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Kaier K, Metzner G, Horstmeier L, Bitzer EM, Heimbach B, Kiekert J, Voigt-Radloff S, Farin-Glattacker E. The economic impact of a local, collaborative, stepped, and personalized care management for older people with chronic diseases: results from the randomized comparative effectiveness LoChro-trial. BMC Health Serv Res 2023; 23:1422. [PMID: 38102609 PMCID: PMC10724907 DOI: 10.1186/s12913-023-10401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Within the ageing population of Western societies, an increasing number of older people have multiple chronic conditions. Because multiple health problems require the involvement of several health professionals, multimorbid older people often face a fragmented health care system. To address these challenges, in a two-group parallel randomized controlled trial, a newly developed care management approach (LoChro-Care) was compared with usual care. METHODS LoChro-Care consists of individualized care provided by chronic care managers with 7 to 16 contacts over 12 months. Patients aged 65 + with chronic conditions were recruited from inpatient and outpatient departments. Healthcare utilization costs are calculated by using an adapted version of the generic, self-reporting FIMA©-questionnaire with the application of standardized unit costs. Questionnaires were given at 3 time points (T0 baseline, T1 after 12 months, T2 after 18 months). The primary outcome was overall 3-month costs of healthcare utilization at T1 and T2. The data were analyzed using generalized linear models with log-link and gamma distribution and adjustment for age, sex, level of care as well as the 3-month costs of care at T0. RESULTS Three hundred thirty patients were analyzed. The results showed no significant difference in the costs of healthcare utilization between participants who received LoChro-Care and those who received usual care, regardless of whether the costs were evaluated 12 (adjusted mean difference € 130.99, 95%CI €-1477.73 to €1739.71, p = 0.873) or 18 (adjusted mean difference €192.99, 95%CI €-1894.66 to €2280.65, p = 0.856) months after the start of the intervention. CONCLUSION This study revealed no differences in costs between older people receiving LoChro-Care or usual care. Before implementing the intervention, further studies with larger sample sizes are needed to provide robust evidence on the cost effects of LoChro-Care. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00013904, https://drks.de/search/de/trial/DRKS00013904 ; date of first registration 02/02/2018.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Lukas Horstmeier
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Bernhard Heimbach
- Centre for Geriatric Medicine and Gerontology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Jasmin Kiekert
- Catholic University of Applied Sciences Freiburg, Karlstraße 63, 79104, Freiburg, Germany
| | - Sebastian Voigt-Radloff
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Centre for Geriatric Medicine and Gerontology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Salm C, Mentzel A, Sofroniou M, Metzner G, Farin E, Voigt-Radloff S, Maun A. Analysis of the key themes in the healthcare of older people with multimorbidity in Germany: a framework analysis as part of the LoChro trial. BMJ Open 2023; 13:e069814. [PMID: 37527899 PMCID: PMC10394557 DOI: 10.1136/bmjopen-2022-069814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Multimorbidity challenges healthcare systems. In Germany, coordination of healthcare for older multimorbid patients remains unstructured.This study aims to identify key themes in the healthcare of these patients and the inter-relationships between them. DESIGN Framework analysis of six cases based on 1-year data of primary and secondary care, patient-answered questionnaires and video material. SETTING Southern Germany. PARTICIPANTS Six multimorbid older patients participating in a randomised controlled trial that compared usual care with a local, collaborative, stepped and personalised care management approach for older people with chronic diseases (LoChro-trial). The LoChro care intervention involved a care manager who assisted participants in self-management. The primary outcome was a composite of functional health and depressive symptoms at 12 and 18 months. The LoChro-intervention had no effect on the primary outcome. PRIMARY OUTCOME MEASURE Key themes in the healthcare of older patients with multimorbidity and the inter-relationships between them. METHODS One-year data included diagnoses, treatment plans, examinations, assessments and discharge reports. Patient perspectives were assessed using the Patient Assessment of Chronic Illness Care. In three cases, videos of the LoChro intervention showed patients describing their health needs. These data were evaluated by three doctors and public health researchers. Using framework analysis, recurring themes influencing the healthcare situation of multimorbid older patients and their inter-relationships were identified. RESULTS Participants had an average age of 77, with 13 diagnoses, taking eight medications regularly. The five key themes describing the healthcare situation of these multimorbid patients were as follows: insufficient coordination, overuse and underuse of medical care, doctor and patient roles. Each theme covered three to four subcategories. The most significant inter-relationships between these themes were a lack of coordination leading to overuse and underuse of medical care. These were characterised by redundant inpatient stays, potential prescribing omissions and missed examinations. Deficiencies in vaccinations and secondary prevention were also demonstrated. CONCLUSION Coordination of care for multimorbid older patients in Germany is still deficient. Future healthcare arrangements should be explored with the participation of physicians and patients. TRIAL REGISTRATION NUMBER LoChro trial: DRKS00013904.
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Affiliation(s)
- Claudia Salm
- Institute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Anja Mentzel
- Institute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Mario Sofroniou
- Institute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Sebastian Voigt-Radloff
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
- Center for Geriatric Medicine and Gerontology Freiburg, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Andy Maun
- Institute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
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Glattacker M, Giesler JM, Bablok I, Kivelitz L, Schaefer J, Kanat M, Mohr J, Motschall E, Voigt-Radloff S, Kienbaum T, Dirmaier J. Availability and quality of assessment instruments on patient-centredness in older adults with multimorbidity: a systematic review. Age Ageing 2023; 52:7078343. [PMID: 36929844 DOI: 10.1093/ageing/afac314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/29/2022] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE Patient-centredness (PC) is central to the health care of older adults with multimorbidity, but knowledge about the psychometric quality of instruments measuring it in this group is scarce. Based on an integrative model of PC, we aimed to identify assessment instruments of PC for this particular group and evaluate their psychometric properties. METHODS We systematically searched six electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, Web of Science and PSYNDEX), initially covering research published up to 2018 and updated later to include work up to July 2022. In evaluating the psychometric properties of identified instruments, we followed the COSMIN methodology. RESULTS We identified 12 studies reporting on 10 instruments measuring PC in the health care of older adults with multimorbidity. For these instruments, structural validity and internal consistency were the psychometric properties reported most often. Based on the COSMIN criteria, eight instruments received favourable ratings for internal consistency with respect to methodological quality ('very good'), measurement property ('sufficient') and overall quality of evidence ('moderate'). Ratings of structural validity varied more largely, with three to seven instruments showing at least adequate methodological quality, sufficient structural validity or moderate quality of evidence. CONCLUSIONS Similar to comparable previous reviews, evidence on the psychometric properties of instruments assessing PC in the health care of older adults with multimorbidity was rather limited. Informed by comprehensive models of PC, further research should aim at developing measures of PC that stand out on a broader range of psychometric properties.
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Affiliation(s)
- Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Juergen M Giesler
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Isabella Bablok
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Laura Kivelitz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Schaefer
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Manuela Kanat
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Jil Mohr
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Edith Motschall
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Sebastian Voigt-Radloff
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Thomas Kienbaum
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Joerg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Metzner G, Horstmeier LM, Bengel J, Bitzer EM, Dreher E, Frank F, Göhner A, Heimbach B, Himmelsbach I, Kaier K, Kiekert J, Kohler K, Laubner K, Lyssenko L, Maun A, Maurer C, Salm C, Seufert J, Voigt-Radloff S, Farin-Glattacker E. Local, collaborative, stepped, and personalized care management for older people with chronic diseases - results from the randomized controlled LoChro-trial. BMC Geriatr 2023; 23:92. [PMID: 36782119 PMCID: PMC9924193 DOI: 10.1186/s12877-023-03797-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND In the aging population of Western societies, an increasing number of older adults have multiple chronic diseases. As multifaceted health problems imply the involvement of several healthcare professionals, multimorbid older people frequently face a fragmentation of health care. Addressing these challenges, we developed a local, collaborative, stepped, and personalized care management approach (LoChro-Care) and evaluated its effectiveness. METHODS A two-group, parallel randomized controlled trial was conducted comparing LoChro-Care recipients (IG) to participants with usual care (CG). Patients aged 65 + with chronic conditions were recruited at inpatient and outpatient departments of the Medical Center, University of Freiburg. Participants were allocated using block randomization (nIG = 261, nCG = 263). LoChro-Care comprised individualized care provided by chronic care managers with 7 to 13 contacts over 12 months. Questionnaires were given at 3 time points (T0: baseline, T1: after 12 months, T2: after 18 months). The primary outcome was the physical, psychological, and social health status represented by a composite score of functional health and depressive symptoms. Secondary outcomes were the participants' evaluation of their health care situation, health-related quality of life (HRQL), and life-satisfaction (LS). The data were analyzed using linear mixed modelling. RESULTS We analyzed N = 491 participants (nIG = 244, nCG = 247), aged M = 76.78 years (SD = 6.35). For the composite endpoint, neither a significant difference between IG and CG (p = .88) nor a group-time interaction (p = .52; p = .88) could be observed. Participants in both groups showed a significant decline on the primary outcome between T0 and T2 (p < .001). Post hoc analyses revealed a decline in both functional health (p < .001) and depressive symptoms (p = .02). Both groups did not differ in their evaluation of their health care situation (p = .93), HRQL (p = .44) or LS (p = .32). Relevant confounding variables were female gender and multimorbidity. CONCLUSION Supporting patients' self-management in coordinating their individual care network through LoChro-Care did not result in any significant effect on the primary and secondary outcomes. A decline of functional health and depressive symptoms was observed among all participants. Potential future intervention adaptations are discussed, such as a more active case management through direct referral to (in-)formal support, an earlier treatment initiation, and the consideration of specific sociodemographic factors in care management planning. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00013904 (02.02.2018), https://drks.de/search/de/trial/DRKS00013904.
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Affiliation(s)
- Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Lukas Maximilian Horstmeier
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Eva Maria Bitzer
- University of Education Freiburg, Public Health and Health Education, Kunzenweg 21, 79117, Freiburg, Germany
| | - Elena Dreher
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Fabian Frank
- Department of Social Work, Protestant University of Applied Sciences Freiburg, Bugginger Straße 38, 79114, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 5, 79104, Freiburg, Germany
| | - Anne Göhner
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Bernhard Heimbach
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Ines Himmelsbach
- Catholic University of Applied Sciences Freiburg, Karlstraße 63, 79104, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Zinkmattenstr. 6a, 79108, Freiburg, Germany
| | - Jasmin Kiekert
- Catholic University of Applied Sciences Freiburg, Karlstraße 63, 79104, Freiburg, Germany
| | - Katharina Kohler
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Lisa Lyssenko
- University of Education Freiburg, Public Health and Health Education, Kunzenweg 21, 79117, Freiburg, Germany
| | - Andy Maun
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Elsässer Str. 2m, 79110, Freiburg, Germany
| | - Christoph Maurer
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Claudia Salm
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Elsässer Str. 2m, 79110, Freiburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Sebastian Voigt-Radloff
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.,Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
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Mavragani A, Röttele N, van der Keylen P, Schöpf-Lazzarino AC, Klimmek M, Körner M, Schnitzius K, Voigt-Radloff S, Maun A, Sofroniou M, Farin-Glattacker E. The Acceptance, Usability, and Utility of a Web Portal for Back Pain as Recommended by Primary Care Physicians: Qualitative Interview Study With Patients. JMIR Form Res 2022; 6:e38748. [PMID: 36580365 PMCID: PMC9837709 DOI: 10.2196/38748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/14/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND An ever-increasing number of patients seek health information via the internet. However, there is an overabundance of differing, often low-quality information available, while a lack of health literacy makes it difficult for patients to understand and assess the quality and trustworthiness of the information at hand. The web portal tala-med was thus conceived as an evidence-based, up-to-date, and trustworthy information resource for lower back pain (LBP), which could be used by primary care physicians (PCPs) and patients during and following consultations for LBP. The current evidence demonstrates that patients with LBP could benefit from web portals. However, the use of such portals by patients remains low, thus limiting their effectiveness. Therefore, it is important to explore the factors that promote or hinder the use of web portals and investigate how patients perceive their usability and utility. OBJECTIVE In this study, we investigated the acceptance, usability, and utility of the web portal tala-med from the patient perspective. METHODS This qualitative study was based on telephone interviews with patients who had access to the web portal tala-med from their PCP. We used a semistructured interview guide that consisted of questions about the consultation in which patients were introduced to tala-med, in addition to questions regarding patient perceptions, experiences, and utilization of tala-med. The interviews were recorded, transcribed, and analyzed through framework analysis. RESULTS A total of 32 half-hour interviews were conducted with 16 female and 16 male patients with LBP. We identified 5 themes of interest: the use of tala-med by PCPs during the consultation, the use of tala-med by patients, its usability, added values derived from its use, and the resultant effects of using tala-med. PCPs used tala-med as an additional information resource for their patients and recommended the exercises. The patients appreciated these exercises and were willing to use tala-med at home. We also identified factors that promoted or hindered the use of tala-med by patients. Most patients rated tala-med positively and considered it a clear, comprehensible, trustworthy, and practical resource. In particular, the trustworthiness of tala-med was seen as an advantage over other information resources. The possibilities offered by tala-med to recap and reflect on the contents of consultations in a time-flexible and independent manner was perceived as an added value to the PCP consultation. CONCLUSIONS Tala-med was well accepted by patients and appeared to be well suited to being used as an add-on to PCP consultations. Patient perception also supports its usability and utility. Tala-med may therefore enrich consultations and assist patients who would otherwise be unable to find good-quality web-based health information on LBP. In addition, our findings support the future development of digital health platforms and their successful use as a supplement to PCP consultations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12875-019-0925-8.
