[Changes in Somatic, Behavioral, and Psychosocial Outcomes during the Inpatient Rehabilitation of Patients with Metabolic Syndrome - A Longitudinal Study of the META-Program]. / Veränderungen somatischer, verhaltensbezogener und psychosozialer Zielkriterien im Kontext der Rehabilitation von Patientinnen und Patienten mit Metabolischem Syndrom.

PURPOSE: This study analyzed whether clinical, behavioral and psychosocial outcomes changed in patients who participate in a five weeks inpatient rehabilitation program addressing the metabolic syndrome (META-program) and whether changes were maintained at a three months follow-up. METHODS: At the beginning of the program, N=114 eligible patients consented to participate in the study. Behavioral and psychosocial outcomes were measured with standardized questionnaires at program entry, program completion and three months later. These outcome measures included eating behaviors, illness beliefs, health literacy and psychosocial health. Data analysis used t-tests for dependent samples and repeated measures ANOVAs for assessing change. RESULTS: Most of the outcomes improved significantly across time with effect sizes frequently medium or larger. At program completion, this included, e. g., blood pressure, fasting blood glucose and blood lipids. Improvements in self-reported eating behaviors at three months included an increase in eating and eating-related health promoting behaviors in terms of a more flexible control of one's eating, sports, and compliance with nutrition recommendations. Illness beliefs also changed significantly: Symptom burden and concern decreased, while understanding of one's illness increased towards the end of the program. Similarly, facets of psychosocial health also improved towards program completion. At three months follow-up, some facets of psychosocial health like somatoform disorder and depression deteriorated again slightly. CONCLUSION: The significant and in part marked changes of the included outcomes are in line with the goals the META-program attempts to achieve. Future research on programs like the one under study here should include longer follow-up intervals and should use designs that allow interpreting observed changes as effects of participating in the program. This also would allow determining how changes in outcomes can be stabilized or even be enhanced in the long term.

Implementation of a Web-Based Work-Related Psychological Aftercare Program Into Clinical Routine: Results of a Longitudinal Observational Study.

BACKGROUND: As inpatient medical rehabilitation serves to promote work ability, vocational reintegration is a crucial outcome. However, previous Web-based trials on coping with work-related stress have been limited to Web-based recruitment of study participants. OBJECTIVE: The aim of our study was to evaluate the implementation of an empirically supported transdiagnostic psychodynamic Web-based aftercare program GSA (Gesund und Stressfrei am Arbeitsplatz [Healthy and stress-less at the workplace])-Online plus into the clinical routine of inpatient medical rehabilitation, to identify characteristics of patients who have received the recommendation for GSA-Online plus, and to determine helpfulness of the intervention and satisfaction of the participants as well as improvement in quality of life and mental health status of the regular users of GSA-Online plus. METHODS: GSA-Online plus was prescribed by physicians at termination of orthopedic psychosomatic inpatient rehabilitation. Participants' use of the program, work-related attitudes, distress, and quality of life were assessed on the Web. RESULTS: In 2 rehabilitation centers, 4.4% (112/2562) of rehabilitants got a recommendation for GSA-Online plus during inpatient rehabilitation. Compared with usual person aftercare, the Web-based aftercare program was rarely recommended by physicians. Recommendations were made more frequently in psychosomatic (69/1172, 5.9%) than orthopedic (43/1389, 3.1%) rehabilitation (χ21=11.845, P=.001, Cramér V=-0.068) and to younger patients (P=.004, d=0.28) with longer inpatient treatment duration (P<.001, r=-0.12) and extended sick leaves before inpatient medical rehabilitation (P=.004; Cramér V=0.072). Following recommendation, 77% (86/112) of rehabilitants participated in Web-based aftercare. Completers (50/86, 58%) reported statistically significant improvements between discharge of inpatient treatment and the end of the aftercare program for subjective work ability (P=.02, d=0.41), perceived stress (P=.01, d=-0.38), functioning (P=.002, d=-0.60), and life satisfaction (P=.008, d=0.42). CONCLUSIONS: Physicians' recommendations of Web-based aftercare are well accepted by patients who derive considerable benefits from participation. However, a low rate of prescription compared with other usual aftercare options points to barriers among physicians to prescribing Web-based aftercare.

Patients with Rheumatic Diseases do not have an Increased Risk of MRSA Carrier Status.

INTRODUCTION: The aim of this study was to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) both in rheumatologic and non-rheumatologic rehabilitation centers. In addition, we sought to evaluate the practice value of existing screening recommendations of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO). METHODS: The analysis was performed in four rehabilitation clinics (rheumatology, psychosomatic medicine, oncology, and cardiology) with at least 200 patients per clinic tested for MRSA. RESULTS: Nine (1.1%) of the 842 patients were colonized with MRSA. Only five of them should have been tested according to the commission's recommendations. The prevalence was 0.5% (n = 207) in rheumatologic, 0.9% (n = 224) in psychosomatic, 1.4% (n = 209) in oncologic and 1.5% (n = 202) in cardiologic patients. We found a greater exposure to risk factors in cardiologic and oncologic patients. Among patients with carrier status, a higher percentage was exposed to three potential risk factors not applied by the commission. CONCLUSIONS: The prevalence of MRSA in our cohort correlates with data from previous studies. The low percentage among rheumatologic patients suggests that they are not more likely to reveal MRSA carrier status than other patient groups and that long-term immunosuppression does not necessarily represent a risk factor for MRSA colonization. Since only five out of nine patients with carrier status would have been detected following the recommendations of the KRINKO, further studies on potential risk factors are warranted.