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W Mau, I Ehlebracht-König
Die Rehabilitation 02/2013; 52(1):51-62. · 1.36 Impact Factor
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ABSTRACT: HintergrundMotivation wird im Rahmen des Transtheoretischen Modells (TTM) als Bereitschaft zur Änderung von Einstellung und Verhalten
verstanden. Patienten mit chronischen Schmerzen durchlaufen demnach auf dem Weg zu einer definierten Verhaltensänderung (z.B.
regelmäßiges Entspannungstraining) die Stadien Absichtslosigkeit, Vorbereitung, Handlung und Aufrechterhaltung. Die Studie
untersucht die Frage, welche Bedeutung die Änderungsbereitschaft für die Schmerzbewältigung im Verlauf von 3Monaten besitzt.
MethodikInsgesamt wurden 74Patienten einer Rehabilitationsklinik zu 2 Zeitpunkten zur behavioralen und kognitiven Schmerzverarbeitung,
zur schmerzbedingten psychischen Beeinträchtigung und Selbstwirksamkeitserwartungen sowie zur Änderungsbereitschaft befragt.
Die TTM-Stadien wurden im Hinblick auf ihre Bedeutung für den Verlauf der Schmerzverarbeitung statistisch mit Hilfe von Kovarianzanalysen
untersucht (SAS® Prozedur PROC MIXED).
Ergebnisse und SchlussfolgerungenFür die transtheoretischen Stadien Vorbereitung, Handlung und Aufrechterhaltung zeigen sich signifikante Zusammenhänge zur
Schmerzverarbeitung, das Stadium der Absichtslosigkeit kovariiert signifikant mit der schmerzbedingten psychischen Beeinträchtigung.
Die Ergebnisse belegen die Bedeutsamkeit der transtheoretischen Änderungsbereitschaft für das therapeutische Ziel der Realisierung
einer angemessen Schmerzverarbeitung.
BackgroundMotivation in the concept of the transtheoretical model (TTM) is the readiness to change attitudes and behaviour. According
to this patients with chronic pain pass through different stages of change (precontemplation, preparation, action, maintenance)
before they adopt a new behaviour (e.g. relaxation exercise). This study analyses the impact of readiness to change over the
course of 3months.
MethodsDifferent questionnaires [coping with pain, impairment of pain, self-efficacy expectations and the German version of the Pain
Stages of Change Questionnaires (PSOCQ), the FF-STABS] were administered two times to 74patients of a rehabilitation clinic.
Statistical analysis of covariance (SAS PROC MIXED) was used to analyse the relevance of the stages of change for the course
of coping with chronic pain.
Results and conclusionsThe stages of preparation, action and maintenance show statistically significant interrelations with coping with chronic pain
subscales, and precontemplation covaries significantly with impairments of pain. The data suggest the relevance of the “readiness
to change” concept for the realization of appropriate coping with chronic pain.
Der Schmerz 04/2012; 21(6):522-528. · 0.88 Impact Factor
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ABSTRACT: HintergrundIm Rahmen des Selbstmanagements chronischer Schmerzen können Verhaltensänderungen im Hinblick auf kognitive und behaviorale
Aspekte erforderlich werden. Diese Veränderungsbereitschaft kann mit Hilfe des „Transtheoretischen Modells“ (TTM) beschrieben
und durch die motivierende Gesprächsführung gefördert werden. Die vorliegende Studie soll die Frage beantworten, ob durch
eine telefonische Motivationsintervention im Anschluss an eine Rehabilitationsmaßnahme deren Effekte auf die schmerzbedingte
Selbstwirksamkeit, auf kognitive und behaviorale Schmerzbewältigung und auf schmerzbedingte psychische Beeinträchtigungen
gefördert und aufrechterhalten werden können.
MethodikIm Rahmen eines kontrollierten prospektiven Designs wurden zum ersten Untersuchungszeitpunkt 147 Patienten des Rehazentrums
Bad Eilsen (Indikationen: Fibromyalgiesyndrom, chronische Polyarthritis, Spondylitis ankylosans) in die Studie eingeschlossen.
Die Teilnehmer der Interventionsgruppe erhielten 3-mal eine telefonische Intervention auf Basis der motivierenden Gesprächsführung.
Vor Studienbeginn und 9 Monate später wurden u.a. Daten mit dem Fragebogen zur Erfassung der Schmerzverarbeitung (FESV),
der Arthritis Self Efficacy Scale (ASES-D) und dem Freiburger Fragebogen – Stadien der Bewältigung chronischer Schmerzen (FF-STABS)
– erhoben. Die effektive Stichprobengröße betrug 91 Patienten (Dropoutrate 38%), die mit Hilfe eines statistischen Modells
zur Analyse nonparametrisch-longitudinaler Daten ausgewertet wurden.
