Deutsch | Imprint

Suche:


Zoom = Maus über Bild bewegen | Bild hier öffnen

Downloads

Studymaterials will be provided on demand.

 

 

Contact

Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
Institut für Rehabilitationsmedizin
Magdeburger Straße 8
06097 Halle

Dipl.-Psych. Kerstin Mattukat
Tel.: +49 (345) 557-7646
E-Mail:

 

Office

Tel.: +49 (345) 557-4204
E-Mail:

previous article  |  next article

Stepped movement-oriented rehabilitation and aftercare in patients with inflammatory and non-inflammatory diseases of the musculoskeletal system (boRN)

Project leader:

Prof. Dr. med. Wilfried Mau, Institute for Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany

 

Project implementation:

Dipl.‐Psych. Kerstin Mattukat, Institute for Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany 

 

Cooperation:

Dr. Inge Ehlebracht‐König, Rehazentrum Bad Eilsen
Prof. Dr. Karin Kluge, Teufelsbad Fachklinik Blankenburg

 

Funding provider:

German Pension Insurance (Deutsche Rentenversicherung Bund)

 

Funding code:

0421-FSCP-Z237

 

Running time:

01.12.2011 - 31.12.2013 (37 months)

 

Background:

Chronic back pain (BP) and inflammatory rheumatic diseases such as chronic polyarthritis (cP) and spondyloarthritis (SpA) are often accompanied by severe impairments of health. Chronic pain and limitations of productivity lead to a diminished quality of many aspects of life. To prevent chronification and/or a progression of disease, an early diagnosis and adequate medical care (i.a. medication) are of utmost importance. Regular physical activity could ease many of the concomitant afflictions. Activating exercise therapy units and motivational elements within medical rehabilitation support the patients in organizing a healthier and more active lifestyle. Yet the assignment to exercise therapy is rarely based on clear criteria and lacks documented (process) diagnostics and success monitoring. Additionally, rehabilitants often struggle with the implementation of their positive exercise intentions into their daily routine after rehabilitation. Motivational intervention modules are intended to encourage the rehabilitants to implement and keep up their exercise programme even after leaving rehabilitation. In recent studies positive effects of rehabilitation could be prolonged through continued care of the rehabilitants after their discharge.

 

Study aim:

Using a synergistic intervention approach both during and after medical rehabilitation, the project aimed to achieve sustainable improvements in health-related quality of life, physical activity and the social-medical progression of rehabilitants with the most frequent chronic inflammatory and non-inflammatory diseases of the musculoskeletal system (BP, cP, SpA). Within the boRN-study, a screening of physical fitness was developed, practically tested and surveyed for its potential for referral improvement and success documentation. Furthermore the contact with rehabilitants was expanded through regular aftercare messages and implemented resource-efficiently through the employment of new media. The effects of the complex intervention compared to conventional therapy were tested in a one-year-follow-up [1].

 

Outcomes:

Primary outcome: physical role function (SF-36)
Secondary outcomes: pain intensity (NRS), fatigue (NRS), motor fitness status (FFb-Mot), limitation of participation (IMET), physical activity (FPAQ), exercise motivation (HAPA), anxiety and depression (HADS-D), physical component score (PCS) and mental component score (MCS; SF-12), employment, days of sick leave, disability pension.

 

Study design:

The boRN-study was a multi-centre prospective controlled intervention study with a sequential design during which participants with BP (ICD-10: M51-M54), cP (ICD-10: M05-M07) or SpA (ICD-10: M45-M46) in the age of 18 to 65 years were surveyed at four time points of measurement (t1=rehabilitation outset, t2=discharge, t3= 6-months-follow-up, t4= 12-months-follow-up). The participants were assigned to a control group (CG) in the first study phase or - after an implementation phase - to the intervention group (IG) in the second study phase.

