A. Reusch

DGRW-Update: Patientenschulung

Patient education programmes, i. e. standardized, manualized, interactive group programmes aiming to increase self-management and empowerment, are a core element of medical rehabilitation for chronic conditions. In an update of the evidence of the effectiveness of patient education, its effectiveness was proven for a broad spectrum of chronic disorders, such as diabetes mellitus, chronic low back pain, rheumatoid arthritis, coronary heart disease, chronic heart failure, bronchial asthma, COPD, and cancer, as well as for the modification of health behaviours, such as diet and exercise. To sustain effects, aftercare interventions, such as support provided by phone, were found to be successful. Interventions targeted to particular patient groups according to gender, age, or migration background are also being developed more frequently. When evaluating educational interventions not only distal outcomes, such as quality of life and participation, should be used but also proximal outcomes such as self-management skills. A recent survey of patient education practice in medical rehabilitation revealed a continuing potential for optimization relative to manualization, evaluation and didactics. However, the dissemination of innovative programmes into rehabilitation routine presents a major challenge.

Innovative Schulungskonzepte in der medizinischen Rehabilitation

Patient education aims to empower rehabilitants. While patient education has, in the past, been conceived of as providing solely information, modern self-management concepts now focus on both behavioral competencies and motivational factors. Participants receive all the skills and tools necessary to make informed decisions regarding both their health and lifestyles and to actively participate in the rehabilitation process. Accordingly, didactic methods have changed from predominantly vertical lectures to more patient-oriented and interactive approaches. Meta-analyses have proven that patient education is effective in improving the chronic conditions of patients. However, the implementation of modern concepts into routine care is still suboptimal. The Center of Patient Education, funded by the German Statutory Pension Insurance, has performed a survey of the present state of patient education within medical rehabilitation programs in Germany. Furthermore, quality criteria for patient education have been developed, an internet database presenting self-management programs in a systematic manner has been created, and various services designed to improve educational practice are being offered by the Center of Patient Education. Lastly, a state-of-the-art, self-management education program is described.ZusammenfassungModerne Patientenschulung dient dem Empowerment von Rehabilitanden. Während traditionellerweise unter Schulung meist Wissensvermittlung verstanden wurde, stellen aktuelle Konzepte Handlungskompetenzen und motivationale Faktoren in den Mittelpunkt. Den Teilnehmern sollen Strategien und Fertigkeiten zur Verfügung gestellt werden, um informierte Entscheidungen und Selbstmanagement hinsichtlich Gesundheit und Lebensstil vornehmen zu können. Entsprechend hat sich die Didaktik weg vom Frontalvortrag hin zu einem interaktiven, teilnehmerorientierten Vorgehen gewandelt. Metaanalysen dokumentieren, dass eine derart konzipierte Patientenschulung wirksam ist. Allerdings besteht bei der Implementierung neuartiger Programme in der Praxis noch Optimierungsbedarf. Das von der Deutschen Rentenversicherung Bund geförderte Zentrum Patientenschulung hat eine Bestandsaufnahme der Schulungspraxis vorgenommen, Qualitätskriterien für Schulungen entwickelt, eine Internetdatenbank geschaffen, in der Schulungen nutzerfreundlich präsentiert werden, und bietet vielfältige Dienstleistungen zur Optimierung der Schulungspraxis an. Am Beispiel eines innovativen Programms wird der State of the Art bei der Schulung in der medizinischen Rehabilitation vorgestellt.AbstractPatient education aims to empower rehabilitants. While patient education has, in the past, been conceived of as providing solely information, modern self-management concepts now focus on both behavioral competencies and motivational factors. Participants receive all the skills and tools necessary to make informed decisions regarding both their health and lifestyles and to actively participate in the rehabilitation process. Accordingly, didactic methods have changed from predominantly vertical lectures to more patient-oriented and interactive approaches. Meta-analyses have proven that patient education is effective in improving the chronic conditions of patients. However, the implementation of modern concepts into routine care is still suboptimal. The Center of Patient Education, funded by the German Statutory Pension Insurance, has performed a survey of the present state of patient education within medical rehabilitation programs in Germany. Furthermore, quality criteria for patient education have been developed, an internet database presenting self-management programs in a systematic manner has been created, and various services designed to improve educational practice are being offered by the Center of Patient Education. Lastly, a state-of-the-art, self-management education program is described.

