[Experts' uncertainties in decisions on the indication for rehabilitation as part of the assessment of long-term care needs: Results of semi-structured interview]. / Entscheidungsunsicherheiten bei der zweistufigen Prüfung einer Rehabilitationsindikation im Rahmen der Pflegebegutachtung ­ Ergebnisse leitfadengestützter Interviews.

OBJECTIVE: As part of assessment of long-term care needs, Medical Services of the compulsory German Health Insurance have to decide whether medical rehabilitation is indicated. The aim of this study was to identify uncertainties and associated factors while deciding whether rehabilitation was indicated in this standardized review process. METHOD: Semi-structured interviews were conducted with a total of twelve nursing experts and six physician experts from six different Medical Services. In the interviews of the two professional groups, thinking aloud and problem-centered methods were used. They were subjected to a cognitive pretest prior to data collection. All interviews were conducted over telephone in May 2021, digitally recorded and transcribed thereafter. They were analyzed based on the method of structuring qualitative content analysis using the MAXQDA software. RESULTS: Uncertainties in decision-making can arise both from case-related characteristics and case-independent contextual factors. Nursing experts associated uncertainties in assessing the criteria of rehabilitation indication primarily with certain diseases (especially dementia or mental illnesses), multimorbidity, an unclear illness and ambulatory care situation, as well as a negative rehabilitation-related attitude of the persons being assessed. The physician experts, who based their decisions on available documentation in the case files, described uncertainties, particularly due to insufficient information relevant to the decision (e. g., on diagnostics, course of disease and treatment, weighting of existing limitations) in the nursing experts' assessments. Across all criteria, the experts' own professional or private rehabilitation experience and their understanding of the role of rehabilitation before and during the need for long-term care, as well as aspects of communication practice and the professional exchange between the nursing and the physician experts also influenced the overall decision-making process. CONCLUSION: The identification of uncertainties in experts' decision-making process and associated factors enables the development of strategies to strengthen specifically the certainty of experts' decision-making and thus may contribute to the promotion of a needs-based rehabilitation access via long-term care assessment.

[The National Competency-Based Catalogue of Learning Objectives for Medicine 2.0 for the subject Physical and Rehabilitative Medicine, Naturopathic Medicine. Consensus of Scientific Medical Societies]. / Der Nationale Kompetenzbasierte Lernzielkatalog 2.0 für das Fach "Physikalische und Rehabilitative Medizin, Naturheilverfahren". Konsentierte Ergebnisse beteiligter Fachgesellschaften der AWMF.

BACKGROUND: The learning objectives in the current cross-sectional subject "Rehabilitation, Physical Medicine, Naturopathic Medicine" have been revised as part of the further development of the National Competency-Based Catalogue of Learning Objectives for Medicine (NKLM) to its new version 2.0. Since the NKLM is designed as an interdisciplinary catalogue, a subject assignment seemed necessary from the point of view of various stakeholders. Thus, the German Association of Scientific Medical Societies (AWMF) and the German medical faculties initiated a subject assignment process. The assignment process for the subject "Physical and Rehabilitative Medicine, Naturopathic Medicine" (PRM-NHV; according to the subject list of the first draft of the planned novel medical license regulations from 2020) is presented in this paper. MATERIAL AND METHODS: The AWMF invited its member societies to participate in the assignment of learning objectives of chapters VI, VII, and VIII of the NKLM 2.0 to the individual subjects to which they consider to contribute in teaching. For "PRM-NHV", representatives of the societies for rehabilitation sciences (DGRW), physical and rehabilitation medicine (DGPRM), orthopaedics and traumatology (DGOU), as well as for naturopathy (DGNHK) participated. In a structured consensus process according to the DELPHI methodology, the learning objectives were selected and consented. Subsequently, subject recommendations were made by the AWMF for each learning objective. RESULTS: From the NKLM 2.0, a total of 100 competency-based learning objectives of chapters VII and VIII for the subject "PRM-NHV" were consented by the representatives of the involved societies for presentation on the NKLM 2.0 online platform. CONCLUSIONS: In the context of the revision process of medical studies in Germany and under the umbrella of the AWMF and the German medical faculties, a broad consensus of competency-based learning objectives in the subject "PRM-NHV" could be achieved. This provides an important orientation for all medical faculties both for the further development of teaching in the cross-sectional subject "Rehabilitation, Physical Medicine, Naturopathic Medicine" according to the 9th revision of the medical license regulations, which has been valid for twenty years, and for the preparation of the corresponding subjects in the draft bill of the novel license regulations.

Public information needs and preferences on COVID-19: a cross-sectional study.

