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Objectives: The aim of this study was to explore aspects that play a role when general practitioners (GPs) become ill and thus gain a more comprehensive understanding of the overall illness behaviour of GPs and their use of the healthcare system., Setting: Primary care practices in Thuringia, Germany., Participants: Convenience sample of 16 GPs., Design: Qualitative study design with semistructured interviews and content analysis., Results: Using our approach of having participants report their own episodes of illness, we found that self-treatment was practised and accepted by all 16 participants. The widespread use of naturopathy and complementary methods seems to be a special feature of German GPs. Formal use of the healthcare system mainly took place through direct consultation with specialists.Our study revealed various aspects influencing the illness behaviour of the GPs and their use of the healthcare system. Some aspects also apply to lay patients, but it became clear how strongly illness behaviour is influenced by participants' activities as physicians. Noteworthy and less described aspects are especially the influence of patients and practice staff, the influence of biographical and professional imprint and the attitudes and values of the physicians.Complex inter-relationships were found between illness behaviour and influencing aspects; these are subjected to a dynamic and recursive process., Conclusions: The illness behaviour of German GPs seems to be comprehensively influenced by their activities as responsible healthcare providers. The ability to perceive and reflect in this regards should already be actively promoted in studies and further education. Further research is needed for a better understanding of the inter-relationships., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Abstract: The aim of this study was to evaluate the construct validity of the SAIB in a community sample of elderly people. The SAIB was administered to a large community sample representative of the German population aged 60–85 years (n =1593). The original model was assessed and then refined through confirmatory and exploratory factor analyses. Criterion validity was evaluated by comparing SAIB scores with external criteria in 3 categories: subjective health, chronic illness and health care utilization. The originally suggested five factor structure of the SAIB yielded a comparative fit index (CFI) of 0.70 and the weighted root mean square residual (WRMR) was 3.68. A shortened questionnaire with 13 items and four factors resulted in better model fit (CFI 0.97 and WRMR 1.3). Correlations between subjective health and the new scales ranged from 0.06 to 0.33. Effect sizes (Cohens d) of mean differences in factor scores between those with and without healthcare system contact varied by healthcare type, ranging from 0.05 to 0.94; effect sizes were largest in relation to contact with psychotherapy and alternative medicine practitioners. We propose a shortened version of the SAIB with a different scale structure, which resulted in better model fit with our data. Neither the original nor revised SAIB appeared to discriminate well in terms of health care use, suggesting that the illness behavior as currently conceptualized may not fully explain the increased use of healthcare in the elderly. [Copyright &y& Elsevier]

Background: Mobile health applications (mHealth apps) have the potential to help patients with chronic conditions such as hypertension by supporting self-management activities in daily life. However, the uptake of mHealth apps remains poor among patients. To improve the utilization of mHealth apps for hypertension, the analysis of the behavioral intention to use such applications must consider personality traits and illness-related perceptions., Method: Adults with hypertension in Germany and Austria filled out a self-administered questionnaire in a cross-sectional study based on the UTAUT-model in order to identify potential predictors for the behavioral intention to use mHealth applications as an indicator for their early acceptance. Beyond the four core determinants of acceptance of the UTAUT (performance expectancy, effort expectancy, social influence and facilitating conditions), self-efficacy, openness to experience and perceived health threat were analyzed as predictors., Results: 145 participants (mean age 52.51 years, SD 14.33; 60% female) completed the survey. Acceptance was moderate on average (M = 3.26, SD = 1.07, min 1 to max 5). In a multiple hierarchical regression, performance expectancy and effort expectancy were confirmed as significant predictors of acceptance (step 1, R2 = .57, p < .001), while self-efficacy could not be confirmed (step 2, p = .87). In addition, perceived health threat (β = .12, p < .05) and openness to experience (β = .22, p < .001) had a significant influence on acceptance of mHealth apps for hypertension (step 3, overall model with R2 = .62). Age showed a negative association with the intention to use (β = .22, p = .005) while no influence of gender could be found (p = .06)., Conclusion: Above expectations regarding effectiveness and usability, openness to experience and perceived health threat make a significant contribution in predicting the acceptance of mHealth solutions in the field of chronic diseases.

