAUS RAINER FUCHS 58.1 22.1 Bad Rodach HEAD OF ORTHOPAEDICS 80.2 AT BAD FEILNBACH REITHOFPARK Berlin Hum- 43.4 32.8 boldtmühle 76.2 Bad Feilnbach 28.0 28.6 “It may be surprising when doctors say this sort Blumenhof 56.6 of thing, but people learn from mistakes. And so do we. Bad Feilnbach 37.1 26.0 Reithofpark 63.1 I am therefore proud that we have comprehensively
In percent 0 10 20 30 40 50 60 70 80 90 100 and consistently established an awareness of errors in all our facilities. With the sole aim of continuously An average of 37 percent of knee joint patients can do entirely or almost improving treatment quality.” entirely without pain medication – almost 20 percent fewer than hip replacement patients. This phenomenon is well known in medical circles; the sought-after freedom from pain comes more slowly here.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
STAIR CLIMBING Upon admission Upon discharge
Bad Wiessee 1.0 St. Hubertus 2.2
Bad Wiessee 1.0 Spec. Clinic 2.2
Bad Wiessee 0.9 Private Clinic 2.4 1.0 Chiemsee 1.9
Prien 0.9 Kronprinz 1.9 TEN-METRE WALKING TEST 1.1 Bad Rodach 2.1
Berlin Hum- 1.0 The walking test is an inexpensive but very boldtmühle 2.5 effective method of measuring the healing process Bad Feilnbach 0.8 following a knee joint operation (and following Blumenhof 1.4
the implantation of an artificial hip) – all you need is Bad Feilnbach 0.9 19 a stopwatch. Patients are asked to walk a measured Reithofpark 1.6 distance of ten metres on level ground and are timed. 0 1 2 3 The result gives you a walking speed, and average Climbing stairs is easier following discharge: patients figures from healthy people – usually between 6.8 and improve by more than one level on the scale, achieving an average of 2. This corresponds to climbing stairs by bringing one foot to meet 8.2 seconds – enable comparisons. the other but without support. Upon admission, they are still dependent on the handrail.
TEN-METRE WALKING TEST EQ-5D INDEX Upon admission Upon discharge Upon admission Upon discharge
Bad Wiessee 16.0 Bad Wiessee 58.8 St. Hubertus 11. 8 St. Hubertus 73.7
Bad Wiessee 18.3 Bad Wiessee 63.2 Spec. Clinic 13.3 Spec. Clinic 71.0
Bad Wiessee 19.3 Bad Wiessee 58.7 Private Clinic 14.6 Private Clinic 80.8 15.5 62.1 Chiemsee 11. 5 Chiemsee 73.8
Prien 16.3 Prien 57.7 Kronprinz 12.9 Kronprinz 71.9 14.9 57.3 Bad Rodach 11. 5 Bad Rodach 73.5
Berlin Hum- 14.8 Berlin Hum- 59.8 boldtmühle 12.0 boldtmühle 67.9
Bad Feilnbach 15.8 Bad Feilnbach 61.4 Blumenhof 12.0 Blumenhof 74.6
Bad Feilnbach 1 7. 9 Bad Feilnbach 60.0 Reithofpark 13.9 Reithofpark 75.3
In seconds 5 10 15 20 40 50 60 70 80 90
Mobility progress can be assessed effectively by measuring walking times Five conclusions are drawn regarding quality of life, including mobility, over short distances. How long does it take a patient to walk 10 metres? leisure activities and pain. On average, patients score 60 points By the end of treatment they are an average of 3.9 seconds faster than when on admission and 74 on discharge. On average, quality of life increases they arrived at the beginning of their time at our Medical Park clinics. by 14 points during the stay.
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BACK TREATMENT AFTER A SPINE OPERATION
ONCE A QUARTER, OUR EXPERT COMMITTEE DISCUSSES WHAT WE CAN DO EVEN BETTER.
PATIENTS WHO HAVE UNDERGONE BACK TREATMENT AFTER PAIN MEDICATION NEEDED UPON DISCHARGE A SPINE OPERATION IN 2017 None / occasional pain medication Improvement in pain medication dose
Bad Wiessee 61.3 12.2 Bad Wiessee St. Hubertus 364 St. Hubertus 73.5 Bad Wiessee 38.1 15.4 Bad Wiessee am Kirschbaumhügel Spec. Clinic 53.5 Specialist Clinic 139 Bad Wiessee 49.3 20.0 Bad Wiessee am Kirschbaumhügel Private Clinic 69.3 Private Clinic 71 65.2 10.3 Chiemsee 75.5
Chiemsee 376 Prien 59.9 10.0 Kronprinz 69.9 Prien Kronprinz 71 64.4 13.8 Bad Rodach Bad Rodach 379 78.2 Berlin Hum- 54.6 20.0 Berlin Humboldtmühle 174 boldtmühle 74.6
Bad Feilnbach 67.1 4.5 Bad Feilnbach Blumenhof 79 Blumenhof 71.6
Bad Feilnbach Reithofpark 163 Bad Feilnbach 47.9 11. 3 Reithofpark 59.2 20
In percent 0 10 20 30 40 50 60 70 80 90 100
Measuring the decline of painkiller dosage over the course of therapy is a proven method of determining a therapy’s success. 56.4 percent of our patients have no more than an occasional need for painkillers by the time they are discharged.
PAIN SCALE PAIN SCALE Upon admission Upon discharge
Bad Wiessee 4.0 Patients put a cross on a scale of how St. Hubertus 2.1
severe they currently perceive the Bad Wiessee 4.5 pain to be, visually presented on a Spec. Clinic 2.9 Bad Wiessee 4.1 continuum or with the aid of numer Private Clinic 2.3 ical levels. If the data are collected at 3.7 Chiemsee 1.8 the beginning and end of the rehabili- Prien 4.3 tation, a conclusion can be drawn Kronprinz 2.3 4.5 regarding the success of treatment – Bad Rodach 2.1
regardless of the fact that pain per- Berlin Hum- 4.4 ception can be very subjective. boldtmühle 2.5 Bad Feilnbach 5.3 Blumenhof 3.1
Bad Feilnbach 4.4 Reithofpark 2.5
0 1 2 3 4 5 6
Even after at times considerable operative interventions on the spine, the subjective experience of pain is reduced considerably over the course of a stay. The figures we have demonstrate a reduction of 45 percent.
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EQ-5D INDEX Upon admission Upon discharge
Bad Wiessee 63.9 St. Hubertus 75.0
Bad Wiessee 61.2 Spec. Clinic 72.6
Bad Wiessee 61.2 Private Clinic 84.0 65.2 Chiemsee 75.3
Prien 58.9 Kronprinz 71.6 64.1 Bad Rodach 77.2
Berlin Hum- 59.8 boldtmühle 69.3
Bad Feilnbach 62.3 Blumenhof 72.2 ANTIGRAVITY TREADMILL
Bad Feilnbach 64.8 ALTER G 21 Reithofpark 71.0
40 50 60 70 80 90 Only as much exertion as possible – this is
With the EQ-5D questionnaire, a meaningful value for measuring the top priority of gait rehabilitation. quality of life can be collected. On average, patients score 74 points upon discharge. This corresponds to a good quality of life. On the Alter G treadmill, bodyweight relief of up to 80 percent is possible. Patients climb into a kind of inflatable swimming ring and can relearn how to place one foot in front of the other almost weightlessly. They are also not troubled by a belt or other support device in terms of natural movement. The therapist can precisely adjust the device so that pain-free training is possible. Thus, patients are mobilised as early as possible – even after a spine operation. Furthermore, the developers took the system from space travel, DR. MED. HASSO BALASCH which uses this technology to prepare HEAD OF ORTHOPAEDICS astronauts for space. AT PRIEN KRONPRINZ
“Why do we collect, record, compare and evaluate so much data, and consistently in all of our clinics? This ensures transparency. Our patients can thus be sure to find the highest standards in each of our facilities – from the medical–therapeutic treatment to the nursing and service.”
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CONSERVATIVE BACK TREATMENT
THE ATHLETES OF THE GERMAN TRACK- AND-FIELD ASSOCIATION RELY ON THE ABILITIES OF OUR DOCTORS AND THERAPISTS.
PATIENTS WHO HAVE UNDERGONE CONSERVATIVE BACK TREATMENT IN 2017
Bad Wiessee St. Hubertus 415 Bad Wiessee am Kirschbaumhügel Specialist Clinic 26 Bad Wiessee am Kirschbaumhügel Private Clinic 31 Chiemsee 291 DR. MED. GOTTFRIED HEROLD Prien Kronprinz 318 HEAD OF HOLISTIC REHABILITATION Bad Rodach 321 AT BAD FEILNBACH BLUMENHOF Berlin Humboldtmühle 113 Bad Feilnbach Blumenhof 98 “Behind the crude figures, there are of course always the people with their very personal histories. We know this. But standardised quality measurement provides 22 us with millions of pieces of reliable data, which we orthopaedic specialists can also use for comparison company-wide and to learn from each other.”
PAIN MEDICATION REQUIREMENTS PAIN MEDICATION NEEDED UPON DISCHARGE None / occasional pain medication Improvement in pain medication dose
Pain is a warning signal that prevents us from Bad Wiessee 80.5 3.4 St. Hubertus 83.9 doing things that could damage us. But pain can also Bad Wiessee 42.3 21.6 be a hindrance, especially after an operation. It Spec. Clinic 63.9
causes patients to adopt protective postures. This is Bad Wiessee 74.2 7. 1 why in orthopaedics, pain therapy usually consists Private Clinic 81.3 80.8 3.1 of a mix of physiotherapeutic and medicinal treatments. Chiemsee 83.9 The latter are based on the WHO categorisation system, Prien 85.8 1.4 a world-accepted standard. Non-opioid painkillers Kronprinz 87.2 are prescribed for moderate pain. Depending on 78.2 5.0 Bad Rodach the patient’s needs, effectiveness can be increased over 83.2 Berlin Hum- 69.9 11. 0 two additional categories by administering mild or boldtmühle 80.9 stronger opioids. Bad Feilnbach 90.8 1.3 Blumenhof 92.1
In percent 0 10 20 30 40 50 60 70 80 90 100
Therapeutic success can also be measured objectively according to the reduction of pain medication doses over the course of therapy. An average of 75 percent of all patients can do without painkillers by the time they are discharged.
MEDICAL PARK QUALITY REPORT 2017/18 ORTHOPAEDICS
PAIN SCALE Upon admission Upon discharge
Bad Wiessee 4.0 St. Hubertus 2.1
Bad Wiessee 6.2 Spec. Clinic 4.0
Bad Wiessee 5.3 Private Clinic 2.8 4.5 Chiemsee 2.1
Prien 4.8 Kronprinz 2.3 5.5 Bad Rodach 2.8
Berlin Hum- 5.0 boldtmühle 2.5
Bad Feilnbach 6.2 Blumenhof 3.4 PIXFORMANCE
0 1 2 3 4 5 6 23
“Rate your experience of pain from one to ten,” we ask patients at the The digital Pixformance station uses a camera outset and at the end of their stay at our clinics. This reveals that to record 26 articulation points in the person pain is reduced considerably, dropping by an average of 2.4 points to a final reading of 2.8 points. completing the training and thus verifies that the exercise is being performed correctly. At the end, there is an evaluation for, among other EQ-5D INDEX things, stance, precision and strength, so Upon admission Upon discharge that the patient can continue to develop inde-
Bad Wiessee 66.7 pendently in the therapy training. St. Hubertus 77.0 69.9 Chiemsee 74.2
Prien 67.4 Kronprinz 73.7 EQ-5D 66.0 Bad Rodach 71.8
Berlin Hum- 62.1 The EQ-5D Index is the boldtmühle 78.2 world’s most widely used method Bad Feilnbach 58.9 Blumenhof 69.4 for the measurement of health- 40 50 60 70 80 90 related quality of life. Patients are asked about five factors, which they The EQ-5D figure reflects health-related quality of life. On average, can rate at various levels: mobility, patients score 74 points upon discharge. Meaning an average increase of just under ten points. self-care, work and leisure activities, pain/physical discomfort and At the specialist and private Bad Wiessee am Kirschbaumhügel clinic, data collection first began in 2017. A statistically sufficient measurement anxiety/despondence. volume was therefore not reached.
MEDICAL PARK QUALITY REPORT 2017/18 FULL SPEED AHEAD Lothar Palmer during an autumn walk through the grounds of Medical Park Reithofpark. After a moderate stroke, he conducted his rehabilitation here – and can now walk again unassisted after his third week. He now completes at least one large circuit through the park each day. Palmer looks to the future filled with confidence: “It is wonderful to be able to see how I am recovering my movement and independence.” NEUROLOGY “LEARNING TO WALK AGAIN AT 84 YEARS OLD – THE SAME JOY I FELT WHEN MY SON TOOK HIS FIRST STEPS.” 25
CONVALESCENCE CLOSE TO NATURE Head doctor Prof. Dr. Günter Ochs explains the medication and therapy plan that represent, according to Palmer, the ‘crux of rehabilitation’. Above: Lothar Palmer in front of the roundabout with fountain. It is the central area in the park, which allows an unrestricted view of the Alps.
A stroke abruptly interrupted the peaceful retirement of active pensioner Lothar Palmer. Suddenly, he could no longer walk and his ability to speak was severely impaired. At Medical Park Reithofpark in Bad Feilnbach, he is grad ually regaining his faculties. With a great deal of discipline, ambitious therapists and the latest training methods.
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
SUPPORT THROUGH TECHNOLOGY At the ‘Diego’ training apparatus, the fine motor skills of the arm are exercised. The robotics-based device is the world’s most advanced and versatile apparatus in the field of arm and shoulder rehabilitation. With a system of intelligent weight relief, physiological arm movements are possible during the early stages of rehabilitation using finely adjust- able arm slings. A sophisticated sen sor checks the position of the arm in the space. And this is what the training programmes are all about: using skilfully controlled arm move ments, the patients should move a symbol on the screen. Sometimes a point, sometimes a car.
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
“MR PALMER’S GAIT IS GRADUALLY BECOME STEADIER. SOON WE WILL BE ABLE TO ADJUST THE TREADMILL AND INCREASE THE SPEED SOME- WHAT FROM TWO KM/H.” 27 JASMINA BOTONJIC, ERGOTHERAPIST STEP BY STEP During gait exercises on the treadmill, it is important that the patient maintains a constant track width and rolls the foot well. A straight back is also important for a good gait. In addition, a large mirror helps patients to perceive their own shortcomings and makes it easier for them to implement the therapists’ tips. This will not only improve the gait pattern, but the trained condition and walking speed will also continuously in- crease. Fine motor movements can be practised with a tub full of lentils. This helps with relearning everyday activities, such as button- ing up a shirt.