BACKGROUND: Right from the beginning of the SARS-CoV-2 pandemic the general public faced the challenge to find reliable and understandable information in the overwhelming flood of information. To enhance informed decision-making, evidence-based information should be provided. Aim was to explore the general public's information needs and preferences on COVID-19 as well as the barriers to accessing evidence-based information. METHODS: We performed a cross-sectional study. Nine hundred twenty-seven panel members were invited to an online survey (12/2020-02/2021). The HeReCa-online-panel is installed at the Martin Luther University Halle-Wittenberg to assess regularly the general public's view on health issues in five regions in Germany. The survey was set up in LimeSurvey, with nine items, multiple-choice and open-ended questions that allowed to gather qualitative data. Quantitative data were analysed descriptively and a content analysis was carried out to categorise the qualitative data. RESULTS: Six hundred thirty-six panel members provided data; mean age 52 years, 56.2% female, and 64.9% with higher education qualifications. Asked about relevant topics related to COVID-19, most participants selected vaccination (63.8%), infection control (52%), and long-term effects (47.8%). The following 11 categories were derived from the qualitative analysis representing the topics of interest: vaccination, infection control, long-term effects, therapies, test methods, mental health, symptoms, structures for pandemic control, infrastructure in health care, research. Participants preferred traditional media (TV 70.6%; radio 58.5%; newspaper 32.7%) to social media, but also used the internet as sources of information, becoming aware of new information on websites (28.5%) or via email/newsletter (20.1%). The knowledge question (Which European country is most affected by the SARS-CoV-2 pandemic?) was correctly answered by 7.5% of participants. The Robert Koch Institute (93.7%) and the World Health Organization (78%) were well known, while other organisations providing health information were rarely known (< 10%). Barriers to accessing trustworthy information were lack of time (30.7%), little experience (23.1%), uncertainty about how to get access (22.2%), complexity and difficulties in understanding (23.9%), and a lack of target group orientation (15,3%). CONCLUSIONS: There are extensive information needs regarding various aspects on COVID-19 among the general population. In addition, target-specific dissemination strategies are still needed to reach different groups.

["That One Can See How it is Supposed to be." Conception, Piloting and Evaluation of an Interprofessional Rehabilitation-Related Module for the Training Courses in Medicine, Nursing, and Physiotherapy]. / "Dass man mal sieht, wie es eigentlich sein sollte." Konzeption, Pilotierung und Evaluation eines interprofessionellen rehabilitationsbezogenen Moduls für die Medizin, Pflege und Physiotherapie.

BACKGROUND: Considering the growing rehabilitative care requirements, good interprofessional cooperation is of central relevance for health care professions and is increasingly demanded. Interprofessional cooperation does not yet play a significant role in health professions' education, despite the fact that it is considered an important element of success in outcome- and patient-centered health care. The field of rehabilitation lacks interprofessional teaching concepts and material. METHODS: An interprofessional team of instructors developed the didactic and thematic concept for the module. The module focuses on rehabilitation and discharge management. The learning objectives were developed based on the National Competency-Based Catalogue of Learning Objectives for Medicine. The formative evaluation was based on a questionnaire filled out by the students and the learning guides. RESULTS: 47 participants took part in three runs. The results of the formative evaluation demonstrate that the module was overall well received. The trainees rated the module more favorably than the medical students. While participants emphasized the good practical eye-to-eye interaction between the professions and the honest feedback conversation, they also pointed to the contrast they perceived to their everyday practice. They also wished for more time having verbal interprofessional exchange. The medical students criticized that interprofessional modules were only offered in their final year. CONCLUSION: To the author's knowledge, this is the first publication of an interprofessional module on rehabilitation and discharge management including piloting and positive evaluation for the three professional groups of medicine, nursing and physical therapy. Improvement suggestions of the participants led to modifications that will be realized in the next version of the module. The course sets important impulses for the further development of interprofessional cooperation and the teaching of rehabilitation-related skills. The modular package is available to other lecturers in a free online platform for rehabilitation-related teaching materials.

[Comprehension and Perspectives of the Need for Medical Rehabilitation - Results of a German Online Survey]. / Verständnis und Bedürfnis medizinischer Rehabilitation in der Bevölkerung ­ Ergebnisse einer Online-Befragung.

