1
|
Melicherova U, Schott T, Köllner V, Hoyer J. Behavioral activation for depression in groups embedded in psychosomatic rehabilitation inpatient treatment: a quasi-randomized controlled study. Front Psychiatry 2024; 15:1229380. [PMID: 38726384 PMCID: PMC11079813 DOI: 10.3389/fpsyt.2024.1229380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Background Behavioral activation (BA) and cognitive-behavioral therapy (CBT) have shown to be efficacious treatment methods for depression. Previous studies focused mostly on the outpatient treatment either in group or individual setting. The present study aimed at comparing the efficacy of group treatment BA vs. CBT, when embedded in inpatient psychosomatic rehabilitation treatment. Methods 375 inpatients were randomly assigned to either BA (N = 174) or CBT (N = 201). We used established scales for depression such as the Beck Depression Inventory II (BDI-II, self-rating), the Quick Inventory of Depressive Symptomatology (QIDS; expert rating) and the Behavioral Activation for Depression Scale (BADS) to assess changes over the course of the treatment and at follow-up (4 to 6 months). In addition, we measured disability-related functioning with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). Multilevel models with repeated measures were conducted to examine the differences between groups in relation to change over time with patients' random effects. Results Both group formats showed substantial reduction in depressive symptoms at the end of treatment (d= 0.83 BA vs. d= 1.08 CBT; BDI-II) and at follow-up after 4 to 6 months (d = 0.97 BA vs. d = 1.33 CBT, BDI-II; and d = 1.17 BA vs. d = 1.09 CBT, QIDS). There were no significant differences between treatment approaches. At least 50% symptom reduction was achieved by 53.7% and 54.2% in BA vs. CBT respectively. Reported activation levels increased from pre- to posttreatment (d = 0.76 BA vs. d = 0.70CBT), while showing loss of increment between the end of the treatment until follow up in both formats (d = 0.28 BA vs. d = 0.29 CBT). Discussion Both modalities led to significant improvement of symptomatology and functioning at the end of the treatment and at follow-up, thus for the first time demonstrating the practicability of BA in rehabilitation clinics. Considering its lower requirements regarding cognitive abilities and its easier implementation, BA proved to be a good alternative to other psychotherapeutic treatments.
Collapse
Affiliation(s)
- Ursula Melicherova
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Schott
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Volker Köllner
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency Teltow, Teltow, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
2
|
Riedl D, Kampling H, Kruse J, Nolte T, Labek K, Kirchhoff C, Grote V, Fischer MJ, Knipel A, Lampe A. Epistemic Trust Is a Critical Success Factor in Psychosomatic Rehabilitation-Results from a Naturalistic Multi-Center Observational Study. J Clin Med 2023; 13:177. [PMID: 38202184 PMCID: PMC10780285 DOI: 10.3390/jcm13010177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Knowledge about critical success factors underpinning beneficial treatment outcomes in psychosomatic inpatient rehabilitation is scarce. The aim of this study was to evaluate the influence of patients' epistemic stance in relation to the improvement of psychological distress during rehabilitation. In this naturalistic longitudinal observational study, n = 771 patients completed routine assessments for psychological distress (BSI-18), health-related quality of life (HRQOL; WHODAS), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Patients were grouped as best, average, and worst responders based on their mean BSI-18 changes during treatment, and their mean change in epistemic trust, mistrust, and credulity was compared using repeated measures analyses of variance (rANOVAs). No associations of performance with sex (p = 0.09), age (p = 0.11), or relationship status (p = 0.58) were found. Best responders reported significantly improved epistemic trust (p = 0.001) and reduced epistemic mistrust (p < 0.001), whereas worst responders reported a significant increase in epistemic mistrust (p < 0.001) and credulity (p < 0.001). Average responders did not change for either epistemic trust (p = 0.11), mistrust (p > 0.99), or credulity (p = 0.96). Our results underscore the role of the epistemic stance in psychosomatic and psychotherapeutic treatments. These results help to better understand what might determine psychosomatic rehabilitation outcomes and indicate the role of epistemic trust as a critical success factor.
