@article{LukasczikGerlichSchuleretal.2015, author = {Lukasczik, Matthias and Gerlich, Christian and Schuler, Michael and Neuderth, Silke and Dlugosch, Gabriele and Faller, Hermann}, title = {Stress and resources in women attending an inpatient prevention/rehabilitation measure for parents: Secondary analysis of quality assurance data}, series = {Open Journal of Medical Psychology}, volume = {4}, journal = {Open Journal of Medical Psychology}, doi = {10.4236/ojmp.2015.42003}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-125316}, pages = {23-34}, year = {2015}, abstract = {Questionnaire data from two projects on the development of quality assurance instruments for an inpatient rehabilitation/prevention program for parents were used for a secondary analysis. In this analysis, the associations of gains in a psychosocial resource (parenting self-efficacy) and two types of stressors experienced by mothers at the start of treatment (parenting hassles, depressive symptoms) with general life satisfaction and satisfaction with health at the end of treatment were explored. Structural equation modeling was applied to data from N = 1724 female patients. Potential resource-stressor interactions were tested using the Latent Moderated Structural Equations approach. Results showed that parenting hassles were negatively associated with general life satisfaction and satisfaction with health while self-efficacy gains were weakly positively correlated with both variables. No interaction of parenting hassles and self-efficacy gains was found. Depressive symptoms were negatively associated with both satisfaction measures. In these models, self-efficacy gains were not substantially correlated with life satisfaction, but showed a small association with satisfaction with health. There was no significant interaction of depressive symptoms and self-efficacy gains. The findings imply that interventions for distressed mothers—as exemplarily illustrated by this inpatient setting—should focus on identifying and reducing initial stressors as these may continue to impair mothers' subjective health despite gains in parenting-related resources.}, language = {en} } @article{AppelSchulerVogeletal.2017, author = {Appel, Patricia and Schuler, Michael and Vogel, Heiner and Oezelsel, Amina and Faller, Hermann}, title = {Short Questionnaire for Workplace Analysis (KFZA): factorial validation in physicians and nurses working in hospital settings}, series = {Journal of Occupational Medicine and Toxicology}, volume = {12}, journal = {Journal of Occupational Medicine and Toxicology}, number = {11}, doi = {10.1186/s12995-017-0157-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157510}, year = {2017}, abstract = {Background: In recent years, there has been an increasing interest in psychosocial workplace risk assessments in Germany. One of the questionnaires commonly employed for this purpose is the Short Questionnaire for Workplace Analysis (KFZA). Originally, the KFZA was developed and validated for office workers. The aim of the present study was to examine the factorial validity of the KFZA when applied to hospital settings. Therefore, we examined the factorial structure of a questionnaire that contained all the original items plus an extension adding 11 questions specific to hospital workplaces and analyzed both, the original version and the extended version. Methods: We analyzed questionnaire data of a total of 1731 physicians and nurses obtained over a 10-year period. Listwise exclusion of data sets was applied to account for variations in questionnaire versions and yielded 1163 questionnaires (1095 for the extended version) remaining for factor analysis. To examine the factor structure, we conducted a principal component factor analysis. The number of factors was determined using the Kaiser criterion and scree-plot methods. Factor interpretation was based on orthogonal Varimax rotation as well as oblique rotation. Results: The Kaiser criterion revealed a 7-factor solution for the 26 items of the KFZA, accounting for 62.0\% of variance. The seven factors were named: "Social Relationships", "Job Control", "Opportunities for Participation and Professional Development", "Quantitative Work Demands", "Workplace Environment", "Variability" and "Qualitative Work Demands". The factor analysis of the 37 items of the extended version yielded a 9-factor solution. The two additional factors were named "Consequences of Strain" and "Emotional Demands". Cronbach's α ranged from 0.63 to 0.87 for these scales. Conclusions: Overall, the KFZA turned out to be applicable to hospital workers, and its content-related structure was replicated well with some limitations. However, instead of the 11 factors originally proposed for office workers, a 7-factor solution appeared to be more suitable when employed in hospitals. In particular, the items of the KFZA factor "Completeness of Task" might need adaptation for the use in hospitals. Our study contributes to the assessment of the validity of this popular instrument and should stimulate further psychometric testing.