Aims: To find factors that are associated with a general practitioner's (GP's) subjective impression of a patient being 'difficult' within a sample of patients with type 2 diabetes mellitus (T2DM)., Methods: Secondary cross-sectional analysis of a cohort of GP patients with T2DM. GP questionnaire on clinical data and GPs' subjective ratings of patient attributes (including 'patient difficulty'). Patient questionnaire on sociodemographics and illness perceptions. Bivariate and multivariate analyses, adjusted for cluster-effect of GP practice., Results: Data from 314 patients from 49 GPs could be analysed. Independent associations with higher GP-rated difficulty were found for (odds ratio; 95% confidence interval): male patients from male GPs (1.27; 1.06-1.53), unmarried men (1.25; 1.04-1.51), men with non-German nationality (1.80; 1.24-2.61), patients perceiving more problems with diabetes (1.17; 1.04-1.30), patients with higher BMI (1.01; 1.00-1.02) and HbA1c values (1.06; 1.02-1.10), patients being perceived by the GP as less adherent (1.34; 1.22-1.46) and less health-literate (1.19; 1.04-1.35)., Conclusions: The impact of patients' gender and illness perception yield new insights into GP-perceived complexity of care. Culturally and gender-sensitive communication techniques for adapting health care goals to patients' problems (rather than norm values) may alleviate GPs' work., (Copyright © 2019 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Multifamilygroups as a Psychosocial and Contextoriented Intervention for Somatic Illness and Disability This paper provides a detailed description of a multi-family group (MFG) intervention designed for children with disabilities or chronical somatic disease and their families based on a systemic model. A mixed-methods study examines the perspectives of the participating family members regarding specific intervention components and the therapeutic process and its outcomes of this heterogeneous, closed MFG. Problem-centered interviews and questionnaires were used. Attendance of and satisfaction with the group were high. Specific intervention components such as the provided therapeutic environment and the mutual support that was facilitated by offering different opportunities for contact with families in similar situations are highlighted as particularly helpful. Increased feelings of parental togetherness and competence were reported. Results suggest that this MFG for families of children with chronic diseases or disabilities is highly feasible for these families.

Objective: During an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). However, empirical evidences are still sparse., Methods: This cross-sectional study included 533 ST-elevated myocardial infarction (STEMI) patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed using the Cardiac Denial of Impact Scale (CDIS) with the median split as cutoff point. A total of 206 (41.8%) STEMI patients were thus classified as deniers., Results: Deniers were less likely to suffer from major depression (p=0.04), anxiety (p=0.01) and suboptimal well-being (p=0.01) compared to non-deniers during the last six months prior to STEMI. During STEMI, they were less likely to perceive severe pain strength (p=0.04) and racing heart (p=0.02). Male deniers were also less likely to perceive shortness of breath (p=0.03) and vomiting (p=0.01). Denial was not associated with overall delay time. However, in the time window of 3 to 24h, denial accounted for roughly 40min extra delay (356 vs. 316.5min p=0.02 n=196)., Conclusions: Denial not only contributes to less suffering from acute heart related symptoms and negative affectivity but also leads to a clinically significant delay in the prevalent group., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: Illness perceptions are usually conceptualized using the self-regulatory model of illness. Although a few examinations of illness perceptions among Turkish language populations exist, the validity of the self-regulatory model of illness has never been confirmed for this population group. The aim of our study was to explore the validity of the self-regulatory model of illness in chronically ill Turkish migrants residing in Germany using diabetes mellitus type 2 as an example., Methods: Qualitative semi-structured interviews were conducted with 24 Turkish migrants with self-reported diabetes who were recruited through key persons. The core aspects of the qualitative data were extracted through a hermeneutic approach. Subsequently, a system of categories and sub-categories was developed by means of content analysis., Results: Seven distinct core dimensions of illness perceptions, each with a different number of sub-domains, could be identified in the sample. They comprised the perceived timeline of diabetes, its consequences, its causes, its controllability as well as the identity/coherence and the emotional response with respect to the condition., Discussion: As regards the conceptualization of illness perceptions, the dimensions identified are in line with the self-regulatory model of illness. Addressing illness perceptions through tailored interventions may contribute to improving health care and health outcomes in Turkish migrants.