Ergebnisse und SchlussfolgerungenFür die kognitive Schmerzbewältigung zeigten sich signifikant positive Effekte im Hinblick auf die Handlungsplanungskompetenzen
(U-Wert −2,423; p=0,015; Gruppe × Zeit-Effekt) und die emotionale Bewältigung der Schmerzen (Subskala Angst: U-Wert −2,3618;
p=0,018; Subskala Ärger: U-Wert 2,8638; p=0,004; Gruppe × Zeit-Effekt) für die Interventionsgruppe. Es ergab sich keine signifikant
positive Beeinflussung der schmerzbedingten Selbstwirksamkeit und der behavioralen Schmerzbewältigung. Eine explorative Subgruppenanalyse
zeigte, dass Patienten mit chronischer Polyarthritis und Spondylitis ankylosans stärker als Patienten mit Fibromyalgiesyndrom
profitierten.
BackgroundFor effective self-management of chronic pain changes of cognitive and behavioral attitudes are required. The readiness to
change can be described within the framework of the transtheoretical model (TTM) and is facilitated through motivational interviewing.
This prospective study evaluated the effectiveness of brief motivational interviewing by telephone for the variables self-efficacy,
cognitive and behavioral coping and psychological strain through chronic pain over a period of 9 months.
MethodsDifferent questionnaires, the self-efficacy expectations (ASES-D), cognitive, behavioral coping and psychological strain through
chronic pain (FESV) and the German version of the pain stages of change questionnaires (PSOCQ), the FF-STABS were distributed
to 147 patients at a rehabilitation clinic (indications: fibromyalgia syndrome, rheumatoid arthritis, ankylosing spondylitis).
The intervention group participants received 3 telephone calls at intervals of 2 months with a follow-up time of 9 months
after first study admission. At the end of the study 91 patients were enrolled for analysis (drop out rate 38%). To evaluate
the effects of treatment nonparametric-analysis for longitudinal data was used.
Results and conclusionThe analysis showed significant positive effects in the intervention group for cognitive coping (U-value −2.423; p=0.015 group
× time-effect) and for coping with emotional strains of chronic pain (subscale anxiety: U-value −2.3618; p=0.018; subscale
anger: U-value 2.8638; p=0.004; group × time-effect). No significant effects were shown for self-efficacy expectations and
behavioral coping with pain. Further explorative analysis of subgroups revealed slightly better treatment effects for patients
with rheumatoid arthritis and ankylosing spondylitis than for those with fibromyalgia syndrome.
Der Schmerz 04/2012; 22(5):575-585. · 0.88 Impact Factor
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ABSTRACT: To analyze the short-term efficacy of the Vocational Perspective programme for patients identified as having extensive work-related problems during rheumatology or orthopaedic inpatient rehabilitation. The primary objectives of the programme on patient level are to convey information about the legal provisions regarding earning incapacity and occupational reintegration, to suggest strategies for dealing with one's own occupational situation, and to strengthen the motivation to stay employed. The programme is explicitly designed for patients who wish to retire or have applied for a pension. On the systemic level, the main goals are to facilitate doctor-patient communication and to increase rehabilitation teams' awareness of occupational problems.
In a controlled quasi-experimental design, 359 subjects were consecutively assigned to either the control group (CG, n=177) or the intervention group (IG, n=182). The control group received standard care only, whereas the intervention group additionally participated in the 5-part Vocational Perspective programme. Evaluation criteria were assessed by questionnaire at the beginning (t1) and at end of rehabilitation (t2). Survey participation was 92.2% at t2. The socio-medically relevant knowledge status was objectively documented using a specially designed knowledge questionnaire. Aspects of treatment satisfaction were evaluated using individual items, and the subjective prognosis of gainful employment was assessed using the Subjective Prognosis of Gainful Employment (SPE) scale. Facilitation of communication between doctor and patient was operationalized at patient level in terms of patient satisfaction with medical care, and increased awareness of the rehabilitation team was operationalized in terms of the rate of recommendations to apply for vocational reintegration (LTA) services at discharge. Emotional and functional parameters were exploratively analyzed (anxiety and depression using the IRES 3.1 scales, and subjectively experienced pain-related impairment using the Pain Disability Index).
Scores for subjective satisfaction with job-related information, medical care, socio-medical assessment, and the overall benefits of rehabilitation were significantly higher in the intervention group than in the control group. IG subjects moreover were better able to use the rehabilitation measure to clarify their occupational situation and exhibited significantly greater improvement of socio-medically relevant knowledge. Age proved to be an important predictor of change in a patient's subjective prognosis for gainful employment (SPE): A positive change in SPE was observed in both groups in subjects under 50, in those aged 50 and older, however, only in the intervention group. No differences between the two groups were observed in terms of functional and emotional parameters (e. g., disability through pain, anxiety, and depression). A total of 60% of the subjects received a recommendation at discharge to apply for vocational reintegration services, the proportion however was significantly higher in the IG.
