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Biomedical subjects

I Ehlebracht-König

Publications and source records attributed to I Ehlebracht-König.

12 recordsLinked to original sources
PubMed2005

[Structural validity of the Short Form 36 (SF-36) in patients with rheumatic diseases].

BACKGROUND: Quality of life is gaining relevance as a criterion of success in therapeutic outcome studies. In order to record quality of life, disease-specific instruments are being used as well as generic instruments. Generic instruments offer the possibility to compare outcome among different indications; however for this it is necessary to prove the differential factorial validity of the instrument's structure. AIM OF THE STUDY: Using structural equation modeling the SF-36 was administered to a sample of patients with rheumatic diseases. The sensitivity to change of the measure was calculated after six months. Furthermore, age- and sex-specific scale values were calculated and compared with norm data. METHODS: SF-36 data of 436 patients as well as sex and age from two scientific rehabilitation research projects were pooled for this secondary analysis. RESULTS: The structure of the questionnaire proves to be acceptable and comparable with international results. The confirmatory analysis supports the best fit for a model with crossloadings assuming correlated main dimensions. Sensitivity to change is low in general. The best effect size is found for the subscale pain. The comparison with norm data shows that patients are impaired particularly within their physical health (regarding the SF subscales) both at the beginning of the treatment and after six months. In all age groups men have better conditions than women. CONCLUSIONS: The generic SF-36 show sufficient factorial validity. From this point of view there is no objection to using the SF-36 in patients with rheumatic diseases. Indeed the use of the SF summary scales as a representation of (uncorrelated) physical and mental health must be questioned critically.

Adolescent↗
PubMed2005

[Significance of the chronic fatigue syndrome in rehabilitation medicine--status and perspectives].

It appears that from a clinical point of view chronic exhaustion or fatigue is an important factor in rehabilitation. This is, however, first of all a phenomenon that can be described as a function in accordance with the International Classification of Functioning, Disability and Health (JCF), caused by chronic illnesses or chronic excessive stress. The clinical and sociomedical ranking of chronic fatigue or exhaustion in respect of rehabilitation was discussed in the framework of a Workshop at the 12th Rehabilitation Science Colloquium, 2003 from the viewpoints of psychiatric rehabilitation, methodology, sociology and practical rehabilitation, and conclusions for future research were drawn. The definition of chronic fatigue is first of all mainly based on the feeling of chronic tiredness but also on phenomena of disturbed concentration, physical discomfort, headache and disorders of "drive" and mood. A psychiatric diagnosis linked with symptoms of chronic fatigue is neurasthenia, which is arrived at according to precisely defined criteria. Depressive disorder is one of the most important differential diagnoses in this sphere. Examinations by general practitioners revealed that about 90 % of the patients who had been diagnosed as suffering from psychovegetative disorders completely agreed with the diagnosis of neurasthenia. Neurasthenia resulted more often in work disability periods than disorders of somatisation and other psychosomatic diagnoses. Basing on the "IRES" scale "vital exhaustion", singular of even serious changes become evident in about 50 % to 90 % of the patients undergoing rehabilitation, depending on their individual range of indications. As was to be expected, the majority of pathologic findings concerns patients undergoing psychosomatic rehabilitation, since in such cases there is an overlapping with symptoms of psychosomatic diseases. It is, however, remarkable that also in somatically oriented orthopaedic rehabilitation symptoms of fatigue are seen in up to 50 % of the patients. Preliminary studies have shown that these symptoms can be definitely ameliorated within the rehabilitation framework, although pathological signs are still abundantly apparent in follow-up examinations. Markedly severe degrees of "vital exhaustion" and "vocational exhaustion" are also seen in rheumatology patients undergoing somatic rehabilitation. This agrees with case history details related by many female and male patients. Hence, it appears necessary to adapt rehabilitative intervention to both the psychovegetative and the medical behavioural aspects of this symptom. Scientific classification of the entire sphere of chronic fatigue in respect of rehabilitation requires classification of the relevant functions within the ICF framework. To this end it would be necessary to conduct patient inquiries within cross-sectional studies on the one hand and, on the other, a systematic consensus process among experts would have to be used for allocation to the relevant functions. This is the basis for development of suitable assessment tools for use in prospective studies in order to systematically evaluate the impact on functions and especially their effects on activities and participation.