Objective: The article examines how voice-hearing as an (in)direct experience can become a subject of ethnographic observation., Methods: An ethnographic participant observation was conducted over a five-month period of time in two "Trialogue" self-help groups organized by the "Netzwerk Stimmenhören", an NGO based in Berlin, Germany. Additionally, feedback interviews were held within the groups., Results: Four different collective modes of ordering of voice-hearing are captured: Within the groups the phenomenon was at times (1) normalized in the mode of normalization, structured in the mode of voice-hearing (2) as a passion, (3) as a turn of fate or (4) as a disability., Conclusions: Psychiatric-social anthropological cooperative research projects may help to achieve and support a change of perspectives for actors working in the psychiatry, actors in psychiatric self-help organizations and individuals who hear voices. Due to the applied methods results may not only be of interest within field of scientific discourse and furthermore create a different insight into the field., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Current diagnostic criteria for somatoform disorders demand revisions due to their insufficient clinical as well as scientific usability. Various psychological and behavioral characteristics have been considered for the proposed new category Somatic Symptom Disorder (SSD). With this study, we were able to jointly assess the validity of these variables in an inpatient sample., Methods: Using a cross-sectional design, we investigated N=456 patients suffering from somatoform disorder, anxiety, or depression. Within one week after admission to the hospital, informed consent was obtained and afterwards, a diagnostic interview and a battery of self-report questionnaires were administered. Logistic regression analyses were performed to determine which variables significantly add to construct and descriptive validity., Results: Several features, such as somatic symptom severity, health worries, health habits, a self-concept of being weak, and symptom attribution, predicted physical health status in somatization. Overall, our model explained about 50% of the total variance. Furthermore, in comparison with anxious and depressed patients, health anxiety, body scanning, and a self-concept of bodily weakness were specific for DSM-IV somatoform disorders and the proposed SSD., Conclusions: The present study supports the inclusion of psychological and behavioral characteristics in the DSM-5 diagnostic criteria for somatoform disorders. Based on our results, we make suggestions for a slight modification of criterion B to enhance construct validity of the Somatic Symptom Disorder., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Patients' readiness to behavioural changes according to the transtheoretical model (TTM) and criteria of treatment outcome are positively associated and have in part already been confirmed. For a stable effect of therapeutic treatment, patients' readiness to change seems indispensable for an independent and active pain management. Thus, in addition to an enhanced quality of life, increasing patients' motivation is a declared objective of the treatment at Dresden's Comprehensive Pain Center. In this study, it was examined how the readiness to change develops in the course of and during the 2 years following the multimodal treatment program. Furthermore, associations between outcome criteria of the treatment and patients' readiness to change were explored., Materials and Methods: The database constitutes 169 patients who took part in a 4-week interdisciplinary, partially residential pain treatment. Beside the Freiburg Pain Stages questionnaire ("Frieburger Fragebogen - Stadien der Bewältigung chronischer Schmerzen", FF-STABS), a comprehensive pain diagnostic inventory including the Pain Disability Index (PDI), the SF-36 questionnaire, and the Hospital Anxiety and Depression Scale (HADS) was completed at six different time points (beginning of treatment, end of treatment, booster session after 10 weeks, after 6, 12, and 24 months). The statistical analyses were performed with SPSS 16.0 including nonparametric analyses and variance analyses., Results: Significant differences in the level of readiness to change between the beginning of treatment and all follow-up measures were observed. The average patients' readiness to change was still higher after 2 years than at the first measurement. However, a differentiated consideration revealed a small portion of patients who showed no change or even a reduction of motivation. After an additional week (booster session), the stages of readiness to change remained stable, irrespective of the direction of the previous change. Regarding therapeutic outcome, significant short- and long-term improvements were evident. For single outcome parameters, positive associations with the stages of readiness to change were found., Conclusion: The results indicate that the outpatient pain management program favorably affects patients' motivation and general quality of life. This effect also seems to be stable over a long period of time. As not all patients show an improvement in stage of readiness to change, the question arises whether the reason of the differences might lie within the patients' and whether specific interventions for motivation might be useful to enhance motivation before starting treatment.

