Effectiveness of rehabilitation for working-age patients after a total hip arthroplasty: a comparison of usual care between the Netherlands and Germany.

BACKGROUND: Postoperative rehabilitation after primary total hip arthroplasty (p-THA) differs between the Netherlands and Germany. Aim is to compare clinical effectiveness and to get a first impression of cost effectiveness of Dutch versus German usual care after p-THA. METHODS: A transnational prospective controlled observational trial. Clinical effectiveness was assessed with self-reported questionnaires and functional tests. Measurements were taken preoperatively and 4 weeks, 12 weeks, and 6 months postoperatively. For cost effectiveness, long-term economic aspects were assessed from a societal perspective. RESULTS: 124 working-age patients finished the measurements. German usual care leads to a significantly larger proportion (65.6% versus 47.5%) of satisfied patients 12 weeks postoperatively and significantly better self-reported function and Five Times Sit-to-Stand Test (FTSST) results. German usual care is generally 45% more expensive than Dutch usual care, and 20% more expensive for working-age patients. A scenario analysis assumed that German patients work the same number of hours as the Dutch, and that productivity costs are the same. This analysis revealed German care is still more expensive but the difference decreased to 8%. CONCLUSIONS: German rehabilitation is clinically advantageous yet more expensive, although comparisons are less straightforward as the socioeconomic context differs between the two countries. TRIAL REGISTRATION: The study is registered in the German Registry of Clinical Trials (DRKS00011345, 18/11/2016).

[Need for Action and Research in Psychosomatic and Orthopaedic Rehabilitation from the Point of View of Rehabilitants and Individuals who work in Rehabilitative Care]. / Handlungs- und Forschungsbedarf in der Psychosomatischen und Orthopädischen Rehabilitation aus der Sicht von Rehabilitand:innen und Mitarbeitenden in der Rehabilitation.

PURPOSE: The aim of this study was to assess the need for practical action and research in psychosomatic and orthopaedic rehabilitation from the perspective of rehabilitants and individuals who work in rehabilitative care. METHODS: The project was divided into an identification and a prioritization phase. In the identification phase, 3872 former rehabilitants, 235 employees from three rehabilitation clinics and 31 employees of the German Pension Insurance Oldenburg-Bremen (DRV OL-HB) were invited to participate in a written survey. The participants were asked to name relevant needs for action and research for psychosomatic and orthopaedic rehabilitation. The answers were evaluated qualitatively using an inductively developed coding system. Practical fields of action and research questions were formulated from the categories of the coding system. In the prioritization phase, the identified needs were ranked. For this purpose, 32 rehabilitants were invited to a prioritization workshop and 152 rehabilitants, 239 clinic employees and 37 employees of the DRV OL-HB to a two-round written Delphi survey. The resulting prioritized lists from both methods were combined into a top 10 list. RESULTS: In the identification phase, 217 rehabilitants, 32 clinic employees and 13 employees of the DRV OL-HB participated in the survey, in the prioritization phase, 75 rehabilitants, 33 clinic employees and 8 employees of the DRV OL-HB in both survey rounds of the Delphi survey, and 11 rehabilitants in the prioritization workshop. A need for practical action primarily in the implementation of holistic and individual rehabilitation, in quality assurance and in the education and participation of rehabilitants was identified, as also a need for research primarily on access to rehabilitation, structures in the rehabilitation setting (e. g., inter-agency cooperation), the design of rehabilitative interventions (more individualized, more suitable for everyday life), and the motivation of rehabilitants. CONCLUSION: The identified needs for action and research include many topics that have already been identified as problems in previous research projects and by various actors in rehabilitation. In the future, there needs to be increased focus on the development of strategies for dealing with and solving the identified needs, as well as on the implementation of these strategies.

[Occupational and Health Strains of Pensioners with Reduced Earning Capacity Due to Mental or Physical Illnesses - Implications for the Health Care System]. / Unterschiedliche berufliche und gesundheitliche Belastungen psychisch und körperlich erkrankter EM-Rentner*innen ­ Implikationen für das Gesundheitswesen.

