Effectiveness of a screening tool to assess prevention and rehabilitation needs of 45 to 59 years old in primary care - study protocol of a pragmatic randomized controlled trial (PReHa45).

BACKGROUND: For years it has been stated that the need for prevention and rehabilitation is not always identified early enough. Although many individuals have regular contact with a general practitioner (GP), this access path for applying for a prevention or rehabilitation service has not been fully exploited. The important role of GPs in supporting the intention to apply is highlighted in the research. This study aims to evaluate the effectiveness of the "check-up 45 + " to support GPs both in identifying the need for prevention and rehabilitation services and in submitting applications. METHODS: The study is designed as a two-arm, pragmatic 1:1 randomised controlled study (RCT), which will be conducted in about 20 general practices in the German states of Berlin and Brandenburg. Patients (n = 1,654) aged from 45 to 59 years will be recruited by medical assistants. In addition to usual care, both study groups will receive a questionnaire covering socio-economic and occupational variables to be filled out immediately in the waiting room. The intervention group passes through the "check-up 45 + ". This includes the completion of the "screening 45 + " that aims to assess the need for prevention and rehabilitation services. Medical assistants will immediately evaluate this 2-page screening tool. If a need is identified and confirmed by the GP, information and application documents will be handed over. Moreover, the application process for rehabilitation services is simplified. Primary outcome is the proportion of applications for prevention or rehabilitation services financed by the German Pension Insurance. Administrative data will be provided for this purpose. Secondary outcomes include the proportion of approved applications and completed services. In addition, the proportion of persons with a need for prevention or rehabilitation according to the "check-up 45 + " will be examined. Semi-structured interviews will be conducted and content-analysed to determine the practicability and acceptance of the "check-up 45 + " by the relevant stakeholders. DISCUSSION: Prevention and rehabilitation need is insufficiently identified and addressed so far. This study will determine the effectiveness of the "check-up 45 + " in primary care. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00028303, 03.03.2022).

Does social support mediate the effect of multimorbidity on mental wellbeing in the German working population? A longitudinal mediation analysis using structural equation modelling.

This study provides insights into the longitudinal relation between multimorbidity, mental wellbeing, and social support. The analysis used the German Sociomedical Panel of Employees, a study of the German working population aged 40 to 54. In the context of multimorbidity, this population has been little studied. Multimorbidity is significantly associated with reduced mental wellbeing and social support, whereas social support increases mental wellbeing. We argue that, especially among the working population, multimorbidity reduces perceived social support and decreases mental wellbeing. We elaborate on the mediation process empirically by comparing two distinct structural equation models: a cross-lagged panel mediation model that models a potential reverse-causality between social support and mental wellbeing; and a synchronous mediation model that allows for more immediate mediation. Both models estimated significant mediation. The relative size of the mediation effect, however, varied widely based on the added mediational paths (8.57% vs. 28%). Fit statistics for both models were good, and the comparison did not favour either model. We conclude that theoretical reasoning must prevail over empirical testing. The cross-lagged model implies a more longitudinal (lagged) mediation process for social support. However, we suggest an immediate, flexible mediation as more plausible. Nevertheless, we suggest that cross-lagged models, when given a data structure and time gaps, reflect the social processes adequately.

Correction to: Development and evaluation of a patient passport to promote self-management in patients with heart diseases.

An amendment to this paper has been published and can be accessed via the original article.

Occupation as a Proxy for Job Exposures? Routine Data Analysis Using the Example of Rehabilitation.

AIM OF THE STUDY: Job exposures are associated with health-related outcomes including sick leave and reduction in earning capacity. Rehabilitation of persons in working age aims primarily to secure or restore work capacity. Information concerning job exposures is, however, not directly available in routine data of healthcare payers. Since exposures relate to specific occupations and the current occupation is part of routine data, job exposures may be determined indirectly via job-exposure matrices (JEM). The aim of the study is to describe the possibilities and challenges of the representation of job exposures by the occupation according to routine data using the example of rehabilitation. METHODS: The Scientific Use File 'SUFRSDLV15B' of the German Pension Insurance was analysed. We used data from n=1 242 171 persons in work with at least one completed medical rehabilitation between 2008 and 2015 (dataset 1). The occupation is coded according to KldB 88 or KldB 2010 (German Classification of Occupations). In addition, data from a nationwide survey with 2530 rehabilitation patients was available (dataset 2). Job exposures are operationalized by the Job Exposure Index via JEM. The relationship to the return-to-work prognosis at the end of rehabilitation (dataset 1) and to patient reported outcome measures (dataset 2) is described. RESULTS: Information concerning the occupation is available for about 91% of rehabilitation measures of employed patients for the year prior to rehabilitation. At high levels of job exposures, the proportion of persons with a predicted working capacity in the last job of fewer than 3 h per day increased by a factor of 4 compared to low-level job exposures (23.5 vs. 6.1%). On the other hand, there is a low association only to reduced working capacity in the general labour market (2.9 vs. 2.4%). High-level job exposures are associated with self-reported, work-related impairments. CONCLUSION: The Job Exposure Index may offer a valid approach to depict occupation-related exposures. The index can be used in the analysis of routine data of the pension insurance and other social security funds, as well as in the linkage of individual assessment data with routine data containing the occupation, without any additional data collection effort. Due to its construction based on job classifications, it will not replace the assessment of individual burdens.

