van Egmond-Fröhlich A, Bräuer W, Goldschmidt H, Hoff-Emden H, Oepen J, Zimmermann E
Kinder-Reha-Klinik Am Nicolausholz, Bad Kösen.
Rehabilitation (Stuttg). 2006 Feb;45(1):40-51. doi: 10.1055/s-2005-915368.
Inpatient rehabilitation is an important contributor to the treatment of child and adolescent obesity with comorbidity in Germany. Thus far outpatient follow-up care has not been subject to research. The main goal of this study is the development and longer-term evaluation of a programme for structured outpatient follow-up care by primary care physicians after inpatient rehabilitation of obese children and adolescents.
This multicentre, randomized, parallel controlled clinical trial enrolled 521 children and adolescents aged 9 - 16 (avg. 13.3) years in 7 cooperating specialized rehabilitation facilities. The patients were randomized at the end of their multimodal inpatient treatment that lasted for 5.9 (+/- 1.2) weeks. The intervention consisted of 12 half-hour outpatient consultations by the primary care physicians utilizing a modular consultation guideline and an internet-based training programme. The control group received standard care. Outcome variables included anthropometric measures, questionnaires on eating behaviour, physical activity, quality of life, self-efficacy and subjective rating of the intervention. Measurements were performed at the beginning (t1) and end (t2) of inpatient rehabilitation as well as 6 (t3) and 12 (t4) months after discharge.
There was a highly significant improvement of BMI-z-score (standard deviation score of the Body Mass Index), relevant behaviour, quality of life and self-efficacy between t1 and t4. On intention to treat analysis no differences were detected between intervention and control groups. The intervention was utilized by only 50 % of entitled. The BMI-z-score reached a minimum at t3 (6-month follow-up). Predictors of longer-term BMI-z-score decline were psychological suffering, poor eating behaviour, low physical activity and high socio-economic status. In multivariate linear regression improvement of eating behaviour and physical activity correlated with the improvement of BMI-z-score.
This low-level outpatient intervention did not improve the demonstrated longer-term effectiveness of inpatient rehabilitation. An interdisciplinary outpatient follow-up care in groups with inclusion of the parents is recommended.
在德国，住院康复是治疗合并症儿童及青少年肥胖症的重要组成部分。迄今为止，门诊后续护理尚未成为研究对象。本研究的主要目标是开发并长期评估一项由初级保健医生在肥胖儿童及青少年住院康复后提供的结构化门诊后续护理计划。
这项多中心、随机、平行对照临床试验在7家合作的专业康复机构中招募了521名9至16岁（平均13.3岁）的儿童及青少年。患者在为期5.9（±1.2）周的多模式住院治疗结束时被随机分组。干预措施包括初级保健医生依据模块化咨询指南进行12次半小时的门诊咨询以及一个基于互联网的培训项目。对照组接受标准护理。结果变量包括人体测量指标、关于饮食行为、身体活动、生活质量、自我效能感以及对干预的主观评价的问卷。测量在住院康复开始时（t1）和结束时（t2）以及出院后6个月（t3）和12个月（t4）进行。
在t1和t4之间，体重指数z评分（体重指数标准差评分）、相关行为、生活质量和自我效能感有极显著改善。在意向性分析中，干预组和对照组之间未发现差异。只有50%符合条件的人使用了该干预措施。体重指数z评分在t3（6个月随访）时达到最低值。长期体重指数z评分下降的预测因素包括心理痛苦、不良饮食行为、低身体活动水平和高社会经济地位。在多元线性回归中，饮食行为和身体活动的改善与体重指数z评分的改善相关。
这种低强度的门诊干预并未提高已证明有效的住院康复的长期效果。建议开展包括家长在内的跨学科门诊后续护理小组。
