Reha Aftercare - One Size Fits All? Analyses of Rehab Patients which do not Benefit from Reha Aftercare

Background: In an own research project funded by this program rehabilitation aftercare as part of a revised rehabilitation philosophy (new credo) was tested and evaluated in a controlled longitudinal trial. Rehabilitation patients from the intervention group reported significantly better implementation of rehabilitation contents and objectives in everyday life during 12 months after their rehabilitation stay. Better long-term effects were also detectable. Anyway, not all rehabilitation patients seemed to benefit from the intervention. The present analysis focuses on this subgroup: How do rehabilitation patients that do not benefit from the new credo differ from rehabilitation patients that draw advantage from it? Method: Data from a controlled study were used for secondary analysis. 3 clinics implemented the new credo. Primary outcomes were: participation constraints (IMET) and functional disabilities in everyday life (FFbH-R). The intervention clinics recruited a total of 166 rehabilitation patients. Data from 163 cases could be analyzed using quantitative methods. In addition, interview data from 7 unsuccessful rehabilitation patients was analyzed qualitatively. Results: 102 (63%) rehabilitation patients improved their values in FFbH-R or IMET by at least 0.3 effect sizes (successful group). Among the 61 unsuccessful rehabilitation patients, 17 (10%) started rehabilitation with initial values that high that they could not reach the fixed minimal improvement criteria (low burdened group). They were excluded from further analysis. The remaining 44 (27%) rehabilitation patients constitute the unsuccessful group. Both groups have comparable levels of impairment concerning somatic and psychosocial parameters. At the end of the rehabilitation stay the unsuccessful group reached improvements of moderate to large effect sizes concerning the recorded health parameters. One year after rehabilitation unsuccessful rehabilitation patients fall back to their baseline levels of impairment, while the successful maintain their achieved effects after rehabilitation. The 2 groups rated several aspects of the intervention differently and the unsuccessful group rated the preparation for the time after the rehabilitation worse. The number of perceived aftercare elements proves to be the strongest predictor of failure in multivariate evaluation; clinic facilities is the only other independent predictor. During the interviews, unsuccessful patients reported different individual barriers for implementation of physical activity in daily life. Conclusions: Rehabilitation patients, who did not benefit from the new rehabilitation and aftercare concept, did neither differ in sociodemographic nor in disease-specific characteristics from the successful rehabilitation patients. However, differences in the implementation of the new rehabilitation philosophy and its individual components in the rehabilitation clinics are significantly associated with the occurrence of success or failure. Overall, the results of our study indicate a need for more flexible design of rehabilitation and aftercare adjusted to individual needs.