in Projekten blättern
Angaben zum Forschungsprojekt
Rehabilitationsnachsorge - Ein 'Neues Credo' für Rehabilitationskliniken
Bezug des Projekts zur internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF):
Der bio-psycho-soziale Ansatz der ICF bildet einen konzeptionellen Bezugsrahmen für das Projekt. Die ICF ist kein ausdrücklicher Forschungsgegenstand, wird aber im Vorhaben genutzt, z.B. durch den Einsatz ICF-basierter Instrumente / Skalen zur Beschreibung von Untersuchungsvariablen, Verlaufsdokumentation, Ergebnismessung etc.
Gefördertes Projekt / Evaluation / Studie
Bundesministerium für Bildung und Forschung (BMBF)
Deutsche Rentenversicherung Bund
Theoretical Background: Due to the lack of long-term effectiveness of rehabilitation treatment and deficits, which were identified in reviews of aftercare recommendations as well as the actual practice of aftercare in Germany post-rehabilitation support and aftercare became more and more important in medical rehabilitation, research, and practice. In light of these findings a new aftercare strategy, named "New Credo was developed by an interdisciplinary group of health professionals and scientists (Deck et al. 2009). Main objective of "New Credo is the resumption and maintenance of regular physical activity for the rehabilitants in everyday life.
Goal: The aim of our study was to evaluate the short-term and long-term (12-month-follow-up) efficacy of the "New Credo (inpatient medical rehabilitation funded by German statutory pension insurance and intensified aftercare = IG) as compared with usual care (inpatient medical rehabilitation funded by German statutory pension insurance and usual aftercare = CG) for patients with chronic back pain.
Methods: In a multicenter, controlled trial all patients with a primary diagnosis of chronic back pain (M51-M54) who had given their consent were included. Exclusion criteria were cognitive, mental and/ or psychological impairments as well as surgery in the last 6 month. Three IG-Clinics implemented the "New Credo in accordance with their local conditions. During the study period an employee of the clinic (funded by the research project) was responsible for managing aftercare activities for patients. Measurements were performed at the beginning (T0) and at the end (T1) of inpatient rehabilitation as well as 12 month after discharge (T2). Primary Outcomes included restriction of social participation and functional capacity (FFbH-R, Kohlmann & Raspe 1996; IMET, Deck et al. 2007), also disability days (Korff et al. 1992). Physical activity, return to work (SPE, Mittag & Raspe 2003) and different health-related variables (such as SF-36: Vitality, Bullinger & Kirchberger 1998) were defined as secondary outcomes.
Nonreponse- and drop-out-analyses were carried out by group comparisons using t-tests for continuous variables and chi-squared-tests for categorical variables. Treatment effects were evaluated using analyses of variance adjusted for baseline values, furthermore we calculated effect sizes (Intergroup-effects and Intragroup-effects).
Results: Complete data were available for 166 IG-rehabilitants and 368 CG-participants (Completer-Analysis, participation-rate: 65%, drop-out-rate: 29%). As expected, short-term results have not shown significant differences between the groups. Regarding primary and secondary outcomes all participants achieved significant moderate to high effects but participants of the intervention group reported a higher use of treatment offerings and felt that they are better prepared for time after discharge. With respect to long-term results significant medium treatment effects were observed among 2 primary outcomes (functional capacity, social participation) in favour of the IG. In addition small-to-medium effects were also observed among all the secondary parameters.
Conclusion: Results of our study confirm that the "New Credo is able to improve longer-term effectiveness of inpatient orthopaedic rehabilitation up to one year. Recommendation for dissemination within German rehabilitation care can be given but there is as well a need for further studies.