QUALITY REPORT 2020

“IT WAS EXTREMELY IMPORTANT THAT THE THERAPY TARGETED THE COORDINATION OF THE ENTIRE BODY – BECAUSE THERE IS HARDLY ANY TYPE OF SPORT AS COMPLEX AS SKIING.”

THOMAS DRESSEN There could not have been a more spectacular comeback: after the injuries of his knee and shoulder at the start of the 2018/19 season, ski racer Thomas Dressen (26) came to reha­bilitation at Medical Park St. Hubertus. The following season, 2019/20, he came back with victories in Lake Louise, Canada, at the Kandahar downhill slope in Garmisch-Parten- kirchen, and in Saalbach, Austria.

His treatment at Medical Park St. Hubertus played a huge part in this success. For him, the holistic training approach of the entire body was a new experience. According to Dressen, skiing requires: “endurance, strength, speed, bounce and coordination – if you can’t manage all of this well enough, you won’t be among the frontrunners.” Dressen also learnt to have a structural routine. “I have tried to make plans for myself ever since. This makes space for new things and helps to maintain a clear head.” MEDICAL PARK LOCATIONS IN GERMANY

Berlin Humboldtmühle Stroke Centre Berlin

Lower Saxony Berlin

Borussia Mönchengladbach Saxony- Bad Sassendorf Anhalt

North Rhine- Westphalia

Saxony Thuringia

Hesse Bad Rodach

Hof Bad Camberg Coburg Czech Würzburg Republic Rhineland- Palatinate St. Theresien Nuremberg

Regensburg

City Med Bavaria Baden- France Württemberg Passau

Prien Kronprinz Munich Chiemsee Chiem­ seeblick Loipl

Switzerland

Bad Wiessee am Austria Kirschbaumhügel Private Rehabili­ tation Hospital

Bad Wiessee am Kirschbaumhügel Specialist Rehabili­ Bad Feilnbach tation Hospital Reithofpark

Bad Wiessee Bad Feilnbach St. Hubertus Blumenhof FIELDS OF TREATMENT

Internal Orthopaedics Neurology Oncology Psychosomatics medicine

Bad Camberg

Bad Rodach

Berlin Humboldtmühle

Bad Wiessee am Kirschbaumhügel Private Rehabili­ tation Hospital

Bad Wiessee St. Hubertus

Bad Wiessee am Kirschbaumhügel Specialist Rehabili­ tation Hospital

Bad Feilnbach Blumenhof

Bad Feilnbach Reithofpark

Chiemsee (Bernau-Felden)

Chiemseeblick (Bernau-Felden)

Prien Kronprinz

Loipl

Bad Sassendorf

MEDICAL CENTRES OUTPATIENT CENTRES STROKE CENTRE BERLIN CITY MED, MUNICH ST. THERESIEN, NUREMBERG BORUSSIA MÖNCHENGLADBACH MEDICAL PARK IN FIGURES

91PERCENT RECOMMENDATION RATE

by our patients – indicates their acceptance and thus trust in our expertise. > PERCENT70 3,100BEDS EQUITY RATIO

of hotel comfort and high shows that Medical Park service level support is a crisis-proof employer that the best possible recovery. is able to innovate.

3,500EMPLOYEES 70,000PATIENTS EACH YEAR

make up a team of highly indicate the high demand for our qualified doctors, therapists, rehabilitation hospitals. nurses and service staff. CONTENTS

“ABOVE ANYTHING ELSE, I AM TAKING AWAY THE TRAINING APPROACH AT MEDICAL PARK.” ORTHOPAEDICS PAGE 10

“I SLEEP LIKE A BABY – AND IT FEELS FANTASTIC.” PSYCHOSOMATICS PAGE 72 2

SAFETY FIRST COVID-19 PAGE 6

“THE FACT THAT I DID NOT SKIP A SINGLE THERAPY SESSION PAID OFF – AND THIS WILL CONTINUE AT HOME.” NEUROLOGY PAGE 36

“IT IS A CHALLENGE, OF COURSE, BUT I KEEP TRYING TO PICK MYSELF UP.” INTERNAL MEDICINE PAGE 56 CONTENTS

MEDICAL PARK NEUROLOGY NURSING LOCATIONS REPORT REPORT Cover flap Page 36 Page 84 MEDICAL PARK IN FIGURES Phase B: admission and discharge Pressure sores Page 1 for phase B Page 92 Page 48 EDITORIAL Page 4 Phase B: admission to phase B, discharge from phase C/D THERAPY Page 50 REPORT Phase C Page 94 COVID-19 Page 52 REPORT Phase D Page 6 Page 54 PATIENT RATING

Recommendations and satisfaction ORTHOPAEDICS INTERNAL MEDICINE Page 98 REPORT REPORT Page 10 Page 56 THERAPY CENTRE Cancer treatment of the BORUSSIA MÖNCHENGLADBACH PUBLICATION DETAILS female genital organs Page 21 Page 102 Page 66

Hip replacement after osteoarthrosis GLOSSARY AND 3 Cancer treatment of the Page 26 QUALITY INDICATORS digestive organs Cover flap Knee replacement after osteoarthrosis Page 67 Page 28 Coronary heart disease Change of prosthesis for hips and knees Page 68 Page 30 Mitral valve disease Treatment after a femoral neck fracture Page 69 Page 32 Aortic valve disease Back treatment after spine operation Page 70 Page 34 Chronic heart failure Conservative back treatment Page 71 Page 35

PSYCHOSOMATICS

REPORT Page 72 Depression Page 80 Anxiety disorders Page 82 Adaptation disorders Page 83

MEDICAL PARK QUALITY REPORT 2020 EDITORIAL

DEAR READERS,

You are reading our latest quality report. We do not know whether you are a specialist looking to recommend patients to us. Or whether you have discovered us while looking for a rehabilitation hospital. Or perhaps you are someone who would like to work with us.

We always ask ourself whom we should address with our quality report. How should we represent our quality? With measurement data, figures and tables? Or with detailed descriptions of procedures, diagnoses and readings? We have decided to provide a platform primarily to those people who have completed medical rehabilitation with us. They can report first-hand what they have ex­ perienced and what rehabilitation in our facilities has done for them. This self- assessment does not perhaps meet the strictest criteria for objective measure- ments. But it does come very close to the actual aim of rehabilitation: the im- provement of mental and physical performance in the recovery or preservation of independence. Whether or not this aim has been achieved can only be assessed 4 by the patient. They must be able to feel as clear a sense of individual improve- ment as possible and must be in a position to do things that were not possible before rehabilitation, or that were only possible to a limited extent.

And rehabilitation research has now reached the conclusion that these “Patient Reported Outcome Measures”, or PROMs, represent valuable quality indicators. Experts are now in agreement that PROMs should be systematically collected as a component of quality measurement.

We thus combine personal reports with various aspects of quality measurement in our quality report. We are therefore certain that we are offering you, the reader of this report, an interesting read that is full of substance.

MEDICAL PARK QUALITY REPORT 2020 EDITORIAL 5

JOHANNES KNEISSL ULF LUDWIG DIRECTOR CHAIRMAN AND QUALITY MANAGEMENT MANAGING DIRECTOR

MEDICAL PARK QUALITY REPORT 2020

COVID-19 SAFETY FIRST

Rehabilitation can still be safely conducted during Everything was going according to plan until the end the corona pandemic: André Baumeister is the best of March, when he had a slight fever. He was tested evidence of this. He has multiple sclerosis. He wanted for an infection of the new coronavirus immediately. to strengthen his trunk muscles at Medical Park The test came back positive. “I thought they had made Loipl to straighten his upper body, but the strength of a mistake at first” – Baumeister could not believe it. his immune system was required at the same time. He and two other patients who had tested positive Baumeister contracted COVID-19, recovered well came to the isolation ward that had been set up by and still had a full schedule in the days shortly before the hospital’s management. The rehabilitation hos­ his departure. 9.30 a.m. physiotherapy: we start with pital’s three COVID-19 patients were in luck: the a concentration exercise and then use a lot of head disease was mild for all of them. But the hospital’s work to move the legs and to stand up from the wheel- staff in Loipl were of course equipped for the emer- chair using the wall bars. “Looking really good,” com- gency. “We don’t have an intensive-care ward here, but mends physiotherapist Melanie Adam. After 30 min- we do have substantial care options even for patients utes, it is time to move on to medical training therapy who are acutely unwell,” says Professor Peter Rieck- in the rehabilitation hospital’s gym. Baumeister lifts mann, head doctor at Medical Park Loipl. weights and groans a little beneath his protective face mask. “It’s hard work, but I’m getting enough air.” The windows are wide open and everyone trains at a safe distance from one another. Aside from the fact every- 7 Physiotherapy and occupational therapy one is wearing masks, everything appears to be just can take place without problems even during the same at the rehabilitation centre during the cor­ the corona pandemic. Masks are not only ona pandemic. an accepted necessity for everyone in situations where the therapist and patient have to be But appearances can be deceptive. Medical Park Loipl close to one another. is high up in the Berchtesgaden mountains and is a specialist neurology hospital focusing on MS. It has been the leading German centre for clinical neuroplasticity ­ for a year. For André Baumeister, SARS-CoV-2 was detected after rehabilitation began. As a patient with multiple sclerosis, Baumeister is con- sidered as being in an at-risk group. Almost 20 years ago, the now 44-year-old from the Munich area was diagnosed with the autoimmune disease of the nervous system. He has been in a wheelchair for ten years now. He has become accustomed to the fact that his legs no longer obey him. He therefore wanted to strengthen his trunk muscles in Loipl and train his arms.

MEDICAL PARK QUALITY REPORT 2020 COVID-19

Physiotherapist Johannes Ripperger explains the digital rehabilitation assistant to André Baumeister. Three hundred different exercises are stored on the tablet. With it, patients are able to train in the room by themselves with professional support.

André Baumeister also benefited from this. In the four weeks prior to the virus no longer being detect­ able, he was isolated but not alone. The nursing staff took a lot of time, even if they looked a bit different

8 than usual in their “spacesuits”. Therapists and doc- tors called regularly and physiotherapist Johannes Ripperger not only came for the training, but also just to chat. “That was really important,” says Ripperger. The pandemic has also had an impact on his work – and accelerated the digitisation of day-to-day life in the hospital. The computer-aided training developed in-house was completed in no time. There are now ten tablets with 300 different rehabilitation exercises so that patients can also train by themselves with pro- fessional instruction. Two hundred and fifty of these exercises have been installed by the team since the start of the corona crisis. Baumeister also trained each day with the digital rehabilitation assistant: “It was good that I was also able to train in quarantine like cast them using the hospital’s large monitors,” explains that.” He made the best of this time. It helped that he Rieckmann. The patients’ readiness to cooperate was was already a rather calm but motivated person. and remains high. And the team has embraced the new situation. It remains especially important that In the process, the agitation caused by the corona the patients’ mental well-being does not fall behind pandemic was significant, and this remains the case. in spite of the hygiene measures. There are therefore In Loipl, the entire team quickly and consistently im- creative activities in the fresh air and the possibility plemented the required safety measures. The three of playing music – they even organised a grand piano, imperatives of the pandemic – test, track, isolate – with which Rieckmann serenaded the patients. Dur- also form the foundation in Loipl. In addition, hy- ing the visiting ban, a secure “airlock” was set up so giene measures and social distancing have been taken that patients could see their loved ones. The entire very seriously at the rehabilitation hospital. It was rehabilitation hospital family regrouped in the face of mandatory for everybody to wear a protective mask these challenges. very early on. Communication and information was open and transparent: “Because we could not convene any meetings, we made videos ourselves and broad-

MEDICAL PARK QUALITY REPORT 2020 COVID-19

MORE THAN 1,000,000 PROTECTIVE MASKS WERE PURCHASED DURING THE CORONA CRISIS AS PART OF THE “SECURE REHABILITATION”­ CONCEPT.

This also applies to the other facilities in the hos­ pital group. Together, all Medical Park rehabili­ tation hospitals were the first large provider of med­ ical rehabilitation to de­velop a comprehensive “secure rehabilitation” concept. Thanks to the three-step plan, all facilities are able to ensure effective rehabilitation measures with complete infection protection even Hygiene measures and distancing rules are during the pandemic. taken very seriously in all Medical Park rehabili­ation hospitals. Within the scope of the The hospital in Loipl has now been “corona-free” for new “secure rehabilitation” concept, every weeks. The new “secure rehabilitation” concept works. patient is tested upon arrival – and, of course, Since mid-May, every patient is tested on arrival. And all employees are also tested regularly. the hospital’s employees are regularly tested – not least for their own safety. For Rieckmann, there is therefore no reason to delay medically required rehabilitation due to the pandemic. On the contrary: “Here, patients are able to withdraw a little from the stress of the world and concentrate fully on their well-being.”

André Baumeister was released in mid-May after more than two months in Loipl. He can’t imagine things getting too stressful for him. As a recovered COVID-19 patient, he knows how people should inter- act during the pandemic. And how does he look back on this somewhat unusual rehabilitation? “Touch wood, things are going very well,” says Baumeister. The protective mask means the fact he chuckles slightly can only be seen in his eyes.

MEDICAL PARK QUALITY REPORT 2020

ORTHOPAEDICS

“ABOVE ANYTHING ELSE, I AM TAKING AWAY THE TRAINING APPROACH AT MEDICAL PARK.” What Thomas Dressen (26) has accomplished the past two years would be enough for two careers. First the spectacular victory in Kitzbühel in 2018. Then the serious crash followed by surgery on the cruciate ligament and shoulder. During rehabilitation at Medical Park St. Hubertus, Dressen assesses his experience and gets to know his body again. The following season, he celebrates his comeback and wins. 11

THE HIGHEST STANDARDS FOR EVERYONE “A cruciate ligament rupture isn’t like a leg fracture,” says Dressen. Anyone finding themselves at Medical Park for rehabilitation can share this optimism. The hospital team at St. Hubertus in Bad Wiessee gets everyone back on their feet thanks to a tailored treatment programme – young and old, athletes and non-athletes.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

REGAINING FORMER STRENGTH WITH MODERN THERAPY EQUIPMENT Athletes actually know their bodies inside out. But for those rare occasions when they are not sure, high-tech equipment is available whose data leaves no chance of misinterpretation. In the presence of head doctor Nadine Dreyer and sports therapist Klaus Remuta, Dressen gets acquainted with a balance board, which helps to evaluate balance and posture. A silicon chip in the board precisely meas­ ures each movement. The result is transferred to a screen in real time. This is tremendously motivating. The view of the therapist and hard data: these things together provide optimal care.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

GETTING WELL AND FEELING GOOD Without physical exertion, the comeback won’t work. And it won’t work without the right atmosphere. “Getting well and feeling good in idyllic surroundings”: anyone who, like Dressen, ambles across the extensive, park- like area around the St. Hubertus am Tegernsee rehabilitation hospital with head doctor Nadine Dreyer will recognise that there is more behind this than just an advertising slogan. When checking in inside the large lobby with adjoin­ ing cafe, patients become guests of a facility that is comparable to a four-star hotel.

“I DO NOT JUST PRIORITISE ONE KIND OF THERAPY; I FOCUS ON WHAT THE PATIENT NEEDS.”

DR. MED. NADINE DREYER, HEAD OF ORTHOPAEDICS AT BAD WIESSEE ST. HUBERTUS 13

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

“WE ARE NOT CHESS PLAYERS, 14 AFTER ALL. THERE IS A LOT MORE RISK ON THE SLOPES.”

THOMAS DRESSEN

TRAINING LIKE ATHLETES Rope hoist equipment, mats, weights, balls, and the finest hall floor with sports markings and large panoramic windows: the athletic area is a state-of-the-art fitness centre in which people can not only train tendons and muscles, but also regain their former mental strength. Even top athletes like Dressen work up a sweat here. With the help of first-rate equipment, the pros can work towards their training rhythm after going through an operation.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

SENSE OF COMMUNITY The encounters at Medical Park St. Hubertus are something special. When Dressen gets into the downhill position with therapist Klaus Remuta, this doesn’t take place in a closed-off room. Every­ one trains alongside one another here to­ wards their own personal comeback. This community spirit has a motivational effect – especially for those whose injury is not an occupational hazard.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

NEW PHYSICAL AWARENESS What a view. From his balcony, Thomas Dressen has a view of Lake Tegernsee. Behind it, the Alps rise – his ancestral home. The optimism visible on Dressen’s face shows that the therapy is going to plan. More than that. Dressen has got to know his body again during his stay at Medical Park St. Hubertus. He suspects that this knowledge makes him stronger.

“THE REAL-TIME BIO- FEEDBACK MOTIVATES ATHLETES AND NORMAL PATIENTS IN EQUAL MEASURE.”

KLAUS REMUTA, SPORTS THERAPIST

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

BACK ON HIS FEET

“He’s already a wild dog,” skiing legend Markus Was- meier said into the microphone after upcoming skiing star Thomas Dressen had won the Kandahar run. That was in early February 2019, slightly more than a year after his cruciate ligament operation. Just think about that: the skiing ace seriously injured himself at 25PERCENT the start of the 2018/19 season and needed operations on his cruciate ligament and shoulder. Season over! IMPROVEMENT A year later, he finishes first in Lake Louise, Canada, IN WALKING SPEED. followed by additional victories, such as Garmisch- Partenkirchen and Saalbach. What a comeback! Well, people who knew him could say that it was on the cards. Who – if not Dressen – would be up to that kind of performance? The Medical Park rehabilitation A few months later, in March 2019. The heavy winter hospital team are part of this inner circle. Because one is drawing to a comfortable close as his teammates of the most decisive phases in the DSV star’s incred­ compete in the final races. The first German Streif ible success story did not play out in the rugged moun- winner in 39 years is sitting contentedly in the à la tains, but in the lovely Tegernsee valley as a guest at carte restaurant of the specialist rehabilitation hos­ the St. Hubertus facility. pital for orthopaedics, traumatology and sports med- icine in Bad Wiessee. “Thanks, I’m doing really well.” The fact that Dressen, the most successful downhill That kind of crash and injury set you back, of course, ski racer to date from the ranks of the German Ski but you have to make the best of the situation. That is Association (DSV), ultimately established himself at Dressen. Always straightforward, no airs and graces – the pinnacle of the world’s ski mountaineers is not decisive and focused on his next objective. 17 just thanks to his strength and dynamism, which, with his 1.9-metre frame combined with skis, make Following his knee operation in Munich, Dressen ar- him a force of nature. It is also far more than just his rived at the St. Hubertus facility for the first time at inimitable blend of an easy-going attitude and dare- the start of 2019. Three weeks of rehabilitation in devilry, which all but obliges success on occasion if January ensured he had already made so much pro- the piste is especially icy and the competition gets gress that he was at least able to travel to be a spectator within a hair’s breadth of him. What counts is the and guest of honour at Kitzbühel for the Hahnen- sense of completeness – total immersion in the ex- kamm race – for that notorious race that he won sen- treme situation with every fibre of your body. It is a sationally a year before. Shortly after came the oper­ particular form of foresight that not everyone has and ation on his shoulder and the second stay at Tegernsee that often requires a painful transformation to achieve. for more intensive knee training on the one hand, and the start of rehabilitation on his shoulder on the other. But first things first: on 30 November 2018, Dressen Overall, the knee was the more seriously injured of crashes heavily on his descent at Beaver Creek, USA; the two. The cartilage damage to his shoulder added his anterior cruciate ligament in his right knee the final touch to the whole miserable business. ruptures and he injures his shoulder. At more than 100 km/h, his skis twist and he barrels erratically into The snow, glistening in the spring sunshine, shines the safety fence. The TV cameras caught his cries of through the panoramic window and into the restaur­ agony, which were then broadcast live around the ant. But he doesn’t want to talk about his crash any world. more. A baptism of fire. Check. “We’re not chess play- ers, after all. There’s a lot more risk on the slopes. I don’t think there’s anyone among the world’s elite that hasn’t had a cruciate injury – especially in down- hill.” Office workers have back complaints. Ski champions have cruciate ligament injuries. And then some. Sometimes it is almost a miracle that down- hill aces like Beat Feuz of Switzerland or Norwegian overall-World-Cup-winner Aleksander Aamodt Kilde currently manage to walk straight at all, let alone

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

barrel down the mountains on skis. The strain on the NASA ORIGINALLY knees is huge. With each swing, the joint has to en- DEVELOPED THE dure 2,000 newtons – equivalent to around 200 kilos. This calculation applies to a speed of 60 km/h. For ANTIGRAVITY TREAD­ pros, this is like driving in first gear. MILLS TO PRE-

This poses the question of how athletes’ knees can PARE ASTRONAUTS. withstand this kind of strain over many years. And how athletes like Feuz, Kilde – or even Dressen – can come back from cruciate ligament ruptures even WEIGHTLESS stronger. The answer is certainly multifaceted. A visit to Klaus Remuta offers a significant clue. He has been a sports therapist at the St. Hubertus facility for 30 years. And his domain is the floor beneath the restaurant, cafe INDIVIDUAL and sun terrace with a view of the lake and moun- RESPONSIBILITY tains. The bright, spacious areas with sports mark- ings on the floor and state-of-the-art training equip- ment everywhere evoke a mixture of five-star spa and trendy gym rather than the hardship of getting back to your feet. In the medical training therapy area, convalescents sit up to their waists in hyperbaric chambers, so-called antigravity treadmills. Thanks to the reduction in their own body weight, patients are able to train considerably sooner following sur- gery – weightlessly back to life or onto skis, as in 18 Dressen’s case.