Disability Evaluation↗
PubMed2005

[Patient education].

Patient education is considered to be a major feature of medical rehabilitation in chronic disorders. The rehabilitation sciences research programme funded by the German Pension Insurance scheme and the Federal Ministry of Education and Research comprises a considerable number of evaluation studies carried out with methodological rigor. Over two funding periods, patient education programmes were developed and evaluated with respect to their medical, psychosocial, occupational and economic effects. In this article, a conceptual definition of patient education is presented. Then, the aims and results of ten patient education studies of the funding programme as well as of several implementation projects are described. When integrating these results into previous research taking both a national and international perspective, it can be concluded that patient education programmes are effective regarding medical psychosocial and socio-economic outcomes, although effects sizes may vary. However, in some disorders the state of the research is still unsatisfactory and results are either scarce or heterogeneous. In particular, it is unclear whether such programmes are widely used in medical rehabilitation on a routine basis. Several education programmes provide train-the-trainer opportunities, others are still in the process of development or evaluation. Implementation projects such as those described in the article are aimed at closing these gaps and disseminating research results into the practice of rehabilitation.

Biomedical Research↗
PubMed2004

[Inpatient aftercare in rheumatic diseases--concept, trial, and acceptance].

BACKGROUND: A one-week booster group treatment in rheumatic diseases (rheumatoid arthritis, spondylarthropathies, fibromyalgia) was developed in order to stabilize rehabilitation effects after medical rehabilitation. The program took place in an inpatient setting 3 - 5 months after rehabilitation, aimed at refreshing and deepening already learnt contents as well as teaching new subjects (e. g. about dietetics). Training and educational elements are given priority in this concept. METHOD: A total of 140 patients participated in 19 booster weeks. At the end of each booster week the acceptance was assessed by questionnaire and in a round-table discussion. RESULTS: Comprehensibility and group atmosphere were judged very positively. The course was also considered very helpful, helpfulness being rated with marks about 2 (1 = very helpful, 6 = not at all helpful). Participants especially appreciated the course's framework as a group setting emphasising the exchange of experience with co-patients. At the same time, however, participants wished more individualized treatment such as physiotherapy or massage. With regard to the quantity of the various therapy elements, participants would have preferred more traditional spa therapy, more medical treatment by a physician, more group physiotherapy and sports. They would also have liked more breaks. In general fewer psychological elements, less discussion and reflection but more physical activity was wished for. Little difference was found between the various diagnoses, but the program was rated slightly more positively by the patients with spondylarthropathies. CONCLUSION: Overall, the great number of people participating in the program and their acceptance of the booster week are positive. Patients appreciated the group setting and the possibilities of exchanging experience on a high level. But it was difficult to change patients' traditional expectations concerning medical rehabilitation to a behaviour-orientated course like ours. It is worth thinking about whether this concept should play a greater role in traditional medical inpatient rehabilitation programming.

Adult↗
PubMed2003

[The BASDAI-D--an instrument to defining disease status in ankylosing spondylitis and related diseases].

OBJECTIVE: Translation and validation of the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI) for defining disease status in ankylosing spondylitis (AS) and related diseases. METHODS: The German version BASDAI-D was translated with only a few modifications. It contains six 10 cm horizontal visual analog scales to measure severity of fatigue, spinal and peripheral joint pain, tenderness and morning stiffness. A total of 318 patients with AS and other spondarthropathies completed the instrument at the beginning and at the end of their medical rehabilitation. Psychometric evaluation was performed separately for patients with AS corresponding to the modified New York Criteria ( SPA-NY, N=211) and for a second group of patients, which fulfilled the early diagnostic criteria for AS or the ESSG criteria of spondylarthropathies (Fd/Spond., N=86). RESULTS: SPA-NY: Factor analysis yielded one factor explaining 54.8% of variance. The sum score with a standard deviation of 1.94 is nearly symmetrical distributed with mean of 4.7. Reliability analysis yielded high internal consistency (Cronbach's alpha=0.83). Corrected item-total correlations are also high and are large ranging from 0.48 to 0.71. Concerning concordant validity the BASDAI-D showed a substantial correlation with the scale bodily pain of the SF 36 (r = -0.72). There are no correlations with objective clinical parameters. Furthermore the assessment of disease activity by the physician correlates significantly, albeit low with the BASDAI-D. Sensitivity to change yields effect sizes up to 0.60. Fd/Spond.: The results for this group are almost identical with SPA-NY (one factor explaining 53.8% variance, mean 4.6+/-1.75; corrected item-total correlations from 0.50 to 0.75; correlation with the scale bodily pain r = -0.62). Analysis for subgroups showed higher scores for women in both groups SPA-NY and Fd/Spond. CONCLUSION: BASDAI-D ist applicable for patients with AS and likewise for patients fulfilling the early diagnostic criteria for AS or the ESSG criteria of spondylarthropathies. In summary, BASDAID is reliable and valid. Because of its good acceptance and usability BASDAI-D is easy to use in research as well as in clinical practice.

