The impact of the Covid-19 pandemic on the effectiveness of psychosomatic rehabilitation in Germany.

BACKGROUND: The aim of the present study is to investigate the impact of the Covid-19 pandemic on the effectiveness of psychosomatic rehabilitation. METHODS: Between April 2019 and March 2022, a total of 18,388 patients from 7 rehabilitation centres could be included in the study. For each patient, score values from the HEALTH-49 and ICF AT-50 Psych questionnaires were calculated at the beginning and at the end of rehabilitation and the effectiveness of the rehabilitation program was determined by comparing the scores at the beginning and at the end of the rehabilitation programme. Using risk adjusted linear mixed models, three time intervals were compared: a pre-pandemic episode (April 2019 to March 2020), the first year of the pandemic (April 2020 to March 2021) and the second year of the pandemic (April 2021 to March 2022). RESULTS: Overall, it can be stated that the pandemic has substantially impaired the effectiveness of psychosomatic rehabilitation measures. This phenomenon can be observed across a wide range of psychosocial markers and even two years after the start of the pandemic there is no end to the limited effectiveness. With regard to 'psychological and somatoform disorders', for example, there was a relative decrease in the effectiveness of the rehabilitation measure by 11.29% in the first year of the pandemic compared to the pre-pandemic episode, p < 0.001. In the second year of the pandemic, the effectiveness of the rehabilitation measure was still decreased by 8.8% compared to the pre-pandemic episode, p < 0.001. In addition, the evaluations show that a division of the pandemic effect into direct effects (on the individual) and indirect effects (via further complication of the occupational problem environment) can be made and that the pandemic-related complication of the occupational problem environment are still prevalent more than two years after the start of the pandemic. DISCUSSION: The Covid-19 pandemic has had a significant impact on the psychosomatic rehabilitation programs reducing the effectiveness of treatment not only for a short period of time but constantly until March 2022. TRIAL REGISTRATION NUMBER: DRKS00029669; Date of registration: 02/08/2022.

[Indication and Prevalence of Inpatient Psychosomatic-Psychotherapeutic Rehabilitation in Patients in Outpatient Psychotherapy Data from a Study on the Epidemiology of Care]. / Stationäre psychosomatisch-psychotherapeutische Rehabilitation und ambulante Richtlinienpsychotherapie ­ Ergebnisse einer versorgungsepidemiologischen Untersuchung.

BACKGROUND: Outpatient psychotherapy is qualitatively and quantitatively an important treatment option for patients with psychological disorders. Additionally, there is the option of inpatient care, including psychosomatic rehabilitation units. There is a lack of data on the cooperation between the ambulatory and the inpatient sector, and on which patients in outpatient psychotherapy have already been in psychosoamtic rehabilitation or should be admitted. METHOD: 131 psychotherapists were interview with regard to 322 cases they had recently seen with focus on the ongoing treatment, previous rehabilitation-treatments and current indications for rehabilitation programs. RESULTS: Almost all patients were suffering from year long disorders. More than every second patient had problems at work. Together, these are core criteria for psychosomatic rehabilitation. 28% had already been in inpatient rehabilitation and another 28% were seen in need of inpatient rehabilitation. Comparison of patients who had been, were in need, or did not need such treatment showed that rehabilitation patients were older, had a lower education, were more severe ill, showed a more problematic course of treatment, had more problems with participation and needed more socio-medical support. DISCUSSION: Results suggest that psychotherapists treat many patients, who fullfilled admission criteria for inpatient rehabilitation. They are important cooperation partners of rehabilitation units. Pension and health care insurance should support cooperation. Because of the great number of patients there is also the need to sharpen the criteria for inpatient treatment.

[Psychosomatic Rehabilitation for Post-COVID]. / Psychosomatische Rehabilitation bei Post-COVID.

Aim of the study Post-COVID is characterized by a large number of different symptoms. The indication for medical rehabilitation is based on the main symptom. Insured individuals who suffer from fatigue and have no relevant organic disorder are often rehabilitated in psychosomatic clinics. In the present study, the effectiveness of psychosomatic rehabilitation in patients with post-COVID will be investigated. Methods 91 patients with post-COVID are compared to 124 patients with mental disorders and 68 patients with cancer regarding the improvement of fatigue and depressiveness as well as satisfaction and socio-medical parameters. Results At admission, the level of fatigue did not differ in the three groups and was equally reduced. Patients with post-COVID and high depression scores at admission had clinically significant levels of fatigue at discharge. The proportion of patients with mental disorders who were discharged with a negative prognosis for employment was significantly increased. Discussion Although psychosomatic rehabilitation can reduce fatigue, the proportion of patients suffering from fatigue with post-COVID at discharge is still high. Conclusion The treatment concept for the rehabilitation of patients with post-COVID must take into account the often individual course of the disease. Psychosomatic rehabilitation can make an important contribution here.