 

Control and intervention phase:

The control group received conventional orthopedic-rheumatology rehabilitation in accordance with the respective indication. At rehabilitation outset and shortly before discharge, a screening of individual physical fitness was tested with regard to practicability, sensitivity and acceptance. The results of the screening did not influence the allocation to exercise therapies.

In comparison to the control phase, the intervention phase involved 1) a group screening for individual physical fitness across different musculoskeletal diagnoses with 2) following allocation to one of two training groups with different levels of training intensity, 3) systematic motivation with individual planning and written agreement of prospective training activities, and 4) continuous aftercare over 6 months after discharge via new (short messages/e-mail) or classic media (telephone call/mail).

 

Results:

Dropout analyses of the dropouts during the study course (n=355) revealed an initial state inferior to the participants of the final sample (n=446), pointing to a selection bias. participants of the final sample (nCG=266, nIG=180) were on aged 50 [±7] years, 52 % were male with the diagnosis BP (61 %), cP (28 %) und SpA (11 %). Group differences at t1 (p<0.05) were controlled for in the statistical analyses of the hypotheses testing.

The intervention elements were successfully developed and evaluated by patients and staff. Due to screening results, 73 IG-participants were assigned to moderate (MTG) and 107 IG-participants to intensive training groups (ITG). Both the screening and the fixed diagnosis-mixed training groups with integrated motivational work were evaluated positively by participants and therapists.

All patients had a better health status at t2 compared to t1. IG-patients reported higher exercise motivation and health satisfaction at t2. The general evaluation of rehabilitation was positive. Compared to the CG, the IG felt better prepared for the time after discharge.

About half of the IG-participants decided on new and classic media for the aftercare messages. The aftercare messages were evaluated as being helpful and their frequency as appropriate. The continued contact to the clinic staff was experienced as very positive.

At t4, all study participants reported improvements in their physical role function (main outcome), health-related quality of life, pain intensity, and impairments of participation compared to t1. No benefits for the IG were found compared to the CG. An unexpected higher increase in the sports activities of the CG was explained by their more inactive state at t1.

 

Summary:

In addition to the short-term effects, no long-term advantages of the IG compared to the CG were observed. Instead, long-term improvements were ascertained in both study groups. Conclusions regarding the acceptance and efficacy of the intervention are limited due to selection of study participants. Based on the high acceptance of the intervention in rehabilitants and therapists, the practical relevance of the different intervention elements should be discussed for further projects.

 

Outlook:

Findings of subgroup analyses should be taken into account in the prospective design and implementation of treatments and therapies. For example, analyses of different groups in the rehabilitation context displayed that women and mentally stressed persons reported substantially worse outcomes both at rehabilitation outset as well as at one-year-follow-up compared to men and mentally healthy persons, whereas age and diagnosis group had no considerable influence on the course of the physical and mental health of the rehabilitants [2].

 

Transfer:

The group screening of individual physical fitness is available for an improved therapy assignment during medical rehabilitation. Furthermore, the outcome and success of the rehabilitation can be measured for the purposes of quality assurance. The aftercare messages can be designed freely regarding content, frequency and medium. They can be applied during and after medical rehabilitation as well as cross-sectoral and for other indications. The “aftercare app” that was developed within this study to organize the automatic aftercare messages is available for download under www.nachsorge-app.de.

 

Sources:

[1] Mattukat, K., Golla, A. & Mau, W. (2014). Gestufte bewegungsorientierte Rehabilitation und Nachsorge bei Patienten mit entzündlichen und nicht-entzündlichen Erkrankungen des Bewegungssystems (boRN). Abschlussbericht. Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Rehabilitationsmedizin. (siehe Link rechts)

[2] Mattukat, K., Golla, A., & Mau, W. (2015). Welche Bedeutung  haben Gender, Alter, Hauptdiagnosegruppe und psychische Gesundheit für die Verlaufsprognose während und nach muskuloskelettaler Rehabilitation? DRV-Schriften, 107, 373-375.




< SELF - Glattacker  |  Women@work - Spyra >