Effectiveness of small-group interactive education vs. lecture-based information-only programs on motivation to change and lifestyle behaviours. A prospective controlled trial of rehabilitation inpatients

OBJECTIVE Although patient education may promote motivation to change health behaviours, the most effective method has not yet been determined. METHODS This prospective, controlled trial compared an interactive, patient-oriented group program with lectures providing only information. We evaluated motivational stages of change and self-reported behaviours in three domains (sports, diet, relaxation) at four times up to one year (60% complete data) among 753 German rehabilitation inpatients (mean age 50 years, 52% male) with orthopaedic (59%) or cardiologic disorders (10%) or diabetes mellitus (31%). RESULTS We found improvements between baseline and follow up regarding each outcome (p<.001) in both groups. At the end of rehabilitation, participants of the interactive group, as compared to the lectures, showed more advanced motivation regarding diet (p<.10) and sports (p=.006). Interactive group patients reported healthier diets both after 3 months (p=0.013) and 12 months (p=0.047), more relaxation behaviours (p=.029) after 3 months and higher motivation for sports after 12 months (p=.08). CONCLUSIONS The superior effectiveness of the interactive group was only partly confirmed. PRACTICE IMPLICATIONS This short, 5-session interactive program may not be superior to lectures to induce major sustainable changes in motivation.

Empowerment durch Patientenschulung in der Rheumatologie

Due to the chronic course, rheumatic diseases may be associated with both long-lasting pain and movement limitations. Those afflicted by these disorders thus face continuous challenges regarding both adapting to their illness as well as changing their lifestyle habits, for example increasing the physical activity levels. However, patient education may provide patients with the competencies they need to cope with their illness and modify their behavior. Therefore, patient education programs are core elements of rehabilitation in rheumatology. The German Society for Rheumatology has performed pioneering work concerning conceptualization and evaluation of standardized educational programs. In this article some more recent developments and up to date standards for contents and didactics of self-management programs are presented. Empowerment may be considered the overriding aim of these programs, i.e. enabling patients to make informed decisions in situations where their health is involved. Patient-centered didactic methods as used in state of the art concepts mirror the empowerment approach. To foster sustainability of lifestyle changes, detailed planning of behavioral modifications is recommended, thus increasing the chance of transferring changes adopted during rehabilitation into everyday living. Such methods have been proven to be effective and are employed in the updated education concept for patients with fibromyalgia syndrome, which is described here as an example. The Centre for Patient Education offers support in updating and evaluating patient education concepts.

