[Therapy goal setting in patients with psychological stress in orthopaedic and cardiac rehabilitation].
OBJECTIVE
To study goal-setting for patients with psychological stress in orthopaedic and cardiac rehabilitation centres.


METHODS
A questionnaire assessing patients' somatic, functional and psychosocial status ("IRES"-questionnaire) was administered to 3109 patients with musculoskeletal diseases and 1670 patients with cardiovascular diseases from a total of 26 rehabilitation centres at their admission and discharge. For all patients, physicians filled in the "Physician's Sheet" ("Arztbogen") that assesses patient-specific goals of therapy.


RESULTS
Nearly 50 % of the patients suffered from psychological stress at their admission. Of the patients with high psychological stress (higher than in 90 % of the general population) only 11.1 % (musculoskeletal diseases) and 3.4 % (cardiovascular diseases) were diagnosed as having a mental disorder (ICD-10 diagnosis in the range of F00 - F99). High psychological stress reported by patients themselves is associated with only a small increase of goal setting in psychological therapy documented in the "Physician's Sheet". The most important factors that influence the predefinition of psychological goals of therapy are high multimorbidity, an ICD-10 diagnosis in the range of F00 - F99, low age, high motivation for rehabilitation and being a woman. However, statistically significant differences between rehabilitation centres in the predefinition of psychological goals of therapy were detected. It can be assumed that differences in concepts of therapy are responsible for this finding.


CONCLUSIONS
The results show that physicians use the patient's self-assessments of their psychological stress only to a small extent while planning psychosocial interventions and care. The predefinition of goals in a context of "forced" consideration of patients self-assessments leads to a higher degree of consistency between patients' judgements and goal settings. It also shows a slightly higher predictive power for rehabilitation effects than the predefinition of goals of therapy without noticing patients' self-assessments. This demonstrates the usefulness of a patient-centred screening instrument for psychological stress in orthopaedic and cardiac rehabilitation.
Farin
E
E
Abt. Qualitätsmanagement und Sozialmedizin, Universitätsklinikum Freiburg. farin@aqs.ukl.uni-freiburg.de
Follert
P
P
Jäckel
W H
WH
D000368:Aged; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000523:psychology; D015897:Comorbidity; D005260:Female; D005858:Germany; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009140:Musculoskeletal Diseases / Q000523:psychology / Q000534:rehabilitation*; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010865:Pilot Projects; D011613:Psychotherapy; D011785:Quality Assurance, Health Care; D012047:Rehabilitation Centers; D012737:Sex Factors; D012803:Sick Role; D013001:Somatoform Disorders / Q000523:psychology / Q000534:rehabilitation; D013315:Stress, Psychological / Q000150:complications*