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
TEAMWORK THERAPY Ergotherapist Corinna Weber accompanied
28 Lothar Palmer’s first steps after his stroke. The therapists at Medical Park also provide their patients with valuable tips for further training at home. Thus, for example, Palmer should spe cifically look for places in his surroundings with small inclines and continually walk back and forth there – this trains his organ of equilibrium.
“I AM VERY PROUD OF YOU; YOU HAVE MADE GREAT PROGRESS IN SUCH A SHORT TIME. ENJOY YOUR WELL- DESERVED HOLIDAY.”
CORINNA WEBER, ERGOTHERAPIST
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
OPTIMAL PROVISION Prof. Dr. Günter Ochs is medical director and has headed the neurological department at Medical Park Reithofpark since its founding in 2015. From his perspective, alongside highly modern technical equipment and the proximity to the metropolitan area of Munich, the excellent food and beautiful surroundings of the pre-alpine region also speak in favour of rehabilitation treatment at this Medical Park clinic. Everything comes together so that opti- mal healing results can be achieved.
“AT REITHOFPARK, WE HAVE AN EXCELLENT CARE RATIO. WE CAN THEREFORE ENSURE THAT ALL PATIENTS ARE ACCORDED THE MAX IMUM IN MEDICAL AND THERAPEUTIC CARE. 29
PROF. DR. MED. GÜNTER OCHS, HEAD OF NEUROLOGY AT BAD FEILNBACH REITHOFPARK
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TICKLE NERVES AWAKE So-called sensi training activates muscle memory. Using finely coordinated exercises, the connections between various small facial muscles and the brain are stimulated “FACIAL EXPRESSION again and again. Ultimately, the nerve pathways have to relearn to transmit feelings. IS CENTRAL TO COM- MUNICATION WITH OTHERS. DURING SENSI TRAINING, I SUPPORT MY PATIENTS IN RECOV- ERING THEM.”
ANNA KATHRINA SEIM, SPEECH THERAPIST
STRONG IN THE GROUP Sensi training takes place in groups of up to five people – this promotes discussion and motivation among patients and presents variety from one-to-one therapy. Palmer uses a straw to suck up a scrap of paper, which he then gives to the speech therapist. This exercise teaches coordination and facial expressions – it is therefore particularly effective.
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AFTER THE SHOCK came to Medical Park Reithofpark “severely affected in phase B”, explains Prof. Dr. Ochs (see page 33 > “Then I had better say: hopefully I won’t be seeing Definition of phases). At this point in time, Palmer you again soon!” Lothar Palmer, 84, a gentlemanly was bedridden, unable to walk or move his left arm – type, is in good spirits again and a little mischievous his speech was also severely impaired: “At first it was when he shakes the head doctor’s hand in farewell. horrible; it was as if I had suddenly gone from being a Six weeks ago, he came to Medical Park Reithofpark subject to an object. The fact that it got better so for rehabilitation due to signs of paralysis on his left quickly is something I could never have dreamed of at side – a stroke abruptly interrupted his life. “As a the time,” he says, looking back. healthy person, I couldn’t imagine what it was like to be paralysed,” says Palmer. Quickly adding: “Luckily, Even the head doctor certifies “a favourable disease I can’t today, either.” This is good, because this ‘today’ progression” for him. With the regression of his is also his last full day at Medical Park Reithofpark in symptoms, Mr Palmer has already been rated as phase Bad Feilnbach. D – the stage of rehabilitation when a return to a self-determined life is conceivable. After the discus- But first things first: it is a sunny August morning sion regarding further medication, Prof. Dr. Ochs still when Lothar Palmer notices while brushing his teeth has a few encouraging words ready for Palmer: “There that something is different to usual. “I could sudden- is no doubt that the fact your recovery is progressing ly no longer move the toothbrush well. I really had to so well is due in part to your own commitment.” The press my hand towards my face to get anywhere near final head doctor’s visit is the starting point for our my teeth,” recalls Palmer. Not yet suspecting anything day with Lothar Palmer, who we accompany during serious, he continues with his morning routine, goes his daily routine at the clinic shortly before he returns down to the kitchen and, like every day, prepares home. some filter coffee for himself and his wife. While moving into the adjoining living room, it finally hap- pens: he slumps down and lies motionless for a short THE NEUROLOGICAL 31 time on the carpet until he is able to get back up again. With great presence of mind, his wife recog- DEPARTMENT AT nises the situation, supports him on the way to the BAD FEILNBACH IS car and drives him to a clinic located 300 metres VERY WELL EQUIPPED away. From there, he is immediately transferred to the Klinikum Grosshadern in Munich, which takes BOTH IN TERMS OF on the emergency care. STAFF AND TECHNICAL OPERATIONS. THE Lothar Palmer’s story is far from unique: approxi- mately 270,000 people suffer a stroke each year in AMBITIOUS APPROACH Germany. The symptoms can vary greatly in nature: OF THE THERAPISTS they range from visual or speech impediments to sud- STANDS OUT AS den, unusual dizziness, the sagging of one half of the face, or sensations of drowsiness and confusion. Of ESPECIALLY POSITIVE. course, numbness or the full paralysis of extremities or hands are a clear indication of a stroke, which is triggered in 80 percent of all cases by a blood clot in the brain. Immediate action is required: the insufficiently supplied area of the brain can suffer irreversible dam- age, which may result in considerable impairment to life. “It was very good that everything happened so quickly for me,” Palmer says. And it wasn’t just his journey to primary care that was fast, but also to early rehabilitation. After just six days at Grosshadern, he
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The therapist starts a training game. Some green and some red spots flicker on the screen, moving slowly back and forth. “The aim is to collect as many green spots as possible using skilled arm movements,” ex- plains Prowe, “and to avoid the red ones. This activates the shoulder and teaches fine motor skills.” Palmer DIFFERENT36 THERAPY moves his cursor with such skill through the collection SESSIONS on the screen that it looks like child’s play for him. At the end of the exercise sequence, an acknowledgement ARE AVAILABLE FOR ALL in the form of a smiley flashes up. Then it quickly PATIENTS TO CHOOSE moves to the next stage. The spots move more quick- FROM AND ARE TAILORED ly – and Palmer works his way through level by level. TO THEIR NEEDS. “Well done,” calls Prowe after about ten minutes, “Now you can choose an exercise to finish on.” “Driving,” Palmer quickly replies. Therapist Prowe has already changed the program and Palmer is no longer navigat- ing a cursor through the display area, but a fast car “The therapy plans are the crux of rehabilitation and across the screen that he uses to overtake other ve initially appeared quite cryptic to me,” says Palmer in hicles to the left and right. At the end of the virtual a hushed tone. “There the most plausible and implaus motorway drive, he is happy with his progress: “At the ible things are juxtaposed. Five to six appointments beginning it wasn’t this accident-free!” per day and you really understand nothing at all. But with time, it begins to dawn on you that it’s all very Finally, we move to a long table with four tubs filled well thought out and coordinated.” Today, in any case, with all kinds of grains heated from below. After dis- ‘arm studio’ is noted at 10 o’clock as the first appoint- infecting his hands, Palmer plunges them both into a 32 ment in the table on the A4 sheet. box full of lentils. He reaches in happily, massages the brown balls and lets them trickle through his fingers. ARMS, HANDS, FACE “That feels good,” he says quietly, almost lost in thought. “The hands are quite far removed from the We follow the former engineer and plant director at a brain. After a stroke, some signals do not penetrate all paper mill to a spacious room containing two devices the way through,” explains Prowe. “Positive tactile with monitors. “These are ‘Amadeo’ and ‘Diego’ – a stimuli not only stimulate the hands’ own sensors, but hand and an arm trainer,” explains therapist Armin also promote dexterity.” Prowe, who is busy ensuring the correct settings on the apparatus. In the meantime, Lothar Palmer has Thus, the leisurely and seemingly harmless massaging already positioned himself in front of ‘Diego’ and of lentils can promote fine motor movement processes. raised his left arm slightly. Prowe applies a cuff that is And these are important because apparent trivialities connected to a sensor via thin slings. On the one such as buttoning up a shirt or using a knife and fork hand, this detects the position of the arm in the space are things that many stroke patients still have a great and transmits the data to the screen in front of Palmer; deal of trouble with initially. on the other, the sling system unburdens the arm. “Today I am only reducing the operating weight by 0.6 kilograms,” says Prowe, “Mr Palmer has already ONLY REPETITION, SO regained a good amount of strength.” MAKING THE SAME SPECIFIC MOVEMENTS AGAIN AND AGAIN, CAN BRING ABOUT EN- DURING SUCCESS FOR STROKE PATIENTS WHEN IT COMES TO HEALING.
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After a short break, we continue to the next therapy appointment. At the so-called ‘sensi training’, Palmer P HA S E S sits with three other patients. There is a vanity mirror in front of each of them. Speech therapist Anna Kath- OF REHABILITATION rina Seim is directing the group and demonstrating the exercises: with an ice cube wrapped in a piece of Rehabilitation is divided up into phases kitchen paper, she first dabs her nose several times, measured according to a patient’s abilities. she then moves it across her forehead, over both cheeks Appropriate rehabilitation activities then and her chin. “Sensi training is central to recovering enable seamless therapy. Following a facial expressions,” she later explains. Meanwhile, the stroke, it is essential to begin rehabilita- patients do the same – they trace wrapped-up ice cubes tion as quickly as possible so as to utilise over their faces. Seim then wants all the participants the brain’s neuroplasticity, which means to first wrinkle their noses, then open their eyes wide its ability to adopt new functions in intact and finally purse their lips. This works well for some, brain tissue. Phase B involves early but others require more practice. The fact that the rehabilitation, Phase C post-primary same exercise patterns occur frequently is not down rehabilitation and Phase D the follow-up to carelessness; it is an urgent need. Because only the treatment. Patients are categorised constant repetition of specific movements – and this using the Barthel Index, which measures applies to stroke therapy in general – will bring about dependency on care. enduring success when it comes to healing. Ultimately, new synaptic connections must be created in the in- PHASE B jured brain hemisphere. And these are only formed by This begins immediately after emergency laborious and disciplined repetition, just as in the case treatment at an acute hospital (Phase A). of a child learning something new. Most patients are bedridden and often still
exhibit serious blurring of awareness, 33 LIKE AT A SPA HOTEL paralysis, and impairments in swallowing, speech and fine motor skills. The first “Group therapy complements one-to-one therapy objective is to promote simple sensory and nicely. It motivates patients to see that they are not motor functions; as an example, following alone,” says speech therapist Seim. “And, of course, facial expressions are hugely important for communi- artificial respiration, a patient has to learn cation in everyday life. Even if we are not always aware to breathe autonomously and move around of it.” Finally, she has one last special exercise in store in a wheelchair. for her participants: the patients should use a straw to PHASE C suck up a scrap of paper and pass it on to the next person along in the group, who takes it using their Patients in Phase C no longer have to own straw. “Well, yes, this is going quite well now,” be monitored but are still dependent on calls Seim after several attempts by the participants in care. The aim here is to be able to perform the circle. And Lothar Palmer? “I prefer the exercises life’s simple activities once again inde- where I can move about more.” pendently: bodily care, getting dressed, eating and drinking. The ability to speak is Time for lunch. Together with Palmer, we go into the trained, as are walking, arm movement spacious dining room. With its wooden beams and and the hands. high glass windows, it is almost reminiscent of an al- pine spa hotel. “You can understand that it’s very PHASE D comfortable here,” says the pensioner, and he gestures In Phase D, patients require little nursing with his head out of the window in the direction of the help but can still experience significant Mangfall Mountains. Tablecloths, flowers, a vast, cul- disturbances in some areas. The aim is, tivated park with fountains – he hadn’t expected any once this phase is finished, to be able to of this. But despite the all-encompassing feel-good atmosphere, he has also never lost his sense of duty return home to everyday life. here: “I kept telling myself ‘You’re not on holiday here; you’re on a mission – and that is to get well’.”
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“BABY STEPS” TO FINISH TRAINING A year ago, the clinic – which previously only catered for orthopaedic rehabilitation – started to welcome WITH TECHNOLOGY stroke patients. “The complete gutting and redesign of the Wendelstein building enabled the creation of a neurological department, which is now very well equipped both in terms of staff and technical opera- tions,” says Prof. Dr. Ochs. With an average of 150 pa- tients per month, an outstanding care ratio can thus be guaranteed.
Lothar Palmer has also been able to experience this in the past six weeks. He found that the ‘ambitious approach’ of the therapists stood out as especially posi tive. Such as that of Corinna Weber. Palmer took his first steps in rehabilitation with the ergotherapist. Now he looks at the young, friendly woman and re- GUNTER HÖLIG DIRECTOR OF THERAPY members: “At the time, you encouraged me to just get AT BAD RODACH up and walk. You just held on to me at the waistband.” The appointment with Corinna Weber is his last for “It is with great pleasure that we see our the day – and his very last at Medical Park Reithof- patients completing the movement training park – lymphatic drainage and walking training were with enjoyment and perseverance. straight after lunch. The ergotherapist shows him an The playful component of our computer- exercise to do at home: “Sit up straight with your assisted therapy equipment certainly knees together and move your head in a semicircle
34 plays a part.” from right to left and back again. Repeat this several times and go faster each time.” This stimulates the stereovilli, small sensory cells in the archways of the auricle that help us to balance correctly. Something else that’s good to practise at home: small steps, or ‘baby steps’, as Palmer lovingly calls them. Here one foot is very carefully placed in front of the other. “May I also support myself?” Palmer would like the ergo- therapist to tell him. “Try it without, but it depends on what shape you’re in on the day,” is Weber’s advice.
Time to say goodbye. Palmer thanks the therapist from the bottom of his heart and cannot resist a hug – there isn’t a dry eye in the house. The usually com- posed man explains: “You experience extreme situa- tions here – and you get through them together.” Corinna Weber reciprocates these words and thanks Palmer: “I have to give you a great deal of praise; I am very proud of you. It was always fun to work with you – thank you and much love for the future!” As she leaves the room, the pensioner has already regained his composure and calls after her: “Maybe I will come back, but in plain clothes.” There it is again, the slightly mischievous chuckle of Lothar Palmer.
MEDICAL PARK QUALITY REPORT 2017/18 THERAPY 4.0: ALWAYS ONE STEP AHEAD
Intelligent sensory and robotic systems provide highly effective support for the patients along their treatment path – in every phase of rehabilitation.