Psychokardiologie ­ aus praktischer und klinischer Sicht.

In order to treat and research the development, progression, therapy and prevention of cardiological and psychosomatic disorders and their interactions, the field of psychocardiology has been established in recent years and now offers several treatment options.The well-known somatic risk factors for cardiovascular diseases such as smoking, diabetes mellitus, arterial hypertension and acquired or congenital lipid metabolism disorders, lack of exercise, malnutrition and sleep-related disorders are often related to psychosocial risk factors. Conversely, mental illnesses such as depression and post-traumatic stress disorder can also be viewed as independent risk factors for cardiovascular diseases.Somatic illnesses can, in turn, result in significant psychological reactions that have a severely negative impact on the course of the disease, participation and quality of life.In addition to the scientific research into these connections, psychocardiology offers a clinical specialty that questions, diagnoses and provides treatment for psychosocial connections in cardiovascular patients.The aim of this article is primarily to convey clinical and practical aspects of psychocardiology and the most important psychological comorbidities in connection with heart disease. In addition, it should be shown which therapeutic offers are available in the medical care structures and how therapy can be carried out. Psychotherapy and exercise therapy are preferred for the treatment of these comorbid disorders. The possibility of psychopharmacological therapy for cardiovascular patients is also presented, especially because of possible problematic medication interactions.

[Rehabilitation success after psychosomatic rehabilitation as a function of psychotherapy dose]. / Rehaerfolg nach psychosomatischer Rehabilitation in Abhängigkeit von der Psychotherapiedosis.

BACKGROUND: Increasing the effectiveness of psychosomatic rehabilitation by prolonging the treatment is a subject of controversial debate. The number of sessions over time defines the dosage in psychotherapy. While the dose-response model assumes an optimal therapy dose, the good-enough level model assumes a correlation of the rate of change with the total sessions. A randomized control group study was conducted to investigate the extent to which an adaptive therapy concept with a two-week intensive phase and early intervention could increase rehabilitation success. METHOD: A total of 494 rehabilitants between the ages of 21 and 64 (47% women) who completed a classical or an integrative psychosomatic rehabilitation at the Rehazentrum Oberharz between 2020 and 2022 were analysed. Rehabilitation success was mapped by the Reliable Change Index of individual symptom reduction (depression severity or psychological and somatoform disorders) and as a socio-medical parameter (physician's assessment of potential work ability (WA) after two weeks). Two-factorial ANOVAs and hierarchical binary logistic regressions were calculated, and sick leave before rehabilitation was statistically controlled. RESULTS: Dosage showed no effect on symptom reduction (p = 0.29) and potential WA after two weeks (p = 0.90). However, when stratified by disease severity, there was a mean effect of dosage (p = 0.05) and twice the probability of WA after two weeks (odds 2.13; p = 0.01) for those with mild disease at the start of measure (p = 0.05). DISCUSSION: In the early stages of an affective disorder, early and intensified intervention can counteract the chronification of mental disorders.

[Not Only Multimodal, but also Interdisciplinary: A Concept for Interdisciplinary Cooperation in the Rehabilitation of Post-COVID Syndrome]. / Nicht nur multimodal, sondern auch interdisziplinär: Ein Konzept für fächerübergreifende Zusammenarbeit in der Rehabilitation des Post-COVID-Syndroms.

