[Evaluation of a basic educational program for patients with rheumatoid arthritis]. / Evaluation einer Basisschulung für Patienten mit rheumatoider Arthritis.

BACKGROUND: A new conceptual framework has enabled the flexible development of rheumatological patient educational programs for different healthcare settings. On this basis, a 5­h basic training program for patients with rheumatoid arthritis (RA) was developed to be used in specialized centers. Rheumatologists and psychologists were first trained and then the efficacy of the patient training program was evaluated based on the causal model of patient education. METHODS: The externally randomized waiting control group study with 249 RA patients included 3 measurement points. The impact of the 5­h basic training on disease and treatment-related knowledge as well as health competence of RA patients was examined. Secondary questions included attitudinal parameters, communication competence, effects on the disease and satisfaction with the educational program. Data were analyzed on an intention to treat basis by means of covariance analyses for the main target variables, adjusted for baseline values. RESULTS: The analyses showed that the training program was effective. Even 3 months after training, participants reported more knowledge and health competence than the waiting control group, with small to medium-sized effects (d = 0.37 and 0.38, respectively). With the exception of disease communication, no other effects of training were observed in the secondary objectives. CONCLUSION: The basic training program provides a good foundation to develop further interventions to improve attitudinal and disease parameters. It can serve as a central component for rheumatological healthcare for patients with RA at various levels.

[Flexible programs and advanced training for rheumatological patient education]. / Flexible Programme und Fortbildungen für die rheumatologische Patientenschulung.

In two research projects, rheumatological patient education programmes were updated. The first step was to develop an expert consented framework for all rheumatological patient education programmes. From this, curricula and working materials for rheumatoid arthritis (RA) and axial spondyloarthritis (AS) were derived and two exemplary patient education manuals developed. A randomized controlled trail was designed for the five-hour RA basic education program. Finally, existing train-the-trainer training courses were adapted for these patient education programmes.

Evaluation of a self-management patient education programme for fibromyalgia-results of a cluster-RCT in inpatient rehabilitation.

The objective was to evaluate the effectiveness of a self-management patient education programme for fibromyalgia syndrome (FMS) as compared with usual care education in inpatient rehabilitation. In a multicentre cluster-randomized controlled trial, 583 inpatients in 3 rehabilitation centres received an advanced self-management patient education programme or usual care education. Patients completed questionnaires at admission, discharge and after 6 and 12 months. Primary outcomes were disease- and treatment-specific knowledge at discharge, and self-management-competencies after 6 months. Secondary outcomes included satisfaction, attitudes, coping competencies, psychological distress and health impairment. We found a medium-sized effect on disease- and treatment-specific knowledge at discharge (P < 0.05, Cohen's d = 0.45, 95% CI = 0.27-0.63), and small effects for subjective knowledge, pain-related control, self-monitoring and insight, communication about disease, action planning for physical activity and treatment satisfaction (all P < 0.05). Only the effect on knowledge persisted for 6 and 12 months. This advanced education programme seemed to be more effective in the short term than usual education. However, intermediate- and long-term effects did not emerge. While superior long-term effects on knowledge as well as short-term effects on self-management skills may suggest implementation, additional long-term effects on other patient-relevant outcomes would be desirable. Trial registration: German Clinical Trials Register, DRKS00008782, Registered 8 July 2015.

[Evaluation of effectiveness of education in rheumatology : Recommendations according to a patient education model]. / Wirksamkeitsprüfung rheumatologischer Schulungen : Empfehlungen nach einem Wirkmodell der Patientenschulung.

Patient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.

Self-management education for rehabilitation inpatients suffering from inflammatory bowel disease: a cluster-randomized controlled trial.

Although inflammatory bowel disease (IBD) affects patients' psychological well-being, previous educational programs have failed to demonstrate effects on psychosocial outcomes and quality of life. Therefore, we developed a group-based psychoeducational program that combined provision of both medical information and psychological self-management skills, delivered in an interactive manner, and evaluated it in a large, cluster-randomized trial. We assigned 540 rehabilitation inpatients suffering from IBD (mean age 43 years, 66% female) to either the new intervention or a control group comprising the same overall intensity and the same medical information, but only general psychosocial information. The primary outcome was patient-reported IBD-related concerns. Secondary outcomes included disease knowledge, coping, self-management skills, fear of progression, anxiety, depression and quality of life. Assessments took place at baseline, end of rehabilitation and after 3 and 12 months.The psychoeducational self-management program did not prove superior to the control group regarding primary and secondary outcomes. However, positive changes over time occurred in both groups regarding most outcomes. The superior effectiveness of the newly developed psychoeducational program could not be demonstrated. Since the intervention and control groups may have been too similar, this trial may have been too conservative to produce between-group effects.

