[Towards a Rehabilitation- and Participation-Oriented Psychotherapy]. / Perspektiven einer Teilhabeorientierten Psychotherapie in Anlehnung an Empfehlungen der Deutschen Gesellschaft für Rehabilitationswissenschaften (DGRW).

Mental disorders (such as recurrent mood disorders, personality disorders, or psychotic disorders) come along with enduring impairment in daily life activities. Therefore psychotherapeutic actions in inpatient or outpatient settings require a life-span and participation-oriented treatment perspective. Participation-oriented treatment aims at social and vocational integration in general life despite enduringly recurring or resting symptoms. According to the model of health problems offered by the International Classification of Functioning, Disability and Health, ICF (WHO, 2001), disability can be defined as context-dependent activity impairment due to illness. Disability is not the person̓s illness itself, but depends on the interaction of health status and contextual conditions. This context-dependent impairment shall be overcome with the help of treatment. In psychotherapy, the perspective of participation over the life-span has always been of great importance. However, it has until now hardly been mentioned explicitly.For practical handling of the ICF philosophy, its bio-psycho-social model of health problem-description is useful. Psychotherapists should gain knowledge on medical, vocational, and social rehabilitation treatment aims, institutions and the health care system. Psychotherapists may serve, similar to family physicians, as a case manager of illness processes. They do not only aim reducing mental illness symptoms, but focus on life-span management of the mental disorder. The aim is mainly to improve patients̓ daily life participation.

[Development and Current Status of the Health Education Curriculum of the German Pension Insurance]. / Entwicklung und aktueller Stand des Gesundheitstrainingsprogramms der Deutschen Rentenversicherung Bund.

The health education curriculum of the German pension insurance comprises 27 patient education programs that are mostly indication-based. The curriculum aims to support the implementation of patient-oriented patient education in German rehabilitation centers. The effectiveness of several of the educational programs was evaluated in controlled trials with heterogeneous results. Overall, the dissemination of the evaluated programs in rehabilitation practice can be recommended. They constitute an essential part of the overall treatment concept, but are often modified in clinical practice. In particular, the physician led modules are frequently conducted in larger group settings. It is currently considered how these routine working conditions might be reflected in the quality assurance system of the German pension insurance and a cross-organizational conceptual framework.

Evaluation of a standardized patient education program for inpatient cardiac rehabilitation: impact on illness knowledge and self-management behaviors up to 1 year.

Patient education is an essential part of the treatment of coronary heart disease in cardiac rehabilitation. In Germany, no standardized and evaluated patient education programs for coronary heart disease have been available so far. In this article, we report the evaluation of a patient-oriented program. A multicenter quasi-experimental, sequential cohort design study of patients with coronary heart disease (n = 434) in inpatient cardiac rehabilitation was conducted. Intervention patients received the new patient-oriented program, control patients a traditional lecture-based program (usual care). Primary outcome illness knowledge and secondary behavioral and health outcomes were assessed at admission, discharge and 6- and 12-months follow-up. We found a significant, small between-group intervention effect in both patients' medical illness and treatment knowledge and behavior change knowledge at discharge (medical: η(2) = 0.013; behavior change: η(2) = 0.011) and after 12 months (medical: η(2) = 0.015). Furthermore, a significant, small effect was observed for physical activity after 12 months (η(2) = 0.011), but no effects on healthy diet and medication adherence emerged. Superiority of the patient-oriented educational program for patients with coronary heart disease was partially confirmed. The program produced improved illness knowledge and physical activity compared with usual care after 1 year.

Self-management education for rehabilitation inpatients: A cluster-randomized controlled trial.

OBJECTIVE: To evaluate generic self-management modules (SelMa) as an adjunct to disease-specific educational programs during inpatient medical rehabilitation. METHODS: A bi-center cluster-randomized controlled trial with 698 patients with coronary artery disease, metabolic syndrome, or inflammatory bowel disease was conducted. We compared two versions of SelMa, a group with 3 h or a lecture with 1 h, respectively, in addition to disease-related patient education, to usual care (only disease-related education). SelMa aims at providing skills that may help implementing health behavior. The primary outcomes were goal setting and behavior planning at discharge and goal attainment and health behavior at 6- and 12-months follow-up. Secondary outcomes included motivation, knowledge and self-management competences. RESULTS: At discharge, SelMa group, but not SelMa lecture, proved superior to usual care regarding goal setting (p = 0.007, d = 0.26), but not behavior planning (p = 0.37, d = 0.09). Significant effects were also observed on several secondary outcomes. At later follow-up, however, no effects on primary outcomes emerged. Participants' satisfaction was higher in the group than the lecture format. CONCLUSIONS: These short modules did not succeed in improving self-management skills in the long-term. PRACTICE IMPLICATIONS: A self-management group may foster self-management skills in short term. Interventions should be developed to increase sustainability of effects.