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Affiliation(s)
| | - Nicole Röttele
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Piet van der Keylen
- Institute of General Practice, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Christina Schöpf-Lazzarino
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Klimmek
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Schnitzius
- Institute of General Practice, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Andy Maun
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mario Sofroniou
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Struwe C, Golinski M, Grimm C, Dickel S, Grummich K, Nothacker M, Voigt-Radloff S, Meerpohl J, Moerer O. A Comparison and Evaluation of International Guidelines on the Treatment of Severe SARS-CoV-2 Infection. Dtsch Arztebl Int 2022; 119:23-30. [PMID: 34939920 DOI: 10.3238/arztebl.m2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 08/31/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND When the SARS-CoV-2 pandemic began, no uniform treatment and care strategies for critically ill COVID-19 patients were yet available. National and international treatment recommendations were formulated under time pressure, initially on the basis of indirect evidence from the treatment of similar diseases. In this article, we give an overview of the content, currency, and methodological quality of the existing national and international guidelines, with special attention to the care of critically ill patients. METHODS Guidelines were identified by a comprehensive search, the included guidelines were assessed in standardized fashion with the AGREE II guideline assessment instrument and according to the AMWF rulebook criteria, and the core recommendations of the included and methodologically high-quality guidelines were compared. RESULTS Nine of the 97 guidelines that were identified fulfilled the content criteria for inclusion, and 6 of these fulfilled the qualitative criteria; these 6 guidelines still differed, however, in the topics to which they devoted the most attention, as well as in their methodological quality and currency. The treatment strategies for patients with severe respiratory failure (lung-protective ventilation strategies and rescue measures) deviated little from established standards. Uniform recommendations were made, among other things, for the administration of dexamethasone, which was recommended in all of the guidelines for patients requiring oxygen treatment, as well as for antithrombotic drug prophylaxis and for the prone positioning of ventilated patients. Many recommendations were based on insufficient evidence, and some were contradictory, e.g., those regarding antibiotic treatment or the choice between high-flow oxygen administration via nasal canula (HFNC) and noninvasive ventilation (NIV). CONCLUSION The consultation of multiple high-quality international guidelines and guideline recommendations shared in online portals such as MagicApp are helpful sources of information for clinicians. In view of the continuing lack of strong evidence, further research on intensive care treatments is needed (aspects of ventilation, positioning therapy, and the role of extracorporeal membrane oxygenation [ECMO]).
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Kanat M, Schaefer J, Kivelitz L, Dirmaier J, Voigt-Radloff S, Heimbach B, Glattacker M. Patient-centeredness in the multimorbid elderly: a focus group study. BMC Geriatr 2021; 21:567. [PMID: 34663223 PMCID: PMC8522160 DOI: 10.1186/s12877-021-02448-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/01/2021] [Indexed: 04/21/2023] Open
Abstract
Background Patient-centeredness (PC) aims to adapt health care to the individual needs and preferences of patients. An existing integrative model of PC comprises several dimensions of PC which have not yet been investigated from the patients’ perspective. Older patients with multimorbidity represent a target group for patient-centered care, as their care needs are particularly complex and should be addressed individually. We aimed to assess the perspective that older patients with multimorbidity have of patient-centered care and to examine the transferability of the integrative model of PC to this specific population. Method We performed 4 guided focus group interviews with a total of 20 older individuals with multimorbidity. The focus group interviews were audio-recorded and transcribed verbatim. Patients’ statements were content-analyzed applying an a priori designed system of categories that included the dimensions of PC from the integrative model and the additional category ‘prognosis and life expectancy’, which had emerged from an initial literature search on aspects of PC specific to the multimorbid elderly. Results The new category ‘prognosis and life expectancy’ was confirmed and expanded to ‘individual care needs related to aging and chronic disesase’. All dimensions of our integrative PC model were confirmed for older patients with multimorbidity. Among these, we found that eight dimensions (individual care needs related to aging and chronic disease, biopsychosocial perspective, clinician-patient communication, essential characteristics of the clinician, clinician-patient-relationship, involvement of family and friends, coordination and continuity of care, access to care) were complemented by aspects specific to this target population. Conclusions The integrative PC model is applicable to the population of older patients with multimorbidity. For a population-specific adaptation, it might be complemented by the dimension ‘individual care needs in aging and chronic disease’, in conjunction with age-specific aspects within existing dimensions. Together with corresponding results from a Delphi survey, our adapted PC model will serve as the basis for a subsequent systematic review of instruments measuring PC in older patients with multimorbidity. Trial registration PROSPERO (https://www.crd.york.ac.uk/prospero; CRD42018084057; 2018/02/01), German Clinical Trials Register (www.drks.de; DRKS00013309; 2018/01/23). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02448-8.
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Affiliation(s)
- Manuela Kanat
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Jonas Schaefer
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Laura Kivelitz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sebastian Voigt-Radloff
- Center for Geriatric Medicine and Gerontology Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center - University of Freiburg, Breisacher Str. 86, 79110, Freiburg, Germany
| | - Bernhard Heimbach
- Center for Geriatric Medicine and Gerontology Freiburg, Faculty of Medicine and Medical Center - University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
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Kivelitz L, Schäfer J, Kanat M, Mohr J, Glattacker M, Voigt-Radloff S, Dirmaier J. Patient-Centeredness in Older Adults With Multimorbidity: Results of an Online Expert Delphi Study. Gerontologist 2021; 61:1008-1018. [PMID: 33388770 DOI: 10.1093/geront/gnaa223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults suffering from multimorbidity represent a priority target group for patient-centeredness (PC). We aimed to investigate the transferability of an existing integrated model of PC comprising 15 dimensions on the care of older adults with multimorbidity from an expert perspective. RESEARCH DESIGN AND METHODS A total of 242 experts were invited to participate in a 2-round online Delphi study. In round 1, they were asked to (a) individually rate relevance and clarity of the dimensions, (b) add missing dimensions, and (c) prioritize the dimensions. In round 2, experts received results of round 1 and were asked to rerate their ratings. RESULTS Forty-eight experts participated in round 1 and 39 in round 2. Ten dimensions were rated as sufficiently relevant and clear, including one new dimension ("prognosis and life expectancy, burden of treatment"). Four dimensions were rated as relevant but insufficiently clear. One dimension failed to reach our validation threshold on both criteria. The 5 dimensions rated as most important were: "patient as a unique person," "clinician-patient communication," "patient involvement in care," "physical, cognitive, and emotional support," and "involvement of family and friends." DISCUSSION AND IMPLICATIONS The experts' ratings were higher regarding relevance than regarding clarity, which emphasizes the still existing conceptual uncertainty of PC. Our results give further directions regarding the operationalization of PC in older adults with multimorbidity, which is essential for its implementation in routine care. Further refined using focus groups with geriatric patients, our adapted model serves as a basis for a systematic review of assessment instruments.
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Affiliation(s)
- Laura Kivelitz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Jonas Schäfer
- Section of Health Care Research and Rehabilitation Research, Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Faculty of Medicine, Germany
| | - Manuela Kanat
- Section of Health Care Research and Rehabilitation Research, Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Faculty of Medicine, Germany
| | - Jil Mohr
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Faculty of Medicine, Germany
| | - Sebastian Voigt-Radloff
- Center for Geriatric Medicine and Gerontology Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, Germany.,Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, University of Freiburg, Faculty of Medicine, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
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9
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Wollmann K, der Keylen PV, Tomandl J, Meerpohl JJ, Sofroniou M, Maun A, Voigt-Radloff S. The information needs of internet users and their requirements for online health information-A scoping review of qualitative and quantitative studies. Patient Educ Couns 2021; 104:1904-1932. [PMID: 33563502 DOI: 10.1016/j.pec.2021.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/05/2021] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This scoping review has been conducted to summarise the information needs of internet users and their requirements for online health information. METHODS We searched MEDLINE, Web of Science and Scopus up to July 2019. Qualitative, quantitative and mixed-method studies were included and a thematic synthesis with category formation and exact description of the items was carried out. RESULTS 118 studies were included. To address all users' needs mentioned in the included studies, we grouped them into nine main categories: authority, comprehension, currency, evidence-based information, exchange with others, independence, purpose, services, user experience. The evaluation showed that website users wanted qualifications of authors to be cited. Users preferred health information that offered interactive elements and resources for relatives, whilst also providing an opportunity for online contact with others. The ease with which information was accessed and the intelligibility of texts were regarded as being very important to users. CONCLUSION Given the rapid evolvement and changes of online health information, it is crucial to provide up to date insights and a comprehensive overview of the range of criteria. PRACTICE IMPLICATIONS With the results obtained through this scoping review, the creators of online health information could be assisted in providing user-specific resources.
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Affiliation(s)
- Katharina Wollmann
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
| | - Piet van der Keylen
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany.
| | - Johanna Tomandl
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany.
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
| | - Mario Sofroniou
- Institute for General Practice/Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Andy Maun
- Institute for General Practice/Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center - University of Freiburg, Germany.
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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10
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Dickel S, Grimm C, Popp M, Struwe C, Sachkova A, Golinski M, Seeber C, Fichtner F, Heise D, Kranke P, Meissner W, Laudi S, Voigt-Radloff S, Meerpohl J, Moerer O. A Nationwide Cross-Sectional Online Survey on the Treatment of COVID-19-ARDS: High Variance in Standard of Care in German ICUs. J Clin Med 2021; 10:3363. [PMID: 34362146 PMCID: PMC8347152 DOI: 10.3390/jcm10153363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Coronavirus disease (COVID-19) has recently dominated scientific literature. Incomplete understanding and a lack of data concerning the pathophysiology, epidemiology, and optimal treatment of the disease has resulted in conflicting recommendations. Adherence to existing guidelines and actual treatment strategies have thus far not been studied systematically. We hypothesized that capturing the variance in care would lead to the discovery of aspects that need further research and-in case of proven benefits of interventions not being performed-better communication to care providers. METHODS This article is based on a quantitative and qualitative cross-sectional mixed-methods online survey among intensive-care physicians in Germany during the COVID-19 pandemic by the CEOsys (COVID-19 Evidence Ecosystem) network, endorsed by the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) conducted from December 3 to 31 December 2020. RESULTS We identified several areas of care with an especially high variance in treatment among hospitals in Germany. Crucially, 51.5% of the participating ICUs (n = 205) reported using intubation as a last resort for respiratory failure in COVID-19 patients, while 21.8% used intubation early after admission. Furthermore, 11.5% considered extracorporeal membrane oxygenation (ECMO) in awake patients. Finally, 72.3% of respondents used the ARDS-network-table to titrate positive end-expiratory-pressure (PEEP) levels, with 36.9% choosing the low-PEEP table and 41.8% the high-PEEP table. CONCLUSIONS We found that significant differences exist between reported treatment strategies and that adherence to published guidelines is variable. We describe necessary steps for future research based on our results highlighting significant clinical variability in care.
