TY  - JOUR
A1  - Schwaab, Bernhard
A1  - Bjarnason-Wehrens, Birna
A1  - Meng, Karin
A1  - Albus, Christian
A1  - Salzwedel, Annett
A1  - Schmid, Jean-Paul
A1  - Benzer, Werner
A1  - Metz, Matthes
A1  - Jensen, Katrin
A1  - Rauch, Bernhard
A1  - Bönner, Gerd
A1  - Brzoska, Patrick
A1  - Buhr-Schinner, Heike
A1  - Charrier, Albrecht
A1  - Cordes, Carsten
A1  - Dörr, Gesine
A1  - Eichler, Sarah
A1  - Exner, Anne-Kathrin
A1  - Fromm, Bernd
A1  - Gielen, Stephan
A1  - Glatz, Johannes
A1  - Gohlke, Helmut
A1  - Grilli, Maurizio
A1  - Gysan, Detlef
A1  - Härtel, Ursula
A1  - Hahmann, Harry
A1  - Herrmann-Lingen, Christoph
A1  - Karger, Gabriele
A1  - Karoff, Marthin
A1  - Kiwus, Ulrich
A1  - Knoglinger, Ernst
A1  - Krusch, Christian-Wolfgang
A1  - Langheim, Eike
A1  - Mann, Johannes
A1  - Max, Regina
A1  - Metzendorf, Maria-Inti
A1  - Nebel, Roland
A1  - Niebauer, Josef
A1  - Predel, Hans-Georg
A1  - Preßler, Axel
A1  - Razum, Oliver
A1  - Reiss, Nils
A1  - Saure, Daniel
A1  - von Schacky, Clemens
A1  - Schütt, Morten
A1  - Schultz, Konrad
A1  - Skoda, Eva-Maria
A1  - Steube, Diethard
A1  - Streibelt, Marco
A1  - Stüttgen, Martin
A1  - Stüttgen, Michaela
A1  - Teufel, Martin
A1  - Tschanz, Hansueli
A1  - Völler, Heinz
A1  - Vogel, Heiner
A1  - Westphal, Ronja
T1  - Cardiac rehabilitation in German speaking countries of Europe — evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH — part 2
JF  - Journal of Clinical Medicine
N2  - Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients' groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
KW  - cardiac rehabilitation
KW  - scientific guidelines
KW  - secondary prevention
KW  - physical activity
KW  - exercise training
KW  - psychological interventions
KW  - education
KW  - gender
KW  - frailty
KW  - migration
KW  - old patients
KW  - young patients
KW  - tele-medicine
KW  - home-based-rehabilitation
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242645
SN  - 2077-0383
VL  - 10
IS  - 14
ER  - 
TY  - JOUR
A1  - Musekamp, Gunda
A1  - Schuler, Michael
A1  - Seekatz, Bettina
A1  - Bengel, Jürgen
A1  - Faller, Hermann
A1  - Meng, Karin
T1  - Does improvement in self-management skills predict improvement in quality of life and depressive symptoms? A prospective study in patients with heart failure up to one year after self-management education
JF  - BMC Cardiovascular Disorders
N2  - Background:
Heart failure (HF) patient education aims to foster patients’ self-management skills. These are assumed to bring about, in turn, improvements in distal outcomes such as quality of life. The purpose of this study was to test the hypothesis that change in self-reported self-management skills observed after participation in self-management education predicts changes in physical and mental quality of life and depressive symptoms up to one year thereafter.
Methods:
The sample comprised 342 patients with chronic heart failure, treated in inpatient rehabilitation clinics, who received a heart failure self-management education program. Latent change modelling was used to analyze relationships between both short-term (during inpatient rehabilitation) and intermediate-term (after six months) changes in self-reported self-management skills and both intermediate-term and long-term (after twelve months) changes in physical and mental quality of life and depressive symptoms.
Results:
Short-term changes in self-reported self-management skills predicted intermediate-term changes in mental quality of life and long-term changes in physical quality of life. Intermediate-term changes in self-reported self-management skills predicted long-term changes in all outcomes.