}, language = {en} } @article{EsserMehnert‐TheuerkaufFriedrichetal.2020, author = {Esser, Peter and Mehnert-Theuerkauf, Anja and Friedrich, Michael and Johansen, Christoffer and Br{\"a}hler, Elmar and Faller, Hermann and H{\"a}rter, Martin and Koch, Uwe and Schulz, Holger and Wegscheider, Karl and Weis, Joachim and Kuba, Katharina and Hinz, Andreas and Hartung, Tim}, title = {Risk and associated factors of depression and anxiety in men with prostate cancer: Results from a German multicenter study}, series = {Psycho-Oncology}, volume = {29}, journal = {Psycho-Oncology}, number = {10}, doi = {10.1002/pon.5471}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-218277}, pages = {1604 -- 1612}, year = {2020}, abstract = {Objective In order to optimize psycho-oncological care, studies that quantify the extent of distress and identify certain risk groups are needed. Among patients with prostate cancer (PCa), findings on depression and anxiety are limited. Methods We analyzed data of PCa patients selected from a German multi-center study. Depression and anxiety were assessed with the PHQ-9 and the GAD-7 (cut-off ≥7). We provided physical symptom burden, calculated absolute and relative risk (AR and RR) of depression and anxiety across patient subsets and between patients and the general population (GP) and tested age as a moderator within the relationship of disease-specific symptoms with depression and anxiety. Results Among 636 participants, the majority reported disease-specific problems (sexuality: 60\%; urination: 52\%). AR for depression and anxiety was 23\% and 22\%, respectively. Significant RR were small, with higher risks of distress in patients who are younger (eg, RR\(_{depression}\) = 1.15; 95\%-CI: 1.06-1.26), treated with chemotherapy (RR\(_{depression}\)n = 1.46; 95\%-CI: 1.09-1.96) or having metastases (RR\(_{depression}\) = 1.30; 95\%-CI: 1.02-1.65). Risk of distress was slightly elevated compared to GP (eg, RR\(_{depression}\) = 1.13; 95\%-CI: 1.07-1.19). Age moderated the relationship between symptoms and anxiety (B\(_{urination}\) = -0.10, P = .02; B\(_{sexuality}\) = -0.11, P = .01). Conclusions Younger patients, those with metastases or treatment with chemotherapy seem to be at elevated risk for distress and should be closely monitored. Many patients suffer from disease-specific symptom burden, by which younger patients seem to be particularly distressed. Support of coping mechanisms associated with disease-specific symptom burden seems warranted.}, language = {en} } @article{MehnertKochSchulzetal.2012, author = {Mehnert, Anja and Koch, Uwe and Schulz, Holger and Wegscheider, Karl and Weis, Joachim and Faller, Hermann and Keller, Monika and Br{\"a}hler, Elmar and H{\"a}rter, Martin}, title = {Prevalence of mental disorders, psychosocial distress and need for psychosocial support in cancer patients - study protocol of an epidemiological multi-center study}, volume = {12}, number = {70}, doi = {10.1186/1471-244X-12-70}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-153296}, year = {2012}, abstract = {Background Empirical studies investigating the prevalence of mental disorders and psychological distress in cancer patients have gained increasing importance during recent years, particularly with the objective to develop and implement psychosocial interventions within the cancer care system. Primary purpose of this epidemiological cross-sectional multi-center study is to detect the 4-week-, 12-month-, and lifetime prevalence rates of comorbid mental disorders and to further assess psychological distress and psychosocial support needs in cancer patients across all major tumor entities within the in- and outpatient oncological health care and rehabilitation settings in Germany. Methods/Design In this multicenter, epidemiological cross-sectional study, cancer patients across all major tumor entities will be enrolled from acute care hospitals, outpatient cancer care facilities, and rehabilitation centers in five major study centers in Germany: Freiburg, Hamburg, Heidelberg, Leipzig and W{\"u}rzburg. A proportional stratified random sample based on the nationwide incidence of all cancer diagnoses in Germany