[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.

Temporary disability pension recipients: Contextual stress factors and their effect on return-to-work-intention.

BACKGROUND AND PURPOSE: In the last decades, Germany has experienced a vast increase in the number of individuals applying for or receiving disability benefit. Only a small proportion of them intends to return to work. The present study aims to identify and describe the percentage of temporary disability pensioners, who have the intention to return to working life. METHODS: The final sample consisted of 496 insured individuals who were receiving temporary disability pension from the Regional German Pension Insurance (DRV) at that time. Participation was voluntary and anonymous. The following self-report instruments were administered: a. Evaluation of Contextual Factors; b. German Symptom Validation Test (BEVA); c. German Patient Health Questionnaire (PHQ-9); d. Readiness for Return-to-Work German Scale (RRTW). RESULTS: The results revealed that approximately 6% of participants were at the stage of "preparation", 31.9% at the stage of "contemplation", and more than half of the participants were at the stage of "pre-contemplation" according to the RRTW. Comparing the groups of "pre-contemplation" (Group 1) and "contemplation+preparation" (Group 2+3), no statistically significant differences were found, except for age. CONCLUSIONS: In conclusion, further research is required to identify possible factors which could predict the stage of RRTW. New interventions are needed that can raise the motivation for and success in the return to work of disability pensioners.

[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.

[Insured Persons with High and Moderate Risk of Reduced Earning Capacity - Identification, Analysis of the Use of a Counselling Service and Illustration of their Health and Occupational Situation]. / Versicherte mit Erwerbsminderungsrisiko: Identifikation, Analyse der Inanspruchnahme eines Beratungsangebots und Darstellung der gesundheitlichen und beruflichen Situation ­ Eine Querschnittstudie.

PURPOSE: The aim of this study was to investigate the life situation, and analyse the need for rehabilitative interventions as well as the use of counselling service offered to persons insured by the German Pension Insurance Braunschweig - Hannover (DRV BS-H), using the moderate and high risk index for temporary disability penson (RI-EMR). METHOD: This is a cross-sectional study. The participants were generated from a random sample of the total insured persons of the DRV BS-H. 1778 persons were contacted offering telephone consultation and a request for participation in a questionnaire survey that recorded, among others, symptoms, burdens and impairments. Employed persons were asked about their stress at work, non-employed persons about their motivation to return to work. 391 (24.5%) participated in the questionnaire survey and 157 (9.8%) of those contacted responded to the offer of counselling service. The contents of the counselling sessions were evaluated descriptively. The questionnaire data were analysed comparatively (ANOVA, χ2-test). RESULTS: The offer of the telephone counselling was not used as expected in advance. Insured persons with a high RI-EMR showed more clearly complaints as well as burdens and impairments due to contextual factors than persons with a moderate RI-EMR. The majority of non-employed persons in both groups showed up in the motivational stage of forming intentions with regard to a possible return to employment. CONCLUSION: The question arises as to how insured persons with prognostically limited participation can be better reached with offers of assistance. The goal of early offer of support services is confronted with the problem that delays occur in the application of the routine data of the DRV and thus of the RI-EMR. Future studies should investigate how to improve insured persons' participation in counselling services and also their motivation to return to work.

[Rehabilitation Success After Psychosomatic Rehabilitation as a Function of Symptomatic Load and Duration of Incapacity to Work]. / Reha-Erfolg nach psychosomatischer Rehabilitation in Abhängigkeit von Symptombelastung und Arbeitsunfähigkeitsdauer.

