[Sensitivity and specificity of the PHQ-9 for identifying suicidality in medical rehabilitation]. / Sensitivität und Spezifität des PHQ-9 zur Identifikation von Suizidalität in der medizinischen Rehabilitation.

PURPOSE: Suicidality is rarely assessed in patients treated in German rehabilitation centers, although individuals with physical and mental impairments have an increased risk for suicidality. The item 9 of the 9-item depression module of the Patient Health Questionnaire (PHQ-9) asks about the desire to be dead or to harm oneself and could be used as a possible screening for suicidality. The Columbia Suicide Severity Rating Scale (C-SSRS) is a standardized interview to assess suicidality. We assessed the prevalence of suicidality in orthopedic and cardiac rehabilitation using the C-SSRS and the PHQ-9, examined the diagnostic accuracy of the item 9 of the PHQ-9 and of the PHQ-9 total score for identifying suicidality and surveyed the acceptance of the suicidality assessment by the rehabilitants. METHODS: Study participants were screened with the PHQ-9 and subsequently interviewed using C-SSRS. Sensitivity and specificity of the item 9 of the PHQ-9 and the PHQ-9 total score were tested for the presence of suicidality assessed with the C-SSRS and in a sensitivity analysis for the presence of nonspecific active suicidal ideation (item 2 of the C-SSRS). We calculated the area under the curve (AUC) to predict the ability of the PHQ-9 to discriminate between individuals with and without acute suicidality. Screening and interview were evaluated by the rehabilitants. RESULTS: Among 405 study participants, the prevalence of acute suicidality measured by the C-SSRS was 0.5%. 4% reported nonspecific active suicidal ideation on the C-SSRS. 10.4% reported suicidal ideation on item 9 of the PHQ-9. The sensitivity of item 9 and the PHQ-9 total score for identifying acute suicidality was only 50.0% (95% CI: 1.3% to 98.7%). However, item 9 was sensitive (81.3%, 95% CI: 54.4% to 96.0%) and specific (92.5%, 95% CI: 89.5% to 95.0%) for identifying nonspecific active suicidal ideation. Estimators for sensitivity were highly uncertain because of the low prevalence of acute suicidality. Addressing suicidality was rated as useful and helpful by study participants. CONCLUSION: If the response to item 9 is positive, the immediate risk of suicide is low. However, PHQ-9 is suitable for identifying patients with non-specific suicidal thoughts. A conspicuous score on the item 9 of the PHQ-9 should be further clarified by a psychotherapist.

Cognitive-behavioral rehabilitation in patients with cardiovascular diseases: a randomized controlled trial (CBR-CARDIO, DRKS00029295).

BACKGROUND: Depression, generalized and cardiac anxiety, and posttraumatic stress disorder negatively affect disease severity, participation, and mortality in patients with cardiovascular disease. Psychological treatments within cardiac rehabilitation may improve the outcomes of these patients. We therefore developed a cognitive-behavioral rehabilitation program for patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion. In Germany, similar programs are well established in musculoskeletal rehabilitation and cancer rehabilitation. However, no randomized controlled trials have evaluated if such programs achieve better outcomes in patients with cardiovascular disease compared with standard cardiac rehabilitation. METHODS: Our randomized controlled trial compares cognitive-behavioral cardiac rehabilitation with standard cardiac rehabilitation. The cognitive-behavioral program complements standard cardiac rehabilitation with additional psychological and exercise interventions. Both rehabilitation programs last for four weeks. We enroll 410 patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion aged 18 to 65 years. Half of the individuals are randomly assigned to cognitive-behavioral rehabilitation and the other half to standard cardiac rehabilitation. Our primary outcome is cardiac anxiety 12 months after the end of rehabilitation. Cardiac anxiety is assessed with the German 17-item version of the Cardiac Anxiety Questionnaire. Secondary outcomes cover outcomes assessed by clinical examinations and medical assessments and a range of patient-reported outcome measures. DISCUSSION: This randomized controlled trial is designed to determine the effectiveness of cognitive-behavioral rehabilitation at decreasing cardiac anxiety in patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00029295, June 21, 2022).