NASA originally developed the treadmills to prepare the astronauts. Sensors and cameras also record every PROF. DR. MED. movement. With expert guidance, the performance THOMAS HORSTMANN of the walking device is analysed on a screen. Live and HEAD OF ORTHOPAEDICS in colour, the “rehabilitation astronauts” can marvel AT BAD WIESSEE ST. HUBERTUS at their progress. “The real-time biofeedback mo­tiv­ “By seeing our patients as independent ates athletes and normal patients in equal measure,” and autonomous partners, we says Remuta. Another device, the walk-per-view support their individual responsibility treadmill, should motivate even the biggest jogging- and the sustainability of therapy. phobe to move more. Users can program running And we continue to learn ourselves.” tracks in idyllic countryside via another large screen. The balance board also works with visual support and uses sensors to record even the slightest shoulder, upper-body and leg movements. Improper stress is therefore prevented – getting well as an interactive, playful exercise. The effect of dispersing negative thoughts when overcoming injury is one thing. The data provided by the high-tech devices is another. “Data doesn’t lie,” says Remuta. It facilitates targeted therapy, carefully adapted to the needs to the patient. But “the people here aren’t doing this for fun – just finding a piece of equipment and getting cracking,”

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

explains the therapist. “Every patient in our facility on holistic physical awareness rather than purely on receives a personalised training programme begin- condition. At first, that sounds like a more relaxed ning with physiotherapy and continuing with inde- way to engage in sporting activities. But this is not pendent training.” Under the supervision of Remuta the case. “Some of Klaus’s exercises look simple, but and his colleagues, nothing is left to chance. Dressen it’s brutally tough to muster up a second one. In one also benefited from this friendly, meticulous care that exercise, you lie with your back on a roll, stretch a leg focuses on the people themselves. into the air and then do sit-ups.”

“With Thomas, we are right on track,” says sports WOMAN POWER therapist Remuta. The decisive factor – regardless of whether the patient is an athlete or not – is to agree an It goes without saying that Dressen managed to “mus- objective and to achieve it. And Remuta has got them ter up” more than one. Whether in exercise, down- all back into shape, sports stars like Katja Seizinger hill or everyday life, Dressen won’t accept failure if and Georg Hackl, as well as people for whom it was he hasn’t tried everything. At the same time, he has just about being able to climb the stairs or hold their an infectiously casual, optimistic air. “This natural, children. Remuta is a body whisperer. He can feel in- easy-going attitude on the one hand and, on the other, side his patients like no other. It is almost as if he unbelievable discipline – this huge demand he places is able to speak to the injured bones, muscles and on himself. It’s an interesting combination,” says head tendons. doctor Nadine Dreyer. You can see that this is a meet- ing of two kindred spirits. Dressen and Dreyer. They This ability even impresses professional athletes like aren’t just alike in name. They also share their qual­ Dressen, whose day-to-day work, alongside compe­ ities and love of skiing. She is to all intents and pur­ titions, exclusively aims to strengthen the body. poses a northerner, born in Essen, but she would go “Something I will definitely take away with me is to the mountains each winter with her parents as a Klaus’s training approach.” Above all, this means more child. “Whether deep snow, mogul slopes or ice, I exercises that develop coordination and for which always get down.” And then there is the not inconsid- 19 there is otherwise hardly any space in the tightly erable assertiveness that has seen Dreyer work her packed training schedule, explains Dressen. A focus way to the top in a man’s world. “I grew up with ortho- paedists. In my first rehabilitation hospital, I was greeted by the senior doctor with ‘Morning, men’.” Dreyer laughs as she recounts her first few years fol- lowing her studies. The 49-year-old takes it in good humour. This and her ambition have taken her a long way. She is currently the only head doctor in the com- pany. She has been at Medical Park for eleven years. She has shared medical management of the hospital on Lake Tegernsee with her colleague Dr. Thomas 400GAIT TRAINERS Horstmann since 2017. ARE USED FOR OUR PATIENTS’ THERAPY.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

DREYER IS A team has had in the 2018/19 season and gives Dreyer DOCTOR WHO MOTIV­ reason for reflection. “But we’ve been able to prove ourselves and get fully on board the new partnership ATES PATIENTS. with DSV.” SHE REMAINS CURIOUS AND KNOWS After a four-year flirt with another rehabilitation hos- pital, DSV returned to Medical Park at the start of WHAT SHE WANTS. 2018. One of the reasons for this is “our integrated approach”, Dreyer believes. At Medical Park, the pa- tient takes centre stage. “If an athlete wants a second “I am an orthodox medical practitioner, 100 percent, opinion, they are more than welcome to get one. We but I also like to look at what alternative practition- will support them,” explains the head doctor, who ers are doing. I don’t just prioritise one approach; has no time for the cult of personality surrounding I look at what the patient needs.” Dreyer’s credo also doctors. Time and again there are headlines about describes what the St. Hubertus facility represents: the professional sport, the football community in par­ close intermeshing of classical and new orthopaedic ticular, if their clubs and advisors are at loggerheads practices with the courage to take a broader view. due to the treatment of their protégés. In the end, Sports rehabilitation is the facility’s calling card. This according to Dreyer, it all comes down to the patient, is of course down to expertise, but also the empathy how they feel physically and the joint decision con- and hospitality shown to patients. cerning when they can climb stairs again or get back on their skis. INTEGRATED APPROACH “This means I also don’t have to start lighting candles Sometimes a person’s ringtone on their mobile phone if Tom is back at square one right after his in­jury.” can tell you more than a thousand words ever could. We know what we can do and when we can get him When Dreyer gets a call, the Pippi Longstocking song back on his skis,” says Dreyer, confidently. Dressen’s 20 plays. Dreyer is a doctor who motivates with her posi­ performances a year later show that she is right. tive manner, who has remained curious and who knows what she wants. But she is one thing above all else: she is almost always available to her patients when they need her. When her mobile phone rings, it is most likely a winter athlete on the other end. “I now have almost everyone from the DSV team in my contacts. We’re on first-name terms.” It shows a great deal of trust in her on the one hand. On the other, it also speaks of the extraordinary bad luck the DSV

MEDICAL PARK QUALITY REPORT 2020 TRAINING LIKE PROS THERAPY CENTRE BORUSSIA MÖNCHENGLADBACH 22

“If I injure myself, my goal is always to come back sia’s players: the equipment, the physiotherapists – stronger,” says Salim Jahan Bakhsh. This time, how­ and the great atmosphere.” An attractive bonus, ac- ever, it is a real challenge for the ambitious amateur cording to Bakhsh, is constantly running into one of handball player. The 31-year-old was caught out badly the pros. During his rehabilitation, he even got to as he sped off midway through the game: he ruptured know Borussia U23 player Florian Mayer, who was his right hamstring. After the operation to stitch the working on a cruciate ligament rupture and trained tendon, he couldn’t walk for a long time. And when with him from time to time. In the STT area, for ex- rehabilitation started at Medical Park Mönchenglad- ample: on this artificial turf area with various mark- bach, he knew one thing for sure: “If I can’t do this ings hang slings for so-called sling training. But you here, I can’t do it anywhere.” can find this in other well-equipped gyms, too.

It will be immediately apparent to anyone entering the You’ll be searching for a long time, however, to find therapy and training centre in top-flight Borussia another piece of equipment like the Senso Pro: this Mönchengladbach’s sports complex, which opened in high-end device developed in Switzerland is used 2019, that this isn’t your usual gym. There is some for neuroathletics. The person doing the training really high-tech equipment in the huge, brightly lit stands on two independently swinging elastic bands area with a view of the footballers’ training complex. and moves lateral rubber bands with their hands. The whole floor of the new building alongside the They are thus able to train coordination under load stadium, totalling 1,400 square metres, is dedicated for a golf swing or handball throw, for example. Sta­ to one purpose: getting people fit. And that doesn’t bility can only be achieved during the exercises with just mean Borussia’s pros and rising stars, although good body tension – without the whole thing turn- you could be forgiven for thinking that in view of the ing into a shaky balancing act. You quickly learn, set-up. But anyone who wants to stay in shape or get therefore, how important a stable trunk is as the basis fit again. “I’m actually just a normal patient on statu- for each training element. You can follow your move- tory health insurance,” says Bakhsh. “In spite of this, ments precisely on a monitor. I can benefit from the same possibilities here as Borus-

MEDICAL PARK QUALITY REPORT 2020 THERAPY CENTRE BORUSSIA MÖNCHENGLADBACH

The body movements can be assessed on the Walker View, a treadmill with integrated gait analysis. The Walker View scans the body with a 3D camera, iden- tifies articulation points, measures stride length and contact times, arm swing, knee and hip angle, upper- body presentation, and shift in the centre of gravity. Using an avatar on a screen, the device shows where there is room for improvement in order to get back to the ideal gait. “Using the avatar, I can show the patient very easily: here you’re extending too much, and your leg is making a compensation movement there,” explains Carsten Leicher, the centre’s man­ ager and physiotherapist. These kinds of incorrect PROF. ( DHFPG) DR. MED. load can then be corrected very easily. In par­ticular, THOMAS WESSINGHAGE all data can be saved to a memory stick and the MEDICAL DIRECTOR, HEAD OF patient can understand their progress from session ORTHOPAEDICS, REHABILITATION to session. MEDICINE, SPORTS MEDICINE “Our sports and rehabilitation If they have regained their ideal motion pattern, centre at Borussia-Park offers an overall 6,000 to 10,000 repetitions are needed to automate package that is unique in the area: this so they no longer need to concentrate on it, says the latest training options, professional Leicher. As a best-case scenario, though, you never supervision, plenty of experience lose the ideal gait in the first place. You should there- with patients and athletes, and, of course, fore begin with functional loading as early as pos­ a special ambience. Here, you can get sible following an injury – practise the right walking a taste of the atmosphere in the big world movement. But how can this be achieved without of sports. And you are almost part of pain and without straining the injured body part?

the Borussia family, too.” 23

The movable footplates in the ProkinSystem measure how the rehabilitation patient loads their feet. A video game can be controlled using the plate – such as a ball maze or slalom skiing – which then trains foot coordination.

Straight from training NASA astronauts: in the Alter-G, the patient is supported by air pressure and thus essentially weighs less. Walking exercises can therefore be started early with partial loads.

MEDICAL PARK QUALITY REPORT 2020 THERAPY CENTRE BORUSSIA MÖNCHENGLADBACH

In a break from training, Carsten Leicher ex­ plains to Salim Jahan Bakhsh the next steps in his rehabilitation. The pair have withdrawn to the Borussia-Park stands – the stadium is right next to the rehabili­tation centre. 24

It is as if the Alter-G was made for this, a device that is still rare in Germany but that is already used at three Medical Park locations. Salim Jahan Bakhsh uses the treadmill developed by NASA regularly: he puts on a pair of neoprene trousers that are con- nected to the upper cover of a compressed-air cham- ber via a zip. Bakhsh is positioned hips-down within this compressed-air chamber and is supported with increased air pressure. “We can thereby reduce the weight of the person inside by up to 90 percent,” says Carsten Leicher. “It’s almost like he’s walking on the “In the event of a tendon rupture, the sensory system moon.” And because the walls of the chamber are is initially disrupted. Reflexes have to be re-estab- transparent and cameras record the walk from all lished as early as possible and show the new fibres sides, this can also be precisely monitored on a screen how they should grow by performing the correct mo- and corrected where necessary. tion sequences.”

“Here I have equipment that you hardly find any- Just another few weeks and Salim Jahan Bakhsh can where else and that shows me exactly how things return to team training. If all goes to plan, he’ll not are going. Some are really good fun because they are just be his old self again, but even better than before connected to video games,” says Bakhsh, who regular- physically. This is the aim at Medical Park Mönchen­ ly gets onto the leader board on the Prokin-System, gladbach. The therapy should not only treat the in­ for example, when training the coordination of his jury, but the person as a whole – their entire physique feet, legs and body posture while playing a skiing or should be strengthened. ball maze game. “These kinds of exercises are very im- portant for neuromuscular linking of the feet, tendons, ligaments and muscles with the brain,” says Leicher.

MEDICAL PARK QUALITY REPORT 2020 VALUABLE SELF-ASSESSMENT

PROF. DR. MED. KARSTEN DREINHÖFER HEAD OF ORTHOPAEDICS AT BERLIN HUMBOLDTMÜHLE

“Each patient combines individual goals with their rehabilitation. We provide professional support on the way to achieving those goals. From our perspective, 25 it is important how the patients them- selves assess the success of rehabilitation. Alongside ‘hard’ figures, data and facts, we also incorporate self-assessment into our quality measurement.”

ORTHOPAEDIC LOCATIONS Medical Park offers orthopaedic rehabilitation at nine locations.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

HIP REPLACEMENT AFTER OSTEOARTHROSIS

5,500 PATIENTS A YEAR DECIDE TO UNDERGO REHABILITATION TREATMENT AT ONE OF OUR REHABILI­ TATION HOSPITALS FOLLOWING HIP SURGERY.

PATIENTS WITH HIP REPLACEMENTS AFTER TEN-METRE WALKING TEST OSTEOARTHROSIS IN 2019 Upon admission Upon discharge

Bad Wiessee 15.3 Bad Wiessee St. Hubertus 637 St. Hubertus 11.1 Bad Wiessee am Kirschbaumhügel Bad Wiessee 17.5 Spec. Clinic 12.7 Specialist Rehabilitation Hospital 190 Bad Wiessee 16.8 Bad Wiessee am Kirschbaumhügel Private Clinic 12.4 Private Rehabilitation Hospital 166 14.7 Chiemsee 10.8

Chiemsee 1,049 Prien 15.8 Kronprinz 12.2 Prien Kronprinz 673 Bad Rodach 14.8 Bad Rodach 643 11.5 Berlin Hum­ 15.3 Berlin Humboldtmühle 1,033 boldtmühle 12.0 Bad Feilnbach Reithofpark 406 Bad Feilnbach 16.0 Reithofpark 13.0 Bad Sassendorf * 691 In seconds 5 10 15 20 26 * At the Bad Sassendorf rehabilitation hospital, the collection In this test, the time a patient takes to walk ten metres of data only began in 2019. is measured in seconds. Patients improve by an average of 3.8 seconds – in other words, their walking speed increases by 25 percent.

PAIN SCALE Upon admission Upon discharge

Bad Wiessee 3.2 St. Hubertus 1.7

Bad Wiessee 3.5 Spec. Clinic 1.7

Bad Wiessee 3.1 Private Clinic 1.4 3.2 Chiemsee 1.2

Prien 3.8 Kronprinz 1.5 DR. MED. HANS-JÜRGEN MEES 3.9 HEAD OF ORTHOPAEDICS AT BAD RODACH Bad Rodach 1.4

Berlin Hum­ 3.3 boldtmühle 1.4 “Pains and reduced mobility impair a person’s Bad Feilnbach 4.1 quality of life considerably. The aim of our Reithofpark 1.8 rehabilitative measures is therefore always a tangible 0 1 2 3 4 5 reduction in pain, a strengthening of the muscles A hip operation is usually accompanied by post-operative pain. and an improvement in mobility. This helps to prevent We can relieve our patients of much of it: on a scale of 0 to 10, later complications, too. The result of this approach they rate the intensity at an average of 1.5 points by the time they leave us. That means only a light pain. is a gain in quality of life.”

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

EQ-5D INDEX STAIR CLIMBING Upon admission Upon discharge After six months Upon admission Upon discharge

62.3 Bad Wiessee 1.1 Bad Wiessee 77.5 St. Hubertus 2.7 St. Hubertus 88.1 Bad Wiessee 1.0 61.0 Spec. Clinic 2.3 Bad Wiessee 74.8 Spec. Clinic 79.6 Bad Wiessee 1.1 Private Clinic 2.8 Bad Wiessee 62.1 81.5 1.0 Private Clinic 84.3 Chiemsee 2.1

60.1 Prien 1.0 Chiemsee 77.5 Kronprinz 2.2 82.9 1.2 60.9 Bad Rodach 2.6 Prien 76.3 Kronprinz 84.6 Berlin Hum­ 1.1 boldtmühle 2.8 59.8 Bad Rodach 80.1 Bad Feilnbach 1.0 79.4 Reithofpark 1.8

63.8 0 1 2 3 27 Berlin Hum­ 77.0 boldtmühle 82.1 Climbing stairs gets easier: patients achieve an average of 2.4 on 60.3 a five-point scale. Upon discharge, patients can climb the stairs Bad Feilnbach 79.9 Reithofpark 79.4 bringing one foot to meet the other without using the handrail, or bringing one foot past the other with the support of the handrail. 57.5 Bad 71.6 Sassendorf *

40 50 60 70 80 90

Quality of life is measured using five factors such as independence STAIR CLIMBING or leisure activities – not just on discharge, but six months later, too. The process is very satisfying; the values remain stable or even improve. On average, patients achieve 83 points; this corresponds to a distinctly The ability to measure stair climbing is a high quality of life. simple but reliable evaluation of therapeutic progress following the implantation of an artificial hip. A patient’s ability to walk is PAIN SCALE assessed by a therapist on a scale of 1 to 5. A score of 0 means that the patient cannot climb any steps. 1 means that s/he can move The patient puts a cross on a up the levels by bringing one foot to meet scale of how severe they currently the other and with his/her hand on the hand- perceive the pain to be, visually rail. At 2, climbing is possible without presented on a continuum or with the the handrail. 3 represents climbing by mov- aid of numerical levels. If the data ing the lower foot up and past the standing foot using the handrail. A 4 is for climbing by are collected at the beginning and end moving the lower foot up and past the stand- of the rehabilitation, a conclusion ing foot without support. can be drawn regarding the success of treatment – regardless of the fact that pain perception can be very sub- jective.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

KNEE REPLACEMENT AFTER OSTEOARTHROSIS

WE ARE CONTINUALLY EXTENDING OUR OFFER IN THE AREA OF PREVENTION AND REHABILITATION TREATMENT.

PATIENTS WITH KNEE REPLACEMENT AFTER EQ-5D INDEX OSTEOARTHROSIS IN 2019 Upon admission Upon discharge After six months

59.5 Bad Wiessee St. Hubertus 515 Bad Wiessee 75.6 St. Hubertus 82.1 Bad Wiessee am Kirschbaumhügel 60.7 Specialist Rehabilitation Hospital 226 Bad Wiessee 73.7 Spec. Clinic 72.5 Bad Wiessee am Kirschbaumhügel 61.2 Private Rehabilitation Hospital 134 Bad Wiessee 77.0 Private Clinic 89.4 Chiemsee 970 59.3 Chiemsee 72.6 Prien Kronprinz 707 77.8 59.7 Bad Rodach 656 Prien 73.1 Kronprinz 81.2 Berlin Humboldtmühle 778 60.5 Bad Rodach 75.9 Bad Feilnbach Reithofpark 353 74.8 Bad Sassendorf * 629 62.5 Berlin Hum­ 73.6 28 boldtmühle 76.1 * At the Bad Sassendorf rehabilitation hospital, the collection of data only began in 2019. 59.4 Bad Feilnbach 76.3 Reithofpark 74.1 58.6 Bad 68.1 Sassendorf *

40 50 60 70 80 90 TEN-METRE WALKING TEST Upon admission Upon discharge Five conclusions are drawn regarding quality of life, including mobility, leisure activities and pain. Measurements are taken three times. The process is gratifying, even six months after discharge: the values remain Bad Wiessee 16.4 largely stable or even improve. On average, patients achieve 78.5 points – St. Hubertus 11.5 a good quality of life. Bad Wiessee 17.7 Spec. Clinic 13.3

Bad Wiessee 18.1 Private Clinic 13.4 15.1 Chiemsee 11.1

Prien 16.3 Kronprinz 12.5 14.7 Bad Rodach 11.4 80 PERCENT Berlin Hum­ 15.5 boldtmühle 12.0

Bad Feilnbach 16.8 Reithofpark 13.2 of our patients do not In seconds 5 10 15 20 need any painkillers upon Mobility progress can be assessed effectively by measuring walking times over short distances. How long does it take our patients to discharge or reduce walk 10 metres? By the end of treatment they are an average of 4 seconds faster than when they arrived at the beginning of their time at our their intake of painkillers Medical Park rehabilitation hospitals. considerably.*

*Average figure at Medical Park.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

PAIN SCALE Upon admission Upon discharge

Bad Wiessee 4.4 St. Hubertus 2.6

Bad Wiessee 4.3 Spec. Clinic 2.4

Bad Wiessee 4.5 Private Clinic 2.3 4.3 Chiemsee 2.1 TEN-METRE WALKING TEST Prien 4.7 Kronprinz 2.1 4.6 The walking test is an inexpensive but very Bad Rodach 2.0 effective method of measuring the healing process Berlin Hum­ 4.2 following a knee joint operation (and following boldtmühle 2.0 the implantation of an artificial hip) – all you need is Bad Feilnbach 5.0 a stopwatch. Patients are asked to walk a measured Reithofpark 2.4 distance of ten metres on level ground and are timed. 0 1 2 3 4 5 6 29

The result gives you a walking speed, and average It is important to us that post-operative pain is alleviated as quickly figures from healthy people – usually between 6.8 and as possible. And our surveys show that: pain scale ratings 8.2 seconds – enable comparisons. drop by an average of around 2.3 points from admission to discharge. Pain levels therefore almost halve.

