Ernst G, Hübner P
Medizinische Psychologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1 30625 Hannover.
Rehabilitation (Stuttg). 2012 Oct;51(5):308-15. doi: 10.1055/s-0031-1291282. Epub 2012 Apr 4.
Treating diabetes mellitus type 2 (DMT2) essentially involves long-term changes of health behaviour, especially diet and physical activity habits. Medical rehabilitation tries to support these changes by patient education and practical instructions. While short-term successes are frequently obtained, the main challenge lies in maintaining these results in the longer run. This study examines whether a fractionated inpatient rehabilitation programme of 3 weeks duration in combination with an additional week of inpatient rehabilitation after 6 months and a subsequent aftercare telephone service facilitates positive long-term effects for patients with DMT2.
A prospective randomized controlled trial was conducted with 411 patients with DMT2 in order to compare the fractionated inpatient rehabilitation programme with aftercare to a 3-weeks standard rehabilitation programme without aftercare. The analysis included physiological (cardiovascular risk, HbA1c, BMI) and psychosocial (diabetes-specific coping, quality of life) parameters at baseline (beginning of the programme) and 1 year later.
After 12 months, no significant differences between the groups were found in the physiological parameters. At the same time, however, the aftercare group showed larger benefits in almost every psychosocial dimension (coping, quality of life, subjective health). Coping and quality of life had even improved when compared to baseline. In contrast, these parameters had decreased further in the standard-care control group when compared to baseline.
The intensive aftercare was successful in the long-term improvement of the patients' psychological well-being. Also, the high rate of participation in fractionated inpatient rehabilitation suggests both the acceptance of and the need for aftercare. However, positive long-term changes of physiological parameters probably will require more specific interventions or individual case management. The effectiveness of fractionated inpatient rehabilitation may be limited by the adverse social, psychological and financial situation of the patients.
治疗2型糖尿病（DMT2）本质上涉及健康行为的长期改变，尤其是饮食和体育活动习惯。医学康复试图通过患者教育和实践指导来支持这些改变。虽然经常能取得短期成功，但主要挑战在于长期维持这些成果。本研究探讨了为期3周的分段住院康复计划，结合6个月后额外1周的住院康复以及随后的随访电话服务，是否能为DMT2患者带来积极的长期效果。
对411名DMT2患者进行了一项前瞻性随机对照试验，以比较分段住院康复计划加随访与为期3周的无随访标准康复计划。分析包括基线（计划开始时）和1年后的生理（心血管风险、糖化血红蛋白、体重指数）和心理社会（糖尿病特异性应对、生活质量）参数。
12个月后，两组在生理参数上未发现显著差异。然而，与此同时，随访组在几乎每个心理社会维度（应对、生活质量、主观健康）都显示出更大的益处。与基线相比，应对和生活质量甚至有所改善。相比之下，标准护理对照组的这些参数与基线相比进一步下降。
强化随访在长期改善患者心理健康方面取得了成功。此外，分段住院康复的高参与率表明了对随访的接受度和需求。然而，生理参数的积极长期变化可能需要更具体的干预措施或个案管理。分段住院康复的有效性可能受到患者不良社会、心理和经济状况的限制。