AT THE EQUIPMENT No technology in the world can replace the therapists and their delicate sense of touch regarding the body. But when it comes to high numbers of repetitions, precision or working with large forces, modern rehabili- tation is inconceivable without technical support. THERAPY 4.0
SMART SENSOR TECHNOLOGY The digital ‘Pixformance station’ at Medical Park Bad Rodach includes: a variety of exercises with a virtual trainer that can be custom-assembled into therapy sessions; camera sensors that detect movements; a computer that assesses execution quality and formats it in a visually clear way. Feedback is therefore played back in real time. Therapy progress is thereby recognised immediately. This provides the encouragement to hold on and keep going. Just like the training in small groups. 36
“IF PATIENTS CAN FORGET ABOUT THEIR CONDITION FOR A MOMENT AND JUST HAVE FUN, THEN THAT IS VALUABLE, TOO.”
GUNTER HÖLIG, DIRECTOR OF THERAPY AT BAD RODACH
DOUBLY EFFECTIVE In each rehabilitation phase, the patient is supported, motivated and accompanied by the therapist. Of course, this also applies to training on the machines. At the same time, the modern 4.0 tools provide relief for the therapists – which in turn benefits the patient: because the increased efficiency of treatment leaves more time for the care of each individual.
MEDICAL PARK QUALITY REPORT 2017/18 THERAPY 4.0
THE TREATMENT GOAL IS ACHIEVED BETTER AND FASTER, THANKS TO COMPUTER- ASSISTED THERAPY.
TRAINING PLAYFULLY During standing and balance training, the patient gently leans at a 12-degree angle on all sides, supported by a retaining device previously adjusted by the therapist. The aim is to use one’s own body movements to control a playing piece on a monitor and thus earn points. Of course, the whole thing has a therapeutic purpose within the context of recovering the ability to walk. But the playful components bring with them a lightness and spark ambition.
QUANTIFIABLY BETTER What is the mode of operation for this hand trainer? What is the goal? The therapist explains the device in detail to the patient and begins with simple exercises. Interpretation of the results will be discussed together. It is a fast, objective, accurate analytical tool, from which both the patient and therapist gain something: any visible improvement is a con firmation that they are on the right path. Diagrams serve the ther apist as precise documentation of the progress of therapy.
MEDICAL PARK QUALITY REPORT 2017/18 THERAPY 4.0
LEARN MORE EASILY For stroke patients, the principle of repetition during training is especially important. They should continually repeat the same motion sequences. As here at Medical Park Bad Rodach, robotics-based devices can help to ensure that the person completing the training doesn’t tire too quickly and can exercise for longer – and without getting frustrated. This leg crank ergometer stabilises the cardiovascular system and thus prepares the actual gait training. 38
MEDICAL PARK QUALITY REPORT 2017/18 ALWAYS AT THE CUTTING EDGE OF RESEARCH
PROF. DR. MED. PETER RIECKMANN HEAD OF NEUROLOGY AT LOIPL “Patients benefit from individual treatment concepts here. For a rapid recovery in our patients, our multidisciplinary team applies the latest neuroplasticity procedures.” 39
THE FIVE MOST COMMON CONDITIONS
Berlin Hum- Bad Feilnbach Loipl Bad Rodach Bad Camberg boldtmühle Reithofpark
Stroke 776 1,990 558 1,201 1,120
Polyneuropathy 44 120 49 135 70
Traumatic brain injury 78 86 28 73 55
Multiple sclerosis 101 64 37 87 30
Parkinson’s disease 37 51 45 28 27
NEUROLOGY LOCATIONS You can obtain neurological, acute and rehabilitation treatment at five Medical Park facilities.
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
PHASE B
IN THE BEST INTERESTS OF OUR PATIENTS, WE DESIGN OUR TREATMENT AND CARE CONCEPT UNIFORMLY ACROSS ALL FACILITIES.
ALL PATIENTS IN PHASE B IN 2017 RIVERMEAD MOBILITY INDEX Upon admission Upon discharge
Bad Rodach 226 2.3 Bad Rodach 3.5 Berlin Humboldtmühle 195 Berlin Hum- 1.2 Bad Camberg 661 boldtmühle 2.4 1.4 Bad Feilnbach Reithofpark * 132 Bad Camberg 2.8
0 1 2 3 4 5 * At the Bad Feilnbach Reithofpark clinic, the collection of data only began in 2017. Patients’ mobility is severely restricted at the beginning of Phase B. The Rivermead Mobility Index changes over the course of therapy from that point onwards, giving us an idea of how mobility is improving. Patients improve by an average of at least one classification stage.
40 38 PERCENT
of our most seriously PANAGIOTIS KOSTOPOULOS affected patients can HEAD OF NEUROLOGY move around independently AT BAD CAMBERG using mobility aids by the end of Phase B.* “What is the current state of my patient? The Early Reha Barthel Index facilitates a * Average figure at Medical Park. systematic but also complex evaluation procedure: the ability to understand and the need for ventilation are queried. This is often evaluated differently, which is why the index is so meaningful for us. It serves as a balance sheet. It also shows my patients’ rehabilitation success over the course of the stay.”
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
EARLY REHA BARTHEL INDEX Upon admission Upon discharge
– 72.9 Bad Rodach – 44.4
Berlin Hum- – 93.7 boldtmühle – 39.6 – 69.5 Bad Camberg – 38.6
– 100 – 80 – 60 – 40 – 20 0
The Early Reha Barthel Index is measured as a negative figure. High negative results at the beginning improve considerably during Phase B; the average improvement is almost 40 points. The diagram demonstrates that we stabilise our patients successfully over the course of therapy.
ERGOTHERAPY EARLY REHA BARTHEL INDEX 41 The therapeutic approaches are varied and depend on the symptoms and the capabilities of the The Early Reha Barthel Index patient. Above all, the goal for the patient is to uses a system of points to achieve the greatest possible independence in daily measure serious, sometimes life and in the workplace. The ergotherapists life-threatening situations demonstrate how best to move using aids, they such as the need for monitor- recognise unfavourable movement patterns that could lead to damage, and practise more suitable motion ing, mandatory ventilation sequences with the patient. They help to excite sensory and loss of speech following a stimuli, practise concentration, orientation skills stroke or other serious illness. and memory with the affected person, as well as everyday things such as washing, dressing and eating. After a comprehensive diagnostic assessment at the beginning of rehabilitation, ergotherapists rely on various proven neurophysiological treatment procedures.
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
PHASE B: STROKE
STUDIES SHOW THE ABOVE- AVERAGE EFFECTIVENESS OF TRAINING DEVICES DEVELOPED BY US.
ALL PATIENTS WITH STROKE IN PHASE B IN 2017
Bad Rodach 174 Berlin Humboldtmühle 100 Bad Camberg 485 Bad Feilnbach Reithofpark * 86
* At the Bad Feilnbach Reithofpark clinic, the collection of data only began in 2017.
GAIT THERAPY
42 In classic approaches, the therapist moves the patient’s paralysed leg and thus achieves a maximum of 60 steps per training session. Thanks to the robot- assisted gait trainer developed by Prof. Dr. Stefan Hesse and used here, several hundred steps are possible 81PERCENT on average: the patient is stabilised with a safety belt. A motor moves the feet and legs and thus simulates the natural gait. The brain relearns motion sequences and, at the same time, endurance, of our patients can eat and muscle tension, balance regulation and gait drink independently or symmetry are trained. This innovative technology allows patients to walk again even at an early stage. with assistance by the end of Phase B.*
* Average figure at Medical Park.
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
RIVERMEAD MOBILITY INDEX Upon admission Upon discharge
2.2 Bad Rodach 3.5
Berlin Hum- 1.4 boldtmühle 2.8 1.3 Bad Camberg 2.6
0 1 2 3 4 5
Our patients have improved by an average of 1.3 points on the Rivermead Mobility Index by the time they are discharged. This means DR. MED. DIRK ZAUPER they usually skip over almost one stage of evaluation and their mobility improves visibly and tangibly. HEAD OF NEUROLOGY AT BAD RODACH
RIVERMEAD MOBILITY INDEX “Because early rehabilitation phase B 43 follows on directly from the emergency treat- The Rivermead Mobility Index allows ment, our patients often still suffer from us to draw conclusions about the mobility paralysis and motor disorders and are unable of patients. Its system of points enables to swallow or talk. They generally still us to visualise their walking capability and require acute medical treatment. We use their ability to transfer weight and standardised procedures to regularly verify balance following a neurological illness how individual faculties improve. We such as a stroke. also use the data material to analyse this scientifically.”
EARLY REHA BARTHEL INDEX Upon admission Upon discharge
– 71.2 Bad Rodach – 40.6
Berlin Hum- – 72.1 boldtmühle – 19.7 – 69.8 Bad Camberg – 41.1
– 100 – 80 – 60 – 40 – 20 0
Initial Early Reha Barthel Index figures are in the high negative range upon admission. Measurements upon discharge show the degree to which patients have been stabilised. They improve by an average of 37.2 points.
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
PHASE C
EACH OF OUR FACILITIES IS PARTICIPATING IN CURRENT RESEARCH PROJECTS.
ALL PATIENTS IN PHASE C IN 2017 RIVERMEAD MOBILITY INDEX Upon admission Upon discharge
Loipl 536 5.6 Loipl 7. 8 Bad Rodach 1.262 6.2 Bad Rodach Berlin Humboldtmühle 348 8.3 Berlin Hum- 4.8 Bad Camberg 628 boldtmühle 7. 1 Bad Feilnbach Reithofpark 692 5.3 Bad Camberg 8.1
0 2 4 6 8 10 12 14 16
In Phase C, the Rivermead Mobility Index rises considerably FAC towards the end of therapy and an average three-point improvement Upon admission Upon discharge can be seen. Patients therefore achieve an average of more than 60 percent of the total points that can be obtained. We see this as encouragement not to slacken … 2.5 Loipl 3.7 At the Bad Feilnbach Reithofpark clinic, the collection of data only began in 2017. 2.9 Bad Rodach 3.8 44 Berlin Hum- 2.5 boldtmühle 3.5 1.9 Bad Camberg 3.0
Bad Feilnbach 3.1 Reithofpark 3.9
0 1 2 3 4
The higher the FAC figure moves towards a maximum of 5, the better. Over the course of their stay, patients improve by an average of one point on the scale. And on average, all of them achieve an FAC figure of at least 3 – which means they are no longer reliant upon direct physical 64PERCENT assistance when walking. of our patients FAC can already walk without With the aid of the Functional any mobility aids Ambulation Categories, or FAC for short, a standardised at the end of Phase C.* description is provided * Average figure at Medical Park. regarding how much assistance a person requires when walking. The values range from 0 (unable to walk) to 5 (patient is able to walk unaided). There are different levels in between.
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
BARTHEL INDEX COMMUNITY Upon admission Upon discharge AMBULATORY INDEX (CAI)
39.1 Loipl 52.7 43.7 The CAI indicates to what extent the affected Bad Rodach 60.5 person can participate in daily life. Berlin Hum- 46.7 boldtmühle 63.5 Walking speed is measured. It determines 35.2 Bad Camberg the group allocation, which makes very 48.9 practical statements regarding the life scope 0 10 20 30 40 50 60 70 80 90 100 of the patient: this ranges from ‘can only The Barthel Index measures everyday abilities. Gratifying: patients at the end of Phase C achieve an average of 56 points, more than half of the move safely in their own home’ to ‘can cross maximum 100 points that can be given under the Barthel Index. This is quickly at pedestrian crossings’ or ‘uses satisfactory therapeutic progress and means the patient is already independent again in certain activities. public transport’. At the Bad Feilnbach Reithofpark clinic, the collection of data only began in 2017. 45
TEN-METRE WALKING TEST FOR PATIENTS WITH A RATING < 0.8 M/S BARTHEL INDEX Upon admission Upon discharge
The Barthel Index evaluates Only at home 250 m around the home Public transport usage 0.58 a patient’s independence in performing Loipl 0.85 everyday functions (autonomy in 0.59 eating and grooming, continence and so on). Bad Rodach 0.87 It allows everyday care dependence Berlin Hum- 0.61 boldtmühle 0.76 to be measured. 0.63 Bad Camberg 0.87
Bad Feilnbach 0.58 Reithofpark 0.71
In metres/sec. 0 0.2 0.4 0.6 0.8 1
How long does it take a patient to walk 10 metres? Walking speed is determined by the Community Ambulatory Index: the patient only moves at home, 250 metres around the house, or uses the bus and train. On average, all patients are faster than 0.8 m/s upon discharge, which cor responds to 2.9 km/h and facilitates the use of local public transport.
MEDICAL PARK QUALITY REPORT 2017/18 NEUROLOGY
PHASE D
ONLY A FEW CLINICS IN GERMANY OFFER HORSE-ASSISTED THERAPY AS WE DO.
ALL PATIENTS IN PHASE D IN 2017 RIVERMEAD MOBILITY INDEX Upon admission Upon discharge
Loipl 985 12.0 Loipl 13.2 Bad Rodach 1,476 11. 6 Bad Rodach Berlin Humboldtmühle 614 13.1 Berlin Hum- 10.5 Bad Camberg 840 boldtmühle 12.4 Bad Feilnbach Reithofpark 948 11. 9 Bad Camberg 13.3
0 2 4 6 8 10 12 14 16
It is remarkable how in every Medical Park clinic, a significant improvement in mobility can be measured throughout the phases by the time of discharge. Figures come remarkably close to the highest that can be achieved.
At the Bad Feilnbach Reithofpark clinic, the collection of data only began in 2017. 46
BARTHEL INDEX Upon admission Upon discharge
86.0 Loipl 91.3 90.8 Bad Rodach 93.6
Berlin Hum- 88.7 boldtmühle 94.5 HIPPOTHERAPY 90.0 Bad Camberg 95.7
0 10 20 30 40 50 60 70 80 90 100 Horse-assisted therapy supplements Our patients achieve an average of 94 points by the end of Phase D, physiotherapy and is offered by an outstanding figure considering 100 is the maximum you can specially trained therapists. It has many achieve within the Barthel Index. It means no more nursing is required for everyday living. positive effects in neurological At the Bad Feilnbach Reithofpark clinic, the collection disorders: on the horse’s warm back, the of data only began in 2017. patient feels motion impulses that correspond somewhat to the human gait. Thus, walking is slowly ‘initiated’, as the professionals say. Hippotherapy also stabilises the torso, trains equilibrium, coordination and muscle tension, and promotes courage and self-esteem.