STAIR CLIMBING Upon admission Upon discharge

Bad Wiessee 1.0 St. Hubertus 2.4

Bad Wiessee 1.0 Spec. Clinic 2.1

Bad Wiessee 0.9 Private Clinic 2.5 0.9 Chiemsee 1.9

Prien 1.0 DR. MED. KLAUS RAINER FUCHS Kronprinz 1.9

HEAD OF ORTHOPAEDICS Bad Rodach 1.1 AT BAD FEILNBACH REITHOFPARK 2.2 Berlin Hum­ 1.0 boldtmühle 2.6 “Figures, test results and measurements are Bad Feilnbach 1.0 Reithofpark 1.7 important. But they should not get in the way of our 0 1 2 3 perception of the people themselves. They help us doctors to compare ourselves and find improvement Climbing stairs gets easier again: no hands, bringing one foot to meet the other – this is what an average score of 2.2 on the five-point potential. But the patient is always the focus of scale means for our patients on discharge. On admission, they still our work.” needed to support themselves using the handrail when bringing one foot to meet the other.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

CHANGE OF PROSTHESIS FOR HIPS AND KNEES

OUR REHABILITATION HOSPITALS ARE REGULARLY SELECTED AS BEING AMONG THE BEST REHABILITATION HOSPITALS IN GERMANY.

PATIENTS FOLLOWING A CHANGE OF PROSTHESIS FOR HIPS AND KNEES IN 2019

Bad Wiessee St. Hubertus 59 Bad Wiessee am Kirschbaumhügel Specialist Rehabilitation Hospital * Bad Wiessee am Kirschbaumhügel Private Rehabilitation Hospital * Chiemsee 70 DR. MED. HASSO BALASCH Prien Kronprinz 22 HEAD OF ORTHOPAEDICS Bad Rodach 192 AT PRIEN KRONPRINZ Berlin Humboldtmühle 115 Bad Feilnbach Reithofpark 72 “Handling mistakes correctly is important. Because it is only if I can learn from my own mistakes and Bad Sassendorf ** those of others that I can avoid things not going to plan 30 * The number of measurements required for a statistically in future. But this requires an open approach. meaningful survey was not achieved. For us doctors, evaluation and discussion of mistakes is

**At the Bad Sassendorf rehabilitation hospital, the collection now an essential component of quality assurance.” of data only began in 2019.

EQ-5D INDEX Upon admission Upon discharge After six months STAIR CLIMBING Upon admission Upon discharge 59.7 Bad Wiessee 70.8 St. Hubertus 67.9 Bad Wiessee 1.0 St. Hubertus 2.4 56.2 Chiemsee 69.3 1.0 72.1 Chiemsee 1.8 60.2 Prien 73.3 Prien 1.3 Kronprinz 64.0 Kronprinz 2.1 1.4 59.5 Bad Rodach Bad Rodach 75.7 2.6 74.2 Berlin Hum­ 1.0 56.6 boldtmühle 2.3 Berlin Hum­ 70.3 boldtmühle 71.2 Bad Feilnbach 0.9 Reithofpark 1.6 Bad Feilnbach 60.3 0 1 2 3 73.0 Reithofpark 79.6

40 50 60 70 80 90 Stairs are everyday hurdles. So it is great that climbing them gets easier very quickly: no hands, bringing one foot to meet the other – this is what Quality of life is evaluated using the EQ-5D questionnaire – the higher an average score of 2.1 on the five-point scale means for our patients. the value, the better. On average, patients increase by 13.3 points before On admission, they still needed to support themselves using the handrail. discharge. Because changing a prosthesis is longer and more difficult than first using it, the results after six months are very good compared to the low discharge values.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

TEN-METRE WALKING TEST Upon admission Upon discharge

Bad Wiessee 17.2 St. Hubertus 12.7 14.6 Chiemsee 10.6

Prien 16.2 Kronprinz 11.5 13.4 Bad Rodach 10.5

Berlin Hum­ 16.1 boldtmühle 12.6

Bad Feilnbach 16.4 Reithofpark 13.3

In seconds 5 10 15 20

The stopwatch provides details regarding mobility and the associated rehabilitation progress: how long does it take our patients to walk COMMITTED TO SPORT 10 metres? They are on average 3.8 seconds faster than at the start of their stay; in light of the complexity of the change of prosthesis, this is a very 31 good improvement. Sport has always been part of the tradition at Medical Park rehabilitation PAIN SCALE hospitals. Aftercare and reha­bilitation Upon admission Upon discharge of post-operative or injured athletes therefore form part of our core expertise. For years, Bad Wiessee 4.3 St. Hubertus 2.3 renowned elite athletes and Olympians 3.8 Chiemsee 1.6 like Simon Schempp, Claudia Pechstein and

Prien 4.2 Denise Herrmann have trusted in our Kronprinz 1.9 experts’ specialist knowledge and have been 4.2 Bad Rodach 2.0 regular guests at our locations. Numerous

Berlin Hum­ 3.5 associations and clubs make use of our years boldtmühle 1.8 of therapeutic experience and place the Bad Feilnbach 4.2 Reithofpark 1.8 care of their athletes – especially prior to com- 0 1 2 3 4 5 petitions – in our hands. Among other

Relief in post-operative pain should occur as quickly as possible. things, Medical Park is therefore a premium That we are always successful in this is demonstrated with the evaluation rehabilitation partner for Borussia on the pain scale. On average, patients improve by two levels in the period between admission and discharge. Pain levels therefore almost halve. Mönchengladbach and the official rehabili­ tation hospital partner of the German Ski Association.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

TREATMENT AFTER A FEMORAL NECK FRACTURE

WE ARE DELIGHTED THAT OUR PATIENTS ARE SATISFIED: MORE THAN 90 PERCENT RECOMMEND US TO OTHERS.

PATIENTS AFTER TREATMENT FOR A FEMORAL STAIR CLIMBING NECK FRACTURE IN 2019 Upon admission Upon discharge

Bad Wiessee 0.9 Bad Wiessee St. Hubertus 146 St. Hubertus 2.1 Bad Wiessee am Kirschbaumhügel Bad Wiessee 0.9 Spec. Clinic 2.1 Specialist Rehabilitation Hospital 72 Bad Wiessee 0.5 Bad Wiessee am Kirschbaumhügel Private Clinic 2.2 Private Rehabilitation Hospital 83 0.8 Chiemsee 1.7

Chiemsee 175 Prien 0.9 Kronprinz 2.0 Prien Kronprinz 161 Bad Rodach 1.0 Bad Rodach 167 2.0 Berlin Hum­ 0.8 Berlin Humboldtmühle 165 boldtmühle 2.1 Bad Feilnbach Reithofpark 68 Bad Feilnbach 1.0 Reithofpark 2.0 Bad Sassendorf * 50 0 1 2 3 32 Our therapists evaluate a patient’s ability to walk – and give them * At the Bad Sassendorf rehabilitation hospital, the collection an average level of 2.0. On the five-point scale, this means: climbing stairs of data only began in 2019. by bringing one foot to meet the other without support is possible. An improvement – upon admission, the patients were still dependent on the handrail or could not climb stairs.

PAIN SCALE Upon admission Upon discharge

Bad Wiessee 4.0 St. Hubertus 2.2

Bad Wiessee 3.7 Spec. Clinic 2.0

Bad Wiessee 3.6 91PERCENT Private Clinic 1.6 3.4 Chiemsee 1.5

Prien 3.7 of our patients take no Kronprinz 1.5 4.4 painkillers after treatment, Bad Rodach 1.9 Berlin Hum­ 3.5 or only when needed.* boldtmühle 1.7 Bad Feilnbach 4.0 *Average figure at Medical Park. Reithofpark 1.8 0 1 2 3 4 5

We do everything we can to alleviate post-operative pain as quickly as possible. The results of the pain scale confirm we are achieving this. Upon discharge, our patients evaluate their pain at 1.8 points on average. Level 1 corresponds to very low intensity.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

EQ-5D INDEX Upon admission Upon discharge After six months

58.6 Bad Wiessee 71.5 St. Hubertus 73.0 56.4 Bad Wiessee 72.2 Spec. Clinic 73.1 57.3 Bad Wiessee 74.8 Private Clinic 73.7 52.9 PROF. DR. MED. MARCUS SCHMITT-SODY Chiemsee 68.8 70.4 HEAD OF ORTHOPAEDICS AT CHIEMSEE 60.2 Prien 75.5 Kronprinz 69.4 “Aside from transparency, quality measurement 55.4 ensures that we can recognise trends and deviations Bad Rodach 71.8 71.8 and can therefore always realign what we are 58.0 33 Berlin Hum­ 74.3 doing with our highest aim – ensuring the best medical boldtmühle and therapeutic treatment, the best care, and the 73.0 63.9 best service.” Bad Feilnbach 77.0 Reithofpark 77.1 53.4 Bad 66.5 Sassendorf * TEN-METRE WALKING TEST 40 50 60 70 80 90 Upon admission Upon discharge

Quality of life is evaluated using the EQ-5D questionnaire. Back to their Bad Wiessee 18.9 daily routines, not all patients can maintain the high scores they St. Hubertus 13.2 achieved upon discharge. Overall, a high average score of almost 73 points Bad Wiessee 18.0 is achieved after six months, which equates to a good quality of life. Spec. Clinic 13.6

Bad Wiessee 19.8 Private Clinic 15.4 16.0 Chiemsee 11.4 EQ-5D

Prien 17.1 Kronprinz 12.9 The EQ-5D Index is the 16.8 Bad Rodach 13.0 world’s most widely used method Berlin Hum­ 16.6 boldtmühle 12.9 for the measurement of health-

Bad Feilnbach 18.7 related quality of life. Patients are Reithofpark 15.1 asked about five factors, which they In seconds 5 10 15 20 can rate at various levels: mobility, How long does it take our patients to walk 10 metres? They are self-care, work and leisure activities, 4.3 seconds faster on average when leaving our Medical Park rehabilitation hospitals. The simple but effective test proves how quickly pain/physical discomfort and mobility can increase. anxiety/despondence.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

BACK TREATMENT AFTER SPINE OPERATION

WE SEE THE PATIENT AS A WHOLE PERSON WITH THEIR INDIVIDUAL POTENTIAL, WISHES AND FEARS.

PATIENTS WITH BACK TREATMENT AFTER A SPINE OPERATION IN 2019

Bad Wiessee St. Hubertus 247 Bad Wiessee am Kirschbaumhügel Specialist Rehabilitation Hospital 66 Bad Wiessee am Kirschbaumhügel Private Rehabilitation Hospital 94 Chiemsee 365 Prien Kronprinz 319 Bad Rodach 385 Berlin Humboldtmühle 216 Bad Feilnbach Reithofpark 187 ALTER-G Bad Sassendorf *

34 Only as much exertion as possible – this is * At the Bad Sassendorf rehabilitation hospital, the collection of data only began in 2019. the top priority of gait rehabilitation. On the Alter-G treadmill, bodyweight relief of up to 90 percent is possible. The patient climbs into a kind of inflatable

EQ-5D INDEX swimming ring and can relearn how to place Upon admission Upon discharge After six months one foot in front of the other almost weightlessly.

61.9 Bad Wiessee 73.9 St. Hubertus 69.3 PAIN SCALE 59.0 Bad Wiessee 74.2 Upon admission Upon discharge Spec. Clinic 63.3

Bad Wiessee 4.4 Bad Wiessee 63.8 76.5 St. Hubertus 2.9 Private Clinic 66.6 Bad Wiessee 4.9 62.0 Spec. Clinic 2.7 Chiemsee 72.6 69.3 Bad Wiessee 3.5 Private Clinic 1.8 62.9 Prien 74.4 3.9 Kronprinz 71.1 Chiemsee 1.9 63.7 Prien 4.1 Bad Rodach 75.4 Kronprinz 2.1 64.3 4.4 61.9 Bad Rodach 2.2 Berlin Hum­ 71.5 boldtmühle 67.4 Berlin Hum­ 4.2 boldtmühle 2.0 Bad Feilnbach 63.7 72.5 Bad Feilnbach 5.1 Reithofpark 63.9 Reithofpark 3.0

40 50 60 70 80 90 0 1 2 3 4 5 6

The considerable improvements made between admission and Even after at times significant operative interventions on the spine, discharge prove that the therapeutic process following complex surgical the subjective experience of pain is reduced considerably interventions to the spine is optimal. After six months, various over the course of a stay. The figures we have demonstrate a reduction developments can be recognised, but the results continue to be very good of 53 percent. and remain considerably higher than the admission scores.

MEDICAL PARK QUALITY REPORT 2020 ORTHOPAEDICS

CONSERVATIVE BACK TREATMENT

THE WORK WITH TOP ATHLETES BENEFITS ALL OUR PATIENTS.

PATIENTS WITH CONSERVATIVE BACK TREATMENT PAIN SCALE IN 2019 Upon admission Upon discharge

Bad Wiessee 4.7 Bad Wiessee St. Hubertus 306 St. Hubertus 3.4 Bad Wiessee am Kirschbaumhügel Bad Wiessee 5.9 Private Clinic 3.0 Specialist Rehabilitation Hospital * Chiemsee 4.9 Bad Wiessee am Kirschbaumhügel 2.9 Private Rehabilitation Hospital 28 Prien 4.6 Kronprinz 2.3 Chiemsee 257 5.8 Bad Rodach 3.1 Prien Kronprinz 226 Berlin Hum­ 5.0 Bad Rodach 201 boldtmühle 2.9 Bad Feilnbach 5.5 Berlin Humboldtmühle 109 Reithofpark 3.2 Bad Feilnbach Reithofpark 69 0 1 2 3 4 5 6 “Rate your experience of pain from one to ten,” we ask patients Bad Sassendorf ** 35 at the outset and at the end of their stay at our rehabilitation hospitals. On average, the value goes down by two levels and achieves an * The number of measurements required for a statistically end score of 2.9 points – in light of the high admission values in chronic meaningful survey was not achieved. back pain, this is a significant result.

**At the Bad Sassendorf rehabilitation hospital, the collection of data only began in 2019.

EQ-5D INDEX Upon admission Upon discharge After six months

Bad Wiessee 66.3 St. Hubertus 74.4

Bad Wiessee 67.7 Private Clinic 72.0 PETER CHRISTIAN BRÜNING 67.4 Chiemsee 72.9 HEAD OF ORTHOPAEDICS

Prien 69.5 AT BAD SASSENDORF Kronprinz 80.8 64.5 Bad Rodach 71.3 “For us, it isn’t enough to assess re­ Berlin Hum­ 58.0 boldtmühle 67.7 habilitation success on the day of

Bad Feilnbach 70.2 discharge. We also systematically survey Reithofpark 74.9 our patients half a year after rehabili­ 40 50 60 70 80 90 tation. We are convinced that we are only The EQ-5D value reflects health-related quality of life. successful if patients sense a durable On average, patients score 73 points upon discharge. According to the index, this score equates to a good quality of life for and considerable improvement in their patients with long-term back pain. quality of life on a day-to-day basis. During the follow-up, the number of measurements required for If this happens, we have done well.” a statistically meaningful survey was not achieved.

MEDICAL PARK QUALITY REPORT 2020 IN THE COUNTRYSIDE A walk through the green grounds of Medical Park Bad Camberg – after a long history of illness and nine months lying in bed, Werner Block never thought he would be able to tackle this undertaking. But the five-month rehabilitation is now paying off: hand in hand with physiotherapist Linda Rücker, the 85-year-old is able to take firmer steps each day. NEUROLOGY

“THE FACT THAT I DID NOT SKIP A SINGLE THERAPY SESSION PAID OFF – AND THIS WILL CONTINUE AT HOME.”

Werner Block required intensive care for half 37 a year and was bedridden for months. The 85-year-old was already receiving care – and then fought to get his life back: he worked at Medical Park Bad Camberg for five months with his therapists to relearn how to swallow, eat and walk. He can now go home.

RELEARNING EVERYDAY LIFE Werner Block not only lost his voice due to a disease of the per­ ipheral nervous system, but also basic motor functions. At Medical Park Bad Camberg, he there­ fore had to relearn a great many elements of day-to-day life from scratch – for example, shopping independently. And providing support is ergotherapist Anna Feyder.

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

HAULING YOURSELF BACK TO LIFE The aim of rehabilitation is to facilitate an inde­ pendent life for patients. This includes abilities such as washing and dressing themselves. Tying a bow is a particular challenge here – it requires gross and fine motor skills, and even the body is required. Werner Block had to continue to mo­ tivate himself for the effort involved. His therapeut­ ic success helped him here.

A REAL STEP FORWARDS Werner Block spent the first few weeks at Medical Park in intensive care and the prospects for a return to a normal life were not especially high. But during rehabilitation, he succeeded in strengthening his muscles with holistic body training such that he progressed faster than expected.

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

INTENSIVE DIALOGUE Head doctor Panagiotis Kostopoulos took a lot of time during the five months of rehabilitation to talk to Werner Block and his wife Barbara Hütter. His close relationship with her provided constant motivation not to give up and to try anything that would lead to rehabilitation success.

“THE LONGER INTENSIVE CARE LASTS, THE GREATER THE DANGER OF COMPLICATIONS.”

PANAGIOTIS KOSTOPOULOS HEAD OF NEUROLOGY AT BAD CAMBERG

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

FUN WITH ARM REHABILITATION In ergotherapy for arm and hand rehabilitation, Medical Park uses modern hard- and software to support patients in regaining important arm and hand functions. Werner Block’s arm is linked to soft­ ware via a sensor. This software gives him tasks to complete with his arm in a playful way. He is reward­ ed with stars – three stars mean: complete success. Objective achieved. 40

SWALLOWING HAS TO BE LEARNT Werner Block lost his ability to speak and swallow be­ cause of the artificial ventila­ tion he required for a long time. This was an effect of the illness that he found to be a particular burden. Speech therapist Christina Geis supports patients in drinking safely and using their voice powerfully – for Werner Block, this is a tremendously grat­i­ fying feeling.

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

GAIT THERAPY WITH STATE-OF-THE-ART TECHNOLOGY From the treadmill to the robotic gait trainer – at Medical Park, it is clear how highly modern technology can help to support patients individually by means of various setting options. In addition, “USING THE GAIT TRAINER, the equipment provides the therapists with valuable data on the progress of WE CAN WORK ON WALK- the respective patient. ING AND STAIR CLIMBING WITH PATIENTS CON­ SIDERABLY EARLIER AND COMPLETELY SECURELY.”

LINDA RÜCKER, PHYSIOTHERAPIST

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

“FOR EVERYONE IN THE THERAPY TEAM, IT IS IMPORTANT TO FIND OUT WHAT DISTINGUISHES EACH OF OUR PATIENTS.”

RAMONA BLUME, THERAPY MANAGER AT BAD CAMBERG

WATCH OUT FOR TRAFFIC On the ADL course – the abbreviation stands for 42 “Activities of Daily Living” – Medical Park patients relearn important aspects of daily life. This includes crossing the road safely at a pedestrian crossing: Werner Block is still supported by physiotherapist Linda Rücker; after his rehabilitation, he will be doing this walk alone.