OBJECTIVE: Demographic changes with an increasing number of people receiving pensions and a decreasing number of working people paying into the pension system represent major challenges for the German social security system. In particular, it is important to support people to continue working so that there is no (premature) reduction in their earning capacity and pensioners with reduced earning capacity (disability pensioners) should be helped to return to gainful employment. The aim of this study was to investigate the differing needs of two kinds of disability pensioners, namely those with mental illness and those who were physically ill. METHODS: A total of 453 persons receiving disability pension because of temporararily reduced earning capacity were interviewed over the telephone. Differences in demographic variables, occupational characteristics before applying for disability pension, and general resources were examined in descriptive analyses and multivariate analyses of variance with post-hoc tests. RESULTS: A third of the sample (33.1%) suffered from mental illness and the rest from somatic disorders. Those with mental illness reported higher perceived mental age, lower work-related self-efficacy, and lower quality of life concerning their mental health. Moreover, they reported higher levels of mental stressors at work. CONCLUSION: Mentally ill disability pensioners differ considerably from those with somatic illnesses. Accordingly, to promote a return to work, interventions need to target different factors in these two groups.

[Subjective Financial Resources of Temporary Disability Pensioners: Interrelation with Loneliness and Life Satisfaction]. / Gesundheit und Lebenszufriedenheit bei Erwerbsminderungsrentnern und -rentnerinnen: Die Bedeutung von finanziellen Ressourcen und Einsamkeit.

AIM OF THE STUDY: In Germany, a disability that prevents a person from fully participating in the labor market can partly be compensated for financially with temporary disability pension. Due to fewer financial resources, this group is at a higher risk of poverty, which in conjunction with a worse health status might be related to other limitations such as lower social participation, loneliness and reduced life satisfaction. This study examined the relationships between household income, subjective financial resources, loneliness and life satisfaction. METHODOLOGY: 199 former employees with current reduced earning capacity status were interviewed at 2 points in time (T1; T2=T1+approx. 8 months) by means of structured telephone interviews. RESULTS: Income was not related to loneliness or life satisfaction. However, lower perceived financial resources were associated with higher levels of loneliness, which in turn was related to lower life satisfaction. Loneliness partially mediated this relationship. A lower health status was associated with more loneliness and lower life satisfaction. CONCLUSION: Rehabilitative measures that teach money management skills and aim to overcome loneliness could improve the life satisfaction of people with reduced earning capacity. This is highly relevant, as other studies have shown a connection between life satisfaction and return to work as well as social participation.

[Attitudes toward psychotherapy in the general population]. / Die Einstellung zur Psychotherapie in der Allgemeinbevölkerung.

Attitudes towards psychotherapy are important predictors for the acceptance and usage of psychotherapy. A survey examined attitudes towards psychotherapy in a sample representative of the German population including 2089 persons between 14 to 92 years of age. Two thirds of the sample indicated a positive attitude towards psychotherapy. Men as well as individuals with lower education reported a more negative attitude towards psychotherapy than women and persons with higher educational level. Education had a medium effect size (d=0.44). Individuals with somatoform symptoms did not indicate a more negative attitude towards psychotherapy than the general population. Even though the majority of the population has a more positive attitude towards psychotherapy, this positive attitude does not apply for all groups of the -population.

[Psychological symptoms and body image in patients after surgery of congenital heart disease]. / Psychische Symptome und Körperbild bei Patientinnen und Patienten nach der Operation angeborener Herzfehler.

In the last 20 years the survival rate of patients with congenital heart disease has increased considerably, thus psychological consequences of living with a heart defect have attracted considerable scientific attention. In our study psychological symptoms and the body image of patients with congenital heart disease were compared with the respective scores of general population samples (age: 14 - 45 years). Psychological symptoms were measured by means of the Brief Symptom Inventory (BSI; subscales: somatization, obsessive-compulsive thoughts, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism). Body image was assessed with the FKB-20 body image questionnaire (subscales: rejection of the body, vitality). The patient group consisted of 361 women and men with congenital heart disease. For comparisons with the BSI, a sample of 1165 subjects was available. Comparisons with the FKB-20 were performed with data from a separate survey (N = 1169). After stratification for age and gender, in females only a few differences were found for both instruments. In males higher scores were obtained for "rejection of the body", and lower ones for "vitality". This does not apply to the highest age group (36 - 45 years). For all BSI-subscales except "depression", "phobic anxiety", and "psychoticism" marked differences between patients and controls were found in males and over all age groups. In women group differences emerged on some subscales (obsessive-compulsive thoughts, interpersonal sensitivity, anxiety, hostility, and phobic anxiety), but this does not hold for all age groups. These results do not apply to patients with the severest impairments due to congenital heart disease, because their number in our study was too low.

[Effects of psychosomatic interventions within the consultation service of a gynecological university hospital]. / Effekte psychosomatischer Interventionen im Konsildienst einer Universitätsfrauenklinik.

