Can an educational intervention in the context of inpatient pulmonary rehabilitation improve asthma self-management at work? A study protocol of a randomized controlled trial.

BACKGROUND: Asthma self-management (e.g., trigger avoidance or correct medication use) is a cornerstone of therapy. Its successful implementation in everyday working life is determined by psychosocial working conditions, in particular by support from superiors and colleagues and the job decision latitude (i.e., when and how to carry out which tasks). To empower individuals with asthma to modify their working conditions, employees need to use certain communication skills and acquire specific knowledge. Both could be taught as part of patient education during pulmonary rehabilitation. Therefore, the aim of the planned study is the development and multicentre implementation of an education module for individuals with asthma during their rehabilitation and to generate evidence on its effectiveness. METHODS: Participants (n ≥ 180) will be recruited, randomized into an intervention and a control group, trained and surveyed in two rehabilitation clinics. The intervention group will receive the supplementary patient education module "Asthma and Work" while the control group will participate in a program on " Eating behaviour" (both 2 × 50 min). The effectiveness of the intervention will be examined based on pre-post measurements (T1 and T2) and a 3-month follow-up (T3). We will consider behavioural intention (T2) and asthma self-management at work (T3) as primary outcomes. Secondary outcomes will include self-management-related knowledge, self-efficacy, number of sick days, number of exacerbations, asthma control (Asthma Control Test), asthma-related quality of life (Marks Asthma Quality of Life Questionnaire), and subjective employment prognosis (Brief Scale Measuring the Subjective Prognosis of Gainful Employment). The pre-post comparisons are to be evaluated using univariate analyses of covariance. DISCUSSION: Improving asthma self-management at work could increase the work ability and social participation of employees with asthma. This could reduce costs, e.g. in terms of asthma-related sick leave. TRIAL REGISTRATION: German Clinical Trials Register (ID: DRKS00031843).

[Effects of pulmonary rehabilitation on dysfunctional respiratory patterns in patients with uncontrolled asthma]. / Effekte der pneumologischen Rehabilitation auf dysfunktionale Atemmuster bei Patienten mit unkontrolliertem Asthma.

PURPOSE: Dysfunctional breathing patterns (DAM) are deviations from physiologic breathing patterns. DAM seem to be associated with lower asthma control. To date, it is unclear what effect inpatient rehabilitation can have on this problem. The aim of this work is to investigate the effect of pulmonary rehabilitation (PR) on DAM. METHODS: The data are based on a randomized controlled trial with a waiting control group. The intervention group (IG) received PR 4 weeks after application approval and the control group (KG) after 5 months. Dysfunctional breathing was assessed by Nijmegen-Questionnaire (NQ). Values ≥ 23 points indicate an existing DAM. Values at the end of rehabilitation (T2) and after three months (T3) were compared (analysis of covariance). Supplemental moderator analysis was performed to examine whether the effect of PR was related to baseline NQ scores. RESULTS: Significant differences in NQ score are found between IG (n=202) and KG (n=210) at T2 (AMD=10.5; 95%CI [9; 12]; d=1.4; p<0.001) and at T3 (AMD=5.8; 95%CI [4.3; 7.3]; d=0.8; p<0.001). There is an interaction effect between the difference in NQ score between the groups at T2 and baseline at T0 (b=5.6; 95%CI [2.2; 11.9]; p<0.001). At T3, this interaction effect was no longer detectable (b=4.5; 95%CI [-3.1; 14.1]; p=807). CONCLUSION: Inpatient, multimodality, and interdisciplinary PR is associated with significant and clinically relevant improvement in DAM both at discharge and 3 months later. In the short term, patients with existing DAM benefit more from PR than patients without DAM.

[Patient-Reported Outcomes (PROs) 3 and 6 Months After Pulmonary Rehabilitation Following COVID-19]. / Patient-Reported Outcomes (PROs) 3 und 6 Monate nach pneumologischer Post-COVID-Rehabilitation.