Innovative concepts for patient education in medical rehabilitation

Patient education aims to empower rehabilitants. While patient education has, in the past, been conceived of as providing solely information, modern self-management concepts now focus on both behavioral competencies and motivational factors. Participants receive all the skills and tools necessary to make informed decisions regarding both their health and lifestyles and to actively participate in the rehabilitation process. Accordingly, didactic methods have changed from predominantly vertical lectures to more patient-oriented and interactive approaches. Meta-analyses have proven that patient education is effective in improving the chronic conditions of patients. However, the implementation of modern concepts into routine care is still suboptimal. The Center of Patient Education, funded by the German Statutory Pension Insurance, has performed a survey of the present state of patient education within medical rehabilitation programs in Germany. Furthermore, quality criteria for patient education have been developed, an internet database presenting self-management programs in a systematic manner has been created, and various services designed to improve educational practice are being offered by the Center of Patient Education. Lastly, a state-of-the-art, self-management education program is described.ZusammenfassungModerne Patientenschulung dient dem Empowerment von Rehabilitanden. Während traditionellerweise unter Schulung meist Wissensvermittlung verstanden wurde, stellen aktuelle Konzepte Handlungskompetenzen und motivationale Faktoren in den Mittelpunkt. Den Teilnehmern sollen Strategien und Fertigkeiten zur Verfügung gestellt werden, um informierte Entscheidungen und Selbstmanagement hinsichtlich Gesundheit und Lebensstil vornehmen zu können. Entsprechend hat sich die Didaktik weg vom Frontalvortrag hin zu einem interaktiven, teilnehmerorientierten Vorgehen gewandelt. Metaanalysen dokumentieren, dass eine derart konzipierte Patientenschulung wirksam ist. Allerdings besteht bei der Implementierung neuartiger Programme in der Praxis noch Optimierungsbedarf. Das von der Deutschen Rentenversicherung Bund geförderte Zentrum Patientenschulung hat eine Bestandsaufnahme der Schulungspraxis vorgenommen, Qualitätskriterien für Schulungen entwickelt, eine Internetdatenbank geschaffen, in der Schulungen nutzerfreundlich präsentiert werden, und bietet vielfältige Dienstleistungen zur Optimierung der Schulungspraxis an. Am Beispiel eines innovativen Programms wird der State of the Art bei der Schulung in der medizinischen Rehabilitation vorgestellt.AbstractPatient education aims to empower rehabilitants. While patient education has, in the past, been conceived of as providing solely information, modern self-management concepts now focus on both behavioral competencies and motivational factors. Participants receive all the skills and tools necessary to make informed decisions regarding both their health and lifestyles and to actively participate in the rehabilitation process. Accordingly, didactic methods have changed from predominantly vertical lectures to more patient-oriented and interactive approaches. Meta-analyses have proven that patient education is effective in improving the chronic conditions of patients. However, the implementation of modern concepts into routine care is still suboptimal. The Center of Patient Education, funded by the German Statutory Pension Insurance, has performed a survey of the present state of patient education within medical rehabilitation programs in Germany. Furthermore, quality criteria for patient education have been developed, an internet database presenting self-management programs in a systematic manner has been created, and various services designed to improve educational practice are being offered by the Center of Patient Education. Lastly, a state-of-the-art, self-management education program is described.

Konstruktion eines Verfahrens zur Erfassung der Motivation zu Entspannungsübungen

Zusammenfassung. Entspannungskurse stellen eine weit verbreitete Masnahme in der stationaren Rehabilitation dar. Die Motivation der Rehabilitanden, Entspannungsubungen zu erlernen und diese langfristig auszuuben, ist allerdings nicht bekannt und es liegen keine Instrumente zu ihrer Erfassung vor. Daher wurde die Motivation zur Verhaltensanderung uber die Konstrukte des Transtheoretischen Modells (Stufen der Verhaltensanderung, Selbstwirksamkeitserwartung, Entscheidungsbalance) fur das Zielverhalten “Entspannungsubungen“ operationalisiert. Zusammenhange zwischen den Konstrukten wurden in einer Querschnittstudie an einer Stichprobe von N = 138 Rehabilitanden (50.7% Manner) uberpruft. Dabei zeigte sich, dass die Patienten unterschiedliche Motivationslagen aufweisen. Die Skala zur Selbstwirksamkeitserwartung erwies sich erwartungsgemas als eindimensional mit guter interner Konsistenz. Fur die Items zur Entscheidungsbalance konnten zwei Subskalen gebildet werden, die jeweils ausreichende Gutekriterien aufweise...

Innovative Schulungskonzepte in der medizinischen Rehabilitation@@@Innovative concepts for patient education in medical rehabilitation