Collapse
Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35390 Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, 35037 Marburg, Germany
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London N1 9JH, UK
- Research Department for Clinical, Educational and Heath Psychology, University College London, London WC1E 6BT, UK
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
| | - Christina Kirchhoff
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
- VAMED Rehabilitation Center Kitzbuehel, 6370 Kitzbuehel, Austria
| | | | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
- VAMED Rehabilitation Center Montafon, 6780 Schruns, Austria
| |
Collapse
|
3
|
Riedl D, Rothmund MS, Grote V, Fischer MJ, Kampling H, Kruse J, Nolte T, Labek K, Lampe A. Mentalizing and epistemic trust as critical success factors in psychosomatic rehabilitation: results of a single center longitudinal observational study. Front Psychiatry 2023; 14:1150422. [PMID: 37252135 PMCID: PMC10213326 DOI: 10.3389/fpsyt.2023.1150422] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background Inpatient psychosomatic rehabilitation is a key treatment for patients with mental health issues. However, knowledge about critical success factors for beneficial treatment outcomes is scarce. The aim of this study was to evaluate the association of mentalizing and epistemic trust with the improvement of psychological distress during rehabilitation. Methods In this naturalistic longitudinal observational study, patients completed routine assessments of psychological distress (BSI), health-related quality of life (HRQOL; WHODAS), mentalizing (MZQ), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Repeated measures ANOVA (rANOVAs) and structural equation models (SEMs) were calculated to investigate the association of mentalizing and epistemic trust with the improvement in psychological distress. Results A total sample of n = 249 patients were included in the study. Improvement in mentalizing was correlated with improvement in depression (r = 0.36), anxiety (r = 0.46), and somatization (r = 0.23), as well as improved cognition (r = 0.36), social functioning (r = 0.33), and social participation (r = 0.48; all p < 0.001). Mentalizing partially mediated changes in psychological distress between T1 and T2: the direct association decreased from β = 0.69 to β = 0.57 and the explained variance increased from 47 to 61%. Decreases in epistemic mistrust (β = 0.42, 0.18-0.28; p < 0.001) and epistemic credulity (β = 0.19, 0.29-0.38; p < 0.001) and increases in epistemic trust (β = 0.42, 0.18-0.28; p < 0.001) significantly predicted improved mentalizing. A good model fit was found (χ2 = 3.248, p = 0.66; CFI = 0.99; TLI = 0.99; RMSEA = 0.000). Conclusion Mentalizing was identified as a critical success factor in psychosomatic inpatient rehabilitation. A key component to increase mentalizing in this treatment context is the improvement of epistemic mistrust.
Collapse
Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Sophie Rothmund
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center Kitzbuehel, Kitzbuehel, Austria
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
| | - Tobias Nolte
- Anna Freud National Center for Children and Families, London, United Kingdom
- Research Department for Clinical, Educational and Heath Psychology, University College London, London, United Kingdom
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center, Schruns, Austria
| |
Collapse
|
4
|
Wulfes N, Mitschke AC, Wehrmeyer M, von Drehle C, Kröger C. [Participation Restriction and its Prediction in Victims of Acts of Violence During the Proceedings Under the Victims Compensation Act: A File-Based Exploratory Cohort Study]. Psychother Psychosom Med Psychol 2023; 73:78-84. [PMID: 36055255 DOI: 10.1055/a-1838-3183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
After an act of violence, affected individuals not only suffer psychological and physical damage, but also impairment in their professional, social and societal participation. So far, however, no studies have been conducted examining the severity of participation restrictions and prognostically relevant characteristics. Using a category system, sociodemographic information as well as trauma-, crime- and health-specific characteristics of adult victims of acts of violence, whose entitlement to benefits were recognized under the German Victims Compensation Act (OEG), were recorded from files. Based on psychiatric assessments of damage, participation restrictions were also assessed post-hoc based on the International Classification of Functioning, Disability and Health (ICF). The data are extracted from 99 files; 72 of those affected were female. The average age of the victims at the time of the offence was 25 years. 53 were victims of sexual violence, 24 were victims of forms of bodily injury and 45 were victims of other acts of violence. 29 victims experienced more than one type of violence. All had at least one mental disorder with pathological significance. An average of four years passed between the first and second psychiatric assessment. While 85 of those affected stated that they had been employed before the offence, the number of employees dropped to 53 after the offence. The most pronounced participation restriction was found in professional participation. A multiple regression analysis revealed that a higher degree of participation restriction was associated with lack of employment and a stronger negative impact after the crime as well as the victim's familiarity with the perpetrator; but not associated with a mental disorder or a lack of a victim's trustworthy relationships. In future, participation restrictions should regularly be assessed based on the ICF during the psychiatric assessment. The results suggest that particularly benefits for professional participation are to be granted within the framework of the OEG.
