[Psychological interventions in the rehabilitation of patients with coronary heart disease: summary of evidence and recommendations from systematic reviews and guidelines]. / Psychologische Interventionen in der Rehabilitation von Patienten mit koronarer Herzerkrankung: Zusammenfassung der Evidenz und der Empfehlungen aus systematischen Übersichtsarbeiten und Leitlinien.

OBJECTIVE: To summarize national and international evidence and recommendations for psychological interventions in the rehabilitation of patients with coronary heart disease. Background is a project for the development of evidence-based practice guidelines for psychological interventions in the rehabilitation of patients with coronary heart disease. METHODS: A systematic literature search in several databases and on the websites of professional associations was conducted in order to identify relevant reviews and guidelines. A handsearch was conducted in addition to the electronic search. Eligible publications were selected, and evidence for psychological interventions was extracted as well as recommendations relative to psychological diagnostics or interventions. RESULTS: 5 systematic reviews and 34 guidelines were included. Recommendations and (partially restricted) evidence from systematic reviews was found for the following psychological interventions: patient counselling and health education; screening and treatment of comorbid psychological disorders; occupational counselling; stress management; relaxation training; interventions for smoking cessation; interventions promoting appropriate nutrition and weight management; interventions enhancing sufficient, regular physical activity; interventions enhancing social support; specific interventions for women; involvement of family members or partners; discussion of sexual activity. DISCUSSION/CONCLUSION: For several psychological interventions in the treatment of patients with coronary heart disease we found empirical evidence from systematic reviews. For other psychological interventions, no empirical evidence from systematic reviews was found. The summary of guidelines shows that both in Germany and abroad, a number of psychologically grounded interventions are an inherent part of cardiac rehabilitation. However, many recommendations which refer to psychological diagnostics and interventions are not precise enough to guide psychological care of individual patients. In particular, there are no statements in many guidelines on which (psychological) treatments should be considered for which problems. Moreover, hardly any evidence or recommendations were found for specific interventions referring to special groups of patients (e.g., women, patients with low socio-economic status or migration background). Further research is needed in these respects in order to answer questions concerning the indication and effectiveness of such tailored interventions.

[Acceptance and practicability of the rehab therapy standards for rehabilitation after total hip and knee arthroplasty - findings of a user survey of the pilot version]. / Akzeptanz und Praktikabilität der Reha-Therapiestandards für die Rehabilitation nach Hüft- und Kniegelenks-Totalendoprothese (TEP) - Ergebnisse einer Anwenderbefragung zur Pilotversion.

Implementation of the pilot version of the rehab therapy standards for rehabilitation following total hip or knee replacement was accompanied by a user survey. This survey allowed rehab centres to comment on the standards and suggest changes.Early 2010 a total of 160 rehab centres that had treated at least 50 German Pension Fund insurees following total hip or knee replacement in 2008 received a written survey together with an overview of performance data according to KTL (Classification of Therapeutic Procedures), data that reflect the degree to which the centres had complied with the requirements of the therapy standards.69% of the centres returned the questionnaire. The centres included predominantly agreed that the rehab standards fulfil the quality attributes "scientific foundation (evidence)", "relevance for day-to-day work", "up-to-dateness", and "inter- and multidisciplinary development". There were no statistically significant differences between centres with previously high or low compliance with the requirements of the standards relative to the ratings given for these global quality criteria. Almost all responders considered comprehensiveness and structure of the standards adequate. Between 55 and 94% found that therapeutic procedures were sufficiently represented by the treatment modules. Minimum percentages of patients requiring the respective treatment were considered adequate for 8 out of 13 modules. Responders suggested restricting continuous passive motion to knee replacement. Psychological interventions were considered less important. Among the main reasons for non-adherence to therapy standards in 2008 were: coding problems, too high demands, contraindications, and shortage of staff. Implementation of the standards was associated with both positive and negative expectations on the part of the rehab centres; an issue raised in addition was the effort involved in internal restructuring.The results of the user survey show that the concept of the rehab standards and its implementation basically are accepted. Criticism had mainly concerned continuous passive motion and the need for psychological interventions. Coding problems should not be overrated since the underlying performance data referred to a period of time before the standards were implemented. General appraisal of the rehab standards was independent of previous performance. This emphasizes the weight of user feedback. The rehab standards already have been revised in light of the results of the user survey.