[EULAR recommendations for patient education of people with inflammatory arthritis. Translation and evaluation in Germany]. / EULAR-Empfehlungen für die Schulung von Patienten mit entzündlich-rheumatischen Gelenkerkrankungen. Übersetzung und Bewertung für Deutschland.

In 2015 EULAR published recommendations for patient education of people with inflammatory arthritis. The recommendations included two superior principles and eight recommendations based on the level of evidence and expert knowledge. The German translation of the recommendations was evaluated by 15 German experts. Experts graded the strength of the recommendations (SOR) on an 11 point numerical rating scale (from 0 = no agreement to 10 = total agreement). The mean score was 8,8 ± 0,49.

[Empowerment by patient education in rheumatology]. / Empowerment durch Patientenschulung in der Rheumatologie.

Due to the chronic course, rheumatic diseases may be associated with both long-lasting pain and movement limitations. Those afflicted by these disorders thus face continuous challenges regarding both adapting to their illness as well as changing their lifestyle habits, for example increasing the physical activity levels. However, patient education may provide patients with the competencies they need to cope with their illness and modify their behavior. Therefore, patient education programs are core elements of rehabilitation in rheumatology. The German Society for Rheumatology has performed pioneering work concerning conceptualization and evaluation of standardized educational programs. In this article some more recent developments and up to date standards for contents and didactics of self-management programs are presented. Empowerment may be considered the overriding aim of these programs, i.e. enabling patients to make informed decisions in situations where their health is involved. Patient-centered didactic methods as used in state of the art concepts mirror the empowerment approach. To foster sustainability of lifestyle changes, detailed planning of behavioral modifications is recommended, thus increasing the chance of transferring changes adopted during rehabilitation into everyday living. Such methods have been proven to be effective and are employed in the updated education concept for patients with fibromyalgia syndrome, which is described here as an example. The Centre for Patient Education offers support in updating and evaluating patient education concepts.

[Medical rehabilitation group-programmes concerning health promotion, patient education and psychoeducation - a 2010 national survey]. / Gruppenprogramme der Gesundheitsbildung, Patienten-schulung und Psychoedukation in der medizinischen Rehabilitation 2010 - Eine Bestandsaufnahme.

OBJECTIVE: High quality demands are being placed on concepts of educational group programmes in medical rehabilitation as well as the related trainer qualifications. A nationwide survey of German medical rehabilitation clinics in 2005 had revealed a need for improving educational practice according to these quality criteria. An updated investigation was performed in 2010 aiming at describing group programmes used in medical rehabilitation. METHOD: 1 473 inpatient and outpatient medical rehabilitation clinics were invited to participate. 908 clinics reported on their training programmes. Data from clinics caring for patients with somatic disorders could be compared to the 2005 survey. Data from clinics for both psychosomatic and substance abuse disorders was collected for the first time in 2010. RESULTS: Overall, psychologists and physicians were reported to be the most frequent conductors of educative programmes. In somatic clinics, psychologists, dieticians and occupational therapists or physiotherapists were the most common conductors. Two-thirds of the institutions reported no training prerequisites for staff members to perform patient education. 80% of the education programmes were categorized post hoc into 3 classes: "generic health education", "disorder-specific patient education", and "psychoeducational group programmes". Almost two-thirds of all programmes were carried out with 8-15 participants, and many used several interactive didactic methods. Programmes conducted in small groups (<8 participants) used significantly more interactive methods than those conducted in larger groups did (>15 participants). Only half of the programmes were manualized. Significantly more interactive methods were used in completely manualized programmes. Only about half of the programmes were evaluated, and only very few evaluation studies were published. The institutions wished additional support by workshops especially concerning qualification of their staff and concerning educational concepts. CONCLUSIONS: A need for further improvement and support exists relative to the training of educators and the development of manuals as well as evaluation and publication of the programmes.

[DGRW-update: patient education]. / DGRW-Update: Patientenschulung.

