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[Disease-related self-management of obese children and children with bronchial asthma: changes and predictors during inpatient rehabilitation].

BACKGROUND AND SIGNIFICANCE
There is growing interest in disease-related self-management as a means of coping with chronic disease. Improving disease-related self-management has thus become a key aim of inpatient medical rehabilitation of children and adolescents. We conducted this study in the framework of the project entitled "Outcome quality in medical inpatient rehabilitation of children and adolescents" initiated and financed by the German statutory pension and statutory health insurance programmes.


STUDY AIM
Our study aim was to examine any changes following inpatient medical rehabilitation in the diagnosis-specific disease self-management of children suffering from obesity and from bronchial asthma. In addition we sought to identify any personal characteristics of the rehabilitants that might predict changes in self-management.


METHODS
We collected data from 17 inpatient medical rehabilitation centres on disease-related self-management in children with obesity (n=706) and bronchial asthma (n=162) at the start of rehabilitation and 6 weeks after rehabilitation. The age of the diagnostic group "obesity" averaged 14.3 years, with a male percentage of 39.3%. The average age in the diagnostic group "bronchial asthma" was 14.0 years, with a male percentage of 54.2%. A questionnaire was used addressing the self-management of chronically ill young people. To compare the results from both measurement occasions, we employed t-tests for dependent samples and calculated effect-sizes. Using hierarchical regression analyses, we determined predictors of change in disease-related self-management. The predictor variables were included into the hierarchical regression analyses within 6 topical blocks (baseline disease management, sociodemography, body functions, baseline quality of life, motivation for rehabilitation, and duration of rehabilitation).


RESULTS
We observed significant post-rehabilitation improvement of disease-related self-management in both the obese (T=-22.423; p<0.001) and the bronchial asthma group (T=-5.349; p<0.001). This improvement revealed a strong effect in the obese group (SRM=0.84) and a moderate effect in the bronchial asthma group (SRM=0.42). Regression analyses explained 3.4% of the variance in the obese group and 31.3% in the bronchial asthma group. In the latter group, self-management 6 weeks after the end of rehabilitation can be predicted by good self-management at the start of rehabilitation (ß=0.516; p<0.001) as well as primary school attendance (ß=0.201; p<0.01).


DISCUSSION
Our results show that the disease-related self-management of obese youngsters and those with bronchial asthma benefits from inpatient rehabilitation. Changes in self-management are only poorly predicted by the variables included in the regression analysis in the diagnostic group "obesity". Other factors than those considered in this study seem to influence the success of treatment. In the diagnostic group "bronchial asthma" a significantly higher proportion of incremental variance can be explained, the extent of disease management at the beginning of rehabilitation being the most important predictor.