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Kühn L, Lindert L, Glawe W, Choi KEA. [Determinants of use of rehabilitation services before entering disability pension: Time series analysis of insured members of the German Pension Insurance Federation in Berlin and Brandenburg]. DAS GESUNDHEITSWESEN 2024; 86:182-191. [PMID: 38242157 DOI: 10.1055/a-2217-7846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND The age-standardized application rate for medical rehabilitation services of the German Pension Insurance Association has been declining since 2009. Two of the most frequent reasons for applying for rehabilitation services represent musculoskeletal disorders and mental disorders. The aim of this analysis was to identify factors influencing the utilization of rehabilitation services in the federal states of Berlin and Brandenburg. METHODS The explorative time series analysis is based on a research dataset of the German Pension Insurance Federation. Insured persons of the German Pension Insurance Federation from the federal states of Berlin and Brandenburg with a diagnosis of musculoskeletal disorders or mental disorders were included. Descriptive differences in targeted and prognostic parameters were calculated using chi-square and t-test statistics. Predictive parameters for the utilization of medical rehabilitation services were calculated using binary, logistic regression analyses. RESULTS A total of 11,257 insured cases were examined. For the population of insured persons from Berlin, the use of medical rehabilitation services showed significant prognostic variables for gender, age at retirement, marital status, level of education, occupational requirement level, total accumulated earning points, gross pension level, status of a temporary pension, health insurance status, and diagnosis group. For Brandenburg, significant prognostic variables were found for age at retirement, marital status, nationality, education level, occupational requirement level, total accumulated earning points, status of a temporary pension, occupational sector, and diagnosis group. CONCLUSION In Berlin and Brandenburg mental disorders and sociodemographic parameters are associated with an increased probability of not claiming medical rehabilitation services before the onset of reduced earning capacity. It remains to be investigated which mechanisms cause people with mental disorders to make no use of medical rehabilitation services. Future analyses should examine isolated interaction mechanisms for the utilization of medical rehabilitation services, especially in the case of existing F-diagnoses. In addition, explanations for different influencing variables between states remain to be explored.
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Affiliation(s)
- Lukas Kühn
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Lara Lindert
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Wiebke Glawe
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Kyung-Eun Anna Choi
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Fakultät für Medizin und Zahnmedizin; Forschungszentrum Medical Imaging and Artificial Intelligence (MIAAI), Danube Private University, Krems, Austria
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Topcu G, Mhizha-Murira JR, Griffiths H, Bale C, Drummond A, Fitzsimmons D, Potter KJ, Evangelou N, das Nair R. Experiences of receiving a diagnosis of multiple sclerosis: a meta-synthesis of qualitative studies. Disabil Rehabil 2023; 45:772-783. [PMID: 35254195 PMCID: PMC9928430 DOI: 10.1080/09638288.2022.2046187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE This meta-synthesis aimed to synthesise qualitative evidence on experiences of people with Multiple Sclerosis (MS) in receiving a diagnosis, to derive a conceptual understanding of adjustment to MS diagnosis. METHODS Five electronic databases were systematically searched to identify qualitative studies that explored views and experiences around MS diagnosis. Papers were quality-appraised using a standardised checklist. Data synthesis was guided by principles of meta-ethnography, a well-established interpretive method for synthesising qualitative evidence. RESULTS Thirty-seven papers were selected (with 874 people with MS). Synthesis demonstrated that around the point of MS diagnosis people experienced considerable emotional upheaval (e.g., shock, denial, anger, fear) and difficulties (e.g., lengthy diagnosis process) that limited their ability to make sense of their diagnosis, leading to adjustment difficulties. However, support resources (e.g., support from clinicians) and adaptive coping strategies (e.g., acceptance) facilitated the adjustment process. Additionally, several unmet emotional and informational support needs (e.g., need for personalised information and tailored emotional support) were identified that, if addressed, could improve adjustment to diagnosis. CONCLUSIONS Our synthesis highlights the need for providing person-centred support and advice at the time of diagnosis and presents a conceptual map of adjustment for designing interventions to improve adjustment following MS diagnosis.Implications for RehabilitationThe period surrounding Multiple Sclerosis diagnosis can be stressful and psychologically demanding.Challenges and disruptions at diagnosis can threaten sense of self, resulting in negative emotions.Adaptive coping skills and support resources could contribute to better adjustment following diagnosis.Support interventions should be tailored to the needs of newly diagnosed people.