The Vocational Perspective programme met the patients' high demand for information on relevant socio-medical facilities and services regarding career change and facilitated communication between the doctor and patient by creating greater transparency. The improvement of subjective prognosis for gainful employment observed in the subgroup of older patients indicates that specialized interventions are needed in precisely this disadvantaged group in order to improve their own vocational expectations and thus to improve their chances of reintegration into work life. The high rate of recommendations to apply for vocational reintegration services suggests that rehabilitation teams already have a high awareness of job-related problems even under “usual care” conditions.
Die Rehabilitation 01/2012; 51(1):39-51. · 1.36 Impact Factor
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ABSTRACT: The treatment programme "Vocational Perspective" was developed for patients with health-related social problems, e. g. long-term sick leave, job loss due to disability, job insecurity and psychosocial disabilities. It intends the patient-oriented imparting of information referring to social system, legal rights, earning capacity and occupational reintegration as well as an early feedback of the sociomedical assessment by the physicians. Participants during in-patient rehabilitation are supported to deal with their occupational situation; motivation to stay employed is strengthened. The group programme contains five psychoeducative modules and an additional sociomedical "ward round". The aim of the study was to examine the acceptance of the newly developed sociomedical vocational therapy module.
A total of 179 patients participated in 21 "vocational perspective" seminars within the scope of a controlled quasi-experimental trial. In the experimental group the data on acceptance of the treatment was assessed by questionnaire at the end of the intervention. Experiences with implementation of the programme are described in order to complete the patient-related perspective.
The identification of a demand for work-related interventions in medical rehabilitation seemed successful: Sociodemographic and socioeconomical parameters of the sample proved high risk in view of the social-medical perspective (poor education, high unemployment rates and long-term sick leave). Self-estimations revealed high suffering of the participants, e. g. due to the occupational situation, anxiety and depression, and confirmed high interest in work-related issues. The patients showed quite high acceptance of the programme (regarding importance of seminar, comprehensibility, usefulness of information, atmosphere of the group, mode and extent of the programme). 82.7% of the participants would recommend the programme to other people with work-related problems. Altogether, the experiences during the implementation of the programme can be described as positive. Nevertheless, organizing took much effort and the treatment was very demanding for the therapists. Finally, it is also necessary that the physicians agree to realize high transparency in the process of sociomedical assessment.
The sociomedical programme "Vocational Perspective" helps patients to deal with relevant information referring to social system and occupational reintegration. Problematical sociomedical issues can be handled in a therapeutic way during rehabilitation process. Therefore, the programme can be used as meaningful supplement in regular medical rehabilitation. For final conclusions, the results of short-term and follow-up evaluations described elsewhere have to be considered.
Die Rehabilitation 02/2011; 50(1):44-56. · 1.36 Impact Factor
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ABSTRACT: The aim of this study was to verify the assumption that fractionated inpatient rehabilitation (three weeks and another week at a future date) is superior to a four-week inpatient treatment for patients with rheumatic diseases (spondyloarthropathies, fibromyalgia, rheumatoid arthritis). This expectation was based on the evidence of only short-term effects of inpatient rehab. Fractionation was intended to prolong and consolidate the effects achieved by the three-week inpatient treatment. Altogether, both groups showed significant positive effects for pain-intensity, activity and state of physical health over a period of more than one year, but there were no statistical effects between the groups. Advantages of fractionated inpatient rehabilitation could not be confirmed.
Die Rehabilitation 03/2009; 48(1):30-8. · 1.36 Impact Factor
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I Ehlebracht-König,
W Mau
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ABSTRACT: Today, medical rehabilitation of patients with rheumatic diseases is based on the International Classification of Functioning, Disability and Health (ICF). In addition to the biomedical view, rehabilitation includes the individuals' activities and participation in society; the ICF integrates personal and environmental factors. Disability due to rheumatic disease results from the health condition itself and its structural and functional limitations as well as individual personal and environmental contextual factors. Two case reports--a patient with early rheumatoid arthritis and a patient with advanced ankylosing spondylitis--illustrate interdisciplinary treatment in medical rehabilitation that is based on the ICF.
Zeitschrift für Rheumatologie 11/2008; 67(7):554-64. · 0.46 Impact Factor
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ABSTRACT: Die Rehabilitation von Patienten mit rheumatischen Krankheiten orientiert sich heute an deren Lebenswirklichkeit, die mit
der internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) beschrieben werden kann. Sie geht
damit über eine rein biomedizinische Betrachtungsweise hinaus und bezieht die Aktivitäten des handelnden Subjekts und die
Teilhabe an der Gesellschaft mit ein. Auch werden in dieses Modell die personen- und umweltbezogenen Kontextfaktoren integriert.
