[Effects of a programme for structured outpatient follow-up care after inpatient rehabilitation of obese children and adolescents--a multicentre, randomized study].
BACKGROUND
Inpatient rehabilitation is an important contributor to the treatment of child and adolescent obesity with comorbidity in Germany. Thus far outpatient follow-up care has not been subject to research. The main goal of this study is the development and longer-term evaluation of a programme for structured outpatient follow-up care by primary care physicians after inpatient rehabilitation of obese children and adolescents.


METHODS
This multicentre, randomized, parallel controlled clinical trial enrolled 521 children and adolescents aged 9 - 16 (avg. 13.3) years in 7 cooperating specialized rehabilitation facilities. The patients were randomized at the end of their multimodal inpatient treatment that lasted for 5.9 (+/- 1.2) weeks. The intervention consisted of 12 half-hour outpatient consultations by the primary care physicians utilizing a modular consultation guideline and an internet-based training programme. The control group received standard care. Outcome variables included anthropometric measures, questionnaires on eating behaviour, physical activity, quality of life, self-efficacy and subjective rating of the intervention. Measurements were performed at the beginning (t1) and end (t2) of inpatient rehabilitation as well as 6 (t3) and 12 (t4) months after discharge.


RESULTS
There was a highly significant improvement of BMI-z-score (standard deviation score of the Body Mass Index), relevant behaviour, quality of life and self-efficacy between t1 and t4. On intention to treat analysis no differences were detected between intervention and control groups. The intervention was utilized by only 50 % of entitled. The BMI-z-score reached a minimum at t3 (6-month follow-up). Predictors of longer-term BMI-z-score decline were psychological suffering, poor eating behaviour, low physical activity and high socio-economic status. In multivariate linear regression improvement of eating behaviour and physical activity correlated with the improvement of BMI-z-score.


CONCLUSIONS
This low-level outpatient intervention did not improve the demonstrated longer-term effectiveness of inpatient rehabilitation. An interdisciplinary outpatient follow-up care in groups with inclusion of the parents is recommended.
van Egmond-Fröhlich
A
A
Kinder-Reha-Klinik Am Nicolausholz, Bad Kösen. a.vanegmond-froehlich@uglielje.de
Bräuer
W
W
Goldschmidt
H
H
Hoff-Emden
H
H
Oepen
J
J
Zimmermann
E
E
D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D009765:Obesity / Q000453:epidemiology* / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010045:Outpatients / Q000706:statistics & numerical data; D015397:Program Evaluation; D012047:Rehabilitation Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D016896:Treatment Outcome