Currently (March 2022), more than 17 million people in Germany have been infected with the SARS-CoV-2 virus. It is expected that 5-10% of those infected will develop a clinically relevant post-COVID syndrome. The most common symptoms are fatigue, dyspnoea and cognitive impairment. A causal therapy is currently not available, but there is increasing evidence that a multimodal treatment approach with psychotherapeutic elements is promising. Post-COVID is thus a current challenge for the health care system and especially for rehabilitation. This article describes a dual internal psychosomatic rehabilitation concept. The core elements are a behavioural therapy-oriented, disorder-specific psychotherapy group as well as exercise therapy that is adapted to the individual's capacity and slowly builds up. The goals are support in coping with the illness and an improvement in performance. Interventions based on ACT and the Avoidance Endurance Concept are used. In addition, respiratory therapy, cognitive training as well as nutritional and social counselling are offered on an indicative basis. The internal medicine team provides the patients with the security of being able to engage in the physical training programme. Experience so far shows that the concept is well accepted by the patients and that the intended treatment goals can be achieved.

[Need for Action and Research in Psychosomatic and Orthopaedic Rehabilitation from the Point of View of Rehabilitants and Individuals who work in Rehabilitative Care]. / Handlungs- und Forschungsbedarf in der Psychosomatischen und Orthopädischen Rehabilitation aus der Sicht von Rehabilitand:innen und Mitarbeitenden in der Rehabilitation.

PURPOSE: The aim of this study was to assess the need for practical action and research in psychosomatic and orthopaedic rehabilitation from the perspective of rehabilitants and individuals who work in rehabilitative care. METHODS: The project was divided into an identification and a prioritization phase. In the identification phase, 3872 former rehabilitants, 235 employees from three rehabilitation clinics and 31 employees of the German Pension Insurance Oldenburg-Bremen (DRV OL-HB) were invited to participate in a written survey. The participants were asked to name relevant needs for action and research for psychosomatic and orthopaedic rehabilitation. The answers were evaluated qualitatively using an inductively developed coding system. Practical fields of action and research questions were formulated from the categories of the coding system. In the prioritization phase, the identified needs were ranked. For this purpose, 32 rehabilitants were invited to a prioritization workshop and 152 rehabilitants, 239 clinic employees and 37 employees of the DRV OL-HB to a two-round written Delphi survey. The resulting prioritized lists from both methods were combined into a top 10 list. RESULTS: In the identification phase, 217 rehabilitants, 32 clinic employees and 13 employees of the DRV OL-HB participated in the survey, in the prioritization phase, 75 rehabilitants, 33 clinic employees and 8 employees of the DRV OL-HB in both survey rounds of the Delphi survey, and 11 rehabilitants in the prioritization workshop. A need for practical action primarily in the implementation of holistic and individual rehabilitation, in quality assurance and in the education and participation of rehabilitants was identified, as also a need for research primarily on access to rehabilitation, structures in the rehabilitation setting (e. g., inter-agency cooperation), the design of rehabilitative interventions (more individualized, more suitable for everyday life), and the motivation of rehabilitants. CONCLUSION: The identified needs for action and research include many topics that have already been identified as problems in previous research projects and by various actors in rehabilitation. In the future, there needs to be increased focus on the development of strategies for dealing with and solving the identified needs, as well as on the implementation of these strategies.

[Effectiveness of Psychocardiological Care in Inpatient Rehabilitation: A Pilot Study]. / Effektivität von psychokardiologischer Versorgung in der stationären Rehabilitation ­ ein Pilotprojekt.

An integrative patient-centered care concept is increasingly demanded for treatment of cardiac patients with concomitant mental disorders. The present study aims to investigate the effect of an integrated concept of psycho-cardiac care (PK) versus a monodisciplinary cardiac (K) or psychosomatic (PSO) care. Patients were examined at baseline (T0), at the time of discharge from the rehabilitation program (T1) and after 6 month (T2). General anxiety, depression (HADS), cardiac anxiety (HAF) and quality of life (SF-12) were evaluated using computer-assisted questionnaires. A total of 93 patients were included (PK: n=37, 55.5 years SD=8.0, 43.2% female; K: n=32, 53.6 years SD=8.2, 34.4% female; PSO: n=24, 55.5 years SD=5.0, 45.8% female). Patients in the PK-group showed a significant reduction of heart-focused anxiety (HAF fear p=0.004) and a significant improvement in quality of life (SF-12 physical p=0.034) during follow-up. In contrast, these parameters remained unchanged in patients in the K- and PSO-groups. The results indicate that cardiac-patients with concomitant mental disorders benefit only from an integrated psycho-cardiac treatment concept. The findings provide first data to psycho-cardiac treatment in stationary rehabilitation and support previous clinical experiences. But further research is required to show the advantage of a psycho-cardiac concept towards monodisciplinary care.