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

AN EMERGENCY THAT BECAME THE START OF A STROKE OF LUCK THERAPY IS THE FIRST During the visit to his room, Werner Block gets out DAY WERNER BLOCK of his chair. His legs are a little shaky, but his face CAN REMEMBER AFTER beams confidence. Smiling, the former professional soldier (85) greets the head doctor and therapy man­ EIGHT MONTHS OF ager and briefly chats about the weather. Werner Block DARKNESS. then looks out of his window across the grounds of Medical Park Bad Camberg. “Where has my wife got to?” Barbara Hütter has driven from Wiesbaden to Werner Block arrived in intensive care, was ventilated the Taunus region. “It usually takes half an hour to with a tube through his nose and was therefore placed drive,” explains her husband, “but on a weekday first in an artificial coma. It was then one thing after an- thing, the journey takes a bit longer.” Five minutes other: Werner Block suffered two bouts of pneumonia later, she arrives in the room, fresh and full of energy. and a thrombosis, and was infected by a hospital “There you are at last,” he says. “Better late than never,” pathogen. After six weeks, the patient was relocated she retorts. Barbara Hütter looks at her husband to a specialist ENT clinic, where doctors performed and asks: “Do you want to keep the polo shirt on?” He a tracheotomy in order to ventilate him with a can­ replies: “If you haven’t brought me a different one, nula from that point on. The doctors then carefully then yes.” An amusing back and forth begins. You brought him out of his artificial coma, “but that did can feel how they both enjoy this little game. A few not come as a relief,” recalls Barbara Hütter, “because minutes later, when Werner Block, now dressed in a he was very confused”. The initial rehabilitation ther­ new polo shirt, sets off to physiotherapy, he says, apy delivered only small improvements. The patient quietly: “The fact I can talk to my wife again and that himself has no recollection of this time: “It’s all gone,” I’m almost able to go home is basically unfathomable.” he says, drily. Werner Block was already receiving care, And this time, it is Werner Block’s voice that gets a then came complications when changing the cannula. 43 little shaky. An emergency intervention was required, and this turned out to be a stroke of luck: the doctors went Patient Block’s medical records are full of almost un­ over the case again and, together with Barbara Hütter, believable developments. It began a year before. Werner they decided to try rehabilitation at Medical Park Block had just returned from a trip to China. He went Bad Camberg. there without his wife; Barbara Hütter had felt that the trip would be too strenuous for her. He liked China, REGAINING no question. “But my wife was right; the trip was ex- THE ABILITY TO TALK hausting.” Back in Wiesbaden, the enthusiastic ama- teur film-maker had another look at his recordings Therapy at the rehabilitation hospital specialising in and then went to bed. His wife stayed up for another neurological diseases began on 1 February 2019. The two hours and went to bed herself at 1 a.m. Her hus- patient knows this precisely, because this is the first band was sound asleep as usual. But this all changed day that Werner Block can consciously remember. over the next few hours. Because of his stressed im- After eight months of darkness. “But I was still some- mune system, he developed an inflammation of the one without a voice then,” he says. The tracheal can- tonsils at the base of the tongue. A healthy person nula prevented him from speaking – but provided would deal with that very well, but Werner Block’s vital protection against saliva getting into his wind- tongue swelled and blocked his throat. He could no pipe and causing another inflammation. Four months longer breathe and there was a risk of suffocation. later, there is hardly any trace of this lack of speech. When Barbara Hütter woke and saw her husband, Werner Block talks clearly and powerfully, his dry she knew straight away: “He’s scared he’s dying; this sense of humour is just as present as the self-assured is an emergency!” tone of a man who has seen a lot of the world. “For me, speaking is being able to participate in life,” he says. “And in all honesty, without my voice, I was questioning the point of life.” Christina Geis is a speech therapist at Medical Park and describes how much of a burden this situation is for patients who

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

can no longer find the words: “They are fully con- Four months later, his time at Bad Camberg is almost scious, perceive everything happening around them, over. He will be in his room for just two more weeks. but are not in a position to use their voice and draw But this time, he won’t be heading to another hospital. attention to themselves verbally.” An almost night- This time, he is going home. After a twelve-month marish situation – all the more so if you consider the tale of woe. The path from intensive-care patient and fact that Werner Block couldn’t remember the past the threat of invalidity to a man on a normal diet who eight months. can stand on his own two feet and is close to discharge was not without effort for Werner Block. “Rehabili­ But what precisely was the illness that caused Werner tation means work.” This is what he has learnt here. Block to suffer for so long? And why is the Medical “I never shied away from it, but it was tough, I’ll admit Park Bad Camberg specialist rehabilitation hospital that.” Linda Rücker accompanied Werner Block’s re- the right place for the patient? Head doctor Panagiotis habilitation as a physiotherapist and remembers that Kostopoulos takes time to provide information on the her patient was not especially resilient – either phys­ therapy. The discussion takes place in the cafeteria; ically or mentally – in the first phase at Medical Kostopoulos continually greets other patients and Park. “The challenge following so much time spent has a brief conversation with them. “Mr. Block’s com- lying down was to work on sitting – and to explain plicated illness is the result of a serious infection,” the point of this effort at the same time.” Werner explains the head doctor. What was actually a rather Block tired very quickly, he got dizzy, his circula- trivial tonsil inflammation spread very quickly and tion was causing problems. This phase lasted several aggressively. This led to pus collecting in the pleura weeks. The patient’s patience was put to the test. There resulting in sepsis, or blood poisoning. Werner Block were bursts of depression. “Sometimes he wanted therefore had to spend several months in intensive more, sometimes less. He had good days and less care and be artificially ventilated – “and the longer good days. Sometimes hope came out on top, some- that lasts, the greater the danger of complications”. times frustration,” Linda Rücker sums up. And yet, The nerves in particular were also damaged. In con- working closely with his therapists, Werner Block crete terms, this led to critical-illness polyneuro­ succeeded in making progress in his rehabilitation. 44 pathy – a serious condition of the peripheral nervous system. Medicine has not yet really got to the bottom “JUST DON’T GIVE UP NOW!” of this illness, says Kostopoulos: “The latest pos­ ition is that a number of factors, such as inflammatory From sitting, Werner Block worked on getting to a mediators in the body and artificial nutrition as a standing position with the physiotherapists; when his whole, lead to a marked impairment of the function of resilience permitted, Werner Block was able to take nerve con­duction.” This is why Werner Block lost not his first steps with the aid of an underarm walking only his motor skills, but also the ability to swallow frame accompanied by two therapists: first ten metres, and speak. He thus ultimately came to Medical Park then fifteen – and then? “We wanted to do twenty Bad Camberg: as a rehabilitation patient in phase B, metres, of course – but there were setbacks. Sometimes where intensive care may continue. an infection, sometimes a low mood,” recalls Linda Rücker. The important thing was never losing sight of the objective. The presence of his wife helped. She THE IMPORTANT provided constant motivation for her husband. “Just THING WAS TO don’t give up now!” Climbing stairs presented a real challenge, says Linda Rücker. The patient was NEVER LOSE SIGHT OF initially against this. His argument being – logically, THE OBJECTIVE. from his perspective – that there are no stairs in his HIS WIFE’S PRESENCE house. “But that doesn’t matter to us,” says the physio- therapist. On the whole, the patient had already made WAS VERY HELPFUL. considerably more progress than he would care to admit. “Mr. Block underestimated his abilities some- what. For that reason, the psychological focus was therefore to encourage him to have the confidence to do more.” For example, in the training room with the robotic equipment: together with his physiotherapist, Werner Block approaches a gait trainer that Medical

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

THREE QUESTIONS ON RE­ HABILITATION AFTER COVID-19

DIFFERENT47 THERAPY SESSIONS ARE AVAILABLE FOR EACH PATIENT TO CHOOSE FROM AND ARE TAILORED TO HIS/HER NEEDS.

PROF. DR. MED. PETER YOUNG HEAD OF NEUROLOGY AT BAD FEILNBACH

Have you treated COVID-19 patients? Park helped to develop. The patient positions him- We at Medical Park have treated self on two footplates; Linda Rücker straps him in so countless people since the start of the pan- that he can stand safely. She then programs the robot: demic, some of whom had to fight long Werner Block first simulates level walking, then the and hard to get well again. It is impossible physiotherapist switches to the step mode. “Using the 45 to tell what COVID-19 will do to the gait trainer, we can work on walking and stair climb- body in the short and long term. As a result, ing with patients considerably earlier and completely there are only a few recommendations securely,” says Linda Rücker. And because the robot on treatment during the acute phase, and measures height, length and frequency of the steps even fewer for treatment afterwards. at all times, therapists and doctors obtain valuable additional data on rehabilitation progress. “We don’t What consequential damage have you have to rely on our impressions during our assess- been able to ascertain? ment, but have valid data that shows us how well the patients are getting on.” It varies considerably – primarily in the respiratory organs, the cardiovascular system, neurologically and also concern- ing psychological well-being. While some patients only show very limited failure symptoms, others suffer from a combina- tion. Treating these long-term effects is a classic field of activity for rehabilitation.

What is Medical Park’s approach? A team of head doctors from cardiology, neurology, orthopaedics and psycho­ somatics developed a multimodal concept that is unique in medical rehabilitation. Specifically, a board of specialists from all four disciplines should examine each rehabilitation patient, determine a joint treatment strategy and adapt this during rehabilitation as required.

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

After a short break, Werner Block goes shopping. Not people as a whole if therapy is to succeed. “We there- to a real shop, but to a shop simulation on the ADL fore meet up regularly across functions to look together course on the ground floor of the hospital. ADL stands at what sets the patient apart, which characteristics for “Activities of Daily Living” – within the scope of do they bring along, what is the personal context?” ergotherapy, patients work on relearning basic things explains head therapist Ramona Blume concerning the realistically. Picking up vegetables and fruit, plan- rehabilitation hospital’s approach. ning and structuring shopping, getting into and out of a car – the tasks are specific, and success is also The current context in Werner Block’s life is very important psychologically: “It’s about finding out that pleasing: he was bedridden for eight solid months. you can manage daily life again,” says Anna Feyder, He fought for five long months at Medical Park Bad ergotherapist at Medical Park. “This is important for Camberg with doctors and therapists to get his life Mr. Block, but also for his wife, who can trust in her back. Now he is going home. “The fact I didn’t skip a husband’s abilities again.” single element of therapy paid off,” he says, proudly. “Well, I pestered you occasionally,” says his wife. “And A FOCUS ON PERSONAL this will continue at home,” he retorts. “That’s all down CONTEXT to you,” she counters. They make the perfect team; it is a real joy to listen to them. Werner Block stops A considerable component of the overall therapy abruptly. He looks at his wife and wells up – and the concept was speech therapy. Under the guidance of former professional soldier whispers more than talks: Christina Geis, Werner Block learnt to swallow and “I have occasionally heard that older men tend to cry to use his voice again, and here, too, both the therap­ more easily.” ist and patient had to overcome new challenges time and again. In the first phase, Werner Block still had a tracheal cannula, which ensured he was able to breathe, but also dramatically reduced his ability to swallow and speak. Therapists worked as early as 46 possible with him on breathing using the mouth and nose so that the patient could get his voice back, but he didn’t always want that. “He sometimes felt like he was being interrogated by us in this situation. Some- times he wanted to save his energy so that he could talk to his wife for longer,” says Christina Geis. It is clear here, too, that it is essential to always consider

STUCK IN BED FOR MONTHS, FIVE MONTHS OF THERAPY – NOW IT IS TIME FOR THE PATIENT TO GO HOME.

MEDICAL PARK QUALITY REPORT 2020 BENEFITING FROM DISCOURSE

PROF. DR. MED. DR. PHIL. MARTIN EBINGER, HEAD OF NEUROLOGY AT BERLIN HUMBOLDTMÜHLE

“We provide neurological patients with treatment concepts based on the latest research at five locations. We are in constant dialogue – with the aim of providing 47 the best treatment for our patients.”

THE FIVE MOST COMMON CONDITIONS

Berlin Hum- Bad Feilnbach Loipl Bad Rodach Bad Camberg boldtmühle Reithofpark

Stroke 707 1,853 680 1,043 1,028

Polyneuropathy 42 62 61 65 73

Traumatic brain injury 48 106 34 54 67

Multiple sclerosis 163 75 32 71 30

Parkinson’s disease 44 56 33 19 25

NEUROLOGY LOCATIONS You can obtain neurological, acute and rehabilitation treatment at five Medical Park facilities.

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

PHASE B: ADMISSION AND DISCHARGE FOR PHASE B

FOR US, A PERSONAL DIALOGUE WITH PATIENTS IS AS IMPORTANT AS A SCIENTIFIC ONE.

ALL PATIENTS ADMITTED AND DISCHARGED EARLY REHA BARTHEL INDEX IN PHASE B IN 2019 Upon admission Upon discharge

– 82.6 Bad Rodach 175 Bad Rodach – 70.9 Berlin Hum­ – 64.0 Berlin Humboldtmühle 51 boldtmühle – 60.3 Bad Camberg 297 – 88.0 Bad Camberg – 79.1 Bad Feilnbach Reithofpark 71 Bad Feilnbach – 81.9 Reithofpark – 71.3

– 100 – 80 – 60 – 40 – 20

The Early Reha Barthel Index is measured as a negative figure. Success in this phase is not yet rapid, but it is recognisable: the graph shows that patients who are initially seriously affected in particular improve their score significantly. Medical stabilisation is successful. 48

DR. MED. DIRK ZAUPER HEAD OF NEUROLOGY 30 AT BAD RODACH PERCENT

“When patients come to early of our most affected rehabili­tation following acute neurological patients can move around treatment, their condition is often still independently using serious. Loved ones want to see progress as quickly as possible; we want to use the mobility aids by the end of right therapy. The Early Reha Barthel Index phase B.*

helps us to systematically evaluate a *Average figure at Medical Park. patient’s abilities and their need for ventila- tion, as well as documenting progress.”

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

BARTHEL INDEX PHASES OF REHABILITATION Upon admission Upon discharge

19.3 Bad Rodach 30.1 Rehabilitation is divided up into phases measured according to a patient’s abilities. Appropriate Berlin Hum­ 21.5 boldtmühle 30.0 rehabilitation activities then enable seamless therapy. Following a stroke it is essential to begin rehabili­ Bad Camberg 11.0 16.8 tation as quickly as possible so as to utilise the brain’s Bad Feilnbach 17.3 neuroplasticity, which means its ability to adopt Reithofpark 24.0

0 10 20 30 40 50 60 new functions in intact brain tissue. Phase B involves early rehabilitation, phase C post-primary rehabili­ The Barthel Index measures everyday abilities. Upon admission, these tation and phase D the follow-up treatment. Patients are generally severely restricted. Independent of the individual degree are categorised using the Barthel Index, which of severity, we achieve a satisfactory stabilisation for patients leaving early rehabilitation phase B, with an average of 8 additional points on the scale. measures dependency on care.

PHASE B

This begins immediately after emergency 49 RIVERMEAD MOBILITY INDEX treatment at an acute hospital (phase A). Most Upon admission Upon discharge patients are bedridden and often still exhibit

2.4 serious blurring of awareness, paralysis, and impair- Bad Rodach 4.0 ments in swallowing, speech and fine motor skills. Berlin Hum­ 1.4 The first objective is to promote simple sensory and boldtmühle 2.5 motor functions; as an example, following artificial 1.1 Bad Camberg 2.5 respiration, a patient has to learn to breathe

0 1 2 3 4 5 autonomously and move around in a wheelchair.

PHASE C Upon discharge of patients still in phase B, an improvement of a complete classification level on the Rivermead Mobility Index is achieved Patients in phase C no longer have to be monitored on average. Mobility increases over the course of therapy. but are still dependent on care. The aim here is to be able to perform life’s simple activities once again At the Bad Feilnbach Reithofpark rehabilitation hospital, the number of measurements required for a statistically meaningful survey was not achieved. independently: bodily care, getting dressed, eating and drinking. The ability to speak is trained, as are walking and arm and hand movement.

EARLY REHA PHASE D BARTHEL INDEX In phase D, patients require little nursing help but can still experience significant disturbances The Early Reha Barthel Index in some areas. The aim is, once this phase is finished, uses a system of points to to be able to return home to everyday life. measure serious, sometimes life-threatening situations such as the need for monitor- ing, mandatory ventilation and loss of speech following a stroke or other serious illness.

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

PHASE B: ADMISSION TO PHASE B, DISCHARGE FROM PHASE C/D

STATE-OF-THE-ART MEDICAL EQUIPMENT AND HIGHLY QUALIFIED EXPERTS PROVIDE THE IDEAL CONDITIONS FOR A QUICK RECOVERY.

ALL PATIENTS ADMITTED IN PHASE B, DISCHARGE FROM BARTHEL INDEX PHASE C/D IN 2019 Upon admission Upon discharge

20.4 Bad Rodach 52 Bad Rodach 58.6 Berlin Hum­ 23.2 Berlin Humboldtmühle 65 boldtmühle 68.1 Bad Camberg 253 15.5 Bad Camberg 56.5 Bad Feilnbach Reithofpark 70 Bad Feilnbach 18.5 Reithofpark 51.6

0 10 20 30 40 50 60 70 80 90 100

The Barthel Index measures everyday abilities. Happily, patients at the end of phase C or D achieve an average of around 59 points, almost two-thirds of the maximum 100 points that can be given under the Barthel Index. This is good therapeutic progress and means the patient is already independent again in certain activities.

RIVERMEAD MOBILITY INDEX 50 Upon admission Upon discharge

2.8 Bad Rodach 7.7

Berlin Hum­ 1.9 boldtmühle 7.4 2.4 Bad Camberg 7.5

0 2 4 6 8 10 12

GAIT THERAPY Our patients have improved significantly on the Rivermead Mobility Index by the time they are discharged. They increase by five evaluation levels. Over the course of therapy from admission in In classic approaches, the therapist moves the phase B to discharge from C or D, mobility increases visibly and tangibly. patient’s paralysed leg and thus achieves a maximum At the Bad Feilnbach Reithofpark rehabilitation hospital, the number of of 60 steps per training session. Thanks to the robot- measurements required for a statistically meaningful survey was not achieved. assisted gait trainer developed by Prof. Dr. Stefan Hesse and used here, several hundred steps are possible on average: the patient is stabilised with a safety RIVERMEAD MOBILITY INDEX 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, muscle tension, The Rivermead Mobility Index allows balance regulation and gait symmetry are trained. This us to draw conclusions about the mobility innovative technology allows patients to walk again of patients. Its system of points enables even at an early stage. us to visualise their walking capability and their ability to transfer weight and balance following a neurological illness such as a stroke.

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

EARLY REHA BARTHEL INDEX Upon admission Upon discharge

– 62.0 Bad Rodach 0.0

Berlin Hum­ – 66.7 boldtmühle – 29.2 – 85.3 Bad Camberg – 32.3

Bad Feilnbach – 84.1 Reithofpark – 32.5

– 100 – 80 – 60 – 40 – 20 0 PROF. DR. MED. PETER RIECKMANN The initial values start in the high negative range on the Early Reha HEAD OF NEUROLOGY AT LOIPL Barthel Index at the point of admission in phase B. The objectives of therapy in phase C and D are a patient’s independence in their day-to-day life and restoring their capabilities. Discharge scores show that this aim has “It is predominantly neurological patients been achieved. with significant disabilities who come to us. They are often bedridden and have to 51 relearn a number of routine activities. With the Rivermead Mobility Index and the Barthel Index, we systematically measure progress and can therefore continually readjust our ther- apies. With data from numerous specialist neurology hospitals, it is possible not just to 50PERCENT make comparisons, but also to conduct a scientific analysis of therapeutic approaches.” of our patients can be cared for over BARTHEL INDEX several phases.*

The Barthel Index evaluates a patient’s *Average figure at Medical Park. independence in day-to-day functions (independence for eating, personal hygiene, continence, etc.). It allows everyday care dependence to be measured.

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

PHASE C

WE DEVELOP OUR TRAINING EQUIPMENT ALONGSIDE THE RESEARCH ITSELF BECAUSE WE KNOW BEST WHAT REALLY HELPS.

ALL PATIENTS IN PHASE C IN 2019 RIVERMEAD MOBILITY INDEX Upon admission Upon discharge

Loipl 575 5.7 Loipl 9.1 Bad Rodach 1,293 Bad Rodach 6.1 Berlin Humboldtmühle 342 8.5 Berlin Hum­ 5.4 Bad Camberg 440 boldtmühle 7.3 Bad Feilnbach Reithofpark 764 6.5 Bad Camberg 9.5

0 2 4 6 8 10 12

FAC In phase C, the Rivermead Mobility Index rises considerably towards the end of therapy and a good eight-point improvement can be seen. Upon admission Upon discharge Patients therefore achieve half of the total points that can be obtained on average. Sticking to it is motivating! 2.9 Loipl 4.0 At the Bad Feilnbach Reithofpark rehabilitation hospital, the number of measurements required for a statistically meaningful survey was not achieved. 3.0 Bad Rodach 3.6 52 Berlin Hum­ 2.8 boldtmühle 3.6 2.2 Bad Camberg 3.4

Bad Feilnbach 3.2 Reithofpark 3.9

0 1 2 3 4

The higher the FAC figure moves towards a maximum of 5, the better. It shows how independently the patient can walk. Over the course of their stay during phase C, our patients achieve a value of 3 to 4 – they are 64PERCENT therefore no longer reliant on immediate physical aid while walking. of our patients can FAC already walk without any With the aid of the Functional mobility aids after Ambulation Categories, or FAC for short, a standardised description discharge from phase C.* is provided regarding how much assist­ *Average figure at Medical Park. ance a person requires when walk- ing. 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 2020 NEUROLOGY

BARTHEL INDEX COMMUNITY Upon admission Upon discharge AMBULATORY INDEX (CAI) 46.6 Loipl 55.3 The CAI indicates to what extent the affected Bad Rodach 45.6 60.4 person can participate in daily life. Berlin Hum­ 52.6 boldtmühle 68.3 Walking speed is measured. It determines

Bad Camberg 49.7 the group allocation, which makes very 63.3 practical statements regarding the life scope Bad Feilnbach 44.5 Reithofpark 56.0 of the patient: this ranges from “can only 10 20 30 40 50 60 70 80 move safely in their own home” to “can cross The Barthel Index measures everyday abilities. Happily, patients quickly at pedestrian crossings” or “uses at the end of phase C achieve an average of around 61 points, two-thirds of the maximum 100 points that can be given under the Barthel Index. public transport”. In other words, we are delighted that the patient is already independent again in certain activities. 53

TEN-METRE WALKING TEST FOR PATIENTS WITH A RATING < 0.8 M/S Upon admission Upon discharge

Only at home 250 m around the home Public transport usage 0.57 Loipl 0.82 0.59 Bad Rodach 0.77

Berlin Hum­ 0.59 boldtmühle 0.72 0.61 Bad Camberg 0.87 PROF. DR. MED. PETER YOUNG Bad Feilnbach 0.57 Reithofpark 0.72 HEAD OF NEUROLOGY AT BAD FEILNBACH In metres/ sec. 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 CAI: the patient only moves at home, 250 metres around the house, or uses the bus and train. All patients are able “Neurological damage usually occurs to considerably increase their radius by the time they leave and, with an as a consequence of a sudden event. Over­ average of 0.78 m / s, are winning their independence back. coming this takes a lot of time, willpower and endless effort. Alongside medical and therapeutic expertise, the right motiv­ ation for the patient is crucial. This is why we are not just doctors, therapists and nursing staff for our patients, but coaches, too.”