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Affiliation(s)
- Gogem Topcu
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- CONTACT Gogem Topcu Institute of Mental Health, Jubilee Campus, University of Nottingham, B Floor, Nottingham, NG7 2TU, UK
| | | | - Holly Griffiths
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Bale
- Multiple Sclerosis Patient and Public Involvement Group, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Deborah Fitzsimmons
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Kristy-Jane Potter
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nikos Evangelou
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Roshan das Nair
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
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Metzner G, Höhn C, Nau A, Sehlbrede M, Waldeck E, Glattacker M. Treatment Beliefs of Children and Adolescents With Chronic Diseases: Development of the Rehabilitation Treatment Beliefs Questionnaire for Children and Adolescents. J Pediatr Psychol 2023; 48:5-13. [PMID: 35426935 DOI: 10.1093/jpepsy/jsac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Rehabilitation is an important component in the health care of children and adolescents with chronic diseases and aims at supporting patients' self-regulation for dealing with the disease. Patients' beliefs about illness and treatment are core elements in the self-regulation process. While questionnaires measuring illness beliefs for children and adolescents exist, questionnaires about their rehabilitation-related treatment beliefs are lacking. We therefore developed a questionnaire to assess the rehabilitation-related treatment beliefs of children and adolescents with chronic diseases (Rehabilitation Treatment Beliefs Questionnaire, RTBQ) and tested its psychometric properties. METHODS Ahead of their rehabilitation, children and adolescents, aged 12-17 years, answered 129 items, which were developed based on previous qualitative findings exploring children and adolescents' rehabilitation-related treatment beliefs. Psychometric testing included item analyses, exploratory factor analysis, internal consistency and bivariate correlations of the extracted scales, and the discriminatory power and difficulty of the final items. RESULTS The sample consisted of 170 participants with a mean age of 14.3 years (SD = 1.6); 53.5% were female. After item analyses, 47 items remained for the exploratory factor analysis which revealed 22 items allocated to 4 scales: "expectations of communication and interaction," "expectations of the treatment process," "expectations of treatment success and sustainability," and "expectations of one's own role in the rehabilitation process." The psychometric properties were acceptable to good. CONCLUSIONS The RTBQ assesses various dimensions of rehabilitation-related treatment beliefs of children and adolescents with chronic diseases. While first psychometric results are promising, further psychometric testing is needed.
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Affiliation(s)
- Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Cindy Höhn
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Anne Nau
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Sehlbrede
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Edith Waldeck
- Deutsche Rentenversicherung Rheinland-Pfalz, Edelsteinklinik (Specialized Clinic for Child- and Adolescent Rehabilitation), Bruchweiler, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Illness perceptions and outcome in multiple sclerosis: A systematic review of the literature. Mult Scler Relat Disord 2022; 67:104180. [PMID: 36130458 DOI: 10.1016/j.msard.2022.104180] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/24/2022]
Abstract
According to Leventhal's self-regulation model, ill people construct personal representations of their disease, namely illness perceptions, which impact their coping strategies and the emotional response to their condition. Since these representations develop in the social environment, the individuals' perceptions may also be related to the opinions of their caregivers. This systematic review aims at synthesising and critically appraising literature pertaining the relationship between illness perceptions and outcome in persons with multiple sclerosis and their caregivers. A literature search was conducted in MEDLINE, PsycINFO, and CINAHL. Only papers with the following characteristics were included: quantitative studies; written in English or Italian; published from 1992; investigating the relationship between illness perceptions and any outcome in persons with multiple sclerosis and/or their caregivers; using validated scales assessing illness perceptions. Twenty papers were included and appraised through the 16-item Quality Assessment Tool for Studies with Diverse Designs. The quality of the papers was acceptable. Eighteen out of 20 papers reported the existence of a moderate effect size when analysing the relationship between illness perceptions and outcome, whereby "positive" perceptions (e.g. stronger beliefs of control) related to better outcomes, while "negative" ones (e.g. attribution of negative consequences to the disease) related to worse outcome.