[Relationship Between The Use of Psychosomatic Rehabilitation and Regional Capacities for Medical and Psychotherapeutic Treatment of Mental Disorders in Westphalia]. / Zusammenhang des Antrags- und Bewilligungsgeschehen in der psychosomatischen Rehabilitation mit der regionalen medizinischen und psychotherapeutischen Versorgung in Westfalen.

BACKGROUND: Regional disparities in mental health care are well known and become apparent in inadequate treatment capacities and long waiting time for psychotherapeutic treatment. Hence, the authors assume that there is a shift from curative to rehabilitative care. Accordingly, the purpose of this study was to analyze the relationship between regional treatment capacities and the use of psychosomatic rehabilitation on behalf of the German Statutory Pension Insurance Westphalia (i. e. DRV Westfalen) in 2013. METHODS: Regional data on medical and psychotherapeutic care within the purview of DRV Westfalen were drawn from public databases. Data on application and approval processes in psychosomatic rehabilitation as well as data on demographic and insurance-related traits, such as periods of insurance, were provided by DRV Westfalen for 2013. Logistic 2-level models were conducted. RESULTS: Regional data showed that poor medical care was associated with a significantly higher chance of applying for rehabilitation. The demographic and insurance-related traits of the applicants were significantly related both with the application for and approval of psychosomatic rehabilitation. Persons with a discontinuous work biography in 2013 had a higher chance for application for and approval of psychosomatic rehabilitation. No significant correlation of regional treatment capacities and the approval of applications for psychosomatic rehabilitation could be found. CONCLUSION: The results show that decisions on applications for psychosomatic rehabilitation basically depend on the personal health situation of the applicants. An increased application and approval rate in areas with poor medical care can be interpreted as compensatory means which indicate a need for improvement in regional care of mental disorders.

[Wisdom Attitudes and Coping In Life of Psychosomatic Patients]. / Weisheitseinstellungen und Lebensbewältigung bei psychosomatischen Patienten.

BACKGROUND: Wisdom is a capacity, which is needed in coping with difficult problems in life. It can be understood as a special type of problem solving skill. It is getting growing recognition in psychology in general, and in psychotherapy and clinical practice in particular. Goal of the present study is to assess wisdom competencies and their correlates in psychosomatic patients, using for the first time the 12-WD-scale. METHOD: The 12-WD-Scale covers 12 wisdom dimensions. As part of their routine intake assessment, 202 unselected inpatients of a department of psychosomatic medicine filled in the 12-WD-scale together with the differential life burden scale, the global belief in a just world scale and the posttraumatic embitterment scale. Additional patient and clinical data could be taken from the routine data. RESULTS: Wisdom scores showed a normal distribution. The mean was in the positive range (4.50, SD=0.71). A factor analysis showed three factors (sobriety, serenity, modesty), explaining 53.7% of the total variance. There were positive correlations of the wisdom score with life satisfaction and age, negative correlations with beliefs in justice and embitterment, but not with formal education. DISCUSSION: The results of the 12-WD-Scale show that psychosomatic patients appreciate wisdom attitudes and that this is associated with better coping in life. Wisdom competencies are an interesting field in psychotherapy when patients are burdened by difficult situations in life. The 12-WD-scale can provide helpful information in this regard.

[Indication for Inpatient Psychosomatic Rehabilitation in Primary Care Patients with Chronic Mental Disorders and Participation Impairments]. / Indikation zur stationären medizinischen Rehabilitation bei Hausarztpatienten mit chronischen psychischen Erkrankungen und Teilhabebeeinträchtigungen.