Long sick leave after orthopaedic inpatient rehabilitation: treatment failure or relapse?

We investigated whether short-term versus long-term sick leave after orthopaedic inpatient rehabilitation can be predicted by initial assessment information, the clinical status at discharge, or whether the follow-up interval is crucial for later sick leave. We examined 214 patients from an orthopaedic rehabilitation hospital at admission, discharge and 1-year follow-up. Outcome measures included disability, depression, self-efficacy, health status and attitudes towards work. Later short-term versus long-term sick leave was not significantly predicted by pretreatment and posttreatment scores. Surprisingly, both groups improved comparably during treatment. The long-term sick leave group deteriorated on most of the variables at follow-up, whereas the short-term sick leave group maintained the improvements. Rehabilitation interventions should not only focus on inpatient treatment but also on the follow-up interval to prevent relapses and maintain success reached during treatment.

Intermediate and long-term effects of a standardized back school for inpatient orthopedic rehabilitation on illness knowledge and self-management behaviors: a randomized controlled trial.

OBJECTIVES: A back school is a mandatory part of the multimodal rehabilitation program for patients with chronic low back pain in Germany. However, no standardized and evaluated back school program has been available for routine use. In this study, we report the evaluation of a new back school that was developed based on theories of health behavior, treatment evidence, practice guidelines, and quality criteria for patient education. METHODS: Randomized controlled trial of patients with low back pain (n=360) in inpatient orthopedic rehabilitation clinic in Germany. Intervention patients received the new back school, whereas control patients a traditional back school (usual care). Illness knowledge (primary outcome) and secondary behavioral and health outcomes were assessed at admission, discharge, and 6 and 12 months follow-up. RESULTS: Results showed a significant medium between-group treatment effect in patients' knowledge about back pain at discharge (η²=0.081), after 6 (η²=0.056), and 12 months (η²=0.026). Furthermore, small-to-medium effects were observed among the secondary self-management behaviors, such as physical activity, back exercises, back posture habits, and coping with pain, after 6 and 12 months. DISCUSSION: The superior effectiveness of the back school based on a biopsychosocial approach was demonstrated with regard to illness knowledge and self-management behaviors up to 1 year. Thus, the program may be recommended for dissemination within medical rehabilitation.

Evaluation of a behavioral-medical inpatient rehabilitation treatment including booster sessions: a randomized controlled study.

OBJECTIVES: The aim of this randomized controlled study was to investigate whether additional psychologic interventions in the context of multidisciplinary inpatient pain treatment increases treatment efficacy compared with normal orthopedic rehabilitation. In addition, we aimed to demonstrate the additional benefit of a subsequent maintenance program in further stabilizing treatment successes. METHODS: We randomly assigned 363 chronic back pain patients to 1 of 3 treatment conditions: traditional orthopedic rehabilitation, multidisciplinary (behavioral-medical) rehabilitation alone, and multidisciplinary rehabilitation with subsequent booster sessions. Pain disability, depression, self-efficacy, health status, life satisfaction, and coping strategies were assessed at admission, discharge, and 12 months follow-up. The completion rate was 94%. RESULTS: All 3 treatment conditions were effective in improving core outcome measures in chronic back pain patients in the short term. The results were almost maintained at follow-up (small-to-medium within-group effect sizes). Significant advantages in favor of behavioral-medical interventions were found on almost all pain coping strategies and depression compared with traditional orthopedic rehabilitation. We found only slight advantages for the behavioral-medical treatment with subsequent booster sessions compared with the condition without a further maintenance program. DISCUSSION: The results concerning the efficacy of the multidisciplinary treatment are in accordance with former meta-analyses. Surprisingly, the findings suggest that the presented traditional orthopedic treatment was inherently very effective. The implications of these findings are discussed with respect to the benefit of additional psychologic interventions and the benefit of aftercare approaches for chronic pain patients.