Personality and the physician-patient relationship as predictors of quality of life of cardiac patients after rehabilitation

<p>Abstract</p> <p>Background</p> <p>Numerous studies document the influence of psychosocial variables on the course of coronary heart disease. This study examines the influence of personality traits (trait anger, cynicism) and aspects of the physician-patient relationship (promoting patient participation by the physician, active communication behavior of the patient, trust in the physician) on the health related quality of life (HRQOL) of cardiac patients after rehabilitation.</p> <p>Methods</p> <p>N = 331 patients with chronic ischemic heart disease were surveyed using questionnaires at two time points (beginning and end of 3-weeks inpatient rehabilitation). In addition, characteristics of the disease and cardiac risk factors were provided by the physician. HRQOL was measured using a total of six scales and three instruments: SF-12, MacNew questionnaire, and SAQ. Hierarchical regression analyses were carried out to predict HRQOL after rehabilitation, in which the baseline values of HRQOL, sociodemographic variables, characteristics of the disease and risk factors, personality traits, and finally the aspects of the physician-patient relationship were included stepwise. As a number of variables were used for the regression models, multiple imputation was conducted.</p> <p>Results</p> <p>The baseline values explain most of the variance (42%-60%). After controlling the baseline values, the sociodemographic variables explain up to 5% incremental variance of HRQOL, with income being the most important predictor. The characteristics of the disease and cardiac risk factors explain between 0.4% and 3.8% incremental variance, however, variance increase is often not significant. The personality traits added in the fourth step explain up to 2% additional variance; trait anger is a significant predictor of HRQOL in three of the six scales. The features of the physician-patient relationship included in the last step lead to a significant increase in explained variance (between 1.3% and 3.9%) for all six scales. In particular, the physician's promotion of patient participation has a significant influence. The overall explanation of variance for HRQOL is between 50% and 64%.</p> <p>Conclusions</p> <p>Low income, a high level of trait anger, and low patient participation are significant risk factors, even if a number of potential confounders are adjusted. Research is needed that shows which causal pathway low income functions on and what therapies in rehabilitation can mitigate the disadvantage of persons with a high level of trait anger. The providers should implement measures to actively integrate rehabilitation patients in treatment (e.g. encourage them to ask questions).</p

Barriers and facilitators to palliative care of patients with chronic heart failure in Germany: a study protocol

Background. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. Design and Methods. Tripartite study. First part of this study evaluates health care providers’ (physicians and nurses) perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. Expected Impact for Public Health. The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients

Evaluating case management for caregivers of children with spinal muscular atrophy type I and II—an exploratory, controlled, mixed-methods trial

IntroductionSpinal muscular atrophy (SMA) is a rare neuromuscular disease requiring various clinical specialists and therapists to provide care. Due to the disease's dynamic nature and the long distances between specialized centers and local providers, integrating care between disciplines can be challenging. Care that is inadequately integrated can compromise the quality of care and become a burden for patients and families. This trial aimed to improve the care of patients through a case management (CM) intervention.MethodsWe conducted an exploratory, controlled, two-arm trial with pre-, post-, and follow-up measures (process and outcome evaluation). Proof of efficacy based on statistical significance was not our primary study objective since we were investigating a rare disease. Primary outcomes were caregivers' HRQoL and caregiver-rated quality of care integration. Our secondary outcome was the children's HRQoL.ResultsQuestionnaires and semi-structured interviews yielded heterogeneous results depending on caregivers' level of experience and desire (or possibility) to delegate care tasks.DiscussionDespite differing perceptions, all participants supported the establishment of a care coordination model. We recommend CM immediately after diagnosis to provide the greatest benefit to families. We hope that our trial will support the further development of CM interventions that can be customized for specific diseases

Health-care utilization of patients with chronic back pain before and after rehabilitation

