„Aktiv in der Reha“: Entwicklung und formative Evaluation einer Patientenschulung zur Förderung der Gesundheitskompetenz von chronisch Kranken

[Influence of Social Status on the Success of Rehabilitation among Patients with Chronic Low Back Pain - Results of a 2-year Follow-up after Inpatient Multidisciplinary Rehabilitation]

PURPOSE

Social inequality in medical rehabilitation is receiving increasing attention. The present study examined the impact of the social status on the long-term effectiveness of the pain competence and depression prevention training "Debora" among patients with chronic low back pain (CLBP) in an inpatient multidisciplinary rehabilitation.

METHODS

The control group study with cluster-block randomization investigated the long-term changes in pain self-efficacy, psychological burden, functional capacity, and subjective work ability among 394 patients with non-specific CLBP depending on the condition (control group, CG: pain competence training vs. intervention group, IG: additional depression prevention training) and the social status (lower, middle vs. upper class; according to Deck [1]). The data were collected at five sample points: pre (t₀), post (t₁), 6-(t₂), 12-(t₃) and 24-month follow-up (t₄). Multi- or univariate repeated-measures analyses of variance were conducted per protocol (pp). In a second step, results should be confirmed by multiple imputations (MI; N=1089).

RESULTS

In general, patients of the lower class showed significantly worse values in depressive symptoms, functional capacity, and subjective work ability compared to the upper class. In addition, positive long-term effects could not be found among patients of the lower class. In contrast, patients of the middle and upper class improved, especially in the IG. Furthermore, only the IG showed long-term improvements in subjective work capacity.

CONCLUSION

This study confirms the influence of the social status on the psychophysical health. Moreover, social inequality in long-term success of rehabilitation of CLBP was suggested, which could be mediated by health literacy. Therefore, these aspects should be taken into account already in the conception and especially in the application of psychological group trainings in inpatient rehabilitation.

Development and Formative Evaluation of a Communication Skills Training Program for Persons with Rheumatic and Musculoskeletal Diseases

OBJECTIVE

Our aim was to develop and evaluate a two-module training program (KOKOS-Rheuma) specifically designed to enhance the ability of persons with rheumatic and musculoskeletal diseases to communicate in various everyday situations.

DESIGN

KOKOS-Rheuma deals with communication at work (particularly superiors), with physicians, acquaintances, strangers and staff members of authorities and institutions and focuses on communication skills such as "saying no" and "giving and receiving feedback." Members of the German League against Rheumatism (GLR) were trained to deliver the program to self-help groups over two sessions or in a full-day session. The participants, trainers and observers completed a short evaluation form after each module or at the end of the full-day session.

MAIN OUTCOME MEASURES

The evaluation was based on 232 participant, 51 trainer, and 8 observer evaluation forms.

RESULTS

The participants rated all aspects of the training as good. The training was rated higher in the single session format. The great majority would recommend the course to other people.

CONCLUSION

After the revision of the training manual, KOKOS-Rheuma can be recommended for inclusion in the training schedule of the GLR. We recommend that future trainers receive more extensive preparation for delivering the course that highlights the preparation time required.

Disease-related everyday communication of persons with rheumatic and musculoskeletal diseases-Results of a participatory research project

OBJECTIVE

The aim of the present study is to describe and analyse significant factors of disease-related everyday communication of persons with RMDs in a nationwide project in Germany funded by the Deutsche Rheumaliga Bundesverband e.V. (German League against Rheumatism).

METHODS

In this participatory research project four persons with RMDs are involved. An online questionnaire addressing context, difficulties, and burden of disease-related everyday communication was answered by 1.015 persons with RMDs. Social and communication skills were recorded by questionnaires to capture social insecurity and patient communication competence.

RESULTS

More than half of the participants reported difficulties in disease-related conversations across various situations. The majority of these persons suffer from this experience particularly in conversations at the work environment or with staff members of authorities. They feel unconfident especially in situations which require saying "no". Furthermore, compared to the general population persons with RMDs have more anxiety about contact with others.

CONCLUSION

Strengthening the social skills of persons with RMDs in conversations related to everyday situations can promote a self-determined life and contribute to the maintenance of social participation.

PRATICE IMPLICATIONS

Based on the results, a communication skills training for persons with RMDs will be developed.

Gesundheitskompetenz durch Patientenschulungen – ein Überblick

Chronisch Kranke benötigen Kompetenzen, die sie dazu befähigen, möglichst selbstbestimmt mit ihrer Erkrankung umzugehen (Selbstmanagement). Solche Kompetenzen können durch Patientenschulungen vermittelt werden (Empowerment). Kontrollierte Studien konnten Effekte innovativer, interaktiver Schulungsprogramme auf Gesundheitskompetenz und Selbstmanagement-Outcomes nachweisen. Außerdem zeigte sich, dass Verbesserungen der Gesundheitskompetenz Verbesserungen der Lebensqualität mit sich bringen.