Die Beeinträchtigung durch eine rheumatische Erkrankung bildet sich aus dem Spannungsfeld zwischen dem Gesundheitsproblem
mit seinen strukturellen und funktionellen Einschränkungen und den vorliegenden Kontextfaktoren heraus. Anhand von 2 Fallbeispielen
– eine Patientin mit einer frühen rheumatoiden Arthritis und ein Patient im Spätstadium einer Spondylitis ankylosans – werden
die interdisziplinären Vorgehensweisen und ihr Bezug zum ICF-Modell in der medizinischen Rehabilitation veranschaulicht.
Today, medical rehabilitation of patients with rheumatic diseases is based on the International Classification of Functioning,
Disability and Health (ICF). In addition to the biomedical view, rehabilitation includes the individuals‘ activities and participation
in society; the ICF integrates personal and environmental factors. Disability due to rheumatic disease results from the health
condition itself and its structural and functional limitations as well as individual personal and environmental contextual
factors. Two case reports – a patient with early rheumatoid arthritis and a patient with advanced ankylosing spondylitis –
illustrate interdisciplinary treatment in medical rehabilitation that is based on the ICF.
Zeitschrift für Rheumatologie 10/2008; 67(7):554-564. · 0.46 Impact Factor
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ABSTRACT: For effective self-management of chronic pain changes of cognitive and behavioral attitudes are required. The readiness to change can be described within the framework of the transtheoretical model (TTM) and is facilitated through motivational interviewing. This prospective study evaluated the effectiveness of brief motivational interviewing by telephone for the variables self-efficacy, cognitive and behavioral coping and psychological strain through chronic pain over a period of 9 months.
Different questionnaires, the self-efficacy expectations (ASES-D), cognitive, behavioral coping and psychological strain through chronic pain (FESV) and the German version of the pain stages of change questionnaires (PSOCQ), the FF-STABS were distributed to 147 patients at a rehabilitation clinic (indications: fibromyalgia syndrome, rheumatoid arthritis, ankylosing spondylitis). The intervention group participants received 3 telephone calls at intervals of 2 months with a follow-up time of 9 months after first study admission. At the end of the study 91 patients were enrolled for analysis (drop out rate 38%). To evaluate the effects of treatment nonparametric-analysis for longitudinal data was used.
The analysis showed significant positive effects in the intervention group for cognitive coping (U-value -2.423; p=0.015 group x time-effect) and for coping with emotional strains of chronic pain (subscale anxiety: U-value -2.3618; p=0.018; subscale anger: U-value 2.8638; p=0.004; group x time-effect). No significant effects were shown for self-efficacy expectations and behavioral coping with pain. Further explorative analysis of subgroups revealed slightly better treatment effects for patients with rheumatoid arthritis and ankylosing spondylitis than for those with fibromyalgia syndrome.
Der Schmerz 06/2008; 22(5):575-78, 580-5. · 0.88 Impact Factor
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ABSTRACT: The growing burden of chronic disease and the current nature of healthcare systems which are structurally ill-equipped to cater to the complex needs of patients with chronic conditions has led to governments and healthcare providers seeking alternative ways to improve patients own capacity to actively self-manage their chronic condition. In Australia, there has been a focus on patient education and self-management programs within the healthcare system to achieve this. These programs aim to empower patients through providing information and teaching skills and techniques to improve self-care and doctor-patient interaction with the ultimate goal of improving quality of life. Patient education and self-management programs have been supported through several national government initiatives and implemented within the healthcare setting. This paper describes the current position of patient education and self-management within the Australian healthcare system. It further describes a new collaboration project between an Australian and a German research team which aims at translating an assessment questionnaire used in Australia for the evaluation of self-management programs, the "Health Education Impact Questionnaire" ("heiQ"); this instrument is expected to be of significant use in the German rehabilitative system.
Zeitschrift für Rheumatologie 06/2008; 67(3):189-98. · 0.46 Impact Factor
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ABSTRACT: A synopsis of different socio-medical consequences of inflammatory rheumatic diseases is not yet available for Germany. Therefore, the data reported during the past decade for rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, systemic sclerosis, systemic lupus erythematodes, and Wegener's granulomatosis are summarized in this article. Apart from clinical studies, relevant data sources were the national data base of the German collaborative arthritis centres, statistical figures from the compulsory health insurance and the national pension insurance scheme. Data were mainly available for sick leave and work disability showing limitations, which frequently occurred during the early course of diseases and increased with disease duration. Furthermore, different risk factors were identified. Measures to maintain continued participation in the labour force, such as part-time employment, partial work disability instead of full work disability, were not being adequately utilized. Only few data regarding the need of help and care were available. The proportion of patients in need of help and care increased with the duration of rheumatoid arthritis to more than 50% after more than 2 decades. This review presents detailed information concerning aspects of the burden of rheumatic diseases, which are frequently not adequately taken into account. They may be useful for the advice and care of individual patients as well as for decision processes concerning the health care system.
