Inpatient Psychosomatic Rehabilitation Research Articles

Behavioral activation for depression in groups embedded in psychosomatic rehabilitation inpatient treatment: a quasi-randomized controlled study.

Behavioral activation (BA) and cognitive-behavioral therapy (CBT) have shown to be efficacious treatment methods for depression. Previous studies focused mostly on the outpatient treatment either in group or individual setting. The present study aimed at comparing the efficacy of group treatment BA vs. CBT, when embedded in inpatient psychosomatic rehabilitation treatment. 375 inpatients were randomly assigned to either BA (N = 174) or CBT (N = 201). We used established scales for depression such as the Beck Depression Inventory II (BDI-II, self-rating), the Quick Inventory of Depressive Symptomatology (QIDS; expert rating) and the Behavioral Activation for Depression Scale (BADS) to assess changes over the course of the treatment and at follow-up (4 to 6 months). In addition, we measured disability-related functioning with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). Multilevel models with repeated measures were conducted to examine the differences between groups in relation to change over time with patients' random effects. Both group formats showed substantial reduction in depressive symptoms at the end of treatment (d= 0.83 BA vs. d= 1.08 CBT; BDI-II) and at follow-up after 4 to 6 months (d = 0.97 BA vs. d = 1.33 CBT, BDI-II; and d = 1.17 BA vs. d = 1.09 CBT, QIDS). There were no significant differences between treatment approaches. At least 50% symptom reduction was achieved by 53.7% and 54.2% in BA vs. CBT respectively. Reported activation levels increased from pre- to posttreatment (d = 0.76 BA vs. d = 0.70CBT), while showing loss of increment between the end of the treatment until follow up in both formats (d = 0.28 BA vs. d = 0.29 CBT). Both modalities led to significant improvement of symptomatology and functioning at the end of the treatment and at follow-up, thus for the first time demonstrating the practicability of BA in rehabilitation clinics. Considering its lower requirements regarding cognitive abilities and its easier implementation, BA proved to be a good alternative to other psychotherapeutic treatments.

Mentalizing and epistemic trust as critical success factors in psychosomatic rehabilitation: results of a single center longitudinal observational study.

Inpatient psychosomatic rehabilitation is a key treatment for patients with mental health issues. However, knowledge about critical success factors for beneficial treatment outcomes is scarce. The aim of this study was to evaluate the association of mentalizing and epistemic trust with the improvement of psychological distress during rehabilitation. In this naturalistic longitudinal observational study, patients completed routine assessments of psychological distress (BSI), health-related quality of life (HRQOL; WHODAS), mentalizing (MZQ), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Repeated measures ANOVA (rANOVAs) and structural equation models (SEMs) were calculated to investigate the association of mentalizing and epistemic trust with the improvement in psychological distress. A total sample of n = 249 patients were included in the study. Improvement in mentalizing was correlated with improvement in depression (r = 0.36), anxiety (r = 0.46), and somatization (r = 0.23), as well as improved cognition (r = 0.36), social functioning (r = 0.33), and social participation (r = 0.48; all p < 0.001). Mentalizing partially mediated changes in psychological distress between T1 and T2: the direct association decreased from β = 0.69 to β = 0.57 and the explained variance increased from 47 to 61%. Decreases in epistemic mistrust (β = 0.42, 0.18-0.28; p < 0.001) and epistemic credulity (β = 0.19, 0.29-0.38; p < 0.001) and increases in epistemic trust (β = 0.42, 0.18-0.28; p < 0.001) significantly predicted improved mentalizing. A good model fit was found (χ2 = 3.248, p = 0.66; CFI = 0.99; TLI = 0.99; RMSEA = 0.000). Mentalizing was identified as a critical success factor in psychosomatic inpatient rehabilitation. A key component to increase mentalizing in this treatment context is the improvement of epistemic mistrust.

