BACKGROUND: Effective concepts are required to overcome the negative impact of daily stressful overwhelming. We investigated the effectiveness of a 1-week multimodal program for stress reduction. METHODS: We performed a randomized controlled trial including adults with above-average stress level. The intervention consisted of health coaching, relaxation, physical activity, and balneotherapeutic elements. Individuals were randomized either to the intervention group (IG) or to one of the two control groups B and C. The main outcome was change in stress (Perceived Stress Questionnaire [PSQ], Screening Scale of Chronic Stress of the Trier Inventory for Chronic Stress [TICS-SSCS]) at 6 months post intervention; further outcomes were well-being (World Health Organization 5-Item Well-Being Index [WHO-5]) and health status (EuroQol visual analog scale [EQ-5D VAS]). Data were collected pre/post intervention as well as after 1, 3, and 6 months. RESULTS: Data of 96 individuals (mean age 48.0 years, 74% female) were available for analyses. The IG improved overtime with -13.45 points for the PSQ and -6.44 points for the TICS-SSCS after 6 months. At 6-month follow-up the IG did not significantly differ from group B (PSQ: p = 0.2332; TICS-SSCS: p = 0.0805) or group C (PSQ: p = 0.0950; TICS-SSCS: p = 0.0607) when controlling for baseline (ANCOVA). Compared to group C, ANCOVA revealed significant differences in WHO-5 (p = 0.0292) and EQ-5D VAS (p = 0.0177) post intervention. At the 3- and 6-month follow-up and compared to group B, no substantial differences could be found for WHO-5 and EQ-5D VAS. CONCLUSION: The results indicate that even a short-term multimodal program for stress reduction appears to set a positive trend towards less perceived and chronic stress.
Exercise , Health Resorts , Adult , Female , Humans , Male , Middle Aged , Pain Measurement , Relaxation , Surveys and Questionnaires
BACKGROUND: The aim of this systematic review of systematic reviews was to identify, summarise, and synthesise the available evidence of systematic reviews (SRs) and meta-analyses (MAs) on the preventative and therapeutic psychological and physical effects of forest-based interventions. Methods: Both bibliographic databases and grey literature sources were searched for SRs and MAs published until May 2020. Eight databases were searched for relevant articles: MEDLINE, Embase, Web of Science, Cochrane Library, PsycInfo, CiNii, EBSCO, and Scopus. Grey literature was sourced from Google Scholar and other web-based search tools. SRs and MAs that included randomised controlled (RCT), non-randomised controlled (NRCT), and non-controlled trials (NCT) on health-related effects of forest-based interventions were eligible if they had searched at least two databases. The methodological quality of eligible reviews was assessed by AMSTAR-2. Results: We evaluated 11 systematic reviews covering 131 different primary intervention studies, mostly from Asian countries, three of which included supplementary meta-analyses. The quality assessment resulted in moderate confidence in the results of two reviews, low confidence in six, and critically low confidence in three. The results of the eight moderate and low-rated reviews indicated that forest-based interventions are beneficial to the cardiovascular system, immune system, and mental health (in the areas of stress, depression, anxiety, and negative emotions). Evidence for the effectiveness of forest-based interventions on metabolic parameters in adults, the severity of atopic dermatitis in children and adolescents, and social skills and sociality in healthy primary school children was weak. Discussion/Conclusions: Evidence suggests beneficial therapeutic effects of forest-based interventions on hypertension, stress, and mental-health disorders, such as depression and anxiety. Changes in immunological and inflammatory parameters after forest therapy should be verified in bio-geographically native forests. In the future, more attention should be paid to careful planning, implementation, and reporting of primary studies and to systematic reviews on the effects of forest-based interventions.
