Manuela Glattacker

Illness beliefs, treatment beliefs and information needs as starting points for patient information—Evaluation of an intervention for patients with chronic back pain

OBJECTIVE The objective of the study was to evaluate an intervention which applied the extended Common Sense Model to the provision of information about illness and treatment during inpatient rehabilitation for patients with chronic back pain. METHODS The intervention was evaluated in a sequential control group design (control group N=105; intervention group N=96). Changes with respect to illness and treatment beliefs, satisfaction with information, and health status at the end of rehabilitation were selected as outcome measures. Analyses of covariance were used to assess differences between control and intervention group. RESULTS Significant time-by-group interactions were shown for causal beliefs, personal control, satisfaction with information about illness and rehabilitation, and for general health. All time-by-group interactions indicated superiority of the intervention group. CONCLUSION The intervention group assessed their back pain as personally controllable and their information needs at the end of rehabilitation as being met to a greater extent than did patients who received care as usual. PRACTICE IMPLICATIONS The extended Common Sense Model seems promising as a frame for discussing illness and treatment perceptions as well as information needs in patients with chronic back pain.

Die deutschsprachige Version des Illness Perception Questionnaire-Revised

Zusammenfassung. Ziel der Studie war es, die deutschsprachige Version des Illness Perception Questionnaire-Revised (IPQ-R) psychometrisch zu evaluieren. Hierbei wurden die faktorielle Validitat, Konstruktvaliditat und konkurrente Kriteriumsvaliditat bestimmt sowie die interne Konsistenz und Test-Retest-Reliabilitat analysiert. Die Mehrzahl der Analysen wurden in einer Querschnittsstudie an N = 817 Patienten aus sechs Rehabilitationskliniken durchgefuhrt. Die Prufung der konkurrenten Kriteriumsvaliditat erfolgte an einer Teilstichprobe dieser Patienten in Kontrastierung zu einer Stichprobe von N = 58 Akutpatienten. Die Test-Retest-Reliabilitat wurde anhand einer Stichprobe von N = 45 Patienten aus zwei Rehabilitationskliniken ermittelt. Die faktorielle Struktur des Original-Fragebogens kann insgesamt bestatigt werden. Die Cronbachs Alpha-Koeffizienten liegen mit Werten zwischen .70 und .87 in einem befriedigend bis guten Bereich, lediglich die Skala „Behandlungskontrolle” weist mit einem α von .58 einen in...

Validity and reliability of the German version of the 9-item European Heart Failure Self-care Behaviour Scale

Background: The promotion of self-care in patients with heart failure (HF) is a promising strategy for maintaining health and preventing exacerbation of HF and a continuous need for healthcare services. To assess patient self-care, valid and reliable instruments are needed, but there is no psychometrically tested instrument for use in a German HF population. Aim: The aim of this study was to determine the validity and reliability of the German version of the 9-item European Heart Failure Self-care Behaviour Scale (G9-EHFScBS). Construct validity including factor analysis and discriminant validity, concurrent validity, test–retest reliability and internal consistency were analysed. Methods and results: The G9-EHFScBS was translated into German, and its validity and reliability were tested with 109 patients. The item-total correlation ranged from 0.09 to 0.63. Internal consistency was fair, with a Cronbach’s alpha of 0.71 (95%CI: 0.63 to 0.77). Test–retest reliability using an intra-class correlation coefficient showed substantial agreement for the entire scale (ICC: 0.69; 95%CI: 0.56 to 0.79). The G9-EHFScBS was able to distinguish patients with and without extra HF education at a statistically significant level (t = 2.105; p = 0.04). A factor analysis did not show the theoretical assumed dimensions of the scale. Conclusion: The G9-EHFScBS is deemed a valid and reliable instrument to assess HF-specific self-care in a German HF population.