Psychometric properties of the rehabilitation treatment beliefs questionnaire for psychosomatic rehabilitation

Purpose Treatment beliefs play a crucial role for patient satisfaction and the treatment outcome in psychosomatic rehabilitation. The aim of this study was the development and the psychometric evaluation of an indication-specific questionnaire of beliefs about psychosomatic rehabilitation. Materials and methods The study was conducted at a psychosomatic rehabilitation clinic. The primary item list comprised k = 125 items. After a descriptive item analysis, we conducted an exploratory factor analysis. Furthermore, we tested reliability via McDonald’s Omega and construct validity by analyzing correlations of the scales with related constructs. Results Of the N = 264 participants, 50% were female and the mean age was 50.4 (SD = 9.8) years. K = 85 items were suitable for factor analysis, which resulted in k = 30 items constituting six scales, explaining of 57% the overall variance. The corrected item-total correlations were between r = 0.48 and r = 0.83. Internal consistency ranged from ω = 0.81 to ω = 0.86. Conclusion The newly developed questionnaire assesses specific treatment beliefs about inpatient psychosomatic rehabilitation. The psychometric properties of the six scales are acceptable. Further studies should confirm the psychometric results, such as the factorial structure of the questionnaire. IMPLICATIONS FOR REHABILITATION Treatment beliefs are known to play an important role for the adherence, therapy outcome and satisfaction in psychosomatic rehabilitation. We developed and tested a indication-specific questionnaire assessing treatment beliefs in psychosomatic rehabilitation. The questionnaire can be used to explore patient’s rehabilitation-related treatment beliefs, predict treatment outcomes, and to develop interventions attempting to modify these.

Effectiveness of the Internet-Based, Job-Related Aftercare GSA-Online Following Inpatient Psychosomatic Rehabilitation: Results of a Randomized Controlled Trial

In order to sustain the treatment results of medical rehabilitation in the long term and to support the transfer of learned strategies into everyday life, outpatient aftercare is often indicated. This is especially true for psychosomatic rehabilitation patients with occupational stress, for whom reintegration into working life is a particular challenge. Since access to care services close to home is limited, internet-based aftercare interventions offer the possibility of timely and flexible aftercare tailored to the patient's needs. In a randomized controlled trial, the internet-based job-related aftercare GSA-Online proved to be effective across indications with regard to job-related and health-related outcome criteria. The aim of the present study is to examine these outcome criteria in a subsample of patients undergoing inpatient psychosomatic rehabilitation. Occupationally stressed rehabilitation inpatients were assigned to the intervention (IG) or control group (CG) by means of cluster randomization after meeting the inclusion criteria and participating an inpatient vocational stress management training. After discharge from rehabilitation, patients in the IG were given access to GSA-Online for twelve weeks. In the intervention, maladaptive social interactions in the workplace were identified with the help of self-written blog posts and addressed with the help of therapeutic comments. The active CG received access to selected online information on health-promoting behaviors. Target measures included subjective prognosis of gainful employment (SPE), depressiveness (PHQ-9), and anxiety (GAD-7). Self-report measures were assessed at the end of aftercare and at follow-up (twelve months after the end of rehabilitation). Missing values were replaced using multiple imputation. Ninety-one percent of the IG (N=89) and 70% of the CG (N=106) logged on to the website at least once. There were no group differences in the subjective prognosis of gainful employment at the end of aftercare but a trend toward more optimistic scores in the IG at follow-up. Significantly lower psychological distress was observed in the IG, especially with regard to anxiety (at both measuring points) but also with regard to depressive symptoms (follow-up) and experience of stress (end of intervention). In the subsample of psychosomatic rehabilitation, the internet-based, job-related aftercare GSA-Online led to a significant reduction in psychological symptoms. Regarding the subjective prognosis of gainful employment, there was at least a trend in favor of IG. A larger sample is needed to more closely examine the results of this exploratory evaluation. Additionally measures to increase adherence in the IG should be explored.

Telephone-based aftercare groups for family carers of people with dementia \u2013 results of the effect evaluation of a randomised controlled trial

BackgroundThe care of people with dementia is associated with enormous stress and, in a quarter of cases, leads to depression and anxiety disorders in the caring relatives. A specially designed inpatient psychosomatic rehabilitation (rehab) programme for family carers of people with dementia has proven to be effective but not sustainable. Therefore, the present study aims to increase the sustainability of the inpatient rehab programme by using thematically structured telephone aftercare group sessions.MethodsThe effectiveness of telephone aftercare groups was investigated in a randomized, controlled, prospective, mixed methods, longitudinal study. The aftercare intervention included social participation in monthly telephone group sessions for 6 months. The primary outcome was increased social participation of family carers, which, like the secondary outcomes (such as quality of life and subjective health), was assessed in written surveys at three or four measurement points.ResultsComplete data from 69 participants from the intervention group and from 72 participants from the control group could be evaluated. A small-sized reduction in restrictions on social participation was observed in the intervention group, whereas the reduction in the control group was negligible. The repeated-measures analysis of variance (ANOVA) showed sustained effects on the secondary outcomes, such as depression, perceived social support, and the mental health domain of quality of life of family carers, in favour of the intervention group. The results also showed that telephone-based aftercare groups had a rather minor influence on the use of support services. Except for those from family, friends and neighbours, existing support offers were hardly used.ConclusionTelephone aftercare group sessions for carers of people with dementia were not able to increase social participation at the expected magnitude. Nevertheless, the clear effects on selected secondary health-related outcomes and the assessment of the telephone-based group sessions by the participants show that the caring relatives were able to benefit greatly from this aftercare measure. Family carers should be informed more extensively about the corresponding resources and encouraged to use them. Overall, this new aftercare concept can be recommended for implementation, and its use also seems to be target-oriented for other indications.Clinical trial registrationGerman Clinical Trials Register: DRKS00013736, 14/05/2018.

