[Implementation of a Behavioral Medicine Oriented Concept in Cardiological Rehabilitation]. / Implementierung einer Verhaltensmedizinisch Orientierten Rehabilitation in der Kardiologie.

This study examined the implementation of a behavioral medicine oriented rehabilitation concept in a cardiological rehabilitation clinic. Psychotherapeutic interventions were based on an Acceptance and Commitment Therapy framework. Participants were treated in a behavioral cardiac rehabilitation program (BCR; n=149), or in a conventional cardiac rehabilitation program (CCR, n=100). We tested and compared the reach of the targeted group, the fidelity of the concept implementation in the BCR, as well as the completeness of the intervention (dose delivered) and the patient-reported behavioral medical treatment dose (dose received). Changes from beginning of rehabilitation until discharge with regard to mental and physical performance were assessed in both groups. BCR-patients were more impaired than CCR-patients, and they confirmed more behavioral medical content, a higher consistency of the behavioral medical strategy and a stronger gain of competence. Adherence ratings indicated a largely accurate implementation of the intervention. In both groups, depression, somatization, anxiety, heart anxiety, exercise self-efficacy expectation, and maximum power in bicycle ergometry improved statistically significant from admission to discharge. Large or nearly large effect sizes were found for avoidance behavior (d=0.78), somatization (d=0.82), depression (d=0.76), anxiety (d=0.72) and performance in bicycle ergometry (d=0.86) in the BCR. A further evaluation by means of a randomized controlled trial should follow this implementation study.

Body Image in Patients with Marfan Syndrome.

This study aimed to assess body image impairments of individuals with Marfan syndrome and to determine to what extent psychological, physical, and sociodemographic factors influence body image. We assessed the physical fitness and psychosocial health of 42 patients with Marfan syndrome at the beginning of an inpatient rehabilitation program. All participants filled out a body image questionnaire consisting of two scales: (1) Negative Body Evaluation and (2) Vital Body Dynamics. We compared body image data of the study sample with the German representative norming sample and carried out two separate regression analyses in order to determine which variables were associated with the two dimensions of patients' body image. Body image of individuals with Marfan syndrome appeared to be significantly impaired, with high percentile ranks for Negative Body Evaluation (women = 88, men = 91) and low percentile ranks for Vital Body Dynamics (women = 11, men = 4). Vital Body Dynamics was predicted by age (p = 0.016) and by depression (p < 0.001), and Negative Body Evaluation was predicted by anxiety (p = 0.001). Body image in individuals with Marfan syndrome is not primarily determined by objective measures of fitness or by objective cardiac impairment but by psychological variables like depression and anxiety and by age. This finding can inform treatment and rehabilitation concepts. Accepting Marfan syndrome, including the acceptance of being visually different, may not only demand medical treatment and physical rehabilitation but also psychological treatment for depression and anxiety.

Inpatient rehabilitation for adult patients with Marfan syndrome: an observational pilot study.

BACKGROUND: Advances in medical, interventional and surgical treatment have increased average life expectancy of patients with congenital heart defects. As a result a new group of adult patients with congenital cardiac defects requires medical rehabilitation. Patients with Marfan syndrome (MFS) are a relevant group among these patients. So far, no reports on the effectiveness of specialized rehabilitation programmes for MFS patients exist. We implemented an inpatient 3-week rehabilitation program for MFS patients at the Muehlenberg-Clinic for rehabilitation and assessed the medical safety as well as the impact of the program on physical fitness and psychological wellbeing of participants by means of an observational pilot study. The comprehensive multidisciplinary program included medical, physiotherapeutic, psychological and social issues. Two groups including 8 and 10 individuals with verified MFS attended the programme. Medically adverse events that occurred during the rehabilitation were registered. Adverse events were defined as: any new cardiac arrhythmias such as atrial fibrillation, ventricular tachycardia, cardiac syncope or any complications located at the aorta. Psychological assessment was performed using Short Form-36 (SF-36), hospital anxiety and depression scale and other psychometric questionnaires. Medical examinations included assessment of maximum power in bicycle ergometry. All assessments were performed at the beginning and at the end of the rehabilitation. Psychometric assessments were repeated 1 year after the end of the programme for both groups, respectively. RESULTS: Patients were highly satisfied with the programme and improved in almost all psychological and physical fitness assessments. The pre-post-comparison resulted in significant positive changes for mental health (p < .001 for SF-36 Mental Health), fatigue (p < .05 for Fatigue Severity Scale), nociception (p < .05 for SF-36 Pain) and vitality (p < .05 for SF-36 Vitality). Physical fitness improved from admission to discharge (p < .001 for maximum power in bicycle ergometry, p < .05 for maximum nordic walking distance). Considerable improvements persisted through 1 year follow-up. Medical assessments excluded medical problems or adverse events caused by participation in the programme. CONCLUSIONS: In our study, inpatient rehabilitation was both safe and helpful for MFS patients. They benefited in terms of physical fitness, health related quality of life and in terms of psychological wellbeing. An evaluation of the efficacy of the programme in a controlled design as well as further conceptual improvements of our current program is desirable.