BACKGROUND: In Germany, medical rehabilitation usually requires an application of the persons in need. Therefore, these persons have to understand what rehabilitation is and in what case they need this type of health care service. In addition to people with health problems, their close persons (e. g. family members) should also have rehabilitation-related knowledge. Since there is only limited data on the perspective towards medical rehabilitation services, a survey was conducted. METHOD: In September 2020, we invited 2,401 registered participants (age: 18-79 years) of a population-based online panel study to participate in an online survey. The cross-sectional survey asked about the understanding of need, subjective information as well as attitudes and expectations towards medical rehabilitation services. We analysed the data descriptively, taking into account the participants' rehabilitation experience and health impairment. In a subgroup analysis, the potential factors influencing the subjective need for rehabilitation were tested using logistic regression. RESULTS: Data from 1,464 persons (Ø age: 52.5±14.5 years; 55% non-male) were analysed, 44% of the participants considered themselves to be "rather well" or "very well" informed about medical rehabilitation. The majority associated a need for rehabilitation with the access requirements related to service providers. In case of an emerging need for rehabilitation, family doctors would be the first point of contact. The participants mainly had function-oriented expectations of rehabilitation services and a majority prefer inpatient rehabilitation if necessary. Among 383 persons with long lasting and pronounced health-related impairment, the concrete individual need for rehabilitation was associated by a higher subjective degree of impairment as well as their own previous rehabilitation experience and rehabilitation experience in their personal social environment. CONCLUSION: Despite an overall good understanding of the need for rehabilitation, different rehabilitation views were found in certain population groups. In order to improve the general understanding of rehabilitation in the public and particularly in close persons, adequate dissemination of low-threshold, population-based rehabilitation information is recommended.

[Reasons and Influencing Factors for the Willingness to Document Preferences Regarding Organ Donation: Results of an Online Survey]. / Gründe und Einflussfaktoren für die Bereitschaft zur Dokumentation von Präferenzen bezüglich Organspende. Ergebnisse einer Online-Umfrage.

OBJECTIVE: Different options to regulate decisions about organ transplantation were subjected to discussions prior to parliamentary decision on 16.01.2020. The goal of this study was the description of citizens' attitudes towards organ donation and investigation of predictors of (documentation of) willingness to donate. METHODS: Cross sectional online survey in Berlin and Saxony-Anhalt between 25.11.2019 till 16.01.2020. Descriptive, statistical analysis. We report absolute and relative frequencies. We conducted logistic regression analysis for the influence of age, income and gender on knowledge, willingness to donate and possession of an organ donor card. RESULTS: Of 20 020 invited citizens, 676 (3.4%) participated in the online survey; 54.9% were in favour of an opt-out regulation, 49.4% supported an opt-in regulation, 63.3% of respondents were willing or rather willing to donate an organ and 43.2% possessed an organ donor card. Willingness to donate and possession of an organ donor card decreased with increasing age. A Higher educational level was associated with having an organ donor card. Gender, income, education and knowledge about organ donation were not associated with the willingness to donate an organ. Of those who were willing to donate but who had not a donor card, 45.7% had communicated their will to relatives. Reasons indicated for lack of documentation included practical reasons as also fears related to medical care in case of critical health state. DISCUSSION: None of the discussed legislative regulations on organ donation has been supported by a clear majority of respondents. Distinct population-based surveys can serve as starting point for developing targeted initiatives to increase the documentation of citizens' will regarding organ donation following brain death.

[Factors Influencing the Access to and Utilization of Medical Rehabilitation Services Recommended after Care Assessment - Results of Qualitative Interviews with Professionals Involved in the Decision Process]. / Einflussfaktoren auf Beantragung und Inanspruchnahme empfohlener Rehabilitationsleistungen nach einer Pflegebegutachtung ­ Ergebnisse qualitativer Interviews mit professionellen Akteur/innen.

PURPOSE: In Germany, persons in need of care can receive a rehabilitation recommendation from the medical service of the health insurance companies. Approximately half of these recommendations lead to applications and every fourth recommendation to actual utilisation of medical rehabilitation. Little is known about the supporting factors for and barriers to this special access to medical rehabilitation for persons in need of care. To explore the influencing factors - both personal and procedural - from the perspectives of involved professionals. METHODS: Interviews regarding on the access to medical rehabilitation were conducted with expert raters from the medical service of the German statutory health insurance system and with employees in long-term care and in health insurance. For data analysis systematic text condensation was used. RESULTS: Based on 53 interviews with 56 involved professionals, individual- and process-related influencing factors were identified. In addition to sociodemographic, health-related, personal and financial characteristics, rehabilitation-related attitudes and a strong attachment to the home environment seem to be particularly relevant. Furthermore, service-related (e. g. expectations and wishes) and process-related (e. g. care structures) characteristics also seem to have an impact. The importance of social support from relatives was emphasized. CONCLUSIONS: The results point to potential supporting factors and barriers in the access to rehabilitation by means of care assessment. They should be considered for possible improvements of the assessment and approval procedures as well as the necessary early and sufficient councelling of the concerned persons and their relatives.

Self-Reported Prognosis of Employability as an Indicator of Need for Rehabilitation: A Cohort Study in People with Back Pain.

