Gutschmidt S, Hänisch S, Würthner K
Klinik Fränkische Saale der Landesversicherungsanstalt Hannover.
Rehabilitation (Stuttg). 1993 Aug;32(3):185-96.
Starting out from the thesis that behaviour and felt experience, i.e., the patient's "subjective world", have considerable influence on chronic diseases and their consequences in the gastrointestinal field, a "basic course documentation"-based comparison has been carried out of the courses of 4-week in-patient rehabilitation programmes designed to increasingly incorporate interventions directed at this area; the study population had consisted of two groups of patients (n = 688 each) without any significant differences concerning age and sex distribution admitted during the summer terms of 1990 (Group A) and 1991 (Group B), respectively. This documentation (in DBASE IV format) compiles (anonymized) patient data at an "objective" level on the one hand, i.e. basic data (such as diagnoses, age, sex), results obtained by the Edinburgh Rehabilitation Status Scale (ERSS), risk behaviour, and scope of interventions both in the organ-medical and physical therapy fields and in the area of "instruction, motivation, support, group work, and creativity" (designed to achieve integration of behaviour and felt experience); on the other hand, at "subjective level", it comprises the patient's own judgements relative to the treatment regimen and its environment, with subsequent correlational analysis of the data obtained (using the SPSSPC statistical package). As had been expected, correlations have on the one hand been stated at the "objective" level between an increased share of more "serious" conditions (ICD) in 1990 as compared to 1991 and higher ERSS scores (i.e., increased impact of disease consequences), greater organ-medical care intensity, and frequency of incapacity for work; on the other hand, at "subjective" level, strong linkages were found among the item ratings for general sense of improvement, specific and general therapy, as well as so-called "therapeutic environment". When the two levels are linked, the sense of improvement, as expected, is found to correlate negatively with the ERSS, but positively with the scope of the interventions designed to foster integration of behaviour and felt experience. The judgements given for quality of care provided relative to the patient's self-reported primary disorder and for general medical care correlate positively both with the scope of diagnostic/therapeutic organ-medical interventions and integration-focussed ones, which, at least from the patient's perspective, hence exercise an ascertainable, essential effect in the therapeutic setting of in-patient rehabilitation in gastrointestinal and metabolic diseases.
基于行为和感觉体验（即患者的“主观世界”）对胃肠道领域的慢性疾病及其后果具有重大影响这一论点，对为期4周的住院康复计划的疗程进行了一项基于“基础课程文档”的比较，这些康复计划越来越多地纳入针对该领域的干预措施；研究人群由两组患者（每组n = 688）组成，他们在1990年（A组）和1991年（B组）夏季学期入院，在年龄和性别分布方面没有任何显著差异。该文档（DBASE IV格式）一方面在“客观”层面汇编（匿名化的）患者数据，即基本数据（如诊断、年龄、性别）、爱丁堡康复状态量表（ERSS）获得的结果、风险行为以及器官医学和物理治疗领域以及“指导、激励、支持、小组工作和创造力”领域（旨在实现行为和感觉体验的整合）的干预范围；另一方面，在“主观”层面，它包括患者对治疗方案及其环境的自身判断，随后对获得的数据进行相关分析（使用SPSSPC统计软件包）。正如预期的那样，一方面在“客观”层面表明，与1991年相比，1990年更多“严重”病症（ICD）的比例增加与更高的ERSS分数（即疾病后果的影响增加）、更大的器官医学护理强度和工作能力丧失频率之间存在相关性；另一方面，在“主观”层面，在总体改善感、特定和一般治疗以及所谓“治疗环境”的项目评分之间发现了紧密联系。当将两个层面联系起来时，正如预期的那样，改善感与ERSS呈负相关，但与旨在促进行为和感觉体验整合的干预范围呈正相关。相对于患者自我报告的主要病症所提供的护理质量判断以及一般医疗护理判断，与诊断/治疗器官医学干预措施和以整合为重点的干预措施的范围均呈正相关，因此，至少从患者的角度来看，这些干预措施在胃肠道和代谢疾病住院康复的治疗环境中发挥了可确定的重要作用。