Illness beliefs and treatment beliefs as predictors of short and middle term outcome in depression

The article investigates whether illness beliefs and beliefs about rehabilitation are predictors of short and middle term outcome in depression even when adjustments are made for variables, which are known to be predictors of the course of depression. Within the context of a non-controlled prospective study design, data were analyzed using forced entry hierarchical multiple regression analyses. The sample comprised N = 98 patients. Adjusting for a range of sociodemographic and medical predictors, illness beliefs and beliefs about rehabilitation predict outcome in depression. Illness beliefs and beliefs about rehabilitation are relevant starting points for designing patient-oriented interventions.

Psychometric Properties of a German Translation of the PROMIS® Depression Item Bank

The patient-reported outcome measurement information system (PROMIS®) initiative has developed and evaluated a set of publicly available, efficient, and flexible measures of patient-reported outcomes in different health domains, including mental health. The objective of this study was to translate the PROMIS Depression item bank into German and evaluate the psychometric properties of the translated items. Items were translated using forward and backward translation and cognitive interviews. Distribution characteristics, unidimensionality, Rasch model fit, reliability, construct validity, and internal responsiveness were investigated in a sample of 234 patients in in-patient psychosomatic rehabilitation centers in Germany. The translated items showed good psychometric properties, the distribution characteristics were satisfactory, and the sufficient unidimensionality was obtained by fitting a bifactor model. The construct validity was demonstrated, and it was reliable and was shown to detect clinically significant changes. The translated items can be recommended for the assessment of depression. Future studies should examine the generalizability of the results.

Development and Psychometric Evaluation of a German Version of the PROMIS® Item Banks for Satisfaction With Participation

The Patient Reported Outcomes Measurement Information System (PROMIS) initiative aims to provide reliable and precise item banks measuring patient-reported outcomes in different health domains. The aim of the present work was to provide a German translation of the PROMIS item banks for satisfaction with participation and to psychometrically test these German versions. Cognitive interviews followed a forward–backward translation. Distribution characteristics, unidimensionality, Rasch model fit, reliability, construct validity, and internal responsiveness were tested in 262 patients with chronic low back pain undergoing rehabilitation. Results for the final 13- and 10-item German static scales (Satisfaction with Participation in Social Roles–German version [PSR-G] and Satisfaction for Participation in Discretionary Social Activities–German version [PSA-G]) regarding unidimensionality were satisfactory. The scales are reliable and show good Rasch model fit and distribution characteristics. Both scales are sensitive to small to moderate clinical changes, and we observed initial proof of construct validity. These German versions of the Satisfaction with Participation scales can be recommended to assess participation in a clinical context. The scales’ applicability in other contexts should be examined.

Leitlinien und Leitlinienforschung

ZusammenfassungDer vorliegende Beitrag befasst sich mit Leitlinien und Leitlinienforschung. Letztere wird hier als der Teil der Versorgungsforschung verstanden, der sich mit der Methodik und Evaluation von Prozessen der Leitlinienentwicklung, -implementierung, -bewertung und -evaluation befasst, also zum Beispiel mit der Wahl adäquater Implementierungsstrategien und dem Nachweis der Effektivität und Effizienz der Leitlinienimplementierung. Die aktuelle Datenlage lässt keine belastbare Aussage darüber zu, ob und inwiefern durch Leitlinienumsetzungen tatsächlich das gesundheitsbezogene Ergebnis bei Patienten verbessert wird. Für die medizinische Rehabilitation existiert eine Reihe von Leitlinien, die hinsichtlich der inhaltlichen Qualität (zum Beispiel Evidenzbasis) den akutmedizinischen Leitlinien nicht nachzustehen scheinen. Allerdings besteht bei den methodischen Gütekriterien Verbesserungsbedarf. Reha-bezogene Leitlinien und Therapiestandards lassen sich in den AWMF-Leitlinien, im Programm für Nationale VersorgungsLeitlinien und im Reha-Leitlinienprogramm der Deutschen Rentenversicherung finden. Leitlinienforschung in der Rehabilitation sollte sich auf Themen konzentrieren, die sich aus den Spezifika dieses Versorgungsbereichs ergeben: zum Beispiel Gestaltung berufsgruppenübergreifender Leitlinien, Anwendbarkeit von Leitlinien bei multiplen Erkrankungen, Möglichkeit der Evidenzbasierung von Leitlinien bei komplexen Interventionen.Abstract“Guideline research” is understood here to be the area of healthcare research that deals with the methodology and evaluation of processes for developing, implementing, assessing, and evaluating guidelines. For example, guideline research deals with the selection of adequate implementation strategies and the proof of the effectiveness and efficiency of the implementation of guidelines. The current data situation does not allow any reliable statements to be made about whether and to what extent the health-related outcome for patients is actually improved by implementing guidelines. For medical rehabilitation, there are a number of guidelines which appear to be just as good with respect to quality as the guidelines for acute medicine. However, there is a need for improvement in the quality criteria for methods. Rehab-related guidelines and therapy standards can be found in the AWMF guidelines, in the program for national healthcare guidelines, and in the rehabilitation quality assurance of the German Pension Fund. Guideline research in rehabilitation should concentrate on topics that arise from the specific situation of this area of healthcare, e.g., development of interdisciplinary guidelines, applicability of guidelines for multiple diseases, or possibility of evidence-based guidelines for complex interventions.