PURPOSE: Rehabilitation is a key strategy to enable people with disabilities or chronic diseases to participate in society and employment. In Germany, the approval of rehabilitation services is linked to personal requirements, including significantly compromised work ability due to illness. The subjective prognosis of employability (SPE) is a brief 3-item scale. The total score assesses the self-rated risk of permanent work disability and was therefore proposed to be an indicator to operationalize the requirements to determine the need for a medical rehabilitation measure. This cohort study examined whether rehabilitation and disability pensions can be predicted by the SPE in employees with back pain. Moreover, the study tested the applicability of the SPE regarding interrupted employment. METHODS: Employees aged 45 to 59 years who reported back pain in the last three months completed the SPE in 2017. The total score ranges from 0 to 3 points, with higher values indicating a higher risk of permanent work disability. Data on rehabilitation, disability pensions, and interrupted employment were extracted from administrative records covering the period until the end of 2018. Proportional hazard and logistic regression models were fitted. RESULTS: Data of 6,742 participants were included (mean age: 52.3 years; 57.8% women). Maximum follow-up was 21 months. Of the participants, 38.8, 33.6, 21.4, and 6.2% had an SPE score of 0, 1, 2, and 3 points, respectively. During follow-up, 535 individuals were approved for a rehabilitation measure and 49 individuals for a disability pension. Fully adjusted analyses showed an increased risk of a rehabilitation in employees with an SPE score of 3 points (HR=2.20; 95% CI 1.55; 3.11) and 2 points (HR=1.76; 95% CI 1.33; 2.31) compared to employees with an SPE score of 0 points. The risk of a disability pension (HR=13.60; 95% CI 4.56; 40.57) and the odds of interrupted employment (OR=2.58; 95% CI 1.72; 3.86) were also significantly increased for those with an SPE score of 3 points. CONCLUSIONS: The brief SPE is an appropriate tool to identify individuals reporting back pain at risk of rehabilitation, poor work participation outcomes, and permanent work disability. HINTERGRUND: Rehabilitation ist eine Schlüsselstrategie, um Menschen mit Behinderungen oder chronischen Erkrankungen die Teilhabe an der Gesellschaft und am Arbeitsleben zu ermöglichen. In Deutschland ist die Bewilligung von Rehabilitationsleistungen an persönliche Voraussetzungen geknüpft, u. a. an eine erhebliche Gefährdung der Erwerbsfähigkeit aufgrund von Krankheit. Die subjektive Erwerbsprognose (SPE) ist eine kurze 3-Item-Skala. Der Gesamtscore bewertet das selbst eingeschätzte Risiko einer dauerhaften Arbeitsunfähigkeit und wurde daher als Indikator zur Operationalisierung der Voraussetzungen und zur Bestimmung des Bedarfs an einer medizinischen Rehabilitationsmaßnahme vorgeschlagen. Die Kohortenstudie untersucht, inwiefern Rehabilitationen und Erwerbsminderungsrenten durch die SPE bei Beschäftigten mit Rückenschmerzen vorhergesagt werden können. Zudem wurde die Assoziation zwischen der SPE und unterbrochener Beschäftigung getestet. METHODEN: Die SPE wurde im Jahr 2017 bei Versicherten im Alter von 45 bis 59 Jahren, die Rückenschmerzen in den letzten drei Monaten berichteten, erhoben. Der Gesamtscore reicht von 0 bis 3 Punkten, wobei höhere Werte ein höheres Risiko für eine dauerhafte Erwerbsunfähigkeit anzeigen. Daten zu Rehabilitationen, Erwerbsminderungsrenten und unterbrochener Beschäftigung umfassen den Zeitraum bis Ende 2018 und wurden aus den Versichertenkonten extrahiert. Die Zusammenhänge wurden mittels proportionaler Hazard- und logistischer Regressionsmodelle getestet. ERGEBNISSE: Es wurden die Daten von 6.742 Teilnehmenden eingeschlossen (mittleres Alter: 52,3 Jahre; 57,8% weiblich). Der maximale Nachbeobachtungszeitraum betrug 21 Monate. 38,8, 33,6, 21,4 und 6,2% hatten einen SPE-Score von 0, 1, 2 bzw. 3 Punkten. Im Beobachtungszeitraum wurde 535 Personen eine Rehabilitationsmaßnahme und 49 Personen eine Erwerbsminderungsrente bewilligt. Vollständig adjustierte Analysen zeigten ein erhöhtes Risiko für eine Rehabilitation bei Beschäftigten mit einer SPE von 3 Punkten (HR=2,20; 95% KI 1,55; 3,11) und 2 Punkten (HR=1,76; 95% KI 1,33; 2,31) im Vergleich zu Personen mit einer SPE von 0 Punkten. Das Risiko einer Erwerbsminderungsrente (HR=13,60; 95% KI 4,56; 40,57) und die Wahrscheinlichkeit für eine unterbrochene Beschäftigung (OR=2,58; 95% KI 1,72; 3,86) waren ebenfalls signifikant erhöht für diejenigen mit einer SPE von 3 Punkten. SCHLUSSFOLGERUNGEN: Die SPE ist bei Menschen mit selbstberichteten Rückenschmerzen ein geeignetes Assessmentinstrument zur Identifizierung von Personen, bei denen ein erhöhtes Risiko für eine Rehabilitation, gefährdete berufliche Teilhabe und dauerhafte Arbeitsunfähigkeit besteht.