Activities of Daily Living↗
PubMed2003

[Patient education in rheumatology-an overview].

Patients with rheumatic diseases need a comprehensive and interdisciplinary treatment. In this context patient education takes the part to lead patients to a better self-management. The goals of patient education are the increase of knowledge and introspection, the positive influencing of attitudes and self-efficacy and in addition the improvement of disease or health behavior. It is well known that the necessary change of behavior is hard and depends on various conditions. The study group "patient education" of the German Society of Rheumatology had developed several education programs, the methods and topics of which are based on behavioral science. These programs are topic centered and close to patients' needs. Their efficacy has been proved on different levels, economic advantages have been shown. At present these programs are mostly used for inpatients. Since there is no payment to implement these programs for outpatients, alternative ways are necessary.

Germany↗
PubMed2003

[Costs and benefits of an education program for patients with ankylosing spondylitis as part of an inpatient rehabilitation programs-study design and first results].

The economic evaluation of a patient education program "ankylosing spondylitis"-based on a randomised controlled prospective multi-center study design-compares program costs and savings in direct and indirect follow-up costs. The collection of health services and cost data was conducted by questioning staff (education programme costs) and patients (follow-up costs). The present study results are: program costs per patient range between 117 euro (10 participants per course) and 186 euro (6 participants per course). Savings in indirect costs (unfitness to work) amount to 2500 euro and thus overcompensate program costs. Currently patient data are verified by sickness fund data and direct follow-up costs and qualitiy of life data are analysed.

Cost Savings↗
PubMed2003

[Qualification via training courses].

Patient education includes cognitive parts as well as coping aspects and learning new skills. Therefore it is necessary to prepare the interdisciplinary training team for their tasks. The German Society of Rheumatology offers special training courses for these tasks. The training courses are divided into a basic seminar and a seminar for special education programs. The basic seminar will mediate knowledge and increase skills used in patient education. Conceptions, effectiveness and advantages are shown. Information and experiences specially mixed with exercises in the areas of communication, group dynamics and adult education take place. In the seminar for special education programs information about this program and its specific problems is given. In addition participants have the possibility to discuss their experiences.

Certification↗
PubMed2002

[Basic principles in rheumatologic patient education. Theoretical principles and didactic aspects].

Nowadays, the handling of a chronic disease is seen as a process, influenced by a variety of factors. Case studies, taken from health behavior, help to illustrate the conduct of patients suffering from chronic diseases and develop strategies of how to increase a patient's skills in coping with his illness. The concept of self-efficacy beliefs is of great importance and will be discussed in detail. In addition, possible effects of patient education in the comprehensive treatment of rheumatic diseases will be presented. In teaching methods, equal emphasis is placed on the transmission of information as on the development of practical know-how. They are on a par with emotional support, motivation, assistance in accepting the disease and coping with fear. The special methods and media required will be discussed, along with the framework for training methods and qualification required of the staff in charge of training.

Adaptation, Psychological↗
PubMed1998

[Quality management in rheumatologic rehabilitation at a time of structural change].

Quality assurance in rehabilitation of rheumatic diseases follows two programs, one developed by VDR (Verband Deutscher Rentenversicherungsträger) and the other developed by DGRh (Deutsche Gesellschaft für Rheumatologie). After introducing Total Quality Management to a rehabilitation center quality measurably increased. This improvement has been achieved by goal-directed steps and modification of clinical structures. Up to now patients' needs and the revision of in-patient treatment have been the central part af these activities. By organizing several special training courses staff has become more content and qualified. New forward-looking perspectives have been worked out in cooperation with other partners.

Forecasting↗