Collapse
Affiliation(s)
- Nele Wulfes
- Arbeitsgruppe Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim
| | - Astrid-Christine Mitschke
- Trauma-Netzwerk Niedersachsen, Niedersächsisches Landesamt für Soziales, Jugend und Familie, Außenstelle Braunschweig, Braunschweig, Germany
| | - Matthias Wehrmeyer
- Hauptstelle Hildesheim, Landesversorgungsamt, Niedersächsisches Landesamt für Soziales, Jugend und Familie, Hildesheim, Germany
| | - Christina von Drehle
- Arbeitsgruppe Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim
| | - Christoph Kröger
- Arbeitsgruppe Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim
| |
Collapse
|
5
|
Hofmann AB, Schmid HM, Jabat M, Brackmann N, Noboa V, Bobes J, Garcia-Portilla MP, Seifritz E, Vetter S, Egger ST. Utility and validity of the Brief Psychiatric Rating Scale (BPRS) as a transdiagnostic scale. Psychiatry Res 2022; 314:114659. [PMID: 35709637 DOI: 10.1016/j.psychres.2022.114659] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/15/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
The Brief Psychiatric Rating Scale (BPRS) was originally conceived to assess psychopathology in several psychiatric disorders, making it an appropriate candidate to be used as a transdiagnostic instrument. We analyzed the utility and validity of the BPRS in a diagnostically heterogeneous sample of 600 psychiatric inpatients. As a comparator, we chose the mini-ICF-APP, a scale used to measure functioning and impairment across the diagnostic spectrum. Both scales had good internal consistency. The BPRS and the mini-ICF-APP showed a moderate correlation, with good levels of agreement. We were able to identify general symptoms present across the diagnostic spectrum, influencing severity and a cluster of symptoms specific for each diagnosis. Our results show the utility and validity of the BPRS as a transdiagnostic assessment tool that could easily be introduced in routine clinical work.
Collapse
Affiliation(s)
- Andreas B Hofmann
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Hanna M Schmid
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Mounira Jabat
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Nathalie Brackmann
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Forensic Psychiatry, Zurich, Switzerland
| | - Vanessa Noboa
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland; University San Francisco de Quito, Faculty of Medicine, Quito, Ecuador
| | - Julio Bobes
- University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Maria Paz Garcia-Portilla
- University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Erich Seifritz
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Stefan Vetter
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Stephan T Egger
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland; University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain.
| |
Collapse
|
6
|
Chrysanthou S, Köllner V. [Anxiety Disorders in Rehabilitation]. REHABILITATION 2022; 61:194-208. [PMID: 35700746 DOI: 10.1055/a-1691-3627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anxiety disorders are among the most common and socio-medically relevant mental illnesses. Correct diagnosis and initiation of appropriate therapy are of the utmost importance for patients' prognosis and for ensuring their social and occupational participation. This article therefore aims to provide an overview of new developments in the field of anxiety disorders relevant to rehabilitation.Within the framework of the changes in ICD-11, anxiety disorders now receive an independent chapter with a focus appropriate to their frequency and relevance. Further innovations concern the revised S3 guideline (2020) with the increasing consideration of digital therapy options, such as virtual reality exposure therapy (VER) as well as Internet-supported therapy methods as part of the therapy recommendations. Systemic therapy is also considered for the first time. However, the evidence for both procedures is significantly lower than for behavioral therapy, psychodynamic therapy, or pharmacotherapy. Online interventions are therefore not recommended as the sole therapy.Important for the practice in rehabilitation is the knowledge of the core symptoms of each of the above mentioned diagnoses as well as the diagnostic possibilities taking into account especially the correlations and interactions with physical diseases.Both psychotherapy and psychopharmacotherapy are available for treatment. In the field of psychotherapy, cognitive behavioral therapy (CBT) is the therapy of first choice due to the broadest base of evidence. In consideration of comorbid somatic diseases, attention must be paid to possible contraindications for antidepressants. Psychosomatic rehabilitation is an important resource in the overall treatment spectrum, especially if chronification or a threat to participation is foreseeable, in order to give the affected person confidence and motivation for further successful treatment of the anxiety disorder in an intensified treatment setting, in addition to teaching anxiety management strategies and socio-medical clarification. An important task of somatic rehabilitation is to recognize comorbid anxiety disorders and to provide the affected persons with an appropriate explanatory model of their complaints and to be able to initiate targeted treatment.