Mental Disorders , Mental Health , Adolescent , Adult , Anxiety/prevention & control , Asia , Child , Forests , Humans , Meta-Analysis as Topic , Systematic Reviews as Topic
CONTEXT: The "Oberstaufen Schrothkur," a traditional naturopathic treatment, has been shown to lead to metabolic improvement in adults with type 2 diabetes. However, data concerning its benefits are still limited. OBJECTIVE: The study aimed to investigate the effects of an Oberstaufen Schrothkur compared to a diabetes-friendly holiday in adults with type 2 diabetes. DESIGN: The study was a single-center, 2-arm randomized controlled trial with 6-month follow-up. SETTING: The interventions were carried out in the Oberstaufen health resort in Bavaria, Germany. PARTICIPANTS: Ninety-eight overweight or obese volunteers (mean age 61.5; 51% female) with type 2 diabetes received the randomly allocated intervention (Oberstaufen Schrothkur = 51; diabetes-friendly holiday = 47). Three participants were lost to follow-up. INTERVENTION: The Oberstaufen Schrothkur included a low-calorie diet, daily changes between a higher or lower fluid intake, daily alternation in physical activities, and daily application of cold and damp body packs. The diabetes-friendly holiday included a holiday stay specifically tailored to diabetics. OUTCOME MEASURES: The primary outcome was change in hemoglobin A1c at 6 months post intervention. Secondary outcomes included body weight, body mass index, blood pressure, levels of cholesterol and triglycerides, well-being (WHO-5), and general health status (EQ-5D and SF-36). RESULTS: Significant within-group improvements at 6 months were observed in both groups: sustained reductions in hemoglobin A1c (Oberstaufen Schrothkur: -0.67%; diabetes-friendly holiday: -0.55%) and weight reduction of 4.65% (-4.71 kg) in the Oberstaufen Schrothkur group and 3.91% (-3.95 kg) in the diabetes-friendly holiday group (P < .001), with no statistically significant difference between groups. The proportion of obese participants decreased by 13.8 (Oberstaufen Schrothkur) and 6.3 (diabetes-friendly holiday) percentage points. Compared to baseline, 80.4% (Oberstaufen Schrothkur) and 85.1% (diabetes-friendly holiday) of the participants reported no changes in hyperglycemia medication intake at 6 months. A medication decrease was observed in 9 (17.7%) participants in the Oberstaufen Schrothkur group and 6 (12.8%) participants in the diabetes-friendly holiday group. CONCLUSION: Adults with type 2 diabetes undergoing one of two 3-week interventions (Oberstaufen Schrothkur or diabetes-friendly holiday) had significant within-group improvements in glycemic control, weight reduction, blood pressure, well-being, and quality of life at 6 months while between-group differences did not reach significance.
Diabetes Mellitus, Type 2 , Quality of Life , Adult , Body Weight , Diabetes Mellitus, Type 2/therapy , Female , Glycated Hemoglobin/analysis , Humans , Male , Middle Aged , Obesity/complications , Obesity/therapy , Overweight/complications , Overweight/therapy
BACKGROUND: Care staff in Germany is being increasingly affected by physical and mental stress, which is reflected in high number of sick days and early retirement rates. A prevention program that addresses the specific needs of caregivers - strengthening their resources in dealing with workloads and daily challenges- was developed in the project PFLEGEprevent. The prevention program was implemented in an RCT and its effects on stress, work ability and quality of life were evaluated. METHOD: The randomized controlled intervention study was conducted with 6 survey periods over 9 months. Targeted data were collected using validated tools: Perceived Stress Questionnaire (PSQ), Perceived Stress Scale (PSS), Work Ability Index (WAI), Recovery-Load Questionnaire for work (EBF-Work 27), Short Form-Health Survey (SF-12) and WHO-Five Well-Being Index (WHO-5). Descriptive analyses and the t-test for independent samples to compare changes in primary and secondary outcomes between study groups were conducted. RESULTS: A total of 125 (92% female, average age 46.7 years) caregivers participated in the study. There were significant group differences in changes of the target size to the follow-up measures up to 9 months. Especially stress was reduced in the long term in the intervention group. Overall well-being in this group improved significantly from baseline to follow-up. CONCLUSION: The evaluation of the prevention program showed a positive effect in the measured outcome of perceived stress. In other outcomes, significant group differences could be shown after 1 and 3 months.
Caregivers , Workload , Female , Germany/epidemiology , Humans , Male , Middle Aged , Quality of Life , Surveys and Questionnaires