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Affiliation(s)
- Steffen Dickel
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, 37085 Göttingen, Germany; (S.D.); (C.G.); (C.S.); (A.S.); (M.G.); (D.H.)
| | - Clemens Grimm
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, 37085 Göttingen, Germany; (S.D.); (C.G.); (C.S.); (A.S.); (M.G.); (D.H.)
| | - Maria Popp
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (M.P.); (P.K.)
| | - Claudia Struwe
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, 37085 Göttingen, Germany; (S.D.); (C.G.); (C.S.); (A.S.); (M.G.); (D.H.)
| | - Alexandra Sachkova
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, 37085 Göttingen, Germany; (S.D.); (C.G.); (C.S.); (A.S.); (M.G.); (D.H.)
| | - Martin Golinski
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, 37085 Göttingen, Germany; (S.D.); (C.G.); (C.S.); (A.S.); (M.G.); (D.H.)
| | - Christian Seeber
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Leipzig, 04103 Leipzig, Germany; (C.S.); (F.F.); (S.L.)
| | - Falk Fichtner
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Leipzig, 04103 Leipzig, Germany; (C.S.); (F.F.); (S.L.)
| | - Daniel Heise
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, 37085 Göttingen, Germany; (S.D.); (C.G.); (C.S.); (A.S.); (M.G.); (D.H.)
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (M.P.); (P.K.)
| | - Winfried Meissner
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Jena, 07743 Jena, Germany;
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Leipzig, 04103 Leipzig, Germany; (C.S.); (F.F.); (S.L.)
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany; (S.V.-R.); (J.M.)
| | - Joerg Meerpohl
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany; (S.V.-R.); (J.M.)
- Cochrane Germany, Cochrane Germany Foundation, 79110 Freiburg, Germany
| | - Onnen Moerer
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, 37085 Göttingen, Germany; (S.D.); (C.G.); (C.S.); (A.S.); (M.G.); (D.H.)
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11
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Seibert M, Mühlbauer V, Holbrook J, Voigt-Radloff S, Brefka S, Dallmeier D, Denkinger M, Schönfeldt-Lecuona C, Klöppel S, von Arnim CAF. Efficacy and safety of pharmacotherapy for Alzheimer's disease and for behavioural and psychological symptoms of dementia in older patients with moderate and severe functional impairments: a systematic review of controlled trials. Alzheimers Res Ther 2021; 13:131. [PMID: 34271969 PMCID: PMC8285815 DOI: 10.1186/s13195-021-00867-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Many patients with Alzheimer's disease (AD) are physically frail or have substantial functional impairments. There is growing evidence that such patients are at higher risk for medication-induced adverse events. Furthermore, frailty seems to be more predictive of poor clinical outcomes than chronological age alone. To our knowledge, no systematic review of clinical trials examining drug therapy of AD or behavioural and psychological symptoms of dementia (BPSD) has specifically focused on the topic of physical frailty. Our objective was to evaluate the efficacy and safety of pharmacotherapy in AD patients with frailty or significant functional impairments. METHODS We performed a systematic literature search in MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) of drug therapy of AD and BPSD in patients with significant functional impairments according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Cochrane research criteria. Significant functionally impaired patient populations were identified using the recommendations of the Medication and Quality of Life in frail older persons (MedQoL) Research Group. Screening, selection of studies, data extraction and risk of bias assessment were performed independently by two reviewers. Outcomes including functional status, cognitive function, changes in BPSD symptoms, clinical global impression and quality of life were analysed. For assessing harm, we assessed adverse events, drop-outs as a proxy for treatment tolerability and death. Results were analysed according to Cochrane standards and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Of 45,045 search results, 38,447 abstracts and 187 full texts were screened, and finally, 10 RCTs were included in the systematic review. Selected articles evaluated pharmacotherapy with acetylcholinesterase-inhibitors (AChEI), anticonvulsants, antidepressants and antipsychotics. Studies of AChEIs suggested that patients with significant functional impairments had slight but significant improvements in cognition and that AChEIs were generally well tolerated. Studies of antidepressants did not show significant improvements in depressive symptoms. Antipsychotics and anticonvulsants showed small effects on some BPSD items but also higher rates of adverse events. However, due to the very small number of identified trials, the quality of evidence for all outcomes was low to very low. Overall, the small number of eligible studies demonstrates that significantly functional impaired older patients have not been adequately taken into consideration in most clinical trials investigating drug therapy of AD and BPSD. CONCLUSION Due to lack of evidence, it is not possible to give specific recommendations for drug therapy of AD and BSPD in frail older patients or older patients with significant functional impairments. Therefore, clinical trials focussing on frail older adults are urgently required. A standardized approach to physical frailty in future clinical studies is highly desirable.
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Affiliation(s)
- M Seibert
- Department of Neurology, University Clinic Ulm, Ulm, Germany
| | - V Mühlbauer
- Agaplesion Bethesda Clinic, Institute for Geriatric Research, Ulm University, Ulm, Germany
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - J Holbrook
- Department of Neurology, University Clinic Ulm, Ulm, Germany
| | - S Voigt-Radloff
- Center for Geriatric Medicine and Gerontology, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - S Brefka
- Agaplesion Bethesda Clinic, Institute for Geriatric Research, Ulm University, Ulm, Germany
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - D Dallmeier
- Agaplesion Bethesda Clinic, Institute for Geriatric Research, Ulm University, Ulm, Germany
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - M Denkinger
- Agaplesion Bethesda Clinic, Institute for Geriatric Research, Ulm University, Ulm, Germany
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - C Schönfeldt-Lecuona
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Ulm, Germany
| | - S Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - C A F von Arnim
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany.
- Division of Geriatrics, University Medical Centre, Georg August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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12
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Grimm C, Dickel S, Sachkova A, Popp M, Golinksi M, Fichtner F, Kranke P, Seeber C, Laudi S, Voigt-Radloff S, Moerer O. Targeted Minimal Staff-to-Patient Ratios Are Unachievable - A Nationwide Survey in German ICUs During the COVID-19 Pandemic. Cureus 2021; 13:e15755. [PMID: 34290932 PMCID: PMC8289403 DOI: 10.7759/cureus.15755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Adequate staffing in the intensive care units (ICUs) is the most important factor to provide optimal care and ensure favorable outcomes in critically ill patients. Recently, the need for ICU beds has reached unprecedented levels and the management and treatment of critically ill patients has been in focus. The aim of the study was to assess the targeted and actual nurse-to-patient (NPR) and physician-to-patient ratios (PPR) regarding patients with and without COVID-19. Methods We conducted a nationwide online survey assessing the standard of care in German ICUs treating patients with COVID-19. We asked questions regarding targeted PPR and NPR and their implementation in daily clinical practice to heads of German ICU departments. Results We received 244 responses of which 171 were eligible for final analysis. Targeted median PPR ratio was 8 [interquartile range (IQR) = 4] and targeted NPR was 2 (IQR = 1). For COVID-19 patients, the median targeted PPR was 6 (IQR = 2) and the median targeted NPR was 2 (IQR = 0). Targeted PPRs were rarely met by 15.2% and never met by 3.5% of responding institutions. Targeted NPRs were rarely met in 32.2% and never in 5.3% of responding institutions. Conclusion In contrast to PPR, targeted NPRs were largely unattainable in German ICUs. Our results raise concern in view of studies linking worse outcomes in critically ill patients to suboptimal NPRs. This warrants further health policy efforts regarding optimal staffing in the ICU.
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Affiliation(s)
- Clemens Grimm
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, DEU
| | - Steffen Dickel
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, DEU
| | - Alexandra Sachkova
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, DEU
| | - Maria Popp
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, DEU
| | - Martin Golinksi
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, DEU
| | - Falk Fichtner
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Leipzig, Leipzig, DEU
| | - Peter Kranke
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, DEU
| | - Christian Seeber
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Leipzig, Leipzig, DEU
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Leipzig, Leipzig, DEU
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, DEU
| | - Onnen Moerer
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, DEU
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13
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Dickel S, Grimm C, Popp M, Struwe C, Sachkova A, Golinski M, Seeber C, Fichtner F, Heise D, Kranke P, Meissner W, Laudi S, Voigt-Radloff S, Meerpohl JJ, Jabs J, Mutters NT, Moerer O. Infection control, prophylactic antibiotics, and testing for SARS-CoV-2 and PPE on German intensive care units: results from a national mixed methods survey. GMS Hyg Infect Control 2021; 16:Doc21. [PMID: 34194922 PMCID: PMC8204667 DOI: 10.3205/dgkh000392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aim: Recommendations on hygiene measures, personal protective equipment (PPE), isolation, and antibiotic prophylaxis were developed during the coronavirus 2019 disease (COVID-19) pandemic and have been revised several times to date. Some of the underlying literature indicates a large evidence gap. We suspect that this leads to a large variance of measures on German intensive care units (ICU). Methods: A mixed methods online survey among intensive-care specialists in Germany caring for COVID-19 patients was conducted in December 2020. Results: We received responses from 205 German ICUs that had treated COVID-19 patients to date. There was wide variation in the use of PPE. Polymerase Chain reaction (PCR) testing for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) was used by 94.8% of the units, with an average waiting time of 12 hours for the result. 18.7% of the respondents prescribed antibiotic prophylaxis in COVID-19 patients. Conclusion: We found a high variance in essential care strategies for COVID-19 patients on German intensive care units. This included differences in infection prophylaxis, personal protective equipment, and the indication of prophylactic antibiotic therapy. Based on our results, we recommend further studies to quantify and improve guideline adherence.
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Affiliation(s)
- Steffen Dickel
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Clemens Grimm
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Maria Popp
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Claudia Struwe
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Alexandra Sachkova
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Golinski
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Christian Seeber
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Leipzig, Leipzig, Germany
| | - Falk Fichtner
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Leipzig, Leipzig, Germany
| | - Daniel Heise
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Winfried Meissner
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Jena, Jena, Germany
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Leipzig, Leipzig, Germany
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Jonas Jabs
- University Hospital Bonn, Institute for Hygiene and Public Health, Bonn, Germany
| | - Nico T. Mutters
- University Hospital Bonn, Institute for Hygiene and Public Health, Bonn, Germany
| | - Onnen Moerer
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
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Röttele N, Schlett C, Körner M, Farin-Glattacker E, Schöpf-Lazzarino AC, Voigt-Radloff S, Wirtz MA. Variance components of ratings of physician-patient communication: A generalizability theory analysis. PLoS One 2021; 16:e0252968. [PMID: 34111197 PMCID: PMC8191893 DOI: 10.1371/journal.pone.0252968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background The ratings of physician-patient communication are an important indicator of the quality of health care delivery and provide guidance for many important decisions in the health care setting and in health research. But there is no gold standard to assess physician-patient communication. Thus, depending on the specific measurement condition, multiple sources of variance may contribute to the total score variance of ratings of physician-patient communication. This may systematically impair the validity of conclusions drawn from rating data. Objective To examine the extent to which different measurement conditions and rater perspectives, respectively contribute to the variance of physician-patient communication ratings. Methods Variance components of ratings of physician-patient communication gained from 32 general practitioners and 252 patients from 25 family practices in Germany were analyzed using generalizability theory. The communication dimensions “shared decision making”, “effective and open communication” and “satisfaction” were considered. Results Physician-patient communication ratings most substantially reflect unique rater-perspective and communication dimension combinations (32.7% interaction effect). The ratings also represented unique physician and rater-perspective combinations (16.3% interaction effect). However, physicians’ communication behavior and the observed communication dimensions revealed only a low extent of score variance (1% physician effect; 3.7% communication dimension effect). Approximately half of the variance remained unexplained (46.2% three-way interaction, confounded with error). Conclusion The ratings of physician-patient communication minimally reflect physician communication skills in general. Instead, these ratings exhibit primarily differences among physicians and patients in their tendency to perceive shared decision making and effective and open communication and to be satisfied with communication, regardless of the communication behavior of physicians. Rater training and assessing low inferential ratings of physician-patient communication dimensions should be considered when subjective aspects of rater perspectives are not of interest.
