[Pneumological Rehabilitation in Long COVID - A Comparative Exploratory Longitudinal Study of Long COVID and Asthma/COPD Rehabilitees]. / Pneumologische Rehabilitation im Antragsheilverfahren bei Long COVID.

BACKGROUND: For some COVID-19 patients, symptoms and health impairments persist for an extended period of time (long COVID). Long-term consequences of the disease can lead to permanent limitations in participatory life. In these cases, medical rehabilitation may be useful. Due to the novelty of the disease, little is known about the need for rehabilitation and therapy and the health benefits of specific rehabilitation interventions. METHODS: A multicentre longitudinal observational study was conducted. Persons affected by long COVID (LC) between 18 and 65 years of age undergoing pulmonary rehabilitation were included. An age-matched comparison group (CG) consisted of rehabilitation patients with bronchial asthma and COPD. Written questionnaires were administered at the beginning and end of rehabilitation, as well as six and twelve months after rehabilitation. Outcomes included parameters of subjective health, occupational outcomes, contents of rehabilitation and rehabilitation aftercare. RESULTS: The sample consisted of 305 participants, of whom 172 were classified as LC and 133 as CG. In the total sample, one third of the participants were male and the average age was 53 years. All rehabilitation participants had high health burdens, LC patients had statistically significantly higher impairments in almost all outcomes recorded. At the beginning of rehabilitation, one third of the respondents were on sick leave, more often in LC than in the CG. Twelve months after rehabilitation, both groups achieved significant health improvement, with LC showing greater improvements in most outcomes (interaction effect p<0.01). Despite success in most parameters, LC patients still showed persistent COVID symptoms at twelve months. One year after rehabilitation, 89% returned to work. CONCLUSION: The majority of rehabilitation patients benefit greatly from pulmonary medical rehabilitation in terms of health and occupation. The content of pulmonary rehabilitation seems to be suitable for this indication group; however, there is an indication-specific use of therapy between CG and LC group. As a result, the LC group seems to need more and different therapies.

Telephone-based aftercare groups for family carers of people with dementia - results of a mixed-methods process evaluation of a randomized controlled trial.

BACKGROUND: Caring for a relative with dementia can be demanding and time-consuming. It is not uncommon for them to be overburdened and overworked, which can lead to symptoms of depression or anxiety disorders in 2/3 of cases. One possibility for treating family carers who have these issues is special medical rehabilitation (rehab). However, studies have shown that while such rehab is effective, it is not sustainable. To increase the sustainability of rehab for this target group, structured telephone-based aftercare groups were implemented in the present study. A process evaluation was conducted focusing on the acceptability of the aftercare programme and its perceived benefits by the participating family carers and group moderators. METHODS: The process evaluation was embedded in a longitudinal randomized controlled trial and followed a mixed methods approach. Quantitative process data were collected using protocols and structured brief evaluations regarding the telephone-based aftercare groups. To assess the acceptability of the aftercare groups as well as their subjective evaluation by the participants, qualitative process data were collected through two longitudinal telephone-based interviews with a subsample of family carers as well as a focus group interview with the group moderators. RESULTS: Telephone-based aftercare groups provide acceptable and supportive experiences, and they are shown to be practicable. The content structure and the procedure of the group sessions could be easily implemented in everyday life after inpatient rehab. The topics addressed with each patient were met with a consistently positive response. Learning from the other group members and sharing a bond based on the experience of caring for a relative with dementia were evaluated as positive outcomes in the group. The universality of suffering as a central effective factor of group psychotherapy also played a decisive role in this telephone-based support group format for a shared bonding and strengthening experience in the groups and thus for their effectiveness. CONCLUSION: Telephone-based aftercare groups for family carers of people with dementia are a useful and acceptable tool in the context of rehab aftercare. This location-independent aftercare programme could be adapted for other indications, focuses or topics in everyday care. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00013736, 14/05/2018.

[Occupational Stress of Long Covid Rehabilitants and Return to Work After Pneumological Rehabilitation]. / Berufliche Belastungen von Long-Covid-Rehabilitand*innen und Rückkehr zur Arbeit nach einer pneumologischen Rehabilitation.

