[Patient-doctor interaction in rehabilitation: is there a relationship between perceived interaction quality and long term treatment results?].
OBJECTIVE
A body of evidence suggests that good interaction is crucial for high-quality medical practice and that it has a considerable impact on treatment outcomes. Less is known about the role and significance of doctor-patient interaction in rehabilitation. The study's aim was to capture perceived quality of doctor-patient interaction in rehabilitation by a rating instrument (P.A.INT-Questionnaire) and to examine the relationship between perceived quality of interaction and long-term treatment outcomes.


METHODS
Referring to the approach of Bensing (1990) and Rogers (1972) we defined "quality of interaction" in terms of 3 dimensions: (1) affective behaviour, i. e., empathy, positive regard and coherence; (2) instrumental behaviour: providing and collecting information, structuring and reinforcement; (3) participation and involvement of patients. 2 parallel versions of the Questionnaire were developed for patients and physicians. 7 rehabilitation clinics in north-western Germany participated in the multi-centre study. 61 doctors and their 470 patients evaluated both their shared dialogues upon admission, discharge and at least one ward round. Furthermore, patients rated their health status on admission (t0), discharge (t1) and 6 months after discharge (t2) using the IRES-3 (Indicators of Rehabilitation Status Questionnaire Version 3).


RESULTS
(1) Comparisons of patient and physician evaluations on admission revealed the following: Affective quality of contact (empathy and coherence) was rated positively and without discrepancies by both patients and physicians. On the other hand, instrumental behaviour (information and structuring) was rated less positively by patients than by physicians. (2) Patients who rated the dialogue on admission more positively showed stronger treatment effects with respect to pain, to anxiety and depression 6 months after discharge. Also disability days decreased about 40% stronger in the group of positive raters. (3) Patient ratings of quality of interaction showed low but significant correlations with patient-related aspects like coping with disease, health-related knowledge and former positive experiences with physicians. A stepwise regression analysis revealed that interaction quality seems to contribute to enhanced treatment results independently of patients' competences.


CONCLUSIONS
Our results suggest a positive relationship between perceived interaction quality as defined by the P.A.INT-Questionnaire and treatment effects 6 months after discharge. Comparisons of patient and physician evaluations showed that physicians seem to be successful in building relationships on the affective level but less successful on the instrumental level (i. e., information, structuring and reinforcement). Our data underline the importance of interaction quality for the success of rehabilitation and thus the importance of specific skills such as providing and collecting information, recognizing patients' concerns and goals as well as reinforcement of health-related action. This is especially important when knowledge of disease and coping with disease on patients' side is poor. Interaction quality seems to contribute to better treatment results independently of patients' competences.
Dibbelt
S
S
Institut für Rehabilitationsforschung, Klinik Münsterland, Bad Rothenfelde. dibbelt.ifr@klinik-muensterland.de
Schaidhammer
M
M
Fleischer
C
C
Greitemann
B
B
D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect; D002908:Chronic Disease / Q000523:psychology / Q000534:rehabilitation*; D003142:Communication; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation / Q000523:psychology; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011785:Quality Assurance, Health Care; D012047:Rehabilitation Centers; D012054:Reinforcement, Psychology; D012803:Sick Role; D011795:Surveys and Questionnaires; D016896:Treatment Outcome