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["谁能从中获利?”——身心康复中作为结果预测指标的患者特征]

["Who profits?" - patient characteristics as outcome predictors in psychosomatic rehabilitation].

作者信息

Oster J, Müller G, Wietersheim J von

机构信息

Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Ulm.

出版信息

Rehabilitation (Stuttg). 2009 Apr;48(2):95-102. doi: 10.1055/s-0029-1214411. Epub 2009 Apr 17.

Abstract

The study was to examine how far treatment success in psychosomatic rehabilitation can be predicted from patients' characteristics. The aim of this study included the development of outcome criteria, the analysis of bivariate correlations, as well as development and examination of multivariate models. The motivation for dealing with job-related problems was evaluated separately. Data were available from admission, discharge and three-months follow-up. The data of 463 patients were included. Generated were success criteria concerning sociomedical development, health as well as the ability to work. All success criteria were dichotomized. In the criteria defined, successful outcomes were found in 40 to 60% of the patients. In the bivariate analyses, it was shown that many sick days before rehabilitation, applications for pension, severe disability, high impairment, and suggestion for rehabilitation by the insurance agency, have basically negative effects on success. Correlations with the variables concerning motivation for dealing with job-related problems were rather weak. In multivariate model development, models of different quality were found. For prediction of working ability at discharge, there was an explained variance of nearly 60%. In the other success criteria as well, explained variance amounted to over 20%. The models consist of different constellations of variables, the number of sick days before rehabilitation, variables of application for pension and severity of the impairment frequently included. In case of a current sick leave, rehabilitation should be started early, sociomedical problems have to be dealt with explicitly, and rehabilitation should be accompanied by preparatory and aftercare measures.

摘要

该研究旨在探讨从患者特征能在多大程度上预测身心康复的治疗成功情况。本研究的目的包括制定结果标准、分析双变量相关性以及开发和检验多变量模型。对处理与工作相关问题的动机进行了单独评估。数据来自入院、出院和三个月随访。纳入了463名患者的数据。生成了关于社会医学发展、健康以及工作能力的成功标准。所有成功标准都进行了二分法划分。在所定义的标准中,40%至60%的患者取得了成功结果。在双变量分析中,结果表明康复前的病假天数、养老金申请、重度残疾、高损伤程度以及保险公司的康复建议,基本上都对成功有负面影响。与处理与工作相关问题的动机变量的相关性相当弱。在多变量模型开发中,发现了不同质量的模型。对于出院时工作能力的预测,解释方差接近60%。在其他成功标准方面,解释方差也超过了20%。这些模型由不同的变量组合构成,康复前的病假天数、养老金申请变量和损伤严重程度经常被纳入其中。如果当前正在休病假,应尽早开始康复,必须明确处理社会医学问题,并且康复应伴有预备措施和后续护理措施。

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