[General Practitioner Centered Rehabilitation Aftercare for Chronic Back Pain]. / Hausarztzentrierte Rehabilitationsnachsorge bei chronischen Rückenschmerzen.

BACKGROUND: Back pain is one of the most common and costly health disorders in Germany. Rehabilitation measures for back pain often show a lack of long-term effects after rehabilitation treatment. The "Neues Credo" aftercare concept has proven to be promising in increasing the long-term effects. In the current study, it was piloted and evaluated in general practitioners' practices. METHODS: A prospective observational study was carried out. Nine orthopedic rehabilitation clinics and N=178 general practitioners were involved in the aftercare. The intervention was evaluated by means of written surveys of 85 rehabilitation patients with chronic back pain at 3 points in time. The outcomes were functional capacity and participation; the secondary outcomes were subjective health and physical activity. The long-term effects were evaluated by analyses of variance with repeated measurements. RESULTS: At the end of the rehabilitation, the main outcome functional capacity shows a significant improvement of small magnitude, all secondary outcomes show significant medium to large effects. During the follow-up period, the participants were able to significantly increase their physical activity. Especially with respect to endurance training and workout. Twelve months after rehabilitation, significant improvements can still be seen in all outcomes. The range of parameters describing effect size are below the usual thresholds for clinically important changes. CONCLUSION: Rehabilitation aftercare like the program "Neues Credo" shows similar lasting effects when supported by the general practitioner instead of the rehabilitation clinic. The successes decrease somewhat 12 months after the rehabilitation, but we still see significant differences in all outcomes compared to baseline. There is a high satisfaction with the program by rehabilitants and general practitioners. Since general practitioners are the first contact after rehabilitation a transfer of the program into routine care would be promising.

ReNaApp: increasing the long-term effects of oncological rehabilitation through an application after medical rehabilitation (ReNaApp): a quasi-randomized longitudinal study of prospective design.

BACKGROUND: Breast cancer is the most common malignant disease in women. Compared with other cancer types, breast cancer has a higher survival rate. The majority of breast cancer patients are overstrained to implement cancer-specific recommendations relating to changes in health behaviour. Numerous epidemiological studies have shown a positive correlation between physical activity and quality of life as well as the course of disease during and after breast cancer treatment. However, many patients have difficulties integrating physical activity into their everyday lives due to cancer symptoms. To develop physical activity into a daily routine, an aftercare programme for breast cancer patients will be developed. In particular, the programme is structured in terms of the validated concept "Neues Credo". The basic concept is converted into a mobile application. METHODS: The study sample includes n = 740 rehabilitants (370 for the intervention group and for the control group) from five different rehab clinics in Northern Germany. The evaluation is as follows: a) Quasi-randomized, prospective longitudinal study (sequential study design). The intervention group receives a mobile application after rehabilitation, and the control group receives treatment as usual. The study evaluation is carried out through a questionnaire at three stages (at the beginning of the rehabilitation, at the end of the rehabilitation, and after 12 months). b) Qualitative analysis of interviews and focus groups in terms of feasibility and acceptance. c) Formative evaluation of the app. DISCUSSION: Above all, the aftercare programme ReNaApp increases the long-term effects of oncological rehabilitation. By documenting physical activity in ReNaApp, rehabilitants become more motivated to engage in physical activity in their everyday lives. Currently, there is no scientifically evaluated app for breast cancer patients in the German language. Thus, ReNaApp ensures an aftercare treatment for breast cancer patients with high-quality performance regardless of their place of residence. By adopting a participatory approach and a user-centred design, ReNaApp corresponds to the demands of the rehabilitants. TRIAL REGISTRATION: German Register of Clinical Trials, www.drks.de. Identifier: DRKS00019017; Registered: November 7th, 2019. Date and version identifier: April 17th 2020; vesion 2.