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SIX-MINUTE WALKING TEST SIX-MINUTE WALKING TEST BAD RODACH
Physical performance is assessed using the walking 333 metres Average when admitted test. Patients walk at their own pace for a total of six minutes. We then measure the distance they cover, and sometimes their pulse, blood pressure and oxygen saturation level. They are allowed 382 metres to take short recovery breaks during the walk. Average when discharged This test is easy to reproduce and supplies important information about a patient’s condition and ability to recover. SIX-MINUTE WALKING TEST BERLIN HUMBOLDTMÜHLE
SIX-MINUTE WALKING TEST 362 metres Average when admitted LOIPL 47
408 metres Average when admitted
413 metres Average when discharged
485 metres Average when discharged
SIX-MINUTE WALKING TEST BAD CAMBERG On average, our patients can cover 60 metres more by the time they are discharged. Their physical capability is higher, a result which 389 metres we are always happy to let our patients go home with. Average when admitted
449 metres Average when discharged
97 SIX-MINUTE WALKING TEST PERCENT BAD FEILNBACH REITHOFPARK
264 metres of our patients can walk Average when admitted without assistance by the end of Phase D.* 329 metres * Average figure at Medical Park. Average when discharged
MEDICAL PARK QUALITY REPORT 2017/18 MOVING FORWARDS! She may very well laugh now: because of a severe narrowing of her aortic valve, Christine Miller-Sobotta required an operation. The teacher from the Allgäu underwent the so-called Ross procedure, which, as with any cardiac surgery, places a heavy burden on the entire organism. The rehabilitative measures at Medical Park St. Hubertus include sweaty morning exercise in the gymnasium – always with the precise instructions of the therapist, of course. Some of the exercises remind her of PE classes at the primary school where she is headmistress. INTERNAL MEDICINE
ON THE RIGHT PATH In the gym, two therapists ensure the correct execution of each exercise. After the operation, the sternum is still extremely fragile – it usually takes three months for the bone over the heart to heal completely. Christine Miller-Sobotta’s condition is improving continuously. 49
“WHO KNOWS? MAYBE I’LL GO KITE SURFING IN HOLLAND AGAIN ON E DAY.” Following complex heart surgery, Christine Miller-Sobotta decided on rehabilitation at Medical Park St. Hubertus in Bad Wiessee. On the banks of the Tegernsee, the Kempten primary school head- mistress is regaining her strength. Her healing process is not always linear, but sangfroid and a great sense of humour are also helping her through the bad days.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
GETTING FIT The daily sessions in the gym are now routine for Mrs Miller-Sobotta. With the Thera-Band, she strengthens her arm and shoulder on the wall bars. For exer cises on machines, a chip card with the patient’s data is read, which immediately 50 sets the individual weights. On the bicycle ergometer (bottom right), sensors meas- ure the pulse and pedal speed and deter- mine the wattage, which sheds light on the fitness of the patient. The primary school headmistress has been able to increase from an initial rate of 25 watts to 75 watts – the equivalent of slow swimming – she can keep this up easily for twelve minutes.
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“IN OUR MODERN DIAGNOSTICS CENTRE, WE EFFICIENTLY ACCOMPANY PATIENTS WITH A WIDE RANGE OF BACKGROUNDS IN THEIR RECOVERY PROCESS.”
PROF. DR. MED. CHRISTIAN FIRSCHKE, HEAD OF CARDIOLOGY BAD WIESSEE ST. HUBERTUS
IN GOOD HANDS Accurate diagnosis is one of the most important pillars in the field of rehabilitation medicine and the basis for tailor-made therapy plans. At Medical Park, echocardi ography, long-term and stress ECGs, and ultrasound vascular diagnosis are used, among other things, which also serve to monitor therapy progress. The Medical Park logo is reminiscent of two hands protectively surrounding a triangle, which symbolises the patient.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
EXERCISE AND WALKING After a few setbacks, things are going significantly better for Christine Miller-Sobotta during her sixth week of rehabilitation – the short, but somewhat steep route to the banks of the lake is no longer a problem for her. Her regular morning ritual before and after the early-morning exercise is measuring her pulse – here the difference between the ratings should not be more than 30 beats. Sports therapist Gaby Britsch takes notes on her patients.
“AS MUCH AS I RESISTED STAYING HERE AT FIRST, I WAS THEN SO HAPPY WHEN I WAS TWICE GRANTED AN EXTENSION.”
CHRISTINE MILLER-SOBOTTA
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
“THE NECESSARY SUPINE POSITION WHILE SLEEPING OFTEN RESULTS IN PAINFUL CRAMPS. PATIENTS ARE THEREFORE GIVEN A MASSAGE AFTER EACH TRAINING SESSION WITH ME.”
GILLIAN HARMS, PHYSIOTHERAPIST
RELAXATION Gillian Harms strengthens the condition of her patients – and thus the capacity of the heart – with exercises on the stepper. But the high- light of the physio session is the subsequent massage, including ‘hot roll’. Here, warm water drops straight onto the skin through a towel rolled into a funnel. Christine Miller-Sobotta: “This is deeply relaxing.” The gym picks up the theme of the mountain backdrop (above).
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
“THE ULTRASOUND HAS SHOWN THAT THERE IS NO MORE WATER IN MRS MILLER-SOBOTTA’S LUNGS. A VERY POSITIVE FINDING!” 54 DR. MED. CLAUDIA BAYER, HEAD PHYSICIAN
ACCOMPANYING RECOVERY Assistant Physician Reem Abualfilat (left) and Head Physician Dr. med. Claudia Bayer (right) visit Christine Miller-Sobotta in her room. Her sternum is also checked during the wound examination. Then the two doctors check whether heart murmurs suggest any changes to the valve – here, too: all clear.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
EARLY-MORNING EXERCISE
Winter, shortly before eight o’clock in the morning. Hardly a ray of sunshine penetrates the cloudy Decem- ber sky; occasionally, snowflakes swirl against the win- dow panes. A day when you would very much prefer to stay huddled under the duvet a while longer. 94PERCENT In the sports hall at Medical Park St. Hubertus in Bad Wiessee, there is already a buzz of activity. Fifteen SATISFACTION rehabilitation patients with various backgrounds have WITH TREATMENT – assembled. What they have in common is that they PATIENT TESTIMONY are all being treated for a heart disorder – the most TO THE CLINICS. common include inflammation of the heart muscles, heart valve diseases and arteriosclerosis. Some of them have also had strenuous heart surgery. Now it’s all about regaining strength in rehabilitative therapy and reinforcing the important pumping muscle. feet should always be moving. And think about always having your upper arms at chest height – your While some patients immerse themselves in a morn- hands shouldn’t go any higher than your shoulders,” ing chat, others still look tired. But now is neither she calls out afterwards. the time for an in-depth discussion, nor for day- dreaming. Because the early-morning exercise pro- While the balls fly wildly around the sports hall and gramme begins at eight o’clock on the dot. Physiother- the rich thwacking noises are interrupted now and apist Gaby Britsch first asks whether anyone is fitted again by shouts and laughter, Britsch explains her with a pacemaker or a defibrillator – no response. training style: “I just have to be strict – after all, nothing 55 This was already noted on the participant list, but should be allowed to happen.” This is also due to the “better safe than sorry”. fact that in some patients, the sternum is not yet firmly anchored in the chest after surgery. “Despite this, We get started with the routine daily check: all the a level should of course be reached whereby everyone patients feel their pulse with their index and middle is challenged and has fun – and here my many years fingers on the inside of their forearm and begin to of experience as a handball player come in useful.” count on Britsch’s command. One, two, three … “Stop!” After 15 seconds, the therapist stops the clock. After half an hour and several partner and group ex- “Please multiply your score by four and remember ercises with the ball, the morning training is over and it.” Participants will then measure it again after the the last remnants of fatigue have disappeared from the early-morning exercise programme. “If the value after participants. They seem a little worn out and satisfied. the exercise is less than 30 beats higher than your One of the participating patients is Christine Miller- resting heart rate, the training was OK.” Otherwise, Sobotta, a 50-year-old primary school headmistress a follow-up discussion is required, and you have to from Kempten. She is familiar with the situation in take things easier. the sports hall; “We call one of the exercises that Ms Britsch had in the programme today the ‘petrified The exercise programme then begins. Participants game’,” she laughs. Given her happiness, you would jog slowly in a circle, continually making short stops scarcely guess how weak she was when she arrived at and stretching their legs. Gaby Britsch raises the tempo St. Hubertus am Tergernsee six weeks ago. Mrs Miller- little by little and then fetches soft, bright-yellow gym Sobotta has expressed her willingness to share her balls from the storeroom. Before explaining quieter story with us. group exercises, she keeps the group on its toes: “Everyone should throw their ball five times against the wall while jogging on the spot – then walk to the opposite side, breathe gently and jog on the spot again.” – “I don’t want anybody growing roots; your
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
However, Christine Miller-Sobotta – like many other patients with the same diagnosis – had to suffer in- SPECIALISTS creasingly from the knock-on effects of the narrowing REQUIRED of the valve orifice. Due to the smaller opening, her heart muscle had to expend ever more force to pump blood through her body – and thus also stretched the aorta behind the valve. “An operation was unavoid able,” explains the headmistress, “but I finally knew where my pain was coming from.” Mrs Miller-Sobotta chose the so-called Ross procedure, performed for the first time by Donald Ross in 1967. Here the damaged aortic valve is replaced by the patient’s own healthy pulmonary valve. In its place, a donated valve is in turn fitted. A major benefit of this procedure is that the patient in question, unlike those fitted with an artificial valve, can avoid having to take blood thin- ners and thus need not expose themselves to the like- KNUT STAMER lihood of internal bleeding. In Christine Miller- THERAPY DIRECTOR AT BAD WIESSEE Sobotta’s case, a prosthesis for the section of aorta ST. HUBERTUS with thinned walls was additionally fitted directly “Following a stressful intervention behind the valve. such as heart surgery, rehabilitative measures must be at the highest level. This “The operation lasted five and a half hours. After- is only possible with highly motivated wards, the hospital stay had to be extended by a week and qualified personnel. Our therapists because bacteria were detected on the donor valve. That week I was given intravenous antibiotics six
56 always apply the latest standards.” times a day,” remembers the Kempten native. She was therefore very weak two weeks after her operation when she arrived at Medical Park St. Hubertus on Lake Tegernsee. “I arrived at the clinic with tears in TOUGH PERIOD my eyes,” she tells us. But there was a little ray of hope shortly after her arrival: “There was Patient Advisor Change of scene: we are sitting in the on-site cafe, Ms Siebert, who gave me a particularly warm wel- exuding great warmth with its wood-panelled walls. come – something I had not expected. I immediately A lavishly decorated Christmas tree adds to the cosy felt a little bit better.” And thus “the good spirit of the atmosphere – a good place to reminisce about the facility”, as the teacher lovingly calls Ms Siebert, also past. “I often felt pains in my chest when walking,” took care of finding a mattress topper – the bed was begins Christine Miller-Sobotta. “It kept getting too hard for Christine Miller-Sobotta at first. worse. To start with, I put it down to my bronchia – I had had a dry cough for a while. But the lung doctor gave me a clean bill of health.” When the headmistress BLOOD PRESSURE noticed an increasingly heavy heartbeat, especially AND PULSE REQUIRE when lying on her side in bed, the time had come for her to go to a cardiologist. The diagnosis followed im- A LONG TIME UNTIL mediately: aortic valve stenosis with bicuspid heart THEY LEVEL OFF AT AN valve. A bicuspid heart valve is a birth defect and the most frequent congenital anomaly of the heart. It is AVERAGE REHABILI estimated that 0.8 to 2 percent of the total population TATION LEVEL. is affected. Instead of the usual three semilunar valves (tricuspid) her aorta has only two valves – but this does not necessarily lead to problems.
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An encouraging finding. Because there have been constant interruptions to the rehabilitation. Christine Miller-Sobotta had to stop the ergometer training twice because it went black before her eyes. Her body continued to retain large quantities of water, which made the exercise measures more difficult. It took her blood pressure and pulse a long time until they 2,700PATIENTS levelled off at an average rehabilitation level. “Each patient is unique and reacts differently – finding the ARE TREATED correct dosage of medication for Mrs Miller-Sobotta RESIDENTIALLY AT MEDICAL was not particularly easy,” explains Claudia Bayer. PARK ON AVERAGE. That this always works, even in complicated cases, is ensured at Medical Park St. Hubertus not least by a comprehensive diagnostic department, in which the latest methods in echocardiography, vascular diag- nostics, electrocardiogram (ECG) and blood gas ana In any case, sleeping: as a person who sleeps on her lysis, among other things, are used. side, the switch to lying on her back was not pleasant to start with for the headmistress. “I had frequent ten- “At first I was a regular guest in this department,” sion in my neck and slept very badly to begin with,” laughs the primary school headmistress. In the past explains Mrs Miller-Sobotta. Due to the fragility of two weeks, on the other hand, the diagnostic centre the chest after heart surgery, lying on your back must has been noticeably less frequent on her treatment be strictly adhered to in the first two weeks in particu- plan. Instead: early-morning exercise, training group, lar. Otherwise, the strain would be too much on the endurance training, ergometer and medical training – sternum, which has been opened during the opera- Christine Miller-Sobotta’s current rehabilitation pro- tion. Daily massages however provide the patients gramme almost reads like the ambitious training plan 57 with relief. of an amateur marathon runner. That she is able to take on this intensity during the rehabilitative meas- During her rounds, Head Physician Claudia Bayer ures today is also the result of two extensions to her enquires about Christine Miller-Sobotta’s well-being residency time. “For the first four weeks, I was only in and then gently touches her upper body. “Does it still the so-called stool group, where all the exercises are hurt here?” Claudia Bayer wants to know. Her patient conducted seated under very precise instructions. sighs a little, but the head physician already certifies a Taking part in Ms Britsch’s demanding training was “stable sternum”. Overall, it will take about three therefore unthinkable.” months until the sword-shaped bone of the sternum completely heals. She has made it halfway. After Bayer RELIEF has gone through the medication plan with the head- mistress and promises that she will soon be able to After the fourth week, Mrs Miller-Sobotta’s long stop taking blood thinners, she advises her on the way tough period with many ups and downs was finally to have her personal training frequency calculated over – from then on, the recovery process was continu with the home cardiologist. Finally, she checks ous. But how did she hold out until then? How did she heart sounds and applies the stethoscope head again: put her initial rehabilitation setbacks behind her? It “I can’t detect any anomalies or any noises that could was certainly also her own sense of duty guiding her indicate changes to the heart valves.” Mrs Miller- through the difficult times. “I never wanted to be a bur- Sobotta’s heart once again beats with the beautiful den to others. Telling my parents and my daughter that regularity of a metronome. I needed heart surgery was, for me, the worst thing. But it was always clear to me that I would get better here.” At the same time, Christine Miller-Sobotta is some one who knows how to take things in good humour. This is also reflected in her vocabulary. Whenever she sorts her tablets in the box, she speaks, for example, of “doping substances”. On her way to the medical exer- cise room, she mumbles “torture chamber” – only to then laugh boldly about her own choice of words.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
THE SURROUNDINGS, SUCCESS
THE MOUNTAINS The final conversation with the head doctor before AND THE WATER OF the primary school headmistress leaves the clinic facil- LAKE TEGERNSEE, ity tomorrow to return home. Christine Miller-Sobotta wants Prof. Dr. Christian Firschke to tell her whether ALONG WITH THE EX- her pericardium is now permanently damaged. She CELLENT MEDICAL remembers having heard or read this. She looks quite CARE, ARE ONE CRITER worried. Prof. Dr. Firschke, a recognised expert in his profession, alleviates her concerns immediately: “Your ION FOR CHOOSING pericardium was opened during the operation. It was REHABILITATION AT irritated and thus secreted fluid – it is therefore not ST. HUBERTUS. broken at all.” He then adds a casual “Don’t listen to rumours; it’s a load of rubbish”. Mrs Miller-Sobotta’s face is full of relief; her eyes light up and her smile grows wider. It’s as if the all-clear signal is an early If you ask whether the location of the clinic right on Christmas present. And the other recommendations the banks of the lake has helped with her recovery, of the approachable head doctor – heart exercise you get a nod of agreement. “Definitely. It is so beau- group in Kempten, request reintegration, ensure a tiful here. But in the beginning, it took an eternity for gradual increase in weight capacity – almost pass into me to get from the banks to the clinic. Umpteen the background. breaks for just 50 metres.” And she laughs again. The fjord-like idyll of the Tegernsee valley not only draws the tourists. There are also plenty of celebrities, such MRS MILLER- as Manuel Neuer or Philipp Lahm, who enjoy the cosy sophistication of the atmosphere around the lake. SOBOTTA’S FACE IS 58 And so do the patients. “The wonderful surround- FULL OF RELIEF; ings, the view of the mountains and the water, along HER EYES LIGHT UP with the excellent medical care, are one criterion for many patients when choosing rehabilitation at St. AND HER SMILE Hubertus,” adds Patient Advisor Siebert. In Christine GROWS WIDER. Miller-Sobotta’s case, it was her husband who tipped the scales in favour of St. Hubertus. Seventeen years ago, he completed an internship at the clinic on Lake She has done it. Christine Miller-Sobotta is at the end Tegernsee: “He said: go there!” of her rehabilitation – six weeks of emotional chaos lie behind her. “As much as I resisted staying here at first, I was then so happy when I was twice granted an ex- tension. After all, I have only been able to step on the gas in the last two weeks.” Tomorrow, her husband will pick her up and travel with her along the Bavarian Alpine ridge towards home. And then what? “For now, get home again, enjoy my own four walls and, most importantly, celebrate Christmas with my family. And who knows: cycling or hiking in the mountains again in summer, and maybe even kite surfing again at some point.” Christine Miller-Sobotta has big plans.