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

PHASE D

WE TREAT OUR PATIENTS INDIVIDUALLY ACCORDING TO HIGH STANDARDS ACROSS ALL OUR FACILITIES.

ALL PATIENTS IN PHASE D IN 2019 BARTHEL INDEX Upon admission Upon discharge

Loipl 966 91.7 Loipl 93.6 Bad Rodach 1,358 Bad Rodach 91.4 Berlin Humboldtmühle 758 96.6 Berlin Hum­ 88.5 Bad Camberg 674 boldtmühle 94.3 Bad Feilnbach Reithofpark 996 92.1 Bad Camberg 95.8

Bad Feilnbach 93.8 Reithofpark 95.2

50 60 70 80 90 100

Our patients achieve a good 95 points on average upon completion of phase D, an excellent score. By comparison: 100 is the maximum you can achieve within the Barthel Index. It means no more nursing is required for everyday living. 54

RIVERMEAD MOBILITY INDEX Upon admission Upon discharge

12.4 Loipl 13.5 11.2 Bad Rodach 12.9

Berlin Hum­ 10.4 boldtmühle 12.0 THERAPY 4.0 – TYROTHERAPY 12.4 Bad Camberg 13.6

4 6 8 10 12 14 16 No technology in the world can replace the therapists and their delicate sense of With an average of 13 points on the index, scores at the end of phase D are visibly approaching the highest achievable value. It is therefore touch regarding the body. But when it comes also clear in this stage of rehabilitation that our patients continue to improve to high numbers of repetition, precision with regard to mobility. or working with large forces, modern rehabili- At the Bad Feilnbach Reithofpark rehabilitation hospital, the number of measurements required for a statistically meaningful survey was not achieved. tation is inconceivable without technical support. Computer-aided forms of rehabilita- tion such as tyrotherapy are used where classic therapy measures and the latest technol- ogy strengthen and support one another. They facilitate a highly intensive training pro- gramme in which people and the joy of rehabilitation take centre stage – suitable for all age groups and every grade of motor impairment.

MEDICAL PARK QUALITY REPORT 2020 NEUROLOGY

SIX-MINUTE WALKING TEST SIX-MINUTE WALKING TEST BAD RODACH

Physical performance is assessed using the walking 337 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 to take short 372 metres recovery breaks during the walk. This test is easy Average when discharged 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 LOIPL 323 metres Average when admitted 55 400 metres Average when admitted

352 metres Average when discharged 490 metres Average when discharged

On average, our patients can cover 54 metres more by the time SIX-MINUTE WALKING TEST they are discharged compared to the initial measurement. Their physical BAD CAMBERG capability is higher – a result which we are always happy to let our patients go home with. 396 metres Average when admitted

466 metres 96 Average when discharged PERCENT SIX-MINUTE WALKING TEST BAD FEILNBACH REITHOFPARK of our patients can walk 333 metres Average when admitted without assistance by the end of phase D.*

*Average figure at Medical Park. 379 metres Average when discharged

MEDICAL PARK QUALITY REPORT 2020 PROCESSING EXPERIENCES Kerstin Büse transfers her soul to paper during art therapy at Medical Park Bad Feilnbach Blumenhof. Almost eight years after the removal of a meningioma in her head and almost simultaneous radiotherapy to her left breast, both cancer symp­ toms returned in 2017 and 2018. Art therapy helps Büse to process what she has experienced – without hav­ ing to talk about it directly. The group sessions, each two hours long, are among her therapeutic highlights: “Here I can really just let go.” INTERNAL MEDICINE

“IT IS A CHALLENGE, OF COURSE, BUT I KEEP TRYING TO PICK MYSELF UP.” A relapse in her breast tissue and unexpected internal bleeding from some tumour remaining in the brain present a real test of Kerstin Büse’s endurance. Two operations went well, but the shock of the sub- sequent cancer diagnosis is clear. At Medical Park Bad Feilnbach Blumenhof, she is able to recover physically and draw new positivity – thanks also to her therapists’ empathy. 57

MULTIFACETED APPROACH Art therapy is an essential component of therapy for many rehabilitation patients in oncology. Here, it isn’t just brushes, paint and paper that are used, but sometimes also inspiring poems and encouraging stories. They are intended to provide motivation for new thinking and help to broaden perspectives.

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

“OFTEN, THE CANCER IS NOT THE ACTUAL PROBLEM; IT IS THE BURDEN MY PATIENTS HAVE TO CARRY WITH THEM.”

GABRIELE DAXEDER, ART THERAPIST AND ALTERNATIVE PRACTITIONER FOR PSYCHOTHERAPY

IMAGES THAT HEAL With a great deal of empathy and care, Gabriele Daxeder heads the art therapy ses­ sions in which around eight participants paint pictures: “An outstanding method for seeing into your subconscious and to find a way to convey things that are not very easy to express.” Because traumas can surface during painting, Daxeder ensures that everything takes place in a protected and trusting framework. If desired, she dis­ cusses the resulting pictures with her pa­ tients, “but only between ourselves”. Some want more detailed classification – “and I am generally able to read well the needs that are portrayed in the pictures”.

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STAYING PHYSICALLY FIT Movement is necessary! Together with sports and gymnastics therapist Elena Hager, Kerstin Büse marches straight through the small apple orchard at the rear of Blumenhof. And always in view: her smartwatch with heart rate monitor. “As a form of outdoor ther­ apy, Nordic walking creates positive balance,” says Hager, “it not only increases a sense of overall well-being, but strengthens the arms and legs.” And breast cancer patients in par­ ticular can benefit from brisk walking: “It helps them with posture.” Right: Kerstin Büse tests her coordination at the climbing wall.

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

60 “THE AIM OF REHABILITATION FOR OUR PATIENTS IS TO ENABLE THEM TO REGAIN THEIR FULL CAPABILITIES – AND TO SIGNIFICANTLY IMPROVE THEIR PSYCHOLOGICAL CONDITION.”

DR. MED. ANDREAS ARNDT, HEAD OF ONCOLOGY AT BAD FEILNBACH BLUMENHOF

GOOD FOR THE BACK At the start of treatment, osteo­ path Kathrin Sturzenbecher gently touches Kerstin Büse’s back before then gliding her fingertips to the patient’s neck muscles. She explains each step she takes. Osteopathic treatments are an essential compo­ nent of Medical Park’s holistic rehabilitation approach – they help to realign the physique and ensure intense moments of deep relaxation.

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

THE LONG GOODBYE After a moment of silence, the therapist shares out TO CANCER large sheets of paper – watercolours, brushes, wax crayons find their way to the centre of the table and are The day begins with art. Just before eight o’clock in quickly snatched up by the participants. The actual art the morning, a handful of women arrive in a room therapy starts now. And while Gabriele Daxeder where the tables have been pushed together to form places a CD with relaxation music into the player, a long bench. The window on the front side looks out we leave the room. This form of therapy is a very in­ onto the lush green of early summer. “Art therapy” is timate process that can lead to tears. The fact that this the first item on the therapy agenda for the eight is desirable is explained to us again by Gabriele Dax­ rehabilitation patients on this Tuesday at the begin- eder after the two-hour therapy session during a one- ning of June. A prickle of expectation can be felt in the to-one chat. air. Here and there, glances are exchanged and the odd word is shared. Some of the women seem to be One of the participants in today’s art therapy session rather introverted and concentrated. is Kerstin Büse. Following the precautionary removal of her left breast, in which a cyst and fibroadenoma Then the doors standing ajar swing open and Gabriele were found, she came to rehabilitation at Medical Daxeder enters the room. The art therapist greets the Park Bad Feilnbach Blumenhof. Kerstin Büse has found group, casts a friendly smile around and immediately the courage to talk to us about her history of illness begins a breathing exercise borrowed from yoga prac- and allowed us to take part in a little more of her daily titioners: “Some people with a history of cancer breathe life at Bad Feilnbach. in a lot more than out,” Daxeder explains to us later, “and with breathing exercises, I want to help my par- THE SHOCK DIAGNOSIS ticipants to steer their focus to breathing and to balance this relationship again.” Then, with her soft voice, “It all began in summer 2009,” begins Kerstin Büse, Daxeder reads “My Declaration of Self-esteem” by Vir- whose tremendous exertions, now behind her, are ginia Satir to the group, gentle yet very powerful. It hardly visible, “when I suddenly started to get awful 61 feels empowering. In it are phrases like “I own my fan- headaches.” She was in the middle of a stressful tasies, my dreams, my hopes, my fears” and “However move – she was moving house with her family from I look and sound, whatever I say and do, and whatever Oldenburg to Bamberg – and already had a medical I think and feel at a given moment in time is authen­ marathon behind her. “At some point when the pain- tically me”. Daxeder ends the text with the words “I am killers stopped helping, I had a CT scan with a neur­­ me. And I am wonderful and unique”. ologist. She found a falx meningioma as big as a fist in my brain.” Büse had the tumour tissue removed during a 13-hour operation – a walnut-sized portion of the benign tumour had to be left in the cerebral membrane, however.

Four months later, breast cancer was discovered dur- ing a biopsy. “I was undergoing radiotherapy on my head and breast at the same time for eight weeks,” recalls Kerstin Büse. “That was a lot to take.” Initially, 1,000THERAPISTS the cancer was able to be treated while retaining the breast. However: the illness didn’t disappear without SUPPORT OUR a trace for Kerstin Büse. “I gave up my job as an inter­ PATIENTS FOLLOWING THEIR ior designer and have worked independently since SURGERY. then in the food industry.”

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

three times a week: “I only joined in with the light, 90-minute elevated hikes at first, but now I feel con­ A HOLISTIC APPROACH fident enough to do the three-hour tours. The country- TO COVID-19 side is beautiful here – it gives me renewed strength.”

THE HEALING POWER OF PICTURES

Change of scene. It is shortly before ten o’clock. We sneak into Gabriele Daxeder’s therapy session, which is just finishing. The empty white A3 sheets are now covered with rich, rather abstract pictures – with brightly coloured circles, flowing patterns and flowery forms. “Were you able to let go?” Daxeder asks the group. A unanimous and loud “Yes!” is the response. Before the therapist lets her participants continue their days, she gives them a reminder to take with PROF. DR. MED. CHRISTIAN FIRSCHKE them: “And always pay attention to what you think HEAD OF CARDIOLOGY about yourself – don’t hide negative feelings away in AT BAD WIESSEE ST. HUBERTUS a drawer. It’s like having too many socks – if there “The knock-on effects of are too many in the drawer, they will jump out at you. COVID-19, which are gradually becoming Don’t make comparisons. Smile at yourself in the apparent, show that we always have to mirror whenever you wash your hands.” There is a choose our therapy approach holistically.” great deal of warmth in her voice and her approach­ able and calm manner is engaging. 62 In the interview, Daxeder – who is in close contact with the in-house psychologists – explains a crucial A couple of years later, during a routine examination advantage of the art-therapeutic approach to us: “The in January 2017, calamity struck again: the breast approach to colours and shapes helps to overcome cancer had returned. The relapse on the right-hand voicelessness – and prior artistic experience is not side is benign, but presents a precursor to cancer and necessary. Painting provides access to the subcon- is already six centimetres in diameter. A mastectomy – scious; it creates scope for spiritual expression. Be- removal of the breast – is unavoidable. A short time cause sorrow, worries or fears sometimes sit so deep later, the remaining tumour in her brain made its that many people are unable to talk about them.” presence known again; it had bled internally and could If desired, she discusses the resulting paintings with luckily be removed entirely in February 2018. her patients, “but only between ourselves – in a re- laxed atmosphere”. She is able to quickly recognise by How do you handle a story like that? What do you do the depicted shapes which of the patient’s needs are with it? “It’s very hard, of course,” says Kerstin Büse, currently the most important. “Often, the cancer isn’t thoughtfully, “but I keep trying to pick myself up – the actual problem; it’s the life baggage that people and take it one step at a time.” She has been at Bad are carrying.” Feilnbach for two weeks now, has been on guided walks with the Medical Park team, and went to the Kampenwand for the first time the day before yes­ terday. “We went up in the cable car. There was still snow up there. We then circled the peak and walked down – I was exhausted in the evening.” She appre­ ciates the fact that Blumenhof offers guided tours

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

Kerstin Büse is now in the middle of her next activ­ ity of the day. Together with physiotherapist Elena Hager, she is marching quickly through the small apple orchard at the rear of the facility with sticks. Just like in a vineyard, the grounds are slightly inclined. The trees are in straight lines. The apples are the size of cherries – but the sun is already warm and power- ful. After a few rounds of going back and forth, Hager 3,000PATIENTS asks: “How are you doing? Are you out of breath?” For Kerstin Büse, it doesn’t look like it has been too ARE TREATED A challenging: “A little, but it’s no problem.” Clearly DAY AT MEDICAL PARK her regular morning walk with her dog has got her ON AVERAGE. into the sort of shape that even setbacks can’t impair too easily.

“Especially in breast cancer, Nordic walking helps with posture and provides the trunk with more stabil- For the majority of cancers, the formation mech­ ity. Prostate patients, on the other hand, can improve anisms are not sufficiently known. The World Health their time management with the walking sessions – Organization (WHO) currently believes that only an important aspect of life quality,” says Elena Hager. 30 percent of illnesses can be avoided by preventive She takes Ms. Büse to the indoor area, where other measures – healthy eating, avoiding the consumption exercises are available. First, it’s time for “good old of too much alcohol or nicotine, and regular physical squats” – five repetitions, four sets. Then it is the turn activity. The vast majority, 70 percent, has causes that of the sling trainer: Kerstin Büse places her underarms are still not clearly identified. This includes genetic in the loops, bends her knees and straightens her predisposition that can favour the development of back. She then alternates pulling each elbow back. cancer. 63 This strengthens the back. “You’re doing really well!” Hager calls to her. She has earnt her lunch break. Whether stress can cause cancer has long been a sub- ject of discussion. A suspicion that was corroborated OFTEN, THE CAUSES ARE for the first time in 2017 by a large-scale long-term UNCLEAR British study. The study, in which data from more than 160,000 participants was evaluated, came to the We meet Dr. Andreas Arndt, head of the oncological following conclusion: participants under significant department: “During rehabilitation at Blumenhof, we ongoing stress had a 32 percent higher risk of dying do everything we can to improve our patients’ psycho- of cancer during the evaluation period. For prostate logical condition and therefore win back their capabil­ and oesophageal tumours, the risk was even around ities little by little.” There are approx. 490,000 newly 2.5 times higher. Colon cancer was at least twice as diagnosed cancers in Germany per year. “According high. to statistics, rehabilitation follows acute treatment in a third of cases.” Dr. Arndt, who has a gentle, sunny charisma, advocates here for residential rehabilita- tion: “Outpatient rehabilitation generally falls short in its effect. In my opinion, the patient has to be taken out of their familiar environment – this has a relaxing effect and provokes intensive contemplation.”

KERSTIN BÜSE DRAWS NEW STRENGTH FROM NORDIC WALKING AND GUIDED HIKES.

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

The fact that stress can lead to cancer is something THE THERAPY PLAN head doctor Arndt also believes: “And women are IS FINE-TUNED especially at risk here – with their career, children and household, they are often active on three fronts.” OVER THE COURSE OF And Dr. Arndt also highlights the fact that women REHABILITATION. “often think of themselves too little compared to men.” His role as head doctor in the oncological de- KERSTIN BÜSE WILL partment has similarities to that of a family doctor: INTEGRATE SOME OF “Radiotherapy or chemotherapy often sadly leave THE THERAPIES secondary illnesses – we also take care of these opti- mally at Blumenhof.” For this reason, his initial conver- INTO HER DAILY LIFE. sation with the patient involves getting a sense of their individual desires and developing therapy according- ly. This is then fine-tuned week on week. Two months later, Kerstin Büse gets a call. How have A POSITIVE PHYSICAL FEEL things been going since rehabilitation? How is she now? “It has been a bit up and down, especially be- Osteopathic treatment can also bring about a general cause I wasn’t really able to relax due to a member strengthening of the body as a whole. Kerstin Büse of the family having an operation,” she says, taking has just stretched out on a treatment table in Kathrin a deep breath. “But I’m now going to an osteopath Sturzenbecher’s treatment room. The osteopath, who regularly, especially given the fact that the treatment also uses relaxation techniques from craniosacral at Feilnbach did me so much good. I was really able to therapy for her treatment, comments precisely on let go there.” She has just been to Wörthersee, where each step: “I’m now moving my fingertips to the neck she would swim in the turquoise water each day with muscles and dispersing the pressure.” While her hands her dog – approx. 20 minutes at a time. “I am even glide gently on the neck, we leave the room – even doing yoga again, even if it’s only minimally to protect 64 osteopathic treatments can be psychologically upset­ ­ my shoulder. And yes, Ms. Daxeder – I really miss her. ting for patients. On this Tuesday, Kerstin Büse is ex- Her sessions were unique.” Overall, she says, she still pecting more pelvic floor and relaxation training, doesn’t often succeed in shedding her vigilant side, then rehabilitation is over for the day. “but I’m trying”. Kerstin Büse goes tenaciously on her way – it is not an easy one. But she is taking it.

MEDICAL PARK QUALITY REPORT 2020 FOCUS ON PEOPLE

PROF. DR. MED. CHRISTIAN FIRSCHKE HEAD OF CARDIOLOGY AT BAD WIESSEE ST. HUBERTUS

“Even if scientific progress means that ever more areas of specialism are coming into being, internists continue to focus on the person as a whole. And, just as with med- 65 ical history, when it comes to the measure- ment of success and quality, we are especially interested in the subjectively experienced factors and indicators.”

INTERNAL-MEDICINE LOCATIONS Medical Park offers cardiology patients rehabilitation at two locations. At one location, we take care of oncology patients.

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

CANCER TREATMENT OF THE FEMALE GENITAL ORGANS

EVEN AFTER DISCHARGE, WE WANT TO KNOW HOW OUR PATIENTS ARE DOING.

PATIENTS WITH CANCER - TREATMENT OF THE FEMALE GENITAL EQ 5D INDEX ORGANS IN 2019 Upon admission Upon discharge After six months

67.3 Bad Feilnbach Blumenhof 85 Bad Feilnbach 74.0 Blumenhof 70.9

50 60 70 80

Quality of life is evaluated using the EQ-5D questionnaire: the higher the value, the better. Six months after discharge, this reduces slightly. An understandable phenomenon – patients must fend for themselves again in their day-to-day lives. However: an average of 70.9 points indicates 70 a visible increase compared to the moment of admission. PERCENT

of our patients are not 66 anxious or depressed after treatment.

DR. MED. ANDREAS ARNDT, EQ-5D HEAD OF ONCOLOGY AT BAD FEILNBACH BLUMENHOF

The EQ-5D Index is the world’s most widely used method for “How can something as simple the measurement of health-related as a walking test be a quality quality of life. Patients are asked indicator? How could it not be? about five factors, which they can rate People who cannot overcome at various levels: mobility, self- care, work and leisure activities, pain/ short distances by themselves or who physical discomfort and anxiety/ can only do so with difficulty despondence. In some specialist areas, have a real sense of freedom when these points are surveyed again they can walk, go shopping six months later in order to record the ongoing progression. or climb stairs again after rehabil­i­ tation.”

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

CANCER TREATMENT OF THE DIGESTIVE ORGANS

OUR HOLISTIC CONCEPT GOES FAR BEYOND MEDICAL TREATMENT.

PATIENTS WITH CANCER - TREATMENT OF THE DIGESTIVE EQ 5D INDEX ORGANS IN 2019 Upon admission Upon discharge

Bad Feilnbach 71.1 Bad Feilnbach Blumenhof 368 Blumenhof 75.7 50 60 70 80

The EQ-5D value reflects health-related quality of life. On average, patients increase by 4.6 points on discharge reaching almost 76 points. This corresponds to a good quality of life.