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Affiliation(s)
- Nicole Röttele
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Christian Schlett
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea C. Schöpf-Lazzarino
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Markus A. Wirtz
- Department of Research Methods, Freiburg University of Education, Freiburg, Germany
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15
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Kienle GS, Werthmann P, Grotejohann B, Hundhammer T, Schmoor C, Stumpe C, Voigt-Radloff S, Huber R. Addressing COVID-19 challenges in a randomised controlled trial on exercise interventions in a high-risk population. BMC Geriatr 2021; 21:287. [PMID: 33933014 PMCID: PMC8087880 DOI: 10.1186/s12877-021-02232-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/19/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is a threat to ongoing clinical trials necessitating regular face-to-face, in-person meetings, particularly in participants with a high risk of complications. Guidance on how to handle and safely continue such trials is lacking. Chronically ill elderly individuals require-in addition to protection from infection-regular physical exercise and social contact to remain healthy. Solutions on how to handle these conflicting necessities are needed. The ENTAIER-randomised controlled trial was investigating the influence of mindful movements on fall risk, fear of falling, mobility, balance, life quality, and other outcomes. The study population was planned to comprise of 550 chronically ill elderly individuals with a high risk of falling. The movements were regularly performed in coached groups over 6 months. After the trial began, COVID-19 lockdowns stopped all in-person meetings, and it was expected that the limitations of this pandemic would continue for a long term. Therefore, the exercise programme, which involved complex movements and was typically conducted face-to-face in groups, had to be substituted by a telemedicine programme within a short timeframe. The objectives, therefore, were to identify challenges and tasks that could to be resolved and steps that could to be taken to achieve high-quality, efficacy, safety, and enable human encounter and motivation. METHODS We proceeded with four steps: 1) A literature review on the quality and feasibility issues of telemedicine in general, and specifically, in exercise training in elderly individuals. 2) Participation in two international telemedicine task forces on integrative medicine, particularly, mind-body medicine. 3) Interviews with study therapists, (for practical purposes, eurythmy therapists and Tai Chi teachers are summarized here as therapists) personnel, and international experts on providing mindful movement exercises and other physiotherapies via live telecommunication technology, and with scientists and patient representatives. 4) Final evaluation by the core trial team and subsequent planning and implementation of changes in the trial organisation. RESULTS Various tasks and challenges were identified: for the technical equipment for therapists and patients; for the ability of therapists and trial participants to adequately manage the technology and telemedicine intervention; the reservations and concerns about the technology among therapists and participants; safety and data protection in using the technology; and study design. The two major options found on how to continue the trial in the COVID-19 situation were a complete switch to telemedicine and a partial switch in the form of risk management implemented into the former design. CONCLUSIONS The management of an ongoing clinical trial in a national or international crisis with a minimum of available time and extra financial resources, alongside with two checklists on steps and procedures for trial continuation and telemedicine implementation, may be informative for other researchers or healthcare providers faced with similar challenges and making similar decisions in the current situation or similar future scenarios. TRAIL REGISTRATION: www.drks.de . DRKS00016609. Registered July 30, 2019.
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Affiliation(s)
- G S Kienle
- Centre for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- IFAEMM at the University of Witten/Herdecke, Freiburg, Germany.
| | - P Werthmann
- Centre for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- IFAEMM at the University of Witten/Herdecke, Freiburg, Germany
| | - B Grotejohann
- Clinical Trials Unit, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - C Schmoor
- Clinical Trials Unit, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ch Stumpe
- Shen Men Institute, Institute for Qigong, Taiji, Acupressure & Traditional Chinese Medicine (TCM), Düsseldorf, Germany
| | - S Voigt-Radloff
- Centre for Geriatric Medicine and Gerontology Freiburg, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Huber
- Centre for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Lenouvel E, Novak L, Wirth T, Denkinger M, Dallmeier D, Voigt-Radloff S, Klöppel S. Cognitive behavioural interventions for reducing fear of falling in older people living in the community. Hippokratia 2021. [DOI: 10.1002/14651858.cd014666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Eric Lenouvel
- Department of Old Age Psychiatry and Psychotherapy; University Hospital of Psychiatry, Bern (UPD, Bern); Bern Switzerland
- Graduate School for Health Science; University of Bern; Bern Switzerland
| | - Lan Novak
- Department of Old Age Psychiatry and Psychotherapy; University Hospital of Psychiatry, Bern (UPD, Bern); Bern Switzerland
| | - Thomas Wirth
- University Hospital for Psychiatry and Psychotherapy; University Hospital of Psychiatry, Bern (UPD, Bern); Bern Switzerland
| | - Michael Denkinger
- Geriatric Research Institute; University of Ulm; Ulm Germany
- AGAPLESION Bethesda Clinic Ulm; Geriatric Centre Ulm/Alb-Donau; Ulm Germany
| | - Dhayana Dallmeier
- Geriatric Research Institute; University of Ulm; Ulm Germany
- AGAPLESION Bethesda Clinic Ulm; Geriatric Centre Ulm/Alb-Donau; Ulm Germany
- Department of Epidemiology; Boston University School of Public Health; Boston USA
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; Freiburg Germany
| | - Stefan Klöppel
- Department of Old Age Psychiatry and Psychotherapy; University Hospital of Psychiatry, Bern (UPD, Bern); Bern Switzerland
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17
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van der Keylen P, Tomandl J, Wollmann K, Möhler R, Sofroniou M, Maun A, Voigt-Radloff S, Frank L. The Online Health Information Needs of Family Physicians: Systematic Review of Qualitative and Quantitative Studies. J Med Internet Res 2020; 22:e18816. [PMID: 33377874 PMCID: PMC7806443 DOI: 10.2196/18816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/20/2020] [Accepted: 11/11/2020] [Indexed: 01/27/2023] Open
Abstract
Background Digitalization and the increasing availability of online information have changed the way in which information is searched for and retrieved by the public and by health professionals. The technical developments in the last two decades have transformed the methods of information retrieval. Although systematic evidence exists on the general information needs of specialists, and in particular, family physicians (FPs), there have been no recent systematic reviews to specifically address the needs of FPs and any barriers that may exist to accessing online health information. Objective This review aims to provide an up-to-date perspective on the needs of FPs in searching, retrieving, and using online information. Methods This systematic review of qualitative and quantitative studies searched a multitude of databases spanning the years 2000 to 2020 (search date January 2020). Studies that analyzed the online information needs of FPs, any barriers to the accessibility of information, and their information-seeking behaviors were included. Two researchers independently scrutinized titles and abstracts, analyzing full-text papers for their eligibility, the studies therein, and the data obtained from them. Results The initial search yielded 4541 studies for initial title and abstract screening. Of the 144 studies that were found to be eligible for full-text screening, 41 were finally included. A total of 20 themes were developed and summarized into 5 main categories: individual needs of FPs before the search; access needs, including factors that would facilitate or hinder information retrieval; quality needs of the information to hand; utilization needs of the information available; and implication needs for everyday practice. Conclusions This review suggests that searching, accessing, and using online information, as well as any pre-existing needs, barriers, or demands, should not be perceived as separate entities but rather be regarded as a sequential process. Apart from accessing information and evaluating its quality, FPs expressed concerns regarding the applicability of this information to their everyday practice and its subsequent relevance to patient care. Future online information resources should cater to the needs of the primary care setting and seek to address the way in which such resources may be adapted to these specific requirements.
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Affiliation(s)
- Piet van der Keylen
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of General Practice, University Hospital Erlangen, Erlangen, Germany
| | - Johanna Tomandl
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of General Practice, University Hospital Erlangen, Erlangen, Germany
| | - Katharina Wollmann
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Cochrane Germany Foundation, Freiburg, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Heinrich-Heine-University Düsseldorf, Center for Health and Society, Faculty of Medicine, Düsseldorf, Germany
| | - Mario Sofroniou
- Division of General Practice, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andy Maun
- Division of General Practice, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Luca Frank
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of General Practice, University Hospital Erlangen, Erlangen, Germany
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18
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Bollig C, Torbahn G, Bauer J, Brefka S, Dallmeier D, Denkinger M, Eidam A, Klöppel S, Zeyfang A, Voigt-Radloff S. Evidence gap on antihyperglycemic pharmacotherapy in frail older adults : A systematic review. Z Gerontol Geriatr 2020; 54:278-284. [PMID: 32303827 PMCID: PMC8096761 DOI: 10.1007/s00391-020-01724-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
Background Although antihyperglycemic pharmacotherapy in frail older adults with type 2 diabetes mellitus (T2DM) is challenging, recommendations from international guidelines are mainly based on indirect evidence from trials not including frail participants. Objective This systematic review investigated the effectiveness and safety of pharmacotherapy in frail older adults with T2DM. Material and methods Randomized (RCT) and non-randomized prospective clinical trials (non-RCT) were searched in three electronic databases (Medline, Embase, Central) up to October 2018. Trials in older adults with T2DM who were assessed as significantly or severely impaired by defined cut-off scores of assessment instruments on frailty, activities of daily living or physical functional impairment were included. Results Two reviewers independently screened 17,391 references for inclusion and assessed risk of bias with ROBINS‑I. Five non-RCTs and no RCT were identified. Treatment of T2DM without insulin compared to insulin could be associated with increased improvement in cardiac functions in patients with cardiac resynchronization therapy and with decreased falls in frail older women. While better glycemic control with low variability and low HbA1c (hemoglobin A1c) values (<7%) was associated with better maintenance of physical function in community-dwelling older persons, higher HbA1c values (8–8.9%) were associated with a reduction in the composite outcome of death or functional decline in community-dwelling diabetic older adults with need for skilled assistance. Due to serious risk of bias in all studies, results should be considered with caution. Conclusion Well-designed, large-scale RCTs including this important group of patients are required to assess the effectiveness and safety of pharmacotherapy and HbA1c targets. Electronic supplementary material The online version of this article (10.1007/s00391-020-01724-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia Bollig
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany. .,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
| | - Gabriel Torbahn
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.,Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Jürgen Bauer
- Center for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Simone Brefka
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany
| | - Michael Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany
| | - Annette Eidam
- Center for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrej Zeyfang
- Department of Epidemiology, University of Ulm, Ulm, Germany
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany. .,Center for Geriatric Medicine and Gerontology Freiburg, Medical Center Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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19
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Kienle GS, Werthmann PG, Grotejohann B, Kaier K, Steinbrenner I, Voigt-Radloff S, Huber R. A multi-centre, parallel-group, randomised controlled trial to assess the efficacy and safety of eurythmy therapy and tai chi in comparison with standard care in chronically ill elderly patients with increased risk of falling (ENTAiER): a trial protocol. BMC Geriatr 2020; 20:108. [PMID: 32183768 PMCID: PMC7076928 DOI: 10.1186/s12877-020-1503-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In elderly poeple, multimorbidity and polypharmacy increase while sensory, motor and cognitive functions decrease. Falls occur in 30% of people aged 65 years and older at least once per year, with injuries at 10-20%. Reducing falls and enhancing physical, emotional and cognitive capacities are essential for healthy aging despite chronic disease. Eurythmy therapy (EYT) and Tai Chi train balance, mobility and concentrative and sensory capacities. METHODS In eight trial sites (academic or community hospitals), 550 outpatients aged 65 years and older with chronic disease and increased risk of falling (history of imbalance, Berg Balance Scale (BBS) score ≤ 49) will be randomly assigned (1:1:1) to receive either EYT or Tai Chi (each provided in one-hour group sessions, twice, later once per week plus practice at home, for over 24 weeks) added to standard care or standard care alone. Standard care includes a detailed written recommendation on fall prevention and the visit of a primary care doctor. Seniors living a reclusive life or economically disadvantaged elderly will be particularly addressed. A motivation and communication concept supports the trial participants' compliance with trial procedures and practicing. Public and patient representatives are involved in the planning and conduction of the trial. Falls will be documented daily in a diary by the participants. These falls as well as injuries and complications will be ascertained during monthly phone visits. The falls efficacy scale, BBS, cognition (MoCA), Mood (GDS-15), quality of life (SF12), instrumental activities of daily living (IADL), use of medical and non-medical services (FIMA) and adherence will be assessed at months 3, 6, and 12 and inner correspondence with practices (ICPH) at month 6. The trial is funded by the Federal Ministry of Education and Research (BMBF 01GL1805). DISCUSSION This study will determine whether EYT and Tai Chi reduce falls, injurious falls, fear of falling and healthcare utilisation and improve mobility, cognition, mood, quality of life and functional independence. A reduction of fall risk and fear of falling and an improvement of mobility, autonomy, quality of life, mood, and cognition are highly relevant for older people to cope with aging and diseases and to reduce healthcare costs. TRAIL REGISTRATION: www.drks.de. DRKS00016609. Registered 30th July 2019.