PURPOSE: Rehabilitation success is directly reflected in individual symptom reduction and indirectly in sociomedical benefits. The findings on the extension of measures to increase rehabilitation success are controversial. Treatment duration does not seem to be a sufficient predictor of rehabilitation success. Long periods of sick leave may contribute to chronification of mental illness. The study examined the relationship between the duration of sick leave before psychosomatic rehabilitation (less vs. more than 3 months) with different depression severity at the start of rehabilitation (below vs. above clinical relevance) and (un)indirect rehabilitation success. For this purpose, 1612 rehabilitants aged 18-64 years, 49% women, who completed psychosomatic rehabilitation at the Oberharz Rehabilitation Centre in 2016 were examined. METHODS: Individual symptom reduction was mapped by the Reliable Change Index (consid-ered as a good estimator of true change) from pre/post test scores of the BDI-II. Periods of sick leave before rehabilitation and insurance/contribution periods one to four years after rehabilitation were taken from the accounts of Deutsche Rentenversicherung Braunschweig-Hannover. Multiple hierarchical regression, repeated measures 2-factorial ANCOVAs, planned contrasts, were calculated. Age, gender and rehabilitation duration were statistically controlled. RESULTS: A multiple hierarchical regression showed incremental variance clarification in symptom reduction for patients who were on sick leave for less than three months before rehabilitation (4%) and for those who started rehabilitation with clinically relevant depression (9%) with medium and large effect sizes, (respectively f2=0,22 and 0,73). Repeated-messures 2-factorial ANCOVAs showed, more contributions/contribution periods for patients with a short period of sick leave before rehabilitation in each year after rehabilitation, with small effect size (ηp 2=0,03 and 0,02). Patients starting rehabilitation with low depression severity showed more insurance but not more contribution periods in the same period (ηp 2=0,01). CONCLUSION: Duration of incapacity for work before rehabilitation appears to be an important pa-rameter for (un)direct rehabilitation success. Future studies should further differentiate and evaluate the effect of early admission within the first months of sick leave in psychosomatic rehabilitation measures.

[Impairment due to Contextual Factors: External Assessment and Self-Assessment of Rehabilitants in Psychosomatic Rehabilitation]. / Beeinträchtigung durch Kontextfaktoren: Fremd- und Selbstbeurteilung von Rehabilitand:innen in der psychosomatischen Rehabilitation.

OBJECTIVES: In addition to an existing external assessment tool for the ICF-based assessment of the impairment of rehabilitation patients due to environmental and personal contextual factors, a self-assessment tool was developed and used for rehabilitation patients in a psychosomatic rehabilitation clinic. The aim was to compare the assessment of the impairment by contextual factors rated by the external assessment and by the rehabilitation patients on the other hand. Furthermore, the aim of the study was to obtain initial indications of the applicability of the newly designed self-evaluation instrument. METHOD: A sample of N=103 rehabilitation patients was examined via both the external and the self-evaluation tools. A comparative evaluation of the assessment of the external assessor and the rehabilitants' assessments was carried out using measures of assessor agreement (Cohen's Kappa, percentual agreement). The results were set in relation to the data of the routine assessment of the rehabilitation facility (Eta-Coefficient). RESULTS: The external assessor and the rehabilitants get to different results in their assessment of the extent of impairment by individual contextual factors. For eight of the 15 context factors, there was only a moderate degree of agreement between the assessors (Cohen's Kappa). The percentage of non-agreement between rating of the external assessor and self-assessment lies between approx. 20% and up to approx. 40% of the cases for the majority of the context factors. Whether or not there is an impairment across all contextual factors (overall measure) was answered non-concordantly in just under a third of the cases. Mostly moderate correlations were found between the context factors classified as particularly relevant in the self-evaluation tool and scales of psychometric survey (e. g. BDI-II). This result provides a first indication of the convergent validity of the self-report tool. CONCLUSION: More attention should be paid to a supplementary assessment of impairment by contextual factors via the rehabilitation patient's self-assessment in addition to the external assessment. There is a need for further research with regard to the development of the self-assessment tool presented.

[Rehabilitation Outcome and Therapeutic Alliance of Inpatients of Psychosomatic Rehabilitation with Pension Request]. / Psychosomatische Rehabilitation bei Patientinnen und Patienten mit Rentenüberlegungen: Reha-Erfolg und therapeutische Beziehung.