[Determinants of the Wish for Rehabilitation and the Intention to Apply in Persons with Back Pain]. / Determinanten des subjektiven Rehabilitationsbedürfnisses und der Antragsintention bei Personen mit Rückenschmerzen.

PURPOSE: Up to now, the main focus of analysis has been on determinants of the application for and utilization of medical rehabilitation due to back pain. The prevalence and determinants of motivational and volitional preceding stages of the application have not yet been well examined. Therefore, this study analyses the prevalence and determinants of the wish for rehabilitation and the intention to apply. METHODS: Data were derived from the baseline survey of a cohort study including a sample of 45,000 persons randomly drawn from the statutory pension agencies (GPI North and GPI Central Germany). The baseline data of persons aged 45-59 years with back pain within the past 3 months, neither receiving disability pension nor medical rehabilitation during the past 4 years were analysed. Determinants of the wish for rehabilitation and the intention to apply were identified using multivariate logistic regression analyses. RESULTS: 2,348 of the 6,549 persons with back pain (36%) wished to participate in a rehabilitation program. Of these 774 (33%) declared their intention to apply. Both dependent variables were strongly associated with the social support by family and friends. The wish for rehabilitation was also strongly determined by the previous experience with rehabilitation services. Another important determinant of the intention to apply was the support by physicians and therapists. Other factors were found to influence both dependent variables differently. CONCLUSION: In order to improve the need-based access to rehabilitation, the preceding stages (wish for rehabilitation and intention to apply) and their partly different determinants should be considered. The support by family and friends as well as physicians and therapists are important. This is a further indication that information and the involvement of these actors are key elements to ensure an acquired access to rehabilitation.

Development and Formative Evaluation of a Communication Skills Training Program for Persons with Rheumatic and Musculoskeletal Diseases.

OBJECTIVE: Our aim was to develop and evaluate a two-module training program (KOKOS-Rheuma) specifically designed to enhance the ability of persons with rheumatic and musculoskeletal diseases to communicate in various everyday situations. DESIGN: KOKOS-Rheuma deals with communication at work (particularly superiors), with physicians, acquaintances, strangers and staff members of authorities and institutions and focuses on communication skills such as "saying no" and "giving and receiving feedback." Members of the German League against Rheumatism (GLR) were trained to deliver the program to self-help groups over two sessions or in a full-day session. The participants, trainers and observers completed a short evaluation form after each module or at the end of the full-day session. MAIN OUTCOME MEASURES: The evaluation was based on 232 participant, 51 trainer, and 8 observer evaluation forms. RESULTS: The participants rated all aspects of the training as good. The training was rated higher in the single session format. The great majority would recommend the course to other people. CONCLUSION: After the revision of the training manual, KOKOS-Rheuma can be recommended for inclusion in the training schedule of the GLR. We recommend that future trainers receive more extensive preparation for delivering the course that highlights the preparation time required.

[Development of a Rehab-Wiki for rehabilitation-Related Educational Materials Assigned to Competence-Based Learning Objectives]. / Entwicklung eines Reha-Wikis für rehabilitationsbezogene Lehrmaterialien mit Zuordnung zu kompetenzbasierten Lernzielen.

