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Mehl A, Klaus AK, Reif M, Rodrigues Recchia D, Zerm R, Ostermann T, Brinkhaus B, Kröz M. Validation of the Internal Coherence Scale (ICS) in Healthy Geriatric Individuals and Patients Suffering from Diabetes Mellitus Type 2 and Cancer. Geriatrics (Basel) 2024; 9:63. [PMID: 38804320 PMCID: PMC11130969 DOI: 10.3390/geriatrics9030063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/23/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND With increased life expectancy, the coexistence of functional impairment and multimorbidity can negatively impact life quality and coherence in geriatric individuals. The self-report 10-item Internal Coherence (ICS) measures how individuals cope with and make sense of disease-specific life challenges. The aim of this study was to validate the ICS in a sample of geriatric individuals. METHODS AND PROCEDURE In a cross-sectional study, geriatric individuals with and without chronic diseases were recruited. A factor analysis with principal component extraction (PCA) and a structural equation model (SEM) was conducted to assess the ICS factor structure in a geriatric sample. To measure convergent validity, the following scales were used: Short Health Survey (SF-12), Karnofsky Performance Index (KPI), Trait autonomic regulation (Trait aR), Sense of Coherence Scale (SOC), and Geriatric Depression Scale (GDS). RESULTS A sample of n = 104 (70-96 years of age) patients with Diabetes Mellitus Type 2 (n = 22), cancer diseases (n = 31) and healthy controls (n = 51) completed the ICS. PCA and SEM yielded the original two-factor solution: 1. Inner resilience and coherence and 2. Thermo coherence. Overall internal consistency for this cohort was satisfying (Cronbach's α with rα = 0.72), and test-retest reliability was moderate (rrt = 0.53). ICS scores were significantly correlated to all convergent criteria ranging between r = 0.22 * and 0.49 ** (p < 0.05 *; p < 0.01 **). CONCLUSION Study results suggest that the ICS appears to be a reliable and valid tool to measure internal coherence in a geriatric cohort (70-96 years). However, moderate test-retest reliability prompts the consideration of potential age-effects that may bias the reliability for this specific cohort.
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Affiliation(s)
- Annette Mehl
- Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany; (A.-K.K.); (R.Z.); (M.K.)
| | - Anne-Kathrin Klaus
- Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany; (A.-K.K.); (R.Z.); (M.K.)
| | - Marcus Reif
- Society for Clinical Research, Hardenbergstraße 20, 10623 Berlin, Germany;
| | - Daniela Rodrigues Recchia
- Lehrstuhl für Forschungsmethodik und Statistik in der Psychologie, University Witten/Herdecke, 58455 Witten, Germany; (D.R.R.); (T.O.)
| | - Roland Zerm
- Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany; (A.-K.K.); (R.Z.); (M.K.)
- Department of Internal Medicine, Havelhöhe Hospital, Kladower Damm 221, 14089 Berlin, Germany
| | - Thomas Ostermann
- Lehrstuhl für Forschungsmethodik und Statistik in der Psychologie, University Witten/Herdecke, 58455 Witten, Germany; (D.R.R.); (T.O.)
- Institute for Integrative Medicine, University Witten/Herdecke, Gerhard Kienle Weg 8, 58313 Herdecke, Germany
| | - Benno Brinkhaus
- Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany;
| | - Matthias Kröz
- Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany; (A.-K.K.); (R.Z.); (M.K.)
- Institute for Integrative Medicine, University Witten/Herdecke, Gerhard Kienle Weg 8, 58313 Herdecke, Germany
- Klinik Arlesheim, Research Department, Pfeffinger Weg 1, 4144 Arlesheim, Switzerland
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Mol TI, van Bennekom CAM, Scholten EWM, Post MWM. Measures of self-regulation used in adult rehabilitation populations: A systematic review and content screening. Clin Rehabil 2022; 36:1120-1138. [PMID: 35473388 PMCID: PMC9284405 DOI: 10.1177/02692155221091510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective We aimed to identify generic measures of self-regulation and to examine the
degree to which these measures fit a recently developed conceptual model of
self-regulation in a rehabilitation context. Data sources Pubmed, Embase, PsycInfo, and CINAHL were searched. Review methods Articles were included if they were published between January 2015 and August
2020 and reported on empirical studies (trials and observational studies)
using a measure of self-regulation or a related concept, in an adult
rehabilitation population. Main content was analysed by linking all items of
the selected measures to one or more of the six sub-themes of
self-regulation: (1) insight into physical and cognitive impairments, (2)
insight into the consequences of the impairments, (3) insight into
abilities, (4) to be able to communicate limitations, (5) trust in body and
functioning, and (6) make use of abilities. Results Two reviewers independently screened 7808 abstracts, resulting in the
inclusion of 236 articles. In these articles, 80 different measures were
used to assess self-regulation or related concept. Nineteen of these
measures met the inclusion criteria and were included for the content
analyses. Nine of these were self-efficacy measures. No measures covered
four or more of the six sub-themes of self-regulation. The three sub-themes
on gaining insights were covered less compared to the sub-domains ‘trust’
and ‘make use of abilities’. Conclusions Many measures on self-regulation exist None of these measures cover all six
sub-themes of self-regulation considered important to measure
self-regulation as a rehabilitation outcome.