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Affiliation(s)
- G S Kienle
- Center for Complementary Medicine; Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- IFAEMM at the University of Witten/Herdecke, Freiburg, Germany.
| | - P G Werthmann
- Center for Complementary Medicine; Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- IFAEMM at the University of Witten/Herdecke, Freiburg, Germany
| | - B Grotejohann
- Clinical Trials Unit, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - K Kaier
- Institute of Medical Biometry and Statistics, Division Methods in Clinical Epidemiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - I Steinbrenner
- Clinical Trials Unit, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Voigt-Radloff
- Center for Geriatric Medicine and Gerontology Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Huber
- Center for Complementary Medicine; Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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20
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Braun C, Voigt-Radloff S. [Treatment of non-specific low back pain: Evidence map of systematic reviews from 2015 to 2019]. Z Evid Fortbild Qual Gesundhwes 2020; 149:12-21. [PMID: 32151527 DOI: 10.1016/j.zefq.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Low back pain represents a major healthcare challenge in Germany and worldwide. The research field is highly dynamic. The aim of this evidence map was to create a compact overview of current systematic reviews on interventions for non-specific low back pain. METHODS Medline (PubMed), the Cochrane Database of Systematic Reviews and Epistemonikos were systematically searched from March 2015 to March 2019 for systematic reviews addressing any interventions for acute, subacute or chronic non-specific low back pain and reporting at least one patient-relevant outcome. Key information on the characteristics and conclusions of the included reviews were extracted and aspects of the methodological quality of the included reviews were assessed independently by two reviewers. The data were tabulated. RESULTS The search identified 1,436 records. 53 systematic reviews were included in the evidence map. The quality of the reviews and of the studies included therein varied. The reviews addressed a variety of different interventions, with considerable heterogeneity of their characteristics and methodological aspects. Many reviews found evidence for positive effects of the studied interventions, some found evidence for no effect, but the quantity and quality of the evidence were often judged as insufficient for formulating robust conclusions. Relatively few data were available on adverse events. CONCLUSION This evidence map provides a compact resource for the use of current systematic reviews on interventions for non-specific low back pain. The methodological deficits of many reviews require a careful approach towards their findings and conclusions and suggest a need for methodologically rigorous reviews.
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Affiliation(s)
- Cordula Braun
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland.
| | - Sebastian Voigt-Radloff
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
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21
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Heupel-Reuter M, Maurer C, Becker C, Bauer J, Voigt-Radloff S. [Exercises and multimodal interventions for prevention of falls in independently living older people]. Z Gerontol Geriatr 2020; 52:694-700. [PMID: 31478075 DOI: 10.1007/s00391-019-01604-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Miriam Heupel-Reuter
- Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Breisacher Str. 153, 79110, Freiburg, Deutschland
| | - Christoph Maurer
- Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Clemens Becker
- Abteilung für Geriatrie und Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Stuttgart, Deutschland
| | - Jürgen Bauer
- Geriatrisches Zentrum, Universität Heidelberg, Heidelberg, Deutschland
| | - Sebastian Voigt-Radloff
- Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Breisacher Str. 153, 79110, Freiburg, Deutschland.
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
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Glattacker M, Kanat M, Schaefer J, Motschall E, Kivelitz L, Voigt-Radloff S, Dirmaier J. Availability and Quality of Assessment Instruments on Patient-Centredness in the Multimorbid Elderly (AQuA-PCE): a study protocol of a systematic review. BMJ Open 2020; 10:e033273. [PMID: 32029488 PMCID: PMC7044947 DOI: 10.1136/bmjopen-2019-033273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/18/2019] [Accepted: 01/06/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Elderly, multimorbid patients are a primary target group for patient-centred care, and fostering patient-centredness (PC) in this group has been associated with different healthcare aims such as safety and quality of healthcare. However, evidence on effects of patient-centred interventions is still limited and mixed. In part, the lack of consistent evidence has its roots in a conceptual uncertainty of the term 'PC', which also hampers the development of assessment tools for PC. Consequently, reviews on assessment instruments of PC reveal problems regarding the quality of identified assessment instruments and regarding their comparability. Some of these reviews focus on the elderly. However, while the concept of multimorbidity is partly inherent, this focus is not explicit in any of the reviews.The aim of this systematic review is to identify assessment instruments of PC in the multimorbid elderly, using a subgroup-specific definition of PC ('subgroup-specific integrative model of PC') as the conceptual underpinning, and to provide a critical quality appraisal of their psychometric properties. METHODS AND ANALYSIS A comprehensive systematic literature search for assessment tools on PC will be conducted in the MEDLINE, CINAHL, EMBASE, PsycINFO, Web of Science and PSYNDEX electronic databases. The search strategy will be informed by the subgroup-specific integrative model of PC. The electronic literature search will be complemented by a hand-search combining citation tracking, search in project databases, and contacting authors from relevant studies/reviews. The literature search (systematic and hand-search) will cover the period from November, 2018 to December 2019.The retrieval of relevant studies will be conducted via title screening, abstract screening, and full-text eligibility assessment applying defined inclusion criteria. Full texts will be independently assessed by two team members. Data from the included articles will be extracted using a standardised extraction form and evaluated based on the COSMIN methodology for systematic reviews of patient-reported outcome measures, which focuses on the methodological quality of included studies as well as on the measurement properties of the assessment instruments. Data extraction and quality assessment will be conducted by two independent reviewers. ETHICS AND DISSEMINATION The study has received approval from the Ethics Committee of the University of Freiburg (reference number 587/17). The results of the project will be disseminated via scientific oral presentations at national and international conferences and will be published in scientific journals. TRIAL REGISTRATION NUMBERS CRD42018084057; DRKS00013309.
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Affiliation(s)
- Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Manuela Kanat
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Jonas Schaefer
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Edith Motschall
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Laura Kivelitz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Voigt-Radloff
- Center for Geriatric Medicine and Gerontology Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Joerg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Müller C, Lautenschläger S, Dörge C, Voigt-Radloff S. A feasibility study of a home-based lifestyle-integrated physical exercise training and home modification for community-living older people (Part 2): the FIT-at-Home fall prevention program. Disabil Rehabil 2019; 43:1380-1390. [PMID: 31868030 DOI: 10.1080/09638288.2019.1700564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was conducted in a home-based context where trained occupational therapists delivered progressive physical exercise training and home modification intervention for preventing falls, namely the FIT-at-Home intervention. We assessed the feasibility of the intervention's content and mode of delivery from the occupational therapists' perspective as well as the feasibility of study procedures. METHODS We used a mixed-methods approach, which generated qualitative data from 14 OTs' after delivering the intervention via interviews and quantitative data of the study procedures via questionnaires and documentation sheets. RESULTS In total, 16 of the 17 older people completed the intervention. Of 9 recorded falls, no serious physical problems occurred. Qualitative data suggested that the intervention content and mode was feasible. Only minor adaptations to the program are needed based on the users' feedback. The main benefit was seen in the fact that simple exercises can be integrated into everyday life for older people with restricted mobility. CONCLUSION The FIT-at-Home intervention comprising lifestyle-integrated balance and strength exercises and home safety is feasible for occupational therapists to deliver. The findings will help to further refine the intervention and study procedures.Implications for rehabilitationFalling is a frequent and serious health problem for many community-living older people, and the incidence of injurious falls increases with advancing age.Home visiting programs comprising physical exercise training and home modification appear to be beneficial for older people with poor health, functional limitations, and limited mobility.This study indicates that it is feasible to introduce lifestyle-integrated balance and strength exercises, performed as part of daily routine for older people at risk of falling.Behavioural self-management strategies have the potential to improve the implementation of exercises during the course of rehabilitation treatment and afterward.
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Affiliation(s)
- Christian Müller
- Department of Occupational Therapy, University of Cooperative Education in Health Care and Welfare Saarland, Saarbrücken, Germany.,Department of Nursing Sciences, School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany
| | - Sindy Lautenschläger
- Department of Nursing Sciences, School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany
| | - Christine Dörge
- Department of Nursing Sciences, School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Centre of Geriatric Medicine and Gerontology Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Voigt-Radloff S, Bollig C, Torbahn G, Denkinger M, Bauer J. [Interventions to optimise prescribing for older people in care homes]. Z Gerontol Geriatr 2019; 53:37-43. [PMID: 31863168 DOI: 10.1007/s00391-019-01673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sebastian Voigt-Radloff
- Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland. .,Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
| | - Claudia Bollig
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Gabriel Torbahn
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Michael Denkinger
- AGAPLESION Bethesda Ulm, Geriatrisches Zentrum Ulm/Alb-Donau, Geriatrische Forschung der Universität Ulm, Ulm, Deutschland
| | - Jürgen Bauer
- Geriatrisches Zentrum, Universität Heidelberg, Heidelberg, Deutschland
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Müller C, Lautenschläger S, Dörge C, Voigt-Radloff S. Development of a lifestyle-integrated physical exercise training and home modification intervention for older people living in a community with a risk of falling (Part 1): the FIT-at-Home fall prevention program. Disabil Rehabil 2019; 43:1367-1379. [PMID: 31760814 DOI: 10.1080/09638288.2019.1661530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE In this paper, we report on the development and refinement of a progressive physical exercise training and home modification intervention for older people with a risk of falling located in Germany by using the United Kingdom's Medical Research Council framework. METHODS The process was iterative and six phases of development emerged: (1) establishing an intervention development group, (2) identifying the evidence on interventions, (3) identifying a theory to underpin the intervention, (4) designing the intervention components, (5) drafting the intervention manual and training course, and (6) piloting and refining of intervention components. RESULTS The result was an evidence-based, theory-informed, and user-endorsed intervention: FIT-at-Home. This intervention comprised nine individual sessions over 12 weeks and two follow-up booster sessions delivered by trained occupational therapists. A feasibility study demonstrated the acceptance and feasibility of intervention delivery. Users responses were generally favorable and included recommendations about the intervention manual, mode of delivery of the home hazard assessment, and producing a manual for older people. CONCLUSIONS We developed a feasible home-based lifestyle-integrated physical exercise training and home modification intervention for older people with a risk of falling by using a systematic approach. Implications include how this intervention could enrich occupational therapy fall prevention strategy in older people living at home.IMPLICATIONS FOR REHABILITATIONFalls in older people represent a major public health concern and occupational therapists in rehabilitation practice are encouraged to apply evidence-based interventions that reduce the risk of falls in older people living in a community.Many physical and environmental fall risks are modifiable by lifestyle changes such as physical exercise training, home safety assessment, and home modification. We developed a home-based balance and strength exercise training and home modification intervention that aims to improve strength, balance, and home safety.This study indicates that older people, at risk of falling, with functional limitations, and limited mobility, who participated in the FIT-at-Home intervention, felt that exercising at home suited them best.
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Affiliation(s)
- Christian Müller
- School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany.,University of Cooperative Education in Health Care and Welfare Saarland, Saarbrücken, Germany
| | - Sindy Lautenschläger
- School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany
| | - Christine Dörge
- School of Social Sciences, University of Applied Sciences Saarbrücken, Saarbrücken, Germany
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisgau, Germany.,Centre of Geriatric Medicine and Gerontology Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Breisgau, Germany
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Bennett S, Laver K, Voigt-Radloff S, Letts L, Clemson L, Graff M, Wiseman J, Gitlin L. Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis. BMJ Open 2019; 9:e026308. [PMID: 31719067 PMCID: PMC6858232 DOI: 10.1136/bmjopen-2018-026308] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the effect of occupational therapy provided at home on activities of daily living, behavioural and psychological symptoms of dementia (BPSD) and quality of life (QOL) for people with dementia, and the effect on family carer burden, depression and QOL. DESIGN Systematic review and meta-analysis. METHODS Eight databases were searched to February 2018. Randomised controlled trials of occupational therapy delivered at home for people with dementia and their family carers that measured ADL, and/or BPSD were included. Two independent reviewers determined eligibility, risk of bias and extracted data. RESULTS Fifteen trials were included (n=2063). Occupational therapy comprised multiple components (median=8 sessions). Compared with usual care or attention control occupational therapy resulted in improvements in the following outcomes for people with dementia: overall ADL after intervention (standardised means difference (SMD) 0.61, 95% CI 0.16 to 1.05); instrumental ADL alone (SMD 0.22, 95% CI 0.07 to 0.37; moderate quality); number of behavioural and psychological symptoms (SMD -0.32, 95% CI -0.57 to -0.08; moderate quality); and QOL (SMD 0.76, 95% CI 0.28 to 1.24) after the intervention and at follow-up (SMD 1.07, 95% CI 0.58 to 1.55). Carers reported less hours assisting the person with dementia (SMD -0.33, 95% CI -0.58 to -0.07); had less distress with behaviours (SMD -0.23, 95% CI -0.42 to -0.05; moderate quality) and improved QOL (SMD 0.99, 95% CI 0.66 to 1.33; moderate quality). Two studies compared occupational therapy with a comparison intervention and found no statistically significant results. GRADE ratings indicated evidence was very low to moderate quality. CONCLUSIONS Findings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy. PROSPERO REGISTRATION NUMBER CRD42011001166.