Patient education programmes, i. e. standardized, manualized, interactive group programmes aiming to increase self-management and empowerment, are a core element of medical rehabilitation for chronic conditions. In an update of the evidence of the effectiveness of patient education, its effectiveness was proven for a broad spectrum of chronic disorders, such as diabetes mellitus, chronic low back pain, rheumatoid arthritis, coronary heart disease, chronic heart failure, bronchial asthma, COPD, and cancer, as well as for the modification of health behaviours, such as diet and exercise. To sustain effects, aftercare interventions, such as support provided by phone, were found to be successful. Interventions targeted to particular patient groups according to gender, age, or migration background are also being developed more frequently. When evaluating educational interventions not only distal outcomes, such as quality of life and participation, should be used but also proximal outcomes such as self-management skills. A recent survey of patient education practice in medical rehabilitation revealed a continuing potential for optimization relative to manualization, evaluation and didactics. However, the dissemination of innovative programmes into rehabilitation routine presents a major challenge.

[Innovative concepts for patient education in medical rehabilitation]. / Innovative Schulungskonzepte in der medizinischen Rehabilitation.

Patient education aims to empower rehabilitants. While patient education has, in the past, been conceived of as providing solely information, modern self-management concepts now focus on both behavioral competencies and motivational factors. Participants receive all the skills and tools necessary to make informed decisions regarding both their health and lifestyles and to actively participate in the rehabilitation process. Accordingly, didactic methods have changed from predominantly vertical lectures to more patient-oriented and interactive approaches. Meta-analyses have proven that patient education is effective in improving the chronic conditions of patients. However, the implementation of modern concepts into routine care is still suboptimal. The Center of Patient Education, funded by the German Statutory Pension Insurance, has performed a survey of the present state of patient education within medical rehabilitation programs in Germany. Furthermore, quality criteria for patient education have been developed, an internet database presenting self-management programs in a systematic manner has been created, and various services designed to improve educational practice are being offered by the Center of Patient Education. Lastly, a state-of-the-art, self-management education program is described.

[Patient education: quality criteria in its implementation]. / Patientenschulung: Qualitätskriterien der Schulungsumsetzung.

Patient education has become increasingly important in medical rehabilitation in recent years. While educational programmes are often conducted under ideal circumstances during the developmental process, basic conditions may be less favourable in routine application on a daily basis. Therefore, quality requirements of patient education are needed. We have previously defined quality requirements regarding the conception of educational programmes and now propose quality criteria concerning the execution of patient education, with particular attention to inpatient medical rehabilitation of adult patients. In this report, both the procedure and the results of the process of criteria development are described. We obtained patient education experts' opinions regarding both dimensions and criteria of educational quality using the Delphi technique, which included a consensus group discussion. Final agreement was reached for eleven dimensions assessed with 59 criteria, covering the following domains: basic conditions of patient education; necessary qualifications of instructors; integration of patient education into the rehabilitation process; and quality management. The quality criteria proposed aim to increase the awareness of quality requirements and to provide a tool for improving the quality of patient education in medical rehabilitation.

[Patient education as a constituent of a patient-oriented approach in rehabilitation]. / Patientenschulung als Element der Patientenorientierung in der Rehabilitation.

Patient education is a central component of patient-oriented medical rehabilitation. The aim of patient education is to provide patients with the fundamentals of acting as competent partners in the rehabilitation process. Thus, the goals of educational group programmes are compliance, self-management, and empowerment, which are aspired by means of providing information, training skills, and modifying attitudes. According to expert opinions, such programmes should comply with certain minimum criteria regarding aims, methods, and frameworks, which can then be complemented by additional quality criteria. Furthermore, educational programmes should meet all the substantial requirements and standards of the respective medical area and exhibit proven effectiveness. A nationwide survey of rehabilitation institutions has shown that the implementation of patient education does not meet the quality requirements in all cases, particularly regarding patient-oriented didactics, standardisation, manual-use and evaluation. An additional quality feature is marked by the skills and qualifications of the educators. Instructors should be competent in leading and moderating groups and using various methods and media in order to fulfill the standards of modern educational concepts. As ample evidence has shown, patient participation and improved self-efficacy are indispensable when trying to promote healthy lifestyles in patients. Additional opportunities for enhancing patient orientation and optimizing patient education are provided by measures of behavioural planning and after-care as attempts to convey the behavioural changes in the patients' everyday lives.

[Patient education]. / Patientenschulung.

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.