This article tries to link the present lack of theoretical discussion within German Social Psychiatry with a loss of phenomenological and anthropological thought. The so-called Phenomenological Psychiatry used to play a very important role in German psychiatry during the 50 ies until the 70 ies and had strong influences on the first reformers of German psychiatry, such as Walter Ritter von Baeyer, Heinz Häfner, Caspar Kulenkampff, Karl Peter Kisker and Erich Wulff. Their reforms were not only founded by a social criticism put forth by theories such as marxism (Basaglia, Wulff) or structuralism (Foucault) but also by a concrete notion of what it is like to suffer from mental illness and what kind of needs are linked to such suffering. This very notion was given by the phenomenological approach. Finally the article tries to give reasons for today's reciprocal loss of connection of the phenomenological and the socio-psychiatric school., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Worries about the risk to personal health from new technology and features of modern life have been shown to be associated with the use of health care services, health behaviours, mood and reporting of physical symptoms. We examined the frequency and nature of these concerns in a large national sample and the relationship of modern health worries to demographic factors, depression, symptom reporting and health-related quality of life., Methods: A representative sample of the German population (n=2485) completed a face-to-face survey which included demographic information, the Modern Health Worries Scale, as well as measures of depression, symptom reporting, and health-related quality of life., Results: The majority of the population reports high or extremely high concerns about aspects of modernity affecting their personal health, while only six percent reported no concerns at all. Higher levels of modern health worries were found in females but were not associated with income or age. Higher levels of modern health worries were significantly associated with depression, symptom reporting and lower health-related quality of life. We found the relationship between modern health worries and both symptom reporting and health-related quality of life was only partially explained by depression for most outcome variables, while the association between MHW and physical component (SF-12) was fully mediated by depression., Conclusions: Concerns about aspects of modernity affecting health are common in a general population sample and associated with depression, symptom reporting and quality of life., (Copyright © 2011 Elsevier Inc. All rights reserved.)

OBJECTIVES How GPs describe their patients who they did not identify as suffering from depression but who were classified as such by PHQ-9? What conclusions can be drawn with regard to how depression is dealt with and the illness model in use? METHOD GPs who took part in a screening study were asked in interviews to talk about some of their patients - not being informed that these were those not identified as depressive by them. This study comprises 21 narrative interviews from 18 GPs. Analysis by Framework method by Lewis and Ritchie. RESULTS The low identification rate of depression is not the result of failed recognition of "psychological problems" but of other factors centring on GPs' particular way of working and their concepts about mental illness: making a diagnosis only in a contextual way of interpreting symptoms; using the time passing as a help for diagnosing; emphasis on the impairment rather the diagnosis; considering the therapeutic consequences before making a diagnosis; a tolerance concerning "deviation" respectively wider view on "normality". CONCLUSION Understanding the different ways of conceptionalizing mental illness by psychiatrists and general practitioners is basic for their cooperation., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To investigate the change of psychological symptoms and quality of life in children and adolescents with congenital heart disease, cancer, or cystic fibrosis after a family-oriented inpatient rehabilitation program., Methods: 302 participants in the intervention (aged 4-17 years, mean=8.7) were assessed using standard questionnaires at admission to the rehabilitation program, at discharge, and 6 months post discharge. Parent-reported behavioral and emotional symptoms were compared to a healthy control group from the National Health Interview and Examination Survey for Children and Adolescents (n=903)., Results: At admission, 27.5% of patients showed abnormal levels on the total difficulties score of the Strengths and Difficulties Questionnaire - parent version (SDQ), while an additional 16.9% had slightly elevated symptoms (relative risk=2.16). Patients' psychological symptoms were negatively correlated with their quality of life (QoL) and with parental QoL. After rehabilitation, the patients' symptoms improved significantly, and the improvement persisted for 6 months in those patients who could be followed., Conclusions: The rehabilitation program can be considered a promising strategy to improve the patients' psychological adaptation., (© Georg Thieme Verlag KG Stuttgart · New York.)