BACKGROUND: Mental disorders often result in social and occupational participation restrictions, which may be an indication for an inpatient psychosomatic rehabilitation treatment. These patients are usually treated by general practitioners, who function as an important gate keeper in the pathway to rehabilitation treatment. The question is which patients receive an inpatient treatment, and which do not. METHOD: A prototypically representative sample of 307 patients with chronic mental disorders from 40 general practitioners were examined by a psychosomatic consultant. The investigation included the medical history, treatment status, illness status, capacity status and participation impairment. The psychosomatic consultant gave a recommendation whether an inpatient rehabilitation was indicated or not. RESULTS: 64% of the patients with chronic mental disorder had not received an inpatient rehabilitation in the past 5 years and there was no present indication. In 5.2% of cases an inpatient rehabilitation had been done before, but there was no indication for a renewal. In 27% there was no rehabilitation in the past five years but now seen indicated. In 3.6% there was an inpatient rehabilitation in the past and a renewed indication now. Patients who had already been in inpatient rehabilitation in the past 5 years were more severely ill and had more severe participation problems. Patients with present indication for rehabilitation had acute work-related problems. Capacity and participation impairment was an important factor to discriminate between patients with and without a present indication for an inpatient rehabilitation. In 13 out of 35 patients who got a recommendation for a new psychosomatic rehabilitation, this rehabilitation was initiated within 6 months after the consult. CONCLUSION: General practitioners play a central role in long-term treatment of mental disorders. Rehabilitation orientation, i. e. a participation-oriented treatment perspective, should be encouraged in the primary care setting.

[Change of Symptom Severity and Functioning According to ICF in the In-Patient Psychosomatic Rehabilitation]. / Veränderung der Symptombelastung und der Funktionsfähigkeit gemäß ICF in der stationären psychosomatischen Rehabilitation.

BACKGROUND: In this naturalistic study the changes of patients of an in-patient psychosomatic rehabilitation with regard to functioning and to symptom severity were examined. METHODS: Self-evaluations of patients concerning their functioning (ICF AT-50 Psych) and their symptom severity (GSI) were elevated at 3 measurement periods: on admission (n=419), on discharge (n=354) and 6 months after discharge (n=297). RESULTS: Functioning as well as symptom severity improved from t1 to t2. With regard to functioning an improvement on global and specific scales was shown. From t2 to t3 the symptom severity increased lightly again, whereas the functioning level remained rather steady. Changes in symptom severity highly correlate with changes of functioning. DISCUSSION: The results point to the fact that psychosomatic rehabilitation has positive effects on functioning. While planning the therapy functioning as well as symptom severity should be considered. Controlled studies are needed.

[Rehabilitants' Expectations and Informational Needs Concerning Inpatient Psychosomatic Rehabilitation - Results of a Qualitative Analysis]. / Erwartungen und Informationsbedarf von Rehabilitanden bezüglich stationärer psychosomatischer Rehabilitation.

AIM OF THE STUDY: In order to develop an online portal for the preparation for inpatient psychosomatic rehabilitation, information requirements as well as the online use behavior of rehabilitants were determined first. METHODS: Four focus groups with rehabilitants (N=31) as well as two with the treatment team (N=18) were performed and evaluated qualitatively. RESULTS: A total of 419 statements by rehabilitants and 333 statements by the treatment team were coded and assigned to categories. Current information materials on rehabilitation have been regarded as too extensive and difficult to understand by rehabilitants. They were uncertain regarding the effectiveness and sustainability of the treatment. While practitioners assumed that rehabilitants expect wellness and relaxation during rehabilitation, rehabilitants themselves reported more of an active treatment orientation. CONCLUSION: Online portals for preparation should address the effectiveness and sustainability of psychosomatic rehabilitation by means of illustrative case studies.

[Psychosomatic Rehabilitation: An Overview]. / Psychosomatische Rehabilitation: eine Übersicht.

Psychosomatic Rehabilitation: An Overview Abstract. Psychosomatic Medicine is based on the shared understanding that physical illnesses can have a multi-factorial aetiology, whereby biological, psychological and social factors interact to cause and maintain physical and mental symptoms and complaints. Commonly implicated aetiological factors in psychosomatic disorders are physical and / or psychological stress, inflammation and degeneration, and the resulting symptoms can manifest themselves in different organ systems, such as: the nervous system, the musculoskeletal system, the cardiovascular system, the respiratory system, the gastrointestinal system and the skin. In order to create a model of psychosomatic symptoms that would allow for a systematic classification of psychosomatic disorders, the Diagnostic Criteria for Psychosomatic Research (DCPR) were developed in 1995. Given that biological, psychological and social factors can interact to cause and maintain physical and mental symptoms and complaints, psychosomatic therapies and rehabilitation are usually provided in multidisciplinary settings, where professionals from different disciplines (physicians, psychologists, osteopaths, physiotherapists and occupational therapists) work as a team. If no interdisciplinary treatment and process organisation close to the patient's home is available for an outpatient setting, psychosomatic rehabilitation is usually carried out in an inpatient setting. The rehabilitation process is organised in several steps: Assessment (1); Conceptualisation (2); Goal planning (3); Interdisciplinary rehabilitation (4); Re-assessment (5); Discharge planning. The clinical effectiveness of inpatient psychosomatic rehabilitation has been documented in several Austrian and German studies. Following discharge, the patient is usually offered a continuation of the rehabilitation as an outpatient.