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Affiliation(s)
- Sally Bennett
- School of Health and Rehabilitation Sciences, The University Queensland, Brisbane, Queensland, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Center for Geriatric Medicine and Gerontology, University of Freiburg, Germany
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Lindy Clemson
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maud Graff
- IQ Healthcare & Radboud Alzheimer Centre, Radboud University, Nijmegen, The Netherlands
| | - Jodie Wiseman
- Centre for Children's Health Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Laura Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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Mühlbauer V, Dallmeier D, Brefka S, Bollig C, Voigt-Radloff S, Denkinger M. The Pharmacological Treatment of Arterial Hypertension in Frail, Older Patients—a Systematic Review. Dtsch Arztebl Int 2019; 116:23-30. [PMID: 30832759 DOI: 10.3238/arztebl.2019.0023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 09/13/2018] [Accepted: 12/04/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND It is debated whether the treatment goals and decision-making algorithms for elderly patients with hypertension should be the same as those for younger patients. The American and European guidelines leave decisions about antihypertensive treatment in frail, institutionalized patients up to the treating physician. We therefore systematically searched the literature for publications on the phamacotherapy of arterial hypertension in frail patients. METHODS The MEDLINE, Embase, and Central databases were systematically searched for randomized, controlled trials (RCTs) and non-randomized studies, including observational studies, on the pharmacotherapy of arterial hypertension in elderly patients since the introduction of the concept of frailty, published over the period 1992-2017. RESULTS Out of 19 282 citations for randomized, controlled trials and 5659 for non-randomized trials and observational studies, four RCTs and three observational studies were included in the further analysis. The included RCTs showed a trend to- wards a benefit from pharmacotherapy of hypertension in frail patients with respect to mortality, cardiovascular disease, functional status, and quality of life. On the other hand, some of the observational studies indicated a lower rate of falls and lower mortality among patients who received no antihypertensive treatment. CONCLUSION In view of the conflicting findings of RCTs and non-randomized studies, the lower representation of frail subjects in RCTs, and the high risk of bias in non- randomized studies, the findings of the studies included in this review do not enable the formulation of any strictly evidence-based treatment recommendations. As a rule of thumb, the authors propose that a target systolic blood pressure of <150 mmHg should be aimed at in patients whose gait speed is less than 0.8 m/s, while a target range of 130-139 mmHg can be set for patients over age 80 who are no more than mildly frail.
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Affiliation(s)
- Viktoria Mühlbauer
- Joint first authors; Department of Geriatrics, University of Ulm and Geriatric Center Ulm/Alb-Donau, Agaplesion Bethesda Hospital; Institute for Evidence in Medicine (for the Cochrane Germany Foundation), Faculty of Medicine, University Hospital Freiburg; Freiburg Center for Geriatrics and Gerontology, Faculty of Medicine, University Hospital Freiburg
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Frank F, Bjerregaard F, Bengel J, Bitzer EM, Heimbach B, Kaier K, Kiekert J, Krämer L, Kricheldorff C, Laubner K, Maun A, Metzner G, Niebling W, Salm C, Schütter S, Seufert J, Farin E, Voigt-Radloff S. Local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro): study protocol of a randomised comparative effectiveness trial. BMC Geriatr 2019; 19:64. [PMID: 30832609 PMCID: PMC6398245 DOI: 10.1186/s12877-019-1088-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/25/2019] [Indexed: 11/30/2022] Open
Abstract
Background Multimorbid older adults suffering from a long-term health condition like depression, diabetes mellitus type 2, dementia or frailty are at high risk of losing their autonomy. Disability and multimorbidity in the older population are associated with social inequality and lead to soaring costs. Our local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro-Care) aims at improving outcomes for older multimorbid patients with chronic conditions whose social and medical care must be improved. Methods The study will evaluate the effects of LoChro-Care on functional health, depressive symptoms and satisfaction with care, resource utilisation as well as health costs in older persons with long-term conditions. The trial will compare the effectiveness of LoChro-Care and usual care in a cross-sectoral setting from hospital to community care. We will recruit 606 older adults (65+) admitted to local hospital inpatient or outpatient departments who are at risk of loss of independence. Half of them will be randomised to receive the LoChro-Care intervention, comprising seven to 16 contacts with chronic care managers (CCM) within 12 months. The hypothesis that LoChro-Care will result in better patient-centred outcomes will be tested through mixed-method process and outcome evaluation and valid measures completed at baseline and at 12 and 18 months. Cost-effectiveness analyses from the healthcare perspective will include incremental cost-effectiveness ratios. Discussion The trial will provide evidence about the effectiveness of local, collaborative, stepped and personalised care management for multimorbid patients with more than one functional impairment or chronic condition. Positive results will be a first step towards the implementation of a systematic cross-sectoral chronic care management to facilitate the appropriate use of available medical and nursing services and to enhance self-management of older people. Trial registration German Clinical Trials Register (DRKS): DRKS00013904; Trial registration date: 02. February 2018.
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Affiliation(s)
- Fabian Frank
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Hauptstraße 5, 79104, Freiburg, Germany. .,Department of Social Work, Protestant University of Applied Sciences Freiburg, 79114, Freiburg, Germany.
| | - Frederike Bjerregaard
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Hauptstraße 5, 79104, Freiburg, Germany.,Center for Geriatric Medicine and Gerontology, Medical Center - University of Freiburg, Lehenerstraße 88, 79106, Freiburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwig-University of Freiburg, Engelbergerstraße 41, 79085, Freiburg, Germany
| | - Eva Maria Bitzer
- Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany
| | - Bernhard Heimbach
- Center for Geriatric Medicine and Gerontology, Medical Center - University of Freiburg, Lehenerstraße 88, 79106, Freiburg, Germany
| | - Klaus Kaier
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany
| | - Jasmin Kiekert
- Institute for Applied Research, Catholic University of Applied Sciences Freiburg, Karlstraße 63, 79104, Freiburg, Germany
| | - Lena Krämer
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwig-University of Freiburg, Engelbergerstraße 41, 79085, Freiburg, Germany
| | - Cornelia Kricheldorff
- Institute for Applied Research, Catholic University of Applied Sciences Freiburg, Karlstraße 63, 79104, Freiburg, Germany
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Andy Maun
- Department of Medicine, Division of General Practice, Medical Center - University of Freiburg, Elsässerstraße 2m, 79110, Freiburg, Germany
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Hugstetterstraße 49, 79106, Freiburg, Germany
| | - Wilhelm Niebling
- Department of Medicine, Division of General Practice, Medical Center - University of Freiburg, Elsässerstraße 2m, 79110, Freiburg, Germany
| | - Claudia Salm
- Department of Medicine, Division of General Practice, Medical Center - University of Freiburg, Elsässerstraße 2m, 79110, Freiburg, Germany
| | - Sandra Schütter
- Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Hugstetterstraße 49, 79106, Freiburg, Germany
| | - Sebastian Voigt-Radloff
- Center for Geriatric Medicine and Gerontology, Medical Center - University of Freiburg, Lehenerstraße 88, 79106, Freiburg, Germany.,Institute of Evidence in Medicine, Medical Center - University of Freiburg, Breisacher Straße 153, 79110, Freiburg, Germany
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Bauer JM, Denkinger M, Voigt-Radloff S, Heppner HJ. Aktuelle Cochrane-Reviews, kommentiert aus geriatrischer Perspektive. Z Gerontol Geriatr 2019; 52:111-112. [DOI: 10.1007/s00391-019-01515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Voigt-Radloff S, Schöpf AC, Boeker M, Frank L, Farin E, Kaier K, Körner M, Wollmann K, Lang B, Meerpohl JJ, Möhler R, Niebling W, Serong J, Lange R, van der Keylen P, Maun A. Well informed physician-patient communication in consultations on back pain - study protocol of the cluster randomized GAP trial. BMC Fam Pract 2019; 20:33. [PMID: 30803433 PMCID: PMC6388488 DOI: 10.1186/s12875-019-0925-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Back pain is one of the most frequent causes of health-related work absence. In Germany, more than 70% of adults suffer from at least one back pain episode per annum. It has strong impact on health care costs and patients' quality of life. Patients increasingly seek health information on the internet. However, judging its trustworthiness is difficult. In addition, physicians who are being confronted with this type of information often experience it to complicate the physician-patient interaction. The GAP trial aims to develop, implement and evaluate an evidence-based, easy-to-understand and trustworthy internet information portal on lower back pain to be used by general practitioners and patients during and after the consultation. Effectiveness of GAP portal use compared to routine consultation on improving communication and informedness of both physicians and patients will be assessed. In addition, effects on health care costs and patients' days of sick leave will be evaluated. METHODS We will conduct a prospective multi-centre, cluster-randomized parallel group trial including 1500 patients and 150 recruiting general practitioners. The intervention group will have access to the GAP portal. The portal will contain brief guides for patients and physicians on how to improve the consultation as well as information on epidemiology, aetiology, symptoms, benefits and harms of treatment options for acute, sub-acute and chronic lower back pain. The GAP portal will be designed to be user-friendly and present information on back pain tailored for either patients or physicians in form of brief fact sheets, educative videos, info-graphics, animations and glossaries. Physicians and patients will assess their informedness and the physician-patient communication in consultations at baseline and at two time points after the consultations under investigation. Days of sick leave and health care costs related to back pain will be compared between control and intervention group using routine data of company health insurance funds. DISCUSSION The GAP-trial intends to improve the communication between physicians and their patients and the informedness of both groups. If proven beneficial, the evidence-based and user-friendly portal will be made accessible for all patients and health professionals in back pain care. Inclusion of further indications might be implemented and evaluated in the long term. TRIAL REGISTRATION German Clinical Trials Register DRKS00014279 (registered 27th of April 2018).
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Affiliation(s)
- Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Andrea C. Schöpf
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Medical Data Science, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Luca Frank
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Division Methods in Clinical Epidemiology, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs-University, Freiburg, Germany
| | - Katharina Wollmann
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
- Cochrane Germany Foundation, Freiburg, Germany
| | - Britta Lang
- Clinical Trials Unit of the Medical Center, University of Freiburg, Freiburg, Germany
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Ralph Möhler
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wilhelm Niebling
- Division of General Practice, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Serong
- Institute for Journalism, Technical University of Dortmund, Dortmund, Germany
| | - Renate Lange
- Bavarian State Association of Company Health Insurance Funds, Bavarian, Germany
| | - Piet van der Keylen
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
| | - Andy Maun
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Division of General Practice, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Brefka S, Dallmeier D, Mühlbauer V, von Arnim CAF, Bollig C, Onder G, Petrovic M, Schönfeldt-Lecuona C, Seibert M, Torbahn G, Voigt-Radloff S, Haefeli WE, Bauer JM, Denkinger MD. A Proposal for the Retrospective Identification and Categorization of Older People With Functional Impairments in Scientific Studies-Recommendations of the Medication and Quality of Life in Frail Older Persons (MedQoL) Research Group. J Am Med Dir Assoc 2019; 20:138-146. [PMID: 30638832 DOI: 10.1016/j.jamda.2018.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/22/2018] [Accepted: 11/06/2018] [Indexed: 12/23/2022]
Abstract
When treating older adults, a main factor to consider is physical frailty. Because specific assessments in clinical trials are frequently lacking, critical appraisal of treatment evidence with respect to functional status is challenging. Our aim was to identify and categorize assessments for functional status given in clinical trials in older adults to allow for a retrospective characterization and indirect comparison of treatment evidence from these cohorts. We conducted 4 separate systematic reviews of randomized and nonrandomized controlled clinical trials in older people with hypertension, diabetes, depression, and dementia. All assessments identified that reflected functional status were analyzed. Assessments were categorized across 4 different functional status levels. These levels span from functionally not impaired, slightly impaired, significantly impaired, to severely impaired/disabled. If available from the literature, cut-offs for these 4 functioning levels were extracted. If not, or if the existing cut-offs did not match the predefined functional levels, cut-off points were defined by an expert group composed of geriatricians, pharmacists, pharmacologists, neurologists, psychiatrists, and epidemiologists using a patient-centered approach. We identified 51 instruments that included measures of functional status. Although some of the assessments had clearly defined cut-offs across our predefined categories, many others did not. In most cases, no cut-offs existed for slightly impaired or severely impaired older adults. Missing cut-offs or values to adjust were determined by the expert group and are presented as described. The functional status assessments that were identified and operationalized across 4 functional levels could now be used for a retrospective characterization of functional status in randomized controlled trials and observational studies. Allocated categories only serve as approximations and should be validated head-to-head in future studies. Moreover, as general standard, upcoming studies involving older adults should include and explicitly report functional impairment as a baseline characteristic of all participants enrolled.
