Das chronische Erschöpfungssyndrom in der naturheilkundlichen Rehabilitation - Prädiktoren des Behandlungsergebnisses

Abstract

Chronic exhaustion and fatigue are increasingly important in rehabilitation medicine. Objectives of this study were (a) to describe the effects of in-patient rehabilitation on patients with chronic fatigue syndromes, (b) to identify predictors for treatment outcome, and (c) to analyze the impact of comprehensive diagnosing on these issues. A total of 171 patients with chronic exhaustion or fatigue (90 % female, mean age 55 +/- 10 yrs) from a rehabilitation hospital with a complementary medicine-based treatment concept were included in a prospective observational study. Within the longitudinal study patients were examined three times (on admission to hospital, at discharge as well as six months later). Participation rate of the postal inquiry was 69 %. Besides items constructed ad hoc, Patient questionnaires included the Symptom Checklist and assessment instruments for depression, quality of life, sense of coherence as well as for changes in experience and behaviour. Treatment outcome was defined as sum score of binary-coded response criteria. The pattern of complaints differed clearly between diagnostic subgroups (neurasthenia, affective disorders, adjustment disorders) before treatment. At discharge from hospital patients showed clinically relevant improvements lasting for six months after rehabilitation. Multiple regression analyses revealed a statistically significant relationship (R (mult) = 0.59) between predictors and outcome at discharge from hospital. A better result was associated with higher trust in treatment success, active information seeking on complementary medicine, healthier feeding habits, better somatic health and a decreased mental status, with regard to the status before treatment. The prediction of outcome after six months was comparably poorer (R (mult) = 0.42). Treatment success was higher in the absence of a diagnosis of neurasthenia, in patients accepting the group-oriented treatment concept and in patients not believing that their disease was due to their own way of living. Trust in the success of the treatment was a highly ranked predictor for longer lasting outcome, too. The results underline the importance of motivation aspects for treatment outcome indicating that individual expectations and attitudes should be considered in a more distinct way when allocating patients to rehabilitative programmes.

Predictors of outcome after 6 and 12 months following anthroposophic therapy for adult outpatients with chronic disease: a secondary analysis from a prospective observational study

“…Some studies of other complementary therapies have identified further outcome predictors which were not significant predictors in the present study: age [60,61,64], gender [60,61], and the number of therapy sessions [48]. However, in other studies of complementary therapies, age [49] and gender [49,64] were not significant predictors, like in the present study.…”

“…Some of the significant outcome predictors in this analysis of AM treatment have also been identified as significant predictors of outcome following other complementary therapies for chronic conditions: baseline symptom intensity [48,60-63], disease duration [62], education [60,61], and baseline SF-36 scores [48,60,61]. However, education was not a significant outcome predictor in other studies of complementary therapies [49,64].…”

“…The analysis also comprised a detailed assessment of socio-demographics, disease status, co-morbidity, disability, depression, AM therapies, adjunctive therapies, and therapist factors. Other factors of potential interest, such as psychosomatic [22] or autonomic [47] self-regulation, patient expectations [48,49], and perceived quality of the physician-patient relationship and therapist-patient relationship could not be assessed, as they were not documented in the study.…”

“…Several outcome prediction analyses of other complementary therapies have included one or both SF-36 summary scores but none of the remaining SF-36 scales or items as independent variables [48,60,61]. In these analyses, baseline SF-36 Physical Component Summary score [48,60,61] and baseline SF-36 Mental component summary score [60,61] were significant positive predictors of intermediate outcomes (discharge from inpatient rehabilitation [48] and three-month follow up [60,61], respectively). When the present analysis was repeated, retaining the two SF-36 summary scores but excluding the remaining SF-36 scales and SF-36 items from the independent variables, both the SF-36 Physical and Mental Component Summary scores emerged as significant positive predictors for the 0-6 month Symptom Score improvement.…”

Adjustment Disorder: epidemiology, diagnosis and treatment

“…Weidenhammer [62] studied a total of 171 patients presenting with chronic fatigue who fell into three diagnostic categories, i.e. neurasthenia, affective disorders, adjustment disorders, before treatment.…”