is used. Patients are consecutively recruited in all centers. On the basis of a depression screener (PHQ-9) 50\% of the participants that score below the cutoff point of 9 and all patients scoring above are assessed using the Composite International Diagnostic Interview for Oncology (CIDI-O). In addition, all patients complete validated questionnaires measuring emotional distress, information and psychosocial support needs as well as quality of life. Discussion Epidemiological data on the prevalence of mental disorders and distress provide detailed and valid information for the estimation of the demands for the type and extent of psychosocial support interventions. The data will provide information about specific demographic, functional, cancer- and treatment-related risk factors for mental comorbidity and psychosocial distress, specific supportive care needs and use of psychosocial support offers.}, language = {en} } @article{HessMengSchulteetal.2020, author = {Heß, Verena and Meng, Karin and Schulte, Thomas and Neuderth, Silke and Bengel, J{\"u}rgen and Faller, Hermann and Schuler, Michael}, title = {Prevalence and predictors of cancer patients' unexpressed needs in the admission interview of inpatient rehabilitation}, series = {Psycho-Oncology}, volume = {29}, journal = {Psycho-Oncology}, number = {10}, doi = {10.1002/pon.5450}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-228369}, pages = {1549 -- 1556}, year = {2020}, abstract = {Objective The admission interview in oncological inpatient rehabilitation might be a good opportunity to identify cancer patients' needs present after acute treatment. However, a relevant number of patients may not express their needs. In this study, we examined (a) the proportion of cancer patients with unexpressed needs, (b) topics of unexpressed needs and reasons for not expressing needs, (c) correlations of not expressing needs with several patient characteristics, and (d) predictors of not expressing needs. Methods We enrolled 449 patients with breast, prostate, and colon cancer at beginning and end of inpatient rehabilitation. We obtained self-reports about unexpressed needs and health-related variables (quality of life, depression, anxiety, adjustment disorder, and health literacy). We estimated frequencies and conducted correlation and ordinal logistic regression analyses. Results A quarter of patients stated they had "rather not" or "not at all" expressed all relevant needs. Patients mostly omitted fear of cancer recurrence. Most frequent reasons for not expressing needs were being focused on physical consequences of cancer, concerns emerging only later, and not knowing about the possibility of talking about distress. Not expressing needs was associated with several health-related outcomes, for example, emotional functioning, adjustment disorder, fear of progression, and health literacy. Depression measured at the beginning of rehabilitation showed only small correlations and is therefore not sufficient to identify patients with unexpressed needs. Conclusions A relevant proportion of cancer patients reported unexpressed needs in the admission interview. This was associated with decreased mental health. Therefore, it seems necessary to support patients in expressing needs.}, language = {en} } @article{SchulerMurauerStangletal.2019, author = {Schuler, Michael and Murauer, Kathrin and Stangl, Stephanie and Grau, Anna and Gabriel, Katharina and Podger, Lauren and Heuschmann, Peter U. and Faller, Hermann}, title = {Pre-post changes in main outcomes of medical rehabilitation in Germany: protocol of a systematic review and meta-analysis of individual participant and aggregated data}, series = {BMJ Open}, volume = {9}, journal = {BMJ Open}, number = {5}, doi = {10.1136/bmjopen-2018-023826}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-201929}, pages = {e023826}, year = {2019}, abstract = {Introduction Multidisciplinary, complex rehabilitation interventions are an important part of the treatment of chronic diseases. However, little is known about the effectiveness of routine rehabilitation interventions within the German healthcare system. Due to the nature of the social insurance system in Germany, randomised controlled trials examining the effects of rehabilitation interventions are challenging to implement and scarcely accessible. Consequently, alternative pre-post designs can be employed to assess pre-post effects of medical rehabilitation programmes. We present a protocol of systematic review and meta-analysis methods to assess the pre-post effects of rehabilitation interventions in Germany. Methods and analysis