The present study investigated whether women and men differ with regard to non-religious and religious coping with cancer, here: colon cancer--a question on which only little research has been done so far. 341 patients filled in a questionnaire during inpatient oncological rehabilitation. Statistical analyses showed that women reported higher mental strain than men. They used more bagatellization and wishful thinking, more depressive and less active problem-oriented coping strategies. A higher use of religious coping among women was to a high degree associated with their generally stronger religiosity. Correlations between coping strategies and measures of mental health indicated commonalities and differences. In particular, a positive correlation between active problem-oriented coping and mental health was found for men but not for women. In accordance with women's higher religiosity, the data indicate a stronger correlation between religious coping and adaptation among women than among men. The results suggest that gender differences and religiosity can be relevant in the context of treatment but that their significance must not be overinterpreted. In terms of patient orientation they speak for the necessity to individually assess the need for support, also with regard to the consideration of religiosity in the treatment process., (Georg Thieme Verlag KG Stuttgart.New York.)

Background: The effect of an incorrect audiological medical assessment of noise trauma deafness can be substantial. The impact will be demonstrated using a case example. The reasons for incorrect assessment are often insufficient examination conditions or simulation and aggression of the subject. The results of a study on this topic will be presented., Patients and Methods: A total of 61 patients who underwent a psycho-acoustic medical assessment were grouped into 1 of 4 categories ranging from category 0 for no simulation or aggravation to category III for severe simulation and aggravation. For category III reliable and valid thresholds of pure tone audiometry can only be achieved using objective audiological measurements. The frequency, extent and socio-economic factors were evaluated., Results: Of the 61 individuals 26 showed no simulation or aggravation behavior (category 0), 10% were grouped into category III and 48% into categories I and II. The tendency to simulation and aggravation increased with the patients' age, the level of education and the frequency of medical examinations prior to this investigation., Conclusions: Simulation and aggravation is a more frequent phenomenon than previously assumed (approximately 58% of all audiological examinations). The effect in terms of economical damage could be substantial. The usage of a well-defined classification is highly recommended in order to improve the quality of medical assessment in ENT.

Bad Sobernheim Stress Questionnaire-Brace and Bad Sobernheim Stress Questionnaire-Deformity are relatively new tools aimed at facilitating the evaluation of long-term results of therapy in persons with idiopathic scoliosis undergoing conservative treatment. To use these tools properly in Poland, they must be translated into Polish and adapted to the Polish cultural settings. The process of cultural adaptation of the questionnaires was compliant with the guidelines of International Quality of Life Assessment (IQOLA) Project. In the first stage, two independent translators converted the originals into Polish. Stage two, consisted of a comparison of the originals and two translated versions. During that stage, the team of two translators and authors of the project identified differences in those translations and created a combination of the two. In the third stage, two independent translators, who were native speakers of German, translated the adjusted version of the Polish translation into the language of the original document. At the last stage, a commission composed of: specialists in orthopedics, translators, a statistician and a psychologist reviewed all translations and drafted a pre-final version of the questionnaires. Thirty-five adolescent girls with idiopathic scoliosis who were treated with Cheneau brace were subjected to the questionnaire assessment. All patients were treated in an out-patient setting by a specialist in orthopedics at the Chair and Clinic of Orthopedics and Traumatology. Median age of patients was 14.8 SD 1.5, median value of the Cobb's angle was 27.8 degrees SD 7.4. 48.6% of patients had thoracic scoliosis, 31.4% had thoracolumbar scoliosis, and 20% patients had lumbar scoliosis. Median results obtained by means of the Polish version of BSSQ-Brace and BSSQ-Deformity questionnaires were 17.9 SD 5.0 and 11.3 SD 4.7, respectively. Internal consistency of BSSQ-Brace and BSSQ-Deformity was at the level of 0.80 and 0.87, whereas the value of the absolute stability factor was 0.82 and 0.88. Overall, the Polish versions of the BSSQ-Brace and BSSQ-Deformity Questionnaires are characterized by high values of internal consistency factor and absolute stability factor. Following the process of adaptation, the authors obtained a tool that is instrumental in clinical evaluations and complies with methodological criteria.

