Assessment and determinants of health care utilization among patients with musculoskeletal conditions undergoing outpatient rehabilitation in Germany

The overall objective of this doctoral thesis is to address some of the conditions necessary to routinely perform alongside economic evaluations of rehabilitation programs. The specific aims are to 1) present a standardized instrument to collect data about health care resource use, 2) identify major cost categories of direct medical costs to be used in comparative economic evaluations of subjects with musculoskeletal diseases and 3) identify determinants of direct medical costs among subjects with musculoskeletal diseases. This thesis is therefore subdivided into three parts. In the first part the development of a standardized instrument to collect health care resource use in the context of rehabilitation is described and lessons learned are discussed. In the next part major direct medical costs categories among patients with musculoskeletal conditions undergoing outpatient rehabilitation are identified. Lastly, the determinants of the direct medical costs as well as direct medical costs beyond the median incurred by chronic musculoskeletal patients are examined. Each of these parts contain a specific discussion section referring to its specific results

Assessment and determinants of health care utilization among patients with musculoskeletal conditions undergoing outpatient rehabilitation in Germany

The overall objective of this doctoral thesis is to address some of the conditions necessary to routinely perform alongside economic evaluations of rehabilitation programs. The specific aims are to 1) present a standardized instrument to collect data about health care resource use, 2) identify major cost categories of direct medical costs to be used in comparative economic evaluations of subjects with musculoskeletal diseases and 3) identify determinants of direct medical costs among subjects with musculoskeletal diseases. This thesis is therefore subdivided into three parts. In the first part the development of a standardized instrument to collect health care resource use in the context of rehabilitation is described and lessons learned are discussed. In the next part major direct medical costs categories among patients with musculoskeletal conditions undergoing outpatient rehabilitation are identified. Lastly, the determinants of the direct medical costs as well as direct medical costs beyond the median incurred by chronic musculoskeletal patients are examined. Each of these parts contain a specific discussion section referring to its specific results

Development of a metric for tracking and comparing population health based on the minimal generic set of domains of functioning and health

Merged planning photographs recording of Pits 1.4 and 1.5 [196] and [197] to south of building; facing west; linked as external references to excavation plan 'Thwing_4-2_excavation_plan.dwg

Rethinking Disability

Disability as a health outcome deserves more attention than it has so far received. With people living longer and the epidemiological transition from infectious to noncommunicable diseases as the major cause of health burden, we need to focus attention on disability - the non-fatal impact of heath conditions - over and above our concern for causes of mortality.With the first Global Burden of Disease study, WHO provided a metric that enabled the comparison of the impact of diseases, drawing on a model of disability that focused on decrements of health. This model has since been elaborated in the International Classification of Functioning, Disability and Health as being either a feature of the individual or arising out of the interaction between the individual's health condition and contextual factors. The basis of WHO's ongoing work is a set of principles: that disability is a universal human experience; that disability is not determined solely by the underlying health condition or predicated merely on the presence of specific health conditions; and finally, that disability lies on a continuum from no to complete disability. To determine whether interventions at individual or population levels are effective, an approach to disability measurement that allows for an appropriate and fair comparison across health conditions is needed. WHO has designed the Model Disability Survey (MDS)~to collect information relevant to understand the lived experience of disability, including the person's capacity to perform tasks actions in daily life, their actual performance, the barriers and facilitators in the environment they experience, and their health conditions. As disability gains prominence within the development agenda in the United Nations Sustainable Development Goals, and the implementation of the United Nations Convention on the Rights of Persons with Disabilities, the MDS will provide the data to monitor the progress of countries on meeting their obligations.The lesson learned from WHO's activities is that disability is a universal human experience, in the sense that everyone can be placed on a continuum of functioning and either currently experiences or is vulnerable to experiencing disability over the course of their lives. This understanding of disability is the key to mainstreaming disability within the public discourse

Can propensity score matching be applied to cross-sectional data to evaluate Community-Based Rehabilitation? Results of a survey implementing the WHO's Community-Based Rehabilitation indicators in Vietnam

OBJECTIVES Community-Based Rehabilitation (CBR) is a multi-sectoral approach working to equalise opportunities and include people with disabilities in all aspects of life. The complexity of CBR and often limited resources lead to challenges when attempting to quantify its effectiveness, with randomisation and longitudinal data rarely possible. Statistical methods, such as propensity score matching (PSM), offer an alternative approach to evaluate a treatment when randomisation is not feasible. The aim of this study is to examine whether PSM can be an effective method to facilitate evaluations of results in CBR when data are cross-sectional. DESIGN Cross-sectional survey. SETTING AND PARTICIPANTS Data were collected using the WHO's CBR Indicators in Vietnam, with treatment assignment (participating in CBR or not) determined by province of residence. 298 participants were selected through government records. RESULTS PSM was conducted using one-to-one nearest neighbour method on 10 covariates. In the unmatched sample, significant differences between groups were found for six of the 10 covariates. PSM successfully adjusted for bias in all covariates in the matched sample (74 matched pairs). A paired t-test compared the outcome of 'community inclusion' (a score based on selected indicators) between CBR and non-CBR participants for both the matched and unmatched samples, with CBR participants found to have significantly worse community inclusion scores (mean=17.86, SD=6.30, 95% CI 16.45 to 19.32) than non-CBR participants (mean=20.93, SD=6.16, 95% CI 19.50 to 22.35); t(73)=3.068, p=0.001. This result did not differ between the matched and unmatched samples. CONCLUSION PSM successfully reduced bias between groups, though its application did not affect the tested outcome. PSM should be considered when analysing cross-sectional CBR data, especially for international comparisons where differences between populations may be greater