WOUND MANAGEMENT

After intestinal surgery, wound care and the provision of an artificial bowel out- let often present problems. Our wound 67 managers and ostomy therapists specialise in this area and, accordingly, guide patients during rehabilitation, show them how ostomy aids are fitted and help them to get their CREATIVE THERAPY bearings with the new and unfamiliar situ­ ation. They recognise possible complications at an early stage and can treat them. It is The term “creative therapy” encompasses not only technical expertise, but also human various therapeutic forms, including art, sensitivity that is required here. music and dance. What they have in common is an artistic approach, which can help to initiate or support psychological processes. The patient is of course not expected to have any prior knowledge. It is about gaining access to oneself in a value-free, results- oriented manner, honing self-perception and developing new ways to express and con­ sider anxiety and conflict, but also positive 82PERCENT feelings and desires. of people have no mobility restrictions upon discharge from rehabilitation.

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

CORONARY HEART DISEASE

DAILY EXERTIONS ARE POSSIBLE WITHOUT SYMPTOMS FOR MANY OF OUR PATIENTS.

PATIENTS WITH CORONARY HEART DISEASE SIX-MINUTE WALKING TEST IN 2019 BAD FEILNBACH BLUMENHOF

319 metres Bad Feilnbach Blumenhof 865 Average when admitted Bad Wiessee St. Hubertus 505

381 metres Average when discharged NYHA CLASSIFICATION Upon admission Upon discharge

Bad Feilnbach 2.5 Blumenhof 1.7 SIX-MINUTE WALKING TEST Bad Wiessee 1.6 St. Hubertus 1.2 BAD WIESSEE ST. HUBERTUS

I II III 412 metres Average when admitted A system of classification that evaluates capacity: patients who

68 were considerably physically restricted on admission improve by an entire class. On average, all of those surveyed are able to improve and, at the end of therapy, can move within the scope of class 1 – this means: no restriction in physical capacity. 488 metres Average when discharged

PAIN SCALE Upon admission Upon discharge A proud achievement for our patients with coronary heart disease: during the walking test, they cover an average of 69 metres Bad Feilnbach 2.4 more within six minutes than at the start of rehabilitation. Blumenhof 1.4

Bad Wiessee 1.1 St. Hubertus 0.3

0 1 2 3 EQ-5D INDEX The measured results show that, with targeted pain therapy and Upon admission Upon discharge After six months the progression of healing, pain can be reduced: the patients improved by one level – depending on the starting situation, from level 1 to 0; 73.4 this concerns low levels of pain to complete freedom from symptoms. Bad Feilnbach 80.5 Blumenhof 76.3 77.0 Bad Wiessee 87.4 St. Hubertus 82.5

50 60 70 80 90

With the EQ-5D questionnaire, a meaningful value for measuring quality of life can be generated. Six months after discharge, this lowers a little, but settles down to almost 80 points on average. This corresponds to the average score of a healthy person.

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

MITRAL VALVE DISEASE

SIMPLE TESTS SHOW WHICH THERAPEUTIC SUCCESSES ARE POSSIBLE.

PATIENTS WITH MITRAL VALVE DISEASE NYHA CLASSIFICATION IN 2019

Cardiac insufficiency is divided into four categories Bad Feilnbach Blumenhof 70 by the New York Heart Association (NYHA). Bad Wiessee St. Hubertus 63 These provide information about the extent to which patients are inhibited by their cardiac disorders. NYHA Class I encompasses any heart disease that does not result in direct physical limitation. Complaints EQ-5D INDEX that occur under normal bodily exertion but which still Upon admission Upon discharge After six months allow longer walks of up to five kilometres are cat­ egorised as Class II. Class III describes patients whose 70.8 Bad Feilnbach 78.1 physical activity is significantly impaired; they do Blumenhof 81.9 not experience any complaints while at rest, but even 76.0 Bad Wiessee 86.0 slight physical activity can cause symptoms such St. Hubertus 83.8 as a shortage of breath. Patients who suffer complaints 50 60 70 80 90 during any kind of physical activity at all are 69 categorised as NYHA Class IV. Six months after discharge, quality of life is measured again using the EQ-5D Index. The evaluated questionnaires result in an average score of 83 points. From 80 points we refer to the average score of a healthy person. A satisfactory progression.

SIX-MINUTE WALKING TEST BAD FEILNBACH BLUMENHOF NYHA CLASSIFICATION 311 metres Upon admission Upon discharge Average when admitted

Bad Feilnbach 2.6 Blumenhof 2.0

Bad Wiessee 1.8 St. Hubertus 1.2 366 metres I II III Average when discharged

The lower the figure, the better, because NYHA classification measures physical impairment. Patients at Medical Park rehabilitation hospitals improve from the upper to the lower end of a class when discharged and are therefore much more able to perform activities. SIX-MINUTE WALKING TEST BAD WIESSEE ST. HUBERTUS

385 metres PAIN SCALE Average when admitted Upon admission Upon discharge

Bad Feilnbach 2.9 Blumenhof 1.6

Bad Wiessee 1.6 466 metres St. Hubertus 0.5 Average when discharged

0 1 2 3

It is not a race, but a valid indication of the increase in physical capability: Pain decreases over the course of the healing process and as a result our patients are able to walk an average of 68 metres further over of pain therapy. Medical Park rehabilitation hospitals demonstrate six minutes by the time they are discharged than they were when admitted. clear and successful results in this department. Patients progress by a level During their rehabilitation stay, capability therefore improves tangibly between 0 and 1 respectively. and visibly.

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

AORTIC VALVE DISEASE

500 PATIENTS A YEAR WISH TO BE TREATED AT ONE OF OUR FACILITIES AFTER TREATMENT OF THE AORTIC VALVE.

PATIENTS WITH AORTIC VALVE DISEASE SIX-MINUTE WALKING TEST IN 2019

Physical performance is assessed using the walking Bad Feilnbach Blumenhof 326 test. Patients walk at their own pace for a total of Bad Wiessee St. Hubertus 174 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 PAIN SCALE to reproduce and supplies important information about Upon admission Upon discharge a patient’s condition and ability to recover.

Bad Feilnbach 2.7 Blumenhof 1.5

Bad Wiessee 1.3 St. Hubertus 0.4 SIX-MINUTE WALKING TEST 0 1 2 3 BAD FEILNBACH BLUMENHOF

Our patients experience less pain following operation and rehabilitation. 277 metres 70 This is measured using a points scale. On average, the scores Average when admitted lower by around one point independent of the level felt initially – so more than one level.

335 metres NYHA CLASSIFICATION Average when discharged Upon admission Upon discharge

Bad Feilnbach 2.5 Blumenhof 1.7

Bad Wiessee 1.8 SIX-MINUTE WALKING TEST St. Hubertus 1.3 BAD WIESSEE ST. HUBERTUS I II III 347 metres Average when admitted Patients improve by a third by the end of their stay according to the New York Heart Association (NYHA) classification. Class I means no restriction of physical activity.

425 metres Average when discharged EQ-5D INDEX Upon admission Upon discharge After six months

Our patients perform significantly better by the time they are 73.0 discharged. When the watch stops after six minutes, they have walked Bad Feilnbach 80.8 Blumenhof 75.8 an average of around 70 metres more than when they were admitted. 76.4 Bad Wiessee 83.9 St. Hubertus 83.6

50 60 70 80 90

The EQ-5D value describes health-related quality of life. The score six months after discharge from our facilities is interesting. It lies at an average of 80 points – this corresponds to the average score of a healthy person.

MEDICAL PARK QUALITY REPORT 2020 INTERNAL MEDICINE

CHRONIC HEART FAILURE

OUR DOCTORS ARE IN CONSTANT DIALOGUE WITH SPECIALIST UNIVERSITIES AND INSTITUTES.

PATIENTS WITH CHRONIC HEART FAILURE SIX-MINUTE WALKING TEST IN 2019 BAD FEILNBACH BLUMENHOF

318 metres Bad Feilnbach Blumenhof 37 Average when admitted Bad Wiessee St. Hubertus 90

370 metres Average when discharged NYHA CLASSIFICATION Upon admission Upon discharge

Bad Feilnbach 2.6 Blumenhof 1.9 SIX-MINUTE WALKING TEST Bad Wiessee 1.9 St. Hubertus 1.5 BAD WIESSEE ST. HUBERTUS

I II III 383 metres Average when admitted 71 We feel validated in our work: on average, all patients achieve the lowest category of the NYHA classification at the end of their stay or are able to further improve in class 1. They all handle low strain without symptoms. 448 metres Average when discharged

EQ-5D INDEX Upon admission Upon discharge Therapy successes are measured in metres. The further a patient walks, the more capable they are. With an average of 59 metres more Bad Feilnbach 66.7 compared to their first attempt, very good results are achieved here. Blumenhof 74.5

Bad Wiessee 78.9 St. Hubertus 86.0

50 60 70 80 90 PAIN SCALE The stay at the Medical Park rehabilitation hospitals has an Upon admission Upon discharge overall positive effect on our patients. The EQ-5D scores measuring health-related quality of life are therefore clearly at their highest Bad Feilnbach 1.6 at the point of discharge. Blumenhof 0.9

The number of measurements required for a statistically meaningful Bad Wiessee 1.5 St. Hubertus 0.5 survey after six months was not achieved. 0 1 2 3

The subjective experience of patients is measured via a standardised points system. With a zero before the decimal point, all patients at Medical Park rehabilitation hospitals achieve the lowest scores on the scale. This therapy is very good at reducing pain.

MEDICAL PARK QUALITY REPORT 2020 PRESSING THE RESET BUTTON Elke Schwarzer with head doctor Andreas Bock on the rehabilitation hospital’s jetty on the south bank of Chiemsee. A year before her rehabilitation stay at Medical Park Chiemseeblick, the stress in her day- to-day work began to increase continually. On the day of her arrival, Ms. Schwarzer places her psycho­ logical stress at nine on a visual analogue scale (VAS) of one to ten – lethargy, negative thoughts and physical pain are troubling her. Four weeks after the start of rehabilitation, the severity of her symptoms has reduced to four points thanks to conversational therapy and resource work within the context of the ICF-based multimodal therapy concept. PSYCHOSOMATICS

“I SLEEP LIKE A BABY – AND IT FEELS FANTASTIC.” It was not only anxiety about the future and depressive symptoms that plagued Elke Schwarzer for a good year, but also severe back pain and insomnia. She then underwent a six-week tailored rehabilitation programme. Patients with burnout symptoms and psychosomatic diagnoses are treated at Medical Park Chiemseeblick. These pathologies are being diagnosed more and more in Germany. 73

IDYLLIC SURROUNDINGS Medical Park Chiemseeblick is right on the south bank of the “Bavarian sea” – from the park, you can see the Herrenchiemsee island, lying two kilometres away. Around 15 percent of all rehabili­ tation patients here exhibit burnout symptoms. Right: Elke Schwarzer during strength training with the Thera-Band under the guidance of sports therapist Britta Regul.

MEDICAL PARK QUALITY REPORT 2020 PSYCHOSOMATICS

“IN RESOURCE WORK, IT’S ABOUT RESTRENGTHENING THE CON­NECTION TO YOUR OWN 74 ENERGY SOURCES, REDISCOVER- ING POSITIVE ACTIVITIES AND INTEGRATING THEM INTO YOUR DAILY ROUTINE.”

MARTINA HEGE, ERGOTHERAPIST

PLAYFUL IMPROVEMENT Collaging is intended to reactivate lost hobbies and desires. During a concentration game, speed and attention are trained – two aspects of ergotherapy that, as with sports therapy, contribute to recovery. Strength exercises on the leg press help Elke Schwarzer to relieve her back. Sports therapist Britta Regul ensures that she performs the movements correctly.

MEDICAL PARK QUALITY REPORT 2020 PSYCHOSOMATICS

“MANY PEOPLE DON’T HAVE THE TIME TO GET THEMSELVES IN ORDER DURING THEIR DAILY LIVES. WE HELP THEM TO ARRANGE THE JUMBLED PIECES AND PUT THEM TOGETHER.”

ANDREAS BOCK, HEAD OF PSYCHOSOMATICS AT CHIEMSEEBLICK

STRENGTHENED BY TRUST The dialogue between patient and therapist is the core of psychosomatic treatment. And head doctor Andreas Bock takes a lot of time for personal discussion with Elke Schwarzer. Only in this way can the neces­ sary trust be built that forms the basis of therapeutic success. Without it, the patient cannot confront their psychosomatic symp­ toms. The tranquillity of the lakeside setting benefits the healing process.

MEDICAL PARK QUALITY REPORT 2020 PSYCHOSOMATICS

OFF TO NEW SHORES When the six-week rehabilitation is completed, Elke Schwarzer will need to integrate what she has learnt in her day-to-day work. “In conversational therapy, we make our patients confront forthcoming private and professional situations,” says psychologist Fabian Krüger, “and we therefore play out together what good behavioural strat­ egies can look like.” Elke Schwarzer has committed to no longer allowing everything from her work life to affect her so much and to pay more attention to her own feelings and needs. 76

“BURNOUT OCCURS WHEN YOU LOSE YOUR SENSE OF SELF AND WORK FAR BEYOND YOUR LIMITS.”

FABIAN KRÜGER, PSYCHOLOGIST

MEDICAL PARK QUALITY REPORT 2020 PSYCHOSOMATICS

STRENGTHENING ENERGY want things to be gentler in her life or is it the strength SOURCES of the tiger that speaks to her here? Perhaps both? One thing is clear: Elke Schwarzer wants to finally get Elke Schwarzer is cutting out a tiger. She cautiously better. When she arrived at Medical Park Chiemsee- moves the tips of the scissors around the illustration blick, she was suffering from serious back and shoul- of the big cat and the words “Be gentle!” next to it. She der pain, insomnia, and severe exhaustion: “On a then sticks the tiger to a large sheet of paper that al- symptom scale of 1 to 10, I was on a 9 when I arrived.” ready has a few images adorning it. We can see a sail- Around a year ago, work stress drastically increased – ing boat, two glasses of white wine, flowers and a per- and a downward spiral of sad thoughts and increas- son looking at the sunset with their arms stretched ingly severe physical symptoms began. The 56-year- far into the air. Elke Schwarzer’s collage gets bigger, old, who works as a self-employed PR advisor, is also brighter and more varied with each sitting. “The fact employed as a part-time secretary “as a fall-back. But it can be so arduous rummaging through magazines I was caught in the middle in precisely this position.” constantly on the lookout for things and pictures that speak to me,” Elke Schwarzer says, smiling, “I didn’t There were ever more internal battles that I was bur- expect that.” dened with, “until I couldn’t take it any more”. And yet Elke Schwarzer tried everything – she went to the staff Putting a collage together with positively charged representatives and even to the management board. images is called resource work in specialist medical Everyone told her that they were aware of the prob- language. Ergotherapist Martina Hege explains the lem but couldn’t do anything about it. “What then principle behind it: “In resource work, it’s about re- set in was a devastating sense of helplessness with strengthening the connection to your own energy an insurmountable workload and no prospects of sources. In psychological conditions in particular, you change, along with the awful feeling of no longer find- quickly lose contact with your inner requirements – ing a stopping point – a classic burnout combination.” in rehabilitation, we strengthen this by drawing atten- tion to it and reactivating it.” Burnout is a problematic term because it was unclear 77 for a long time what was actually meant by the often- She has been able to determine that this is a rewarding used word. With revision of the International Classi- endeavour – albeit not an easy one – on many occa- fication of Diseases (ICD), the World Health Organ­ sions: “I have had patients who have realised after ization created clarity. For the first time, burnout was the task that: whoops! I’ve stuck my wife’s favourite defined as an unambiguously work-related phenom­ food on there and this is my daughter’s sport. Where enon in the 11th revision of the ICD. This is defined am I? And, of course: resources come and go with not only by a “sense of exhaustion”, but also “an in- time – they can change.” Furthermore: some symbols creasing psychological distance or negative attitude to are diverse – such as the tiger. Does Elke Schwarzer one’s job” and “reduced professional capacity”.

By contrast, Andreas Bock, head doctor at Medical Park Chiemseeblick, understands burnout to be a MORE THAN “socially acceptable term for depressive and soma­to­ form symptom complexes in the working process that develop due to the interaction of workplace con- ditions, personality factors and the availability of in­ dividual compensation mechanisms”.

PSYCHOLOGISTS90 ARE CONCERNED WITH THE MENTAL HEALTH OF OUR PATIENTS.

MEDICAL PARK QUALITY REPORT 2020 PSYCHOSOMATICS

RECOGNISING CONNECTIONS But the causes are often different: an intense workload and information overload, the expectation of always How is Elke Schwarzer doing now? More than four being available and the pressure “from above” are the weeks have passed since her arrival at Medical Park primary reasons in industrial nations behind a steep on the south bank of Chiemsee. Elke Schwarzer has upward trajectory on the burnout curve. Thus, for ex- already completed many hours of breathing therapy ample, the number of days absent for employees in and autogenic training – “both new territory for me” – Germany due to psychological strain in the workplace some art therapy sessions – “I love diving into the col- have increased by 144 percent in the past eleven years ours and forgetting the world” – and also eight 90- according to the latest figures from the German gov- minute group therapy sessions in the so-called burn- ernment. A reason for this is also the fact that second- out group. “This has borne the most fruit for me so ary illnesses caused by burnout symptom complexes far.” In addition, she exercises on the stepper and leg are better recognised by doctors and therapists. press in the training room, goes swimming regularly in the 30-degree pool and is writing a therapy diary. Andreas Bock forms two bowls with his hands: Journaling is meant to help recognise connections at “Ideally, stress factors and well-being factors balance the clarification level in order, according to Andreas each other out on the scales.” In order to find out how Bock, “to be able to bring about positive changes at the inner scales look, people should ask themselves various action levels”. honestly at least three times a week: how am I doing? “And if you feel just as bad on Monday morning as The severe physical symptoms have already tangibly you did on Friday evening – if the weekend and an­ weakened: the shoulder and back pain have reduced nual holidays don’t have a tangible restorative effect – significantly and even the quality of her sleep has you know that there is an acute need for action.” improved. “Overall, I would say that I’m now at a pain level of 4,” Elke Schwarzer summarises. “I am In about a week, Andreas Bock will meet Elke now sleeping like a baby – and it feels fantastic,” says Schwarzer for their concluding discussion – and write the 56-year-old Swabian. “The insomnia was the worst a socio-medical recommendation to her employer: 78 part of my burnout, even worse than the hours I spent “Even if a lot of employers don’t want to hear it – every crying.” employer in Germany has a duty of care.” The task of rehabilitation medicine consists of looking at what Fabian Krüger is also delighted with the progress Elke rehabilitation and the employer can positively change Schwarzer has made. For the psychologist, who con- together so that participating in working life while ducts weekly discussions with his patient, a particu- taking health handicaps into consideration is possible lar concern is ensuring that rehabilitation success can for a long time. Head doctor Andreas Bock sees a be effective over the long term: “The hardest part of great deal of positive development potential for the the therapy process is integrating what you have learnt future in the close collaboration with employers and into your daily routine.” For this reason, he prepares rehabilitation patients, as well as in the new legal pro- his patients for problems that they will face and gives visions on psychological health at work (GB Psych). them guidance on how to approach them. From these Elke Schwarzer has already received two concessions discussions, Elke Schwarzer will take with her the fact from her superiors during rehabilitation. So alongside that “it is better to separate myself from my everyday therapeutic success, the approval for a standing desk work by, for example, not always volunteering myself, and an immediate department switch give the patient but reacting in a more reserved way. I am not always cause for optimism: “Something’s happening!” responsible for everything. That’s how I used to feel, though, and it’s what drove me to my burnout.”

A further phenomenon that can lead to burnout is a so-called gratification crisis. “This is understood to be the experience that your work is not considered to be valuable,” explains Fabian Krüger, “and that the activities do not correspond to your own potential.” These gaps between individual ability and actual work are familiar to Elke Schwarzer in her job as secretary. Paradoxically, too little work or the subjective sense of not being sufficiently challenged can also lead to burnout.

MEDICAL PARK QUALITY REPORT 2020 REGAINING QUALITY OF LIFE

PD DR. ANDREAS MENKE HEAD OF PSYCHOSOMATICS AT CHIEMSEEBLICK

“People with psychosomatic illnesses often have years of suffering behind them when they arrive for treatment with us. We want to end the path of suffering. And 79 we want to know if we have succeeded. For this reason, we put together a neuropsy- chological test profile at the start of rehabili- tation and at the end. Using this, patients and therapists can take stock objectively and evaluate rehabilitation success.”

PSYCHOSOMATIC LOCATIONS Psychosomatic treatment is available at Medical Park Chiemseeblick.

MEDICAL PARK QUALITY REPORT 2020 PSYCHOSOMATICS

DEPRESSION

MOST PATIENTS CAN GO BACK TO THEIR JOBS AFTER TREATMENT AT OUR REHABILITATION HOSPITAL.

PATIENTS WITH DEPRESSION IN 2019

Chiemseeblick 1,747

PROGRESS UNDER BDI BDI Upon admission Upon discharge

Normal Mild Moderate Severe The Beck Depression Inventory II (BDI) 22.7 Chiemseeblick 13.7 is a psychological test method which In points 0 13 20 28 can be used to measure the severity of depres-

In the BDI system, any rating higher than 20 points corresponds sive illnesses. It consists of 21 questions in to moderate depression. After treatment at Chiemseeblick, the a survey, concerning things like social with- average rating drops from 22.7 at admission to 13.7, which represents a significant improvement. drawal and propensity to tiredness. There are four possible answers to each ques- 80 tion; patients tick the most applicable BDI EFFECT SIZE one. The total produced by the answers gives

Minor Medium Major Effects an indication of the level of depression.