Development and evaluation of a patient passport to promote self-management in patients with heart diseases.

BACKGROUND: Patients with cardiovascular diseases (CVD) are treated over a long period of time by physicians and therapists from various institutions collaborating within a multidisciplinary team. Usually, medical records detailing the diagnoses and treatment regimens are long and extensive. Brief overviews of relevant diagnostic and treatment data in the form of a patient passport are currently missing in routine care for patients with CVD. This study aimed to develop and evaluate a patient passport (the Kardio-Pass) based on the needs of patients who had undergone cardiac rehabilitation, and of healthcare professionals. METHODS: A mixed method design was adopted consisting of an explorative qualitative phase followed by a quantitative evaluation phase. Interviews with patients and experts were conducted to develop the Kardio-Pass. CVD rehabilitees (N = 150) were asked to evaluate the passport using a semi-standardized written questionnaire. RESULTS: Patients and experts who were interviewed in the qualitative study phase considered the following passport contents to be particularly important: documentation of findings and diagnoses, cardiac diagnostics and intervention, medication plan, risk factors for heart disease, signs of a heart attack and what to do in an emergency. During the evaluation phase, 93 rehabilitees (response rate: 62%) completed the questionnaire. The Kardio-Pass achieved high overall approval: All respondents considered the information contained in the passport to be trustworthy. The professionalism and the design of the passport were rated very highly by 93 and 92% of participants, respectively. Use of the Kardio-Pass prompted 53% of participants to regularly attend follow-up appointments. The most common reasons for non-use were a lack of support from the attending doctor, failure by the patient to make entries in the passport, and loss of the passport. CONCLUSIONS: By documenting the course of cardiac diseases, the patient passport pools all medical data-from diagnosis to treatment and aftercare-in a concise manner. Rehabilitees who used the cardiac passport rated it as a helpful tool for documenting follow-up data. However, with regard to this explorative study there is a need for further research, particularly on whether the patient passport can improve heart patient care.

[Development and Evaluation of herzwegweiser.de - An Informational Website designed for Post-Rehabilitation Support of Cardiac Patients and their Healthcare Professionals in Berlin-Brandenburg]. / Entwicklung und Evaluation des Online-Portals herzwegweiser.de - Ein Informationsangebot für die Nachsorge kardiologischer Rehabilitanden und deren Behandler in Berlin-Brandenburg.

The internet portal 'herzwegweiser.de' was developed to assist individuals with cardiovascular diseases in the phase III rehabilitation in the region of Berlin-Brandenburg. It provides information on this specific disease as well as on aftercare services, e. g. regional cardiac groups. For the medical and therapeutic colleagues specific information such as treatment guidelines and a cardiac group placement service for trainers and medical doctors were set up. The study was based on a mixed-methods design. Initially, structured interviews were conducted to identify the expectations and needs of the internet portal. After implementation of the portal, a partially standardized written survey was used to evaluate its acceptance and usability. 105 former rehab patients and 42 medical colleagues participated. The evaluation of the questionnaires was carried out with frequency distributions, mean comparisons and Chi-square tests. The site was rated with an overall high approval rating. Over 90% of the former rehab patients rated content, structure, design, and the search function of the portal positive as did more than 85% of the medical colleagues. 97% of the former rehab patients and 95% professionals would recommend 'herzwegweiser.de'. This internet portal can serve as a model for other regions and possibly other diseases.

[Importance of Job Demands for Rehabilitation Patients - Application of an Index According to Occupations]. / Bedeutung von Arbeitsbelastungen bei Rehabilitanden ­ Anwendung eines Index für Berufstätigkeiten.

OBJECTIVE: To investigate the importance of job demands for rehabilitation patients. METHODS: A secondary data analysis of 2,089 rehabilitation patients of the Federal German Pension Insurance was conducted. The job exposure index of Kroll was used based on occupations. RESULTS: The prevalence of high job demands was 11.2%. The index correlated significantly with reha-relevant impairments. Furthermore, there was a significant association between high job demands and an unfavorable return-to-work prognosis at discharge from rehabilitation, also independently of the presence of self-reported severe restrictions of work ability. CONCLUSION: The job exposure index reflects occupation-specific job demands of rehabilitation patients. The construction of the index based on the relevant occupation classifications enables its broad application in analyses using routinely collected health data.

[Medical rehabilitation from a lifespan perspective]. / Medizinische Rehabilitation unter einer Lifespan-Perspektive.

