In this study, improvisational theater was investigated in the context of child and adolescent inpatient psychiatric treatment. In a non-randomized, uncontrolled, and explorative study, 29 inpatients participated in an improvisational theater group and in a therapeutic sports group at the same time. To compare the subjective changes after participating in both groups, patients were asked to rate changes in symptom severity on single-question-scales retrospectively. Patients' self-reports indicated that positive changes in most symptoms (e. g. mood, spontaneity, cohesion within the group) were more pronounced after the theater group than after the sports group. Improvisational theater is a novel and promising group offering in inpatient care. The benefits are high, considering the relatively little amount of effort required. Due to methodological limitations, however, changes in symptoms cannot be ascribed to the intervention causally, and further research is necessary.

In this study, improvisational theater was investigated in the context of child and adolescent inpatient psychiatric treatment. In a non-randomized, uncontrolled, and explorative study, 29 inpatients participated in an improvisational theater group and in a therapeutic sports group at the same time. To compare the subjective changes after participating in both groups, patients were asked to rate changes in symptom severity on single-question-scales retrospectively. Patients' self-reports indicated that positive changes in most symptoms (e. g. mood, spontaneity, cohesion within the group) were more pronounced after the theater group than after the sports group. Improvisational theater is a novel and promising group offering in inpatient care. The benefits are high, considering the relatively little amount of effort required. Due to methodological limitations, however, changes in symptoms cannot be ascribed to the intervention causally, and further research is necessary.

Purpose: Patient satisfaction is one core dimension of quality assurance of the German statutory pension insurance. The scale "rehabilitation planning and goals" consistently produced substandard evaluations. The reasons for this effect were Unknown.Method: This two-phased study integrated quantitative and qualitative research methods ("mixed-methods-design). During the quantitative phase predictors for satisfaction on the scale "rehabilitation planning and goals" were identified using multiple regression models based on data from patients' questionnaires. During the qualitative phase open-ended interviews concerning aspects of rehabilitation planning and goal orientation were analysed using the thematic coding approach to find differences between clinics rated below and above average. The items of the scale were analysed using content analysis approach.Results: The quantitative data set contained 149527 patients from 548 clinics. Behavioural recommendations with regard to different areas of life, satisfaction with doctors as well as housing and accommodation turned out to be relevant predictors of satisfaction oil the scale "rehabilitation planning and goals". No substantial differences between clinics were found in the 40 open-ended patient interviews with regard to rehabilitation planning and goal setting. However, differences could be found concerning perceived continuity of care, doctors' concern for the patient and organisational characteristics. Content analysis of the items revealed, that the scale considers rehabilitation goals and planning to lesser extent, but patient orientation and multidimensional goal orientation in the clinic. Discussion: The content validity of the applied "rehabilitation planning and goals" scale has to be questioned. Differences concerning the satisfaction oil the scale "rehabilitation planning and goals" do not refer to differences in regard to rehabilitation planning and goal orientation, but to general aspects of patient orientation: quality of the patient-doctor relationship and alignment of basic structural and organisational parameters to patient needs.Conclusions: Facilitating a patient-doctor relationship which is trustful and Continuous and providing organisational processes related to patients' needs might be a way to increase patient satisfaction substantially.

Measuring quality of life is considered as an important outcome criterion in clinical studies. Generic instruments as the Short Form 12 Health Survey offer the possibility to compare outcomes among different indications. Therefore a test of the factorial (structural) validity of the method in each indication is necessary. This study is based upon SF-12 data from 343 patients with diabetes mellitus, which were pooled together from two rehabilitation research projects. The psychometric properties of the measure were analyzed, and the questionnaires structure was tested using confirmatory structural equation modeling. In a second step age and gender specific analyses were undertaken. The questionnaires psychometric properties prove to be comparable to international results. The structural analyses support a model that specifies covariations of errors between two items of same wording („accomplished less“). SF-12 physical and mental (latent) components are highly associated. Therefore construct validity must be criticized. Moreover both physical and mental health seem not to be independent in patients view, since items response is influenced by same wording more than subjective health reception. SF-12 summary scores should not be seen and misinterpreted as independently.

