ABSTRACT
BACKGROUND: Mental disorders are the main reasons for rising proportions of premature pension in most high-income countries. Although inpatient medical rehabilitation has increasingly targeted work-related stress, there is still a lack of studies on the transfer of work-specific interventions into work contexts. Therefore, we plan to evaluate an online aftercare program aiming to improve vocational reintegration after medical rehabilitation. METHODS: Vocationally strained patients (n = 800) aged between 18 and 59 years with private internet access are recruited in psychosomatic, orthopedic and cardiovascular rehabilitation clinics in Germany. During inpatient rehabilitation, participants in stress management group training are cluster-randomized to the intervention or control group. The intervention group (n = 400) is offered an internet-based aftercare with weekly writing tasks and therapeutic feedback, a patient forum, a self-test and relaxation exercises. The control group (n = 400) obtains regular e-mail reminders with links to publicly accessible information about stress management and coping. Assessments are conducted at the beginning of inpatient rehabilitation, the end of inpatient rehabilitation, the end of aftercare, and 9 months later. The primary outcome is a risk score for premature pension, measured by a screening questionnaire at follow-up. Secondary outcome measures include level of vocational stress, physical and mental health, and work capacity at follow-up. DISCUSSION: We expect the intervention group to stabilize the improvements achieved during inpatient rehabilitation concerning stress management and coping, resulting in an improved vocational reintegration. The study protocol demonstrates the features of internet-based aftercare in rehabilitation. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register (ISRCTN:ISRCTN33957202).
Subject(s)
Aftercare/methods , Inpatients , Internet , Occupational Diseases/rehabilitation , Occupational Therapy/methods , Research Design , Return to Work/psychology , Stress, Psychological/rehabilitation , Therapy, Computer-Assisted , Adaptation, Psychological , Adolescent , Adult , Clinical Protocols , Disability Evaluation , Germany , Humans , Mental Health , Middle Aged , Occupational Diseases/diagnosis , Occupational Diseases/psychology , Pensions , Retirement , Stress, Psychological/diagnosis , Stress, Psychological/psychology , Surveys and Questionnaires , Time Factors , Treatment Outcome , Young AdultSubject(s)
Attitude of Health Personnel , Documentation/standards , Hospital Records/standards , Medical Records Systems, Computerized/standards , Nursing Records/standards , Workload , Cooperative Behavior , Current Procedural Terminology , Diagnosis-Related Groups/standards , Germany , Guidelines as Topic , Humans , Interdisciplinary Communication , National Health Programs/standards , Quality Assurance, Health Care/standards , Reimbursement Mechanisms/standards , Relative Value Scales , Workload/standardsABSTRACT
Depersonalization (DP) and derealization (DR) are considered to be highly underdiagnosed. Therefore the development of screening instruments is important. From the Cambridge Depersonalization Scale (CDS) two items were extracted discriminating best patients with clinical significant DP from patients without DP. These two Items were assembled to a short version of the CDS. This short version (CDS-2) was tested in a sample of 38 patients with clinical significant DP-DR and 49 patients without or only mild DP-DR. Scores were compared against clinical diagnoses based on a structured interview (gold standard). The CDS-2 was able to differentiate patients with clinical significant DP well from other groups (cut-off of CDS-2>or=3, sensitivity=78.9%, specifity=85.7%) and also showed high reliability (Cronbachs alpha=0.92). Therefore the CDS-2 can be considered as a useful tool for screening and identification of DP-DR.