BACKGROUND: The Long Covid syndrome, a condition that is induced by SARS-CoV-2, affects patients in their social and professional life due to persistent symptoms and functional deficits. Medical rehabilitation aims to reduce participation incapacity and restore the ability to work. So far, it is not known what happens to the occupational situation of people affected by Long Covid after pneumological rehabilitation. METHODS: The overall study is designed as a multicentric and prospective observational study with a mixed-method design. Covid-19 rehabilitation patients undergoing pneumological rehabilitation aged between 18 and 65 years were recruited. The questionnaire data of persons that were employed at baseline were evaluated. The written survey took place at the beginning and at end of rehabilitation and, additionally, after six months. The data collected included terms such as return to work, occupational stress and changes, subjective prognosis of gainful employment (SPE scale) and occupational performance and working ability (WAI). RESULTS: The sample comprised N=173 participants (68.2% female) and the average age was 52.5 years. 85.5% of the rehabilitation patients were fit for work six months after rehabilitation and returned to a job. Absenteeism, subjectively perceived performance, and work ability improved statistically significantly over time (p<0.01). The risk of early retirement still existed six months after rehabilitation in 41.3% of the study participants. The participation limitations were statistically significantly reduced during the follow-up with a medium effect size (ES=0.60, p<0.01). In the logistic regression, the WAI proved to be a significantly protective predictor of return to work, while cognitive corona symptoms and high levels of cognitive fatigue proved to be risk factors. CONCLUSION: The majority of rehabilitation patients are gainfully employed six months after pneumological rehabilitation, although persistent symptoms and a reduced ability to work are also reported even after rehabilitation. In the rehabilitation of employed persons, work-related elements, for example clarification of work-related questions and preparation for occupational demands (e. g. concentration, stress, physical demands), could support a sustained return to work.

[Pneumological Rehabilitation in Patients with Long Covid - Health Changes at the End of the Inpatient Rehabilitation Measure]. / Pneumologische Rehabilitation bei Long Covid ­ Gesundheitliche Veränderungen am Ende der stationären Rehabilitationsmaßnahme.

BACKGROUND: Some people suffering from Covid-19 can be affected by persistent symptoms and long-term consequences of the disease (Long Covid) beyond their acute phase. Consequently, this can lead to restrictions in participation. Therefore, the focus is on medical rehabilitation in which Long Covid is treated as a new challenge. METHODS: A prospective, exploratory observational study will be conducted. The written survey of Long Covid rehabilitants takes place at the beginning and end of the pneumological rehabilitation. The aim of the study is to describe the rehabilitation contents and goals, the subjective burdens, the social and occupational participation as well as the health-related changes. Among other factors, disease-specific symptoms, quality of life, participation, psychological impairments, fatigue, and performance were recorded. RESULTS: Long Covid rehabilitants (N=221) participate in the written survey. At the end of rehabilitation, the questionnaire survey indicated significant improvements in almost all outcome parameters with a large effect (p<0.01; ES between 0.76 (anxiety) and 1.30 (fatigue)). All corona symptoms, such as breathlessness on exertion, fatigue or lack of strength improved significantly at the end of rehabilitation. Moreover, the rehabilitants most frequently name the improvement of their health (92%), the increase of their performance (92%) and the improvement of the respiratory muscle strength (78%) as rehabilitation goals. In fact, these goals are achieved by 60 to 70%, significantly fewer rehabilitation patients reach the restoration of their ability to work (32%) or a better ability to concentrate (17%). Respiratory physiotherapy, endurance training and medical training therapy are described as most helpful. At the end of rehabilitation, 76% rated their rehabilitation success as good to excellent based on a single question. CONCLUSION: The first data of the study reveal that Long Covid rehabilitants are exposed to substantial burdens. Through medical rehabilitation, the patients experience medical and social support and experience significant improvements in all recorded health-related outcomes.

Evaluation of an individualized, tablet-based physiotherapy training programme for patients with Parkinson's disease: the ParkProTrain study, a quasi-randomised controlled trial.

BACKGROUND: Regular physical activity is of great relevance in Parkinson's disease (PD). It is part of the inpatient multimodal Parkinson's complex treatment (MKP) in Germany. However, there is often a lack of human resources in outpatient settings to continue an interprofessional approach. A large proportion of PD patients live a predominantly sedentary lifestyle and do not get enough exercise. METHODS: The intervention group (IG) used a tablet-based physiotherapy training programme at home for a period of nine months. We conducted a quasi-randomised longitudinal study with three measurement times (at the beginning (t0) and end of MKP (t1) and at 9 months after MKP (t2)). The primary outcome measured was PD-specific quality of life using the PDQ-8. The secondary outcome focused on participation restrictions, falling anxiety, sleep disorder, anxiety and depression as well as comorbidity, pain, performance capability and physical activity. RESULTS: For n = 93 IG and n = 137 control group (CG) patients, evaluable cases were available for all measurement times. Both groups achieved significant improvements in all parameters at the end of MKP. These parameters deteriorated again at nine months after MKP for most parameters and were even below the baseline levels. However, this deterioration was less pronounced in the IG than in the CG. For general health and social participation, a significant slightly positive effect was observed in the IG nine months after MKP when compared with the baseline level. Paying attention to physical activity slightly increased in the IG for the catamnesis survey compared to baseline. Nearly all IG patients were satisfied with the intervention, especially with the consultations with the physiotherapist. CONCLUSIONS: Although the expected extent of effects could not be determined for the IG, stabilisation effects could be demonstrated. These stabilisation effects shown for the IG might be attributed to the intervention. The effects might have been greater without the COVID-19 pandemic. TRIAL REGISTRATION: German Register of Clinical Trials, drks.de. Identifier: DRKS00014952. Registered 20/06/2018. Date and version identifier 25/04/2019; version 1.

