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AHG-Klinik für Psychosomatik Bad Dürkheim
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Effectiveness of handheld-supported self-management (E-Coaching) in rehabilitation aftercare

E-Coaching is a new behavioural therapeutic form of intervention for the self-regulation of behaviour with the aid of a handheld computer.

The aim is to support patients with a tendency to over-exert themselves in terms of work to implement behaviour learned in an inpatient psychosomatic treatment in their everyday working life. In the E-Coaching, the patient is asked several times per day via a handheld computer to focus his attention on his behaviour and experience, to check whether he is treating himself in a self-caring manner, where applicable to correct his behaviour in terms of the strategies developed during the treatment, and to check later on whether these corrections were successful.

In a clinic for psychosomatic medicine, patients with an increased willingness to overexert themselves are invited to a small group event around the end of their inpatient stay. In this event, their tendency to overexert themselves is picked out as a central theme and concrete behavioural goals for treating oneself in a self-caring manner are developed. In this respect, E-Coaching is introduced as a support for the later implementation into everyday life.

The aim of the study is to check whether, through a temporally limited E-Coaching at home, the implementation of new behaviours learned during inpatient treatment can be improved, consequently enabling the progress achieved during therapy to be maintained.


Background:
An excessive willingness to overexert oneself with respect to one’s work fosters the emergence of stress-related diseases. In the framework of an inpatient psychosomatic treatment, this dysfunctional lifestyle and behavioural style can be identified and replaced by a more favourable one. Introducing a change in behaviour is generally not as difficult for the patient as maintaining it. Once the inpatient measure has been concluded, in everyday life at home, the danger of falling back into older behavioural habits is particularly high.

 

Aims:
E-Coaching is a new, behavioural therapeutic form of intervention for the self-regulation of behaviour with technical aid. The patient is asked several times per day via the program control of a handheld computer, to focus his attention on his current behaviour and experience, to check whether he is treating himself in a self-caring manner, to correct his behaviour where necessary in terms of the strategies developed during treatment, and after a self-determined period of time, to check whether these corrections were successful.

E-Coaching aims, as a post-inpatient aftercare offer, to support patients who evaluate the method positively in transferring that which they learned during inpatient treatment.

To this aim, firstly, it should be examined whether E-Coaching in inpatient psychosomatic rehabilitation is met with acceptance following a short introductory treatment. The effectiveness of E-Coaching in the post-inpatient phase is the object of a randomised control group study.

 

Methods:
The study includes patients in gainful employment with a tendency to overexert themselves in the workplace (AVEM, Schaarschmidt & Fischer) and who are capable of work upon discharge from the clinic. Exclusion criteria are: ongoing pension procedure, anorexia, personality disorders (Cluster A or B).

The evaluation is realised as a randomised control group study with one experimental group (“E-Coaching”) and one comparison group (“intention therapy” as a placebo control condition). The data base provides surveys at three measurement time points (pre, post, 6-month follow-up). The primary dependent variable is the tendency to overexert oneself. Self-management competencies, self-effectiveness, general and disorder-specific symptom pressure and sickness costs are examined in an exploratory manner.

In the framework of the inpatient treatment, the patients take part in a small group event on the theme of overexerting oneself and treating oneself with self-care. During this event, E-Coaching as support in implementing self-caring behaviour is introduced and the patients are given the opportunity to use E-Coaching for two days in everyday clinic life.

Patients who subsequently assess the E-Coaching to be helpful are randomly assigned to the EG or the CG. They are contacted four weeks after their discharge from inpatient therapy and motivated to participate. The EG receives, at time intervals of four weeks and 25 weeks after the discharge, a self-management treatment with the E-coach for seven successive days. The CG receives, also for the same time periods, an encouragement and request to purposefully practice the learned coping strategies in the following seven days.

 

Results:
The psychoeducation group unit is very positively evaluated by the patients. Following the two-day use of the devices in everyday clinic life, a good acceptance of E-Coaching as a psychotherapeutic measure is apparent. The high willingness to participate in the aftercare intervention with the E-coach also speaks in favour of a high acceptance. The evaluations show that both patients in the IG and patients in the CG are able to further reduce their willingness to overexert themselves in the post-inpatient phase. The superiority of E-Coaching compared to the intention therapy could not be proven. Also for the secondary dependent variables, no superiority of E-Coaching over “intention therapy” could be established.

 

Discussion:
Reasons why E-Coaching is not superior to the intention therapy can presumably be sought in the low therapy dose in the two experimental groups and the simultaneously comparatively high dose in the control condition. The high acceptance of E-Coaching and its practicability in everyday life encourage an intensification of handheld-supported interventions to enable their higher effectiveness to be proven.




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