[APPS-Study 2020 - On outpatient psychotherapeutic care for people with psychotic disorders]. / APPS-Studie 2020 ­ Zur ambulanten psychotherapeutischen Versorgung von Menschen mit psychotischen Störungen.

BACKGROUND: Although patients with psychotic disorders (PPS) are indicated for outpatient psychotherapy at any stage of their illness, they are rarely treated in this way. For this purpose, structural conditions, the experience of competence of therapists, as well as content-related aspects of training and further education of psychotherapists are analyzed. METHODS: Based on a qualitative preliminary study, an online survey was conducted among 487 psychological psychotherapists. RESULTS: Half of the respondents indicated a high willingness to treat PPS. In the acute phase of the disease only 20% are willing to do so. In the studies as well as in the theoretical part of the education and further education, there is hardly any preparation for a corresponding treatment. In contrast, practical experience in psychiatric clinics is considered very important. With regard to structural framework conditions, low hourly quotas and inflexible billing modalities are criticized. With regard to patients, in addition to sufficient motivation for treatment, low reliability, low cognitive ability, low insight into the illness, and frequent discontinuation of therapy are stated. Contrary to some prejudices, patients are characterized as "peaceful" in their interactions. The reduction of psychotic relapses, social integration and reduction of comorbid symptoms are mainly mentioned as achievable outcomes. The reduction of psychotic symptoms is rated less optimistically. Psychotherapists from psychiatric outpatient clinics (PIA) differ from other outpatient psychotherapists by better competence experience and correspondingly more frequent work with PPS, also in the acute stage. DISCUSSION: Although every second therapist does not feel well trained, the willingness to treat PPS seems to be higher than the pure supply figures suggest. There is potential for optimization in education and training as well as in networking with other professional groups/relatives. This could be responsible for the fact that in the acute psychotic stage there are fears of contact and competence concerns. Psychotherapists in PIAs, where there is closer networking with other professional groups for structural reasons, experience corresponding deficits to a lesser extent. With regard to other structural barriers, the question arises as to whether these represent disorder-specific or rather general problems in psychotherapy.

[Questionnaire to Assess the Work-Related Orientation of Medical Rehabilitation from the Perspective of the Rehabilitants (WMR-R): Cross-Sectional Study Comparing the Short and Long Versions]. / Fragebogen zur Erfassung der medizinisch-beruflichen Orientierung der Rehabilitation aus der Perspektive der Rehabilitanden (MBOR-R): Querschnittsstudie zum Vergleich der Kurz- und Langversion.

BACKGROUND: The user perception of the work-related treatment is of great importance for the further development and success of work-related medical rehabilitation (WMR). The German Pension Insurance Fund (Deutsche Rentenversicherung DRV Bund) has therefore supported the development of the questionnaire WMR-R that can be used to assess the quality of the structure, process and results of work-related rehabilitation treatment from the patient's point of view. This paper presents a short version and compares it with the long version. METHODS: Based on a representative sample stratified by indication, employed rehabilitants up to the age of 65 were randomly selected to be questioned 6 months after their rehabilitation with a long version (N=28276) or a short version (N=6611) of WMR-R. In addition, routine data of the German Pension Insurance Fund were included. 27 items each of the long version and 8 items of the short version are added up to a total score and compared with regard to test statistical quality criteria and sample sensitivity. RESULTS: Participation rates were slightly higher in the short version (31%, N=2115) than in the long version (28%, N=8019). The processing quality in both versions is comparable. The short and long versions correlate with each other at r=0.96 (p<0.01). Both versions have similar validity characteristics and separate well between WMR and standard rehabilitation. Both versions are robust to demographic, disease-related and socio-medical risk factors. Rehabilitants with addiction and psychosomatic as well as neurological diseases rate their rehabilitation as significantly more work-oriented compared to other indications, especially pneumology. DISCUSSION: Due to the low survey effort and the simple evaluation and interpretation, the short version is particularly suitable for routine surveys of WMR care quality. The long version allows a differentiated recording of the WMR offer of rehabilitation facilities in the sense of strength/weakness analyses.

[Outcome Quality of Medical Rehab in the Mirror of Singular and Multiple Outcome Criteria - Where is Psychosomatic Rehab when Comparing Indications?] / Ergebnisqualität medizinischer Rehabilitation im Spiegel singulärer und multipler Ergebniskriterien ­ Wo steht die Psychosomatische Rehabilitation im Indikationenvergleich?