Abstract Background Patients with chronic back pain show an increased use of health-care services leading to high direct costs. Multidisciplinary rehabilitation reduces pain intensity, depression, disability and work inability. The study aims to investigate whether health-care utilization in patients with chronic back pain is lower after rehabilitation than before rehabilitation and if, in addition to sociodemographic, medical and psychological characteristics, changes in these characteristics immediately after rehabilitation can predict health-care utilization. Methods N = 688 patients with chronic back pain were asked about their overall health-care services use and the use of general practitioners, specialists, physiotherapy, psychotherapy, complementary therapist, massages, and admission to hospital both 6 months before and 6 months after rehabilitation. In addition, various sociodemographic, medical and psychological variables were assessed. To measure changes due to rehabilitation, differences in pain intensity, disability, impairment and coping, quality of life, and days on sick leave before and after rehabilitation were calculated. Dependent t-tests and hierarchical regression analyses were used to analyse the data. Results Health-care utilization 6 months after rehabilitation was, except for physiotherapy and psychotherapy, significantly lower than before. The effect sizes were rather small (Cohens’d =. 01–.34). After rehabilitation between 15.2% and 39.9% of the variance of health-care utilization could be explained. The baseline values of health-care utilization explained between 3.2% and 15.9% of the incremental variances. The changes in psychological impairment and coping as well as in sick leave after rehabilitation could explain between 0.8% and 2.9% of the variance of health-care utilization after rehabilitation. Its influence was significant for the general use of health-care services, general practitioners and specialists. Conclusions The results indicate that use of health-care services after rehabilitation in the present study is slightly lower than before, which has an impact on direct costs due to chronic back pain in Germany. The predictors show the importance in terms of health-care utilization of improving work ability and psychological impairment

The effect of the patient–physician relationship on health-related quality of life after cardiac rehabilitation

<p><b>Purpose</b> The patient–physician relationship has effects on adherence and health outcomes in chronic diseases. This prospective study investigates the effect of the patient–physician relationship on patients’ health-related quality of life (HRQOL) in the context of cardiac rehabilitation. <b>Methods</b> Three hundred and thirty-eight German patients filled out questionnaires at the start and end of rehabilitation and at 6 months follow-up. Patient–physician relationship variables surveyed were patient involvement (perceived involvement in care scales), trust in the physician, patient satisfaction (PHYSAT) and physician’s communicative behaviour (KOVA). After adjusting for multiple confounders, hierarchical regression analyses were conducted to predict the influence of the patient–physician relationship on HRQOL after rehabilitation. We further examined clinical relevance using minimal clinically important differences (MCID). <b>Results</b> In the hierarchical regression analyses, 42.8–54.9% of the variance at the end of rehabilitation and 22.4–40.5% at follow-up were explained. The patient–physician variables patient satisfaction, physician’s emotionally supportive communication and effective and open communication accounted for 1.4–2.6% of the variance and proved statistically and clinically significant for HRQOL change. Further predictors for better HRQOL were higher income and less trait anger. <b>Conclusion</b> Aspects of the patient–physician relationship are significant predictors for patients’ HRQOL after rehabilitation. Rehabilitation physicians should emotionally support the patients and communicate in an effective and open manner to enhance HRQOL.Implications for rehabilitation</p><p>Aspects of the patient–physician relationship have effects on adherence and clinical outcomes in chronic diseases.</p><p>In this cardiac sample, the patient–physician relationship had an influence on patients’ health-related quality of life (HRQOL) after inpatient rehabilitation.</p><p>Rehabilitation physicians should emotionally support and encourage the patients and communicate with them in an effective and open manner to enhance patients’ HRQOL.</p><p></p> <p>Aspects of the patient–physician relationship have effects on adherence and clinical outcomes in chronic diseases.</p> <p>In this cardiac sample, the patient–physician relationship had an influence on patients’ health-related quality of life (HRQOL) after inpatient rehabilitation.</p> <p>Rehabilitation physicians should emotionally support and encourage the patients and communicate with them in an effective and open manner to enhance patients’ HRQOL.</p