Treatment Beliefs in Patients with Mental Disorders in Psychosomatic Rehabilitation

Abstract. Background: The efficacy of inpatient psychosomatic rehabilitation in Germany can be considered proven. However, a significant number of patients with mental disorders remain unsatisfied with rehabilitation or being non-responders. Illness beliefs, as the core element of the Common-Sense Model of Self-Regulation (CSM), are widely known as predictors of various health outcomes. Yet, little is known about treatment beliefs as an extension of the CSM and their impact on health outcomes. Aim: As treatment beliefs differ in relation to the treatment, this study aimed to explore rehabilitation-related treatment beliefs in psychosomatic rehabilitation patients with mental disorders before inpatient admission. Thus, knowledge of the concept of rehabilitation-related treatment beliefs will be added. Methods: N = 10 semi-structured telephone interviews were conducted in September/October 2018. A purposive sampling approach was chosen based on the criteria gender, age, and diagnosis. Participants were asked about their rehabilitation expectations starting with an open narrative question. Interviews were analyzed using qualitative content analysis. Results: Participants had a mean age of 48.3 years ( SD = 9.42); five participants were female and five male. 9 main themes with 32 subthemes as components of the rehabilitation-related treatment beliefs were identified: reasons for rehabilitation, conditions within the clinic, rehabilitation planning, organization of the rehabilitation, the content of the rehabilitation, results of the rehabilitation, concerns, expectations toward one’s behavior, and contact to other patients. Limitation: Our sample was too small to analyze the data for different subgroups. Conclusion: Results show that rehabilitation-related treatment beliefs are multidimensional, addressing different aspects of psychosomatic rehabilitation.

Pushing occupational rehabilitation \u2013 implementation of a therapy diary in the outpatient aftercare of psychosomatic rehabilitation may promote the occupational reintegration process: a survey of therapists and patients

BackgroundTreatment results achieved after fulfilling an inpatient psychosomatic rehabilitation are often not permanent. Additional participation in outpatient rehabilitation aftercare may reduce the risk of recurrent disorders and support a successful reentry to working life. A therapy diary should accompany the aftercare and bring about the self-reflection process of psychosomatic rehabilitates, which could reduce recurrent disease progressions and support the recovery process as a whole. The study focuses on the evaluation of the effectiveness and implementation potentialities of a therapy diary in outpatient rehabilitation aftercare.MethodsIn a qualitative study, seven therapists for outpatient rehabilitation aftercare in Central Germany and eleven outpatient psychosomatic rehabilitation patients were interrogated using partially standardized, guideline-based expert interviews.The data evaluation is based on the Qualitative Content Analysis according to Mayring.ResultsThe results show that an accompanying use of a therapy diary during the outpatient rehabilitation aftercare enables an intense commitment through own thoughts and feelings. By writing down thoughts, emotions, dysfunctional behaviors in problematic situations, great successes are experienced. Through this initiated self-reflection process, the rehabilitant gains a better knowledge of one’s behavior in dealing with oneself and the environment and thereby, whenever necessary, learns to create new ways of acting.ConclusionsThe voluntary use of the therapy diary in the outpatient rehabilitation aftercare could assist the therapy process and henceforward the recovery of the rehabilitants, and also increase the prospect of successful occupational rehabilitation.