BACKGROUND: A series of studies proves a good outcome quality of psychosomatic rehabilitation. However, outcome-related comparisons with other indications are hardly available. METHODS: As part of a multicenter study, n=6608 rehabilitants from the indications psychosomatics, cardiology, neurology, oncology and orthopedics were checked regarding starting features and longer-term outcome quality (one-point survey 1 year after the end of the rehab). With a generic measurement and evaluation approach, direct and quasi-indirect change measurements and status measurements were made. In addition to comparing singular and multiple outcome criteria ("Patient Reported Outcomes", PRO), outcome criteria from the rehab statistics database (RSD) have also been checked. RESULTS: The 5 indication groups differ in both starting and process characteristics as well as in the short and longer-term outcome criteria. However, the effect sizes of the associations are mostly low. In all indications, there are positive changes in the field of health-related characteristics. The highest pre-post effect sizes are mostly found in psychosomatics, the least in neurology. In all indications, social security contributions in the first year after rehab are a bit declining - least in oncology, most clearly in neurology. Despite the biggest pre-post effects sizes in the health-related features, the rehabilitants of psychosomatics are less satisfied with the rehab and evaluate the benefits of rehab less positive. At the level of multiple outcome criteria, the indications - except neurology - are relatively little different. The multiple outcome criterion can be predicted to 28% from starting and process characteristics. Best predictor is the user sided rating regarding the job-related orientation of the rehab. CONCLUSION: The study once again proves a good longer-term outcome quality of psychosomatic rehab. However, it also shows that the longer-term outcome quality of all major indications measured by means of multiple outcome criteria is at a similar level (except neurology).Possible limitations of the study result from the one-point measurement and the resulting mode of change measurement.

[Work-Related Medical Rehabilitation (WMR) Care in Psychosomatic Medicine in Comparison with Other Indications]. / Medizinisch-berufliche Orientierung (MBOR) in der Psychosomatischen Rehabilitation im Vergleich zu somatischen Indikationen.

BACKGROUND: So far, there is little data on the quality of work-related medical rehabilitation (WMR)-care in the routine, including from a user perspective. The best data are still available for orthopedic rehabilitation. For psychosomatic rehabilitation, a special need for WMR is known due to the long periods of inability to work and the frequent early retirements. It is unclear how precisely and to what extent WMR services are provided in routine care. METHODS: In 2019, a representative sample (N=34.887) of employed insured persons up to 65 years old, stratified by indication, was surveyed by the German Pension Insurance fund six months after their rehabilitation with the self-assessment tool MBOR-R. In addition, standard data of the rehabilitation provider (RSD) were collected, from which WMR-related therapeutic offer data (KTL) could be taken. Rehabilitants were asked about their return to work as part of the catamnesis. RESULTS: The participation rate in the survey is 29%, complete survey and RSD data are available after exclusion of addiction rehabilitation and post-operative-procedures from a total of 6.128 rehabilitants, of which N=1.460 after psychosomatic rehabilitation. The comparison of indications shows that 37% of the rehabilitation patients need WMR, which is by far the highest rate. WMR care in psychosomatic rehabilitation is still the best developed and most targeted, but still far from the standards required by the pension insurance. More than 50% of the rehabilitants, even after WMR, rate their employment-related treatment offer as too low. These subjective rehabilitation assessments in the MBOR-R questionnaire prove to be a relevant factor for the prognosis of the return to work quotes, in contrast to the documented KTL services, in addition to the need indicators of WMR and the implementation of WMR. DISCUSSION: The results suggest that in the field of psychosomatic rehabilitation, too, increased efforts should be made in the future to offer and expand basic WMR services for all rehabilitants and core and special services for rehabilitants with poor work ability and an increased risk of permanent work disability (BBPL) in routine care. The scope and design of MBOR measures should also be quality-optimized from the user's perspective in order to achieve the greatest possible effects.Limitations of the results result from the restriction to rehabilitants of the German Federal Pension Insurance, to limited participation rates, Limitations of the interpretability of the therapy documentations and due to the study design with a one-point measurement and remembered pre-values.

[Rehabilitation Outcome and Therapeutic Alliance of Inpatients of Psychosomatic Rehabilitation with Pension Request]. / Psychosomatische Rehabilitation bei Patientinnen und Patienten mit Rentenüberlegungen: Reha-Erfolg und therapeutische Beziehung.

OBJECTIVE: Inpatients of psychosomatic rehabilitation with a latent or manifest desire for a pension are a risk group with regard to successful participation in rehabilitation and return to work. Reaching this group of patients, is both a legal requirement (rehabilitation before retirement), and important from an economic and health perspective. This study examines patients who are considering applying for a reduced earning capacity. The questions are whether these patients differ in socio-demographic variables and the success of rehabilitation from patients without pension considerations, and which patients benefitted from their rehabilitation despite pension considerations. Particular attention is paid to the therapeutic relationship. METHODS: Data are routinely collected from patients of 2 rehabilitation clinics who were undergoing inpatient psychosomatic treatment between October 2012 and February 2017 (n=8503). RESULTS: Inpatients with pension considerations were slightly older, more often incapacitated for work and more often receiving unemployment benefits. Both groups reported a significant reduction in symptoms over the course of the rehabilitation. Within the group considering retirement, patients who reported an improvement in symptoms reported a more positive relationship satisfaction. DISCUSSION/CONCLUSION: Patients who are thinking about retirement often have difficult socio-demographic and health-related conditions for successful rehabilitation. Despite these conditions, many report an improvement in psychosomatic symptoms and a positive therapeutic relationship.