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Affiliation(s)
- Simone Brefka
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany; Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany; Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Viktoria Mühlbauer
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany; Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Christine A F von Arnim
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany; University Clinic Ulm, Department of Neurology, Ulm, Germany
| | - Claudia Bollig
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany; Medical Center, University of Freiburg, Cochrane Germany, Freiburg, Germany
| | - Graziano Onder
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mirko Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University, Ghent, Belgium
| | - Carlos Schönfeldt-Lecuona
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany; University Clinic Ulm, Department of Psychiatry and Psychotherapy III, Ulm, Germany
| | - Moritz Seibert
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany; University Clinic Ulm, Department of Neurology, Ulm, Germany
| | - Gabriel Torbahn
- Medical Center, University of Freiburg, Cochrane Germany, Freiburg, Germany; Institute for Biomedicine of Aging, Friedrich Alexander University Erlangen-Nürnberg, Germany
| | - Sebastian Voigt-Radloff
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany; Medical Center, University of Freiburg, Cochrane Germany, Freiburg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Michael D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany; Geriatric Center Ulm/Alb-Donau, Ulm, Germany.
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Müller C, Lautenschläger S, Voigt-Radloff S. Potentialanalyse zu ergotherapeutischen körperlichen Trainingsprogrammen und Wohnraumanpassungen zur Sturzprävention von Senioren. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C Müller
- Hochschule für Technik und Wirtschaft des Saarlandes, Fakultät für Sozialwissenschaften; Department Gesundheit und Pflege, Saarbrücken
| | - S Lautenschläger
- Hochschule für Technik und Wirtschaft des Saarlandes, Fakultät für Sozialwissenschaften; Department Gesundheit und Pflege, Saarbrücken
| | - S Voigt-Radloff
- Deutsches Cochrane Zentrum, Freiburg i.Br
- Universitätsklinikum Freiburg, Zentrum für Geriatrie und Gerontologie, Freiburg i.Br
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Denkinger M, Dallmeier D, Brefka S, Klöppel S, Voigt-Radloff S, Schönfeldt-Lecuona C, von Arnim C, Bauer J. EVIDENCE MAPS FOR DRUG THERAPY IN FRAIL OLDER ADULTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M. Denkinger
- Agaplesion Bethesda Clinic Ulm, Geriatric Medicine Ulm University, Ulm, Germany,
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany,
| | - D. Dallmeier
- Agaplesion Bethesda Clinic Ulm, Geriatric Medicine Ulm University, Ulm, Germany,
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany,
| | - S. Brefka
- Agaplesion Bethesda Clinic Ulm, Geriatric Medicine Ulm University, Ulm, Germany,
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany,
| | - S. Klöppel
- Centre for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg i. Br., Germany,
| | - S. Voigt-Radloff
- Centre for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg i. Br., Germany,
| | | | - C. von Arnim
- Department of Neurology, Ulm University Hospital, Ulm, Germany,
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany,
| | - J. Bauer
- Department of Geriatric Medicine, Klinikum Oldenburg, Oldenburg, Germany,
- Centre of geriatrics, University of Oldenburg, Oldenburg, Germany,
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35
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Schüßler B, Abel A, Holzer M, Meise R, Voigt-Radloff S, Schäfer A. Potential analysis of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain / Potentialanalyse der multidisziplinären biopsychosozialen Rehabilitation für Patienten/-innen mit chronischen Rückenschmerzen. International Journal of Health Professions 2017. [DOI: 10.1515/ijhp-2017-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Health problem
The prevalence of low back pain ranges from 74 to 85%, almost everybody in Germany suffers from low back pain once in his or her life. The recurrence rate within twelve months is 62%, which often leads to inability to work and reduction in earning capacity. The rate of chronic manifestation of low back pain is 5%. Subsequent loss of mobility and functional disability lowers quality of life and participation in private life and at work.
Evidence
A recent Cochrane review (Kamper et al., 2014) analysed six (outcome disability) and seven (outcome pain) studies with 722 and 821 participants respectively and showed that multidisciplinary rehabilitation compared to usual care has a small, but clinically relevant effect (pain: SMD -0,21 [CI 95% -0,37; -0,04]; disability: SMD -0,23 [CI 95% -0,4; -0,06]). There is a lack of evidence about the intervention conception, patient-centred outcomes and the cost effectiveness.
Implication for research
Prior to a randomised controlled trial a feasibility study about individualised multidisciplinary biopsychosocial rehabilitation compared to usual care considering people with chronic low back pain at employable age in Germany is needed. The applicability of available manuals, patient-centred outcomes and cost effectiveness should be explored.
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Affiliation(s)
- Beate Schüßler
- Fakultät Soziale Arbeit und Gesundheit , HAWK Hildesheim, Hildesheim , Germany
| | - Angsar Abel
- Fakultät Soziale Arbeit und Gesundheit , HAWK Hildesheim, Hildesheim , Germany
| | - Milena Holzer
- Fakultät Soziale Arbeit und Gesundheit , HAWK Hildesheim, Hildesheim , Germany
| | - Ruth Meise
- Fakultät Soziale Arbeit und Gesundheit , HAWK Hildesheim, Hildesheim , Germany
| | | | - Axel Schäfer
- Hochschule Bremen, Fakultät Gesellschaftswissenschaften , Studiengang Angewandte Therapiewissenschaften Logopädie und Physiotherapie, Bremen , Germany
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36
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Voigt-Radloff S, de Werd MME, Leonhart R, Boelen DHE, Olde Rikkert MGM, Fliessbach K, Klöppel S, Heimbach B, Fellgiebel A, Dodel R, Eschweiler GW, Hausner L, Kessels RPC, Hüll M. Structured relearning of activities of daily living in dementia: the randomized controlled REDALI-DEM trial on errorless learning. Alzheimers Res Ther 2017; 9:22. [PMID: 28335810 PMCID: PMC5364615 DOI: 10.1186/s13195-017-0247-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/21/2017] [Indexed: 01/08/2023]
Abstract
Background Errorless learning (EL) is a method for optimizing learning, which uses feed-forward instructions in order to prevent people from making mistakes during the learning process. The majority of previous studies on EL taught patients with dementia artificial tasks of little or no relevance for their daily lives. Furthermore, only a few controlled studies on EL have so far been performed and just a handful of studies have examined the long-term effects of EL. Tasks were not always trained in the patients’ natural or home environment, limiting the external validity of these studies. This multicenter parallel randomized controlled trial examines the effects of EL compared with trial and error learning (TEL) on the performance of activities of daily living in persons with Alzheimer’s or mixed-type dementia living at home. Methods Patients received nine 1-hour task training sessions over eight weeks using EL or TEL. Task performance was measured using video observations at week 16. Secondary outcome measures were task performance measured at week 26, satisfaction with treatment, need for assistance, challenging behavior, adverse events, resource utilization and treatment costs. Results A total of 161 participants were randomized, of whom 71 completed the EL and 74 the TEL arm at week 11. Sixty-nine EL patients and 71 TEL patients were assessed at the 16-week follow-up (the primary measurement endpoint). Intention-to-treat analysis showed a significantly improved task performance in both groups. No significant differences between the treatment groups were found for primary or secondary outcomes. Conclusions Structured relearning improved the performance of activities of daily living. Improvements were maintained for 6 months. EL had no additional effect over TEL. Trial registration German Register of Clinical Trials DRKS00003117. Registered 31 May 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13195-017-0247-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sebastian Voigt-Radloff
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany
| | - Maartje M E de Werd
- Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, P.O. Box 9101 (internal post 925), 6500 HB, Nijmegen, The Netherlands
| | - Rainer Leonhart
- Department of Social Psychology & Methodology, University of Freiburg, Psychological Institute, Freiburg, Germany
| | - Danielle H E Boelen
- Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, P.O. Box 9101 (internal post 925), 6500 HB, Nijmegen, The Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine & Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Klaus Fliessbach
- Department of Psychiatry and Psychotherapy, University Medical Center Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Stefan Klöppel
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Freiburg, Germany
| | - Bernhard Heimbach
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany
| | - Andreas Fellgiebel
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Richard Dodel
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Department of Geriatrics, University Clinic Essen, Essen, Germany
| | | | - Lucrezia Hausner
- Department of Gerontopsychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Roy P C Kessels
- Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, P.O. Box 9101 (internal post 925), 6500 HB, Nijmegen, The Netherlands. .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
| | - Michael Hüll
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Freiburg, Germany
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37
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Göhner A, Hüll M, Voigt-Radloff S. [Non-pharmacological treatment of dementia in geriatric psychiatry care units : Scoping review]. Z Gerontol Geriatr 2016; 51:169-183. [PMID: 27986999 DOI: 10.1007/s00391-016-1161-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/27/2016] [Accepted: 11/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The number of persons suffering from dementia will continuously increase in the coming years; therefore, evidence-based interventions are needed in geriatric psychiatric care. When evidence is poor scoping reviews may help to identify knowledge gaps and needs for research. AIM OF THE ARTICLE To present an overview of clinical trials on non-pharmacological treatment for elderly with dementia in hospitals, wards and nursing homes, specializing in gerontopsychiatric care. MATERIAL AND METHODS A systematic search was carried out by one of the authors for clinical trials (randomized controlled, controlled and single group pre-post design, English and German, 1998-2014) in PsycINFO, PubMED, PSYNDEX and the Cochrane Library as well as a manual search in two relevant German peer-reviewed journals. Two authors included studies according to a priori defined inclusion criteria. One author extracted data after consulting the second author in cases of ambiguity. The risk of bias of the studies was not assessed. RESULTS AND DISCUSSION A total of 77 studies were identified, 29 studies on restructured treatment pathways or settings, 14 trials on environmental changes and 34 studies on therapeutic single or group interventions. Both the methodological quality of the studies and the evidence for the efficacy of non-pharmacological treatment were limited. There are clear indications for an advantage of specialized environments and treatment settings for the elderly with dementia in hospitals, wards and nursing homes. There are consistent indications for positive effects of psychosocial activation alone or in combination with cognitive or physical activation, partly with high-quality study designs. This is consistent with the German S3 guidelines for dementia. For single interventions, such as electroconvulsive therapy or horticultural activities, the level of evidence remains limited.
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Affiliation(s)
- Anne Göhner
- Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Lehener Str. 88, 79106, Freiburg, Deutschland.
| | - Michael Hüll
- Klinik für Alterspsychiatrie und Psychotherapie, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychiatrie Emmendingen, Universitätsklinikum Freiburg, Emmendingen, Freiburg, Deutschland
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38
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de Werd MME, Hoelzenbein AC, Boelen DHE, Rikkert MGMO, Hüell M, Kessels RPC, Voigt-Radloff S. Interrater Reliability and Concurrent Validity of a New Rating Scale to Assess the Performance of Everyday Life Tasks in Dementia: The Core Elements Method. Am J Alzheimers Dis Other Demen 2016; 31:605-611. [PMID: 27303065 PMCID: PMC10852601 DOI: 10.1177/1533317516653468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Errorless learning (EL) is an instructional procedure involving error reduction during learning. Errorless learning is mostly examined by counting correctly executed task steps or by rating them using a Task Performance Scale (TPS). Here, we explore the validity and reliability of a new assessment procedure, the core elements method (CEM), which rates essential building blocks of activities rather than individual steps. Task performance was assessed in 35 patients with Alzheimer's dementia recruited from the Relearning methods on Daily Living task performance of persons with Dementia (REDALI-DEM) study using TPS and CEM independently. Results showed excellent interrater reliabilities for both measure methods (CEM: intraclass coefficient [ICC] = .85; TPS: ICC = .97). Also, both methods showed a high agreement (CEM: mean of measurement difference [MD] = -3.44, standard deviation [SD] = 14.72; TPS: MD = -0.41, SD = 7.89) and correlated highly (>.75). Based on these results, TPS and CEM are both valid for assessing task performance. However, since TPS is more complicated and time consuming, CEM may be the preferred method for future research projects.
