A multicentre cluster-randomized controlled study to evaluate a train-the-trainer programme for implementing internal and external participation in medical rehabilitation

Objective: Evaluation of the effect of the train-the-trainer programme ‘Fit for Shared Decision-Making’ on internal (team) and external (patient) participation in medical rehabilitation from a patient and staff perspective. Design: A multicentre, cluster-randomized controlled study. Setting: Eleven medical rehabilitation clinics, divided into intervention and control groups. Subjects: A staff and a patient survey were conducted pre- and post-intervention, plus a further patient survey six months later. Intervention: Train-the-trainer programme ‘Fit for Shared Decision-Making’ for interprofessional settings. Main measures: Each survey measured internal participation with a self-compiled six-item scale (Internal Participation Scale, IPS), and external participation by means of a nine-item Shared Decision-Making Questionnaire (SDM-Q-9) for the patients and for healthcare professionals. Results: Patient samples numbered 402 for the pre-, 463 for the post-intervention data collection period and 461 six months after the intervention. Patients’ appraisal of external participation (F period x group (2) = 0.256, p=0.774, η 2 =0.000) showed no change, whereas internal participation (F period x group (2) = 3.785, p=0.023, η 2 =0.007) showed a significant increase. A total of 195 healthcare professionals participated in the pre- and 168 in the post-intervention staff survey. Here external participation was significantly enhanced in the intervention group (F period x group (1) = 4.893, p=0.028, η 2 =0.014). Conclusions: The train-the-trainer approach can be recommended for implementing internal and external participation in interprofessional settings such as medical rehabilitation clinics. However, there is a need for more intensive staff training for internal participation and an additional intervention for patients to achieve success in all aspects.