Long-term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures.

We conducted a prospective cohort study, examining long-term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures (PNES). Subjects diagnosed with documented PNES were scheduled for 4 psychiatric visits. Survival analysis was performed, and covariates were assessed for association with time to nonadherence using Cox proportional hazard regression analysis. One hundred twenty-three subjects were recruited and followed for up to 17 months. Eighty percent of subjects attended the first outpatient visit, 42% attended the second, 24% attended the third, and only 14% remained adherent through the fourth visit. Two covariates were associated with nonadherence: (1) a prior diagnosis of PNES (hazard ratio 1.57, P-value .046); (2) a lower score on the Brief Illness Perception Questionnaire (BIPQ), signifying lower concern about one's illness (hazard ratio 0.77 for every 10-point increment on the 80-point scale, P-value .008). Adherence with psychiatric treatment among patients with PNES is initially reasonably good but worsens rapidly over visits 2-4. Risk factors for nonadherence include a history of a prior diagnosis of PNES, and a lower level of concern about the illness as assessed by a lower score on the BIPQ.

[Application for Inpatient Psychosomatic Rehabilitation: Frequency, Quality, and Approval Rates]. / Anträge auf psychosomatische Rehabilitation ­ Häufigkeit, Qualität und Befürwortungsrate.

BACKGROUND: There has been a steady increase in psychiatric primary diagnoses in medical rehabilitation services carried out by the statutory pension insurance (DRV). To date, no data are available regarding frequency, quality, and approval rates of applications for psychosomatic rehabilitation. Pension insurance physicians reviewing the application require sufficient information on rehabilitation-related needs, motivation, abilities, and prognosis of an insured person. Medical reports accompanying application for rehabilitation are often provided by a family physician. Psychiatric disorders are often misdiagnosed by general practitioners. METHOD: In a 2-week period, all decisions made by pension insurance physicians evaluating applications for rehabilitation were recorded. For each incoming application, the following data were documented: psychiatric and somatic primary diagnosis; availability of medical reports; information on prior treatment/therapy; request for further information; decision made by the physician. RESULTS: 1,366 applications (with 81% first-time applications) were included in the analysis. 16.2% of all applications were from insurants with psychiatric primary diagnoses. 44.0% of these applications included a medical report from the family physician only. The proportion of rejected applications (34.7%) and undecided applications (27.2%) was higher in the group of applicants with psychiatric primary diagnosis vs. somatic primary diagnosis (19.6% rejected; 12.7% undecided; χ2=79.8(4), p=0.001). Applications from patients with psychiatric primary diagnosis that lacked a medical report from a psychiatrist/psychotherapist were more likely to be rejected (45.3 vs. 32.3%) or to remain undecided (28.0 vs. 18.3%; χ2=10.2(2), p=0.006). In contrast, among applicants with a history of psychiatric/psychotherapeutic treatment, there was a higher proportion of undecided applications accompanied by a medical report from the family physician (35.7 vs. 18.2%). CONCLUSION: It might be useful to have medical reports generally provided by medical specialists. This may help both to increase the informative value of applications for psychosomatic rehabilitation and enable quicker decisions and better diagnosis.

[Promoting Self-Care Instead of Resistance Orientation: Therapeutic or Side Effect in Regard to Work?] / Zunahme der Selbstpflege statt der Widerstandsbereitschaft bei Belastungen: Haupt- oder Nebenwirkung in der medizinisch­beruflich orientierten psychosomatischen Rehabilitation?