Telephone-based aftercare groups for family carers of people with dementia - results of the effect evaluation of a randomised controlled trial.

BACKGROUND: The care of people with dementia is associated with enormous stress and, in a quarter of cases, leads to depression and anxiety disorders in the caring relatives. A specially designed inpatient psychosomatic rehabilitation (rehab) programme for family carers of people with dementia has proven to be effective but not sustainable. Therefore, the present study aims to increase the sustainability of the inpatient rehab programme by using thematically structured telephone aftercare group sessions. METHODS: The effectiveness of telephone aftercare groups was investigated in a randomized, controlled, prospective, mixed methods, longitudinal study. The aftercare intervention included social participation in monthly telephone group sessions for 6 months. The primary outcome was increased social participation of family carers, which, like the secondary outcomes (such as quality of life and subjective health), was assessed in written surveys at three or four measurement points. RESULTS: Complete data from 69 participants from the intervention group and from 72 participants from the control group could be evaluated. A small-sized reduction in restrictions on social participation was observed in the intervention group, whereas the reduction in the control group was negligible. The repeated-measures analysis of variance (ANOVA) showed sustained effects on the secondary outcomes, such as depression, perceived social support, and the mental health domain of quality of life of family carers, in favour of the intervention group. The results also showed that telephone-based aftercare groups had a rather minor influence on the use of support services. Except for those from family, friends and neighbours, existing support offers were hardly used. CONCLUSION: Telephone aftercare group sessions for carers of people with dementia were not able to increase social participation at the expected magnitude. Nevertheless, the clear effects on selected secondary health-related outcomes and the assessment of the telephone-based group sessions by the participants show that the caring relatives were able to benefit greatly from this aftercare measure. Family carers should be informed more extensively about the corresponding resources and encouraged to use them. Overall, this new aftercare concept can be recommended for implementation, and its use also seems to be target-oriented for other indications. CLINICAL TRIAL REGISTRATION: German Clinical Trials Register: DRKS00013736 , 14/05/2018.

[Implementation of an individualized tablet-based training program in the domestic setting following complex treatment of Parkinson's disease-Success factors and barriers]. / Implementierung eines individualisierbaren tabletbasierten Trainingsprogramms im Anschluss an eine Parkinson-Komplexbehandlung in der Häuslichkeit ­ Erfolgsfaktoren und Barrieren.

BACKGROUND: Regular physical activity is of great relevance in Parkinson's disease. As part of the project "Individualized training program for Parkinson's disease patients" (ParkProTrain), a tablet-based program was developed to support individual self-training. It has been tested over a period of 9 months in domestic settings. Patients were asked about the feasibility of use and satisfaction. METHODS: Patients who used the program at home following inpatient Parkinson's complex treatment (PCT) were interviewed twice (9 and 36 weeks after PCT). RESULTS: The program helped patients to stay motivated throughout the interventional period. It provided them with both structure and flexibility to develop their own training routine. The following were named as positive aspects (success factors), including: the introductory seminars in the clinic, the close supervision during the interventional period, the soundness and Parkinson's specificity, the feasibility and manageability of the program and the individualized training plans; however, patients also provided information on how the program could still be optimized (barriers). DISCUSSION: The program has already successfully implemented a number of aspects that promote activity. Further recommendations were derived for future use, to which more attention should be paid: Parkinson's specificity and individualization of the program, flexible training in terms of location and time, close and personal support throughout the study period and the technique should be designed to be easy to learn and manage.

Study protocol medical rehabilitation after COVID-19 disease: an observational study with a comparison group with obstructive airway disease / Re_Co.