Collapse
|
7
|
One-year follow-up of functional impairment in inpatients with mood and anxiety disorders - Potentials of the Mini-ICF-APP. BMC Psychiatry 2022; 22:334. [PMID: 35570275 PMCID: PMC9107757 DOI: 10.1186/s12888-022-03977-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/05/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The aim of the study was to investigate functional impairment and its relationship to illness severity in a sample of patients with a diagnosis of mood or anxiety disorder during inpatient treatment and 1 year after discharge. METHODS Two hundred thirty-nine inpatients with primary diagnoses of mood or anxiety disorders were assessed at baseline and at follow-up by a range of validated instruments. Mini-ICF-APP was used for the assessment of functional impairment, BDI-II for the assessment of clinical symptoms and remission. Sample characteristics and measures of impairment at baseline and at follow-up were analysed descriptively. Symptomatically remitted and non-remitted patients were compared with regard to capacity limitations. RESULTS Initially, the sample showed considerable impairment in many capacities, particularly endurance, spontaneous activities, structuring of tasks, competency and flexibility. After 1 year, all capacities significantly improved. The level of impairment was correlated with employment status and severity of clinical symptoms. About 50% of the patients remitted in clinical symptomatology. Retrospectively, the remitted and the unremitted did not differ in functional impairment at baseline but there were considerable differences at follow-up. CONCLUSIONS Mini-ICF-APP is a useful instrument to monitor functional status and change in psychiatric samples, complementing the usual focus on symptom reduction.
Collapse
|
8
|
Egger ST, Knorr M, Bobes J, Bernstein A, Seifritz E, Vetter S. Real-Time Assessment of Stress and Stress Response Using Digital Phenotyping: A Study Protocol. Front Digit Health 2021; 2:544418. [PMID: 34713030 PMCID: PMC8521792 DOI: 10.3389/fdgth.2020.544418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Stress is a complex phenomenon that may have a negative influence on health and well-being; consequently, it plays a pivotal role in mental health. Although the incidence of mental disorders has been continuously rising, development of prevention and treatment methods has been rather slow. Through the ubiquitous presence of smartphones and wearable devices, people can monitor stress parameters in everyday life. However, the reliability and validity of such monitoring are still unsatisfactory. Methods: The aim of this trial is to find a relationship between psychological stress and saliva cortisol levels on the one hand and physiological parameters measured by smartphones in combination with a commercially available wearable device on the other. Participants include cohorts of individuals with and without a psychiatric disorder. The study is conducted in two settings: one naturalistic and one a controlled laboratory environment, combining ecological momentary assessment (EMA) and digital phenotyping (DP). EMA is used for the assessment of challenging and stressful situations coincidentally happening during a whole observation week. DP is used during a controlled stress situation with the Trier Social Stress Test (TSST) as a standardized psychobiological paradigm. Initially, participants undergo a complete psychological screening and profiling using a standardized psychometric test battery. EMA uses a smartphone application, and the participants keep a diary about their daily routine, activities, well-being, sleep, and difficult and stressful situations they may encounter. DP is conducted through wearable devices able to continuously monitor physiological parameters (i.e., heart rate, heart rate variability, skin conductivity, temperature, movement and acceleration). Additionally, saliva cortisol samples are repeatedly taken. The TSST is conducted with continuous measurement of the same parameters measured during the EMA. Discussion: We aim to identify valid and reliable digital biomarkers for stress and stress reactions. Furthermore, we expect to find a way of early detection of psychological stress in order to evolve new opportunities for interventions reducing stress. That may allow us to find new ways of treating and preventing mental disorders. Trial Registration: The competing ethics committee of the Canton of Zurich, Switzerland, approved the study protocol V05.1 May 28, 2019 [BASEC: 2019-00814]; the trial was registered at ClinicalTrials.gov [NCT04100213] on September 19, 2019.
