[Promoting Factors, Barriers and Barrier Management to the Implementation of Health-Promoting Behavior among Rehabilitative Patients with Chronic Low Back Pain - A Qualitative Analysis]. / Förderfaktoren, Barrieren und Barrierenmanagement zur Umsetzung gesundheitsförderlicher Verhaltensweisen von Rehabilitanden mit chronischem Rückenschmerz - Eine qualitative Analyse.

UNLABELLED: Backgroundand aim: The long-term success of rehabilitation in chronic low back pain is not yet established. The present study examined promoting factors, barriers and barrier management of health-promoting behavior among rehabilitative patients. METHOD: In total, 35 documents of patients of 4 inpatient behavioral medicine orthopedic rehabilitation clinics were included into the analysis of a written survey based on 3 open questions. The free-worded statements were electronically recorded and then analyzed by content analysis. RESULTS: Promoting factors of patients for the implementation of healthy life style behaviors included the learning of techniques for pain and stress management as well as increased volition and quality of life. Among patients with increased depressive symptoms, insufficient volition, family and professional pressures were identified as barriers. Finally, social support was reported to facilitate implementing health-promoting behavior into daily life. CONCLUSIONS: The results suggest that the long-term rehabilitation success can be improved by treating exercises to implement health-promoting behavior into daily life, applying individualized barrier management, and offering post-rehabilitative treatments in all communities.

[Benefits of the Curriculum "Social Medicine for the Rehabilitation Team" in Rehabilitation Practise]. / Nutzen des Curriculums "Sozialmedizinische Leistungsbeurteilung im Reha-Team" für die Rehabilitationspraxis.

The Federal German Pension Insurance in cooperation with professional organisations developed a curriculum for further socio-medical education of psychologists/psychotherapists, occupational therapists, physiotherapists, sports therapists and social workers/social pedagogues involved in medical rehabilitation. This curriculum aims to improve the professional competence of the therapeutic groups named above with regards to their contributions to the socio-medical capacity evaluation and related communication within the rehabilitation team. The curriculum was implemented for the first time in 2013. Using the results of the usibility evaluation the continued education concept was revised and manualised. The manual allows for a wide dissemination of the education concept.

[Development and short-term effects of a standardized patient education program for in-patient cardiologic rehabilitation]. / Entwicklung und kurzfristige Effektivität eines standardisierten Schulungsprogramms für die Rehabilitation bei koronarer Herzkrankheit.

BACKGROUND: Patient education is an essential part in the treatment of coronary heart disease in medical rehabilitation. In the German-speaking area, no standardized and evaluated patient education program for coronary heart disease is available so far. In this paper, we demonstrate the development of a quality assured patient education program based on a health-education program of the German statutory pension insurance scheme. METHODS: In a multi-level approach, an existing program was modified concerning treatment evidence, practical guidelines, theories of health and illness behavior and quality criteria for patient education as well as clinical experience and thereafter manualized. In a formative evaluation, feasibility and patient acceptance of this modified program were assessed using evaluation questionnaires of patients and trainers. Afterwards, effects of the patient education program as compared to a traditional education program were assessed on a short-term (at discharge), medium-term (6-month follow-up) and long-term (12-month follow-up) basis in a multicenter quasi-experimental control group study of patients with coronary heart disease (n=434). RESULTS: Results of the formative evaluation demonstrate an overall good acceptance and a good feasibility of the manualized program. Short-term results show a significant small treatment effect in the primary outcome variable patients' knowledge (p=0.001, η2 =0.028). Furthermore, small effects were also observed among some secondary outcomes, such as attitude towards medication, planning of physical activity, psychological quality of life and satisfaction with the education program. CONCLUSION: A standardized education program for patients with coronary heart disease has been developed in a systematic process based on established quality standards. Depending on the outstanding medium and long-term effects, the program may be recommended for general use in medical rehabilitation. The manual provides the prerequisites allowing for a successful transfer into clinical practice.

[Development of a standardized back school for in-patient orthopaedic rehabilitation]. / Entwicklung eines standardisierten Rückenschulungsprogramms für die orthopädische Rehabilitation.

Medical rehabilitation in Germany is still lacking in patient education programmes that meet certain quality requirements such as the use of manuals, patient-oriented didactics, and evaluations of effectiveness. For patients with chronic low back pain, no standardized and evaluated back school programme has so far been available for routine use. In this paper, we demonstrate the development of a quality-assured back school based on a health-education programme of the German statutory pension insurance scheme. Both topics and didactics incorporate treatment evidence, practice guidelines, quality criteria for patient education and theories of health and illness behaviour. First, formative evaluation was conducted to assess patient acceptance and practicability of the manual. Second, effects of the back school programme were assessed on a short-term (at the end of rehabilitation), medium-term (6-month follow-up) and long-term (12-month follow-up) basis in a randomized controlled study of patients with low back pain (n=360). Results show a significant medium treatment effect in patients' knowledge about chronic back pain and its treatment at the end of rehabilitation (p<0.001; eta (2)=0.080). Furthermore, small to medium effects were also observed among some secondary outcomes, such as motivation to physical activity, pain beliefs and pain intensity. After the programme's medium- and long-term effects have been demonstrated, it will be recommended for implementation in medical rehabilitation. The manual meets the requirements that allow for a successful transfer into clinical practice.

[Patients with versus without psychological disorders in orthopedic rehabilitation]. / Patienten mit vs. ohne psychische Störung in der orthopädischen Rehabilitation.