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Affiliation(s)
- Maartje M E de Werd
- Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Geriatric Medicine, Radboud Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Psychology, De Zorggroep, Venlo, the Netherlands
| | - Angela C Hoelzenbein
- Department of Social Psychology and Methodology, Psychological Institute, University of Freiburg, Breisgau, Germany
| | - Daniëlle H E Boelen
- Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Klimmendaal Rehabilitation Centre Arnhem, the Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboud Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Michael Hüell
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Geriatric Medicine, Radboud Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Sebastian Voigt-Radloff
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany
- University Medical Center Freiburg, Cochrane Germany, Freiburg, Germany
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39
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Habermann C, Voigt-Radloff S. Das Ergotherapeutische Assessment als Prozess. World Federation of Occupational Therapists Bulletin 2016. [DOI: 10.1080/20566077.1998.11800242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Hüll M, Leonhart R, Olde Rikkert MG, Kessels RP, Voigt-Radloff S. P1‐426: The Effects of Structured Relearning Methods on Daily Living Task Performance of Persons with Dementia: Results from The Redali‐Dem Trial. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Hüll
- University of FreiburgFreiburgGermany
- Center for Psychiatry EmmendingenEmmendingenGermany
| | | | - Marcel G.M. Olde Rikkert
- Radboud Alzheimer Centre, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenNetherlands
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41
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Kunzweiler K, Bender J, Voigt-Radloff S. Cochrane Review Map Physiotherapie nach Schlaganfall. physioscience 2016. [DOI: 10.1055/s-0035-1567092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - J. Bender
- Berner Fachhochschule, Fachbereich Gesundheit, Disziplin Physiotherapie, CH-Bern
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Abstract
ZusammenfassungDer Kommentar erläutert mit kurzen Beispielen die Notwendigkeit und Möglichkeiten der TIDieR-Leitlinie zur Forschungsberichterstattung.
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Affiliation(s)
| | - A. Blümle
- Universitätsklinikum Freiburg, Cochrane Deutschland, Freiburg
| | - J. Meerpohl
- Universitätsklinikum Freiburg, Cochrane Deutschland, Freiburg
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43
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Toews I, Meerpohl JJ, Flatz A, Voigt-Radloff S, Nussbaumer B, Ried J, von Elm E. Cochrane Kompakt – Evidence of Cochrane Reviews in German. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv172.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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44
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Lohkamp M, Braun C, Wasner M, Voigt-Radloff S. Potenzialanalyse zur physiotherapeutischen Laufbandtherapie bei Morbus Parkinson. physioscience 2015. [DOI: 10.1055/s-0034-1399635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M Lohkamp
- Fakultät für Therapiewissenschaften, SRH Hochschule Heidelberg
| | | | - M. Wasner
- Fakultät für Therapiewissenschaften, SRH Hochschule Heidelberg
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45
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Voigt-Radloff S, Lang B, Antes G. [Potentials for research and innovations in allied health professions in Germany]. Z Evid Fortbild Qual Gesundhwes 2014; 108 Suppl 1:S4-8. [PMID: 25458398 DOI: 10.1016/j.zefq.2014.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 11/27/2022]
Abstract
In order to address the increasing complexity and continuously changing needs and demands in the German healthcare system, there is a need to strengthen knowledge translation, evidence-based practice and the conduct of clinical trials in the field of allied health professions. An interdisciplinary working group representing the fields of nursing, midwifery, physiotherapy, occupational therapy and speech therapy developed a guide and a concept for seminars to provide potential analyses for research and innovations in the allied health professions in Germany. These potential analyses compare the current state of health care delivery for specific health problems and the corpus of evidence for the effectiveness of related interventions. Thus innovations can be identified which might improve client-centred healthcare in Germany. The introductory paper briefly reports the activities and results of the working group, describes the international context of transferring research into practice and outlines possibilities for the future development of coordinated research strategies in Germany. The following papers consist of five potential analyses: (1) Advanced Practice Nursing (APN) in long-term care; (2) giving birth in an upright position; (3) treadmill training for patients with Parkinson's disease; (4) training of everyday activities after stroke; and (5) communication training for patients with aphasia.
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Affiliation(s)
| | - Britta Lang
- Universitätsklinikum Freiburg, Deutsches Cochrane Zentrum, Freiburg, Deutschland
| | - Gerd Antes
- Universitätsklinikum Freiburg, Deutsches Cochrane Zentrum, Freiburg, Deutschland
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46
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Müller C, Glässel A, Marotzki U, Voigt-Radloff S. [Potential analyses for research on occupational therapy-led training of activities of daily living in stroke patients]. Z Evid Fortbild Qual Gesundhwes 2014; 108 Suppl 1:S36-44. [PMID: 25458397 DOI: 10.1016/j.zefq.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 11/26/2022]
Abstract
HEALTH PROBLEM Every year about 200,000 people in Germany suffer from a first stroke and 65,000 persons from a recurrent stroke. Stroke is one of the major causes of acquired life-long disability. It is associated with multiple limitations in functioning, activities of daily living and social participation. People with stroke must develop and apply considerable coping and adaptation strategies to manage the consequences of disabilities in daily life. Insufficient adaptations may result in social isolation, depressive disorders, need for medical and nursing care and subsequently lead to increasing costs for care. Thus occupational therapy-led treatment addressing social participation as well as skills training, adaptation strategies and assistive technology for activities of daily living is essential for stroke patients after hospital discharge. CORPUS OF EVIDENCE Based on nine randomised comparisons, a Cochrane review from 2006 revealed that occupational therapy-led training after stroke had positive effects on personal activities of daily living (8 studies; 961 participants; 0.18 SMD; 95 % CI [0.04 to 0.32]), on extended activities of daily living (6 studies; 847 participants; 0.21 SMD; 95 % CI [0.03 to 0.39]), and on poor outcome (7 studies; 1,065 participants; odds ratio 0.67; 95 % CI [0.51 to 0.87]). However, direct implementation into the German healthcare context is not recommendable due to (1) different settings and heterogeneity within the primary studies, (2) lack of manualisation of treatment programmes and (3) insufficient evaluation of client-oriented outcomes. IMPLICATION FOR RESEARCH It is recommended to manualise client-centred standardised modules of a stage-specific occupational therapy-led training of activities of daily living and to pilot-test this intervention programme in a feasibility study. If this trial results in a set of reliable and valid client-oriented outcome measurements applicable within the German care context and in a feasible treatment programme well accepted by stroke patients and their treating occupational therapists, a large-scaled randomised clinical trial in terms of comparative effectiveness research may follow.
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Affiliation(s)
- Christian Müller
- Medizinische Psychologie und Medizinische Soziologie, Medizinische Fakultät, Albert-Ludwigs-Universität, Freiburg, Deutschland; Berufsakademie für Gesundheits- und Sozialwesen Saarland, Saarbrücken, Deutschland.
| | - Andrea Glässel
- Swiss Paraplegic Research, Human Functioning Sciences, Nottwil, Schweiz
| | - Ulrike Marotzki
- Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Deutschland
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47
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Lohkamp M, Braun C, Wasner M, Voigt-Radloff S. [Potential analysis for research on physiotherapy-led treadmill training in Parkinson's disease]. Z Evid Fortbild Qual Gesundhwes 2014; 108 Suppl 1:S29-35. [PMID: 25458396 DOI: 10.1016/j.zefq.2014.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
HEALTH PROBLEM Parkinson's disease is one of the major neurodegenerative disorders with prevalence rates between 0.1 and 0.2 % in the global population and 1.8 % in people aged 64 years and over. Future incidence rates are estimated to increase within aging societies. The progressive course of Parkinson's disease is clinically characterised by bradykinesia, rigidity and tremor. These limitations in motor functioning reduce the capacity to work, social participation and the clients' quality of life. Parkinson's disease causes incapacity to work and a large number of days off from work. The benefits clients expect from physiotherapy-led treatment include an improvement of gait, a better speed of motion and the decrease of fatigue and rigidity. CORPUS OF EVIDENCE A recent Cochrane review (Mehrholz et al., 2010) analysed seven randomised comparisons with 153 participants and found that treadmill training compared with no treatment improved gait speed (SMD 0.50; 95 % confidence interval [0.17 to 0.84]). A lack of evidence exists on how to reduce fatigue and rigidity. There is also need to evaluate long-term effects and cost-effectiveness. Furthermore, an updated meta-analysis should include eleven new randomised trials on treadmill training after 2009. Physiotherapy-led treadmill training can easily be transferred into the German healthcare context since the environmental and educational preconditions are met by German physiotherapeutic care. IMPLICATION FOR RESEARCH Within the German context, there is need to prepare a randomised clinical trial evaluating the impact of physiotherapy-led treadmill training on motor functioning, quality of life, costs, adverse events und long-term effects. Prior to this, a feasibility study should explore the acceptance and intensity of treadmill training as well as the access of private physiotherapy practices to people suffering from early- to mid-stage Parkinson's disease.
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Affiliation(s)
- Monika Lohkamp
- Fakultät für Therapiewissenschaften, SRH Hochschule Heidelberg, Heidelberg, Deutschland.
| | | | - Mieke Wasner
- Fakultät für Therapiewissenschaften, SRH Hochschule Heidelberg, Heidelberg, Deutschland
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48
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Voigt-Radloff S, Hüll M. [Practice example: neurodegenerative disorders: randomised controlled multicentre trial of home-based occupational therapy for patients with dementia]. Z Evid Fortbild Qual Gesundhwes 2013; 107:222-228. [PMID: 23790699 DOI: 10.1016/j.zefq.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper summarises the methods and results of a seven-centre, single-blind, parallel group, actively controlled randomised trial evaluating the effectiveness of a Dutch 10-session community occupational therapy programme for patients with mild to moderate Alzheimer's disease in German routine healthcare. Methodological aspects for future research on complex psychosocial interventions are discussed. (As supplied by publisher).
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Affiliation(s)
- Sebastian Voigt-Radloff
- Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg; Deutsches Cochrane Zentrum, Universitätsklinikum Freiburg.
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49
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Ewers M, Grewe T, Höppner H, Huber W, Sayn-Wittgenstein F, Stemmer R, Voigt-Radloff S, Walkenhorst U. [Research in the health care professions]. Dtsch Med Wochenschr 2012; 137 Suppl 2:S34-6. [PMID: 22674442 DOI: 10.1055/s-0032-1305067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Ewers
- Institut für Medizin-, Pflegepädagogik und Pflegewissenschaft, Charité - Universitätsmedizin Berlin.
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50
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Ewers M, Grewe T, Höppner H, Huber W, Sayn-Wittgenstein F, Stemmer R, Voigt-Radloff S, Walkenhorst U. Forschung in den Gesundheitsfachberufen. Dtsch Med Wochenschr 2012; 137 Suppl 2:S37-73. [DOI: 10.1055/s-0032-1305035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- M. Ewers
- Institut für Medizin-, Pflegepädagogik und Pflegewissenschaft, Charité - Universitätsmedizin Berlin
| | - T. Grewe
- Fachbereich Gesundheit, Logopädie und Therapiewissenschaft, Hochschule Fresenius Idstein
| | - H. Höppner
- Fachbereich Soziale Arbeit und Gesundheit, Physiotherapie, Fachhochschule Kiel
| | - W. Huber
- Neurologische Klinik, Neurolinguistik und Logopädie, Universitätsklinikum der RWTH Aachen
| | - F. Sayn-Wittgenstein
- Fakultät für Wirtschafts- und Sozialwissenschaften, Hebammenwesen, Hochschule Osnabrück
| | - R. Stemmer
- Fachbereich Gesundheit und Pflege, Pflegewissenschaft und Pflegemanagement, Katholische Fachhochschule Mainz
| | - S. Voigt-Radloff
- Zentrum für Geriatrie und Gerontologie, Ergotherapie, Universität Freiburg
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