OBJECTIVE: Inpatients of psychosomatic rehabilitation with a latent or manifest desire for a pension are a risk group with regard to successful participation in rehabilitation and return to work. Reaching this group of patients, is both a legal requirement (rehabilitation before retirement), and important from an economic and health perspective. This study examines patients who are considering applying for a reduced earning capacity. The questions are whether these patients differ in socio-demographic variables and the success of rehabilitation from patients without pension considerations, and which patients benefitted from their rehabilitation despite pension considerations. Particular attention is paid to the therapeutic relationship. METHODS: Data are routinely collected from patients of 2 rehabilitation clinics who were undergoing inpatient psychosomatic treatment between October 2012 and February 2017 (n=8503). RESULTS: Inpatients with pension considerations were slightly older, more often incapacitated for work and more often receiving unemployment benefits. Both groups reported a significant reduction in symptoms over the course of the rehabilitation. Within the group considering retirement, patients who reported an improvement in symptoms reported a more positive relationship satisfaction. DISCUSSION/CONCLUSION: Patients who are thinking about retirement often have difficult socio-demographic and health-related conditions for successful rehabilitation. Despite these conditions, many report an improvement in psychosomatic symptoms and a positive therapeutic relationship.

[The Influence of a Statement of Truth on the Authenticity of Complaints]. / Zum Einfluss einer Ehrlichkeitserklärung auf die Authentizität von Beschwerdedarstellungen.

BACKGROUND: Implicit motives have a moderating effect on dishonest answering behaviour during the testing of applicants for disability pensions. Persons would rather act dishonest if they do not have do keep up their positive self-image therefore. OBJECTIVE: Does a statement of truth at the beginning of a functional capacity evaluation lead to lower dishonest answering behaviour? METHODS: 248 applicants for a disability pension were randomly allocated to giving such a statement either before or after symptom validity tests (SIMS, BEVA). RESULTS: The statement of truth affected the SIMS but not the BEVA. The effect depended on the education level. CONCLUSION: Moral and social motives have to be taken into account when assessing malingering during a functional capacity evaluation. Higher educated persons refer to other moral standards or take a more individual and case-by-case approach to morally challenging situations.

Health-Enabling Technologies for Telerehabilitation of the Shoulder: A Feasibility and User Acceptance Study.

BACKGROUND: After discharge from a rehabilitation center the continuation of therapy is necessary to secure already achieved healing progress and sustain (re-)integration into working life. To this end, home-based exercise programs are frequently prescribed. However, many patients do not perform their exercises as frequently as prescribed or even with incorrect movements. The telerehabilitation system AGT-Reha was developed to support patients with shoulder diseases during their home-based aftercare rehabilitation. OBJECTIVES: The presented pilot study AGT-Reha-P2 evaluates the technical feasibility and user acceptance of the home-based telerehabilitation system AGT-Reha. METHODS: A nonblinded, nonrandomized exploratory feasibility study was conducted over a 2-year period in patients' homes. Twelve patients completed a 3-month telerehabilitation exercise program with AGT-Reha. Primary outcome measures are the satisfying technical functionality and user acceptance assessed by technical parameters, structured interviews, and a four-dimensional questionnaire. Secondary endpoints are the medical rehabilitation success measured by the active range of motion and the shoulder function (pain and disability) assessed by employing the Neutral-0 Method and the standardized questionnaire "Shoulder Pain and Disability Index" (SPADI), respectively. To prepare an efficacy trial, various standardized questionnaires were included in the study to measure ability to work, capacity to work, and subjective prognosis of work capacity. The participants have been assessed at three measurement points: prebaseline (admission to rehabilitation center), baseline (discharge from rehabilitation center), and posttherapy. RESULTS: Six participants used the first version of AGT-Reha, while six other patients used an improved version. Despite minor technical problems, all participants successfully trained on their own with AGT-Reha at home. On average, participants trained at least once per day during their training period. Five of the 12 participants showed clinically relevant improvements of shoulder function (improved SPADI score > 11). The work-related parameters suggested a positive impact. All participants would recommend the system, ten participants would likely reuse it, and seven participants would have wanted to continue their use after 3 months. CONCLUSION: The findings show that home-based training with AGT-Reha is feasible and well accepted. Outcomes of SPADI indicate the effectiveness of aftercare with AGT-Reha. A controlled clinical trial to test this hypothesis will be conducted with a larger number of participants.