Psychosomatic Rehabilitation: An Overview

Psychosomatic Rehabilitation: An Overview Abstract. Psychosomatic Medicine is based on the shared understanding that physical illnesses can have a multi-factorial aetiology, whereby biological, psychological and social factors interact to cause and maintain physical and mental symptoms and complaints. Commonly implicated aetiological factors in psychosomatic disorders are physical and / or psychological stress, inflammation and degeneration, and the resulting symptoms can manifest themselves in different organ systems, such as: the nervous system, the musculoskeletal system, the cardiovascular system, the respiratory system, the gastrointestinal system and the skin. In order to create a model of psychosomatic symptoms that would allow for a systematic classification of psychosomatic disorders, the Diagnostic Criteria for Psychosomatic Research (DCPR) were developed in 1995. Given that biological, psychological and social factors can interact to cause and maintain physical and mental symptoms and complaints, psychosomatic therapies and rehabilitation are usually provided in multidisciplinary settings, where professionals from different disciplines (physicians, psychologists, osteopaths, physiotherapists and occupational therapists) work as a team. If no interdisciplinary treatment and process organisation close to the patient's home is available for an outpatient setting, psychosomatic rehabilitation is usually carried out in an inpatient setting. The rehabilitation process is organised in several steps: Assessment (1); Conceptualisation (2); Goal planning (3); Interdisciplinary rehabilitation (4); Re-assessment (5); Discharge planning. The clinical effectiveness of inpatient psychosomatic rehabilitation has been documented in several Austrian and German studies. Following discharge, the patient is usually offered a continuation of the rehabilitation as an outpatient.

Indication for Inpatient Psychosomatic Rehabilitation in Primary Care Patients with Chronic Mental Disorders and Participation Impairments

Mental disorders often result in social and occupational participation restrictions, which may be an indication for an inpatient psychosomatic rehabilitation treatment. These patients are usually treated by general practitioners, who function as an important gate keeper in the pathway to rehabilitation treatment. The question is which patients receive an inpatient treatment, and which do not. A prototypically representative sample of 307 patients with chronic mental disorders from 40 general practitioners were examined by a psychosomatic consultant. The investigation included the medical history, treatment status, illness status, capacity status and participation impairment. The psychosomatic consultant gave a recommendation whether an inpatient rehabilitation was indicated or not. 64% of the patients with chronic mental disorder had not received an inpatient rehabilitation in the past 5 years and there was no present indication. In 5.2% of cases an inpatient rehabilitation had been done before, but there was no indication for a renewal. In 27% there was no rehabilitation in the past five years but now seen indicated. In 3.6% there was an inpatient rehabilitation in the past and a renewed indication now. Patients who had already been in inpatient rehabilitation in the past 5 years were more severely ill and had more severe participation problems. Patients with present indication for rehabilitation had acute work-related problems. Capacity and participation impairment was an important factor to discriminate between patients with and without a present indication for an inpatient rehabilitation. In 13 out of 35 patients who got a recommendation for a new psychosomatic rehabilitation, this rehabilitation was initiated within 6 months after the consult. General practitioners play a central role in long-term treatment of mental disorders. Rehabilitation orientation, i. e. a participation-oriented treatment perspective, should be encouraged in the primary care setting.

Rehabilitants' Expectations and Informational Needs Concerning Inpatient Psychosomatic Rehabilitation - Results of a Qualitative Analysis

In order to develop an online portal for the preparation for inpatient psychosomatic rehabilitation, information requirements as well as the online use behavior of rehabilitants were determined first. Four focus groups with rehabilitants (N=31) as well as two with the treatment team (N=18) were performed and evaluated qualitatively. A total of 419 statements by rehabilitants and 333 statements by the treatment team were coded and assigned to categories. Current information materials on rehabilitation have been regarded as too extensive and difficult to understand by rehabilitants. They were uncertain regarding the effectiveness and sustainability of the treatment. While practitioners assumed that rehabilitants expect wellness and relaxation during rehabilitation, rehabilitants themselves reported more of an active treatment orientation. Online portals for preparation should address the effectiveness and sustainability of psychosomatic rehabilitation by means of illustrative case studies.

Change of Symptom Severity and Functioning According to ICF in the In-Patient Psychosomatic Rehabilitation

In this naturalistic study the changes of patients of an in-patient psychosomatic rehabilitation with regard to functioning and to symptom severity were examined. Self-evaluations of patients concerning their functioning (ICF AT-50 Psych) and their symptom severity (GSI) were elevated at 3 measurement periods: on admission (n=419), on discharge (n=354) and 6 months after discharge (n=297). Functioning as well as symptom severity improved from t1 to t2. With regard to functioning an improvement on global and specific scales was shown. From t2 to t3 the symptom severity increased lightly again, whereas the functioning level remained rather steady. Changes in symptom severity highly correlate with changes of functioning. The results point to the fact that psychosomatic rehabilitation has positive effects on functioning. While planning the therapy functioning as well as symptom severity should be considered. Controlled studies are needed.

