title: A multicentre cluster-randomized controlled study to evaluate a train-the-trainer programme for implementing internal and external participation in medical rehabilitation.
abstract: OBJECTIVE
  Evaluation of the effect of the train-the-trainer programme 'Fit for Shared Decision-Making' on internal (team) and external (patient) participation in medical rehabilitation from a patient and staff perspective.
  
  
  METHODS
  A multicentre, cluster-randomized controlled study.
  
  
  METHODS
  Eleven medical rehabilitation clinics, divided into intervention and control groups.
  
  
  METHODS
  A staff and a patient survey were conducted pre- and post-intervention, plus a further patient survey six months later.
  
  
  METHODS
  Train-the-trainer programme 'Fit for Shared Decision-Making' for interprofessional settings.
  
  
  METHODS
  Each survey measured internal participation with a self-compiled six-item scale (Internal Participation Scale, IPS), and external participation by means of a nine-item Shared Decision-Making Questionnaire (SDM-Q-9) for the patients and for healthcare professionals.
  
  
  RESULTS
  Patient samples numbered 402 for the pre-, 463 for the post-intervention data collection period and 461 six months after the intervention. Patients' appraisal of external participation (Fperiod x group (2) = 0.256, p=0.774, η(2)=0.000) showed no change, whereas internal participation (Fperiod x group (2) = 3.785, p=0.023, η(2)=0.007) showed a significant increase. A total of 195 healthcare professionals participated in the pre- and 168 in the post-intervention staff survey. Here external participation was significantly enhanced in the intervention group (F(period x group) (1) = 4.893, p=0.028, η(2)=0.014).
  
  
  CONCLUSIONS
  The train-the-trainer approach can be recommended for implementing internal and external participation in interprofessional settings such as medical rehabilitation clinics. However, there is a need for more intensive staff training for internal participation and an additional intervention for patients to achieve success in all aspects.
authors.affiliation: 1Department of Medical Psychology and Medical Sociology, University Freiburg, Freiburg, Germany.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Koerner
authors.forename: Markus
authors.initials: M
authors.lastname: Wirtz
authors.forename: Martina
authors.initials: M
authors.lastname: Michaelis
authors.forename: Heike
authors.initials: H
authors.lastname: Ehrhardt
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Steger
authors.forename: Eva
authors.initials: E
authors.lastname: Zerpies
authors.forename: Jürgen
authors.initials: J
authors.lastname: Bengel
mesh_terms: D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010358:Patient Participation; D012046:Rehabilitation / Q000193:education*; D013663:Teaching / Q000379:methods*
keywords: Shared decision-making; cluster-randomized controlled study; interprofessional team; patient-centred care; train-the-trainer programme