PURPOSE: If COVID-19 disease sequelae also (co-)affect the respiratory organs, national and international guidelines recommend pulmonary rehabilitation (PR). So far, however, no studies are available from Germany on the course after PR, nor on possible course differences between the two Long COVID subgroups "Ongoing symptomatic COVID-19" and "Post-COVID-19 syndrome" (PCS). METHODS: In a prospective observational study, patient-reported outcomes (PROs) regarding exertional dyspnea, quality of life, pain, fatigue, depression, and anxiety were assessed at the beginning of PR (T1), end of PR (T2), and after 3 (T3) and 6 months (T4). Statistical analyses were performed using latent difference models. RESULTS: There were 224 rehabilitation patients (MAge=54.4; SDAge=10.4; 42.0% female) included in the study. During PR, all PROs improved significantly. After PR, improvements either persisted with large pre-post effect sizes (exertional dyspnea, quality of life), decreased slightly to small pre-post effect sizes (depression, fatigue), or decreased to baseline levels (anxiety, pain). PCS patients had greater burdens in depression, fatigue, and pain at baseline, but did not differ in trajectories. Indicators of the severity of the preceding acute phase (oxygen therapy, ICU treatment, ventilation) were associated with higher burdens at T0 in depression, fatigue, and pain, but not with the courses during and after PR. In contrast, female patients showed higher burdens in both depression and fatigue at T1 and higher pre-post effects than male patients. CONCLUSION: The fact that improvements in PROs occurred in both subgroups only during PR, but not during the follow-up period suggests that the changes are not due to the natural healing process but at least partly due to PR. Moreover, the results suggest that both patient groups may benefit from PR. Persisting improvements in exertional dyspnea and quality of life and, to a reduced extent, in depression and fatigue until 6 months after PR, but not in pain and anxiety warrant study of additional multimodal interventions that may be needed to maintain these effects.

Causes and Risk Factors for Absenteeism among Medical Staff in German Specialized Lung Clinics during the COVID Pandemic.

BACKGROUND: Staff shortages pose a major challenge to the health system. OBJECTIVES: The objective of this study was to clarify the role of different causative factors we investigated on staff absenteeism during the COVID pandemic. METHODS: The prospective multicentre cohort study assessed the private and professional impact of the pandemic on health care workers (HCWs) using a specially developed questionnaire. HCWs from 7 specialist lung clinics throughout Germany were surveyed from December 1 to December 23, 2021. The current analysis addresses pandemic-related absenteeism. RESULTS: 1,134 HCW (55% female; 18.4% male, 26.3% not willing to provide information on age or gender) participated. 72.8% had received at least one vaccination dose at the time of the survey, and 9.4% reported a COVID infection. Of those with positive tests, 98% reported home quarantine for median (IQR) 14 (12-17) days; 10.3% of those who ultimately tested negative also reported quarantine periods of 14 (7-14) days. 32.2% of vaccinated respondents reported absenteeism due to vaccine reactions of 2 (1-3) days. Overall, 37% (n = 420) of HCW reported pandemic-related absenteeism, with 3,524 total days of absenteeism, of which 2,828 were due to illness/quarantine and 696 to vaccination effects. Independent risk factors for COVID-related absenteeism ≥5 days included already having COVID, but also concern about long-term effects of COVID (OR 1,782, p = 0.014); risk factors for vaccine-related absenteeism ≥2 days included concerns of late effects of vaccination (OR 2.2, 95% CI: 1.4-3.1, p < 0.000). CONCLUSION: Staff shortages due to quarantine or infections and vaccine reactogenicity have put a strain on German respiratory specialists. The fact that staff concerns also contributed to absenteeism may be helpful in managing future pandemic events to minimize staff absenteeism.

Negative association between fatigue and signs of sleep apnoea in patients after COVID-19.

Compared to the general population, there are increased apnoea-hypopnoea indices in patients recovering from #COVID19, yet there is a negative correlation to symptoms of fatigue and no significant correlation to daytime sleepiness https://bit.ly/3pEl9C8.

Psychometric evaluation of the German version of the Brief Reflective Functioning Interview.