Zeitschrift für Rheumatologie 04/2008; 67(2):157-64. · 0.46 Impact Factor
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ABSTRACT: Da eine Übersicht zu verschiedenen sozialmedizinischen Folgen entzündlich-rheumatischer Krankheiten für Deutschland bisher nicht vorliegt, wurden Daten der letzten 10 Jahre für die rheumatoide Arthritis (RA), Spondylitis ankylosans, Psoriasisarthritis, systemische Sklerose, den systemischen Lupus erythematodes und M. Wegener zusammengestellt. Neben Ergebnissen vor allem klinischer Studien sind die Kerndokumentation der Regionalen Kooperativen Rheumazentren sowie Statistiken der Gesetzlichen Kranken- und Rentenversicherung wichtige Datenquellen.Vor allem für die Arbeitsunfähigkeit und Erwerbsminderung liegen Daten vor. Sie verdeutlichen die z. T. bereits früh eintretenden Einschränkungen, die mit der Krankheitsdauer und bei verschiedenen Risikofaktoren zunehmen. Maßnahmen zum Erhalt der Erwerbstätigkeit wie Teilzeittätigkeit bzw. Teilrente statt voller Erwerbsminderungsrente und Leistungen zur Rehabilitation werden wahrscheinlich nicht konsequent realisiert. Zur Hilfs- und Pflegebedürftigkeit sind nur wenige Daten verfügbar. Sie nimmt mit der Dauer der RA zu und betrifft nach 20-jähriger Krankheit mehr als die Hälfte der Patienten.Die Ergebnisse bieten differenzierte Informationen über diese nicht immer ausreichend beachteten Aspekte der Krankheitslast sowohl für die Beratung und Versorgung einzelner Patienten als auch für gesundheitspolitische Entscheidungsprozesse.
Zeitschrift für Rheumatologie 02/2008; 67(2):157-164. · 0.46 Impact Factor
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ABSTRACT: Da eine Übersicht zu verschiedenen sozialmedizinischen Folgen entzündlich-rheumatischer Krankheiten für Deutschland bisher
nicht vorliegt, wurden Daten der letzten 10Jahre für die rheumatoide Arthritis (RA), Spondylitis ankylosans, Psoriasisarthritis,
systemische Sklerose, den systemischen Lupus erythematodes und M.Wegener zusammengestellt. Neben Ergebnissen vor allem klinischer
Studien sind die Kerndokumentation der Regionalen Kooperativen Rheumazentren sowie Statistiken der Gesetzlichen Kranken- und
Rentenversicherung wichtige Datenquellen.
Vor allem für die Arbeitsunfähigkeit und Erwerbsminderung liegen Daten vor. Sie verdeutlichen die z.T. bereits früh eintretenden
Einschränkungen, die mit der Krankheitsdauer und bei verschiedenen Risikofaktoren zunehmen. Maßnahmen zum Erhalt der Erwerbstätigkeit
wie Teilzeittätigkeit bzw. Teilrente statt voller Erwerbsminderungsrente und Leistungen zur Rehabilitation werden wahrscheinlich
nicht konsequent realisiert. Zur Hilfs- und Pflegebedürftigkeit sind nur wenige Daten verfügbar. Sie nimmt mit der Dauer der
RA zu und betrifft nach 20-jähriger Krankheit mehr als die Hälfte der Patienten.
Die Ergebnisse bieten differenzierte Informationen über diese nicht immer ausreichend beachteten Aspekte der Krankheitslast
sowohl für die Beratung und Versorgung einzelner Patienten als auch für gesundheitspolitische Entscheidungsprozesse.
A synopsis of different socio-medical consequences of inflammatory rheumatic diseases is not yet available for Germany. Therefore,
the data reported during the past decade for rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, systemic sclerosis,
systemic lupus erythematodes, and Wegener’s granulomatosis are summarized in this article. Apart from clinical studies, relevant
data sources were the national data base of the German collaborative arthritis centres, statistical figures from the compulsory
health insurance and the national pension insurance scheme.Data were mainly available for sick leave and work disability showing
limitations, which frequently occurred during the early course of diseases and increased with disease duration. Furthermore,
different risk factors were identified. Measures to maintain continued participation in the labour force, such as part-time
employment, partial work disability instead of full work disability, were not being adequately utilized. Only few data regarding
the need of help and care were available. The proportion of patients in need of help and care increased with the duration
of rheumatoid arthritis to more than 50% after more than 2 decades.