Collapse
Affiliation(s)
- Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Marius Knorr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Abraham Bernstein
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
9
|
Egger ST, Weniger G, Müller M, Bobes J, Seifritz E, Vetter S. Assessing the severity of functional impairment of psychiatric disorders: equipercentile linking the mini-ICF-APP and CGI. Health Qual Life Outcomes 2019; 17:174. [PMID: 31744498 PMCID: PMC6862821 DOI: 10.1186/s12955-019-1235-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background The assessment of functioning and impairment due to psychiatric illness has been acknowledged to be crucial for research and practice. This led to the development of the mini-ICF-APP, which provides a reliable and time-efficient measure of functioning and impairment. Although its use is increasing, it remains unclear how it reflects severity and how change might be interpreted from a clinical perspective. Methods In a clinical sample of 3067 individuals hospitalized for mental health treatment, we used an equipercentile approach to link the mini-ICF-APP with the Clinical Global Impression scale (CGI) at admission and discharge. We linked the mini-ICF-APP sum score to the CGI-S scale and the mini-ICF-APP proportional change between admission and discharge to the CGI-I scale. Results The mini-ICF-APP and CGI scales showed a Spearman correlation of 0.50 (p < .000). CGI-S: “borderline-ill” corresponded to a mini-ICF-APP score 1–2; “mildly-ill” to 3–7; “moderately-ill” to 8–15; “markedly-ill” to 16–24; “severely-ill” to 25–37; and “extremely-ill” to a score ≥ 38. The Spearman correlation between the percentage change of mini-ICF-APP sum score and the CGI-I was 0.32 (p > .000); “no-change” in the CGI-I corresponded to an increase or decrease of 2%; “minimally-improved” to a mini-ICF-APP reduction of 3–30%; “much-improved” to a reduction of 31–63%; “very-much-improved” to a reduction of ≥64% “minimally-worse” to an increase of 3–34% “much-worse” to an increase of 35–67%; and finally “very-much-worse” with an increase of ≥68%. Conclusions Our findings improve understanding of the clinical meaning of the mini-ICF-APP sum score and percentage change in patients hospitalized for treatment.
Collapse
Affiliation(s)
- Stephan T Egger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland. .,Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain.
| | - Godehard Weniger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Mario Müller
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Erich Seifritz
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Stefan Vetter
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| |
Collapse
|
10
|
Sprung M, Münch HM, Kaiser E, Streibl L, Riffer F. [Meta-analysis of evaluation results of psychiatric-psychosomatic rehabilitation in Austria]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2018; 33:8-24. [PMID: 30328582 DOI: 10.1007/s40211-018-0290-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Since previous meta-analyses of psychiatric-psychosomatic rehabilitation only rarely included studies from Austrian rehabilitation clinics a systematic review with meta-analysis of previously available evaluation results from Austrian rehabilitation clinics should be conducted. METHODS A systematic literature search in several data bases (Psyndex, PsycInfo, MEDLINE, Pubmed) and additional manual search was conducted. Evaluation results from the most commonly used assessment instruments (SCL-90/BSI, BDI, WHOQOL-BREF, GAF) were extracted from the studies included and subsequently a meta-analysis was calculated with the extracted data (pre-post comparison). RESULTS 12 publications with 9 studies from 6 different Austrian rehabilitation clinics could be included in the meta-analysis, with a total of 9329 patients. Results show a significant improvement from pre- to post assessment in the medium effect size range, with a Hedges' g of 0.53 (95%-confidence interval [0.45;0.60]) for improvement in global symptom severity, a Hedges' g of 0.59 (95%-confidence interval [0.54;0.63]) for improvement in subjective quality of life and a Hedges' g of 1.00 (95%-confidence interval [0.83;1.18]) for improvement in global functioning. The effects are robust and there is no evidence for distortion or publication bias. CONCLUSIONS On average medium effect sizes have been previously achieved with psychiatric-psychosomatic rehabilitation in Austrian rehabilitation clinics. This is comparable with the previous results of rehabilitation clinics in Germany. However, since only one controlled study is available thus far it can not be ruled out that the effects in comparison to no rehabilitation might turn out smaller. Thus, in the future increasingly controlled studies should be conducted and the quality of conducted studies should be improved.
Collapse
Affiliation(s)
- Manuel Sprung
- Klinik Eggenburg und Rehabilitationsklinik Gars am Kamp, Psychosomatisches Zentrum Waldviertel (PSZW), Universitätsklinik für Psychosomatische Medizin der Karl Landsteiner Privatuniversität, Grafenberger Straße 2, 3730, Eggenburg, Österreich.