Psychometric properties of the German version of the MacNew heart disease health-related quality of life questionnaire

<p>Abstract</p> <p>Background</p> <p>There is a lack of German-language, disease-specific health related quality of life instruments applicable in cardiac rehabilitation. The purpose of this project was to investigate the psychometric properties of the German version of the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) in patients undergoing cardiac rehabilitation.</p> <p>Methods</p> <p>The MacNew was filled out by 5692 inpatients. We analysed acceptance (number of missing values), ceiling and floor effects, reliability (Cronbach’s α), factor structure (confirmatory factor analysis), construct validity (correlation with a generic health-related quality of life instrument), and sensitivity to change.</p> <p>Results</p> <p>Two items had more than 7% missing data. We observed neither floor nor ceiling effects. Cronbach’s α of the scales ranged from 0.78 (physical scale) to 0.95 (global scale). Confirmatory factor analysis failed to reproduce the proposed factor structure (CFI = 0.882; TLI = 0.871; RMSEA = 0.074). We therefore drafted our own model (CFI = 0.932; TLI = 0.921; RMSEA = 0.064), and observed a correlation pattern largely conforming to the hypotheses with a generic health-related quality of life instrument. The effect sizes we noted between the start and end of rehabilitation fell between 0.66 and 0.74; at the 6-month follow-up they ranged from 0.69 to 0.92.</p> <p>Conclusions</p> <p>The German version of the MacNew Heart Disease Health-related Quality of Life Questionnaire is a suitable instrument with which to measure the impairment experienced by individuals with heart disease during inpatient cardiologic rehabilitation. The social and the global scale must be interpreted cautiously.</p

Post-stroke care after medical rehabilitation in Germany: a systematic literature review of the current provision of stroke patients

Abstract Background Although Germany’s acute care for stroke patients already has a good reputation, continuous follow-up care is still not widely available, a problem originating in the strict separation of inpatient and outpatient care. This gap in the German health care system does not just lead to patients’ potential readmission to inpatient care and compromise the sustainability of what they have accomplished during medical rehabilitation; it also places a burden on caregivers. Methods To illustrate the current procedures on follow-up care of stroke patients in Germany, a systematic literature search was conducted to gather all available evidence. Research articles in the English or German language were searched between 2007 and 2017. Different study designs ranging from non-experimental descriptive studies, expert reports and opinions were included and categorised by two independent researchers. Relevant data was electronically searched through international and national databases and incorporated in a summary grid to investigate research outcomes and realise a narrative synthesis. Results A literature search was conducted to identify all relevant information on how current follow-up care is carried out and evaluated in Germany. We identified no systematic reviews on this topic, but included a total of 18 publications of various original studies, reviews and expert opinions. Included study populations also differed in either: experts, caregivers or stroke patients, including their viewpoints on the outpatient care situation of stroke patients; to capture their need for assistance or to investigate caregivers need and use for assistance. So far there is no standardised follow-up care in Germany, but this review reveals that multidisciplinary cooperation within occupational groups in outpatient rehabilitation is a key item that can influence and improve the follow-up care of stroke patients. Conclusion This review was conducted to provide a broadly based overview of the current follow-up care of stroke patients in Germany. Both the new implementation of a standardised, discharge service that supports early support, to be initiated this year and numerous approaches are promising steps into the right direction to close the follow-up gap in German health care provision

Trajectories of depressive symptoms after a major cardiac event

Depression is a common comorbidity in cardiac patients. This study sought to document fluctuations of depressive symptoms in the 12 months after a first major cardiac event. In all, 310 patients completed a battery of psychosocial measures including the depression subscale of the Symptom Check List-90-Revised. A total of 252 of them also completed follow-up measures at 3 and 12 months. Trajectories of depressive symptoms were classified as none, worsening symptoms, sustained remission, and persistent symptoms. Although the prevalence of depressive symptoms was consistent at each assessment, there was considerable fluctuation between symptom classes. Regression analyses were performed to identify predictors of different trajectories