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) has been the subject of a numerous research projects over the past year. In cases with a severe disease course or threatening long-term impairment due to disease, the German health care system offers insured persons the possibility of medical rehabilitation. In contrast to what was observed and expected at the beginning of the pandemic, COVID-19 patients with varying degrees of disease severity are represented in rehabilitation. To date, there is no common consensus on the content and aftercare of rehabilitation nor is there any knowledge about the short- and long-term effects of such a rehabilitation programme. In addition, these aspects were not considered with regard to the varying severity of the course of the disease. The present research project investigates this question. METHODS: The study sample will consist of N = 350 rehabilitants after COVID-19 and a comparison group (CG) with N = 230 rehabilitants suffering from an obstructive respiratory disease. The participants will be recruited at five German rehabilitation facilities and undergo medical rehabilitation. This prospective, exploratory, multicentre, mixed-methods study will be evaluated as follows: (A) The quantitative portion includes questionnaires at different points in time (at the beginning and end of rehabilitation, after six and twelve months) and contains standardised measurement instruments. For example, participation limitations, quality of life, health status, fatigue, psychomental limitations and disorders, performance in different areas of life and ability to work are measured. (B) Qualitative interviews are held at different times (end of rehabilitation, after six and twelve months), and an expert workshop is conducted. Topics are rehabilitation content, satisfaction and aftercare as well as different outcomes on subjective health and participation impairments. DISCUSSION: Studies on other indications have already shown that pneumological rehabilitation has positive effects. Thus, it is expected that an improvement in different dimensions will be observed at the end of rehabilitation in both groups. With regard to the different severities of COVID-19, this study evaluates the long-term developments. Subsequently, the authors will elaborate concrete recommendations for medical rehabilitation after different courses of disease with regard to existing pneumological rehabilitation concepts. TRIAL REGISTRATION: German Register of Clinical Trials, www.drks.de .Identifier: DRKS00023642; Registered: 01.12.2020.Date and version identifier: 08.04.2021; version 4.

[General Practitioner Centered Rehabilitation Aftercare for Chronic Back Pain]. / Hausarztzentrierte Rehabilitationsnachsorge bei chronischen Rückenschmerzen.

BACKGROUND: Back pain is one of the most common and costly health disorders in Germany. Rehabilitation measures for back pain often show a lack of long-term effects after rehabilitation treatment. The "Neues Credo" aftercare concept has proven to be promising in increasing the long-term effects. In the current study, it was piloted and evaluated in general practitioners' practices. METHODS: A prospective observational study was carried out. Nine orthopedic rehabilitation clinics and N=178 general practitioners were involved in the aftercare. The intervention was evaluated by means of written surveys of 85 rehabilitation patients with chronic back pain at 3 points in time. The outcomes were functional capacity and participation; the secondary outcomes were subjective health and physical activity. The long-term effects were evaluated by analyses of variance with repeated measurements. RESULTS: At the end of the rehabilitation, the main outcome functional capacity shows a significant improvement of small magnitude, all secondary outcomes show significant medium to large effects. During the follow-up period, the participants were able to significantly increase their physical activity. Especially with respect to endurance training and workout. Twelve months after rehabilitation, significant improvements can still be seen in all outcomes. The range of parameters describing effect size are below the usual thresholds for clinically important changes. CONCLUSION: Rehabilitation aftercare like the program "Neues Credo" shows similar lasting effects when supported by the general practitioner instead of the rehabilitation clinic. The successes decrease somewhat 12 months after the rehabilitation, but we still see significant differences in all outcomes compared to baseline. There is a high satisfaction with the program by rehabilitants and general practitioners. Since general practitioners are the first contact after rehabilitation a transfer of the program into routine care would be promising.

[Effects of Supported Aftercare in the Post-Rehabilitation Phase in COPD Patients: A Controlled Study]. / Effekte einer begleiteten Nachsorge in der Post-Reha-Phase bei COPD-Patienten: eine kontrollierte Studie.