| | - Hannah M Münch
- Abteilung für Klinische Psychologie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland
| | - Elmar Kaiser
- Klinik Eggenburg und Rehabilitationsklinik Gars am Kamp, Psychosomatisches Zentrum Waldviertel (PSZW), Universitätsklinik für Psychosomatische Medizin der Karl Landsteiner Privatuniversität, Grafenberger Straße 2, 3730, Eggenburg, Österreich
| | - Lore Streibl
- Klinik Eggenburg und Rehabilitationsklinik Gars am Kamp, Psychosomatisches Zentrum Waldviertel (PSZW), Universitätsklinik für Psychosomatische Medizin der Karl Landsteiner Privatuniversität, Grafenberger Straße 2, 3730, Eggenburg, Österreich
| | - Friedrich Riffer
- Klinik Eggenburg und Rehabilitationsklinik Gars am Kamp, Psychosomatisches Zentrum Waldviertel (PSZW), Universitätsklinik für Psychosomatische Medizin der Karl Landsteiner Privatuniversität, Grafenberger Straße 2, 3730, Eggenburg, Österreich
| |
Collapse
|
11
|
[Assement of incapacity to work and the Mini-ICF-APP]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2017; 31:182-186. [PMID: 28856567 DOI: 10.1007/s40211-017-0246-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/10/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE According to recent recommendations the Mini-ICF Rating for Limitations of Activities and Participation in Psychological Disorders (Mini-ICF-APP) should be used in the assessment of incapacity to work. However evidence from empirical research in the field is missing. METHODS The application of the Mini-ICF-APP in the psychiatric assessment of 121 cases was analysed. RESULTS A significant correlation between capacity to work and the duration of sick-leave with the Mini-ICF-APP sum-score was confirmed. The probability that criteria for disability insurance compensations was fulfilled according to the assessor increased with the Mini-ICF-APP-sum-score. CONCLUSION Our study provides first empirical evidence regarding the application of the Mini-ICF-APP in the psychiatric assessment of incapacity to work.
Collapse
|
12
|
Müller M, Vandeleur C, Weniger G, Prinz S, Vetter S, Egger ST. The performance of the Health of the Nation Outcome Scales as measures of clinical severity. Psychiatry Res 2016; 239:20-7. [PMID: 27137958 DOI: 10.1016/j.psychres.2016.02.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/12/2016] [Accepted: 02/27/2016] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine the performance of the Health of the Nation Outcome Scales (HoNOS) against other measures of functioning and mental health in a full three-year cohort of admissions to a psychiatric hospital. A sample of N=1719 patients (35.3% females, aged 17-78 years) was assessed using observer-rated measures and self-reports of psychopathology at admission. Self-reports were available from 51.7% of the sample (34.4% females, aged 17-76 years). Functioning and psychopathology were compared across five ICD-10 diagnostic groups: substance use disorders, schizophrenia and psychotic disorders, affective disorders, anxiety/somatoform disorders and personality disorders. Associations between the measures were examined, stratifying by diagnostic subgroup. The HoNOS were strongly linked to other measures primarily in psychotic disorders (except for the behavioral subscale), while those with substance use disorders showed rather poor links. Those with anxiety/somatoform disorders showed null or only small associations. This study raises questions about the overall validity of the HoNOS. It seems to entail different levels of validity when applied to different diagnostic groups. In clinical practice the HoNOS should not be used as a stand-alone instrument to assess outcome but rather as part of a more comprehensive battery including diagnosis-specific measures.
Collapse
Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland.
| | | | - Godehard Weniger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Susanne Prinz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| |
Collapse
|
13
|
Schreiner A, Bergmans P, Cherubin P, Keim S, Llorca PM, Cosar B, Petralia A, Corrivetti G, Hargarter L. Paliperidone palmitate in non-acute patients with schizophrenia previously unsuccessfully treated with risperidone long-acting therapy or frequently used conventional depot antipsychotics. J Psychopharmacol 2015; 29:910-22. [PMID: 25999398 PMCID: PMC4512527 DOI: 10.1177/0269881115586284] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PALMFlexS, a prospective multicentre, open-label, 6-month, phase IIIb interventional study, explored tolerability, safety and treatment response in adults (n = 231) with non-acute but symptomatic schizophrenia switching to flexibly dosed paliperidone palmitate (PP) after unsuccessful treatment with risperidone long-acting injectable therapy (RLAT) or conventional depot antipsychotics (APs). Treatment response was measured by change in Positive and Negative Syndrome Scale (PANSS) total score from baseline (BL) to last-observation-carried-forward (LOCF) endpoint (EP). Safety and tolerability assessments included Extrapyramidal Symptom Rating Scale (ESRS) total score and treatment-emergent adverse events. Significant reductions in mean PANSS total score were observed for all groups (-7.5 to -10.6; p ⩽ 0.01 [BL to LOCF EP]). After switching to PP, more than 50% of all patients achieved ⩾20% and one-third of RLAT-treated patients even achieved ⩾50% improvement in PANSS total score. Across groups, there were significant improvements (p < 0.05) in symptom severity as measured by Clinical Global Impression-Severity (CGI-S; trend for improvement with RLAT; p = 0.0568), subjective well-being, medication satisfaction, and patient functioning with PP. PP was generally well tolerated. Clinically relevant benefits were observed in non-acute patients with schizophrenia switched from RLAT or conventional depot APs to PP.