This review presents detailed information concerning aspects of the burden of rheumatic diseases, which are frequently not
adequately taken into account. They may be useful for the advice and care of individual patients as well as for decision processes
concerning the health care system.
Zeitschrift für Rheumatologie 02/2008; 67(2):157-164. · 0.46 Impact Factor
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ABSTRACT: Chronische Krankheiten nehmen in der westlichen Welt stark zu und stellen die Gesundheitssysteme vor neue Herausforderungen.
Im Zuge verstärkter Patientenorientierung sollen Strukturen zur Unterstützung von Selbstmanagement und Selbstverantwortung
geschaffen werden, wobei effizienten Schulungsprogrammen eine wichtige Rolle zukommt. Im australischen Gesundheitssystem wurden
bereits Strategien im Umgang mit chronischen Erkrankungen umgesetzt. Eine davon ist die „Sharing Health Care Initiative“,
die seit 1999 die verschiedenen Selbstmanagementprogramme untersucht. Eine nationale Evaluation dieser Initiative hat Empfehlungen
zur Optimierung und Implementierung von Selbstmanagementprogrammen ausgesprochen, die in die Entwicklung der „National Chronic
Disease Strategy“ eingeflossen sind, in deren Rahmen umfangreiche finanzielle Mittel ausgeschüttet werden. Vor dem Hintergrund
der als notwendig erachteten Einführung eines Qualitätssicherungssystems entwickelte die Universität Melbourne den „Health
Education Impact Questionnaire“ (heiQ) zur Evaluation und Qualitätssicherung von Selbstmanagementprogrammen. Im Rahmen eines
vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Forschungsprojekts soll dieser nun auch in Deutschland
eingesetzt werden.
The growing burden of chronic disease and the current nature of healthcare systems which are structurally ill-equipped to
cater to the complex needs of patients with chronic conditions has led to governments and healthcare providers seeking alternative
ways to improve patients own capacity to actively self-manage their chronic condition. In Australia, there has been a focus
on patient education and self-management programs within the healthcare system to achieve this. These programs aim to empower
patients through providing information and teaching skills and techniques to improve self-care and doctor-patient interaction
with the ultimate goal of improving quality of life. Patient education and self-management programs have been supported through
several national government initiatives and implemented within the healthcare setting. This paper describes the current position
of patient education and self-management within the Australian healthcare system. It further describes a new collaboration
project between an Australian and a German research team which aims at translating an assessment questionnaire used in Australia
for the evaluation of self-management programs, the “Health Education Impact Questionnaire” (“heiQ”); this instrument is expected
to be of significant use in the German rehabilitative system.
Zeitschrift für Rheumatologie 01/2008; 67(3):189-198. · 0.46 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Motivation in the concept of the transtheoretical model (TTM) is the readiness to change attitudes and behaviour. According to this patients with chronic pain pass through different stages of change (precontemplation, preparation, action, maintenance) before they adopt a new behaviour (e.g. relaxation exercise). This study analyses the impact of readiness to change over the course of 3 months.
Different questionnaires [coping with pain, impairment of pain, self-efficacy expectations and the German version of the Pain Stages of Change Questionnaires (PSOCQ), the FF-STABS] were administered two times to 74 patients of a rehabilitation clinic. Statistical analysis of covariance (SAS PROC MIXED) was used to analyse the relevance of the stages of change for the course of coping with chronic pain.
The stages of preparation, action and maintenance show statistically significant interrelations with coping with chronic pain subscales, and precontemplation covaries significantly with impairments of pain. The data suggest the relevance of the "readiness to change" concept for the realization of appropriate coping with chronic pain.
Der Schmerz 12/2007; 21(6):522-8. · 0.88 Impact Factor
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ABSTRACT: In earlier studies the lack of correlation between subjective need for rehabilitation of the applicant and the medically determined objective need for rehabilitation was reported again and again. The correlation between fatigue and subjective need for rehabilitation was not yet examined so far. Nevertheless fatigue is not defined sufficiently in the ICD, so interactions between chronic fatigue and somatic diseases are not taken into account appropriately. The following questions are considered: How high is the degree of chronic fatigue in insurees applying for rehabilitation? Is there a correlation between degree of fatigue and need for rehabilitation? Is it possible to predict approval of medical rehabilitation by fatigue and need for rehabilitation? How will insurees accept a screening accompanying their application for rehabilitation?
The study is based on data of 500 (response rate 85.6%) insurees of the pension insurance Braunschweig-Hannover, who had applied for medical rehabilitation between 1/2004 and 3/2004. The screening instrument included: scales on functional activity, mobility, social support, coping (IRES), the Chalder Fatigue Scale, SCL 14, Items concerning need for rehabilitation. As statistical methods t-, chi (2)-test, correlations, covariance-analysis and regression analysis are used.