Strukturqualität stationärer neurologischer Rehabilitationskliniken : Ergebnisse aus dem QS-Reha-Verfahren auf der Basis definierter Bewertungskriterien

ZusammenfassungHintergrund und FragestellungSeit 2003 liegen trägerübergreifende Anforderungen an die Strukturqualität stationärer Rehabilitationseinrichtungen vor. Im vorliegenden Beitrag werden die anhand dieser Bewertungskriterien ermittelten Ergebnisse der Strukturqualität in neurologischen Rehabilitationskliniken vorgestellt und die Anwendbarkeit der Bewertungskriterien geprüft.MethodenDie Prüfung der Strukturqualität erfolgte im Rahmen des Qualitätssicherungsprogramms der Gesetzlichen Krankenkassen in der medizinischen Rehabilitation in bundesweit 18 stationären neurologischen Rehabilitationskliniken.ErgebnisseDurchschnittlich werden 93,9% der geforderten Basiskriterien erfüllt. Klinikvergleichende Analysen zeigen, dass trotz dieses insgesamt hohen Erfüllungsgrades eine zum Teil deutliche Variabilität in der Erfüllung der Basiskriterien abbildbar ist. Die Basiskriterien geben basale Qualitätsanforderungen wieder, die realistisch sind, ohne Klinikunterschiede zu nivellieren.SchlussfolgerungAuf der Basis definierter Sollwerte ermöglicht eine kriterienorientierte Strukturbewertung Aussagen im Sinne eines Benchmarkings und gibt Hinweise für eine klinikspezifische Qualitätsverbesserung.SummaryBackgroundIn 2003, criteria for assessing the structural quality of rehabilitation units for inpatient treatment were developed in cooperation with the German statutory pension insurance and health insurance. The aim of this study was to assess this quality using predefined valuation criteria and to test their applicability.MethodsIn the context of the Quality Assurance Programme for Rehabilitation provided by the German statutory health insurance, the structural quality of 18 neurological rehabilitation units was assessed applying the criteria for the first time.ResultsOn average, the 18 rehabilitation units fulfilled 93.9% of the basic criteria. Despite this high proportion, variability in the degree of realisation in the individual rehabilitation units could be demonstrated. The basic criteria are realistic in respect to the structural requirements, without leveling out the differences between the centres.ConclusionAssessing the structural quality of rehabilitation units on the basis of defined standards allows for a benchmark between units as well as for improvements within the individual units.

Yellow flags as predictors of rehabilitation outcome in chronic low back pain.

