Musekamp Gunda, Bengel Jürgen, Schuler Michael, Faller Hermann
Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany.
Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany.
Patient Educ Couns. 2016 Aug;99(8):1355-61. doi: 10.1016/j.pec.2016.03.022. Epub 2016 Mar 22.
Self-management programs aim to improve patients' skills to manage their chronic condition in everyday life. Improvement in self-management is assumed to bring about improvements in more distal outcomes, such as quality of life. This study aimed to test the hypothesis that changes in self-reported self-management skills observed after participation in self-management programs predict changes in both quality of life and depressive symptoms three months later.
Using latent change modeling, the relationship between changes in latent variables over three time points (start and end of rehabilitation, after three months) was analysed. The sample comprised 580 patients with different chronic conditions treated in inpatient rehabilitation clinics. The influence of additional predictor variables (age, sex, perceived social support) and type of disorder as a moderator variable was also tested.
Changes in self-reported self-management skills after rehabilitation predicted changes in both quality of life and depressive symptoms at the end of rehabilitation and the 3 months follow-up. These relationships remained significant after the inclusion of other predictor variables and were similar across disorders.
The findings provide support for the hypothesis that improvements in proximal outcomes of self-management programs may foster improvements in distal outcomes. Further studies should investigate treatment mechanisms.
自我管理项目旨在提高患者在日常生活中管理自身慢性病的技能。自我管理的改善被认为会带来更长远结果的改善，如生活质量。本研究旨在检验这一假设：参与自我管理项目后观察到的自我报告的自我管理技能变化可预测三个月后生活质量和抑郁症状的变化。
采用潜在变化模型，分析了三个时间点（康复开始和结束时、三个月后）潜在变量变化之间的关系。样本包括580名在住院康复诊所接受治疗的患有不同慢性病的患者。还测试了其他预测变量（年龄、性别、感知到的社会支持）的影响以及作为调节变量的疾病类型的影响。
康复后自我报告的自我管理技能变化预测了康复结束时以及三个月随访时生活质量和抑郁症状的变化。纳入其他预测变量后，这些关系仍然显著，且在不同疾病中相似。
研究结果支持了这一假设，即自我管理项目近端结果的改善可能促进远端结果的改善。进一步的研究应调查治疗机制。