Einleitung: Ziel dieser systematischen Übersicht war die Bewertung der verfügbaren Evidenz zur Wirkung der Kneipp-Therapie. Methoden: MEDLINE, Embase, Web of Science, Cochrane-Library und CAMbase wurden nach relevanten Artikeln, veröffentlicht zwischen 2000 und 2019, durchsucht. Graue Literatur wurde über Google Scholar und andere Tools bezogen. Studien mit jeglicher Art von Studiendesign, die die Effekte der Kneipp-Therapie untersuchten, wurden eingeschlossen. Die Qualitätsbewertung erfolgte mittels EPHPP-QAT. Ergebnisse: 25 Quellen, darunter 14 kontrol-lierte Studien, wurden eingeschlossen. Gemäß EPHPP-QAT wurden 3 Studien "stark", 13 "moderat" und 9 "schwach" bewertet. Neun (64%) der kontrollierten Studien berichteten signifikante Verbesserungen nach Kneipp-Therapie im Gruppenvergleich bei chronisch-venöser Insuffizienz, Hypertonie, leichter Herzinsuffizienz, menopausalen Be-schwerden und Schlafstörungen in verschiedenen Patientenkollektiven sowie verbesserte Immunparameter bei gesunden Probanden. Im Hinblick auf Depression und Angst bei Mammakarzinom-Patientinnen mit klimakterischen Beschwerden, Lebensqualität bei Post-Polio-Syndrom, krankheitsbedingten polyneuropathischen Beschwerden und Inzidenz von Erkältungsepisoden bei Kindern konnten keine signifikanten Gruppenunterschiede festgestellt werden. Elf unkontrollierte Studien berichteten Verbesse-rungen bei allergischen Symptomen, Dyspepsie, Lebens-qualität, Herzratenvariabilität, Infekten, Hypertonie, Wohlbefinden, Schmerz und polyneuropathischen Beschwerden. Diskussion/Schlussfolgerung: Die Kneipp-Therapie scheint bei zahlreichen Beschwerdebildern in verschiedenen Patientenkollektiven positive Effekte zu bewirken. Zukünftige Studien sollten noch stärker auf eine methodisch sorgfältige Studienplanung achten (Kontrollgruppen, Randomisierung, adäquate Fallzahlen, Verblindung), um Verzerrungen entgegenzuwirken. INTRODUCTION: The aim of this systematic review was to evaluate the available evidence on the effect of Kneipp therapy. METHODS: MEDLINE, Embase, Web of Science, Cochrane Library and CAMbase were searched for relevant articles published between 2000 and 2019. Grey literature was obtained through Google Scholar and other tools. Studies with any kind of study design that examined the effects of Kneipp therapy were included. The quality assessment was carried out using EPHPP-QAT. RESULTS: 25 sources, including 14 controlled studies, were included. According to EPHPP-QAT, 3 studies were rated as "strong," 13 as "moderate" and 9 as "weak." Nine (64%) of the controlled studies reported significant improvements after Kneipp therapy in a between-group comparison in chronic venous insufficiency, hypertension, mild heart failure, menopausal complaints, and sleep disorders in different patient collectives as well as improved immune parameters in healthy subjects. Regarding depression and anxiety in breast cancer patients with climacteric complaints, quality of life in post-polio syndrome, disease-related polyneuropathic complaints and incidence of cold episodes in children, no significant group differences were found. Eleven uncontrolled studies reported improvements in allergic symptoms, dyspepsia, quality of life, heart rate variability, infections, hypertension, well-being, pain and polyneuropathic complaints. DISCUSSION/CONCLUSION: Kneipp therapy seems to be beneficial for numerous symptoms in different patient groups. Future studies should pay even more attention to methodologically careful study planning (control groups, randomisation, adequate case numbers, blinding) to counteract bias.
Hydrotherapy , Phytotherapy , Quality of Life , Humans
This study compared the effectiveness of a 12-day stress-prevention program (SGS) supplemented by individualized, structured, four-session telephone-coaching to that of an SGS without telephone-coaching in entrepreneurs from the green professions presenting with increased stress levels. All participants went through the SGS before being randomized either to the telephone-coaching group (TC) or to the control group without telephone-coaching (noTC). SGS included four key therapeutic elements: stress-management intervention, relaxation, physical exercise, and balneotherapy. The primary outcome was the current degree of subjectively experienced stress assessed with the Perceived Stress Questionnaire (PSQ) at a 9-month follow-up. Secondary outcomes included burnout symptoms, well-being, health status, sleep disorders, expectation of self-efficacy, depression, anxiety, ability to work, pain, and days of sick leave. Assessments were conducted at baseline, 12 days (end of program), and 1 (start telephone-coaching), 3, 6 (end of telephone-coaching), and 9 months. Data from 103 adults (TC = 51; noTC = 52), mostly fulltime farmers, were available for analysis (mean age: 55.3; 49.1% female). Participants experienced significant immediate improvement in all outcome measurements, which declined somewhat during the first three months after the end of SGS and then remained stable for at least another six months. While within-group changes from baseline to 9 months showed significant improvements at medium to large effect sizes for all target variables (PSQ-total, TC: -13.38 (±14.98); 95%-CI: (-17.68; -9.07); noTC: -11.09 (±14.15); 95%-CI: (-15.11; -7.07)), no statistically significant differences were found between the groups at any time and for any target variable (between-group ANCOVA for PSQ-total at 9 months, parameter estimator for the group: -1.58; 95%-CI: (-7.29; 4.13)). The stress-prevention program SGS is a feasible, effective, and practical way to reduce perceived stress and improve participants' resources. Four subsequent telephone-coaching sessions do not seem to contribute to a further improvement in the results.