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Affiliation(s)
- T I Mol
- Center of Excellence for Rehabilitation Medicine, 526115UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,84792Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C A M van Bennekom
- 100506Heliomare Rehabilitation Center, Research and Development, Wijk aan Zee, the Netherlands.,522567Amsterdam University Medical Center, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam, the Netherlands
| | - E W M Scholten
- Center of Excellence for Rehabilitation Medicine, 526115UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - M W M Post
- Center of Excellence for Rehabilitation Medicine, 526115UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,84792Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Chen Q, Wright F, Duncan L, Huntley A. Profiling mistletoe therapy research and identifying evidence gaps: A systematic review of conditions treated, mode of application and outcomes. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2021.101392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Brunet J, Wurz A, Hussien J, Pitman A, Conte E, Ennis JK, Herry CL, Seely AJE, Seely D. Exploring the Effects of Yoga Therapy on Heart Rate Variability and Patient-Reported Outcomes After Cancer Treatment: A Study Protocol. Integr Cancer Ther 2022; 21:15347354221075576. [PMID: 35393867 PMCID: PMC9016564 DOI: 10.1177/15347354221075576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Following cancer treatment, adults commonly report worsened patient-reported outcomes (PROs) such as anxiety, stress, depression, persistent and upsetting cognitive complaints, unrelenting fatigue, and reduced quality of life. Poorer PROs are associated with disrupted autonomic nervous system functioning as measured by heart rate variability (HRV), both of which have been associated with greater morbidity and mortality. Interventions to improve HRV and PROs among adults following cancer treatment are needed. Yoga therapy holds promise as an intervention to improve HRV and PROs. Therefore, we conducted a single-subject exploratory experimental study to investigate the effects of yoga therapy on HRV and specific PROs (ie, cancer-related fatigue, anxiety, cognitive function, depression, stress, quality of life) in adults treated for cancer. To reduce publication bias, improve reproducibility, and serve as a reference for forthcoming reporting of study results, we present the study protocol for this study herein. METHODS Participants were adults who completed cancer treatment that were recruited from the Ottawa Integrative Cancer Centre. Consenting and eligible participants received one 1:1 yoga therapy session (ie, 1 participant, 1 Yoga Therapist) and 6 weekly group-based yoga therapy sessions (ie, 2-3 participants, 1 Yoga Therapist). Participants completed assessments 7 times: 3 times prior to the program (ie, -6 weeks, -3 weeks, immediately prior to the 1:1 yoga therapy session), immediately following the 1:1 yoga therapy session, prior to the first group-based yoga therapy session, after the last group-based yoga therapy session, and at a 6-week follow-up. Hierarchical linear modeling will be used to test the average effects of the yoga therapy program across participants. DISCUSSION This study will explore several novel hypotheses, including whether yoga therapy can improve HRV and/or specific PROs among adults treated for cancer acutely (ie, during a 1:1 yoga therapy session) and/or through repeated exposure (ie, after completing 6 weeks of group-based yoga therapy). Although the findings will require confirmation or refutation in future trials, they may provide initial evidence that YT may benefit adults treated for cancer. TRIAL REGISTRATION ISRCTN registry, ISRCTN64763228. Registered on December 12, 2021. This trial was registered retrospectively. URL of trial registry record: https://www.isrctn.com/ISRCTN64763228.