The influence of psychotherapeutic interventions on the long-term course of anxiety and depression of inpatients of a Gynaecological University Hospital was examined in a prospective naturalistic provision study. All patients admitted to hospital within a year were examined regarding anxiety and depression (HADS). The patients who had conspicuous values in their questionnaires were randomly assigned to an intervention or a control group. There was a follow-up examination for them one year after the first examination. In the first examination 715 participants took part, in the follow-up examination there were 429. Women with malignant gynaecological diseases suffer more severely from anxiety (t=7.02; p<0.001) and depression (t=3.87; p<0.001) in comparison with the normal population. Women suffering from general gynaecological (t=7.75; p<0.001) and obstetrical diseases (t=5.95; p<0.001) are significantly more anxious. Whereas the anxiety in patients with general gynaecological (F=3.02; p=0.031) as well as in patients with obstetrical diseases (F=3.52; p=0.017) can be reduced significantly in the long-term by psychotherapeutic interventions, depression cannot or only slightly be influenced. This shows that low-frequent psychotherapeutic interventions with psycho-educative, supportive approaches (e. g. in the framework of psychosomatic consultation and liaison service) have positive effects on anxiety in the long run, whereas depression is to be influenced rather by long-term interventions or classic depth-psychological or behaviour therapeutic interventions.

[Occupation of health care system because of body complaints by young people--results of a representative survey]. / Inanspruchnahme des Gesundheitssystems durch Jugendliche wegen körperlicher Beschwerden.

In a sample of adolescents between 14 and 25 years of age (n=266), drawn from a sample of 2089 representatively selected people, we found that a significant part of the adolescents suffers from physical complaints. The regions which were most frequently affected were head or face (33%), back (24%), and stomach (22%). We did not find significant influences of sociodemographic parameters like age, gender and residence on the prevalence of physical complaints in adolescents. Adolescents occupy the health care system frequently because of physical complaints. In comparison to adults, younger people suffer less from physical complaints and occupy the health care system significantly less often. It seems that somatoform complaints begin in young age, but that they do not reach their chronic form until adulthood. Early interventions are necessary to reduce individual suffering and to act in an economically responsible way.

[Utilization of the health care system due to somatoform complaints -- results of a representative survey]. / Inanspruchname des Gesundheitssystems wegen somatoformer Beschwerden--Ergebnisse einer bevölkerungsrepräsentativen Befragung.

OBJECTIVES: Utilization of the health care system is not determined by the presence of an organic illness, but by a multitude of interacting factors. This applies particularly to somatoform complaints and disorders, in the context of which the health care system is used very intensively and inadequately in relation to the disorder. The present paper summarizes the frequency of somatoform complaints in the general population and health care utilization due to these complaints. METHODS: On the basis of a survey carried out in 2002 for a representative population of 2089 persons (aged 14 to 92 years), the prevalence of somatoform complaints during a period of 2 years was determined. In this survey, physical complaints were defined as being somatoform when they seriously affected the person's well-being but exhibited a disparity between objective diagnostic findings and subjective experience. The psychosocial aspects were also determined. When somatoform complaints were identified, the specific utilization of the healthcare system for them was investigated. RESULTS: Somatoform complaints are very frequent in Germany: 8.3% of the population claim to suffer from clinically relevant somatoform disorders that fully meet the criteria mentioned above. The health care system is used heavily for these complaints. Within the last two years, each test person suffering from somatoform disorders consulted a physician a mean 18 times and was incapable of working for a mean of 20 days. 16% of these persons were hospitalized, 9 % received treatment at a health resort, 9 % retired, etc. DISCUSSION: The considerable utilization of health care services is an essential element of somatoform pathology and has immense medico-political relevance. The most important prerequisite for handling the 'commitment to health care system' symptom is thorough training of all physicians in the basics of somato-psycho-social medicine. This will be an important measure for cost reduction in the health care system.

Prevalence of somatoform pain complaints in the German population.

The prevalence of somatoform pain complaints was assessed in a representative sample of 2050 persons in Germany in the age range from 18 to 92 years by the Screening for Somatoform Symptoms questionnaire [57]. A high percentage of the study participants turned out to complain of serious somatoform pains. Most frequently, back pain (30.5%), joint pain, pain in the arms and/or legs (19.9%) and headache or facial pain (19.5%) were reported. Women complained of more somatoform pain symptoms than men. Pain was higher with an increasing age, lower education, lower income, rural residency, and residency in Eastern Germany. While the prevalence of somatoform pain is high, the majority of patients does not receive adequate psychotherapeutic care but is inadequately treated by somatic treatments.

[Symptom Checklist SCL-27]. / Die Symptom-Checkliste SCL-27 - Ergebnisse einer deutschen Repräsentativbefragung.