BACKGROUND: C: hronic O: bstructive P: ulmonary D: isease (COPD) is a chronic degenerative disease characterized by an irreversible obstruction of the respiratory system. Medical rehabilitation is of central importance in disease management. Physical training is one of the most important non-drug therapy modules. The effectiveness of inpatient pneumological rehabilitation is considered proven, but the effects are not sustainable. AIM OF THE STUDY: Increasing the sustainability of rehabilitation success in patients with COPD through supported aftercare. METHOD: Evaluation of the effectiveness of the New Credo in a single-center, controlled longitudinal study with three measurement times (start of rehabilitation, end of rehabilitation, 12-month follow-up). Rehabilitation patients with confirmed COPD were included. The control group (CG) received the guideline-compliant standard care, the intervention group (IG) underwent rehabilitation and follow-up care in accordance with the New Credo. The New Credo is a concept in which aftercare is taken into account at the start of rehabilitation and which emphasizes the personal responsibility and own initiative of the rehabilitation patients. Supporting tools are used for training clinic employees, including a "to do list", checklists for doctors, information for follow-up institutions. A group session is held for the rehabilitation patients assigned to aftercare; they keep different diaries, which they send the rehabilitation clinic at different times after completing rehabilitation. The clinic provides patients feedback that is intended to support them in maintaining physical activity. The primary outcome measure was participation (I: ndex zur M: essung von E: inschränkungen der T: eilhabe, IMET score) in an intra- and intergroup comparison at three measurement times. Secondary outcomes were: C: OPD A: ssessment T: est (CAT), various P: atient R: eported O: utcome M: easures (PROMs) and the extent of physical activity. RESULTS: Complete data on 149 IG and 135 CG members were used (complete case analysis). The participants were on average 64 years old, 57 % (IG) and 67 % (KG) were male. Most of the respondents had COPD grade II-III. Twelve months after rehabilitation, the IG showed the same value for primary outcome participation as at the beginning of rehabilitation (M = 30.8; SD = 21.8), the control group showed worse results (M = 41.3; SD = 24.7). The same findings (stability in the IG, deterioration in the CG) was also seen in the secondary outcomes. In the time after rehabilitation, the IG showed in secondary outcomes less deterioration than the CG, but the differences were not significant. With regard to the increase in physical activity, the IG reported significantly more often that they were able to achieve their subjective rehabilitation goals (69 % vs. 34 %, p < 0.01). In addition, they increased the amount of physical activity in the period after rehabilitation to a greater extent than the CG (p = 0.064). They participated in sports at a sports club more often (15 % vs. 5 %, p < 0.01) and did endurance sports significantly more frequently during the follow-up period (46 % vs. 21 %, p < 0.01) CONCLUSION: Through the intervention with the New Credo, a lasting effect (effect size ES = .40) was expected for the primary outcome participation in the IG as compared to the CG. This assumption was not confirmed: there was neither a time nor a group effect. However, against the background of the particular importance of physical activity in the course of COPD, integration of physical activity permanently into everyday life by the IG can be looked upon as a sort of success of the New Credo.

ReNaApp: increasing the long-term effects of oncological rehabilitation through an application after medical rehabilitation (ReNaApp): a quasi-randomized longitudinal study of prospective design.

BACKGROUND: Breast cancer is the most common malignant disease in women. Compared with other cancer types, breast cancer has a higher survival rate. The majority of breast cancer patients are overstrained to implement cancer-specific recommendations relating to changes in health behaviour. Numerous epidemiological studies have shown a positive correlation between physical activity and quality of life as well as the course of disease during and after breast cancer treatment. However, many patients have difficulties integrating physical activity into their everyday lives due to cancer symptoms. To develop physical activity into a daily routine, an aftercare programme for breast cancer patients will be developed. In particular, the programme is structured in terms of the validated concept "Neues Credo". The basic concept is converted into a mobile application. METHODS: The study sample includes n = 740 rehabilitants (370 for the intervention group and for the control group) from five different rehab clinics in Northern Germany. The evaluation is as follows: a) Quasi-randomized, prospective longitudinal study (sequential study design). The intervention group receives a mobile application after rehabilitation, and the control group receives treatment as usual. The study evaluation is carried out through a questionnaire at three stages (at the beginning of the rehabilitation, at the end of the rehabilitation, and after 12 months). b) Qualitative analysis of interviews and focus groups in terms of feasibility and acceptance. c) Formative evaluation of the app. DISCUSSION: Above all, the aftercare programme ReNaApp increases the long-term effects of oncological rehabilitation. By documenting physical activity in ReNaApp, rehabilitants become more motivated to engage in physical activity in their everyday lives. Currently, there is no scientifically evaluated app for breast cancer patients in the German language. Thus, ReNaApp ensures an aftercare treatment for breast cancer patients with high-quality performance regardless of their place of residence. By adopting a participatory approach and a user-centred design, ReNaApp corresponds to the demands of the rehabilitants. TRIAL REGISTRATION: German Register of Clinical Trials, www.drks.de. Identifier: DRKS00019017; Registered: November 7th, 2019. Date and version identifier: April 17th 2020; vesion 2.