Collapse
Affiliation(s)
- A Schreiner
- EMEA Medical Affairs, Janssen Cilag GmbH, Neuss, Germany
| | - P Bergmans
- Biometrics & Reporting, Janssen Cilag Benelux, Tilburg, the Netherlands
| | - P Cherubin
- EMEA Medical Affairs, Janssen Cilag, Issy-les-Moulineaux, France
| | - S Keim
- Global Clinical Operations EMEA Medical Affairs, Janssen Cilag, Barcarena, Portugal
| | - P-M Llorca
- CHRU Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - B Cosar
- Gazi University Medical Faculty, Ankara, Turkey
| | - A Petralia
- UOPI of Psychiatry, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - G Corrivetti
- UOSM Distretto D, Pontecagnano-Faiano (Sa), Italy
| | - L Hargarter
- EMEA Medical Affairs, Janssen Cilag GmbH, Neuss, Germany
| |
Collapse
|
14
|
Hargarter L, Cherubin P, Bergmans P, Keim S, Rancans E, Bez Y, Parellada E, Carpiniello B, Vidailhet P, Schreiner A. Intramuscular long-acting paliperidone palmitate in acute patients with schizophrenia unsuccessfully treated with oral antipsychotics. Prog Neuropsychopharmacol Biol Psychiatry 2015; 58:1-7. [PMID: 25448776 DOI: 10.1016/j.pnpbp.2014.11.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/28/2014] [Accepted: 11/10/2014] [Indexed: 11/26/2022]
Abstract
In this prospective multicentre, open-label, 6-month study (Paliperidone Palmitate Flexible Dosing in Schizophrenia [PALMFlexS]), tolerability, safety and treatment response with paliperidone palmitate (PP) were explored in patients with acute symptoms of schizophrenia following switching from previously unsuccessful treatment with oral antipsychotics. This pragmatic study was conducted in a large, more representative sample of the general schizophrenia population compared to randomized controlled pivotal trials, to specifically mimic real-world clinical situations. After initiation on Day 1 and Day 8, patients received PP once monthly at flexible doses (50-150mgeq.) intramuscularly. The primary efficacy outcome was defined as the percentage of patients achieving ≥30% improvement in PANSS total score from baseline (BL) to last-observation-carried-forward (LOCF) endpoint (EP). Safety and tolerability assessments included Extrapyramidal Symptom Rating Scale (ESRS) total score and treatment-emergent adverse events (TEAEs). Overall, 212 patients received PP at least once after switching from oral antipsychotics, primarily due to lack of efficacy (45.8%). Significant improvements from BL in mean (SD) PANSS total score were observed from Day 8 onwards (BL to LOCF EP: -31.0 [29.0]; p<0.0001). At endpoint, two-thirds (66.7%) and 43.5% of patients achieved a ≥30% and ≥50% improvement in mean PANSS total score, respectively. PP was associated with significant improvements across secondary measures of symptom severity, subjective well-being, medication satisfaction, illness-related disorders of activity and participation, and patient functioning (p<0.0001; BL to LOCF EP). PP was generally well tolerated, with significant reductions in ESRS total score (p<0.0001) and mainly mild-to-moderate TEAEs. TEAEs reported in ≥5% of patients were injection-site pain (13.7%), insomnia (10.8%), psychotic disorder (10.4%), headache and anxiety (both 6.1%). The PALMFlexS study findings provide valuable pragmatic clinical data on PP treatment in patients with acute schizophrenia previously unsuccessfully treated with oral antipsychotics.
Collapse
Affiliation(s)
- Ludger Hargarter
- Medical & Scientific Affairs, Janssen Cilag EMEA, Neuss, Germany.