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Metzner G, Höhn C, Waldeck E, Stapel M, Glattacker M. Rehabilitation-related treatment beliefs in adolescents: A qualitative study. Child Care Health Dev 2022; 48:239-249. [PMID: 34738647 DOI: 10.1111/cch.12922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/08/2021] [Accepted: 10/30/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Medical rehabilitation plays an important role in the health care of chronically ill children and adolescents. During medical rehabilitation, supporting illness-related self-regulation is a central goal. Beliefs about illness and beliefs about treatment are core elements of patients' self-regulation, and there is evidence that these beliefs are relevant predictors of different health- and treatment-related outcomes such as adherence. However, little is known about adolescents' beliefs about rehabilitation. This study therefore explores adolescents' treatment beliefs in the context of inpatient medical rehabilitation. METHODS A qualitative study was conducted in a German rehabilitation clinic for children and adolescents. Using a purposive sampling method, 13 adolescents (12-16 years old) were recruited. Semi-structured, audiotaped interviews were conducted and analysed using content analysis. RESULTS Results demonstrate that adolescents have differentiated rehabilitation-related treatment beliefs. Twelve themes, with various subthemes, emerged, which include access to and knowledge about rehabilitation, the rehabilitation-related individual position and normative aspects, expectations of oneself, as well as in respect of the social context (fellow patients, contact with family and friends), expectations of the structure, process and outcome of rehabilitation, concerns and barriers and emotional aspects. CONCLUSIONS Our explorative study revealed a broad range of rehabilitation-related treatment beliefs in adolescents, indicating parallels, but also differences, to research results with adults. Treatment beliefs are assumed to be an influencing factor for various health- and treatment-related outcomes. Thus, implications of our findings for clinical practice and further research are discussed.
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Affiliation(s)
- Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Cindy Höhn
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Edith Waldeck
- Deutsche Rentenversicherung Rheinland-Pfalz, Edelsteinklinik - Fachklinik für Kinder- und Jugendrehabilitation, Bruchweiler, Germany
| | - Matthias Stapel
- Deutsche Rentenversicherung Rheinland-Pfalz, Speyer, Germany.,SRH Fernhochschule - The Mobile University, Riedlingen, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Glattacker M, Rudolph M, Bengel J, von der Warth R. Illness Beliefs, Treatment Beliefs, and Fulfilled Treatment Expectations in Psychosomatic Rehabilitation: Associations with Patient Satisfaction. Patient Prefer Adherence 2022; 16:3303-3317. [PMID: 36545541 PMCID: PMC9762405 DOI: 10.2147/ppa.s390596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Patients' illness and treatment beliefs have been shown to predict health outcomes in many health care settings. However, information about their impact on patient satisfaction is scarce. The aim of this study was to investigate illness- and rehabilitation-related treatment beliefs and met rehabilitation-related treatment expectations and their relationship with patient satisfaction in psychosomatic rehabilitation. METHODS In a repeated measures study design, patients filled out questionnaires 2 to 3 weeks before the start of rehabilitation and at the end of an inpatient rehabilitation 6 to 7 weeks later. The predictive value of illness beliefs, treatment beliefs, and fulfilled treatment expectations regarding patient satisfaction was analyzed with multiple hierarchical regression analyses controlling for sociodemographic and clinical variables. RESULTS Two hundred sixty-four patients participated. The sample was composed of equal numbers of men and women (n = 129 each). The mean age was 50.4 years. Most patients had diagnoses from the ICD-10 diagnostic group F3 (affective disorders; n = 145) or F4 (neurotic, stress-related and somatoform disorders; n = 94). Sociodemographic and clinical variables were not associated with patient satisfaction. The explained variance of patient satisfaction increased to 10% by adding illness beliefs (namely personal control and coherence) (p = 0.006), to 5% by adding rehabilitation-related treatment beliefs (namely concerns) (p = 0.063), and to 49% by adding fulfilled expectations (namely a positive discrepancy between expectations and experiences related to outcome expectations and related to participation and treatment structure, and a negative discrepancy between expectations and experiences related to concerns) (p < 0.001) as predictor variables. CONCLUSION This study highlights the relationship of fulfilled (rehabilitation-related) treatment expectations with patient satisfaction in psychosomatic rehabilitation. Given the evidence underlining the importance of patients' illness and treatment beliefs and expectations, it is vital that these constructs are addressed in corresponding interventions.