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Affiliation(s)
- Jennifer Brunet
- University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Institut du savoir de l'Hôpital Montfort, Ottawa, ON, Canada
| | - Amanda Wurz
- University of the Fraser Valley, Chilliwack, BC, Canada
| | | | - Anne Pitman
- The Centre for Health Innovation, Ottawa, ON, Canada
| | - Ellen Conte
- The Centre for Health Innovation, Ottawa, ON, Canada.,Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Julie K Ennis
- The Centre for Health Innovation, Ottawa, ON, Canada
| | | | - Andrew J E Seely
- University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - Dugald Seely
- University of Ottawa, Ottawa, ON, Canada.,The Centre for Health Innovation, Ottawa, ON, Canada.,Canadian College of Naturopathic Medicine, Toronto, ON, Canada
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Rentsch G, Steinborn C, Klemd AM, Kienle GS, Gründemann C, Huber R. Investigations on the constitutional types under consideration of anthropometric data, autonomic regulation and immunological parameters. Complement Ther Med 2018; 40:133-144. [DOI: 10.1016/j.ctim.2018.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/18/2018] [Accepted: 04/26/2018] [Indexed: 11/25/2022] Open
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Kröz M, Reif M, Pranga D, Zerm R, Schad F, Baars EW, Girke M. The questionnaire on autonomic regulation: a useful concept for integrative medicine? JOURNAL OF INTEGRATIVE MEDICINE-JIM 2016; 14:315-21. [PMID: 27641604 DOI: 10.1016/s2095-4964(16)60264-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The concept of autonomic regulation (aR) reflects the relevance of the function of different autonomic systems for health. aR can be captured by questionnaires. We differentiate between a trait or constitutional aR questionnaire version including 12 (short-version) or 18 items, respectively, with three subscales (orthostatic-circulatory, rest/activity and digestive regulation), and an 18-item state aR questionnaire on the preceding week with four subscales (rest/activity, orthostatic-circulatory, thermo- and digestive regulation). The validated questionnaires show satisfying to good reliability and robust validity with clear construct validity. In this article, we summarized the actually available literature on aR and the use of aR questionnaires in clinical and observational studies. We described the relationship of high aR with health and in case of low aR or loss of regulation with disease and functional disorder in the three (four) different subscales and functional systems, such as rest/activity, orthostatic-circulatory or digestive regulation (thermoregulation) with the consecutive therapeutic need. Finally, we gave perspectives of its further application in clinical research.
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Affiliation(s)
- Matthias Kröz
- Research Institute Havelhöhe, D-14089 Berlin, Germany
- Department of Internal Medicine, Havelhöhe Hospital, D-14089 Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, D-10117 Berlin, Germany
- Institute for Integrative Medicine, University of Witten/Herdecke, D-58313 Witten/Herdecke, Germany
| | - Marcus Reif
- Society for Clinical Research, D-10623 Berlin, Germany
| | - Danilo Pranga
- Research Institute Havelhöhe, D-14089 Berlin, Germany
| | - Roland Zerm
- Research Institute Havelhöhe, D-14089 Berlin, Germany
- Department of Internal Medicine, Havelhöhe Hospital, D-14089 Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, D-14089 Berlin, Germany
- Department of Internal Medicine, Havelhöhe Hospital, D-14089 Berlin, Germany
| | - Erik Wim Baars
- Professorship Anthroposophic Healthcare, University of Applied Sciences Leiden, NL-2300 AJ Leiden, the Netherlands
| | - Matthias Girke
- Research Institute Havelhöhe, D-14089 Berlin, Germany
- Department of Internal Medicine, Havelhöhe Hospital, D-14089 Berlin, Germany
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Polit DF. Getting serious about test–retest reliability: a critique of retest research and some recommendations. Qual Life Res 2014; 23:1713-20. [DOI: 10.1007/s11136-014-0632-9] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
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Zerm R, Zerm R, Lutnæs-Mast F, Mast H, Girke M, Kröz M. Effects of eurythmy therapy in the treatment of essential arterial hypertension: a pilot study. Glob Adv Health Med 2014; 2:24-30. [PMID: 24381822 PMCID: PMC3833577 DOI: 10.7453/gahmj.2013.2.1.