MEDICAL PARK QUALITY REPORT 2017/18 LOTS OF DATA MAKE A WHOLE
PROF. DR. MED. CHRISTIAN FIRSCHKE HEAD OF CARDIOLOGY AT BAD WIESSEE ST. HUBERTUS “We are pursuing a holistic treatment approach. This is why we also look at a wide range of indicators when measuring quality, from physical performance 59 to freedom from pain to weight gain and subjective quality of life. Only in this way do we obtain a coherent overall picture of therapeutic progress.”
INTERNAL-MEDICINE LOCATIONS Medical Park offers cardiology patients rehabilitation at three locations. At one location, we take care of gastroenterology patients.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
GENERAL CARDIOLOGY
AN OPTIMAL CARE RATIO IS IMPORTANT TO US, WHICH IS WHY 800 THERAPISTS ARE THERE FOR OUR PATIENTS.
AVERAGE AGE OF CARDIOLOGY PATIENTS IN 2017
Bad Feilnbach Blumenhof 73 years Bad Wiessee St. Hubertus 66 years Berlin Humboldtmühle 73 years
DR. MED. HAGEN GROSS-ELLINGER HEAD OF CARDIOLOGY MORTALITY RATE AT BAD FEILNBACH BLUMENHOF
Bad Feilnbach 0.06 Blumenhof “Early-morning exercise, endurance Bad Wiessee 0.00 training, ergometer – we keep our patients on St. Hubertus their toes. But we of course accompany and 60 Berlin Hum- 0.00 boldtmühle monitor them meticulously with very sophisticated
In percent 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 diagnostic procedures.”
Thanks to state-of-the-art, patient-oriented scientific rehabilitation methods, our patients maintain a permanently low individual risk profile. The mortality rate is also correspondingly low at our facilities. EQ-5D INDEX Upon admission Upon discharge
Bad Feilnbach 70.4 Blumenhof 85.4 EQ-5D Bad Wiessee 75.6 St. Hubertus 84.2
Berlin Hum- 68.2 The EQ-5D Index is the boldtmühle 76.3 world’s most widely used method 40 50 60 70 80 90 for the measurement of health- With the EQ-5D questionnaire, a meaningful value for measuring related quality of life. Patients are quality of life can be collected. On average, patients score 82 points upon asked about five factors, which they discharge. From 80 points we refer to a high quality of life. can rate at various levels: mobility, self-care, work and leisure activities, pain/physical discomfort and anxiety/despondence.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
AORTIC VALVE DISEASE
OUR DOCTORS ENJOY AN EXCELLENT PROFESSIONAL REPUTATION.
PATIENTS WITH AORTIC VALVE DISEASE SIX-MINUTE WALKING TEST IN 2017 BAD FEILNBACH BLUMENHOF
279 metres Bad Feilnbach Blumenhof 380 Average when admitted Bad Wiessee St. Hubertus 348 Berlin Humboldtmühle 155
337 metres Average when discharged
NYHA CLASSIFICATION SIX-MINUTE WALKING TEST Upon admission Upon discharge BAD WIESSEE ST. HUBERTUS
Bad Feilnbach 2.9 355 metres Blumenhof 1.8 Average when admitted 61 Bad Wiessee 1.7 St. Hubertus 1.3
Berlin Hum- 2.6 boldtmühle 1.6
I II III 499 metres Average when discharged
Objective achieved: by the end of their stay, patients at Medical Park clinics average between I and II according to the New York Heart Association (NYHA) classification. Class I means no restriction of physical activity. SIX-MINUTE WALKING TEST BERLIN HUMBOLDTMÜHLE
PAIN SCALE 314 metres Upon admission Upon discharge Average when admitted
Bad Feilnbach 3.0 Blumenhof 1.4
Bad Wiessee 1.5 St. Hubertus 0.3 367 metres Average when discharged Berlin Hum- 2.3 boldtmühle 1.3
0 1 2 3 Our patients perform significantly better by the time they are Our patients experience less pain following operation and rehabilitation. discharged. They cover much more distance during the six-minute walking This is measured using a system of points; the figures drop by an test than they could when admitted. average of 1.3 points, so more than one level. Patients experience hardly any residual pain.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
CORONARY HEART DISEASE
OUR PATIENTS CAN RESUME EVERYDAY ACTIVITIES AGAIN.
PATIENTS WITH CORONARY HEART DISEASE PAIN SCALE IN 2017 Upon admission Upon discharge
Bad Feilnbach 2.9 Bad Feilnbach Blumenhof 907 Blumenhof 1.4 Bad Wiessee 1.1 Bad Wiessee St. Hubertus 1,039 St. Hubertus 0.3
Berlin Humboldtmühle 417 Berlin Hum- 2.4 boldtmühle 1.4
0 1 2 3
Specific pain therapy and the process of natural healing reduce pain levels during the post-operative and rehabilitation phases. Measured results reveal a significant reduction to level 1 to 0, which means very low levels of pain that are barely noticeable, all the way to virtually no complaints at all.
NYHA CLASSIFICATION Upon admission Upon discharge 62 Bad Feilnbach 2.8 Blumenhof 1.7
Bad Wiessee 1.7 St. Hubertus 1.2
Berlin Hum- 2.6 boldtmühle 1.7
I II III
NYHA classification declines over the course of therapy; how much depends partly on a patient’s constitution at the beginning of rehabilitation. Happily, almost every patient at Medical Park clinics who has had coronary heart disease goes down to Class I or II, which means they are able to take on considerably more activity. SIX-MINUTE WALKING TEST
Physical performance is assessed using the walking test. Patients walk at their own pace for a total of six minutes. We then measure the distance they cover, and sometimes their pulse, blood pressure and oxygen saturation level. They are allowed to take short recovery breaks during the walk. This test is easy to reproduce and supplies important information about a patient’s 89PERCENT condition and ability to recover. of our patients improve their stamina.*
* Average figure at Medical Park.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
SIX-MINUTE WALKING TEST BAD FEILNBACH BLUMENHOF
297 metres Average when admitted
64PERCENT 357 metres Average when discharged of our patients have no more pain at all SIX-MINUTE WALKING TEST after rehabilitation.* BAD WIESSEE ST. HUBERTUS 411 metres * Average figure at Medical Park. Average when admitted 63
NYHA CLASSIFICATION 489 metres Average when discharged
Cardiac insufficiency is divided into four categories by the New York Heart Association (NYHA). These provide information about SIX-MINUTE WALKING TEST the extent to which patients are inhibited by BERLIN HUMBOLDTMÜHLE their cardiac disorders. NYHA Class I 321 metres encompasses any heart disease that does not Average when admitted result in direct physical limitation. Complaints that occur under normal bodily exertion but which still allow longer
walks of up to five kilometres are categorised 372 metres as Class II. Class III describes patients whose Average when discharged physical activity is significantly impaired; they do not experience any complaints while at rest, but even slight physical activity can How many metres can a patient with coronary heart disease walk in six minutes? By the end of treatment the answer is an average cause symptoms such as a shortage of breath. of 63 metres more than at the start of rehabilitation – a significant Patients who suffer complaints during any achievement by our patients. kind of physical activity at all are categorised as NYHA Class IV.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
MITRAL VALVE DISEASE
300 PATIENTS CHOOSE TO UNDERGO REHABILITATION AT ONE OF OUR CLINICS EACH YEAR.
PATIENTS WITH MITRAL VALVE DISEASE SIX-MINUTE WALKING TEST IN 2017 BAD FEILNBACH BLUMENHOF
285 metres Bad Feilnbach Blumenhof 101 Average when admitted Bad Wiessee St. Hubertus 148 Berlin Humboldtmühle 61
346 metres Average when discharged
SIX-MINUTE WALKING TEST BAD WIESSEE ST. HUBERTUS
363 metres Average when admitted 64
95PERCENT 443 metres Average when discharged of our patients
can handle minor activity SIX-MINUTE WALKING TEST without symptoms.* BERLIN HUMBOLDTMÜHLE 310 metres * Average figure at Medical Park. Average when admitted
373 metres Average when discharged
During their rehabilitative stay, patients become increasingly efficient and can walk faster. As a result they are able to walk an average of 68 metres further over six minutes by the time they are discharged than they were when admitted – a clear sign that their physical ability has risen.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
PAIN SCALE Upon admission Upon discharge
Bad Feilnbach 3.0 Blumenhof 1.4
Bad Wiessee 1.4 St. Hubertus 0.4
Berlin Hum- 2.0 boldtmühle 1.0
0 1 2 3
Pain decreases over the course of the healing process and as a result of pain therapy. Medical Park clinics demonstrate clear and successful results in this department, which is good news for patients since less pain means better quality of life.
NYHA CLASSIFICATION ENDURANCE TRAINING Upon admission Upon discharge 65
Bad Feilnbach 2.9 It has long been recognised that movement is good for Blumenhof 1.8 heart patients. On the other hand, rest does not Bad Wiessee 1.8 contribute to rebuilding or improving performance. St. Hubertus 1.3 Light endurance training in the optimal heart rate Berlin Hum- 2.8 boldtmühle 1.7 zone is ideal for the cardiovascular system – treadmills
I II III and cycling machines, walking, rambling and swimming, for instance. Furthermore, a combination
The lower the figure, the better, because NYHA classification measures of endurance and strength training has proven physical impairment. Patients at Medical Park clinics are one class better especially beneficial for treating cardiological disease. when discharged and are much more able to perform activities. In the process, therapists always bear the optimal connection to rehabilitation in mind and offer patients tips on how to implement their training regularly into their everyday lives so as to take on responsibility for the health of their heart.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
CHRONIC HEART FAILURE
SIGNIFICANTLY FEWER SYMPTOMS CAN BE ACHIEVED IN ALMOST ALL PATIENTS.
PATIENTS WITH CHRONIC HEART FAILURE SIX-MINUTE WALKING TEST IN 2017 BAD FEILNBACH BLUMENHOF
243 metres Bad Feilnbach Blumenhof 55 Average when admitted Bad Wiessee St. Hubertus 460 Berlin Humboldtmühle 60
313 metres Average when discharged
PAIN SCALE SIX-MINUTE WALKING TEST Upon admission Upon discharge BAD WIESSEE ST. HUBERTUS
Bad Feilnbach 2.8 402 metres Blumenhof 1.2 Average when admitted Bad Wiessee 1.3 66 St. Hubertus 0.5
Berlin Hum- 1.6 boldtmühle 0.9
0 1 2 3 482 metres Average when discharged
This therapy is very good at reducing pain, measured as the subjective experience of patients. The diagram shows that all patients at Medical Park clinics class themselves at a lower level of pain by the time they are discharged. SIX-MINUTE WALKING TEST BERLIN HUMBOLDTMÜHLE
NYHA CLASSIFICATION 324 metres Upon admission Upon discharge Average when admitted
Bad Feilnbach 2.9 Blumenhof 2.1
Bad Wiessee 1.8 St. Hubertus 1.4 399 metres Average when discharged Berlin Hum- 2.7 boldtmühle 2.1
I II III Therapy success can be measured in metres. The further patients walk, Physical impairment is measured here. It is an affirmation of our work that, the more capable they are. Results achieved are very good and the distance on average, our patients achieve the bottom two categories of the walked increases by an average of more than 75 metres. NYHA classification scheme by the end of their stay; this means that mild activity is possible without any symptoms.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
ARTERIAL OCCLUSIVE DISEASE
90 PERCENT OF OUR PATIENTS FEEL THAT THEY RECEIVED EXCELLENT TREATMENT.
PATIENTS WITH ARTERIAL OCCLUSIVE DISEASE SIX-MINUTE WALKING TEST IN 2017 BAD FEILNBACH BLUMENHOF
226 metres Bad Feilnbach Blumenhof 89 Average when admitted Bad Wiessee St. Hubertus 76 Berlin Humboldtmühle 15
298 metres Average when discharged
PAIN SCALE SIX-MINUTE WALKING TEST Upon admission Upon discharge BAD WIESSEE ST. HUBERTUS
Bad Feilnbach 4.0 306 metres Blumenhof 2.4 Average when admitted 67 Bad Wiessee 2.3 St. Hubertus 0.8
Berlin Hum- 3.4 boldtmühle 1.9
0 1 2 3 4 392 metres Average when discharged
Our patients rate the subjective experience of their pain on a scale of points. Over the course of rehabilitation, patients at Medical Park clinics are able to improve by one category. SIX-MINUTE WALKING TEST BERLIN HUMBOLDTMÜHLE
NYHA CLASSIFICATION 348 metres Upon admission Upon discharge Average when admitted
Bad Feilnbach 2.8 Blumenhof 2.0
Bad Wiessee 1.5 St. Hubertus 1.2 403 metres Average when discharged Berlin Hum- 2.3 boldtmühle 1.7
I II III On average, patients who have suffered arterial occlusive disease can cover 71 metres more by the time they are discharged. Their physical The main symptoms of peripheral arterial occlusive diseases are capability is higher, a result which we are always happy to let our patients leg pains and a limitation of how far you can walk. Despite this, these go home with. patients also become physically more capable, as proven by NYHA classification.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
INTESTINAL SURGERY AFTERCARE
THE INTERDISCIPLINARY TREATMENT IS AN OUTSTANDING FEATURE OF OUR FACILITY.