70.2% of the patients claiming rehabilitation reported relevant clinical symptoms of chronic fatigue. There were no differences in age, work status, motivation, or expectations of returning to work, but differences in sex. Patients with chronic fatigue met more citeria of need for rehabilitation. But the approval of medical rehabilitation could not be predicted by fatigue and need for rehabilitation. Nevertheless the acceptance of the screening was high in the insurees.
Patients with chronic fatigue met more criteria of need for rehabilitation. But the approval of medical rehabilitation could not be predicted by fatigue and need for rehabilitation. We assume that the reduction of activity and participation is associated with the degree of fatigue. It is discussed that the information an investigator may derive from a screening which is accepted by the insurees claiming medical rehabilitation will complete the collected clinical documents in a meaningful manner.
Die Rehabilitation 03/2007; 46(1):33-40. · 1.36 Impact Factor
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ABSTRACT: Patient education is considered to be a major feature of medical rehabilitation in chronic disorders. The rehabilitation sciences research programme funded by the German Pension Insurance scheme and the Federal Ministry of Education and Research comprises a considerable number of evaluation studies carried out with methodological rigor. Over two funding periods, patient education programmes were developed and evaluated with respect to their medical, psychosocial, occupational and economic effects. In this article, a conceptual definition of patient education is presented. Then, the aims and results of ten patient education studies of the funding programme as well as of several implementation projects are described. When integrating these results into previous research taking both a national and international perspective, it can be concluded that patient education programmes are effective regarding medical psychosocial and socio-economic outcomes, although effects sizes may vary. However, in some disorders the state of the research is still unsatisfactory and results are either scarce or heterogeneous. In particular, it is unclear whether such programmes are widely used in medical rehabilitation on a routine basis. Several education programmes provide train-the-trainer opportunities, others are still in the process of development or evaluation. Implementation projects such as those described in the article are aimed at closing these gaps and disseminating research results into the practice of rehabilitation.
Die Rehabilitation 11/2005; 44(5):277-286. · 1.36 Impact Factor
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ABSTRACT: It appears that from a clinical point of view chronic exhaustion or fatigue is an important factor in rehabilitation. This is, however, first of all a phenomenon that can be described as a function in accordance with the International Classification of Functioning, Disability and Health (JCF), caused by chronic illnesses or chronic excessive stress. The clinical and sociomedical ranking of chronic fatigue or exhaustion in respect of rehabilitation was discussed in the framework of a Workshop at the 12th Rehabilitation Science Colloquium, 2003 from the viewpoints of psychiatric rehabilitation, methodology, sociology and practical rehabilitation, and conclusions for future research were drawn. The definition of chronic fatigue is first of all mainly based on the feeling of chronic tiredness but also on phenomena of disturbed concentration, physical discomfort, headache and disorders of "drive" and mood. A psychiatric diagnosis linked with symptoms of chronic fatigue is neurasthenia, which is arrived at according to precisely defined criteria. Depressive disorder is one of the most important differential diagnoses in this sphere. Examinations by general practitioners revealed that about 90 % of the patients who had been diagnosed as suffering from psychovegetative disorders completely agreed with the diagnosis of neurasthenia. Neurasthenia resulted more often in work disability periods than disorders of somatisation and other psychosomatic diagnoses. Basing on the "IRES" scale "vital exhaustion", singular of even serious changes become evident in about 50 % to 90 % of the patients undergoing rehabilitation, depending on their individual range of indications. As was to be expected, the majority of pathologic findings concerns patients undergoing psychosomatic rehabilitation, since in such cases there is an overlapping with symptoms of psychosomatic diseases. It is, however, remarkable that also in somatically oriented orthopaedic rehabilitation symptoms of fatigue are seen in up to 50 % of the patients. Preliminary studies have shown that these symptoms can be definitely ameliorated within the rehabilitation framework, although pathological signs are still abundantly apparent in follow-up examinations. Markedly severe degrees of "vital exhaustion" and "vocational exhaustion" are also seen in rheumatology patients undergoing somatic rehabilitation. This agrees with case history details related by many female and male patients. Hence, it appears necessary to adapt rehabilitative intervention to both the psychovegetative and the medical behavioural aspects of this symptom. Scientific classification of the entire sphere of chronic fatigue in respect of rehabilitation requires classification of the relevant functions within the ICF framework. To this end it would be necessary to conduct patient inquiries within cross-sectional studies on the one hand and, on the other, a systematic consensus process among experts would have to be used for allocation to the relevant functions. This is the basis for development of suitable assessment tools for use in prospective studies in order to systematically evaluate the impact on functions and especially their effects on activities and participation.
Die Rehabilitation 07/2005; 44(3):176-85. · 1.36 Impact Factor
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ABSTRACT: Quality of life is gaining relevance as a criterion of success in therapeutic outcome studies. In order to record quality of life, disease-specific instruments are being used as well as generic instruments. Generic instruments offer the possibility to compare outcome among different indications; however for this it is necessary to prove the differential factorial validity of the instrument's structure.