Disability and recovery in schizophrenia: a systematic review of cognitive behavioral therapy interventions

Background: Schizophrenia is a disabling disease that impacts all major life areas. There is a growing need for meeting the challenge of disability from a perspective that extends symptomatic reduction. Therefore, this study aimed to systematically review the extent to which traditional and “third wave” cognitive – behavioral (CBT) interventions address the whole scope of disabilities experienced by people with lived experience of schizophrenia using the WHO’s International Classification of Functioning, Disability and Health (ICF) as a frame of reference. It also explores if current CBT interventions focus on recovery and what is their impact on disability domains.Methods: Medline and PsycINFO databases were searched for studies published in English between January 2009 and December 2015. Abstracts and full papers were screened against pre-defined selection criteria by two reviewers. Methodological quality of included studies was assessed by two independent raters using the Effective Public Health Practice Project Quality assessment tool for quantitative studies (EPHPP) guidelines.Results: A total of 50 studies were included, 35 studies evaluating traditional CBT interventions and 15 evaluating “third wave” approaches. Overall, traditional CBT interventions addressed more disability domains than “third wave” approaches and mostly focused on mental functions reflecting schizophrenia psychopathology. Seven studies met the inclusion criteria of recovery-oriented interventions. The majority of studies evaluating these interventions had however a high risk of bias, therefore evidence on their effectiveness is inconclusive.Conclusions: Traditional CBT interventions address more disability domains than “third wave” therapies, however both approaches focus mostly on mental functions that reflect schizophrenia psychopathology. There are also few interventions that focus on recovery. These results indicate that CBT interventions going beyond symptom reduction are still needed. Recovery-focused CBT interventions seem to be a promising treatment approach as they target disability from a broader perspective including activity and participation domains. Although their effectiveness is inconclusive, they reflect users’ views of recovery and trends towards improvement of mood, negative symptoms and functioning are shown

A systematic review of brief mental health and well-being interventions in organizational settings

Objectives The aim of the systematic review was to provide an overview of the evidence on the effectiveness of brief interventions targeting mental health and well-being in organizational settings and compare their effects with corresponding interventions of common (ie, longer) duration. Methods An extensive systematic search was conducted using the Medline and PsycINFO databases for the period of 2000-2016. Randomized-controlled trials (RCT) and quasi-experimental studies evaluating primary or secondary brief interventions carried out in the workplace settings were included. Subsequently, common interventions matching brief interventions by type and assessed outcomes were included. The methodological quality of included studies was appraised using NICE guidelines and the best evidence synthesis approach was applied. Results The review identified 11 brief interventions and 9 corresponding common interventions. Included studies varied substantially in sample size and characteristics, methodological quality, duration of follow-up, types of intervention, and assessed outcomes. All but one study evaluating brief interventions had high risk of bias. No evidence was found on the effectiveness of brief stress management, relaxation, massage, mindfulness meditation, or multimodal interventions. We found limited evidence on the effectiveness of brief positive psychology interventions. Conclusions Our review highlights the need for high-quality studies evaluating brief mental health and well-being interventions in organizational settings. Future studies should use methodologically rigorous designs and improved reporting of methods and results to provide conclusive evidence on the effectiveness and sustainability of the intervention effects

Can Participants' Characteristics Predict Benefit from a Multimodal Burnout Prevention Program? Secondary Analysis of a Randomized Controlled Trial Conducted in Germany

Chronic psychological distress appears to be increasing markedly among the working population. A recent randomized controlled trial (RCT) supported the effectiveness of a three-week outpatient burnout prevention program-comprised of stress management interventions, relaxation, physical exercise, and moor baths followed by massage-in reducing perceived stress and emotional exhaustion. However, the effectiveness of treatments in the real world that were shown to be efficacious in RCTs is related to the appropriate selection of individuals who are most likely to yield sustainable gains. Therefore, factors predicting the intensity of response and nonresponse of individuals to treatment are of interest. This secondary data analysis aims to explore predictors of response to the outpatient burnout prevention program in a sample of eighty employed persons at high risk of burnout. Hierarchical linear regression was performed to identify predictors of successful response-defined by lower perceived stress at last follow up. Nutritional behavior, symptoms of eating disorder syndrome, and well-being were significant predictors of perceived stress at last follow up, when adjusted for age, sex, education level, baseline stress values, and timing of intervention. Persons with low levels of well-being, poor nutritional behavior, and higher symptoms of eating disorders should be given special care and attention to ensure that they respond well to the outpatient burnout prevention program

WHO Functioning and Disability Disaggregation (FDD11) tool: a reliable approach for disaggregating data by disability

Background There is a global scarcity of good quality disability data, which has contributed to a lack of political will to address the challenges that persons with disabilities face. The current paper proposes a way forward to overcome this gap by demonstrating the psychometric properties of the World Health Organization Functioning and Disability Disaggregation Tool (FDD11) - a brief disability disaggregation instrument that countries can use. Results The study demonstrated that FDD11 is a valid and reliable tool. Unidimensionality of the scale produced by each calibration was supported by the factor analysis performed. The analysis indicated good fit of the items, and targeting of the items was deemed to be sufficient. The person separation index was 0.82, indicating good reliability of the final scale. Conclusion FDD11 provides a good opportunity to researchers and governments to capture good quality disability data and to disaggregate existing data by disability. The tool can facilitate low- and middle-income countries in their efforts to develop evidenced-based policies to address any barriers faced by persons with disabilities, to monitor the implementation of the Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals, and to take stock of the challenges that still remain