The respective study will be conducted within the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A systematic literature review will be conducted to identify studies reporting the pre-post effects (start of intervention vs end of intervention or later) in German healthcare. Studies investigating the following disease groups will be included: orthopaedics, rheumatology, oncology, pulmonology, cardiology, endocrinology, gastroenterology and psychosomatics. The primary outcomes of interest are physical/mental quality of life, physical functioning and social participation for all disease groups as well as pain (orthopaedic and rheumatologic patients only), blood pressure (cardiac patients only), asthma control (patients with asthma only), dyspnoea (patients with chronic obstructive pulmonary disease only) and depression/anxiety (psychosomatic patients only). We will invite the principal investigators of the identified studies to provide additional individual patient data. We aim to perform the meta-analyses using individual patient data as well as aggregate data. We will examine the effects of both study-level and patient-level moderators by using a meta-regression method. Ethics and dissemination Only studies that have received institutional approval from an ethics committee and present anonymised individual patient data will be included in the meta-analysis. The results will be presented in a peer-reviewed publication and at research conferences. A declaration of no objection by the ethics committee of the University of W{\"u}rzburg is available (number 20180411 01).}, language = {en} } @article{SchulerMusekampBengeletal.2014, author = {Schuler, Michael and Musekamp, Gunda and Bengel, J{\"u}rgen and Nolte, Sandra and Osborne, Richard H. and Faller, Hermann}, title = {Measurement invariance across chronic conditions: a systematic review and an empirical investigation of the Health Education Impact Questionnaire (heiQ™)}, doi = {10.1186/1477-7525-12-56}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-110441}, year = {2014}, abstract = {Background To examine whether lack of measurement invariance (MI) influences mean comparisons among different disease groups, this paper provides (1) a systematic review of MI in generic constructs across chronic conditions and (2) an empirical analysis of MI in the Health Education Impact Questionnaire (heiQ™). Methods (1) We searched for studies of MI among different chronic conditions in online databases. (2) Multigroup confirmatory factor analyses were used to study MI among five chronic conditions (orthopedic condition, rheumatism, asthma, COPD, cancer) in the heiQ™ with N = 1404 rehabilitation inpatients. Impact on latent and composite mean differences was examined. Results (1) A total of 30 relevant studies suggested that about one in three items lacked MI. However, only four studies examined impact on latent mean differences. Scale means were only affected in one of these three studies. (2) Across the eight heiQ™ scales, seven scales had items with lack of MI in at least one disease group. However, in only two heiQ™ scales were some latent or composite mean differences affected. Conclusions Lack of MI among disease groups is common and may have a relevant influence on mean comparisons when using generic instruments. Therefore, when comparing disease groups, tests of MI should be implemented. More studies of MI and according impact on mean differences in generic questionnaires are needed.}, language = {en} } @article{SemrauHentschkeBuchmannetal.2015, author = {Semrau, Jana and Hentschke, Christian and Buchmann, Jana and Meng, Karin and Vogel, Heiner and Faller, Hermann and Bork, Hartmut and Pfeifer, Klaus}, title = {Long-term effects of interprofessional biopsychosocial rehabilitation for adults with chronic non-specific low back pain: a multicentre, quasi-experimental study}, series = {PLoS ONE}, volume = {10}, journal = {PLoS ONE}, number = {3}, doi = {10.1371/ journal.pone.0118609}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-143594}, pages = {e0118609}, year = {2015}, abstract = {Background Improvement of the long-term effectiveness of multidisciplinary ortho-paedic rehabilitation (MOR) in the management of chronic non-specific low back pain (CLBP) remains a central issue for health care in Germany. We developed an interprofessional and interdisciplinary, biopsychosocial rehabilitation concept named "PASTOR" to promote self-management in adults with CLBP and compared its effectiveness with the current model of MOR. Methods A multicentre quasi-experimental study with three measurement time points was implemented. 