[Rehab Aftercare 'New Credo' in the Cardiac Follow-Up Rehabilitation]. / Nachsorge 'Neues Credo' in der kardiologischen Anschlussrehabilitation.

PURPOSE: Physical inactivity is considered the most important modifiable risk factor of cardio-vascular diseases. Therefore medical rehabilitation is focused on the improvement of physical activity. To maintain physical activity after rehabilitation aftercare strategies are necessary which help to transfer the skills learned during rehabilitation into daily routine. In this study the aftercare concept "Neues Credo" which has been evaluated several times has been implemented and evaluated into cardiological follow-up rehabilitation. METHODS: Prospective, controlled, multicentre study with 4 cardiological rehabilitation institutions. INCLUSION CRITERIA: rehabilitants with initial diagnosis from the ICD groups I20-25 and I34-43. In the first phase of the study, patients received standard rehabilitation and standard aftercare (control group (KG)). In the second phase, patients received rehabilitation based on the conditions of "Neues Credo" with the focus on increasing physical activity (intervention group (IG)). Data for evaluation were collected by paper-and-pencil questionnaires at 3 points in time. Primary outcome variable: restriction in participation (IMET); secondary outcome variables: depression (CES-D), several scales of subjective health and physical activity. Analysis of variance with repeated measures was used for the evaluation of long-term effects. RESULTS: Complete data could be evaluated from 152 patients of the IG and from 165 patients of the KG. At the end of rehabilitation both IG and KG showed improvements in outcome variables. In the period after rehabilitation patients in the IG improved their physical activity significantly more often than members of the KG (66 vs. 42%, p<0,01), they showed more physical activity than the KG (p=0,040) and they performed endurance sports more often (58 vs. 38%, p<0,01). The primary outcome of participation shows significant improvements in both groups (p<0,01) 12 months after the rehabilitation, difference between groups did not reach statistical significance but indicated a clear tendency in favour of the IG. Similar trends could be found for the secondary outcome-data CONCLUSION: In this study, the "Neues Credo" was applied and evaluated in cardiologic rehabilitation for the first time. Participants reported high practicability and high satisfaction. Health- related outcomes show a trend of positive effects in favour of the IG, but the interaction effects did not reach statistical significance in most cases. Regarding physical activity the intervention group shows clear advantage and will probably benefit from the long-term effects of regular endurance training.

Correction to: ParkProTrain: an individualized, tablet-based physiotherapy training programme aimed at improving quality of life and participation restrictions in PD patients-a study protocol for a quasi-randomized, longitudinal and sequential multi-method study.

Following publication of the original article [1], the authors reported errors in reference citations found in Table 1.

ParkProTrain: an individualized, tablet-based physiotherapy training programme aimed at improving quality of life and participation restrictions in PD patients - a study protocol for a quasi-randomized, longitudinal and sequential multi-method study.

BACKGROUND: Parkinson's disease (PD) is one of the most common neurodegenerative diseases. Patients suffer from a variety of motor and non-motor symptoms that severely affect their daily lives and quality of life. In many cases, a three-week inpatient Parkinson's complex treatment (MKP) can improve the overall condition and quality of life of patients in a short time. In the outpatient sector, however, there is often a lack of human resources and structures necessary for the interdisciplinary treatment of the disease. To support PD patients in continuing the physical exercises they learned from the MKP on a regular basis, a tablet-based training programme will be developed in which exercises can be adjusted to the patient's abilities. This programme is expected to increase quality of life and social participation, as well as delay the progression of the impairment. METHODS: a) Quasi-randomized, prospective longitudinal study (sequential study design). The intervention group receives a tablet-based training programme during and for 9 months after the MKP, and the control group receives treatment as usual. The evaluation is carried out by means of a written survey at three points in time (the beginning and end of the MKP and after 9 months). b) Qualitative analysis of interviews and focus groups in terms of feasibility and acceptance. c) Formative evaluation of the app and the administration panel. d) Evaluation of the implementation of the training programme by analysing the planned and performed physical activities, as well as evaluation of the phone calls between physiotherapists and patients. DISCUSSION: The tablet-based training programme can ensure continuous and long-term support for PD patients. They learn different self-management strategies during and after their MKP and are empowered to assume responsibility for carrying out regular physical activity on their own. Because common app stores have no scientifically evaluated apps for PD patients in the German language, the app can fill this gap and help PD patients receive high-quality care in the implementation of physically activating exercises regardless of their place of residence. In addition, the user-centred development of the app ensures that the app meets the specific needs of PD patients. TRIAL REGISTRATION: German Register of Clinical Trials, drks.de . Identifier: DRKS00014952. Registered on June 20th 2018. Date and version identifier April 25th 2019; version 1.