BACKGROUND: In this study it was examined whether orthopedic rehabilitants with versus without a comorbid mental disorder profit from inpatient orthopedic rehabilitation to the same degree. It was also investigated whether there were differential treatment effects between the traditional and behavioral-medical rehabilitation approaches. METHOD: Questionnaires which assess pain-specific and associated variables were issued to a total of 361 patients on admission and discharge from rehabilitation. RESULTS: In some aspects patients with a mental disorder benefited more from the treatment than patients without comorbidities. Differential treatment effects were found only in patients with a mental disorder and improvements were higher in the behavioral-medical than in the traditional rehabilitation approaches. CONCLUSION: Psychological interventions in the inpatient orthopedic rehabilitation are recommended in order to adequately deal with the higher rate of persons with comorbid mental disorders.

[The assignment of orthopaedic rehabilitants to the traditional or the behaviour-medical rehabilitation approach--is it clinically relevant?]. / Welche klinische Bedeutung hat die Vorabzuweisung von Patienten zur orthopädischen bzw. verhaltensmedizinisch-orthopädischen Rehabilitation durch den Rentenversicherungsträger?

Rehabilitants with chronic orthopaedic diseases are assigned to either the traditional or the behaviour-medical rehabilitation approach by consultant physicians of the rehabilitation department within the Deutsche Rentenversicherung Bund (German pension insurance agency). The clinical relevance of this assignment was evaluated at the Rehazentrum Bad Pyrmont-Klinik Weser within a randomised controlled trial. In a sample of 363 rehabilitants the agreement of consultant physicians with the ratings of physicians and psychologists in the clinic was analyzed. We also tested whether rehabilitants treated in their assigned approach benefit more from the treatment than patients who by randomisation were not treated in their assigned approach. Results indicate that psychiatric comorbidity frequently is taken into consideration as a decision-making criterion in the assignment made by the consultant physicians. However, there is only little agreement between the assignment by consultant physicians and the ratings by treating physicians and psychologists. Further, rehabilitants treated in their assigned approach did not benefit more from the treatment than patients who due to randomisation had not been treated in their assigned approach but in the other. Therefore, the procedure applied so far for assigning rehabilitants to either the traditional or the multidisciplinary rehabilitation approach is not sufficiently valid. Concluding, implications for the modification of assignment criteria are discussed.

[Documentation and treatment of mental impairment in somato-medical rehabilitation]. / Erfassung und Behandlung psychischer Beeinträchtigungen in der somatisch-medizinischen Rehabilitation.

Using routine data collected in 2000 for the quality assurance programme of the German Pension Insurance subjective mental impairment and disorders documented in discharge letters of patients undergoing rehabilitation funded by the Federal Insurance Institute for Salaried Employees (BfA) (n = 19,272) were correlated with psychological treatment and inpatient somato-medical rehabilitation provided. The results show discrepancies between self-evaluation, original diagnosis and treatment received. The frequency of treatments varies between hospitals. The differences in treatment are attributed rather to a varying quality of implementation of the bio-psycho-social concept than to a lack of human resources.

Simultaneous interdisciplinary counseling in German breast/ovarian cancer families: first experiences with patient perceptions, surveillance behavior and acceptance of genetic testing.

As part of a multicenter study supported by the German Mildred Scheel foundation we have established an interdisciplinary counseling setting for members of breast and/or ovarian cancer families. We offer simultaneous counseling by a team consisting of a geneticist, a gynecologist and a psycho-oncologist. Here we describe our counseling protocol and our first short-term experience with this interdisciplinary approach. Preliminary data on patient perceptions and behaviors in the context of DNA testing are reported. Overall, our counseling approach was perceived as beneficial both by the counselors and the consultants. A marked overestimation of the risk to develop breast and/or ovarian cancer was noted in the group of unaffected individuals from medium to low risk breast cancer families in contrast to an appropriate risk perception in members from high risk families. All participants shared many of the same expectations about genetic testing and counseling and appeared to base their decision-making about testing on the risk classification given by the genetic counselor. The reported participation in gynecological cancer prevention programs was high in all families at risk, but was less sufficient in unaffected as compared to affected persons. Although current data on BRCA1/BRCA2 mutation analyses render testing in medium to low risk individuals questionable, our findings emphasize the importance of genetic counseling and education in all risk categories of breast and/or ovarian cancer families.

[Introduction of the Bavarian Scientific Rehabilitation Group]. / Der Rehabilitationswissenschaftliche Forschungsverbund Bayern (RFB) stellt sich vor.

As a part of the Rehabilitation Research Programme of both the Ministry for Education, Science, Research and Technology and the German Pension Insurance, the Rehabilitation Research Network of Bavaria has begun its work after having completed a planning phase of three years. Under the heading entitled "Patients in Rehabilitation" physical, psychological and social consequences of chronic diseases are addressed from a bio-psycho-social point of view. The network contains ten research projects which are located in different university institutions and rehabilitation clinics all over Bavaria. These projects can be assigned to three thematic clusters: diagnostical and predictor studies; evaluation of treatments; interface problems in rehabilitation. The interventions to be evaluated are aimed at strengthening patients' coping abilities. Wherever feasable, randomized controlled studies are performed. Both economical and gender-specific effects are investigated. A central facility for coordination and methodological consultation was implemented at the University of Würzburg. The network has the objective of both improving the quality of rehabilitation research and education and increasing the resources of institutions doing rehabilitation research in Bavaria.