PATIENTS WITH INTESTINAL SURGERY AFTERCARE IN 2017 Prien Kronprinz 163 80 PERCENT
of our patients leave our facility with unimpeded digestive function.
68 DR. MED. ANDREA BRIETZMANN OVER-/UNDERWEIGHT PATIENTS UPON DISCHARGE HEAD OF INTERNAL MEDICINE Normal (BMI 20 – 25) Improvement of at least 1 kg AT PRIEN KRONPRINZ
Prien 6.5 56.5 Kronprinz 63.0 “Many of our patients have a long disease progression In percent 0 10 20 30 40 50 60 70 80 90 100 behind them: surgery, intensive care, frequent
complications with follow-up operations, infections, Many patients complain of a loss of appetite. Underweight problems with wound healing. When they come and protein deficiency lead to physical weakness. Therefore, every kilo of weight gained is a therapeutic success. This is the case for more to rehabilitation, alongside digestive trouble, they often than half of our patients. complain about back pain, physical weakness due to muscle loss and circulatory problems. Our treatments are adapted to the individual situation. The patient PATIENTS WITH AN OVERLY LARGE WAIST CIRCUMFERENCE should never be overwhelmed, but should experience UPON DISCHARGE an improvement on a day-to-day basis.” Normal (m < 94 cm; f < 80 cm) Improvement of at least 1 cm
Prien 2.0 55.1 Kronprinz 57.1
In percent 0 10 20 30 40 50 60 70 80 90 100
Hormones form in stomach fat that negatively influence metabolism and thus increase the risk of a heart attack or stroke. More than half of our patients were able to reduce their waist circumference by at least one centimetre.
MEDICAL PARK QUALITY REPORT 2017/18 INTERNAL MEDICINE
PATIENTS WITH HIGH BLOOD PRESSURE UPON DISCHARGE Normal Improvement of 5 mmHG systolic
Prien 93.2 5.1 Kronprinz 98.3
In percent 0 10 20 30 40 50 60 70 80 90 100
With holistic treatment, risk factors must also be taken into account where appropriate. An inpatient stay of several weeks is ideally suited to reducing blood pressure to normal levels – as with more than 93 percent of our patients.
WOUND MANAGEMENT
After intestinal surgery, wound care and the NUTRITIONAL ADVICE provision of an artificial bowel outlet often present problems. Our wound managers and 69 ostomy therapists specialise in this area In the first few weeks following intestinal and, accordingly, guide patients during surgery, patients are often unsure as to how rehabilitation, show them how ostomy aids are they should feed themselves. Many foods fitted and help them to get their bearings are no longer tolerated and sometimes lead with the new and unfamiliar situation. They recognise possible complications at an early to violent reactions. Some patients are also stage and can treat them. It is not only only able to have small portions and are there- technical expertise, but also human sensi fore underweight and physically weak. In tivity that is required here. other patients, it is sensible within the context of rehabilitation to address health risks such as overweight. Regardless of the case, experienced nutritional advisors know what is digestible and beneficial at this time.
MEDICAL PARK QUALITY REPORT 2017/18 PRIVATE DISCUSSION Precisely what Medical Director Prof. Dr. Michael Soyka (left) and his patient Matthias Schroers are discussing is known only to them. But one thing is certain: the surroundings, with park, flowers and house of prayer in the background, have a positive effect. PSYCHOSOMATICS
OASIS OF CALM Watching a boat sail across Lake Chiemsee signals to those suffering from stress: you can also get where you want to go calmly and slowly. But of course, discussions between specialist and patient are at least as important when it comes to recovery. 71 “THE LAKE AND THE MOUNTAINS EXUDE SUCH IMMENSE CALM THAT THEY ALREADY REDUCE STRESS.” Matthias Schroers had burnout – and took no notice. Until he was close to a heart attack. A psychologist referred him on the spot to the psychosomatic clinic on Lake Chiemsee. Six weeks and many hours of therapy later, he says that his battery is fully charged again, and he will in future incorporate numerous exercises into his working day.
MEDICAL PARK QUALITY REPORT 2017/18 PSYCHOSOMATICS
“PSYCHOSOMATIC MEDI- CINE IS RELATIONSHIP MEDICINE. A PATIENT WILL ONLY OPEN UP IF THERE IS TRUST.”
PROF. DR. MED. MICHAEL SOYKA, HEAD OF PSYCHOSOMATICS AT CHIEMSEEBLICK
CONFIDENCE The medical director of the clinic, Prof. Dr. Michael Soyka, prefers his normal clothes to the white doctor’s coat; this reduces the distance between doctor and patient – because he is convinced that the discussions should take place on a level playing field. Prof. Dr. Soyka is a specialist in psychiatry, psychotherapy and neurology, with the additional title of forensic psychiatry, and a widely recognised expert in addiction medicine.
MEDICAL PARK QUALITY REPORT 2017/18 PSYCHOSOMATICS
BODY AND MIND Not needing to be on top of his game and yet training every day under the guidance of therapist Eva Aschenbrenner to give his body new strength was until now an unfamiliar experience for Matthias Schroers. Exercises with Thera-Bands feature on the programme, as does endur- ance training using the fitness machines. For mental recovery, the talks with one of the over 20 psychologists are important.
MEDICAL PARK QUALITY REPORT 2017/18 PSYCHOSOMATICS
AWARENESS One of the most important aspects of Prof. Dr. Michael Soyka’s daily work are the conversations with the patients. In his eyes, psycho somatic medicine is relationship medicine – only if the patients have confidence in a doctor or therapist will they open up to him. And only in this way can the patients receive help. 74
MEDICAL PARK QUALITY REPORT 2017/18 PSYCHOSOMATICS
ENFORCED BREAK at night, while lying awake, he won’t start to ruminate, but will switch off. “You learn this here with psycho- He suffered sleepless nights for many years and had logical support,” says Schroers, a well-built man who no drive during the day. But never once did Matthias doesn’t tend to glorify things or sugarcoat circum- Schroers say to himself: something in my life isn’t stances. His sentences are clear, short, to the point. He right. I have to make a change. Instead, he slogged on; says: “The topic of burnout is not yet socially accept- his job as a car salesman on a commission basis would able; many people think that you are just off your not allow for a break, of that he was sure. It got even rocker.” Matthias Schroers knows that he basically worse: he had had three instances of acute hearing thought this, too. About people who claim to suffer loss; he was also on the verge of a heart attack, his from it, as well as psychologists who help these people. GP – who also happened to be a good friend of his – Then he came here himself. “At the beginning I was had determined, and he strongly advised him to final- distant,” he says, but after a few days he understood: ly take a break. Today, Matthias Schroers says: “I dis- “If you come here, you have to get involved in things.” missed it as nothing.” One day in the early summer of He got involved, went regularly to progressive muscle 2017, he reached the point where his friend explained relaxation sessions and Tai-Chi, learned breathing to him that he couldn’t continue that way. He had to techniques, took part in painting and dance therapy, talk to a psychologist, and right away. If he refused, he and even mindfulness exercises. would have to find a new GP. The threat worked – and had repercussions: the psychologist referred Schroers If you ask Matthias Schroers why he was ‘distant’ to on the spot to the Medical Park Chiemseeblick psycho start with, it was perhaps because of this: anyone who somatic clinic in Bernau am Chiemsee. The diagnosis: works 60 to 70 hours a week like him selling commer- acute burnout. “Total burnout after 30 years in the cial vehicles, primarily lorries, to major clients can’t profession,” he now says this himself. do anything by halves. They have to plug away rather than be aware of their breathing. Painting and dancing A good six weeks later, he sits relaxed on the banks are quickly dismissed as kids’ stuff. But, alongside the of Lake Chiemsee. Fifty-two years old, he wears a discussions with psychologists and daily exercise out- black polo shirt and black jogging bottoms. In a couple doors or in the gym, these gentle and slow therapies of days, he will leave Upper Bavaria and drive home, are what it’s all about: becoming increasingly aware of 75 750 kilometres away near Mönchengladbach. He has yourself again; recognising what a biscuit tastes like already been up the nearby Kampenwand on his because you chew it slowly and concentrate only on mountain bike; he’s been around Lake Chiemsee and this; understanding that your body isn’t a machine explored Rosenheim. He is doing well and has learned that you can quickly dump oil in to make it run a lot here, he says with his deep, almost guttural voice: smoothly and that work pressure can consume you – certain breathing techniques, for example, which will that you have to apply the brakes. not only allow him to calm himself later at work, but can also be inconspicuously incorporated into highly In the six weeks at the Medical Park Chiemseeblick stressful negotiations such that nobody else notices. psychosomatic clinic, he has become more relaxed Or not always wanting to do everything so perfectly; with the help of the doctors, psychologists and ther he will try to heed this advice after his discharge – and apists, he says – more patient, calmer. We believe him immediately. Then he says the sentence he will often say on this summer afternoon: “My battery is fully IT IS VERY IMPORTANT charged again.” He can even sleep well again. The “hotel here even has a psychological aspect,” the lake, TO PROVIDE the sun, the mountains, the calm, the “stress factor has THE PATIENTS WITH already decreased”. He actually says hotel, not clinic – METHODS THAT and there are plenty of reasons for this. Anyone who didn’t know that the reception, the cafe and the res- THEY CAN ALSO USE taurant are part of a rehabilitation and acute clinic, IN THEIR EVERYDAY with many treatment rooms and a gym, could easily LIVES IN ORDER TO take the facility for an idyllically located four-star hotel in Upper Bavaria with sunbathing area and dir PREVENT A RELAPSE. ect access to Lake Chiemsee. And anyone who sees the comfortably generous rooms decked out with plenty of homely wood would have good reason to think that.
MEDICAL PARK QUALITY REPORT 2017/18 PSYCHOSOMATICS
It seems appropriate that Head Doctor and Medical Director Prof. Dr. Michael Soyka only wears his white MORE THAN doctor’s coat unwillingly, which would allow you to recognise him as a doctor straight away. He much pre- fers meeting his patients in his room in his everyday clothes, a shirt and trousers, to talk to them. On a level playing field. It is not only clear that he knows a great deal about burnout, depression and anxiety disorders, which are treated in this clinic, from his CV, but also PSYCHOLOGISTS80 from his titles: he is a specialist in psychiatry, psycho- therapy and neurology, with the additional title of LOOK AFTER forensic psychiatry, and a recognised expert in addic- THE MENTAL HEALTH tion medicine. He worked for 20 years in the psychi- OF PATIENTS atric clinic of the University of Munich and then spent IN OUR CLINICS. ten years as the head doctor of the private Meiringen clinic in Switzerland. He has been head doctor here at Bernau am Chiemsee since 2016. Six head physicians, up to ten assistant doctors and more than 20 psycholo- gists work beneath and with him. Prof. Dr. Soyka says: REACHING GOALS WITH “Psychosomatic medicine is relationship medicine,” MINDFULNESS and this means: only if the patients have confidence in a therapist or doctor will they open up and talk about Matthias Schroers’ work life and his view of things their affliction – only in this way can the patients played a large part in his burnout, and this will con- receive help. tinue when he gets home again; the psychologists know this. Establishing mindfulness in this regard is That Prof. Dr. Michael Soyka has written reference one of their greatest challenges, as well as providing 76 books is almost a given. But the fact he has written patients with exercises and advice on how to avoid two crime thrillers sounds a little more unusual. And falling back into old behaviours. And Matthias yet it commands confidence: that here stands a man, a Schroers wants precisely that. However, working with fully qualified specialist on the one hand, and on the the handbrake on is not possible in his line of work. other, someone who doesn’t speak in incomprehen A basic salary of 800 euros a month is not enough to sible technical jargon, but rather has a very direct line make ends meet, especially not for a family of four. and an inclination towards everyday life with all its He thus has to sell many commercial vehicles to problems and phenomena. There is no pretence with make an adequate living: he gets a percentage of the him. In a short-sleeved shirt and trousers, he matter- net value of the goods. He doesn’t want to say exactly of-factly takes a seat next to Matthias Schroers on the how much that is in the end. Only this: “The financial bench in front of Lake Chiemsee. Whatever they have pressure in the automotive industry is enormous.” been discussing will remain between the two of Although in the past he took time to go on holiday them – even if this is clearly not one of the one-to-one with his family, he was unable to switch off. And nor discussions that they regularly have together. did his mobile. He at least wants to turn off his phone in future while on holiday. The fact that things are going well for him is something he has appreciated in the six weeks that he has been at Chiemsee. The psychologists also advised him to only give 90 per- cent energy to his job. He hopes it will work, but he isn’t exactly sure.
There are three things, however, that he is certain of: he won’t need a GP or psychologist any more to recog- nise if he’s close to a burnout; he will also notice this condition in other people – and he won’t hesitate to address it with those affected. And he’ll also let them know about a great place to go on Lake Chiemsee where they are certain to be able to get help.
MEDICAL PARK QUALITY REPORT 2017/18 THERAPY SUCCESS IN BLACK AND WHITE
PD DR. FRIEDRICH WURST HEAD OF PSYCHOSOMATICS AT CHIEMSEEBLICK “Our aim is to maximise patient satisfaction with the course of treatment, with an improvement in complaints and symptoms. This satisfaction can also be measured: 77 at the beginning and end of a stay at the clinic, we create a neuropsychological test profile that records the extent and severity of symptoms. Thus, patient and therapist can objectively take stock of the success of treatment.”
PSYCHOSOMATIC LOCATIONS Psychosomatic treatment is available at Medical Park Chiemseeblick.