Lifespan research investigates the development of individuals over the course of life. As medical rehabilitation deals with primary and secondary prophylaxis, treatment, and compensation of chronic illnesses, a lifespan perspective is needed for the classification and diagnosis of chronic disorders, the assessment of course modifying factors, the identification of vulnerable life periods and critical incidents, the implementation of preventive measures, the development of methods for the evaluation of prior treatments, the selection and prioritization of interventions, including specialized inpatient rehabilitation, the coordination of therapies and therapists, and for evaluations in social and forensic medicine. Due to the variety of individual risk constellations, illness courses and treatment situations across the lifespan, personalized medicine is especially important in the context of medical rehabilitation, which takes into consideration hindering and fostering factors alike.

Prevalence of comorbid depressive symptoms in rehabilitation: A cross-indication, nationwide observational study.

OBJECTIVE: Patients in rehabilitation with comorbid depressive disorders display increased morbidity, mortality and inability to work. The aim of this study is to determine the prevalence of comorbid depressive symptoms in rehabilitation. METHODS: A total of 6,000 patients were contacted by post at the same time as receiving approval for their medical rehabilitation from German Federal Pension Insurance. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-2). Results were compared with prevalences in the general population by analysing the German Health Interview and Examination Survey for Adults (DEGS). RESULTS: A total of 2,152 out of 5,891 patients participated in the study (response rate: 36.5%). The prevalence of self-reported depressive symptoms was 33.1% (women 34.1%, men 31.3%). In contrast, 7.8% of the German general population reported depressive symptoms (women 9.4%, men 6.2%). The highest prevalences were found in neurological (36.4%) and orthopaedic (35.6%) rehabilitation, the lowest in cancer rehabilitation (23.0%). Depressive symptoms were significantly associated with higher comorbidity and impairment due to pain, with lower social support and self-efficacy and with specific work-related problems. CONCLUSION: A short routine screening yielded a positive test result for depressive symptoms in a third of rehabilitation patients, thus approximately four times higher than in the general population. This is valuable information in order to better adjust treatment to patient needs.

The Efficacy of Goal Setting in Cardiac Rehabilitation-a Gender-Specific Randomized Controlled Trial.

BACKGROUND: Patients with coronary heart disease undergo cardiac rehabilitation in order to reduce their cardiovascular risk factors. Often, however, the benefit of rehabilitation is lost over time. It is unclear whether this happens in the same way to men and women. We studied whether the setting of gender-specific behavior goals with an agreement between the doctor and the patient at the end of rehabilitation can prolong its positive effects. METHODS: This study was performed with a mixed-method design. It consisted of qualitative interviews and group discussions with patients, doctors and other treating personnel, and researchers, as well as a quantitative, randomized, controlled intervention trial in which data were acquired at four time points (the beginning and end of rehabilitation and then 6 and 12 months later). 545 patients, 262 of them women (48.1%), were included. The patients were assigned to a goal checking group (n = 132), a goal setting group (n = 143), and a control group (n = 270). The primary endpoints were health-related behavior (exercise, diet, tobacco consumption), subjective state of health, and medication adherence. The secondary endpoints included physiological protection and risk factors such as blood pressure, cholesterol (HDL, LDL, and total), blood sugar, HbA1c, and body-mass index. RESULTS: The intervention had no demonstrable effect on the primary or secondary endpoints. The percentage of smokers declined to a similar extent in all groups from the beginning of rehabilitation to 12 months after its end (overall figures: 12.4% to 8.6%, p <0.05). The patients' exercise behavior, diet, and subjective state of health also improved over the entire course of the study. Women had a healthier diet than men. Subgroup analyses indicated a possible effect of the intervention on exercise behavior in women who were employed and in men who were not (p<0.01). CONCLUSION: The efficacy of goal setting was not demonstrated. Therefore, no indication for its routine provision can be derived from the study results.

[Indicators of process and outcome quality in the context of multicenter quality management in cardiac rehabilitation]. / Indikatoren der Prozess- und Ergebnisqualität im Rahmen eines multizentrischen Qualitätsmanagements in der kardiologischen Rehabilitation.

From the point of view of quality management in general and clinic comparisons in particular, indicators of outcome quality must be chosen in such a way that conclusions regarding the quality of rehabilitational care processes can be drawn. Moreover, these indicators should reflect disease characteristics which, on the one hand, are relevant in terms of prognoses and, on the other, provide indications for rehabilitation therapy. Predictors of rehabilitation success need to be differentiated analytically in order to safeguard the adjustment of risks when, for instance, clinics are being compared. Suitable outcome indicators for cardiological rehabilitation are LDL-cholesterol and functional-physiological capacities. Taking low-density lipoprotein (LDL) as an example, a well-tested approach to applying the results of studies, in this case those of the Cardiac Rehabilitation Outcome (CARO) study, to internal and external quality management is shown. The way in which information is provided by a quality information system is explained. The scheme is to be expanded into a routine monitoring system with the aid of a nation-wide follow-up study (CARO-II). The studies are being supported by the DGPR cardiological society.