OBJECTIVES: To measure mentalization in a feasible manner, various instruments have been designed in recent years. The Brief Reflective Functioning Interview (BRFI) is a short interview that is based on the Adult Attachment Interview (AAI). The aim of both studies was to examine the psychometric properties of the German version of the BRFI and to compare them to those of the AAI. METHODS: In Study 1, we examined 60 students using the BRFI and the AAI. In Study 2, the validity of the BRFI was examined using a mixed sample of students and patients (N = 149). Trained coders evaluated the Reflective Functioning Scale (RFS) for the BRFI and the AAI. RESULTS: We found a significant positive correlation between the RFS total scores of the BRFI and those of the AAI. In addition, both interviews showed excellent internal consistency. We could also show that persons with mental disorders exhibit lower levels of RF score than mentally stable individuals. Women had higher RF scores in the BRFI than men in both samples. Persons whose mentalization capacity was rated below average in either the BRFI or the AAI also reported significantly lower mentalization ability in the self-assessment (p < .01). CONCLUSIONS: Our results revealed that the RFS scores measured by the BRFI are highly comparable to those measured by the AAI. Our findings support the results of previous studies, suggesting that the BRFI is a reliable, valid and easy-to-administer alternative to the AAI. PRACTITIONER POINTS: The German version of the Brief Reflective Functioning Interview (BRFI) proved to be a reliable and valid instrument for the assessment of reflective functioning that is shorter in terms of time to complete and the evaluation process than the measurement via the Adult Attachment Interview (AAI). Reflective functioning is negatively associated with psychopathology.

Effectiveness of a Three-Week Inpatient Pulmonary Rehabilitation Program for Patients after COVID-19: A Prospective Observational Study.

For COVID-19 patients who remain symptomatic after the acute phase, pulmonary rehabilitation (PR) is recommended. However, only a few studies have investigated the effectiveness of PR, especially considering the duration between the acute phase of COVID-19 and the onset of rehabilitation, as well as the initial severity. This prospective observational study evaluated the efficacy of PR in patients after COVID-19. A total of 120 still-symptomatic patients referred for PR after overcoming acute COVID-19 were asked to participate, of whom 108 (mean age 55.6 ± 10.1 years, 45.4% female) consented. The patients were assigned to three groups according to the time of referral and initial disease severity (severe acute; severe after interval; mild after interval). The primary outcome was dyspnea. Secondary outcomes included other respiratory disease symptoms, physical capacity, lung function, fatigue, quality of life (QoL), depression, and anxiety. Furthermore, patients rated the overall effectiveness of PR and their subjective change in health status. At the end of PR, we detected improvements with large effect sizes in exertional dyspnea, physical capacity, QoL, fatigue, and depression in the overall group. Other parameters changed with small to medium effect sizes. PR was effective after acute COVID-19 in all three groups analyzed.

[Smoking Cessation and Prescription of Ambulatory Exercise Training as Part of Pulmonary Rehabilitation in Germany]. / Tabakentwöhnung und Verordnung von ambulantem Lungensport im Rahmen der pneumologischen Rehabilitation in Deutschland.

PURPOSE: This survey was conducted on behalf of the German Respiratory Society (DGP) section 12. The aim was to assess the means of achieving tobacco cessation and prescription of exercise training on an outpatient basis after discharge from pulmonary rehabilitation clinic as part of aftercare of pulmonary rehabilitation programs in Germany. METHODS: We contacted all pulmonary rehabilitation clinics in Germany. Of the 67 clinics we identified, 62 fulfilled the inclusion criteria; 39 clinics (62.9 %) agreed to participate and returned the completed questionnaires. RESULTS: Each clinic rated ambulatory exercise training sessions as effective aftercare. In each case, slightly above 50 % of the sample informed their patients via standardized talks or information brochures. In 38.5 % of the clinics, ambulatory exercise in groups was provided as aftercare. The number of patients who received prescription for aftercare at the end of the rehabilitation program ranged between 0 % and 100 %. Only a quarter of the clinics had ever been asked by the funding organizations regarding the success rate of the exercise program. All clinics assessed the smoking status of their patients and explained the importance of tobacco abstinence to them. The percentage of smokers was estimated to be 33 %; 69.7 % of the clinics stated that the rehabilitation program included standardized talks regarding tobacco cessation and 61.5 % reported having therapeutic group meetings on a regular basis. Further treatment options included psychological counselling (89.7 %), nicotine replacement therapy (61.5 %), or varenicline (15.4 %). Aftercare was offered only in 10.3 % of the clinics. On average, the percentage of smokers who achieved tobacco abstinence during the rehabilitation program was 32 %. Only one clinic (2.6 %) had ever been asked by the funding organization regarding the success rate of the tobacco cessation program. CONCLUSION: This survey emphasizes that most of the pulmonary rehabilitation clinics in Germany have already achieved a good standard regarding tobacco cessation and exercise training programs for their inpatients; however, there are still areas of improvement as far as providing care after discharge from a rehabilitation clinic is concerned with regard to smoking cessation and prescription of ambulatory exercise training.