MEDICAL PARK QUALITY REPORT 2017/18 PSYCHOSOMATICS
DEPRESSION
OUR FACILITY WAS RECOGNISED AS THE BEST REHABILITATION CLINIC AMONG MORE THAN 1,000 PSYCHOSOMATIC CLINICS.
PATIENTS WITH DEPRESSION IN 2017
Chiemseeblick 1,072
PROGRESS UNDER BDI-II BDI-II Upon admission Upon discharge
Negligible Mild Moderate Severe The Beck Depression Inventory II (BDI-II) is a 22.6 Chiemseeblick 12.2 psychological test method which can be used
In points 0 13 20 28 to measure the severity of depressive illnesses. It consists of 21 questions in a survey, concerning things In the BDI-II system, any rating higher than 20 points corresponds like social withdrawal and propensity to tiredness. to moderate depression. After treatment at Chiemseeblick, the average There are four possible answers to each question; rating drops from 22.6 at admission to 12.2, which represents a significant improvement. patients tick the most applicable one. The total produced by the answers gives an indication of the 78 level of depression.
BDI-II EFFECT SIZE
Minor Medium Major Effects
Chiemseeblick 1.04
0.2 0.5 0.8 1.1
BDI-II effect size indicates how successful the treatment of depressive disorders has been. Any figure of 0.8 or above can be regarded as a considerable improvement. Effectiveness at our clinic is at a very good rating, which demonstrates how successful therapy is.
ANDREAS BOCK DEPUTY HEAD OF PSYCHOSOMATICS AT CHIEMSEEBLICK
“Psychotherapy and drug treatment complement each other. Our goal is to use 89PERCENT both approaches to improve the mood of the patients, the symptoms of depression, and thus their quality of life. All measures of our formerly are aligned in the team and coordinated.” depressive patients leave our clinic in better spirits.
MEDICAL PARK QUALITY REPORT 2017/18 PSYCHOSOMATICS
DEVELOPMENT OF MENTAL AND PHYSICAL IMPAIRMENT (BSI) Upon admission Upon discharge
Normal Requiring treatment 74.3 Chiemseeblick 62.8
In t-scores 40 50 60 70 80 90
A mix of psychotherapy and medicinal treatment alleviates depressive feelings of dejection as well as actual bodily symptoms. The t-score at our clinics drops by more than 10 points to 62.8, which represents an almost total abatement of symptoms. 79
BSI EFFECT SIZE
CREATIVE THERAPY Minor Medium Major Effects
Chiemseeblick 1.10
The term ‘creative therapy’ encompasses 0.2 0.5 0.8 1.1 several therapeutic forms, including art, music The BSI effect size achieved at Chiemseeblick is testimony to the and dance. What they have in common is an careful, patient-centred work done by our clinical personnel. A rating artistic approach, which can help to initiate or of 1.1 indicates significant therapeutic effectiveness. support psychological processes. The patient is of course not expected to have any prior knowledge. It is about gaining access to one- EFFECT SIZE self in a value-free, results-oriented manner, honing self-perception and developing new Effect size has proven a useful measure ways to express and consider anxiety and con- for assessing therapeutic success. The state flict, but also positive feelings and desires. of a patient upon admission is compared with their state when discharged. The greater the difference between the two ratings, the more effective treatment has been. Figures between 0.2 and 0.5 are considered minor effects, between 0.5 and 0.8 medium, and over 0.8 major.
MEDICAL PARK QUALITY REPORT 2017/18 PSYCHOSOMATICS
ANXIETY AND SOMATOFORM DISORDERS
OUR QUALITY CRITERIA INCLUDE INTEGRATIVE THERAPY CONCEPTS TAILORED TO THE PATIENT.
PATIENTS WITH ANXIETY AND SOMATOFORM DISORDERS IN 2017
Chiemseeblick 133
HEALTH-RELATED QUALITY OF LIFE – SF-36 DEVELOPMENT OF MENTAL AND PHYSICAL IMPAIRMENT (BSI) Upon admission Upon discharge Upon admission Upon discharge
Target range Normal Requiring treatment Total 33.0 physical score 36.9 70.5 Chiemseeblick 60.5 Total psycho- – 1.1 logical score 24.6 In t-scores 40 50 60 70 80 90
In t-scores – 10 0 10 20 30 40 50 60 The figures show that mental and physical symptoms improve following inpatient psychosomatic treatment at Chiemseeblick Specialist An SF-36 survey measures quality of life in terms of physical Clinic. With a t-score of 60.5, stress levels are now below the range and mental well-being. Mental symptoms improve by 25.7 points over requiring treatment.
80 the course of our treatment.
BSI EFFECT SIZE
SF-36 Minor Medium Major Effects
Chiemseeblick 0.79
SF-36 is used to illustrate patients’ 0.2 0.5 0.8 1.1 quality of life. Patients are asked about 36 items, such as mental well- The success of therapy is tangible: at Chiemseeblick Specialist Clinic patients with anxiety and somatoform disorders experience an effect size being, general physical constitution of 0.79. The rating is approaching a high efficiency. and social contacts. A patient’s results are compared against standard figures. The process takes ten minutes. BDI-II EFFECT SIZE
Minor Medium Major Effects
Chiemseeblick 0.85
0.2 0.5 0.8 1.1
The measure known as ‘effect size’ has established itself as a means of illustrating how effective therapies are. Chiemseeblick Specialist Clinic achieves an effect size of 0.85 points, which is in the upper range.
MEDICAL PARK QUALITY REPORT 2017/18 PSYCHOSOMATICS
POST-TRAUMATIC AND ADAPTATION DISORDERS
WHEN HELPERS NEED HELP: AT-RISK GROUPS, SUCH AS POLICE OFFICERS OR RESCUE TEAMS, TEND TO COME TO US.
PATIENTS WITH POST-TRAUMATIC AND ADAPTATION DISORDERS IN 2017
Chiemseeblick 164
DEVELOPMENT OF MENTAL AND PHYSICAL IMPAIRMENT BSI (BSI) (BRIEF SYMPTOM INVENTORY) Upon admission Upon discharge
Normal Requiring treatment This process measures the impairment experienced 65.6 by patients as a result of physical and mental symptoms, Chiemseeblick 55.0 over a period of seven days. It allows patients to see In t-scores 40 50 60 70 80 90 for themselves how they can extricate themselves slowly from the clutches of post-traumatic stress disorder. This therapy has a direct effect on physical well-being. Totals of over 60 indicate a pathological symptom level. At our clinic, levels drop from 65.6, which indicates a need for treatment, Figures of up to 60 are considered normal. to 55.0, which is a significant reduction in symptoms. 81
BSI EFFECT SIZE HEALTH-RELATED QUALITY OF LIFE – SF-36
Upon admission Upon discharge Minor Medium Major Effects
Chiemseeblick 0.78 Target range
Total 37.1 0.2 0.5 0.8 1.1 physical score 47.2
Total psycho- 14.5 With a rating of 0.78 points, effect size is in the upper-middle logical score 36.1 range here. This is an endorsement for us, because it is a very good In t-scores 0 10 20 30 40 50 60 result for this disorder.
An SF-36 survey measures quality of life in terms of physical and mental well-being. Mental symptoms improve by 21.6 points over the course of our treatment. 90 PERCENT
of our patients with adaptation disorders experience significant improvement.
MEDICAL PARK QUALITY REPORT 2017/18 THE PATIENT TAKES CENTRE STAGE In terms of nursing neurology patients, the clinic relies on a diverse team – from neurologists to physiotherapists and nurses to the psychologist. The patients and their individual environments take centre stage: How do they live? Do they live on the ground floor? Are there stairs that they need to climb at home? Are they alone? Do they live with a partner? What is their workplace like? From day one, rehabilitation treatment is based on getting the person back to their usual surroundings as well as possible. NURSING
PIONEERING ARM STUDIO In the robot-assisted arm studio, Gerda Rohde is learning to move her paralysed arm again follow- ing a stroke. The arm studio was developed by Prof. Dr. Stefan Hesse at Medical Park Humboldt mühle and is considered to be pioneering. And during locomotion training for walking and climbing stairs, the therapists also rely on machine-assisted exercises with a large number of repetitions. If necessary, everyday situations such as shopping and refuelling at a specially built station are trained. 83
“I WANT TO BE HEALTHY AND I WILL GET BETTER. I PROMISED MYSELF THAT.” At 86 years old, Gerda Rohde suffers a stroke. Having worked as a nurse for decades, she recognises the symptoms and quickly calls a doctor. Despite good emergency care, her arm is paralysed and she is brought to the rehabilitation clinic in a wheelchair. Six weeks later, Gerda Rohde is again well enough that she can, for the most part, care for herself – the result of comprehensive nursing at Medical Park Humboldtmühle.
MEDICAL PARK QUALITY REPORT 2017/18 NURSING
ALWAYS AT THE LIMITS OF APPEAL At Medical Park, the therapists value the fact that training pushes patients to the limit of appeal – setting new goals is important so that physio- therapy can move forwards set by step. Everyone knows that if you do something that doesn’t appeal any more, there will be no improvement. The therapists at Humboldtmühle of course notice if a patient is exhausted or is going through a bad patch. In which case, they will just have a conversation during the therapy session. 84
“IT DOES YOU GOOD TO GET TOGETHER WITH OTHER PATIENTS DURING THERAPY – AND HAVE A LITTLE JOKE OCCASIONALLY.”
GERDA ROHDE, STROKE PATIENT
MEDICAL PARK QUALITY REPORT 2017/18 NURSING
“IT IS IMPORTANT THAT OUR PATIENTS TRUST THEIR BODIES AGAIN. WE SUPPORT THEM – NOT ONLY HERE AT THE CLINIC, BUT ALSO WITH TIPS FOR LIFE AT HOME.”
MANDY SCHENK, NEUROLOGY NURSE 85
THE PATIENT’S ENVIRONMENT IN MIND Healthy development is only one area that the clinic draws on with its treatment. The employees have the full situation in mind: what conditions are present in the patient’s work, family and free time? In order to create a treatment plan that the person can use to target the best results in the medium and long term, doctors also speak with the families and sometimes even the employer.
MEDICAL PARK QUALITY REPORT 2017/18 NURSING 86 ENCOURAGEMENT AND CONFIDENCE At Medical Park Humboldtmühle, the patients are the central pillar of medical treatment. Nursing and therapy are built around them. The nursing also provides the patient with encourage- ment and confidence – both of which are important for healing. In neurology in particular, nursing is often much more complex than in other areas, such as orthopaedics: a patient with an ankle injury, but who is otherwise healthy, can accomplish a great deal in everyday life. A stroke patient, on the other hand, is dependent on nursing.
MEDICAL PARK QUALITY REPORT 2017/18 NURSING
MENTAL STRESS Rehabilitation is not only physically demanding for patients; it is also often mentally stressful. The nursing staff at the Medical Park Berlin Humboldtmühle clinic are highly professional and well trained. The nurses can handle it if a patient is sometimes overwhelmed by the stress. For Head of Neurology Prof. Dr. Dr. Martin Ebinger, it is always fascinating to see how patients recover – and how someone who arrives paralysed down one side can walk out of the clinic again just a few weeks later. 87
“IT NEVER CEASES TO AMAZE ME HOW WELL THE BODY IS MADE IN ORDER TO MAKE UP FOR DEFICIENCIES – LIKE AFTER A STROKE.”
PROF. DR. MED. DR. PHIL. MARTIN EBINGER, HEAD OF NEUROLOGY AT BERLIN HUMBOLDTMÜHLE
MEDICAL PARK QUALITY REPORT 2017/18 NURSING
“IT IS SOMETIMES DIFFICULT, BUT YOU HAVE TO CHALLENGE YOUR- SELF. YOU HAVE TO SET YOURSELF GOALS.”
GERDA ROHDE, PATIENT 88
INVOLVING FAMILY MEMBERS There are sometimes short comings even after successful rehabilitation. High doorsills can be an obstacle for patients; sometimes the bathroom needs to be rebuilt at home. From the very start, the clinic involves family members in the treatment and long-term therapy plan. Especially if a patient cannot communicate sufficiently, it is important that someone from the family or friendship circle can speak for them.
MEDICAL PARK QUALITY REPORT 2017/18 NURSING
A STROKE WHILE DRINKING MACHINES ARE NOT COFFEE REPLACING PEOPLE. Gerda Rohde knew what was happening to her THE HUMAN INFLU- straight away. “I had just made coffee and put two ENCE OF THE NURSES cups out on the living room table,” the 86-year-old recalls. “And then I was standing at the table and AND THERAPISTS wanted to take the pot and noticed: I can’t; my arm IS ALSO EXTREMELY isn’t working … what’s going on, I thought, am I having IMPORTANT FOR THE a stroke?” Gerda Rohde had worked at a hospital for almost fifty years; she was head nurse at the Charité PATIENT. and trained student nurses – on this afternoon in July, she quickly realises that she has all the signs of a stroke. “Look at me,” she says to her husband, who is “We all see this in ourselves: if we are doing some- sitting in the armchair by the window. He is startled. thing that doesn’t appeal to us, there will be no im- “You’re stammering. Your mouth is lopsided.” provement,” explains nursing director Olaf Arnhold. “Therefore, the training plan for therapy must always Six weeks later, it is a bright sunny morning. Gerda be at the limit of patient performance – thus, new Rhode sits at a small table on the first floor of Berlin goals are set.” Daily training with a large number of rehabilitation clinic Medical Park Humboldtmühle repetitions ensures that patients are back on their feet and trains her arm. Her right side was paralysed at quickly. “But if the patient isn’t doing so well or has first due to the stroke; the Berlin native was brought experienced an emotional breakdown, we may have from the acute clinic to the rehabilitation clinic in a a discussion instead,” says Arnhold. “Machines are wheelchair. Gerda Rohde now energetically grasps the not replacing people. The human influence of the device mounted on the table in the therapy room and nurses and therapists is also important.” pushes the heavy block upwards and downwards. A 89 short break, then to the right and to the left. Rohde At Medical Park, value is placed on the fact that ther- executes the movements slowly: her physiotherapist apy and nursing work closely together. “If nurses have has set the resistance such that his patient has to work been told by the therapist that the patient can take a a bit. “I’ve done 40,” says Rohde. “I have to get to 100.” few steps with the walking frame, the nursing staff will instruct the patient to walk to meals themselves,” says Arnhold. “Participation is paramount here. We look at precisely how the patients live at home – do they live on the ground floor? Are there steps in the house? Is there a lift? Do they live with a partner who can perhaps support them with the shopping? The inter- play between therapy and nursing is heavily focused on day-to-day life here.”