Patient education aims to empower rehabilitants. While patient education has, in the past, been conceived of as providing solely information, modern self-management concepts now focus on both behavioral competencies and motivational factors. Participants receive all the skills and tools necessary to make informed decisions regarding both their health and lifestyles and to actively participate in the rehabilitation process. Accordingly, didactic methods have changed from predominantly vertical lectures to more patient-oriented and interactive approaches. Meta-analyses have proven that patient education is effective in improving the chronic conditions of patients. However, the implementation of modern concepts into routine care is still suboptimal. The Center of Patient Education, funded by the German Statutory Pension Insurance, has performed a survey of the present state of patient education within medical rehabilitation programs in Germany. Furthermore, quality criteria for patient education have been developed, an internet database presenting self-management programs in a systematic manner has been created, and various services designed to improve educational practice are being offered by the Center of Patient Education. Lastly, a state-of-the-art, self-management education program is described.ZusammenfassungModerne Patientenschulung dient dem Empowerment von Rehabilitanden. Während traditionellerweise unter Schulung meist Wissensvermittlung verstanden wurde, stellen aktuelle Konzepte Handlungskompetenzen und motivationale Faktoren in den Mittelpunkt. Den Teilnehmern sollen Strategien und Fertigkeiten zur Verfügung gestellt werden, um informierte Entscheidungen und Selbstmanagement hinsichtlich Gesundheit und Lebensstil vornehmen zu können. Entsprechend hat sich die Didaktik weg vom Frontalvortrag hin zu einem interaktiven, teilnehmerorientierten Vorgehen gewandelt. Metaanalysen dokumentieren, dass eine derart konzipierte Patientenschulung wirksam ist. Allerdings besteht bei der Implementierung neuartiger Programme in der Praxis noch Optimierungsbedarf. Das von der Deutschen Rentenversicherung Bund geförderte Zentrum Patientenschulung hat eine Bestandsaufnahme der Schulungspraxis vorgenommen, Qualitätskriterien für Schulungen entwickelt, eine Internetdatenbank geschaffen, in der Schulungen nutzerfreundlich präsentiert werden, und bietet vielfältige Dienstleistungen zur Optimierung der Schulungspraxis an. Am Beispiel eines innovativen Programms wird der State of the Art bei der Schulung in der medizinischen Rehabilitation vorgestellt.AbstractPatient education aims to empower rehabilitants. While patient education has, in the past, been conceived of as providing solely information, modern self-management concepts now focus on both behavioral competencies and motivational factors. Participants receive all the skills and tools necessary to make informed decisions regarding both their health and lifestyles and to actively participate in the rehabilitation process. Accordingly, didactic methods have changed from predominantly vertical lectures to more patient-oriented and interactive approaches. Meta-analyses have proven that patient education is effective in improving the chronic conditions of patients. However, the implementation of modern concepts into routine care is still suboptimal. The Center of Patient Education, funded by the German Statutory Pension Insurance, has performed a survey of the present state of patient education within medical rehabilitation programs in Germany. Furthermore, quality criteria for patient education have been developed, an internet database presenting self-management programs in a systematic manner has been created, and various services designed to improve educational practice are being offered by the Center of Patient Education. Lastly, a state-of-the-art, self-management education program is described.

Wirksamkeitsprüfung rheumatologischer Schulungen@@@Evaluation of effectiveness of education in rheumatology: Empfehlungen nach einem Wirkmodell der Patientenschulung@@@Recommendations according to a patient education model

Patient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.ZusammenfassungPatientenschulungen in der Rheumatologie sollten evidenzbasiert sein. Laut Empfehlungen der European League Against Rheumatism (EULAR) sollten sich die Zielgrößen der Evaluation an den Zielen der jeweiligen Schulung orientieren. In Deutschland wurden für alle relevanten rheumatologischen Indikationen Schulungsziele beschrieben, Schulungsprogramme publiziert und evaluiert. Zur Wirksamkeitsprüfung sollten proximale und distale Zielgrößen herangezogen werden, die in unserem „Wirkmodell der Patientenschulung“ dargestellt werden. Proximale Zielgrößen sind Gesundheitskompetenzen (Wissen, Fertigkeiten, Einstellungen, Motivation) und Empowerment. Diese können direkt durch die Schulungselemente beeinflusst werden. Distale Zielgrößen sind Selbstmanagement (Gesundheitsverhalten, Adhärenz, Krankheitsbewältigung, Emotionsregulation), Morbidität, Funktionsfähigkeit, Lebensqualität und Teilhabe. Letztere werden durch proximale Zielgrößen und eine Reihe von person- und umweltbezogenen Faktoren beeinflusst. Ergebnisse einer Literaturrecherche fassen geeignete Messinstrumente zur Erfassung dieser Zielgrößen zusammen. Für distale Zielgrößen gibt es für einige rheumatologische Indikationen valide Fragebogeninstrumente in deutscher Sprache. Zur Erfassung proximaler Zielgrößen gibt es noch Entwicklungsbedarf. Wir empfehlen, bei der Evaluation von Patientenschulungen proximale und distale Zielgrößen nach dem Wirkmodell auszuwählen und die Wirkzusammenhänge zwischen den Zielgrößen zu überprüfen.AbstractPatient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.