Treatment Changes in General Practice Patients With Chronic Mental Disorders Following a Psychiatric-Psychosomatic Consultation.

Objective:To determine whether a psychiatric–psychosomatic consultation can identify unmet treatment needs and improve treatment of patients with mental disorders in general practice.Methods:In 40 primary care practices, 307 consecutive primary patients who met criteria for chronic mental disorders were assessed by a psychiatric–psychosomatic consultant. After random assignment, general practitioners (GPs) were informed for half of the patients about the results of the assessment and received recommendations on how to improve treatment. Changes in treatment and patient status were reevaluated after 6 months.Results:Patients were mostly having depression, adjustment, or anxiety disorders, with 28.8% on sick leave. Contact with their respective GPs was longer than a year in 77.2% of cases. Patients had already received pharmacotherapy (60.9%), psychotherapeutic counseling by GPs themselves (27.7%), psychotherapy by specialists (73.9%), psychiatric outpatient care (57%), inpatient psychiatric treatment (12.1%), inpatient psychosomatic rehabilitation (ie, specialized behavioral medicine facilities for patients with work problems; 41.4%), and a broad spectrum of other diagnostic and therapeutic measures. Newly recommended interventions included leisure activities (42%), a new specialist psychotherapy (37.5%), or inpatient psychosomatic treatment (15.3%). Most recommendations were agreed upon by the GP. Nevertheless, there was only a limited increase in therapeutic actions 6 months later, and no statistically significant improvement in the status of patients.Conclusion:General practitioners undertake a broad spectrum of therapeutic interventions in patients with chronic mental disorders. According to our results, additional psychiatric–psychosomatic consultations can intensify treatment but does not significantly change the general course of chronic mental disorders.

Changes of Motor Balance in the Course of an Inpatient Psychosomatic Rehabilitation

Aim of the study For many rehabilitants both the motor balance and the feeling of being emotionally stable and in balance are essential preconditions for participation in employment and society. The goal of this study was to capture changes in motor balance in the course of an inpatient psychosomatic rehabilitation and to set them in relation to changes in mental variables. Methods 118 patients of a psychosomatic clinic (49.3±8.6 years; 75.4 % women) were examined at the beginning and the end of rehabilitation. To measure motor balance the balance test (GGT) of Bös, Wydra and Karisch, the timed up and go test (TUG), eight tasks of standing balance on an unstable surface as well as eight tasks on a stable surface were used. As psychological variables, self-esteem (MSWS), degree of depressive (BDI-II) and anxiety symptoms (BAI) were measured. Results The motor balance ability, assessed by the GGT (d=1,37), the TUG (d=0,56), tasks of standing balance on an unstable surface (d=1,48) as well as on a stable surface (d=0.67), increased significantly in the course of rehabilitation and was also reflected in the self-evaluation of motor balance (d=0,97). Correlations in the change of motor and mental variables were particularly evident between the balance tasks on an unstable and a stable surface and different scales of the MSWS. Conclusion In the course of rehabilitation, an improvement in psychological symptoms as well as the balance ability was found, however, contrary to our expectations, no significant correlations were observed. At the first view it seems like there would be no relationship between psychological factors and the motor balance of the patients. However it should be noted that motor balance was examined in a standardized situation in which the patients were not exposed to any particular psychological distress. Observations during the conduct of the study suggest that changes in motor balance could be shown rather in observable characteristics of postural control (for example in contraction and relaxation) than in the number of fulfilled tasks. The motor balance tests were not only accepted very well by the rehabilitants but often also provoked self-reflection processes on topics such as balance and stability in a psychosomatic sense. Further research both on the factors influencing the motor balance ability as well as on their relation to the improvement in activity and participation appears promising.