Counseling , Farmers , Mentoring , Stress, Psychological , Adult , Combined Modality Therapy , Counseling/methods , Counseling/standards , Exercise Therapy , Farmers/psychology , Female , Humans , Male , Mentoring/methods , Mentoring/standards , Middle Aged , Relaxation/psychology , Stress, Psychological/prevention & control , Surveys and Questionnaires , Telephone , Treatment Outcome
AIM: The burden on nursing staff in Germany is continuously increasing. Specific health promotion programs can help to reduce this burden. To develop such programs, the concrete needs of nurses for instructions and training have to be determined. The aim of the project "PFLEGEprevent" (funded by the Bayerisches Staatsministerium für Gesundheit und Pflege) is to develop a prevention program that focuses on the special needs of the nursing staff. The project is structured in four subprojects: (1) identification of needs, workloads and occupational challenges of caregivers and the scientific evidence (national expert survey and systematic literature review), (2) development of a specific prevention program, (3) implementation and evaluation of the prevention program (Intervention study; DRKS00012870), (4) development of a manual to instruct the implementation of the prevention program (transferability). METHOD: In subproject (1) the current subjective work ability of the nursing staff in Germany and their need for preventive offers were revealed by a national expert survey. The survey was directed to nurses in outpatient, semi-inpatient and inpatient care facilities and clinics. In addition to personal information and questions on current work and organization, the subjective work ability of the nurses (based on the Work Ability Index, WAI) and the need for preventive offers were queried. RESULTS: A total of 1381 questionnaires were analysed. The majority of surveyed healthcare staff was female (81%). On average they were 40.1 years old (SD=12.0) and had worked in the care sector for 16.3 years (SD=10.9). The mean of the WAI score was 37.2 (SD=7.1) points, which indicates a good work ability. However, there were differences in work ability between types of institution and number of years in job. The care staff needed instructions mainly on the topics of stress, communication and teamwork. Active training was required for relaxation, back muscle training and strengthening. 75% of respondents said they would participate in a 5-day prevention program.
Health Personnel , Health Promotion , Work Capacity Evaluation , Adult , Female , Germany , Humans , Surveys and Questionnaires
BACKGROUND: Chronic psychological distress appears to have increased in recent years, mainly among the working population. The data available indicate that mental and behavioral disorders, including burnout syndrome, represent not only a personal problem for those afflicted, but also a serious public health issue. This study aimed at evaluating the effects of an outpatient burnout prevention program in a mono-center health resort setting. METHODS: Adults experiencing an above-average level of stress and thus being at an increased risk of burnout were randomized either to the intervention group (IG) or the waiting control group (WG). The 3-week program included stress management intervention, relaxation, physical exercise and moor applications. The primary outcome was change in perceived stress (PSQ) at 6 months post-intervention. Secondary outcomes included burnout symptoms, well-being, health status, psychological symptoms, back pain, and number of sick days. Participants were examined at baseline, post-intervention (3 weeks) and after 1, 3 and 6 months. RESULTS: Data from 88 adults (IG=43; WG=45) were available for (per protocol) analysis (mean age: 50.85; 76.1% female). Participants in the IG experienced significant immediate improvement in all outcome measures, which declined somewhat during the first three months post-intervention and then remained stable for at least another three months. Those in the WG did not experience substantial change across time. For the 109 randomized persons, results for PSQ were confirmed in an intention-to-treat analysis with missing values replaced by last observation carried forward (between-group ANCOVA for PSQScore at 6 months, parameter estimator for the group: -20.57; 95% CI: [-26.09; -15.04]). Large effect sizes (Cohen's d for PSQ: 1.09-1.72) indicate the superiority of the intervention. CONCLUSION: The program proved to be effective in reducing perceived stress, emotional exhaustion and other targets. Future research should examine the long-term impact of the program and the effect of occasional refresher training.
Behavior Therapy , Burnout, Professional/therapy , Psychotherapy , Relaxation Therapy , Exercise , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care
Health resort medicine (HRM; in German: Kurortmedizin) is a field of medicine with long-lasting tradition in several European countries. A number of systematic reviews have shown the effectiveness of HRM in musculoskeletal conditions. Reviews focusing on the effectiveness of HRM in non-musculoskeletal disorders are rare. This systematic review aims to provide an overview about all types of health resort treatments applied in non-musculoskeletal conditions, to summarize evidence for its effectiveness and to assess the quality of published studies. MEDLINE, Web of Knowledge and Embase were searched for articles published between January 2002 and December 2013. We used a broad search strategy in order to find studies investigating the effects of HRM in non-musculoskeletal disorders. Two authors independently extracted data and assessed quality using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (EPHPP-QAT). Forty-one studies (19 of them with control group) from eight countries examining the efficacy of various forms of spa treatment for 12 disease groups were included. The studies are markedly heterogeneous regarding study design, population and treatment. HRM treatment is associated with clinical improvement in diseases of the skin, respiratory, circulatory, digestive and nervous system among others. However, small samples, the lack of control groups and an insufficient follow-up often limit the generated evidence. The scientific literature of the last decade has shown that a number of non-musculoskeletal disorders are treated with different kinds of HRM. The challenge for the future will be to carry out thoroughly designed studies in larger patient populations to corroborate the impact of HRM treatment on non-musculoskeletal disorders.
Complementary Therapies , Health Resorts , Balneology , Humans , Hydrotherapy , Treatment Outcome
