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Starke F, Sikora A, Stegmann R, Knebel L, Buntrock C, de Rijk A, Houkes I, Szycik GR, Unger HP, Schumacher JO, Stark H, Hauth I, Holzapfel C, Borgolte A, Schneller C, Unterschemmann SL, Paetow W, Jung AL, Berking M, Zimmermann J, Wegewitz U. Evaluating a multimodal, clinical and work-directed intervention (RTW-PIA) to support sustainable return to work among employees with mental disorders: study protocol of a multicentre, randomised controlled trial. BMC Psychiatry 2023; 23:380. [PMID: 37254157 DOI: 10.1186/s12888-023-04753-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Mental disorders (MDs) are one of the leading causes for workforce sickness absence and disability worldwide. The burden, costs and challenges are enormous for the individuals concerned, employers and society at large. Although most MDs are characterised by a high risk of relapse after treatment or by chronic courses, interventions that link medical-psychotherapeutic approaches with work-directed components to facilitate a sustainable return to work (RTW) are rare. This protocol describes the design of a study to evaluate the (cost-)effectiveness and implementation process of a multimodal, clinical and work-directed intervention, called RTW-PIA, aimed at employees with MDs to achieve sustainable RTW in Germany. METHODS The study consists of an effectiveness, a health-economic and a process evaluation, designed as a two-armed, multicentre, randomised controlled trial, conducted in German psychiatric outpatient clinics. Sick-listed employees with MDs will receive either the 18-month RTW-PIA treatment in conjunction with care as usual, or care as usual only. RTW-PIA consists of a face-to-face individual RTW support, RTW aftercare group meetings, and web-based aftercare. Assessments will be conducted at baseline and 6, 12, 18 and 24 months after completion of baseline survey. The primary outcome is the employees´ achievement of sustainable RTW, defined as reporting less than six weeks of working days missed out due to sickness absence within 12 months after first RTW. Secondary outcomes include health-related quality of life, mental functioning, RTW self-efficacy, overall job satisfaction, severity of mental illness and work ability. The health-economic evaluation will be conducted from a societal and public health care perspective, as well as from the employer's perspective in a cost-benefit analysis. The design will be supplemented by a qualitative effect evaluation using pre- and post-interviews, and a multimethod process evaluation examining various predefined key process indicators from different stakeholder perspectives. DISCUSSION By applying a comprehensive, multimethodological evaluation design, this study captures various facets of RTW-PIA. In case of promising results for sustainable RTW, RTW-PIA may be integrated into standard care within German psychiatric outpatient clinics. TRIAL REGISTRATION The study was prospectively registered with the German Clinical Trials Register ( DRKS00026232 , 1 September 2021).
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Affiliation(s)
- Fiona Starke
- Division 3 Work and Health, Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42, Berlin, 10317, Germany.
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
| | - Alexandra Sikora
- Division 3 Work and Health, Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42, Berlin, 10317, Germany
| | - Ralf Stegmann
- Division 3 Work and Health, Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42, Berlin, 10317, Germany
| | - Leonie Knebel
- Division 3 Work and Health, Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42, Berlin, 10317, Germany
| | - Claudia Buntrock
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto-Von-Guericke University Magdeburg (OVGU), Leipziger Str. 44, 39120, Magdeburg, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nägelsbachstr. 25a, 91052, Erlangen, Germany
| | - Angelique de Rijk
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Inge Houkes
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Gregor R Szycik
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Podbielskistr. 162, Hanover, OE7110, Germany
| | - Hans-Peter Unger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Mental Health, Asklepios Clinic Harburg, Eißendorfer Pferdeweg 52, Hamburg, 21075, Germany
| | - Jan Ole Schumacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Mental Health, Asklepios Clinic Harburg, Eißendorfer Pferdeweg 52, Hamburg, 21075, Germany
| | - Heiko Stark
- Department of Psychiatry, Burghof-Clinic, Ritterstr. 19, 31737, Rinteln, Germany
| | - Iris Hauth
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexian St. Joseph-Hospital Berlin-Weissensee, Gartenstr. 1, 13088, Berlin, Germany
| | | | - Anna Borgolte
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Podbielskistr. 162, Hanover, OE7110, Germany
| | - Carlotta Schneller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexian St. Joseph-Hospital Berlin-Weissensee, Gartenstr. 1, 13088, Berlin, Germany
| | | | - Wiebke Paetow
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Mental Health, Asklepios Clinic Harburg, Eißendorfer Pferdeweg 52, Hamburg, 21075, Germany
| | - Anna Lena Jung
- Clinic Wittgenstein, Sählingsstr. 60, 57319, Bad Berleburg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nägelsbachstr. 25a, 91052, Erlangen, Germany
| | - Johannes Zimmermann
- Department of Psychology, University of Kassel, Holländische Str. 36-38, 34127, Kassel, Germany
| | - Uta Wegewitz
- Division 3 Work and Health, Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42, Berlin, 10317, Germany
