Modellhafte Einführung von Patientenschulungsprogrammen in der Rehabilitation

Development, implementation and formative evaluation of a motivational-volitional intervention to promote sustainable physical activity in breast cancer survivors

OBJECTIVE

The aim of the current project was the development, implementation and evaluation of the programme, Motivational-Volitional Intervention-Movement After Breast Cancer (Mo-Vo-BnB), an intervention for the sustainable promotion of physical activity of breast cancer survivors.

METHODS

In a multi-stage interdisciplinary development process, the pedagogical-didactic, psychological and physical evidence-based programme was developed and implemented for women after breast cancer who were approved for medical rehabilitation and were minimally, physically active (<60 min/week). Train-the-trainer seminars were carried out for the implementation. Four sessions were implemented in two German clinics. The training quality, didactic methods and accompanying material were evaluated 6 weeks and 12 months after implementation by patients, trainers and project members (n = 127 evaluations).

RESULTS

The standardised and published MoVo-BnB programme can provide practical and quality training. Content and methods can be implemented according to the manual. Training quality, didactic methods, and accompanying materials were evaluated positively.

CONCLUSION

The results suggest that MoVo-BnB is a useful standardised intervention for promoting the physical activity of breast cancer survivors. The demonstrated process is also suitable for other projects.

CLINICAL TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00011122; Trial registration date: 2016 October 13.

Effectiveness of a standardized back school program for patients with chronic low back pain after implementation in routine rehabilitation care

OBJECTIVE

To evaluate the effectiveness of a standardized, patient-oriented, biopsychosocial back school after implementation in inpatient orthopedic rehabilitation.

METHODS

A multi-center, quasi-experimental controlled study of patients with low back pain (n=535) was conducted. Patients in the control group received the traditional back school before implementation of the new program (usual care); patients in the intervention group received the new standardized back school after implementation into routine care. Patients' illness knowledge and conduct of back exercises (primary outcomes) and secondary self-management outcomes and treatment satisfaction were obtained at admission, discharge, and 6 and 12 months after rehabilitation.

RESULTS

We found a significant small between-group intervention effect on patients' illness knowledge in medium- to long term (6 months: η²=0.015; 12 months: η²=0.013). There were trends for effects on conduct of back exercises among men (6 and 12 months: η²=0.008 both). Furthermore, significant small effects were observed for treatment satisfaction at discharge and physical activity after 6 months.

CONCLUSIONS

The standardized back school seems to be more effective in certain outcomes than a usual care program despite heterogeneous program implementation.

PRACTICE IMPLICATIONS

Further dissemination within orthopedic rehabilitation may be encouraged to foster self-management outcomes.

Experiences of Rehabilitation Professionals with the Implementation of a Back School for Patients with Chronic Low Back Pain: A Qualitative Study

A standardized curriculum back school (CBS) has been recommended for further dissemination in medical rehabilitation in Germany. However, implementation of self-management education programs into practice is challenging. In low back pain care, individual factors of professionals could be decisive regarding implementation fidelity. The study aim was to explore attitudes and experiences of professionals who conducted the back school. Qualitative interviews were led with 45 rehabilitation professionals. The data were examined using thematic analysis. Three central themes were identified: (a) “back school as a common thread,” (b) “theory versus practice,” and (c) “participation and patient-centeredness.” The CBS and its manual were frequently described positively because they provide structure. However, specified time was mentioned critically and there were heterogeneous perceptions regarding flexibility in conducting the CBS. Theory and practice in the CBS were discussed concerning amount, distribution, and conjunction. Participation and patient-centeredness were mainly mentioned in terms of amount and heterogeneity of participation as well as the demand for competences of professionals. Factors were detected that may either positively or negatively influence the implementation fidelity of self-management education programs. The results are explorative and provide potential explanatory mechanisms for behavior and acceptance of rehabilitation professionals regarding the implementation of biopsychosocial back schools.