[Post-rehabilitation care in the context of cardiac rehabilitation--aspects of prevention and health promotion].
OBJECTIVE
This article presents a literature review on post-rehabilitation care focussing on preventive and health promotion aspects set out on the example of coronary heart disease. Selected studies and programmes for intensified aftercare are analyzed as to whether and to what extent preventive and health promotion aspects are integrated in post-rehabilitation care.


METHODS
The analysis includes a stock-taking of practice concepts and evaluation studies on aftercare programmes in cardiac rehabilitation in Germany. Presented is an overview of the aftercare programmes in place based on a comprehensive, systematic literature search.


RESULTS
The review shows a great diversity of aftercare programmes available in cardiac rehabilitation. The findings support the assumption that aftercare offers a range of promising approaches for implementing preventive and health promotion activities due to its aim of achieving sustained rehabilitation success. So far, implementation of those activities has been insufficient. Cardiovascular risk factors such as lifestyle and psychosocial status are being considered to different degrees in those programmes in terms of intensity and frequency. Along with programmes showing a large proportion of preventive measures, only limited preventive structures are found for a majority of the aftercare concepts analyzed. Health promotion strategies are also identified in only few aftercare programmes.


CONCLUSIONS
Effectiveness studies support good results for intensified aftercare, but they often refer to only part of the relevant cardiovascular risk factors and to only medium-term observation, while long-term proof of effectiveness is scarce. A small number of programmes with positive outcomes relative to the risk profile suggest that integration of preventive and health promotion activities can contribute strongly to improving and stabilizing the effects achieved in rehabilitation. The present analysis indicates further need for research in order to verify the effects of existing post-rehabilitation programmes concerning cardiovascular risk factors and determination of the relevant target groups.
Sterdt
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E
Stiftungslehrstuhl Prävention und Rehabilitation in der System- und Versorgungsforschung, Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover. Sterdt.Elena@mh-hannover.de
Brandes
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I
Dathe
R
R
Walter
U
U
D000359:Aftercare; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000517:prevention & control* / Q000534:rehabilitation*; D004185:Disability Evaluation; D005858:Germany; D006293:Health Promotion; D006801:Humans; D008019:Life Style; D010348:Patient Care Team; D012307:Risk Factors; D055502:Secondary Prevention; D012657:Self-Help Groups