Self-management education for rehabilitation inpatients: A cluster-randomized controlled trial
Introduction
Patient education conveyed by disease-specific self-management programs are targeting disease-related knowledge, self-management skills and health behavior to reduce the impact of disease and foster health-related quality of life [[1], [2]]. Self-management requires a dynamic and continuous process of self-regulation performed by the individual deemed responsible for his/her health management [[1], [3]]. Self-management patient education comprises a number of behavior change approaches, such as providing information, encouragement, and skill training enabling patients to take an active role in their treatment [2]. Behavior change techniques with regard to changing health behavior have been systematized by Michie and Colleagues [4]. Systematic reviews and meta-analyses provide evidence for the effectiveness of self-management programs, but the effects vary depending on conditions and outcomes [[5], [6], [7], [8], [9]]. Due to the diversity of included interventions, information on the most effective means of delivery, educational approaches and techniques is incomplete.
In Germany, patient education is a mandatory part of (inpatient) medical rehabilitation for patients with chronic somatic diseases. Previous trials showed the superior efficacy of interactive patient-centered disease-specific group programs with regard to illness-knowledge and self-management outcomes [[10], [11], [12]]. Furthermore, theory-based interventions addressing self-regulatory variables, like planning, showed favorable effects on physical activity [[13], [14], [15]]. Additionally, plan enactment, a significant proximal outcome, was positively associated with later physical activity [16]. However, many programs are still predominantly providing knowledge or disease-related skills and lack a strong focus on behavior change techniques to foster health behavior change maintained after inpatient rehabilitation. Moreover, many programs are lecture based, provided in larger group settings and lack patient-oriented didactics [17]. Generic self-management modules promoting general self-management skills for taking action regardless of any specific disease and addressing self-tailored health behavior goals are not available so far. We therefore developed such generic self-management modules (SelMa) for use in inpatient rehabilitation. In the realm of health behavior change, we used evidence-based effective techniques [[18], [19]], self-tailoring [3] and the Health Action Process Approach [[20], [21]] as a theoretical framework. In consideration of applicability in routine care, we developed two SelMa interventions: a group program and a single lecture.
In this study, we evaluated the effects of both interventions employed in addition to disease-specific patient education as compared with usual care in inpatient rehabilitation. Usual care includes disease-specific patient education, among others. We hypothesized that the SelMa interventions are superior to usual care regarding goal setting and planning in short-term, as well as goal attainment and health behavior in medium-/long-term (primary outcomes). In addition, we expected superior effectiveness of the new interventions regarding motivation, knowledge and several self-management competences (secondary outcomes). We also explored differences in intervention satisfaction between the two self-management interventions.
Section snippets
Design and procedure
This study was a bi-center cluster-randomized controlled trial in inpatient rehabilitation centers in Germany. Clusters were patient education groups that comprise patients recruited within one week after commencement of inpatient rehabilitation. Clusters were randomly assigned to the three study groups using a computer-generated list of random numbers. Randomization was performed by a scientific assistant at the university research institute (central randomization per phone) guarantying
Sample characteristics
Table 1 presents the sociodemographic and clinical characteristics of participants by study group. The initial sample comprised N = 698 rehabilitants. Participants’ mean age was 50 years (SD = 10.2), 55% were male, and 76% reported to live with a partner. The sample mostly consisted of employed persons (87%), with 87% salaried employees and 9% blue-collar workers. About 51% had inflammatory bowel disease, and 49% cardiac rehabilitation. There were no systematic differences among the study
Discussion
In this cluster-randomized controlled trial we evaluated the effectiveness of two short generic self-management modules (SelMa group, SelMa lecture) as compared to usual care (including disease-specific patient education) in patients with inflammatory bowel disease or cardiac disease undergoing inpatient medical rehabilitation.
The SelMa group showed a significant, but small effect on one primary outcome, patients‘ goal setting at discharge. However, there were no effects on goal attainment and
Confirm of interests
The authors confirm that there is no conflict of interest.
“I confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story.”
Funding
This work was supported by the German Statutory Pension Insurance Scheme [grant number: 8011 – 106 – 31/31.110].
Acknowledgements
We thank the participating patients and therapeutic teams from the Rehabilitation Centre Bayerisch Gmain and the Rehabilitation Centre Mölln.
References (34)
- et al.
Selfmanagement approaches for people with chronic conditions: a review
Patient Educ. Couns.
(2002) - et al.
Self-management program for chronic low back pain: a systematic review and meta-analysis
Patient Educ. Couns.
(2017) - et al.
Effectiveness of disease-specific self-management education on health outcomes in patients with chronic obstructive pulmonary disease: an updated systematic review and meta-analysis
Patient Educ. Couns.
(2017) - et al.
Intervention effects of exercise self-regulation on physical exercise and eating fruits and vegetables: a longitudinal study in orthopedic and cardiac rehabilitation
Prev. Med.
(2011) - et al.
Effectiveness of small-group interactive education vs. lecture-based information-only programs on motivation to change and lifestyle behaviours. A prospective controlled trial of rehabilitation inpatients
Patient Educ. Couns.
(2011) - et al.
DGRW- update: patient education
Rehabilitation
(2011) - et al.
Self-management education: history, definition, outcomes, and mechanisms
Ann. Behav. Med.
(2003) - et al.
A refined taxomomy of behaviour change techniques to help people change their physical activity and health eating behaviours: the CALO-RE taxonomy
Psychol. Health
(2011) - et al.
Patient education in the management of coronary heart disease
Cochrane Database Syst. Rev.
(2011) - et al.
A systematic review of self-management interventions for inflammatory bowel disease
J. Nurs. Scholarsh.
(2016)
Do self-management interventions work in patients with heart failure? An individual patient data meta-analysis
Circulation
Intermediate and long-term effects of a standardized back school for inpatient orthopedic rehabilitation on illness knowledge and self-management behaviors: a randomized controlled trial
Clin. J. Pain
Evaluation of a standardized patient education program for inpatient cardiac rehabilitation: impact on illness knowledge and self-management behaviors up to one year
Health Educ. Res.
Long-term effects of interprofessional biopsychosocial rehabilitation for adults with chronic non-specific low back pain: a multicentre, quasi-experimental study
PLoS One
Long-term effects of a psychological group intervention on physical exercise and health: the MoVo concept
J. Phys. Act. Health
Long-term effects of two psychological interventions on physical exercise and self-regulation following coronary rehabilitation
Int. J. Behav. Med.
What contributes to action plan enactment? Examining characteristics of physical activity plans
Br. J. Health Psychol.
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