In rehabilitation medicine an important goal is to restore the ability to work by improving resistance to stress. We observed the development of resistance orientation on one hand and the tendency of self-care, stress avoidance, and regeneration orientation on the other, in the course of a 5 week psychosomatic inpatient rehabilitation. A convenience sample of 121 inpatients of a psychosomatic rehabilitation unit filled in the ReRe-Scale (Resistance-Regeneration-Scale) at the beginning and end of a 5 week inpatient treatment. Also patients rated their ability to work before discharge from the hospital. There was a decline in resistance orientation and a clear increase in regeneration orientation. Regeneration orientation, in contrast to resistance orientation, was associated with a greater ability to work. The reduction in resistance and increase in regeneration orientation was unexpected and could be seen as an unwanted effect of inpatient rehabilitation. When taking into account the disposition to go back to work, promotion of regeneration seems to be the better way. This raises questions in respect to treatment strategies for stress tolerance, and occupational rehabilitation but also for the definition of positive or negative treatment effects in psychotherapy.

[The Significance of Work Motivation for Rehabilitation Success]. / Die Bedeutung von Arbeitsmotivation für den Reha-Erfolg.

AIM OF THIS STUDY: Apart from the reduction of symptoms and the restoration of working ability, return to work is a long-term goal of medical rehabilitation. The aim of this study is to analyze the influence of work motivation on the outcome of rehabilitation. METHODS: The data basis consists of N=998 patients at the psychosomatic department of the Oberharz Rehabilitation Center as well as data from insurance accounts. Using multiple linear regression analysis the predictive power of work motivation on rehabilitation outcome as well as different facets of work motivation in their function as predictors are analyzed. RESULTS: Only minor statistical relations could be found between work motivation and rehabilitation success when also taking employment status of the previous year and subjective vocational disability into account. A small predictive power can be attributed to work motivation as a factor in rehabilitation success in the sense of a reduction of symptoms. Particular facets of work motivation are suitable to predict rehabilitation success. Patients with a work motivation risk profile differ from patients with a normal work motivation profile as regards their capacity to work in the year following rehabilitation treatment. CONCLUSION: Work motivation represents a relevant construct in rehabilitation success but is strongly influenced by individual factors. During rehabilitation, individual problems which influence work motivation should be taken into account more strongly.

[Exercise Therapy in German Medical Rehabilitation - an Analysis based on Quantitative Routine Data]. / Bewegungstherapeutische Versorgung in der medizinischen Rehabilitation der Rentenversicherung ­ eine Analyse auf Basis quantitativer Routinedaten.

AIM OF THIS STUDY: This study describes the quantitative importance of exercise therapy in German medical rehabilitation based on 2014 routine data of the German Pension Insurance. It also shows changes in comparison with data from 2007. METHODS: Data from 710012 rehabilitation discharge letters comprising 83677802 treatments from central indications in medical rehabilitation were analysed descriptively. RESULTS: Overall 35.4% of treatments could be classified as exercise therapy. Total and relative duration, percentage of individual treatment and kind of exercise treatment varied between indications in 2007 as well as in 2014. There were also differences between sexes, age groups and settings. CONCLUSION: During the period examined the high importance of exercise therapy in German medical rehabilitation has increased. The results point at a meaningful concept behind the composition of exercise therapy taking indications and disease related factors into account.

[Effects of psychosomatic treatment for the elderly on cognition and quality of life : Naturalistic study at the psychosomatic day care hospital for the elderly in Nuremberg]. / Einfluss einer psychosomatischen Behandlung für Ältere auf Kognition und Lebensqualität : Naturalistische Studie an der Psychosomatischen Tagesklinik für Ältere am Klinikum Nürnberg.

BACKGROUND AND OBJECTIVE: In 2006 the psychosomatic day care hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of the study was to determine treatment effectiveness regarding quality of life and cognition. MATERIAL AND METHODS: Designed as a naturalistic study of a population sample of 116 patients, the cognitive capacity (memory performance and cognitive speed) and the subjective quality of life were measured by the Nuremberg aging inventory (NAI) and the World Health Organization quality of life for elderly persons (WHOQOL-OLD). The patients were surveyed at four points in time including at 8­month follow-up. A 5-week waiting time before admission to the 5­week therapy was implemented as a control condition. RESULTS: In comparison with the waiting time, after treatment significant improvement (<0.05) was found in cognitive capacity and quality of life. Effect sizes were partly small and mostly moderate (ES 0.2-1.0) with larger effect sizes in the quality of life than in the cognitive domain. Improvements of cognition and quality of life remained stable at follow-up (admission to follow-up ES 0.1-1.0). No correlation was found between cognitive improvement and reduction of depressive symptoms. CONCLUSION: The results indicate that the psychosomatic day care hospital treatment of the elderly improves subjective quality of life and cognitive capacity.