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Jekauc D, Rayling S, Klopp S, Schmidt D, Rittmann LM, Fritsch J. Effects of a web-based rehabilitation aftercare on subjective health, work ability and motivation: a partially randomized controlled trial. BMC Musculoskelet Disord 2021; 22:366. [PMID: 33874917 PMCID: PMC8054846 DOI: 10.1186/s12891-021-04239-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Rehabilitation is seen as crucial in dealing with the demographic change in many European countries. In Germany, for example, after having stayed in a rehabilitation center, patients have the possibility to participate in aftercare programs aimed at promoting long-term health behaviour. Despite the relevance of follow-up support for patients’ long-term health and work ability, participation rates in aftercare programs are quite low. Here, web-based aftercare programs can be a viable alternative to the traditional face-to-face programs due to their flexibility in time and location. This research project aims to use quantitative and qualitative methods to gain more insight into the potential of web-based aftercare programs. Methods The goal is to recruit up to 1150 patients at baseline in five rehabilitation centers across Germany. For ethical reasons, partially randomized experimental study design is used to quantitatively assess the effectiveness of web-based aftercare programs. All patients are offered the traditional face-to-face aftercare treatment (IRENA). When patients deny to participate in traditional face-to-face aftercare, they are randomly distributed into either web-based aftercare (digIRENA) or a control group. In all three groups, the SF-12, which measures subjective health, and the WAI, which measures working ability, will be used at baseline, 13 weeks, 26 weeks and 43 weeks after the patients have left the rehabilitation center. BREQ-2, which measures motivation, is used only in the traditional aftercare group and the web-based aftercare group. A multivariate analysis of variance with repeated measurement and latent growth curve models will be used to compare the development of the variables in the three groups. For the qualitative part of the study, interviews with patients and therapists will be conducted to shed light on the applicability, acceptance, and usability of web-based aftercare programs. Discussion This study may provide valuable insight into the potential of web-based rehabilitation aftercare programs as a way to supplement traditional face-to-face programs. This seems particularly promising if it can manage to reach those patients who do not currently participate in traditional face-to-face rehabilitation aftercare programs due to time and location constraints. Trial registration The trial has been registered at the German Register of Clinical Studies (DRKS) with the registration number: DRKS00022467. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04239-z.
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Affiliation(s)
- Darko Jekauc
- Institute for Sport and Sport Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.
| | - Sabine Rayling
- Institute for Sport and Sport Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Sara Klopp
- Institute for Sport and Sport Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Detlef Schmidt
- Institute for Sport and Sport Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Lena-Marie Rittmann
- Institute for Sport and Sport Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Julian Fritsch
- Institute for Sport and Sport Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
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Höpner J, Junge U, Schmidt-Pokrzywniak A, Fischer C, Mikolajczyk R. Determinants of persistent smoking after acute myocardial infarction: an observational study. BMC Cardiovasc Disord 2020; 20:384. [PMID: 32838741 PMCID: PMC7446164 DOI: 10.1186/s12872-020-01641-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background Smoking cessation is one of the most effective secondary prevention measures after acute myocardial infarction (AMI). However, around 50% of smokers do not quit smoking after AMI. The aim of the present study is to estimate the proportion of patients quitting smoking and to identify determinants of persistent smoking after AMI in a region with increased cardiovascular mortality. We also assessed the time of smoking cessation after AMI. Methods We used follow-up data of patients registered with the Regional Myocardial Infarction Registry in Saxony-Anhalt (RHESA) in Germany. We assessed smoking status and determinants of persistent smoking six weeks after discharge from hospital after AMI. Information on smoking, sociodemographic characteristics, risk factors for AMI, experienced symptoms of AMI, and clinical care were gathered in a computer-assisted telephone interview and questionnaires filled out by study subjects and physicians or study nurses. Results Out of 372 smokers at the time of AMI, 191 (51.3%) reported that they quit smoking within six weeks after discharge from hospital after AMI. Strongest determinant of persistent smoking was a previous AMI before the current one (OR = 2.19, 95%CI 1.10–4.38) and strongest determinants of smoking cessation were experiencing complications in the hospital (0.37, 95%CI 0.12–1.12) and having a life partner (0.56, 95%CI 0.34–0.95). Most individuals who stopped smoking did so during the initial stay in the hospital, before the cardiac rehabilitation (CR). Conclusions Persistent smoking after AMI and its determinants were similar in our region to previous studies. CR cannot be viewed as determinant of smoking cessation – more likely the same teachable moment induces behavioural change with regard to smoking and participation in CR.
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Affiliation(s)
- Jens Höpner
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany
| | - Udo Junge
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany
| | - Andrea Schmidt-Pokrzywniak
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany
| | - Christian Fischer
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany.