International guidelines do not apply to cardiac rehab in Germany in every aspect since rehab here is delivered mostly in an in-patient setting over three weeks only. Based on a survey of 737 members of the interdisciplinary rehab team in 104 cardiac rehab clinics problem-treatment-profiles were outlined. An analysis of actual and nominal conditions allowed to identify possible problem spots in cardiac rehabilitation. Finally treatment needs were identified in a convenience sample of 342 cardiac rehab patients. The results give important indications for the further development of cardiac rehabilitation services in Germany.

OBJECTIVE:The study analyzes pain complaints of chronic pain patients in comparison to representative data from the general population.METHODS:In a cross-sectional study 493 patients from different health care settings were interviewed about their pain during the previous 12-month and the currently strongest pain. Locations, frequency, intensity and duration of pain, restrictions in daily activities and utilization of therapies were assessed. For comparison data from the German federal health survey 1998 (n=6702) was used.RESULTS:The patients experienced pain more frequently and more severely than the general population. The largest difference was found in limitations of daily activities. Several qualitative similarities were observed, e.g. for the relative frequency of pain locations. Most patients reported multiple pain locations. The number of reported pain locations increased with intensity and duration of pain. Women reported more frequent and stronger pain than men, utilized more therapies and underwent more often alternative treatments.CONCLUSIONS:The high prevalence of pain complaints in both samples indicates the importance of early pain prevention, adequate diagnosis and treatment in order to obviate the development and chronification of pain.

Recent efforts to operationalize persons’ readiness to adopt a self-management approach to chronic pain have met with promising, but somewhat limited, results. The current study describes the development and psychometric evaluation of a German version of Pain Stages of Change Questionnaire (PSOCQ). A new item pool was developed to attempt to improve in particular the discriminant validity of the scales and in order to obtain a shortened measure. The items were administered to 494 chronic pain patients who were split into two independent samples. Item- and factor-analysis performed on data from one half of the sample resulted in four scales: precontemplation, preparation, action, and maintenance. The scales of the new measure, called the “Freiburg Questionnaire-Stages of Chronic Pain Management (FQ-STAPM)”, showed good indices of reliability, homogeneity, and discriminant validity. Both the concurrent and divergent validity indices and the relationships between scale scores and pain related variables proved to be consistent with the transtheoretical model. Confirmatory factor analysis using LISREL performed on the second half of the sample supported the goodness-of-fit of the structure model. Implications of these findings for future research exploring the relevance of the pain stages of change model are discussed.

Measuring quality of life is increasingly considered as an outcome criterion in clinical studies. In order to assess quality of life, disease specific as well as generic instruments are used. Generic instruments make it possible to compare outcomes among different indications, but for this purpose a test of the factorial validity of the method in each indication is necessary. In this study, the generic short form 12 was administered to a sample survey of 545 patients with inflammatory-rheumatic disease. Patients data from three scientific rehabilitation research projects were pooled for the analysis. First the structure was tested using confirmatory structural equation modeling. In a second step age and gender specific values were calculated and compared to norm data from the German National Health Survey 1998. The questionnaire's structure is acceptable and comparable to international results. Confirmatory analyses support a model allowing covariations of error terms between items of the same subdimensions. The two latent dimension are highly correlated. Crossloadings of items from different subdimension does not improve the model fit significantly. Comparisons with the German norm data shows that the patients are impaired within their physical and mental dimension of subjective health. Higher impairment is evident especially on the physical sumscale. Women show higher impairment in both scales. However no effects of age can be detected. The SF-12 could be used with trust in the study of patients with inflammatory-rheumatic diseases. But physical and mental health can not be seen as indepentently.

This article describes the utility of factor analysis in the context of developing questionnaires for clinical use in rehabilitation. The basic principles of both exploratory factor analysis and confirmatory factor analysis are presented in order to give the necessary knowledge for choosing between both concepts. Exploratory and confirmatory factor analyses complement one another, and there is a place for both in the process of questionnaire development. Finally, the potential use of factor analysis for scaling procedures as well as intercultural validity studies is outlined.