Increasing Mentalization to Reduce Maladaptive Defense in Patients With Mental Disorders.

Background: There are indications of associations between the ability to mentalize and psychological defense mechanisms. However, only a few studies have focused on these associations, and even fewer have included empirical analyses. In the present study, we aimed to fill this research gap by analyzing the link between the ability to mentalize and psychological defense mechanisms in patients with mental disorders. We examined whether changes in defense mechanisms are predicted by an increase in mentalization or whether such changes are only related to reductions in psychopathology and interpersonal problems. Methods: A clinical sample of N = 89 patients was studied during and after inpatient psychiatric rehabilitation. Repeated-measures analyses of variance were performed to determine changes in mentalization, psychological defense, psychopathology, and interpersonal problems over the course of therapy and post-treatment. Linear regression analyses were used to predict the change in defense patterns based on an increase in mentalization. Results: Maladaptive defense mechanisms were significantly reduced during inpatient therapy and remained low until follow-up, whereas neurotic and adaptive defense mechanisms did not change significantly. The results of the regression analyses indicated that mentalization played an important role in the reduction in maladaptive defense during and after inpatient rehabilitation for mental disorders, whereas reductions in psychopathology and interpersonal distress were only partially associated with a reduction in maladaptive defense. Conclusion: We conclude that mentalization is vital for reducing maladaptive defense mechanisms, which are commonly associated with mental disorders. In therapy, an increase in patients' capacity to mentalize may be a practicable approach to diminish maladaptive defense mechanisms.

Mentalization as Mediator between Adult Attachment and Interpersonal Distress.

BACKGROUND: The aim of this study was to investigate the mediating role of mentalization in the association between adult attachment and interpersonal problems. METHODS: The sample consisted of 89 patients with different types of mental disorders who were at the beginning of treatment in one of two medical centers. Both mediational analysis and path analysis were used to test the model. RESULTS: The proposed model revealed a good model fit. The data indicate that mentalization fully mediates the effect of attachment on interpersonal distress. Symptom severity proved to be a strong confounding variable that influenced all other variables and reduced existing effects. CONCLUSION: We conclude that both mentalization and symptom distress are key components in the association of adult attachment and interpersonal problems. Therefore, we recommend research on integrative psychotherapy concepts rather than unilateral approaches.

Improvements in mentalization predict improvements in interpersonal distress in patients with mental disorders.

OBJECTIVES: Associations between interpersonal problems and mentalization have rarely been investigated. In this study, we explored patterns of interpersonal problems, mentalization, symptom severity, and attachment during inpatient treatment and at follow-up. Additionally, we investigated whether mentalization predicts a decrease in interpersonal distress. METHOD: We analyzed time-series data from patients with mental disorders. Data were collected at the beginning and at the end of inpatient treatment, and approximately 6 months after discharge from hospital. RESULTS: Patterns of correlations were stable from admission to the hospital until follow-up. Treatment significantly increased the levels of mentalization and decreased the levels of interpersonal problems and symptom severity, whereas attachment was only partially targeted. Improvements in mentalization significantly predicted reduction in interpersonal distress at each point in time. CONCLUSION: Results revealed characteristic patterns of interpersonal problems, mentalization, symptom severity, and attachment. Mentalization was found to play a key role in the reduction of interpersonal distress.