PURPOSE: For adequate rehabilitative care, it is indispensable to impart appropriate competences in medical education based on learning objectives. In addition to the "National Competence-Based Learning Objectives Catalogue for Medicine (NKLM)", a competence-based learning objectives catalogue for the field of rehabilitation in the interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathy" (RPMN) was recently presented. These learning objectives were to be assigned to a wide variety of teaching materials of different media types and made easily accessible to university lecturers in a free online database. The database should also contain flexible teaching and learning modules as well as information on didactic methods. METHODS: Teaching materials from six university locations were assigned to the rehabilitation-related learning objective sections of the competence-based learning objective catalogue for RPMN and the NKLM. Presentation slides and text-based material were integrated in PDF-format. Educational films were embedded in a non-public channel on the video platform "YouTube". As a result, they could be referenced in the online database designed as a MediaWiki. RESULTS: The contents of this "rehab-wiki" (www.rehawiki.uni-halle.de) were structured using four thematic portals: The "Teaching and Learning Objectives Portal" contains the competence-based learning objectives and keywords for the content to be taught along with links to suitable didactic methods and available teaching materials. The "Teaching and Learning Methods Portal" contains didactic methods with detailed instructions. In the "Teaching Materials Portal" the teaching materials are grouped according to media type and the "Glossary" portal contains definitions and links to important rehabilitation medicine terms based on the "Social Medicine Glossary" published by the Federal German Pension Insurance. Just 6 months after implementation and presentation of the platform at a congress, 53 interdisciplinary users with teaching positions at German universities have registered. CONCLUSIONS: The "rehab-wiki" provides an intuitive online database. It contains teaching materials of various media types, which are assigned to competence-based learning objective sections, and suitable didactic methods. Teachers are supported in designing learning goal-oriented, didactically advanced and appealing rehabilitation courses. The MediaWiki-system enables constant further development by the teaching community requiring low long-term supervision effort. The "rehab-wiki" also offers a starting-point for continuing education and advanced training as well as for other occupational groups involved in rehabilitation.

Peritoneal dialysis is associated with better cognitive function than hemodialysis over a one-year course.

Impaired cognitive functioning in patients with end-stage renal disease may reduce their capabilities to adhere to complex medical or dietary regimens and to fully participate in medical decisions. With decreasing renal function, cognitive abilities are likely to decline, with cognitive dysfunction improving after initiation of dialysis and even being generally reversible after successful renal transplantation. However, little is known about cognitive changes particularly regarding different treatment modalities. To gain further insight into this, we focused on a one-year course of cognitive functions, comparing peritoneal to hemodialysis patients. Within the CORETH-project, two validated neurocognitive tests, assessing executive functioning (Trail Making Test-B) and attention (d2-Revision-Test) and the self-reported Kidney Disease Quality of Life Short Form Cognitive Function-subscale, were administered to 271 patients at baseline and after one year. Subsamples were matched by propensity score, adjusting for age, comorbidity, education, and employment status for 96 hemodialysis and 101 peritoneal dialysis patients. The effects of time and treatment modality were investigated, controlling for well-known confounders. Both tests revealed improvement over one year. Peritoneal dialysis was associated with better outcomes than hemodialysis at baseline and follow-up, but comparability between groups may be limited. The opposite pattern applied to self-reporting. Hemodialysis patients had to be excluded from cognitive testing more often than peritoneal dialysis patients. As such, the number of exclusions may have biased the findings, limiting generalizability. Thus, our findings suggest an improvement of cognitive functioning and support previous indications for peritoneal dialysis being associated with better cognitive functions during a one-year course than hemodialysis.

Social relationships and their impact on health-related outcomes in peritoneal versus haemodialysis patients: a prospective cohort study.

Background: Social relationships are important determinants of health-related outcomes for patients with chronic conditions. However, the effects of social networks and social support on health outcomes of dialysis patients in different treatment modalities have been under studied. Methods: We surveyed peritoneal dialysis (PD) and haemodialysis (HD) patients in the Choice of Renal Replacement Therapy project about their social relationships and health-care outcomes at baseline and 1-year follow-up. Two propensity score-matched groups (n = 353; HD = 200, PD = 153) with similar age, comorbidity level, education and employment status were compared. We used an ego-centred Network Generator to assess quantitative and qualitative aspects of social networks and the Berlin Social Support Scales to evaluate dimensions of social support, and analysed the effects of the social variables on anxiety, depression, autonomy preferences, and physical and psychological quality of life. Results: Over time, the non-family networks (e.g. friends) of both groups decreased (P = 0.04) and the absolute number of types of relationships increased (P = 0.01). The family-network size, quality of relationships and social support remained stable. Larger social networks were associated with higher participation-seeking preferences (B = 1.39, P = 0.002) and lower anxiety (B = -0.11, P = 0.03). Closer and more satisfying relationships were associated with better psychological well-being (B = 3.41, P = 0.003). PD patients had larger networks, more types of relationships and received more social support than HD patients (P ≤ 0.05). Conclusions: These differences may reflect the degree of autonomy and self-care associated with the different treatment modalities. In practice, our findings suggest that the early identification and inclusion of persons providing social support for patients may have a positive effect on different aspects of their care and quality of life.

The Choice of Renal Replacement Therapy (CORETH) project: dialysis patients' psychosocial characteristics and treatment satisfaction.