Chiemseeblick 0.85

0.2 0.5 0.8 1.1 HEALTH-RELATED QUALITY OF LIFE – SF-36 BDI effect size indicates how successful the treatment of depressive Upon admission Upon discharge After six months disorders has been. Any figure of 0.8 or above can be regarded as a consider­ able improvement. At our rehabilitation hospital, we achieve an effect size Target range of 0.85 – a very good value, which demonstrates how successful therapy is. 40.3 Total 41.7 physical score 45.1 25.1 Total psycho­ 34.6 EFFECT SIZE logical score 34.6

In t-scores 0 10 20 30 40 50 60

Effect size has proven a useful measure An SF­-36 survey measures quality of life in terms of physical and mental for assessing therapeutic success. The state well-being. The graph shows not only a considerable improvement over the course of treatment, but also – when surveyed again six months after of a patient upon admission is compared discharge – a stabilisation of the patients’ psychological condition, as well with their state when discharged. The greater as a positive development in their physical state. 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 2020 PSYCHOSOMATICS

DEVELOPMENT OF MENTAL AND PHYSICAL IMPAIRMENT (BSI) Upon admission Upon discharge

Normal Requiring treatment 67.5 Chiemseeblick 59.6

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. At our facility, the t-score drops to 59.6 points – and is therefore under the level requiring treatment. This represents an almost total abatement of symptoms. 81

BSI EFFECT SIZE

ACCEPTANCE AND Minor Medium Major Effects

COMMITMENT THERAPY Chiemseeblick 0.89

0.2 0.5 0.8 1.1 Acceptance and commitment therapy (ACT) is a new integrated form of psycho­ The BSI effect size achieved at Chiemseeblick is testimony to the careful, patient-centred work done by our rehabilitation hospital’s personnel. therapy in which classic techniques of A rating of almost 0.9 indicates significant therapeutic effectiveness. behavioural therapy with mindfulness- and acceptance-based strategies are combined with interventions on value clarification. The aim is to support patients in increasing their “psychological flexibility”. This means being able to behave in a value-oriented manner adapted to the situation. 86 PERCENT

of our formerly depressive patients leave our rehabilitation hospital in better spirits.

MEDICAL PARK QUALITY REPORT 2020 PSYCHOSOMATICS

ANXIETY DISORDERS

MANY OF OUR THERAPIES, SUCH AS THE ANXIETY MANAGEMENT PROGRAMME, ARE UNIQUE.

PATIENTS WITH ANXIETY DISORDERS IN 2019

Chiemseeblick 91

HEALTH-RELATED QUALITY OF LIFE – SF-36 DEVELOPMENT OF MENTAL AND PHYSICAL ( ) Upon admission Upon discharge After six months IMPAIRMENT BSI Upon admission Upon discharge

Target range 38.0 Normal Requiring treatment Total 41.0 physical score 64.5 51.2 Chiemseeblick 54.5

25.0 In t-scores 40 50 60 70 80 Total psycho­ 37.4 logical score 43.7 The figures show that mental and physical symptoms improve following In t-scores 10 20 30 40 50 60 inpatient psychosomatic treatment at Chiemseeblick specialist rehabilitation hospital. With a t­-score of 54.5, stress levels are now clearly An SF­-36 survey measures quality of life in terms of physical and mental in the inconspicuous range.

82 well-being. During treatment, we are able to put our patients on such a good path that, when surveyed again six months after discharge, they comfortably achieve the target range. BSI EFFECT SIZE

Minor Medium Major Effects

Chiemseeblick 1.04

0.2 0.5 0.8 1.1

Therapeutic success in figures: at Chiemseeblick specialist rehabilitation hospital, patients with anxiety disorders experience an effect size of 1.04. This means that treatment has a measurably good effect.

PD DR. ULRICH PALM SF-36 HEAD OF PSYCHOSOMATICS AT CHIEMSEEBLICK SF-36 is used to illustrate patients’ quality of life. Patients are asked “How do you measure how much about 36 items, such as mental well- a person enjoys life?” Admittedly, this being, general physical constitution is a difficult undertaking and we rely on indirect parameters. Various indicators and social contacts. A patient’s results help us in our evaluation. Ultimately, are compared against standard though, it is our patient who provides us figures. The process takes ten minutes. with the most important clues as to whether therapies have helped.”

MEDICAL PARK QUALITY REPORT 2020 PSYCHOSOMATICS

ADAPTATION DISORDERS

IN TERMS OF STAFFING AND FACILITIES, WE ARE CONTINUALLY EXPANDING OUR REHABILITATION HOSPITAL IN ORDER TO FURTHER PERSONALISE OUR TREATMENTS.

PATIENTS WITH ADAPTATION DISORDERS IN 2019

Chiemseeblick 170

DEVELOPMENT OF MENTAL AND PHYSICAL BSI IMPAIRMENT (BSI) (BRIEF SYMPTOM INVENTORY) Upon admission Upon discharge

Normal Requiring treatment This process measures the impairment experienced 60.7 by patients as a result of physical and mental symptoms, Chiemseeblick 52.7 over a period of seven days. It allows patients to see In t-scores 40 50 60 70 80 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 rehabilitation hospital, levels drop to 52.7. After their therapy, Figures of up to 60 are considered normal. our patients only feel low residual symptoms. 83

BSI EFFECT SIZE HEALTH-RELATED QUALITY OF LIFE – SF-36 Upon admission Upon discharge After six months Minor Medium Major Effects

Chiemseeblick 0.95 Target range 43.3 0.2 0.5 0.8 1.1 Total 47.6 physical score 49.8 With a rating of 0.95 points, effect size is comfortably in the 33.6 Total psycho­ 42.9 upper range. An outstanding result that our patients, suffering from logical score 40.0 very different psychological stress, achieve as a whole.

In t-scores 10 20 30 40 50 60

An SF­-36 survey measures quality of life in terms of physical and mental well-being. The psychological symptoms improve over the course of treatment and stabilise even six months after discharge with ratings in the target area. 88 PERCENT

of our patients with adaptation disorders experience sig- nificant improvement.

MEDICAL PARK QUALITY REPORT 2020 INDIVIDUAL TREATMENT As a wound expert, Katharina Pfroepffer treats chronic wounds. The specific treat­ ment is not only dependent on the type of wound, but also the individual reactions of the patients to the large range of dif­ ferent dressings: “For two people with the same syndrome, we may use different materials,” says Pfroepffer, “good com­ munication is a must here – and some­ times a creative solution, too.” NURSING

PROFESSIONALISATION Medical Park Bad Feilnbach Reithofpark is currently expanding its portfolio of professional wound management. Around 70 percent of all treatments are for patients with decubitus ulcers – the term refers to pressure sores that often arise due to poor position. But post- operative wound healing disorders, burns, inter­ trigo and diabetic foot syndrome are also treated professionally here. The type of treat­ ment and progress in the healing process are then recorded in the wound log. Wound experts generally train through the recognised Initiative Chronische Wunden (ICW) – and so did Katharina Pfroepffer. 85

“MY FAMILY DOCTOR WILL BE ASTONISHED OF THE SHAPE I AM IN WHEN I GET BACK HOME.” Wound management: the adequate care of chronic wounds is ever more important in rehabilitative medicine; new research successes help patients to return to health quicker. Insights into an area whose importance is increasing.

MEDICAL PARK QUALITY REPORT 2020 NURSING

“PATIENTS WITH CHRONIC WOUNDS REQUIRE SPECIAL CARE – THEY ARE MORE VULNERABLE TO INFECTIONS AND ARE NOT AS MOBILE.”

MARKUS LUNK, DIRECTOR OF NURSING AT BAD FEILNBACH REITHOFPARK

NUMEROUS BENEFITS Director of nursing Markus Lunk would like each of the five wards at Reithofpark to have its own wound care specialist in future. Due to the fast pace in acute hospitals, adequate follow-up wound care is not always ensured – “this then has to be compensated for in part by rehabi­litation hospitals like us.” Comprehen­ sive wound management is also the logical 86 consequence of a holistic treatment approach that sets Medical Park apart. The nurse sees an additional benefit of professionalisation in communication­ with family doctors – who can be brought up to speed on the respective treatment status quickly and seamlessly by inspecting the wound logs.

MEDICAL PARK QUALITY REPORT 2020 NURSING 87

WITH SURGICAL PRECISION Sixty-three-year-old Otto Paukner came to Reithofpark with a post-operative wound. A haematoma complicated healing. During a weekly check, expert Pfroepffer is happy to determine that the elongated wound pocket – initially five centimetres in size – has grown some way back. After she has cleaned the wound, she carefully inserts a tamponade that will support the open tissue from the inside and absorb bacteria. Paukner, meanwhile, is delighted at how healing has progressed. “It itches quite a lot, of course – but it’s good that I can feel something.”

MEDICAL PARK QUALITY REPORT 2020 NURSING

ADDRESSING COGNITION, TOO Sporting activity gets the circulation going and there­ fore also encourages wound healing. After the third week of treatment, physical exertion can be continual­ ly increased. Otto Paukner balances on the Cortex- Trainer. The plate under his feet reacts to every move­ ment. He gets feedback on the monitor immediately. “The special thing about this equipment,” explains 88 trainer Marko Mijic, “is that we can work on motor and cognitive abilities at the same time.”

“WE AIM TO DIS- CHARGE PATIENTS IN A BETTER PHYSICAL CONDI- TION THAN THEY WERE IN BEFORE THEIR ILLNESS.”

MARKO MIJIC, HEAD OF SPORTS THERAPY AT BAD FEILNBACH REITHOFPARK

MEDICAL PARK QUALITY REPORT 2020 NURSING

THE SORE POINT NEW WOUND DRESSINGS ABSORB “That is looking much better, Mr. Paukner!” Kath­ arina Pfroepffer has just removed her patient’s dress- BACTERIA AND ing and seems pleased. During their weekly check, the THEREFORE ENCOUR­ certified wound expert carefully examines the healing process each time – her eagle eye doesn’t miss a single AGE THE HEALING tiny detail. PROCESS.

Pfroepffer now asserts, without any surprise at all, that the wound pocket, which was initially five centi­ How did the change of dressing feel to Paukner? metres long, has shrunk and grown back a little “It didn’t hurt at all, although I can feel it, of course. more, and she cleans it with a wound disinfectant. She But it would also be bad if I didn’t notice anything then users some narrow tweezers to pick up a thin, at all,” says the 63-year-old, laughing. Otto Paukner, reed-green latticed piece of material and carefully in- a landlord in Offenbau, Franconia, is a tough cookie. serts it into the open wound pocket. “As you already An aneurysm with a diameter of 5.7 centimetres on know, Mr. Paukner,” explains Pfroepffer, “this tam- his left leg led to surgery – and ultimately also to ponade supports the wound pocket from the inside Paukner having his post-operative wound treated at and ensures that a hollow doesn’t form. At the same Medical Park Reithofpark. “When watching television, time, it absorbs bacteria.” A useful side effect of chan­ I suddenly experienced incredible pains in my left leg. ging the dressing: each time the old tamponade is re- After vascular dilatation was stopped at hospital and moved, bacteria that could hinder the wound heal- a vein was removed, I got a huge haematoma,” says ing process are carried out with it. After Paukner’s Paukner, summarising his history of ill health. “This wound on his thigh is filled with the green compress, haematoma prevented the wound from being able to Pfroepffer cuts the surplus material with a pair of close.” Paukner has been at Bad Feilnbach for two and sterile scissors, wraps the area with a dressing and seals a half weeks now and is completing his individually 89 it all with a compression plaster – all done. adapted rehabilitation programme of lymphatic drain- age, physio treatment and sporting activities in the gym. And, of course, his weekly wound check with Katharina Pfroepffer. He has a good feeling: “My fam- ily doctor will be astonished at the shape I’m in when I get home.”

Wound management has established itself as an inde- pendent clinical requirement over the past five years and is enjoying more and more attention thanks to new research successes. “It is fascinating what is going 1,000NURSES on in this field – research is now even being conduct- SUPPORT PATIENTS ed into biological wound dressings that can be manu- IN OUR CLINICS. factured from the body’s own blood,” says Katharina Pfroepffer. She treats all wounds that have become chronic and that have not healed within a maximum period of six weeks. Pfroepffer, who completed her training as a wound expert at the ICW (Initiative Chronische Wunden e. V.) six years ago, is enthusias- tic about the many possibilities: “Biological wound dressings are not yet used here, though; there are an awful lot of dressings that encourage the healing pro- cess – hydrogel, silver alginate or PU foam, to name but a few.” This diversity is necessary in order to opti- mally treat the large range of wound causes and types. Alongside patients with post-operative wound heal- ing disorders, Pfroepffer also treats those with inter- trigo – a weeping inflammation – large burns, and diabetic foot syndrome, and tends to decubitus ulcers,

MEDICAL PARK QUALITY REPORT 2020 NURSING

“the classic among wounds”. Seventy percent of all patients whom I treat come with varying categories of decubitus ulcer – this collective term refers to pres- sure sores.” DOCUMENTATION IS IMPORTANT 10,000 Pfroepffer’s constant companions are two A4 sheets LITRES OF DISINFECTANT of paper, whose Excel spreadsheets seem as finely meshed as the gauze dressing that she has put on Otto HELP US TO MEET Paukner this lunchtime. She adds every detail of the HYGIENE REGULATIONS – healing process to the wound log: how long and wide FOR THE SAFETY is the wound in question at the moment? Is there a OF OUR PATIENTS AND pocket formation, and if so, how deep is it? How is it EMPLOYEES. oriented? Is the edge of the wound intact or fissured? Or is it macerated? Swollen? How does the wound ex- udate look – meaning any secretion that the wound gen- erates itself? Is it transparent, cloudy or even bloody?

And, very importantly: what surface has the wound formed? Is it white and fibrinous or is it made of pus? The wound log tells all. Including, of course, A DIFFERENT whether additional measures are being taken, such PERSPECTIVE as compression therapy, a balanced diet or support aids – and which medical instructions are in place for the current therapy. Photographic documentation 90 taken at regular intervals during the healing process for the respective wound supplements the wound log.

“I get the most information from looking at the uncleaned wound,” the wound expert reveals. “And what I see before me determines how we care for the wound. For purulent wounds without pockets, a dress- ing of silver alginate makes the most sense, for ex­ ample. But be careful: this can lead to resistance, which is why I only use it for a maximum of two weeks.” This sounds like it follows causal logic, but is actually RALF HACKBARTH much more complex in reality. “Patients with the same DIRECTOR OF NURSING AT BERLIN symptoms can react very differently to the same HUMBOLDTMÜHLE treatment,” explains Pfroepffer. “But that is something “Of course, medical and therapeutic I find really nice about my job. In wound healing, care of the patient takes centre stage nothing goes according to the book. Here, good com- during rehabilitation. Nursing is intended munication with the patient is a must – and some- to keep the basis for therapeutic pro- times even a creative solution is, too.” gress in mind. We begin with activating nursing and see the mental and psycho­ logical condition of the patient from a different perspective during their stay. And we witness how important the interaction of all areas is for rehabilita- tion success.”

MEDICAL PARK QUALITY REPORT 2020 NURSING

A HOLISTIC APPROACH THREE QUESTIONS ON NURS- Markus Lunk is also aware of the increasing signifi- ING DURING REHABILITATION cance of professional wound management. The nurse at Reithofpark would like each of the total of five wards to have its own wound care specialist in future: “Patients with chronic wounds require special care because they are more vulnerable to infections, are not as mobile and can sometimes only take advantage of other types of therapy to a limited extent. For this reason, we have to look after them as well and as quickly as possible and get them back to fitness.” The fact that specially trained wound experts are now being increasingly used is also a result of the holistic treatment approach that Medical Park rehabilitation hospitals pursue. And there is also a highly pragmatic argument: “With precise wound logs, family doctors MARGUERITE LICHT can get a detailed picture of healing progression dur- DIRECTOR OF NURSING AT BAD CAMBERG ing aftercare.”

What distinguishes nursing during rehabilitation from that received OTTO PAUKNER’S in an acute hospital? CAVERNOUS Our contact with the patient is more intensive and longer than it is at the hos­ WOUND POCKET 91 pital. We do everything we can to HAS ALMOST convey security and trust. Our activating ENTIRELY REGROWN rehabilitation nursing is characterised by guiding and training interventions – UPON DISCHARGE. we thereby support the patients in returning to as independent an everyday life as possible. In Otto Paukner’s case, only a fleeting glance at the wound log was necessary for his family doctor follow- ing his discharge from Medical Park. “The pockets What is cooperation like with the had healed so nicely that they didn’t need to be pad- other occupational groups? ded with a dressing any more,” explains the landlord. We see ourselves as a large team that sup- Two weeks after he returned to his home in Fran­ ports the patient on their path to recovery conia, he was able to remove the dressing entirely. and that works together in a patient- Even the pinhead-sized dot – along with the large ori­ented and interdisciplinary way. Our wound pocket this was the second, considerably mutual appreciation thereby increases smaller, problem on Otto Paukner’s left leg – albeit and we have more of an understanding of deep and persistent, has now made significant pro- the work of other occupational groups. gress. As with the larger wound, lower layers of abundantly grainy granulation tissue have formed How challenging is the job of nursing here and the new, healthy skin has grown upwards. during rehabilitation? The sore point – has now healed. I find it very challenging. We are the only occupational group that takes care of the patient around the clock. Whether in intensive care, early neuro­ logical rehabilitation, orthopaedics or psychoso­matics – we always have a high degree of responsibility.

MEDICAL PARK QUALITY REPORT 2020 NURSING

PRESSURE SORES

OUR NURSING EXPERTS GAIN THEIR KNOWLEDGE AND ABILITY FROM TRAINERS RECOGNISED ACROSS GERMANY.

PATIENTS RECEIVING NURSING IN 2019

Berlin Humboldtmühle 4,136 Bad Camberg 2,004 Chiemsee 3,709 Loipl 1,881 Prien Kronprinz 3,275 Bad Rodach 6,173 Bad Feilnbach Reithofpark 3,671 ANTJE NEIDERHELL DIRECTOR OF NURSING AT BAD FEILNBACH Bad Feilnbach Blumenhof 4,283 BLUMENHOF Bad Wiessee St. Hubertus 6,330 Bad Wiessee am Kirschbaumhügel “Our specialist wound managers also train their Specialist Rehabilitation Hospital 1,309 colleagues in nursing and thus communicate expertise – always in line with current guidelines –

92 Bad Wiessee am Kirschbaumhügel Private Rehabilitation Hospital 851 in the healing of chronic wounds to more and more employees. I see that as a thoroughly positive Bad Sassendorf 2,917 development. We are in close dialogue with doctors, continually develop the therapy and can therefore treat the patients more individually.” 93 PERCENT MANUELA ERDMANN DIRECTOR OF NURSING AT CHIEMSEE of our patients are satisfied “A pressure sore is always an added affliction for with our nursing care.* the patient. We treat it with empathy and in accord- ance with clear guidelines. Our employees are *Average figure at Medical Park. trained in the implementation of the expert standard “care of people suffering from chronic wounds”. Thanks to our professional interdisciplinary cooper­ ation, we improve the patients’ quality of life.”

MEDICAL PARK QUALITY REPORT 2020 NURSING

PRESSURE SORE HEALED WITH TREATMENT FOUR GRADES In percent OF DECUBITUS ULCER

100 Decubitus ulcers, colloquially referred to as bedsores or pressure sores, result when the body is 80 77 positioned lying on one side, for example for a prolonged period of immobility following an operation 64 60 or stroke. The pressure to specific body parts 50 50 50 means that the skin no longer receives sufficient blood 40 40 39 flow, cells are damaged and the tissue dies off. Poor circulation is also a frequent consequence of cardiologic­

20 al illnesses and interventions: they put strain 11 on the blood vessels and weaken them in their function.

0 For diagnosis, an international classification model has been agreed upon with four categories that deter- Hum­ Bad Chiem- Loipl Prien Bad Reit­hof- Blumen- boldt­ Cam­ see Kron­ Rodach park hof mine the severity of the characteristics. 93 mühle berg prinz CATEGORY I A pressure sore can develop quickly, but therapy can sometimes be lengthy. All the more pleasing: in at least 40 percent of our patients, The skin is reddened but intact. The red area complete healing is achieved. In many cases, the numbers are generally occurs over a bony projection. The area can even higher depending on the severity at the beginning of treatment. be tender, hardened, soft, warmer or colder than the surrounding tissue. A pressure sore can result here if measures are not taken to prevent it. IMPROVEMENT IN DECUBITUS ULCER GRADE CATEGORY II In percent The skin is sometimes damaged to the dermis. It exhibits a dry or weeping flat ulcer with a red to pink 100 wound bed or a blister. 89 80 81 82 CATEGORY III 71 All skin layers are damaged. Subcutaneous fat – 64 60 57 lying directly under the skin – can be seen. Bones, 50 50 muscles or tendons are not visible.