The Prognostic Significance of ICF Data with Regard to Realization of Recommendations Given in the Medical Discharge Report after In-Patient Psychosomatic Rehabilitation

Target In this trial, the prognostic significance of ICF-related diagnostics compared to social and medical, disease-related and personal factors with regard to realization of recommendations given in the medical discharge report after the in-patient psychosomatic rehabilitation should be examined. Methodology ICF-related, social and medical, disease-related and personal prognostic factors were surveyed by questionnaires and interviews, on admission, discharge and 6 months after discharge from rehabilitation (time of catamnesis). As target criteria, realizations of recommendations from the fields of sports and exercise, psychotherapy and social medicine were chosen, they could be evaluated by telephone from N=344 participants at the time of catamnesis. For determination of relevant predictors, bivariate and multi-variate analyses were performed. Results 70% of patients realized the recommended sports and exercise, 45% the recommended psychotherapy and 44% a social and medical recommendation. With regard to the target criterion for the realization of recommended sports and exercise, the elevated prognostic factors had only a low prognostic value. For the prognosis of the target criterion of realizing a recommended psychotherapy, interpersonal problems and a low ability to interact in groups (Mini-ICF-APP) turned out to be relevant ICF-related predictors. Different problems (e. g., job-related conditions) appeared as relevant, ICF-related predictors concerning the realization of social and medical recommendations. Disturbances of reliability, self-evaluated by means of ICF AT-50 Psych, showed in the bivariate analyses significant correlations with the target criteria. Conclusion Besides other variables, also ICF-supported attributes turned out to be suitable for the prognosis of target criteria. They should be evaluated and considered in the rehabilitation process.

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.

Evaluation of a video-based Internet intervention as preparation for inpatient psychosomatic rehabilitation: study protocol for a randomized controlled trial.

BackgroundPatients’ treatment expectations are a key factor in psychotherapy. Several studies have linked higher expectations to better treatment success. Therefore, we want to evaluate the impact of a targeted video-based intervention on patients’ expectations and the treatment success of inpatient rehabilitation.Methods/designAll patients who will be referred to inpatient psychosomatic rehabilitation in three clinics will receive a study flyer with information about how to log in to the study platform together with the usual clinic information leaflet. Patients will receive the study information and informed consent upon login and will be randomized into the intervention or the control group. The intervention group (n = 394) will get access to our virtual online clinic, containing several videos about inpatient rehabilitation, until their admission to inpatient rehabilitation. The control group (n = 394) will receive no special treatment preparation. Questionnaires will be given at study inclusion (T0), two weeks before admission to (T1), and at the end of (T2) inpatient rehabilitation. The primary outcome is the outcome expectancy measured with the Credibility Expectancy Questionnaire at T1. Secondary outcomes include treatment motivation, mental health, work ability, depression, anxiety, and satisfaction with and usage of the Internet platform.DiscussionWe expect the intervention group to benefit from the additional preparation concerning their outcome expectancy. If successful, this approach could be used in the future to enhance the efficacy of inpatient rehabilitation.Trial registrationClinicalTrials.gov: NCT02532881. Registered on 25 August 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1417-y) contains supplementary material, which is available to authorized users.

Application for Inpatient Psychosomatic Rehabilitation: Frequency, Quality, and Approval Rates

There has been a steady increase in psychiatric primary diagnoses in medical rehabilitation services carried out by the statutory pension insurance (DRV). To date, no data are available regarding frequency, quality, and approval rates of applications for psychosomatic rehabilitation. Pension insurance physicians reviewing the application require sufficient information on rehabilitation-related needs, motivation, abilities, and prognosis of an insured person. Medical reports accompanying application for rehabilitation are often provided by a family physician. Psychiatric disorders are often misdiagnosed by general practitioners. In a 2-week period, all decisions made by pension insurance physicians evaluating applications for rehabilitation were recorded. For each incoming application, the following data were documented: psychiatric and somatic primary diagnosis; availability of medical reports; information on prior treatment/therapy; request for further information; decision made by the physician. 1,366 applications (with 81% first-time applications) were included in the analysis. 16.2% of all applications were from insurants with psychiatric primary diagnoses. 44.0% of these applications included a medical report from the family physician only. The proportion of rejected applications (34.7%) and undecided applications (27.2%) was higher in the group of applicants with psychiatric primary diagnosis vs. somatic primary diagnosis (19.6% rejected; 12.7% undecided; χ2=79.8(4), p=0.001). Applications from patients with psychiatric primary diagnosis that lacked a medical report from a psychiatrist/psychotherapist were more likely to be rejected (45.3 vs. 32.3%) or to remain undecided (28.0 vs. 18.3%; χ2=10.2(2), p=0.006). In contrast, among applicants with a history of psychiatric/psychotherapeutic treatment, there was a higher proportion of undecided applications accompanied by a medical report from the family physician (35.7 vs. 18.2%). It might be useful to have medical reports generally provided by medical specialists. This may help both to increase the informative value of applications for psychosomatic rehabilitation and enable quicker decisions and better diagnosis.

