[Supported own initiative of rehabilitation patients ("new credo") - a successful model?]

Abstract

Background: In recent years, rehabilitation aftercare has become an important topic in rehabilitation research and practice. This development was initiated by the lack of long-term effects after rehabilitation treatment and by the deficits identified in several reviews of aftercare recommendations and of actual practice of aftercare. Against this background, a new aftercare strategy was developed, the "New Credo", which focused aftercare from the beginning of rehabilitation treatment. A substantial element of the concept is the resumption and maintenance of physical activity in everyday life of the rehabilitation patient. The goal of the present study was the evaluation of this concept in a sample of patients with chronic back pain.

Method: The "New Credo" was evaluated in a multi-centre, prospective controlled longitudinal study with 3 points of measurement (before and after rehab as well as after 12 months). 6 rehabilitation clinics in Schleswig-Holstein were included in the intervention arm (IG, 3 clinics) and in the control arm (CG, 3 clinics), participants were rehabilitants with chronic back pain. The clinics in the intervention arm implemented "the New Credo" in accordance with their local conditions. During the study period they were provided with a person who was responsible for managing aftercare activities for patients. Participants in the CG received standard rehabilitation treatment according to general guidelines. Restriction of social participation, disability days and restriction in functional capacity in everyday life were defined as primary outcomes. Complete data were available for 166 rehabilitants in the IG and 368 in the CG.

Results: At the end of rehabilitation rehabilitants in the IG reported significantly higher use of treatment offerings and more intensive preparation for the time after rehabilitation treatment than rehabilitants in the CG. Rehabilitants in the IG found recommendations for the time after treatment significantly better than those in the CG. As expected, both rehabilitants in the IG and in the CG showed similar outcomes directly after inpatient treatment. With respect to long-term effects 12 months later, significant differences with moderate effect sizes were observed in 2 of the 3 primary outcomes (function capacity and social participation) in favour of the IG. With respect to secondary outcomes, rehabilitants in the IG showed significantly better long-term results than those in the CG.

Discussion and conclusion: Our results show that the "New Credo" can successfully be implemented into rehabilitation practice. The "New Credo" was positively rated by clinicians and rehabilitants. Rehabilitants in the IG found offerings of supported aftercare very helpful. The intensity of actual use of aftercare by rehabilitants as well as the emphasis laid on aftercare by clinicians indicate that treatment was focused on aftercare over the whole time of rehabilitation and that the rehabilitants transferred these aspects into everyday life. For the rehabilitants in the IG higher long-term effects could be observed compared to those in the CG. This suggests an improved sustainability of rehabilitation effects and a successful transfer of acquired knowledge and self-efficacy in everyday life.