40 CATEGORY IV

20 The tissue is totally destroyed. The bones, tendons or muscles are exposed. A surface layer and slough

0 may have formed at the wound site. Wounds in this category can spread to the muscles, facias, tendons and Hum­ Bad Chiem- Loipl Prien Bad Reit­hof- Blumen- boldt­ Cam­ see Kron­ Rodach park hof joint capsules. The depth of the pressure sore mühle berg prinz depends on where it occurs on the body.

The severity of a patient’s pressure sores is divided into four categories. Each improvement by one level in this classification system highlights the effectiveness of the healing process. We achieve this in more than two-thirds of our patients.

At the Bad Wiessee St. Hubertus specialist and private rehabilitation hospital and Bad Sassendorf, no pressure sores were treated in 2019.

MEDICAL PARK QUALITY REPORT 2020 “Lyra” is the key component of the “gait rehabilitation therapy centre” at Bad Rodach. It gets the paralysed patient walking again and conjures a smile on the face of therapists. THERAPY STEP BY STEP

Patients with restrictions in their ability to walk are hip surgery often use high-tech treadmills that re- back on their feet quickly again at Medical Park Bad lieve the strain on the joints by reducing weight, as Rodach. The new flagship project is the installation well as activating important muscle groups through of a “gait rehabilitation therapy centre”. In a spacious climbing. room, patients have access to more than a dozen co­ ordinated therapy devices for recovering their ability If possible, rehabilitation should begin while the to walk. The highly technical machinery serves only patient is still in bed. In the case of stroke patients in one purpose here: it should assist the patient in re- particular, early mobilisation is incredibly signifi- learning what appears to be the simplest thing in the cant because it allows neural connections to be revi- world: walking upright. talised. The chances of recovering the ability to walk are greatest within the first few months following an Gunter Hölig, head of therapy at Medical Park Bad acute event – or, as Hölig puts it: “Here, the old adage Rodach, is proud of the exclusive equipment and the ‘time is brain’ applies. The earlier suitable therapy specialist concept at the new Bad Rodach therapy begins and the higher the intensity of therapy, the centre: “Our offer at Bad Rodach is unique across greater the probability of a favourable progression. Germany – the pooling of various devices to form a During early rehabilitation, severely affected patients central location in the rehabilitation hospital facili- in particular are initially put into the position of being tates even better therapeutic successes than before, able to leave their bed by an interdisciplinary team as well as direct cooperation between several occu­ of psychologists, ergotherapists, speech therapists and 95 pational groups.” In the Upper Franconian thermal physiotherapists so as to be able to set themselves new town of Bad Rodach in the district of Coburg, people challenges. Simply getting up and standing for a few with neurological or orthopaedic pathologies train minutes after being bedridden for a long time can on the machines under the expert guidance of dedi- present a challenging objective. Even here, supporting cated sports therapists and physiotherapists. As a rule, equipment can come into play. Some patients, how­ the robotic devices are especially suited to patients ever, start therapy at Medical Park Bad Rodach im­ with neurological conditions such as a stroke, multiple mediately with machine assistance. The benefit of sclerosis or Parkinson’s disease in order to relearn the equipment-based gait therapy as opposed to physio- ability to work. By contrast, patients following knee or therapy without equipment is higher effectiveness and efficiency of treatment with regards to recovering walking ability. This was proven back in 2005 in the Deutsche Gangtrainer Studie (German gait training study – DEGAS). The main finding of this multi­ centre investigation was that 25 minutes of physio- therapy combined with 25 minutes of gait trainer therapy presented­ a significantly higher effect than two lots of 25 minutes of physiotherapy. These results have now been confirmed by numerous additional studies and have been included in guidelines for specialist neurological societies.

MEDICAL PARK QUALITY REPORT 2020 THERAPY

The superiority of combined therapy can be explained by the high degree of stimulus when working on the machines. An effect that the team at Medical Park Bad Rodach has known to take advantage of for a long time: “In robot-assisted therapy, some patients are able to complete 1,000 steps in 20 minutes,” explains Gunter Hölig, “which means 1,000 impulses for the brain, whereas the same patient would perhaps only manage 60 to 80 steps in the same amount of time walking level even with a very good therapist.”

The repetitive exercises take place, among other things, on a gait trainer, which bears the poetic name “Lyra” because of its special shape. “Lyra” is designed so that the patient’s feet are moved in exactly the same way as when walking normally. The patient is secured in a belt and is unburdened a little. The inbuilt sen- sors in the gait trainer, working in accordance with the so-called end-effector principle – “sense” if the patient wants to walk faster or slower and it adjusts itself immediately and automatically. The next step comes after successful therapy using the various equipment for gait rehabilitation: level walking on a “PATIENTS REQUIRE normal surface without support. A motorised walk- SPECIAL SUPPORT, WHICH ing frame is used to ensure this vital transfer step. The patient can use it to move about the room freely. The IS WHY WE CUSTOMISE device no longer provides support, but rather protec- THEIR THERAPY PLANS.” tion in the event of a stumble or fall. Thus secured, 96 an anxiety-free transfer of newly acquired walking DR. DIRK ZAUPER, ability to day-to-day life may be achieved. In accord- HEAD OF NEUROLOGY AT BAD RODACH ance with the specialist concept, the right equipment must be selected at the right time and taking into account the current situation and capability of the patient – the best results will then be achieved. Be- cause this selection may only be made by an experi- enced therapist, a certain change has taken place in the occupational profile. Gunter Hölig believes: “The successful therapist will best support the patient on their journey with a combination of empathy, expert­

With the “e-go”, our patients can learn to walk again safely and without the danger of falling. It is just one of a num­ ber of training devices in Bad Rodach’s therapy centre.

MEDICAL PARK QUALITY REPORT 2020 THERAPY

Rehabilitation begins when the pa­ tient is still in bed. For stroke patients in particular, it is incredibly import­ ant that the neural connections are revitalised with early mobilisation. The earlier therapy begins, the better rehabilitation progresses.

ise, experience and state-of-the-art technology. They “Anyone wanting to learn to walk has to walk” – the should therefore see themselves as a pilot and man­ maxim of neurological authority Professor Stefan ager, because a machine cannot know the patient or Hesse also applies to the orthopaedic sector. Among their goals.” Furthermore, personal care and tailored other things, Dr. Hans-Jürgen Mees is responsible for motivation by the therapist remain irreplaceable pathologies and the consequences of accidents to the for patients with a neurological background, such as pelvic area and the lower extremities at Medical Park people suffering from a stroke. Bad Rodach. For the head of orthopaedics, follow-up treatments after artificial joint replacement and after Nobody knows this better than Dr. Dirk Zauper, head injuries or other surgery to large joints and the spine 97 of neurology: “The patients in our field always need are especially important, as are rehabilitation measures very specific assistance because of their paresis – signs in orthopaedic pathologies. In the state-of-the-art of paralysis – and that is reflected in the therapy plans equipment at Medical Park Bad Rodach, Dr. Mees sees that I design individually.” Any restriction in walk- a clear location benefit: “With the antigravity treadmill ing resulting from a functional disruption in the brain Alter-G, a physiological gait pattern is trained on a or peripheral nervous system can therefore by treat- level surface and also at an incline – at the same time, ed at Medical Park Bad Rodach: “Among others, we the prescribed unburdening of body weight by up to help patients with multiple sclerosis, myasthenia – a 90 percent can be satisfied.” Common rehabilitation special type of muscle disorder – or those who have standards, such as unburdening via crutches or in the undergone long-term treatment with a severe pro- exercise pool are, according to Mees, “not comparable. gression, as with COVID-19 patients recently, as a They lack the precision of the Alter-G”. follow-up.” It is not just the evidence-based therapy methods, Our absolute priority here is to develop standing first which are always state of the art, that speak for them- of all, because not all people with a neurological back- selves at Bad Rodach. It is also the rehabilitation hos­ ground can easily stand up straight. As soon as this pital’s location in the gentle hills of Upper Franconia has been relearnt and initial progress can be targeted with its wide meadows and green woods. Dr. Zauper, in gait development, the upper extremities form the head doctor, puts it like this: “The best therapeutic next focus of therapy. “The more strongly the arms expertise used to be the preserve of the metropolitan swing along physiologically, the easier walking be- regions; today, you can get back to your feet in no comes,” says Dr. Zauper, “a fact that, sadly, has long time in tranquil, natural surroundings.” been neglected in Germany – and this is still the case.” Parkinson’s patients in particular would benefit con- siderably from this therapeutic focus.

MEDICAL PARK QUALITY REPORT 2020 PATIENT RATING

91PERCENT of our patients recommend us to others.* *Average figure at Medical Park. 98

In Percent

93.6 94.5 93.6 89.3 90.1 88.4 89.8 88.4 85.8 84.6 85.9 82.0 82.1 8 1 % current average in Germany**

Bad Feiln­ Bad Berlin Bad Chiem- Chiem- Bad Bad Bad Loipl Prien Bad Bad bach Sassen­ Hum­- Camberg see seeblick Wiessee Wiessee Wiessee Kronprinz Rodach Feilnbach Blumen­ dorf 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 2020 PATIENT RATING

MANUELA ERDMANN DIRECTOR OF NURSING

HOW SATISFIED WERE YOU WITH THE REHABILITATION HOSPITAL FACILITIES “We help patients to work AND YOUR ACCOMMODATION? through illnesses or accidents Average rating and to find their way back

Bad Feilnbach 1.57 Blumenhof to their former everyday life,

Bad 1.81 Sassendorf or a new one. The more

Berlin Hum­ 1.51 boldtmühle independent the patient gets,

Bad Camberg 1.59 the greater the success.”

Chiemsee 1.34 99

Chiemseeblick 1.23

Bad Wiessee 1.38 St. Hubertus HOW SATISFIED Bad Wiessee 1.80 Spec. Clinic WERE YOU WITH YOUR Bad Wiessee 1.40 NURSING CARE? Private Clinic Average rating Loipl 1.53

Bad Feilnbach Prien 1.65 1.33 Kronprinz Blumenhof

Bad Bad Rodach 1.42 1.46 Sassendorf

Berlin Hum­ Bad Feilnbach 1.74 1.39 Reit­hofpark boldtmühle

1 * 1 2 3 4 5 Bad Camberg 1.52

Chiemsee 1.14

Chiemseeblick 1.62

Bad Wiessee 1.37 St. Hubertus

Bad Wiessee 1.40 Spec. Clinic

Bad Wiessee 1.09 Private Clinic

Loipl 1.49

Prien 1.12 Kronprinz

Bad Rodach 1.29

Bad Feilnbach 1.46 Reit­hofpark

1 * 1 2 3 4 5

MEDICAL PARK QUALITY REPORT 2020 PATIENT RATING

HOW SATISFIED WERE YOU WITH OUR COOKING AND SERVICE?

Average rating

Bad Feilnbach 1.35 Blumenhof

Bad 1.41 Sassendorf

RALPH JUNG Berlin Hum­ 1.51 EXECUTIVE CHEF boldtmühle Bad Camberg 1.33 “Service is perfect Chiemsee 1.43 when nobody notices it, Chiemseeblick 1.27 Bad Wiessee 1.80 but nobody misses it. St. Hubertus Bad Wiessee 1.48 It belongs just as much to Spec. Clinic Bad Wiessee 1.19 rehabilitation as good, Private Clinic healthy food.” Loipl 1.51 Prien 1.50 Kronprinz

Bad Rodach 1.43

Bad Feilnbach 1.31 Reit­hofpark 100 HOW SATISFIED WERE YOU WITH YOUR 1 * 1 2 3 4 5 THERAPEUTIC TREATMENT?

Average rating

Bad Feilnbach 1.36 Blumenhof

Bad 1.46 Sassendorf

Berlin Hum­ 1.27 boldtmühle

Bad Camberg 1.26

Chiemsee 1.18

Chiemseeblick 1.52 GUNTER HÖLIG Bad Wiessee 1.24 DIRECTOR OF THERAPY St. Hubertus

Bad Wiessee 1.25 Spec. Clinic

Bad Wiessee 1.03 Private Clinic “We therapists should

Loipl 1.10 also see ourselves as pilots and

Prien 1.30 Kronprinz managers. We best support

Bad Rodach 1.28 patients with a combination of

Bad Feilnbach 1.57 Reit­hofpark empathy, expertise, experi- 1 * 1 2 3 4 5 ence and state-of-the-art technology.”

MEDICAL PARK QUALITY REPORT 2020 PATIENT RATING

PROF. (DHFPG) DR. MED. THOMAS WESSINGHAGE MEDICAL DIRECTOR, HEAD OF ORTHOPAEDICS, REHABILITATION MEDICINE, SPORTS MEDICINE HOW SATISFIED WERE YOU WITH YOUR STAY AT THE REHABILITATION HOSPITAL AS A WHOLE?

“Rehabilitation is hard work Average rating for the patient – with six Bad Feilnbach 1.37 to eight therapy sessions a day. Blumenhof Bad 1.56 Pleasant surroundings and Sassendorf Berlin Hum­ 1.43 good service can have a very boldtmühle motivating effect.” Bad Camberg 1.46

Chiemsee 1.25 101

Chiemseeblick 1.55

Bad Wiessee 1.47 St. Hubertus HOW SATISFIED WERE Bad Wiessee 1.53 YOU WITH YOUR PHYSICIANS Spec. Clinic AND MEDICAL CARE? Bad Wiessee 1.23 Private Clinic Average rating Loipl 1.42

Bad Feilnbach 1.29 Prien Blumenhof 1.42 Kronprinz Bad 1.52 Sassendorf Bad Rodach 1.39

Berlin Hum­ 1.40 Bad Feilnbach boldtmühle 1.56 Reit­hofpark

Bad Camberg 1.53 1 * 1 2 3 4 5

Chiemsee 1.21

Chiemseeblick 1.87

Bad Wiessee 1.54 St. Hubertus

Bad Wiessee 1.46 Spec. Clinic

Bad Wiessee 1.20 Private Clinic

Loipl 1.67

Prien 1.31 Kronprinz

Bad Rodach 1.40

Bad Feilnbach 1.51 Reit­hofpark

1 * 1 2 3 4 5

MEDICAL PARK QUALITY REPORT 2020 PUBLICATION DETAILS

PUBLISHER MEDICAL PARK SE, AMERANG

DATA COLLECTION MEDICAL PARK REHABILITATION HOSPITALS

DATA EVALUATION MEDICAL PARK SE, JOHANNES KNEISSL

EDITORIAL MANAGEMENT MEDICAL PARK SE, MARKUS HANSER

CONCEPT/EDITING/DESIGN ANZINGER UND RASP, MUNICH

AUTHORS JAN BERNDORFF ANDRÉ BOSSE MICHAEL GRIMM PHILIPP HAUNER ELISA HOLZ ANNA PATACZEK

PHOTOGRAPHY URS GOLLING, KREUTH

LITHOGRAPHY MXM, MUNICH 102 PRINTING WEBER OFFSET GMBH, MUNICH

FOR QUERIES ABOUT THE QUALITY REPORT: JOHANNES KNEISSL TEL. +49 (0 ) 8075 91311-0 [email protected] JÜRGEN FABIAN INDRA FÖRG

FOR QUERIES ABOUT THE REHABILITATION HOSPITALS: ANDREA FRITZ, BAD RODACH FRANZISKA GORAL, BERLIN HUMBOLDTMÜHLE CORNELIA HOJA, BAD WIESSEE VERONIKA MAIER, CHIEMSEE AND PRIEN KRONPRINZ MICHAELA SCHACH, LOIPL MILICA SIMON, CHIEMSEEBLICK KATRIN STRASSER, BAD FEILNBACH ANITA STRUNK, BAD SASSENDORF ISA WEIMAR, BAD CAMBERG

THIS REPORT CONTAINS DATA FROM 2019. ALMOST ALL PATIENTS TREATED AT MEDICAL PARK REHABILITATION HOSPITALS 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 2020 GLOSSARY

We collect a lot of data and measure, compare and evaluate. We present the results to you on the blue fact page for the individual specialist areas. To make reading the data easier, the pages are presented in a similar way and the majority of the graphs follow a uniform pattern. Here, we always present the values comparing rehabilitation hospitals in the respective specialist area.

ORTHOPAEDICS Specialist medical area

KNEE REPLACEMENT AFTER OSTEOARTHROSIS Pathology

PATIENTS WITH KNEE REPLACEMENT AFTER OSTEOARTHROSIS IN 2019

Bad Wiessee St. Hubertus 515 Rehabilitation hospital and patient numbers in this pathology and in 2019

EQ-5D INDEX Quality indicator Upon admission Upon discharge After six months Time of collection Upon admission: the first collection 59.5 Bad Wiessee 75.6 takes place at the very start of therapy. St. Hubertus 82.1 Upon discharge: the measurement is 60.7 Bad Wiessee 73.7 repeated at the end of the stay. Spec. Clinic 72.5 61.2 Bad Wiessee 77.0 Private Clinic 89.4 After six months: systematic follow-up sur- 59.3 veys take place at Medical Park rehabilitation Chiemsee 72.6 77.8 hospitals. For us, it is especially important to 59.7 know the state of our patients’ health after their Prien 73.1 Kronprinz 81.2 stay. All patients therefore receive mail from us 60.5 after six months. With the health-related question- Bad Rodach 75.9 74.8 naire EQ-5D, for example, we survey how pa- 62.5 tients assess their quality of life, whether this has Berlin Hum­ 73.6 boldtmühle 76.1 changed vis-à-vis the stay at one of our facilities 59.4 or whether this corresponds to its status upon dis- Bad Feilnbach 76.3 Reithofpark 74.1 charge. We learn from the answers provided 58.6 by the patient and use the findings to improve Bad 68.1 Sassendorf * the offer at our rehabilitation hospitals. This

40 50 60 70 80 90 is unique in the field of rehabilitation hospitals.

Five conclusions are drawn regarding quality of life, including mobility, leisure activities and pain. Measurements are taken three times. The process is gratifying, even six months after discharge: the values remain largely stable or even improve. On average, patients achieve 78.5 points – a good quality of life. Scale Here, we provide the units underlying the quality measurement. QUALITY INDICATORS AND PAGE REFERENCES

In medicine, measurement takes place using so-called indicators. Depending on the specialist area and pathology, various indicators exist that allow the severity and intensity of an illness to be measured. These indicators can also often be used to present the progression of an illness – and thus even to measure the quality and success of the medical, therap­ eutic and nursing treatment, in other words: quality indicators. Our rehabili­ tation hospitals and specialist areas have used the following indicators. The precise description can be found on the corresponding page.

ORTHOPAEDICS Functional Ambulation Categories (FAC) Pain scale These measure a patient’s ability to walk (page 52). We use it to measure the subjective intensity of the patient’s pain. The patient marks their current Community Ambulatory Index (CAI) experience of pain on a scale (page 27). By measuring walking speed, it is possible to make statements about a patient’s ability to participate in Stair climbing everyday life (page 53). Using a five-point scale, the therapist assesses the patient’s ability to climb stairs (page 27). Six-minute walking test An instrument for assessing physical capability Ten-metre walking test (page 55). Speed is calculated using the time it takes for the patient to walk ten metres (page 29). INTERNAL MEDICINE EQ-5D Index New York Heart Association (NYHA) Using five factors, the health-related quality of life Cardiac insufficiency is divided into four levels of the patient is measured (page 33). here that can provide information on the patient’s impairment (page 69).

NEUROLOGY Barthel Index PSYCHOSOMATICS An assessment method for a patient’s independ- Beck Depression Inventory (BDI) ence during everyday activities (page 51). This test method measures the severity of depressive illnesses (page 80). Early Reha Barthel Index The Barthel Index is expanded to include Brief Symptom Inventory (BSI) parameters used for evaluation in the early phases Over the previous seven days, the subjective of rehabilitation (page 49). impairment of the patient through physical and psychological symptoms is measured (page 83). Rivermead Mobility Index The patient’s mobility is measured using a points Short Form Health Questionnaire (SF-36) system (page 50). This indicator serves to record health-related quality of life (page 82). “The health system in Germany is outstanding – this has also been demonstrated during the corona pandemic. In this country, patients did not need to fear a shortfall in care. When caring for patients suffering from COVID-19, the rehabilitation hos­ pitals played a significant role alongside acute hos­ pitals. When returning to normality – albeit one that has altered – rehabilitation following oper­ ations and illnesses will be in higher demand again. When looking for the right rehabilitation hospital, the Medical Park Group quality report, in its third edition, once again offers orientation to patients, loved ones, doctors and health insurance providers. New and unique in the world of rehabilitation is the fact Medical Park now surveys and records the patients’ condition six months after their stay. An im­portant criterion in this decision – for your health.”

PROF. DR. MED. KARL MAX EINHÄUPL FORMER CHAIRMAN OF CHARITÉ UNIVERSITÄTSMEDIZIN BERLIN MEMBER OF THE BOARD OF MANAGEMENT AND MEDICAL ADVISORY BOARD AT MEDICAL PARK