The Symptom-Checklist-27 (SCL-27) forms a modification of the widely used Symptom-Checklist-90-R, with the latter demonstrating considerable shortcomings in psychometric properties. The SCL-27 is designed to screen for psychiatric symptoms in patients presenting somatic complaints. It contains the six subscales depressive, dysthymic, vegetative, agoraphobic, sociophobic symptoms and symptoms of mistrust. Additionally, a global severity index (GSI-27), similar to the GSI in the SCL-90-R is available. The subscales are short, the number of items varies between four and six. Psychometric properties and reference values based on a representative German sample of more than 2000 subjects are presented for the various subscales. All subscales show sufficient internal consistency with Cronbach's alpha > or = 0.70 and for the GSI-27 alpha is = 0.93. The correlation between GSI-27 and GSI is r = 0.93. Sex-specific cut-offs are presented to identify those patients, who need further examination.

Quality of life in patients with malignant choroidal melanoma after radiotherapy.

BACKGROUND: Patient-orientated endpoints have attracted little attention in patients with malignant choroidal melanoma. This study was conducted to explore the long-term effects of malignant choroidal melanoma and radiotherapy on QOL by means of a differentiated and modular QOL approach, including global QOL, social support, and mental health, in comparison with sociodemographically matched healthy controls. METHODS: A random sample of 100 outpatients treated by radiotherapy were asked by mail to take part in a psychodiagnostic study [instruments: Short-Form 36 Health-Survey (SF-36), Symptom Checklist-90-Revised, German Social Support Questionnaire]. The same instruments were applied to a healthy control group, which was matched to patients with regard to age, gender, and vocational situation. RESULTS: 93 patients (average age 61.2 years) responded at an average of 5.5 years (+/-3.7) after diagnosis. Visual acuity in the affected eye decreased considerably from diagnosis (0.49+/-0.30) to participation in the study (0.09+/-0.21). Compared with healthy controls, patients reported on average statistically significantly lower global QOL (SF-36), whereas social support and mental distress did not differ. Frequencies of clinically relevant mental distress were significantly higher in patients than in controls (35.5% vs. 16.1%). Mental distress was associated with poorer visual acuity, but not with the extent of loss of visual acuity or number of follow-up treatments. CONCLUSION: Patients with choroidal melanoma suffer from low long-term global QOL, and every third patient suffers from relevant mental distress. Regular screening for mental distress should be implemented along with psychological counseling. Additional follow-up treatment does not seem to induce mental distress.

[Somatoform complaints in the German population]. / Somatoforme Beschwerden in der Bevölkerung Deutschlands.

The study presents the subjective responses of a representative sample of the German population (2050 subjects, aged 14 to 92 years) on the prevalence of somatoform complaints, using the SOMS (Screening for somatoform disorders) developed by Rief et al. (1997). The results show that somatoform disorders are widespread in the German population. The symptoms named most frequently were pains in the back, aching limbs, pains in the arms or legs, headaches, facial pains and sensations of fullness in the stomach. Women named more somatoform complaints than men and elderly suffered more than the young. The higher rate found in East Germany could be accounted for by the responses of the East German women. Of particular economic and political relevance is the health care utilization behaviour of this group of patients. High medical consultation frequencies and increasing drug consumption were found for a significant proportion of all patients with somatoform disorders. In apparent contradiction to these findings is the classification according to DSM-IV and ICD-10, which diagnose somatoform disorders in only 0.2%-0.4% of the population. Such low prevalence can be attributed to the restrictive diagnostic criteria applied by these systems which obscure the real frequency of somatoform syndromes requiring specific treatment.

[Utilization of the health system and acceptance of psychosocial professionals] / Inanspruchnahme des Gesundheitswesens und Akzeptanz psychosozialer Kompetenzen.

The study presents the results of a representative survey on the utilization of the health system and subjective attitudes to the psychosocial professions, based on the responses of 2179 subjects aged 16 to 96 years. The residents of Germany frequently seek medical and non-medical help in cases of illness or health-related problems. General practitioners are consulted most of all, but medical specialists also play a significant role. Women seek professional help more than men and the demand increases with age. Comparisons between West and East Germany reflect a few persistent qualitative differences. Doctors from the psychosocial fields (psychotherapists, psychiatrists) are consulted least of all. Utilization of psychotherapy is deficient, information about the existence of the psychosocial professions is poor and acceptance of their competence relatively low. However, the high proportion of those who have sought out a psychotherapist on the advice of a doctor demonstrates the high latent readiness to accept help in this field when needed. The particular responsibility of primary doctors in influencing attitudes here is thereby underlined.