Objective: While it is agreed that yellow flags (prognostic psychosocial factors for poor recovery in low back pain) predict pain-related outcomes, uncertainty remains regarding which constructs are the central ones, particularly as there is considerable conceptual overlap between constructs. Therefore, the aim of our study was to analyze the distinctiveness of different psychological factors in predicting rehabilitation outcomes in a sample of patients with chronic low back pain (CLBP) in a rehabilitation setting. Research Method/Design: We conducted a longitudinal study using multivariable modeling taking into account a broad set of psychological variables as potential predictors. Rehabilitation outcome was assessed via health related quality of life (HRQL) and disease-specific functioning at the end of rehabilitation and six months later. The sample comprised N = 214 patients. Results: When considered separately, a range of psychological factors were significant predictors of HRQL and functioning at the end of rehabilitation and at six months follow-up, even if baseline values of outcome variables, sociodemographic variables, and baseline pain intensity are controlled. When considered in combination, a better work prognosis, self-efficacy and intensity of depressive symptoms were verified as independently significant predictors of HRQL. None of the psychological constructs remained significant predictors for disease-specific functioning. The incremental variance explained by the psychological constructs varied between 3 and 24%. Conclusions: The contribution of psychological factors may be different depending on the sample (acute vs. chronic) and the outcome domain. Future research should validate these results with respect to other patient-centered outcomes and in other CLBP samples.

Guidelines and guideline research. Overview and state of guideline implementation in medical rehabilitation

ZusammenfassungDer vorliegende Beitrag befasst sich mit Leitlinien und Leitlinienforschung. Letztere wird hier als der Teil der Versorgungsforschung verstanden, der sich mit der Methodik und Evaluation von Prozessen der Leitlinienentwicklung, -implementierung, -bewertung und -evaluation befasst, also zum Beispiel mit der Wahl adäquater Implementierungsstrategien und dem Nachweis der Effektivität und Effizienz der Leitlinienimplementierung. Die aktuelle Datenlage lässt keine belastbare Aussage darüber zu, ob und inwiefern durch Leitlinienumsetzungen tatsächlich das gesundheitsbezogene Ergebnis bei Patienten verbessert wird. Für die medizinische Rehabilitation existiert eine Reihe von Leitlinien, die hinsichtlich der inhaltlichen Qualität (zum Beispiel Evidenzbasis) den akutmedizinischen Leitlinien nicht nachzustehen scheinen. Allerdings besteht bei den methodischen Gütekriterien Verbesserungsbedarf. Reha-bezogene Leitlinien und Therapiestandards lassen sich in den AWMF-Leitlinien, im Programm für Nationale VersorgungsLeitlinien und im Reha-Leitlinienprogramm der Deutschen Rentenversicherung finden. Leitlinienforschung in der Rehabilitation sollte sich auf Themen konzentrieren, die sich aus den Spezifika dieses Versorgungsbereichs ergeben: zum Beispiel Gestaltung berufsgruppenübergreifender Leitlinien, Anwendbarkeit von Leitlinien bei multiplen Erkrankungen, Möglichkeit der Evidenzbasierung von Leitlinien bei komplexen Interventionen.Abstract“Guideline research” is understood here to be the area of healthcare research that deals with the methodology and evaluation of processes for developing, implementing, assessing, and evaluating guidelines. For example, guideline research deals with the selection of adequate implementation strategies and the proof of the effectiveness and efficiency of the implementation of guidelines. The current data situation does not allow any reliable statements to be made about whether and to what extent the health-related outcome for patients is actually improved by implementing guidelines. For medical rehabilitation, there are a number of guidelines which appear to be just as good with respect to quality as the guidelines for acute medicine. However, there is a need for improvement in the quality criteria for methods. Rehab-related guidelines and therapy standards can be found in the AWMF guidelines, in the program for national healthcare guidelines, and in the rehabilitation quality assurance of the German Pension Fund. Guideline research in rehabilitation should concentrate on topics that arise from the specific situation of this area of healthcare, e.g., development of interdisciplinary guidelines, applicability of guidelines for multiple diseases, or possibility of evidence-based guidelines for complex interventions.