KW  - patient education
KW  - chronic heart failure
KW  - self-management
KW  - quality of life
KW  - latent change
KW  - cardiac rehabilitation
Y1  - 2017
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157501
VL  - 17
IS  - 51
ER  - 
TY  - THES
A1  - Brüser, Judith
T1  - Prüfung der Effektivität eines interdisziplinären psychokardiologischen Behandlungsprogrammes auf die Reduktion von Depressivität, Angst und Panik und die Verbesserung der gesundheitsbezogenen Lebensqualität bei psychisch belasteten kardiologischen Rehabilitanden
T1  - Examination of the Effectiveness of an Interdisciplinary Psychocardiological Treatment Programme for the Reduction of Depressivity, Anxiety, and Panic and the Improvement of the Health-Related Quality of Life in Psychologically burdened Cardiological Rehabilitants
N2  - In dieser Arbeit wurde geprüft, ob ein leitlinienkonformes psychokardiologisches Behandlungskonzept einer herkömmlichen kardiologischen Behandlung bei psychisch belasteten kardiologischen Rehabilitanden in der Reduktion von Angst, Depression und Panik (primäre Zielkriterien) und einer Verbesserung der gesundheitsbezogenen Lebensqualität (sekundäre Zielparameter) überlegen ist. In der Nebenfragstellung wurden Unterschiede in der Wirksamkeit der Intervention in Abhängigkeit vom Geschlecht explorativ geprüft.
Die Fragestellungen wurden mit einem quasiexperimentellen Studiendesign mit sequentiell aufeinanderfolgenden Kohorten untersucht. Die Zielparameter wurden zu Rehabeginn, -ende und 6 Monate nach Entlassung mit validierten Fragebögen (PHQ-9, PHQ-Panik, GAD-7 und MacNew Heart Disease-Fragebogen) erfasst. 
Die Hauptanalyse ergab einen kleinen signifikanten Intergruppeneffekt für den Zielparameter Depressivität zugunsten der Kontrollgruppe zu Rehaende und in der Katamnese keine signifikanten Unterschiede im Behandlungserfolg beider Studienbedingungen mehr. 
Die Moderatoranalyse ergab kleine Interaktionseffekte zwischen Intervention und    Geschlecht für Angst und die gesundheitsbezogene Lebensqualität zu beiden Folgemess-zeitpunkten. Deskriptiv zeigte sich der Trend, dass Frauen von der Interventionsbedingung schlechter, Männer hingegen besser profitierten.
Für die mangelnde Überlegenheit des Interventionsprogrammes kommen vielfältige Aspekte in Frage, die methodisch das sequentiell aufeinanderfolgenden Behandlungsdesign betreffen sowie interventionsbezogen die Ausschöpfung der Therapieressourcen, den Zeitpunkt des Behandlungsbeginns, die Behandlungsdauer, die Berücksichtigung spezifischer Patientenbedürfnisse und auch die Möglichkeit einer ungünstigen Wirkung von Psychotherapie. Ferner war die statistische Power und damit die Aussagekraft der Studie einschränkt. Als Fazit unterliegen noch vielfältige Einflussgrößen gezieltem Forschungsbedarf.
N2  - In this study, it was examined whether a guideline-conforming psychocardiological treatment concept is superior to conventional cardiological treatment for psychologically burdened cardiological rehabilitants in the reduction of anxiety, depression, and panic (primary target criteria) and an improvement of the health-related quality of life (secondary target parameters). In the supplementary question, differences in the effectiveness of the intervention depending on gender were exploratively examined.
The questions were investigated with a quasiexperimental study design with sequentially consecutive cohorts. Target parameters were assessed at the start and end of rehabilitation and 6 months after discharge using validated questionnaires (PHQ-9, PHQ-Panic, GAD-7, and MacNew Heart Disease Questionnaire). 
The main analysis showed a small significant intergroup effect for the target parameter depressivity in favour of the control group at the end of rehabilitation and no significant in the treatment success of both study conditions in the catamnesis. 
The moderator analysis revealed small interaction effects between intervention and gender for anxiety and health-related quality of life at both follow-up measurement points. Descriptively, the trend showed that women benefited less from the intervention condition than men.
For the lack of superiority of the intervention programme, various aspects can be considered, which methodically concern the sequentially successive treatment design as well as the exhaustive use of therapy resources, the time of the onset of treatment, the duration of treatment, the consideration of specific patient needs, and also the possibility of an unfavourable effect of psychotherapy. Furthermore, the statistical power and thus the significance of the study was limited. In conclusion, a wide range of influencing variables are still subject to a targeted need for research.
KW  - Depression
KW  - Angstsyndrom
KW  - Lebensqualität
KW  - Klinische Psychotherapie
KW  - Herzkrankheit
KW  - Psychokardiologische Behandlung
KW  - Angst/Panik
KW  - gesundheitsbezogene Lebensqualität
KW  - kardiologische Rehabilitation
KW  - psychological treatment
KW  - depression
KW  - anxiety/panic
KW  - health-related quality of life
KW  - cardiac rehabilitation
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-198233
ER  -