Deck R, Schramm S, Hüppe A
Institut für Sozialmedizin der Universität Lübeck.
Rehabilitation (Stuttg). 2012 Oct;51(5):316-25. doi: 10.1055/s-0031-1291279. Epub 2012 Apr 2.
In recent years, rehabilitation aftercare has become an important topic in rehabilitation research and practice. This development was initiated by the lack of long-term effects after rehabilitation treatment and by the deficits identified in several reviews of aftercare recommendations and of actual practice of aftercare. Against this background, a new aftercare strategy was developed, the "New Credo", which focused aftercare from the beginning of rehabilitation treatment. A substantial element of the concept is the resumption and maintenance of physical activity in everyday life of the rehabilitation patient. The goal of the present study was the evaluation of this concept in a sample of patients with chronic back pain.
The "New Credo" was evaluated in a multi-centre, prospective controlled longitudinal study with 3 points of measurement (before and after rehab as well as after 12 months). 6 rehabilitation clinics in Schleswig-Holstein were included in the intervention arm (IG, 3 clinics) and in the control arm (CG, 3 clinics), participants were rehabilitants with chronic back pain. The clinics in the intervention arm implemented "the New Credo" in accordance with their local conditions. During the study period they were provided with a person who was responsible for managing aftercare activities for patients. Participants in the CG received standard rehabilitation treatment according to general guidelines. Restriction of social participation, disability days and restriction in functional capacity in everyday life were defined as primary outcomes. Complete data were available for 166 rehabilitants in the IG and 368 in the CG.
At the end of rehabilitation rehabilitants in the IG reported significantly higher use of treatment offerings and more intensive preparation for the time after rehabilitation treatment than rehabilitants in the CG. Rehabilitants in the IG found recommendations for the time after treatment significantly better than those in the CG. As expected, both rehabilitants in the IG and in the CG showed similar outcomes directly after inpatient treatment. With respect to long-term effects 12 months later, significant differences with moderate effect sizes were observed in 2 of the 3 primary outcomes (function capacity and social participation) in favour of the IG. With respect to secondary outcomes, rehabilitants in the IG showed significantly better long-term results than those in the CG.
Our results show that the "New Credo" can successfully be implemented into rehabilitation practice. The "New Credo" was positively rated by clinicians and rehabilitants. Rehabilitants in the IG found offerings of supported aftercare very helpful. The intensity of actual use of aftercare by rehabilitants as well as the emphasis laid on aftercare by clinicians indicate that treatment was focused on aftercare over the whole time of rehabilitation and that the rehabilitants transferred these aspects into everyday life. For the rehabilitants in the IG higher long-term effects could be observed compared to those in the CG. This suggests an improved sustainability of rehabilitation effects and a successful transfer of acquired knowledge and self-efficacy in everyday life.
近年来，康复后续护理已成为康复研究与实践中的一个重要课题。这一发展是由康复治疗后缺乏长期效果以及在对后续护理建议和实际后续护理实践的多项综述中发现的缺陷所引发的。在此背景下，制定了一种新的后续护理策略，即“新信条”，该策略从康复治疗一开始就注重后续护理。该理念的一个重要要素是恢复并维持康复患者日常生活中的身体活动。本研究的目的是在慢性背痛患者样本中评估这一理念。
在一项多中心、前瞻性对照纵向研究中对“新信条”进行评估，有3个测量点（康复前后以及12个月后）。石勒苏益格 - 荷尔斯泰因州的6家康复诊所被纳入干预组（IG，3家诊所）和对照组（CG，3家诊所），参与者为患有慢性背痛的康复者。干预组的诊所根据当地情况实施“新信条”。在研究期间，为他们配备了一名负责管理患者后续护理活动的人员。CG组的参与者接受根据一般指南进行的标准康复治疗。将社会参与受限、残疾天数以及日常生活功能能力受限定义为主要结局。IG组有166名康复者和CG组有368名康复者获得了完整数据。
在康复结束时，IG组的康复者报告称与CG组的康复者相比，他们对治疗服务的利用率显著更高，并且对康复治疗后的时间做了更充分的准备。IG组的康复者认为治疗后阶段的建议比CG组的更好。正如预期的那样，IG组和CG组的康复者在住院治疗后直接显示出相似的结果。关于12个月后的长期效果，在3项主要结局中的2项（功能能力和社会参与）观察到了具有中等效应量的显著差异，有利于IG组。关于次要结局，IG组的康复者显示出比CG组显著更好的长期结果。
我们的结果表明，“新信条”能够成功地应用于康复实践。“新信条”得到了临床医生和康复者的积极评价。IG组的康复者认为获得支持的后续护理服务非常有帮助。康复者对后续护理实际利用的强度以及临床医生对后续护理的重视表明，治疗在整个康复期间都侧重于后续护理，并且康复者将这些方面融入了日常生活。与CG组的康复者相比，IG组的康复者观察到了更高的长期效果。这表明康复效果的可持续性得到了改善，并且在日常生活中获得的知识和自我效能得到了成功转化。