This article describes the utility of factor analysis in the context of developing questionnaires for clinical use in rehabilitation. The basic principles of both exploratory factor analysis and confirmatory factor analysis are presented in order to give the necessary knowledge for choosing between both concepts. Exploratory and confirmatory factor analyses complement one another, and there is a place for both in the process of questionnaire development. Finally, the potential use of factor analysis for scaling procedures as well as intercultural validity studies is outlined.

This study describes the psychometric development of an instrument to measure the "stages of change" in tinnitus sufferers. Based on our own previous work about measuring stages of change in chronic pain patients, 48 items were administered to 128 tinnitus sufferers in inpatient and outpatient facilities as well as in self helping groups. Principle component analysis and item analysis led to a four factor solution. Each factor (resp. stage) consisted of four items: precontemplation, preparation, action, and termination. Scales showed theoretically conformed associations with measure of pain burden e. g. tinnitus loudness and cumbersomeness as well with standardized measures (HADS, TB-12, SF-12). High burden was correlated positively with high expressions on the lower scales, and it was correlated negatively with higher stage scores. Against the assumption there was no association between tinnitus durability and stages expression.

The effects of a nurse-managed secondary prevention program for patients after acute cardiac events were examined. Special interest was given to gender-specific results. The design was a prospective, randomized, controlled trial involving 343 patients following 3 weeks of inpatient cardiac rehabilitation, randomly assigned to either of two study groups. Patients in the treatment group were contacted monthly by phone over 1 year. The main goals of the intervention were the reduction of behavioural coronary risk factors and enhancing quality of life. The program was conducted by specially trained nurses. The control group received written information only. Primary outcome was the Framingham risk score. Follow-up examination after 12 months was completed by 297 patients. Patients in the intervention group showed lower Framingham risk scores as compared to controls. Separate analyses by sex revealed that this was mostly due to the men in the sample. Women, on the other hand, showed a significant rise of clinically relevant anxiety/depressiveness in the control but not in the intervention group; in males there were no differences between study conditions. In conclusion, telephone counselling by specially trained nurses seems a cost-effective way to achieve a lasting reduction in cardiac risk factors and to maintain the effects of cardiac rehabilitation.

Background Quality of life is gaining relevance as a criterion of success in therapeutic outcome studies. In order to record quality of life, disease-specific instruments are being used as well as generic instruments. Generic instruments offer the possibility to compare outcome among different indications; however for this it is necessary to prove the differential factorial validity of the instrument's structure. Aim of the study Using structural equation modeling the SF-36 was administered to a sample of patients with rheumatic diseases. The sensitivity to change of the measure was calculated after six months. Furthermore, age- and sex-specific scale values were calculated and compared with norm data. Methods SF-36 data of 436 patients as well as sex and age from two scientific rehabilitation research projects were pooled for this secondary analysis. Results The structure of the questionnaire proves to be acceptable and comparable with international results. The confirmatory analysis supports the best fit for a model with crossloadings assuming correlated main dimensions. Sensitivity to change is low in general. The best effect size is found for the subscale pain. The comparison with norm data shows that patients are impaired particularly within their physical health (regarding the SF subscales) both at the beginning of the treatment and after six months. In all age groups men have better conditions than women. Conclusions The generic SF36 show sufficient factorial validity. From this point of view there is no objection to using the SF-36 in patients with rheumatic diseases. Indeed the use of the SF summary scales as a representation of (uncorrelated) physical and mental health must be questioned critically.

Die multimodale verhaltensmedizinische Behandlung von Tinnituspatienten erfordert eine aktive Mitarbeit und Veränderungsbereitschaft der Betroffenen. Das transtheoretische Modell definiert die Veränderungsmotivation in 6 Stadien. Es wurde untersucht, ob sich diese Stadien bei Tinnitusbetroffenen mittels eines Selbstbeurteilungsinstrumentes identifizieren lassen.

Die Studie analysiert Schmerzbeschwerden bei chronischen Schmerzpatienten im Vergleich zu repräsentativen Daten aus der Allgemeinbevölkerung.