Medical rehabilitation in Germany is still lacking in patient education programmes that meet certain quality requirements such as the use of manuals, patient-oriented didactics, and evaluations of effectiveness. For patients with chronic low back pain, no standardized and evaluated back school programme has so far been available for routine use. In this paper, we demonstrate the development of a quality-assured back school based on a health-education programme of the German statutory pension insurance scheme. Both topics and didactics incorporate treatment evidence, practice guidelines, quality criteria for patient education and theories of health and illness behaviour. First, formative evaluation was conducted to assess patient acceptance and practicability of the manual. Second, effects of the back school programme were assessed on a short-term (at the end of rehabilitation), medium-term (6-month follow-up) and long-term (12-month follow-up) basis in a randomized controlled study of patients with low back pain (n=360). Results show a significant medium treatment effect in patients' knowledge about chronic back pain and its treatment at the end of rehabilitation (p<0.001; eta (2)=0.080). Furthermore, small to medium effects were also observed among some secondary outcomes, such as motivation to physical activity, pain beliefs and pain intensity. After the programme's medium- and long-term effects have been demonstrated, it will be recommended for implementation in medical rehabilitation. The manual meets the requirements that allow for a successful transfer into clinical practice., (Copyright Georg Thieme Verlag KG Stuttgart . New York.)

The response styles theory (S. Nolen-Hoeksema, B. E. Wisco, & S. Lyubomirsky, 2008) supposes that ruminative coping is a cognitive risk factor for the course of depression, whereas distractive coping has protective effects. The authors present a longitudinal study on reciprocal relations between coping styles and depressive symptoms. They investigated 82 formerly depressed inpatients 4 weeks, 6 months, and 3.5 years after hospital discharge together with 76 age- and gender-matched community controls. Depressive symptoms predicted future symptom-focused rumination over the initial short-term interval in both samples. In former inpatients, this predictive effect was also significant over the subsequent long-term interval. Symptom-focused rumination and distraction were significant predictors of future depressive symptoms across both intervals, with sample-specific effects. In the community sample, symptom-focused rumination predicted more depressive symptoms, whereas in former inpatients, distractive coping predicted fewer depressive symptoms over time. The authors conclude that interventions aimed at reducing rumination should preferably be applied in preventive and early intervention settings, although in individuals with a history of more severe and long-standing depression rumination might gradually lose its capacity to predict the further illness course. In these persons, interventions should particularly strengthen distractive coping., (PsycINFO Database Record 2009 APA, all rights reserved.)