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Although eurythmy therapy (ET) has been used in the context of anthroposophic medicine (AM) for the treatment of, among other conditions, arterial hypertension (AH) for more than 80 years, there are as yet no studies on its effectiveness on disease entity. However, it has been shown that ET can increase heart rate variability comparably to ergometer training. Objective: To determine whether a 10-week course of ET has an impact on AH and if so, to determine the strength of the effect. The impact of ET on state-autonomic regulation, self-regulation, internal coherence, and quality of life is also explored. Methods: Consecutive inclusion of 9 subjects (6 female, 3 male, mean age of 64 years, SD 8.26) with AH diagnosed by their general practitioners. Inclusion criteria: no or unchanged antihypertensive medication from 4 weeks prior to the start of the study until the end of the study. ET was carried out with weekly instruction along with a daily, home-based program for 10 weeks with specific exercises. Twenty-four–hour blood pressure (BP) measuring was carried out, and the questionnaires were administered before and after the intervention. In addition, after a further 6 months during which 8 of the 9 patients carried on with the exercises of their own accord, the aforementioned parameters were assessed for a third time. Results: Parameters of the 24-hour BP measurements show a moderate, but not significant, improvement immediately after the intervention and 6 months after the intervention. After the 10-week intervention, we saw an improvement of the State-autonomic Regulation questionnaire, the subscale on “Rest/Activity regulation,” of the Self-regulation questionnaire, and the subscale “Initiative and Interest” of the Herdecke Quality of Life Questionnaire (HLQ) (all P < .045). After the 6-month post-study observation period, the aforementioned parameters improved further still, and an additional, significant improvement was seen for the Trait-autonomic Regulation subscale “Rest/Activity regulation,” the HLQ-sum score, and the HLQ subscales “social interaction,” “mental balance,” and “physical ability.” Conclusion: A 10-week course of ET does not result in a significant improvement in BP. The average BP measurements improved post-intervention by an absolute 3.2/2.0 mmHg and after 6 months of independent continuation of ET by 6.3/4.4 mmHg (systolic/diastolic). Despite the small group size, the regulation and quality-of-life parameters improved significantly after the intervention and further still after the 6-month observation period. The results need to be validated with larger patient collectives and control groups.
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Affiliation(s)
| | - Ronald Zerm
- Research Institute Havelhoehe Berlin, Community Hospital Havelhoehe, Berlin, Germany
| | - Froeydis Lutnæs-Mast
- Practice for Eurythmy Therapy at the Ambulatory Healthcare Centre, Zehlendorf, Berlin, Germany
| | - Heiner Mast
- Ambulatory Healthcare Centre, Zehlendorf, Berlin, Germany
| | - Matthias Girke
- Research Institute Havelhoehe Berlin, Community Hospital Havelhoehe, Berlin, Germany
| | - Matthias Kröz
- Research Institute Havelhoehe Berlin, Community Hospital Havelhoehe, Berlin, Germany
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Kröz M, Reif M, Büssing A, Zerm R, Feder G, Bockelbrink A, von Laue HB, Matthes H H, Willich SN, Girke M. Does self-regulation and autonomic regulation have an influence on survival in breast and colon carcinoma patients? results of a prospective outcome study. Health Qual Life Outcomes 2011; 9:85. [PMID: 21961625 PMCID: PMC3192663 DOI: 10.1186/1477-7525-9-85] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 09/30/2011] [Indexed: 12/21/2022] Open
Abstract
Background Cancer Related Fatigue (CRF) and circadian rhythm have a great impact on the quality of life (HRQL) of patients with breast (BC) and colon cancer (CRC). Other patient related outcomes in oncology are measured by new instruments focusing on adaptive characteristics such as sense of coherence or self-regulation, which could be more appropriate as a prognostic tool than classical HRQL. The aim of this study was to assess the association of autonomic regulation (aR) and self-regulation (SR) with survival. Methods 146 cancer patients and 120 healthy controls took part in an initial evaluation in 2000/2001. At a median follow up of 5.9 years later, 62 of 95 BC, 17 of 51 CRC patients, and 85 of 117 healthy controls took part in the follow-up study. 41 participants had died. For the follow-up evaluation, participants were requested to complete the standardized aR and SR questionnaires. Results On average, cancer patients had survived for 10.1 years with the disease. Using a Cox proportional hazard regression with stepwise variables such as age, diagnosis group, Charlson co-morbidity index, body mass index (BMI)) aR and SR. SR were identified as independent parameters with potential prognostic relevance on survival While aR did not significantly influence survival, SR showed a positive and independent impact on survival (OR = 0.589; 95%-CI: 0.354 - 0.979). This positive effect persisted significantly in the sensitivity analysis of the subgroup of tumour patients and in the subscale 'Achieve satisfaction and well-being' and by tendency in the UICC stages nested for the different diagnoses groups. Conclusions Self-regulation might be an independent prognostic factor for the survival of breast and colon carcinoma patients and merits further prospective studies.
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Affiliation(s)
- Matthias Kröz
- Center of Integrative Medicine, Professorship Quality of Life, Spirituality and Coping, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
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