680 adults aged 18 to 65 with CLBP were assed for eligibil-ity in three inpatient rehabilitation centres in Germany. At first the effects of the MOR, with a total extent of 48 hours (control group), were assessed. Thereafter, PASTOR was implemented and evaluated in the same centres (intervention group). It consisted of six interprofessional modules, which were provided on 12 days in fixed groups, with a total extent of 48 hours. Participants were assessed with self-report measures at baseline, discharge, and 12 months for functional ability (primary outcome) using the Hannover Functional Ability Questionnaire (FFbH-R) and vari-ous secondary outcomes (e.g. pain, health status, physical activity, pain coping, pain-related cognitions). Results In total 536 participants were consecutively assigned to PASTOR (n=266) or MOR (n=270). At 12 months, complete data of 368 participants was available. The adjusted between-roup difference in the FFbH-R at 12 months was 6.58 (95\% CI 3.38 to 9.78) using complete data and 3.56 (95\% CI 0.45 to 6.67) using available da-ta, corresponding to significant small-to-medium effect sizes of d=0.42 (p<0.001) and d=0.10 (p=0.025) in favour of PASTOR. Further improvements in secondary out-comes were also observed in favour of PASTOR. Conclusion The interprofessional and interdisciplinary, biopsychosocial rehabilita-tion program PASTOR shows some improvements of the long-term effectiveness of inpatient rehabilitation in the management of adults with CLBP. Further insights into mechanisms of action of complex intervention programs are required.}, language = {en} } @article{TiffeMorbachRueckeretal.2019, author = {Tiffe, Theresa and Morbach, Caroline and R{\"u}cker, Viktoria and Gelbrich, G{\"o}tz and Wagner, Martin and Faller, Hermann and St{\"o}rk, Stefan and Heuschmann, Peter U.}, title = {Impact of patient beliefs on blood pressure control in the general population: findings from the population-based STAAB cohort study}, series = {International Journal of Hypertension}, volume = {2019}, journal = {International Journal of Hypertension}, doi = {10.1155/2019/9385397}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200992}, pages = {9385397}, year = {2019}, abstract = {Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of W{\"u}rzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5\% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8\%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95\%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences.}, language = {en} } @article{PetersFallerPfeiferetal.2016, author = {Peters, Stefan and Faller, Hermann and Pfeifer, Klaus and Meng, Karin}, title = {Experiences of Rehabilitation Professionals with the Implementation of a Back School for Patients with Chronic Low Back Pain: A Qualitative Study}, series = {Rehabilitation Research and Practice}, volume = {2016}, journal = {Rehabilitation Research and Practice}, number = {9}, doi = {10.1155/2016/6720783}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-146053}, pages = {6720783}, year = {2016}, abstract = {A standardized curriculum back school (CBS) has been recommended for further dissemination in medical rehabilitation in Germany. However, implementation of self-management education programs into practice is challenging. In low back pain care, individual factors of professionals could be decisive regarding implementation fidelity. The study aim was to explore attitudes and experiences of professionals who conducted the back school. Qualitative interviews were led with 45 rehabilitation professionals. The data were examined using thematic analysis. Three central themes were identified: (a) "back school as a common thread," (b) "theory versus practice," and (c) "participation and patient-centeredness." The CBS and its manual were frequently described positively because they provide structure. However, specified time was mentioned critically and there were heterogeneous perceptions regarding flexibility in conducting the CBS. Theory and practice in the CBS were discussed concerning amount, distribution, and conjunction. Participation and patient-centeredness were mainly mentioned in terms of amount and heterogeneity of participation as well as the demand for competences of professionals. Factors were detected that may either positively or negatively influence the implementation fidelity of self-management education programs. The results are explorative and provide potential explanatory mechanisms for behavior and acceptance of rehabilitation professionals regarding the implementation of biopsychosocial back schools.}, language = {en} }