[Testing the Psychometric Properties of the Helping Alliance Questionnaire (HAQ) in Different Health Care Settings]. / Psychometrische Überprüfung des Helping Alliance Questionnaire (HAQ) in unterschiedlichen Versorgungssettings.

Introduction The Helping Alliance Questionnaire developed by Luborsky was psychometricly examined for the first time and translated into German by Bassler et al. in the mid-1990s. It consists of 11 Items, which are summarized to the scales "relation to the therapist" and "satisfaction with therapeutic outcome". HAQ is now one of the most used instruments to measure therapeutic alliance. The goal of this study was to test the psychometric properties based on three large patient samples in different treatment settings. Material and methods Analyses were conducted based on 2 samples of patients in inpatient psychosomatic/psychotherapeutic rehabilitation (n=655, n=2494) and one sample in outpatient psychotherapy (n=1477). Exploratory factor analyses and for verification confirmatory factor analyses were applied. Furthermore reliability and validity analysis were conducted. Results The 2-factorial structure found in literature was replicated with an increasing stability at the end of treatment. Item 2 and 3 had inconsistent factor loadings at different points of measurement and study. Reliability and validity indices were satisfying to good. The fit of the model, on the other hand, was less satisfying and suggests a solution without Item 2 and 3. For reasons of content as well as for reasons of dissemination, it is pleaded for the maintenance of the existing item assignments in the HAQ for the present.

Impact of an acceptance facilitating intervention on psychotherapists' acceptance of blended therapy.

Blended therapy is a new approach combining advantages of face-to-face psychotherapy and Internet- and mobile-based interventions. Acceptance is a fundamental precondition for its implementation. The aim of this study was to assess 1) the acceptance of psychotherapists towards blended therapy, 2) the effectiveness of an acceptance facilitating intervention (AFI) on psychotherapists' acceptance towards blended therapy and 3) to identify potential effect moderators. Psychotherapists (N = 284) were randomly assigned to a control (CG) or an intervention group (IG). The IG received a short video showing an example of blended therapy, the CG an attention placebo video. Both groups received a reliable online questionnaire assessing acceptance, effort expectancy, performance expectancy, facilitating conditions, social influence and internet anxiety. Between group differences were examined using t-tests and Mann-Whitney tests. Exploratory analysis was conducted to identify moderators. Psychotherapists in CG showed mixed baseline acceptance towards blended therapy (low = 40%, moderate = 33%, high = 27%). IG showed significantly higher acceptance compared to CG (d = .27, pone-sided = .029; low = 24%, moderate = 47%, high = 30%). Bootstrapped confidence intervals were overlapping. Performance expectancy (d = .35), effort expectancy (d = .44) and facilitating conditions (d = .28) were significantly increased (p < .05). No effects on social influence and internet anxiety were found (p>.05). Exploratory analysis indicated psychodynamic oriented psychotherapists profiting particularly from the AFI. Blended therapy is a promising approach to improve healthcare. Psychotherapists show mixed acceptance, which might be improvable by AFIs, particularly in subpopulations of initially rather skeptical psychotherapists. Forthcoming studies should extend the present study by shifting focus from attitudes to the impact of different forms of AFIs on uptake.

[The satisfaction of relatives with service delivery of nursing homes for the elderly. Development of the screening-questionnaire ZUF-A-7]. / Zufriedenheit von Angehörigen mit der Versorgung in stationären Altenpflegeeinrichtungen. Entwicklung des Screening-Fragebogens ZUF-A-7.

PURPOSE: To enable the measurement of satisfaction with the service delivery of residential homes, a practicable and statistical proven screening-test was supposed to educe. In order to identify critical quality-related situations a specific cut-off should be allocated. METHODS: Based on literature research a questionnaire was developed and responded by 3581 relatives of residents of 45 nursing homes for the elderly. The questionnaire was analysed and compressed based on scale, item and factor analysis. For validation, demographic variables and separate quality-ratings were available. Finally a ROC analysis was performed to recognize specificity and sensitivity of possible cut-offs. RESULTS: The Angehörigen-Screening-Fragebogen (relatives-screening-questionnaire) ZUF-A-7 was generated consisting of seven items. The scale is reliable (Cronbach's Alpha). Like other satisfaction measurements it displays a skew distribution. Middle size up to large correlations with the quality-ratings exists but there were no relevant coherences to the demographic variables. The ROC analysis suggested a critical cut-off of 21 (range = 7-28).