Background: Until today, research has underestimated the role of psychosocial conditions as contributing factors to dialysis modality choice. The novelty within the Choice of Renal Replacement Therapy (CORETH) project (German Clinical Trials Register #DRKS00006350) is its focus on the multivariate associations between these aspects and their consecutive significance regarding treatment satisfaction (TS) in peritoneal dialysis (PD) versus haemodialysis (HD) patients. In this article, we present the baseline results of a multicentre study, which is supported by a grant from the German Ministry for Education and Research. Methods: Six to 24 months after initiation of dialysis, 780 patients from 55 dialysis centres all over Germany were surveyed. The questionnaire addressed psychosocial, physical, socio-demographic and shared decision-making (SDM) aspects. Furthermore, cognitive functioning was tested. After indexing the measures, two propensity score-matched groups (n = 482) were compared in a first step, after having chosen PD or HD. In a second step, a moderated multiple regression (n = 445) was conducted to initially investigate the multivariate impact of patient characteristics on TS. Results: In comparison with HD patients, PD patients were more satisfied with their treatment (P < 0.001), had a more autonomy-seeking personality (P = 0.04), had better cognitive functioning (P = 0.001), indicated more satisfying SDM (P < 0.001) and had a larger living space (P < 0.001). All patients were more satisfied when they had a good psychological state and received SDM. Especially in HD patients, TS was higher when the patient had a less autonomous personality, lower cognitive functioning, more social support, a poorer physical state and poorer socio-demographic conditions (R2 = 0.26). Conclusions: Psychosocial characteristics play a major role in TS in dialysis patients. Within a multivariate approach, these factors are even more important than physical or environment-related factors. In practice, focusing on SDM and screening patient characteristics at an early stage can foster patients' TS. Changes will be examined in a 1-year follow-up.

Rehabilitation access and effectiveness for persons with back pain: the protocol of a cohort study (REHAB-BP, DRKS00011554).

BACKGROUND: Back pain is one of the most common chronic diseases in Germany and has a major impact on work ability and social participation. The German Pension Insurance (GPI) is the main provider of medical rehabilitation to improve work ability and prevent disability pensions in Germany. However, over half of the persons granted a disability pension have never used a medical rehabilitation service. Furthermore, evidence on the effects of medical rehabilitation in Germany is inconclusive. Consequently, this study has two aims: first, to determine barriers to using rehabilitation services, and second, to examine the effectiveness of medical rehabilitation in German residents with chronic back pain. METHODS: In 2017 a postal questionnaire will be sent to 45,000 persons aged 45 to 59 years whose pension insurance contributions are managed by the GPI North or the GPI Central Germany. In 2019 respondents who report back pain in the first survey (n = 5760 expected) will be sent a second questionnaire. Individuals will be eligible for the first survey if they are employed, have neither used nor applied for a rehabilitation programme during the last 4 years and neither received nor applied for a disability pension. The sample will be drawn randomly from the registers of the GPI North (n = 22,500) and the GPI Central Germany (n = 22,500) and stratified by sex and duration of sickness absence benefits. Barriers to rehabilitation services will be related to socio-demographic and social characteristics, pain and attitudes to pain, health and health behaviour, healthcare utilisation, experiences and cognitions about rehabilitation services and job conditions. Propensity score matched analyses will be used to examine the effectiveness of rehabilitation services. Data on use of medical rehabilitation will be extracted from administrative records. The primary outcome is pain disability. Secondary outcomes are pain intensity and days of disability, pain self-efficacy, fear avoidance beliefs, self-rated health, depression, healthcare utilisation, self-rated work ability and subjective prognosis of employability, sickness absence benefits, and disability pensions. DISCUSSION: This study identifies barriers to use of rehabilitation services and determines the effectiveness of medical rehabilitation for patients with chronic back pain. TRIAL REGISTRATION: German Clinical Trials Register ( DRKS00011554 , January 26, 2017).

[Competence Based Catalogue of Learning Objectives for Rehabilitation, Physical Medicine, Naturopathic Treatment - Revised Version - Joint Recommendations of the German Society of Rehabilitation Science and the German Society of Physical Medicine and Rehabilitation]. / Kompetenzbasierter Lernzielkatalog "Rehabilitation, Physikalische Medizin, Naturheilverfahren" (RPMN) ­ revidierte Fassung.

Since the first publication of learning objectives for the interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" in undergraduate medical education in 2004 a revision is reasonable due to heterogenous teaching programmes in the faculties and the introduction of the National Competence Based Catalogue of Learning Objectives in Medicine as well as the "Masterplan Medical Education 2020". Therefore the German Society of Rehabilitation Science and the German Society of Physical Medicine and Rehabilitation started a structured consensus process using the DELPHI-method to reduce the learning objectives and arrange them more clearly. Objectives of particular significance are emphasised. All learning objectives are assigned to the cognitive and methodological level 1 or to the action level 2. The learning objectives refer to the less detailed National Competence Based Catalogue of Learning Objectives in Medicine. The revised learning objectives will contribute to further progress in competence based and more homogenous medical teaching in core objectives of Rehabilitation, Physical Medicine, and Naturopathic Treatment in the faculties.