The study was to examine how far treatment success in psychosomatic rehabilitation can be predicted from patients' characteristics. The aim of this study included the development of outcome criteria, the analysis of bivariate correlations, as well as development and examination of multivariate models. The motivation for dealing with job-related problems was evaluated separately. Data were available from admission, discharge and three-months follow-up. The data of 463 patients were included. Generated were success criteria concerning sociomedical development, health as well as the ability to work. All success criteria were dichotomized. In the criteria defined, successful outcomes were found in 40 to 60% of the patients. In the bivariate analyses, it was shown that many sick days before rehabilitation, applications for pension, severe disability, high impairment, and suggestion for rehabilitation by the insurance agency, have basically negative effects on success. Correlations with the variables concerning motivation for dealing with job-related problems were rather weak. In multivariate model development, models of different quality were found. For prediction of working ability at discharge, there was an explained variance of nearly 60%. In the other success criteria as well, explained variance amounted to over 20%. The models consist of different constellations of variables, the number of sick days before rehabilitation, variables of application for pension and severity of the impairment frequently included. In case of a current sick leave, rehabilitation should be started early, sociomedical problems have to be dealt with explicitly, and rehabilitation should be accompanied by preparatory and aftercare measures.

Background: Medical rehabilitation is a basic component in the German health care system. However, several studies have shown only moderate effects by rehabilitation treatment. The effectiveness of medical rehabilitation depends on different factors, like rehabilitation need, access, preparation for rehabilitation treatment, therapy intensity and rehabilitation aftercare. During the past few years the lack of cooperation and communication between cost carriers and general practitioners has been emphasized. Since general practitioners play a central role in the patients' decision for rehabilitation treatment, the aim of the present study was to facilitate the identification of rehabilitation need by general practitioners., Methods: The project group integrated different professions. To facilitate assessment of rehabilitation need in patients attending a medical practice, two different approaches were applied: First, a self-administered patient questionnaire was developed, containing different subjective indicators of rehabilitation need (e. g., subjective health, problems in activities and participation as well as daily or occupational stress). Secondly, the project group worked out a short checklist for general practitioners, containing a number of criteria confirming patients' potential need for rehabilitation. Both instruments were tested in nine medical practices with 60 patients presumably in need for medical rehabilitation., Results: The short checklist as well as the patient questionnaire proved to be practicable and economical. Nine of 40 general practitioners participated. Based on the checklist a need for rehabilitation was identified in 85% of their patients. In another 10% of the patients the result was questionable, and in three patients the finding was negative. In the self-assessment of the patients, 98% stated a subjective need of rehabilitation (global rating), only one patient indicated no rehabilitation need. The agreement between physician and patient assessments was only weak (kappa: 0.11, p=0.08). Defining deviation by one category as still indicative of agreement of the two ratings, an agreement of 78% is reached., Discussion: Both instruments in principle proved to be useful in medical practice. They allow quick and easy assessment of a potential rehabilitation need in everyday practice. Despite these positive results and the supportive function of the checklist, the participation rate among general practitioners was unexpectedly low, possibly mainly due to the additional bureaucracy, a negative image of the rehabilitation system, and the concurrence with DMPs., Conclusion: Poor accessibility of general practitioners regarding questions of medical rehabilitation is well-known from numerous earlier research projects. Satisfying integration of physicians could not be reached, although the approach of needs assessment seems to be promising. Further research should focus on how the urgently required cooperation could be achieved.

Background: Primary care physicians play a crucial role in the assessment of restrictions in of participation, i. e. especially sick leave. In this study we investigated to which degree patients in primary care suffer from disorders of participation and how this is related to problems at the workplace and sick leave., Method: A total of 382 patients, aged 18-65, were investigated in primary care office practices. Self-reported disorders of participation were measured with the IMET, together with sociodemographic and work-related information., Results: 27,4% of 299 patients who were at present working reported to have problems at the workplace. 19% were at present on sick leave. These patients did significantly more often report mobbing at the workplace. No differences were found with respect to quantitative or qualitative overtaxation or with respect to context variables. Restrictions in of participation were strongest related to the workplace but were also reported for the domain of family or social activities. Patients on sick leave also showed more impairment in these private areas than patients at work. The treating physicians saw psychosocial problems as a primary cause for disorders of participation at the workplace., Conclusion: Chronic illness does impair occupational as well as general social participation, and such patients are frequently seen in primary care. Physicians in primary health care therefore play an important role in the treatment of restrictions in of participation and especially in early intervention.