Deck Ruth, Beitz Sebastian, Baumbach Christian, Brunner Susanne, Hoberg Eike, Knoglinger Ernst
Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck.
Herz- und Gefäßzentrum Bad Bevensen.
Rehabilitation (Stuttg). 2020 Feb;59(1):17-25. doi: 10.1055/a-0899-1444. Epub 2019 Jun 17.
Physical inactivity is considered the most important modifiable risk factor of cardio-vascular diseases. Therefore medical rehabilitation is focused on the improvement of physical activity. To maintain physical activity after rehabilitation aftercare strategies are necessary which help to transfer the skills learned during rehabilitation into daily routine. In this study the aftercare concept "Neues Credo" which has been evaluated several times has been implemented and evaluated into cardiological follow-up rehabilitation.
Prospective, controlled, multicentre study with 4 cardiological rehabilitation institutions.
rehabilitants with initial diagnosis from the ICD groups I20-25 and I34-43. In the first phase of the study, patients received standard rehabilitation and standard aftercare (control group (KG)). In the second phase, patients received rehabilitation based on the conditions of "Neues Credo" with the focus on increasing physical activity (intervention group (IG)). Data for evaluation were collected by paper-and-pencil questionnaires at 3 points in time. Primary outcome variable: restriction in participation (IMET); secondary outcome variables: depression (CES-D), several scales of subjective health and physical activity. Analysis of variance with repeated measures was used for the evaluation of long-term effects.
Complete data could be evaluated from 152 patients of the IG and from 165 patients of the KG. At the end of rehabilitation both IG and KG showed improvements in outcome variables. In the period after rehabilitation patients in the IG improved their physical activity significantly more often than members of the KG (66 vs. 42%, p<0,01), they showed more physical activity than the KG (p=0,040) and they performed endurance sports more often (58 vs. 38%, p<0,01). The primary outcome of participation shows significant improvements in both groups (p<0,01) 12 months after the rehabilitation, difference between groups did not reach statistical significance but indicated a clear tendency in favour of the IG. Similar trends could be found for the secondary outcome-data CONCLUSION: In this study, the "Neues Credo" was applied and evaluated in cardiologic rehabilitation for the first time. Participants reported high practicability and high satisfaction. Health- related outcomes show a trend of positive effects in favour of the IG, but the interaction effects did not reach statistical significance in most cases. Regarding physical activity the intervention group shows clear advantage and will probably benefit from the long-term effects of regular endurance training.
身体活动不足被认为是心血管疾病最重要的可改变风险因素。因此，医学康复的重点是提高身体活动水平。为了在康复后维持身体活动，需要有后续照护策略，以帮助将康复期间学到的技能转化为日常生活。在本研究中，已多次评估的“新信条”后续照护概念已在心脏病学随访康复中实施并进行评估。
在4个心脏病康复机构进行前瞻性、对照、多中心研究。
国际疾病分类（ICD）I20 - 25组和I34 - 43组的初诊康复患者。在研究的第一阶段，患者接受标准康复和标准后续照护（对照组（KG））。在第二阶段，患者接受基于“新信条”条件的康复，重点是增加身体活动（干预组（IG））。通过纸质问卷在3个时间点收集评估数据。主要结局变量：参与受限（IMET）；次要结局变量：抑郁（CES - D）、主观健康和身体活动的几个量表。采用重复测量方差分析评估长期效果。
可对干预组的152名患者和对照组的165名患者的完整数据进行评估。康复结束时，干预组和对照组的结局变量均有所改善。在康复后的时期，干预组患者身体活动改善的频率显著高于对照组（66%对42%，p < 0.01），他们的身体活动比对照组更多（p = 0.040），并且进行耐力运动的频率更高（58%对38%，p < 0.01）。康复12个月后，两组的主要参与结局均有显著改善（p < 0.01），组间差异未达到统计学意义，但显示出明显有利于干预组的趋势。次要结局数据也发现了类似趋势。
在本研究中，“新信条”首次在心脏病康复中应用并进行评估。参与者报告其具有很高的实用性和满意度。与健康相关的结局显示出有利于干预组的积极影响趋势，但在大多数情况下，交互作用效应未达到统计学意义。在身体活动方面，干预组显示出明显优势，可能会从定期耐力训练的长期效果中受益。