Using structural equation modeling the SF-36 was administered to a sample of patients with rheumatic diseases. The sensitivity to change of the measure was calculated after six months. Furthermore, age- and sex-specific scale values were calculated and compared with norm data.
SF-36 data of 436 patients as well as sex and age from two scientific rehabilitation research projects were pooled for this secondary analysis.
The structure of the questionnaire proves to be acceptable and comparable with international results. The confirmatory analysis supports the best fit for a model with crossloadings assuming correlated main dimensions. Sensitivity to change is low in general. The best effect size is found for the subscale pain. The comparison with norm data shows that patients are impaired particularly within their physical health (regarding the SF subscales) both at the beginning of the treatment and after six months. In all age groups men have better conditions than women.
The generic SF-36 show sufficient factorial validity. From this point of view there is no objection to using the SF-36 in patients with rheumatic diseases. Indeed the use of the SF summary scales as a representation of (uncorrelated) physical and mental health must be questioned critically.
Zeitschrift für Rheumatologie 06/2005; 64(4):255-64. · 0.46 Impact Factor
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ABSTRACT: Hintergrund
Lebensqualitt besitzt als Erfolgskriterium therapeutischer Manahmen hohe Relevanz. Zur ihrer Erfassung werden neben krankheitsspezifischen auch generische Instrumente eingesetzt, die Vergleiche ber verschiedene Indikationen ermglichen. Hierzu ist es jedoch notwendig, die differentielle faktorielle Validitt des Verfahrens in unterschiedlichen Indikationen nachzuweisen.
Studienziel
Mittels Strukturgleichungsmodellierung wurde die Fragebogenstruktur des Short Form 36 in einer Stichprobe von Patienten mit entzndlich-rheumatischen Erkrankungen konfirmatorisch getestet. Zudem wurde die Vernderungssensitivitt des Verfahrens sechs Monate nach einer Rehabilitationsmanahme ermittelt. Anschlieend wurden alters- und geschlechtsspezifische Kennwerte berechnet und mit Normdaten verglichen.
Methoden
Die SF-36 Daten von 436 Patienten sowie deren Alter und Geschlecht wurden aus zwei Forschungsprojekten im Rahmen einer Sekundranalyse zusammengefhrt.
Ergebnisse
Die konfirmatorischen Analysen belegen fr ein Modell mit Mischladungen unter der Annahme korrelierter Hauptdimensionen die beste Gte. Die Vernderungssensitivitt ist bis auf die Subskala Schmerz gering. Der Normdatenvergleich weist darauf hin, dass die Patienten vor allem auf den physischen SF-Subskalen sowohl zu Beginn der Manahme als auch nach sechs Monaten erheblich beeintrchtigt sind. Mnner zeigen dabei ber alle Altersgruppen hinweg eher besseres Befinden als Frauen.
Schlussfolgerungen
Der generische SF-36 ist ausreichend faktoriell valide, so dass aus dieser Perspektive nichts gegen dessen Einsatz bei Patienten mit entzndlich-rheumatischen Erkrankungen spricht. Die Verwendung der (unkorrelierten) SF-Summenskalen als Operationalisierung psychischer bzw. physischer Gesundheit sollte allerdings kritisch hinterfragt werden.
Background
Quality of life is gaining relevance as a criterion of success in therapeutic outcome studies. In order to record quality of life, disease-specific instruments are being used as well as generic instruments. Generic instruments offer the possibility to compare outcome among different indications; however for this it is necessary to prove the differential factorial validity of the instruments structure.
Aim of the study
Using structural equation modeling the SF-36 was administered to a sample of patients with rheumatic diseases. The sensitivity to change of the measure was calculated after six months. Furthermore, age- and sex-specific scale values were calculated and compared with norm data.
Methods
SF-36 data of 436 patients as well as sex and age from two scientific rehabilitation research projects were pooled for this secondary analysis.
Results
The structure of the questionnaire proves to be acceptable and comparable with international results. The confirmatory analysis supports the best fit for a model with crossloadings assuming correlated main dimensions. Sensitivity to change is low in general. The best effect size is found for the subscale pain. The comparison with norm data shows that patients are impaired particularly within their physical health (regarding the SF subscales) both at the beginning of the treatment and after six months. In all age groups men have better conditions than women.
Conclusions
The generic SF- 36 show sufficient factorial validity. From this point of view there is no objection to using the SF-36 in patients with rheumatic diseases. Indeed the use of the SF summary scales as a representation of (uncorrelated) physical and mental health must be questioned critically.
Zeitschrift für Rheumatologie 04/2005; 64(4):255-264. · 0.46 Impact Factor