| | - Pierre Cherubin
- Medical Affairs, Janssen Cilag EMEA, Issy-les-Moulineaux, France
| | - Paul Bergmans
- Biometrics and Reporting, Janssen Cilag Benelux, Tilburg, The Netherlands
| | - Sofia Keim
- Global Clinical Operations EMEA MAO, Janssen Cilag, Barcarena, Portugal
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | - Yasin Bez
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Eduard Parellada
- Barcelona Clinic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Pierre Vidailhet
- Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | | |
Collapse
|
15
|
A prospective flexible-dose study of paliperidone palmitate in nonacute but symptomatic patients with schizophrenia previously unsuccessfully treated with oral antipsychotic agents. Clin Ther 2014; 36:1372-88.e1. [PMID: 25444566 DOI: 10.1016/j.clinthera.2014.08.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/18/2014] [Accepted: 08/09/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE The goal of this study was to explore the tolerability, safety, and treatment response of flexible doses of once-monthly paliperidone palmitate (PP) in the subset of nonacute but symptomatic adult patients with schizophrenia previously unsuccessfully treated with oral antipsychotic agents in the PALMFlexS (Paliperidone Palmitate Flexible Dosing in Schizophrenia) study. METHODS This was an interventional, single-arm, international, multicenter, unblinded, 6-month study performed in patients with schizophrenia. Patients were categorized according to reasons for switching. In patients switching because of lack of efficacy or for other reasons, primary efficacy outcomes were the proportion achieving treatment response (defined as ≥20% improvement in Positive and Negative Syndrome Scale [PANSS] total score from baseline to last-observation-carried-forward end point) and maintained efficacy (defined as noninferiority in the change in PANSS total score at end point versus baseline [Schuirmann's test]), respectively. FINDINGS A total of 593 patients (intention-to-treat population) were enrolled: 63.1% were male; their mean (SD) age was 38.4 (11.8) years; and 78.6% had paranoid schizophrenia. The main reasons for transition to PP were patient's wish (n = 259 [43.7%]), lack of efficacy (n = 144 [24.3%]), lack of compliance (n = 138 [23.3%]), and lack of tolerability (n = 52 [8.8%]) with the previous oral antipsychotic medication. The recommended PP initiation regimen (150 milligram equivalents [mg eq] day 1 and 100 mg eq day 8) was administered in 93.9% of patients. Mean PANSS total score decreased from 71.5 (14.6) at baseline to 59.7 (18.1) at end point (mean change, -11.7 [15.9]; 95% CI, -13.0 to -10.5; P < 0.0001). Sixty-four percent of patients showed an improvement of ≥20% in PANSS total score, and the percentage of patients rated mildly ill or less in Clinical Global Impression-Severity increased from 31.8% to 63.2%. Mean personal and social performance total score (SD) increased (ie, improved) significantly for all patients from baseline to end point (58.1 [13.4] to 66.1 [15.7]; P < 0.0001). IMPLICATIONS The PALMFlexS study is a pragmatic interventional study compared with randomized controlled trials, conducted in a large, more representative sample of patients with schizophrenia, and designed specifically to mimic real-world clinical situations. The findings support the results from randomized controlled studies. They also demonstrate that a clinically relevant treatment response is possible in patients who are considered to be clinically stable by their physician, supporting the use of flexibly dosed PP in such patients. Clinical trials.gov number: NCT01281527.
Collapse
|
16
|
Werden in Österreich Patienten mit psychosomatischen Störungen ausreichend versorgt? ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2013. [DOI: 10.13109/zptm.2013.59.4.408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Weiss HR. Spinal deformities rehabilitation - state of the art review. SCOLIOSIS 2010; 5:28. [PMID: 21184673 PMCID: PMC3023759 DOI: 10.1186/1748-7161-5-28] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 12/24/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medical rehabilitation aims at an improvement in function, capacity and participation. For the rehabilitation of spinal deformities, the goal is to maintain function and prevent secondary symptoms in the short- and long-term. In patients with scoliosis, predictable signs and symptoms include pain and reduced pulmonary function. MATERIALS AND METHODS A Pub Med review was completed in order to reveal substantial evidence for inpatient rehabilitation as performed in Germany. No evidence has been found in general to support claims for actual inpatient rehabilitation programmes as used today. Nevertheless, as there is some evidence that inpatient rehabilitation may be beneficial to patients with spinal deformities complicated by certain additional conditions, the body of evidence there is for conservative treatment of spinal deformities has been reviewed in order to allow suggestions for outpatient conservative treatment and inpatient rehabilitation. DISCUSSION Today, for both children and adolescents, we are able to offer intensive rehabilitation programmes lasting three to five days, which enable the patients to acquire the skills necessary to prevent postures fostering scoliosis in everyday life without missing too much of school teaching subjects at home. The secondary functional impairments adult scoliosis patients might have, as in the opinion of the author, still today require the time of 3-4 weeks in the clinical in-patient setting. Time to address psychosocial as well as somatic limitations, namely chronic pains and cardiorespiratory malfunction is needed to preserve the patients working capability in the long-term. CONCLUSION Outpatient treatment/rehabilitation is sufficient for adolescents with spinal deformities.Inpatient rehabilitation is recommended for patients with spinal deformities and pain or severe restrictive ventilation disorder.
Collapse
Affiliation(s)
- Hans-Rudolf Weiss
- Orthopedic Rehabilitation Services, D-55457 Gensingen, Alzeyerstr, 23, Germany.
| |
Collapse
|