title: [Different Health Impairments at the Beginning of Medical Rehab: Possibilities of more Flexibility using the Example of Rehab Aftercare].
abstract: BACKGROUND
  The aftercare-program new credo was developed interdisciplinary and with practical orientation for rehabilitation patients with chronic back pain. The concept focuses on rehabilitation aftercare from the beginning of rehabilitation treatment and includes a long-term support of rehabilitation patients after inpatient rehabilitation. A multi-center, controlled longitudinal study demonstrated that participants in the intervention group (IG) implemented significantly better rehabilitation contents and objectives in everyday life and had significant better long-term effects. Anyway, there are participants who don't benefit from the new credo as they begin rehabilitation treatment with low impairments. Assuming that rehabilitation patients with lower impairments need a less comprehensive rehabilitation aftercare compared to those with higher impairments, a follow-up study including a flexible aftercare strategy was conducted. Thereby it is investigated whether the IG achieves more sustainable effects despite of less aftercare compared to the control group (CG) without the aftercare program.
  
  
  METHODS
  A prospective controlled longitudinal study in 2 rehabilitation clinics with 3 points of measurement was conducted. The flexibilization of the aftercare program was based on the level of impairment in the main outcome variable functional limitation in activities of daily living (FFbH-R) and restriction in participation (IMET) at the beginning of rehabilitation. Both questionnaires have been used in numerous studies successfully. Rehabilitation patients with low impairments received only the elements of the new credo during inpatient rehabilitation, rehabilitation patients with relevant impairments received the entire new credo over a period of 12 month after inpatient rehabilitation. The effects were evaluated with data from the CG of the primary study [Deck et al., 2012]. This sample was also divided according to their impairments. Rehabilitation patients with no relevant impairments were included in the analysis (IG N=81, KG N=157).
  
  
  RESULTS
  Regarding the long-term effects for the primary outcome variable FFbH-R a significant positive intragroup-effect was detected for the IG, the CG reached the initial value 12 month after inpatient rehabilitation. For the IMET a significant intragroup-effect is also visible in the IG, the CG does not change over the period of time. For both primary outcomes, there are no significant interaction effects to be observed. With respect to the secondary outcomes, in the IG significant small to moderate intragroup-effects were determined in all outcomes, the CG achieved for half of those outcomes significant small intragroup-effects.
  
  
  CONCLUSIONS
  Rehabilitation patients, who begin rehabilitation with rather low impairments perpetuate their rehabilitation effects with an even reduced aftercare. Aftercare-programs should therefore be adapted to the individual needs. Rehabilitation patient, who start the rehabilitation with relative good health, seem not to have an added value from an intensive aftercare-program.
authors.affiliation: Institut für Sozialmedizin und Epidemiologie der Universität Lübeck.
authors.forename: A L
authors.initials: AL
authors.lastname: Walther
authors.affiliation: Institut für Sozialmedizin und Epidemiologie der Universität Lübeck.
authors.forename: R
authors.initials: R
authors.lastname: Deck
mesh_terms: D000359:Aftercare / Q000379:methods / Q000523:psychology*; D017677:Age Distribution; D001416:Back Pain / Q000523:psychology* / Q000534:rehabilitation*; D059350:Chronic Pain / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D012046:Rehabilitation / Q000379:methods / Q000523:psychology*; D017678:Sex Distribution; D016896:Treatment Outcome