The influence of aftercare sessions on sociomedical development after an inpatient psychosomatic rehabilitation

The aim of this study was to examine the influence of aftercare sessions in a psychosomatic rehabilitation on the sociomedical development. The after care group was compared with treatment as usual. In a prospective, controlled and randomized longitudinal study data about the state of health and job status were assessed at 4 measured time points. As an indicator of the sociomedical development the current employment status was used. Aftercare treatment (n=139) included 2-4 interview contacts (via telephone or face-to-face) within the first 3 months after discharge from inpatient psychosomatic rehabilitation. A control group (n=62) received treatment as usual. 3 and 9 months after the end of rehabilitation participants in the aftercare showed a better sociomedical development than the participants in the control condition.

Day-care vs. inpatient psychosomatic rehabilitation

The present study compares patient characteristics and treatment outcome of 138 patients from a day-care psychosomatic rehabilitation and 540 patients from an inpatient psychosomatic rehabilitation. It was analyzed if patients differ in demographic-, clinical- and socio-medical characteristics, if there are different treatment effects between the 2 types of rehabilitations and if other patient characteristics can predict success of treatment. Data was assessed twice (at intake and at discharge of rehabilitation) by self-reported surveys and external assessment of clinical discharge reports. Success of treatment was measured by changes in somatic and mental complaints, psychological well-being, work motivation, subjective forecast of employment, and externally estimated ability to work. RESULTS indicate that day-care patients were higher burdened than inpatients at intake. They showed more complaints, had a higher number of days of incapacity and a higher chance of work difficulties. Furthermore, the prevalence of a migration background was higher. Both kinds of rehabilitation were successful in reducing somatic and mental complaints and in increasing psychological well-being. The "Würzburger Screening", which measures the subjective forecast of employment and occupational stress, turned out to be the best predictor for success of treatment. Both day-care- and inpatient rehabilitation were mostly successful, even if day-care patients were more burdened at intake. Therefore day-care rehabilitation can be seen as a good alternative to inpatient rehabilitation.

Web-basierte Rehabilitationsnachsorge nach stationärer psychosomatischer Therapie (W-RENA)

High relapse rates following treatment for mental health disorders are a challenge for psychosomatic rehabilitation treatments. The goal of the present study is to evaluate the feasibility, acceptance and process-quality of a 12-week transdiagnostic Internet-based maintenance treatment (W-RENA) following psychosomatic rehabilitation treatment. Findings regarding effectiveness and moderators of treatment outcome that were already reported elsewhere are briefly summarized.In a preliminary study we first assessed whether rehab patients have the technical requirements and abilities to successfully participate in Internet-based treatments. Patients expressing interest for participation in W-RENA (N=400) were compared with non-participants (N=1789) with regard to sociodemographic and clinical characteristics. In a 2-arm randomized controlled trial (N=400) we subsequently compared participants of W-RENA with participants of a treatment as usual group (TAU). Self-report measures were assessed at the beginning of inpatient treatment (t1), at discharge from inpatient treatment/start of W-RENA (t2), and at 3- (t3) and 12-months follow-ups (t4). The majority of assessed rehab-patients had the technical prerequisites (78.79%) and necessary skills (79.9%) to successfully participate in an Internet-based intervention. A third of the patients (32%) which were invited to take part in the intervention (and the study) expressed interest to participate. Study participants and non-participants differed only slightly. Most participants (80.6%) reported to have gained benefit from participating. Treatment achievements as well as quality of therapist alliance were rated high from both patients and therapists. Moreover, participants of the W-RENA group could stabilize their inpatient treatment outcomes up to 3- and 12-months follow-up better than controls could do (differences in symptom change from discharge to 3-months follow-up: d=0.38; to 12-months follow-up: d=0.55). Clinical significant symptom deterioration from discharge to 1-year follow-up could be reduced by 2/3 (29.45% vs. 11.45%). We could not identify any subgroup not profiting from study participation. Patients with low education benefited particularly. Internet-based aftercare interventions are a feasible, accepted and effective approach to successfully sustain treatment outcomes achieved in inpatient psychosomatic rehabilitation.