Telephone-based aftercare groups for family carers of people with dementia: study protocol of the Talking Time - REHAB project.

BACKGROUND: More than one million people in Germany live with dementia. Most of these people are cared for at home in the family setting. Supporting and caring for people with dementia is time-consuming, and family carers often have high stress levels and are at an increased risk of becoming physically and mentally ill. Medical rehabilitation (rehab) helps to relieve family carers and provide them with strategies to cope with stress. The aim of this study is to improve the sustainability of a multimodal rehab program for family carers of people with dementia. RESEARCH QUESTION: can the effects of this rehab be maintained through telephone-based aftercare groups following the rehab program? METHODS: A prospective randomized controlled longitudinal trial is performed. The intervention group (IG) participates in telephone-based aftercare groups; the control group (CG) receives treatment as usual. For evaluation, a mixed-methods approach is used. The effects of the intervention are quantitatively evaluated by written questionnaires at four measuring points (pre- and post-rehab, as well as 6 and 12 months after the end of rehab). PRIMARY OUTCOME: participation (IMET). SECONDARY OUTCOMES: Depressive Mood State CES-D, General Complaints SCL-90-R, Subjective Quality of Life WHOQUOL-BREF, Social Support F-SozU, performance in different areas of life, single scales, and support offers (single items). The intervention process is evaluated through qualitative interviews and focus groups with regard to the acceptance of and satisfaction with the aftercare offered; in addition, a health economic evaluation is performed using the EQ-5D questionnaire. Rehabilitants are included in the study (N = 103 each in the IG and CG) who, accompanied by their family members with dementia, participate in the rehab measure in Ratzeburg. The IG participates monthly in 6 telephone aftercare groups over a period of 6 months. Typical stress situations are discussed and worked on. DISCUSSION: Upon successful evaluation, the offer to participate in telephone-based aftercare groups can be firmly established in the participating rehab clinic. Through minor adjustments, the offer would also be suitable for carers of physically ill people and for non-nursing-specific rehabilitation indications. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00013736 , May 14, 2018.

[Reasons for the Non-Utilisation of an Oncological Rehabilitation. Results of a Written Survey with Patients of Oncological Healthcare Centers]. / Gründe für die Nichtinanspruchnahme einer onkologischen Rehabilitation. Ergebnisse einer schriftlichen Befragung von Patienten aus onkologischen Versorgungszentren.

BACKGROUND: Incidence and survival rates in patients with cancer are rising as well as the potential rehabilitation needs. In contrast, the numbers of rehabilitation treatments after cancer are decreasing. The reasons are not yet completely understood. METHODS: A written survey with patients of three cancer indications breast cancer, prostate cancer and colon cancer after acute medical treatment. 376 persons participated and were asked for rehabilitation utilisation, reasons against medical rehabilitation and subjective health status. Statistical analyses were mainly performed descriptively. RESULTS: Half of the participants used a medical rehabilitation. Those patients were more affected in subjective health and showed a higher level of disease severity. Participants who refused the utilisation of a medical rehabilitation mentioned primarily family, personal and private reasons. CONCLUSION: The written survey provided a variety of reasons why a medical rehabilitation is not used after cancer disease. From this data, suggestions for the optimization of rehabilitation and organizational arrangements can be derived.

[Rehabilitation Program for Persons with Relatives Suffering from Dementia: Results of a Longitudinal Observational Study]. / Rehabilitation mit einem demenzkranken Angehörigen: Ergebnisse einer längsschnittlichen Beobachtungstudie.

BACKGROUND: Caregiving relatives of dementia patients are exposed to considerable burdens. A multimodal rehabilitation concept which enables the inpatient treatment of caregiving relatives together with the dementia patients was evaluated. METHODS: Questionnaire survey including 121 caring relatives at 3 times of measurement. Indicators of subjective health and the use of nursing and psychosocial support services were measured during the course of the study. RESULTS: Relevant improvements in health can be seen after rehabilitation. Six months after rehabilitation, the effects decrease, but do not reach the baseline value before rehabilitation for any of the variables measured. CONCLUSION: The multimodal rehabilitation concept shows sustainable effects, at least in some variables. In connection with the high level of satisfaction of the participants, the results indicate that the rehabilitation concept is successful and is associated with a large health benefit.

[Need for Information about Medical Rehabilitation of Persons with German Pension Insurance: a Written Survey]. / Informationsbedürfnisse von Versicherten der Deutschen Rentenversicherung zur medizinischen Rehabilitation ­ eine schriftliche Befragung.