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Zwerenz R, Böhme K, Wirth A, Labitzke N, Pachtchenko S, Beutel ME. Integration of the work-related online aftercare intervention 'GSA-online plus' (healthy and without stress at the workplace) into clinical practice: study protocol for an implementation study. BMC Health Serv Res 2018; 18:312. [PMID: 29716605 PMCID: PMC5930936 DOI: 10.1186/s12913-018-2995-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 03/14/2018] [Indexed: 11/12/2022] Open
Abstract
Background In a previous RCT we established the efficacy of the psychodynamic online aftercare programme ‘GSA-Online’ (‘Health Training Stress Management at the Workplace’) for rehabilitants with work-related stress facing return to work after long-term sickness absence. The purpose of this trial is to implement it into routine care. Methods/design The study is performed in rehabilitation clinics with patients of different medical indications (psychosomatic, orthopedic and cardiological diseases). Rehabilitants get access to the study platform during inpatient medical rehabilitation. ‘GSA-Online plus’ integrates exploratory and motivational videos on the web application to familiarize potential participants and motivate them to follow through with it. In the 12-week writing intervention, patients write weekly online diary entries, answered by anonymous online therapists within 24 h. Primary outcome measures are the recommendation rate of ‘GSA-Online plus’ and participation rates of the rehabilitants. As secondary outcomes, psychological symptoms, overall satisfaction, helpfulness of the therapeutic feedback and utilization of ‘GSA-Online plus’ will be analysed exploratory along with the course of weekly ratings of well-being and work ability. Discussion Meanwhile many clinical trials and meta-analysis prove that internet-based interventions are effective. This study will add insights on the dissemination and implementation of efficacious, evidence-based online treatments into medical practice. We expect a successful implementation of ‘GSA-Online plus’ in the clinical routine of the rehabilitation clinics. The focus of evaluation is on acceptance of the programme, both by the physicians in charge and the patients. In the future ‘GSA-Online plus’ could be implemented as a routine aftercare programme for rehabilitation inpatients with occupational stress. Trial registration The trial was retrospectively registered on 6th January 2017 at ClinicalTrials.gov (Trial Registration number: ClinicalTrials Gov ID NCT03019718).
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Affiliation(s)
- Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre of the Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Katja Böhme
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre of the Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131, Mainz, Germany. .,Department of Clinical Psychology, Psychotherapy & experimental Psychopathology, Johannes Gutenberg University, Mainz, Germany.
| | - Astrid Wirth
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre of the Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.,German Reading Foundation, Mainz, RP, Germany
| | - Nicole Labitzke
- Media Centre of the Johannes Gutenberg-University, Mainz, RP, Germany
| | - Sergei Pachtchenko
- Knowledge Media Institute of the University of Koblenz-Landau, Koblenz, RP, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre of the Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
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Hirsch K, Bohley S, Mau W, Schmidt-Pokrzywniak A. The RHESA-CARE study: an extended baseline survey of the regional myocardial infarction registry of Saxony-Anhalt (RHESA) design and objectives. BMC Cardiovasc Disord 2016; 16:159. [PMID: 27534534 PMCID: PMC4989530 DOI: 10.1186/s12872-016-0336-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/27/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of death in Europe. In Germany, a declining mortality rate from acute myocardial infarction (AMI) has been observed in the last decades. Nevertheless, there are large differences between the federal states when looking at the mortality and morbidity of AMI. Saxony-Anhalt is one of the federal states with the highest mortality rates for AMI in Germany. In 2012, the regional myocardial infarction registry of Saxony-Anhalt (RHESA) was established to investigate the individual, infrastructural, and health care factors with respect to an urban (city of Halle) and rural (region of Altmark) population. For detailed observation the RHESA-CARE study was conducted in 2014. RHESA-CARE focuses on the symptoms during infarction, the behaviour of patients while alerting for infarction, the use of rehabilitation possibilities, and long-term care. METHODS/DESIGN RHESA-CARE is an extended baseline survey of AMI patients registered in RHESA who are aged 25 or more, and inhabitants of the city of Halle (Saale) or the district of Altmark in the federal state of Saxony-Anhalt, Germany. Detailed information was collected on classical and psychosocial cardiovascular risk factors as well as factors of alerting behaviour, first aid, and utilization of medical and rehabilitation services. High data quality is ensured by a detailed system of quality control. DISCUSSION RHESA-CARE has the main objective to investigate factors that influence morbidity and mortality rates due to AMI. Another purpose is the comparison of a rural and urban patient population. It provides an opportunity to serve as a base for improvement of patients' behaviour and health care as well as further research.
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Affiliation(s)
- Katharina Hirsch
- Martin Luther University Halle-Wittenberg, Institute of Medical Epidemiology, Biostatistics, and Informatics, Magdeburger Str. 8, Halle (Saale), D-06097 Germany
| | - Stefanie Bohley
- Martin Luther University Halle-Wittenberg, Institute of Medical Epidemiology, Biostatistics, and Informatics, Magdeburger Str. 8, Halle (Saale), D-06097 Germany
| | - Wilfried Mau
- Martin Luther University Halle-Wittenberg, Institute of Rehabilitation Medicine, Magdeburger Str. 8, Halle (Saale), D-06097 Germany
| | - Andrea Schmidt-Pokrzywniak
- Martin Luther University Halle-Wittenberg, Institute of Medical Epidemiology, Biostatistics, and Informatics, Magdeburger Str. 8, Halle (Saale), D-06097 Germany
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