900NURSING STAFF NURSING WITH A VIEW ONTO THE WATER ACCOMPANY AND SUPPORT PATIENTS The Medical Park Humboldtmühle clinic is located to IN OUR CLINICS. the north-west of Berlin, right where the Tegeler Fliess flows into Lake Tegel. The water flows in part under the main building; a glass walkway connects the front portion of the clinic complex across the stream to the ward block. The patient rooms are lo cated in a former granary. There, Gerda Rohde is now sitting in her room looking at photos that her niece has sent to her in the clinic. We can see Gerda Rohde drinking coffee with her husband. He is laughing in the picture. “Yes, that’s how he is,” she says. “We are both happy people. We have had a nice life.” She shakes her head. “Will I have to deal with this sort of
MEDICAL PARK QUALITY REPORT 2017/18 NURSING
thing again so close to the end … I’m 86. I already FAMILY MEMBERS ARE have so many spare parts in my body – that this is happening now, I could never have imagined it.” ALSO OFTEN UNSURE AS TO HOW The senior nurse at Humboldtmühle knows how THINGS WILL hard it can be for the patients. People want to return to their old condition and it is hard for them to ac- CONTINUE. SOMETIMES cept limitations. Just as it is for their family. They are THEY ALSO NEED often unsure as to how things will continue. Some- SOMEONE WHO WILL times, family members also need someone who will just listen. Here it is important that the team func- JUST LISTEN. tions and that everyone works closely together, from the facility’s doctors to the therapists and nurses to CLOSE TO THE PATIENT the psychologists. Prof. Dr. Dr. Ebinger has been head of the neurology It is often older people like Gerda Rohde who come to department since May 2017; he specialised in stroke Medical Park Humboldtmühle after a stroke. “But we medicine more than 10 years ago – and he also stresses also have many younger patients – also 30- and 40-year- the importance of the nursing. “The nursing staff are olds – who are severely affected and are sometimes closest to the patient,” says the head doctor. “They with us for several months of rehabilitation,” says have the closest contact and the employees are the Prof. Dr. Dr. Martin Ebinger, head of neurology. It is first to recognise whether the patient is any better or sometimes seemingly banal, small causes that lead to not.” Particularly in the field of neurology, nursing is a stroke; “a blow to the neck during sport, for example,” often much more complex than in other subject areas, says the neurologist. “And there are even strokes in such as in orthopaedics: a patient with an ankle injury, children, even if this is rare.” but who is otherwise healthy, can still accomplish a great deal in everyday life. A neurology patient who 90 has suffered a stroke and is paralysed down one side is dependent on care. “Nursing is at the heart of everything that happens around the patient,” says HELP IN HELPING Prof. Dr. Dr. Ebinger. ONESELF Family members are also closely involved at Medical Park. It is often the case after a stroke that the speech centre is also affected, and the patient cannot commu- nicate sufficiently with the doctors and nurses. “Here, family members are our first port of call,” says Prof. Dr. Dr. Ebinger. “They then have to speak for the pa- tient and must also say ‘my husband or my wife would now prefer this or that’.” This often concerns planning after rehabilitation. “The goal is always that the pa- tients can return to their old life. But there are some- times certain shortcomings even after successful re- habilitation. Are renovations required at home because of high doorsills or stairs? Does the bathroom need to MANUELA ERDMANN be converted? We also need the family members DIRECTOR OF NURSING AT CHIEMSEE here – for example, if our colleagues from social ser- “We provide guidance so that our patients vices visit the house to take a look.” feel secure again and can summon up courage. Thus, with our help, they learn to overcome their illness and to deal with the consequences.”
MEDICAL PARK QUALITY REPORT 2017/18 NURSING
The head doctor says that he is amazed each and every day by neurology. Because, of course, a great S T R O N G deal can be scientifically documented, such as how a nerve cell works and sends its message to another TOGETHER nerve cell. “But how feelings or colours are thus per- ceived cannot be condensed into scientific formulae. “It never ceases to amaze me, for example, that on the one hand, a stroke can trigger deficiencies in the patient – but on the other, how well the body is made to make up for this in the majority of cases.”
BACK TO THE OLD LIFE
Nursing is not just physically demanding; it can also sometimes be mentally stressful, emphasises the doc- tor. “Everyone copes with stress differently and the nursing staff are consulted in particular if patients are overburdened with management of their condition. If MARGUERITE LICHT DIRECTOR OF NURSING a person is sad or depressed, or even reacts in a ver- AT BAD CAMBERG bally or physically aggressive manner. We have highly professional nursing staff who are well trained and “The health-related restriction is only can handle it.” Above all, nurses at Medical Park are a part of the treatment. It is important extremely motivated to contribute to people’s recov- to bear the entire life situation of the ery. “The nursing staff know the patients, can handle patient in mind. As an interdisciplinary their problems and make the best of things. And they team, we complement each other – see day after day how people who arrive in a very bad from the neurologists to the nursing staff 91 way recover very well – how people who arrive here to the therapist; we all work together. paralysed down one side can then walk out of the Only in this way can we do everything that clinic again and back into their old lives.” is humanly possible for our patients.”
Gerda Rohde has just enjoyed a quick midday nap. Freshly coiffed, a necklace that matches her floral blouse, she is now on her way to have a cup of coffee. “I have been able to get about with the walking frame following an accident several years ago – and he is by myself for a few days now. It’s difficult, but you showing the first signs of dementia. “He had to be have to challenge yourself. You have to set goals,” she operated on four times in quick succession,” says Gerda says. Her goal is to go home as soon as possible. Her Rohde. “And he suffered with the anaesthetics.” husband is waiting for her there. “We have been mar- ried for almost 60 years,” says Gerda Rohde. “Never She finds a place on the cafeteria terrace. She can see any regrets.” Her husband was also a nurse. They met the ducks in the water from here; a couple of canoeists at the hospital. Now he also needs more and more are also out and about on the stream. The server support because he is no longer able to walk as well brings a slice of apple pie. “I can serve myself a slice now, and I can hold the coffee cup again,” says Gerda Rohde. “I’m getting better every day. I want to be THE NURSING healthy and I will get better. I promised myself that.” STAFF KNOW THE PATIENTS, CAN HANDLE THEIR PROBLEMS AND MAKE THE BEST OF THINGS.
MEDICAL PARK QUALITY REPORT 2017/18 PATIENT RATING
91PERCENT of our patients recommend us to others.* * Average figure at Medical Park. 92
In percent
94.9 96.5 92.1 91.5 91.7 90.9 90.4 89.8 87.8 83.9 84.1 83.1 81 % current average in Germany**
Bad Berlin Bad Chiem- Chiem- Bad Bad Bad Loipl Prien Bad Bad Feilnbach Hum- Camberg see seeblick Wiessee Wiessee Wiessee Kronprinz Rodach Feilnbach Blumen- boldt- St. Specialist Private Reit hof mühle Hubertus Clinic Clinic hofpark
** Current average in Germany for recommending to others from the ‘Weisse Liste’.
MEDICAL PARK QUALITY REPORT 2017/18 PATIENT RATING
HOW SATISFIED WERE YOU WITH YOUR NURSING CARE?
Average rating
Bad Feilnbach 1.24 Blumenhof
Berlin 1.44
Bad Camberg 1.49 MANUELA ERDMANN Chiemsee 1.07 DIRECTOR OF NURSING
Chiemseeblick 1.25
Bad Wiessee 1.34 “We recognise the problems St. Hubertus
Bad Wiessee 1.42 and limitations of the Spec. Clinic
Bad Wiessee 1.02 patients. They feel in good Private Clinic
Loipl 1.41 hands with us and learn to
Prien 1.22 master everyday life confidently Kronprinz
Bad Rodach 1.36 and independently.”
Bad Feilnbach 1.46 Reithofpark 93 1 * 1 2 3 4 5
HOW SATISFIED WERE YOU WITH YOUR PHYSICIANS AND MEDICAL CARE?
Average rating
Bad Feilnbach 1.22 Blumenhof
Berlin 1.42
Bad Camberg 1.68 PROF. (DHFPG) DR. MED. THOMAS WESSINGHAGE Chiemsee 1.14 MEDICAL DIRECTOR, HEAD OF ORTHOPAEDICS, REHABILITATION Chiemseeblick 1.70 MEDICINE, SPORTS MEDICINE Bad Wiessee 1.46 St. Hubertus
Bad Wiessee 1.45 “A lovely atmosphere and Spec. Clinic Bad Wiessee 1.02 rehabilitation clinic are Private Clinic not mutually exclusive.” Quite Loipl 1.77 Prien 1.35 the contrary. The pleasant Kronprinz surroundings help with many Bad Rodach 1.47 Bad Feilnbach 1.45 Reithofpark
exertions.” 1 * 1 2 3 4 5
MEDICAL PARK QUALITY REPORT 2017/18 PATIENT RATING
HOW SATISFIED WERE YOU WITH YOUR THERAPEUTIC TREATMENT?
Average rating
Bad Feilnbach 1.30 Blumenhof
Berlin 1.31
Bad Camberg 1.39 KNUT STAMER Chiemsee 1.08 DIRECTOR OF THERAPY
Chiemseeblick 1.36
Bad Wiessee 1.27 St. Hubertus “We encourage the individual Bad Wiessee 1.22 Spec. Clinic responsibility of our patients. Bad Wiessee 1.03 Private Clinic In return, we therapists not only Loipl 1.10 offer technical expertise, but Prien 1.25 Kronprinz also a great deal of empathy.” Bad Rodach 1.22
Bad Feilnbach 1.48 Reithofpark
1 * 1 2 3 4 5 94
HOW SATISFIED WERE YOU WITH THE TREATMENT YOU RECEIVED OVERALL?
Average rating
Bad Feilnbach 1.35 Blumenhof
Berlin 1.37
Bad Camberg 1.61
Chiemsee 1.15
Chiemseeblick 1.39
Bad Wiessee 1.34 St. Hubertus
Bad Wiessee 1.42 Spec. Clinic
Bad Wiessee 1.04 Private Clinic
Loipl 1.37
Prien 1.35 Kronprinz
Bad Rodach 1.39
Bad Feilnbach 1.56 Reithofpark
1 * 1 2 3 4 5
MEDICAL PARK QUALITY REPORT 2017/18 PATIENT RATING
HOW SATISFIED WERE YOU WITH THE CLINIC FACILITIES AND YOUR ACCOMMODATION?
Average rating
Bad Feilnbach 1.54 Blumenhof
Berlin 1.50
Bad Camberg 1.67 HOW SATISFIED WERE Chiemsee 1.21 YOU WITH OUR COOKING AND
Chiemseeblick 1.04 SERVICE? Average rating Bad Wiessee 1.39 St. Hubertus
Bad Wiessee 1.73 Bad Feilnbach 1.35 Spec. Clinic Blumenhof
Bad Wiessee 1.30 Private Clinic Berlin 1.62
Loipl 1.45 Bad Camberg 1.44
Prien 1.60 Kronprinz Chiemsee 1.16
Bad Rodach 1.51 Chiemseeblick 1.10
Bad Feilnbach 1.59 Bad Wiessee 1.58 Reithofpark St. Hubertus 95 1 * 1 2 3 4 5 Bad Wiessee 1.49 Spec. Clinic
Bad Wiessee 1.19 Private Clinic
Loipl 1.35
Prien 1.18 Kronprinz
Bad Rodach 1.56
Bad Feilnbach 1.35 Reithofpark
1 * 1 2 3 4 5
At the Medical Park clinics we give all of our patients a questionnaire to fill in. We try to get as many of them back as possible, and an average of 56 percent of our patients give us feedback. Our rating scale is: 1* out- standing, 1 very good, 2 good, 3 satisfactory, 4 adequate and 5 poor. RALPH JUNG EXECUTIVE CHEF
“All-round care does not stop at the kitchen door. For us, good, healthy food also plays a part.”
MEDICAL PARK QUALITY REPORT 2017/18 PUBLICATION DETAILS
PUBLISHER MEDICAL PARK AG, AMERANG
DATA COLLECTION MEDICAL PARK CLINICS
DATA EVALUATION MEDICAL PARK AG, JOHANNES KNEISSL
EDITORIAL MANAGEMENT MEDICAL PARK AG, REGINA MITTERMAIR
CONCEPT/EDITING/DESIGN ANZINGER UND RASP, MUNICH
AUTHORS PHILIPP HAUNER KERSTIN LÖFFLER ANNA PATACZEK SUSANNE SCHNEIDER
PHOTOGRAPHY THOMAS STRAUB, MUNICH SORIN MORAR, MUNICH
TRANSLATION GÖTZ TRANSLATIONS AND PROOFREADING, HAMBURG 96 LITHOGRAPHY MXM, MUNICH
PRINTING PARAT DRUCK, MUNICH
FOR QUERIES ABOUT THE QUALITY REPORT: JOHANNES KNEISSL TEL. +49 ( 0 ) 8075 91311-0 [email protected] JÜRGEN FABIAN HANS-JÜRGEN WENGRAF
FOR QUERIES ABOUT THE CLINICS: ANDREA FRITZ, BAD RODACH FRANZISKA GORAL, BERLIN HUMBOLDTMÜHLE VERONIKA MAIER, CHIEMSEE AND PRIEN KRONPRINZ ISABELL PATTERER, LOIPL SIMONE PUTTINS, BAD CAMBERG MILICA SIMON, CHIEMSEEBLICK KATRIN STRASSER, BAD FEILNBACH CORNELIA ZIMMERMANN-SCHULZE, BAD WIESSEE
THIS REPORT CONTAINS DATA FROM 2017. ALMOST ALL OF THE PATIENTS TREATED AT MEDICAL PARK CLINICS ARE INCLUDED IN THE STATISTICS. IF THEY ARE NOT THEN IT IS BECAUSE SOME OF THE QUESTIONS WERE VOLUNTARY AND NOT EVERY CASE CAN BE DOCUMENTED.
MEDICAL PARK QUALITY REPORT 2017/18 “It isn’t easy to find the right clinic. There is such a large provision in Germany, especially in the field of rehabilitation. For the second time and in an extended form, the Medical Park Group Quality Report now offers patients, family members, doctors and even health insurance providers orientation. What services are there? What progress can I expect to make during my stay? For the Medical Park Group, this edition is a new milestone. It considers even more comprehensively than before the point of view of patients. How do they rate their quality of life after rehabilitation at Medical Park? Their testimony complements the perspective of doctors, therapists and nursing staff. This report can help people to get a truly comprehensive picture. Make the right decision – for the good of your health.”
PROF. DR. MED. KARL MAX EINHÄUPL CHAIRMAN OF THE BOARD, CHARITÉ UNIVERSITY HOSPITAL BERLIN MEDICAL ADVISOR, MEDICAL PARK