AIM: In order to acquire target group-specific information on rehabilitation for members of the German pension insurance, they were asked about their ideas about medical rehabilitation and desired information regarding subjects and kind of information transfer. METHOD: The core of the project was a written survey of members of the German pension insurance. N=600 insured people were invited to participate in the study. The questionnaire was developed in a qualitative pre-study. RESULTS: N=196 questionnaires were evaluated. Recovery of working ability was mentioned by most persons as the aim of medical rehabilitation. The most common idea regarding indication for rehabilitation was a specific operation. Physiotherapy was most often considered as therapy during medical rehabilitation. Information about formal steps, realistic aims and rehabilitation clinics were important. A conversation with their physician, written information material and a website were the preferred information pathways. Two-thirds of participants thought that information about medical rehabilitation was important even though they had no rehabilitation indication at the time of survey. CONCLUSION: The identified target-related information needs can be considered in a need-oriented development of information material. These can contribute to an informed decision for members of the German pension insurance for or against medical rehabilitation or an application for rehabilitation. Moreover, patient-oriented information can contribute to more successful rehabilitation participation, higher satisfaction with and a better rating of medical rehabilitation.

[Digital Information on Rehabilitation and Retirement for Physicians - A Practical Test]. / Digitale Bereitstellung von Informationen für Ärzte zum Thema Rehabilitation und Rente ­ ein Praxistest.

BACKGROUND: About 1.6 million rehabilitation applications are submitted to the German pension insurance annually. Physicians working in ambulatory care play an important role in the application process. Studies show that there is too little knowledge about medical rehabilitation in these groups of physicians, the detection of rehabilitation needs and the process of application for rehabilitation. Against this background, a website Information for Doctors on Rehabilitation & Retirement was developed which addresses especially these needs. The aim of the study was to evaluate the website within a practical test. METHODS: The practical test was performed with a mixed Methods Approach: 1) Quantitative survey with respect to increased knowledge after using the homepage, 2) assessment of cases with regard to rehabilitation indication and 3) evaluation of the user friendliness of the homepage by participating doctors by means of think-aloud technique. RESULTS: A total of 79 postgraduate General Practice trainees participated. They had high information needs regarding different aspects of rehabilitation, which were partly satisfied by the use of the homepage. The correct assessment of rehabilitation cases improved with the aid of the website for general practitioners with experience with application for rehabilitation only. The homepage was evaluated as clear and helpful, but the texts were judged as too extensive. CONCLUSION: The homepage can support physicians working in ambulatory care with respect to rehabilitation. Some impulses for optimization of the content have been identified and can help to further increase the usefulness of the website.

[Telephone Aftercare by Social Services to Improve Return to Work after Medical Rehabilitation]. / Telefonische sozialdienstliche Nachsorge zur Verbesserung der beruflichen Reintegration nach stationärer medizinischer Rehabilitation.

Aim Many patients are discharged from the rehabilitation clinic with a restored working ability, but are often unemployed or there is a mismatch between their skills and the job requirements. Those patients often feel to be left alone with their problems regarding their adequate occupational reintegration and wish to be supported over the course of stationary rehabilitation in terms of socio-legal and social-medical issues. The randomized controlled trial investigated if a 12 month telephone aftercare conducted by staff of the social service has a positive influence on occupational reintegration. Method Patients with severe limitations of work-related functioning were recruited in one rehabilitation center and randomized at the end of rehabilitation. The intervention group (N=171) received a telephone aftercare for 12 month by staff of the social service, the control group (N=162) received the standard aftercare recommendation. The risk of an unsuccessful occupational reintegration was operationalized by means of 3 items, which where summed up to a risk index. The evaluation of the aftercare was conducted by written survey on 3 measurement points. Results Overall 333 patients were included in the study. 45% (N=152) of the sample were female, the mean age was 50 years. 12 month after rehabilitation 71% (N=120) of patients from the intervention group stated to be employed. In the control group the proportion amounts to 68% (N=110; p=0.074, CI -0.0718; 0.1252). The control group has a significant higher risk constellation according to the risk score for occupational reintegration as the intervention group. Conclusion The risk score shows significant advantages for patients in the intervention group. The risk of a non-successful reintegration 12 month after rehabilitation was significant lower in the intervention group. All further occupational and health related outcomes indicate only moderate differences. These should be considered against the background of the low-threshold intervention. The telephone aftercare by staff of the social service was rated as very helpful by most of the patients in the intervention group.