[Rehabilitation in undergraduate education and advanced professional training of the participating professional groups]. / Rehabilitation in der Aus-, Fort- und Weiterbildung beteiligter Berufsgruppen.

In the German health care system, multiprofessional and coordinated rehabilitation care provides support for successful disease management. Against a background of the conditions and strong dynamics of the provision, this article gives an overview of some of the pertinent developments in rehabilitation-related undergraduate education and advanced professional training of physicians, psychologists, and exercise therapy professions in Germany. Frequently, there are few provisions and great variation between different locations. New conditions, such as the National Competence-Based Learning Objectives for Undergraduate Medical Education, the National Guidelines for Graduate Medical Education, and the ongoing reform of the psychotherapists' law emphasizing training in psychotherapy at university, allow the expectation of a positive effect on the competence of rehabilitation professionals. Education in physiotherapy is developing according to international standards aimed at improved evidence-based care. For the widely evidence-based undergraduate education and advanced professional training in sports and exercise therapy better profiling and professionalization should be sought.

The RHESA-CARE study: an extended baseline survey of the regional myocardial infarction registry of Saxony-Anhalt (RHESA) design and objectives.

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of death in Europe. In Germany, a declining mortality rate from acute myocardial infarction (AMI) has been observed in the last decades. Nevertheless, there are large differences between the federal states when looking at the mortality and morbidity of AMI. Saxony-Anhalt is one of the federal states with the highest mortality rates for AMI in Germany. In 2012, the regional myocardial infarction registry of Saxony-Anhalt (RHESA) was established to investigate the individual, infrastructural, and health care factors with respect to an urban (city of Halle) and rural (region of Altmark) population. For detailed observation the RHESA-CARE study was conducted in 2014. RHESA-CARE focuses on the symptoms during infarction, the behaviour of patients while alerting for infarction, the use of rehabilitation possibilities, and long-term care. METHODS/DESIGN: RHESA-CARE is an extended baseline survey of AMI patients registered in RHESA who are aged 25 or more, and inhabitants of the city of Halle (Saale) or the district of Altmark in the federal state of Saxony-Anhalt, Germany. Detailed information was collected on classical and psychosocial cardiovascular risk factors as well as factors of alerting behaviour, first aid, and utilization of medical and rehabilitation services. High data quality is ensured by a detailed system of quality control. DISCUSSION: RHESA-CARE has the main objective to investigate factors that influence morbidity and mortality rates due to AMI. Another purpose is the comparison of a rural and urban patient population. It provides an opportunity to serve as a base for improvement of patients' behaviour and health care as well as further research.

Trans-sectoral care in patients with colorectal cancer: Protocol of the randomized controlled multi-center trial Supportive Cancer Care Networkers (SCAN).

BACKGROUND: Managing therapy-related side-effects and improving health-related quality of life in patients with colorectal cancer is still challenging. The need for an effective management of adverse events and unmet supportive care needs have been widely discussed. In the past decade, interventions by nursing staff gained more and more importance. Evidence suggests that a majority of patients even in early stages of the disease experience substantial impairments potentially resulting in diminished therapy adherence as well as impaired quality of life. However, evidence for the effectiveness of nurse-led interventions on symptom management and quality of life is still very limited. This especially applies to care transitions between different inpatient and outpatient health care providers throughout the course of treatment and aftercare. METHODS/DESIGN: Supportive Cancer Care Networkers (SCAN) is a prospective randomized controlled trial conducted in eight large and middle-sized German cancer centers and municipal hospitals. The target population is adults with colorectal cancer UICC I-III after initial R-0 resection scheduled for adjuvant chemotherapy or guideline-based aftercare only. 370 patients will be randomly assigned to either intervention or control group. Patients in the intervention group will receive an additional support by specialized oncology nurses for eight weeks after discharge from hospital by telephone, consisting of symptom monitoring, counselling on self-assessment and self-management and dealing with individual resources for coping and psychosocial well-being. The primary endpoint will be health-related quality of life (HRQoL) at eight weeks after discharge from the initial treating hospital. DISCUSSION: The presented SCAN trial is to provide information that will be useful to advance our understanding of complex interdependencies between symptom severity, supportive care needs, functioning and the risk for diminished HRQoL. Most importantly, these patient-reported outcomes are not fully implemented in today's clinical routine practice potentially resulting in therapy cessations and lower chemotherapy treatment rates for colorectal cancer especially in older patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01651832.