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Affiliation(s)
- Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Correspondence: Manuela Glattacker, Section of Health Care Research and Rehabilitation Research, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, Freiburg, D-79106, Germany, Tel +49 761 270 36940, Email
| | - Matthias Rudolph
- Deutsche Rentenversicherung Rheinland-Pfalz (German Statutory Pension Insurance Rhineland Palatinate); Mittelrhein-Klinik (Clinic for Psychosomatic Rehabilitation), Boppard-Bad Salzig, Germany
| | - Jürgen Bengel
- Section of Rehabilitation Psychology and Psychotherapy; Department of Psychology; University of Freiburg, Freiburg, Germany
| | - Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Veillard D, Le Page E, Epstein J, Wiertlewski S, Gallien P, Hamonic S, Debouverie M, Edan G. Evaluation of the quality of the care pathway for patients with multiple sclerosis in France: Results of an original study of a cohort of 700 patients. Rev Neurol (Paris) 2021; 178:580-590. [PMID: 34893353 DOI: 10.1016/j.neurol.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Evaluating the quality of the care pathway for patients with chronic diseases, such as multiple sclerosis (MS), is an important issue. Process indicators are a recognized method for evaluating professional practices. However, these tools have been little developed in the field of MS, and few data are available. The aim of this study was to describe, retrospectively, with validated indicators, the quality of the care pathway in a population-based cohort of 700 patients with the first manifestations of the disease occurring between January 1, 2000 and December 31, 2001 and during the first 10 years of disease. METHOD This assessment was based on 48 indicators specific to MS. The information required for the calculation of each indicator was collected from the source files of the 700 patients of the cohort. RESULTS Data for the 10 years of follow-up were collected for 80% of the patients. In total, 36 indicators were calculated. These results reveal that there is room for improvement, particularly in terms of the initial assessment, access to ophthalmological evaluation, employment, obtaining an evaluation of the need for rehabilitation and access to such care. CONCLUSION The results of this survey provide access to unprecedented new data in France, that professionals and patients can appropriate to improve the targeting of actions, to improve the quality of care further for patients with MS in France. We propose to continue this process by submitting, for discussion, a targeted list of updated indicators relating to changes in guidelines, and in issues concerning the quality of patient management.
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Affiliation(s)
- D Veillard
- Service d'épidémiologie et de santé publique, CHU, 35000 Rennes, France; Équipe d'accueil 3279, centre d'études et de recherche sur les services de santé, Aix-Marseille Université, 13000 Marseille, France.
| | - E Le Page
- Inserm, service de neurologie, Clinical Neuroscience Center CIC-P 1414, CHU, 35000 Rennes, France.
| | - J Epstein
- Service d'épidémiologie, clinique du centre hospitalier universitaire and Clinical Investigation Center CIC 1433, 54000 Nancy, France.
| | - S Wiertlewski
- Clinique neurologique, CHU de Nantes, 44000 Nantes, France.
| | - P Gallien
- Pôle de médecine physique et de rehabilitation Saint-Hélier, 35000 Rennes, France.
| | - S Hamonic
- Service d'épidémiologie et de santé publique, CHU, 35000 Rennes, France.
| | - M Debouverie
- Équipe d'accueil 4360 adaptation, mesure et évaluation en santé, approches interdisciplinaires, service de neurologie, université de Lorraine, CHU de Nancy, 54000 Nancy, France.
| | - G Edan
- Inserm, Clinical Neuroscience Centre, CIC-P 1414, Université de Rennes 1, 35000 Rennes, France.
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