Wirksamkeitsprüfung rheumatologischer Schulungen

Patient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.ZusammenfassungPatientenschulungen in der Rheumatologie sollten evidenzbasiert sein. Laut Empfehlungen der European League Against Rheumatism (EULAR) sollten sich die Zielgrößen der Evaluation an den Zielen der jeweiligen Schulung orientieren. In Deutschland wurden für alle relevanten rheumatologischen Indikationen Schulungsziele beschrieben, Schulungsprogramme publiziert und evaluiert. Zur Wirksamkeitsprüfung sollten proximale und distale Zielgrößen herangezogen werden, die in unserem „Wirkmodell der Patientenschulung“ dargestellt werden. Proximale Zielgrößen sind Gesundheitskompetenzen (Wissen, Fertigkeiten, Einstellungen, Motivation) und Empowerment. Diese können direkt durch die Schulungselemente beeinflusst werden. Distale Zielgrößen sind Selbstmanagement (Gesundheitsverhalten, Adhärenz, Krankheitsbewältigung, Emotionsregulation), Morbidität, Funktionsfähigkeit, Lebensqualität und Teilhabe. Letztere werden durch proximale Zielgrößen und eine Reihe von person- und umweltbezogenen Faktoren beeinflusst. Ergebnisse einer Literaturrecherche fassen geeignete Messinstrumente zur Erfassung dieser Zielgrößen zusammen. Für distale Zielgrößen gibt es für einige rheumatologische Indikationen valide Fragebogeninstrumente in deutscher Sprache. Zur Erfassung proximaler Zielgrößen gibt es noch Entwicklungsbedarf. Wir empfehlen, bei der Evaluation von Patientenschulungen proximale und distale Zielgrößen nach dem Wirkmodell auszuwählen und die Wirkzusammenhänge zwischen den Zielgrößen zu überprüfen.AbstractPatient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.

[Evaluation of effectiveness of education in rheumatology : Recommendations according to a patient education model].

Patient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.ZusammenfassungPatientenschulungen in der Rheumatologie sollten evidenzbasiert sein. Laut Empfehlungen der European League Against Rheumatism (EULAR) sollten sich die Zielgrößen der Evaluation an den Zielen der jeweiligen Schulung orientieren. In Deutschland wurden für alle relevanten rheumatologischen Indikationen Schulungsziele beschrieben, Schulungsprogramme publiziert und evaluiert. Zur Wirksamkeitsprüfung sollten proximale und distale Zielgrößen herangezogen werden, die in unserem „Wirkmodell der Patientenschulung“ dargestellt werden. Proximale Zielgrößen sind Gesundheitskompetenzen (Wissen, Fertigkeiten, Einstellungen, Motivation) und Empowerment. Diese können direkt durch die Schulungselemente beeinflusst werden. Distale Zielgrößen sind Selbstmanagement (Gesundheitsverhalten, Adhärenz, Krankheitsbewältigung, Emotionsregulation), Morbidität, Funktionsfähigkeit, Lebensqualität und Teilhabe. Letztere werden durch proximale Zielgrößen und eine Reihe von person- und umweltbezogenen Faktoren beeinflusst. Ergebnisse einer Literaturrecherche fassen geeignete Messinstrumente zur Erfassung dieser Zielgrößen zusammen. Für distale Zielgrößen gibt es für einige rheumatologische Indikationen valide Fragebogeninstrumente in deutscher Sprache. Zur Erfassung proximaler Zielgrößen gibt es noch Entwicklungsbedarf. Wir empfehlen, bei der Evaluation von Patientenschulungen proximale und distale Zielgrößen nach dem Wirkmodell auszuwählen und die Wirkzusammenhänge zwischen den Zielgrößen zu überprüfen.AbstractPatient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.