@article{GrillStroblMuelleretal.2011, author = {Grill, E. and Strobl, R. and M{\"u}ller, Martin and Quittan, M. and Kostanjsek, N. and Stucki, G.}, title = {ICF Core Sets for early post-acute rehabilitation facilities}, series = {Journal of rehabilitation medicine}, journal = {Journal of rehabilitation medicine}, number = {43(2)}, editor = {Foundation of Rehabilitation Information,}, year = {2011}, abstract = {Objective: To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in early post-acute rehabilitation facilities. Design: Prospective multi-centre cohort study. Patients: Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in early post-acute rehabilitation facilities. Methods: Functioning was coded using the ICF. The criterion for selecting candidate categories for the ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables. Results: A total of 165 patients were included in the study (67 neurological, 37 cardiopulmonary, 61 musculoskeletal), mean age 67.5 years, 46.1\% female. Selection yielded 38 categories for neurological, 32 for cardiopulmonary, and 31 for musculoskeletal. Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the assessment and monitoring of functioning in patients undergoing early post-acute rehabilitation for neurological, cardiopulmonary, and musculoskeletal conditions.}, language = {en} } @article{MuellerGrill2011, author = {M{\"u}ller, Martin and Grill, E.}, title = {Die Internationale Klassifikation der Funktionsf{\"a}higkeit, Behinderung und Gesundheit (ICF). Core Sets im Akutkrankenhaus: Nutzen und Relevanz f{\"u}r Pflegewissenschaft und -praxis.}, series = {Pflegewissenschaft}, journal = {Pflegewissenschaft}, number = {13(5)}, editor = {hps media,}, pages = {280 -- 288}, year = {2011}, language = {de} } @article{MuellerGrillStrobl2011, author = {M{\"u}ller, Martin and Grill, E. and Strobl, R.}, title = {Core Sets for early post-acute rehabilitation facilities}, series = {Journal Rehabilitation Medicine}, journal = {Journal Rehabilitation Medicine}, editor = {Medical Journals Limited,}, year = {2011}, abstract = {Objective: To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in early post-acute rehabilitation facilities. Design: Prospective multi-centre cohort study. Patients: Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in early post-acute rehabilitation facilities. Methods: Functioning was coded using the ICF. The criterion for selecting candidate categories for the ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables. Results: A total of 165 patients were included in the study (67 neurological, 37 cardiopulmonary, 61 musculoskeletal), mean age 67.5 years, 46.1\% female. Selection yielded 38 categories for neurological, 32 for cardiopulmonary, and 31 for musculoskeletal. Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the assessment and monitoring of functioning in patients undergoing early post-acute rehabilitation for neurological, cardiopulmonary, and musculoskeletal conditions.}, language = {en} } @article{MuellerGrillQuittanetal.2011, author = {M{\"u}ller, Martin and Grill, E. and Quittan, M. and Strobl, R. and Kostanjsek, N. and Stucki, G.}, title = {ICF Core Set for patients in geriatric post-acute rehabilitation facilities}, series = {Journal of Rehabilitation Medicine}, journal = {Journal of Rehabilitation Medicine}, editor = {Medical Journals Limited,}, year = {2011}, abstract = {Objective: To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and clinical measurement of functioning in older patients in early post-acute rehabilitation facilities. Design: Prospective multi-centre cohort study. Patients: Older patients receiving rehabilitation interventions in early post-acute rehabilitation facilities. Methods: Functioning was coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables. Results: A total of 209 patients were included in the study, mean age 80.4 years, 67.0\% female. Selection yielded a total of 29 categories for the functioning part and 9 categories for the contextual part of the ICF. Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the clinical assessment and monitoring of functioning in older patients undergoing early post-acute rehabilitation.}, language = {en} } @article{MuellerGrillStrobl2011, author = {M{\"u}ller, Martin and Grill, E. and Strobl, R.}, title = {Goals of patients with rehabilitation needs in acute hospitals: goal achivement is an indicator for improved functioning}, series = {Journal of Rehabilitation Medicine}, journal = {Journal of Rehabilitation Medicine}, editor = {Medical Journals Limited,}, year = {2011}, abstract = {Objective: To identify goals of patients with rehabilitation needs in the acute hospital setting using the International Classification of Functioning, Disability and Health (ICF), to examine association of goal achievement with improvement in overall functioning, and to examine whether ICF Core Sets for the acute hospital cover patients goals. Design: Multi-centre cohort study. Patients: A total of 397 patients (50\% female, mean age 63 years) from 5 hospitals in Austria, Switzerland and Germany. Methods: A semi-structured questionnaire was used to assess patient goals and goal achievement. Overall functioning from the patients' and health professionals' perspective was assessed on a numerical rating scale. Improvement in functioning was calculated using a residualized gain score. Association between goal achievement and improvement in overall functioning was assessed with logistic regression. Results: A total of 397 patients reported achievement of at least 1 goal. Eighty-eight percent of the goals were translated into categories of the ICF. Logistic regression analyses revealed significant association between goal achievement and overall functioning. Conclusion: The ICF might be useful to identify and structure patient's goals in acute hospital care. The association between goal achievement and improved functioning underlines that it is essential to involve the patient in the process of planning rehabilitation interventions in acute hospitals.}, language = {en} } @article{MuellerStroblJahnetal.2014, author = {M{\"u}ller, Martin and Strobl, R. and Jahn, K. and Linkohr, B. and Ladwig, K.H. and Mielk, A. and Grill, E.}, title = {Impact of vertigo and dizziness on self-perceived participation and autonomy in older adults: Results from the KORA-Age study}, series = {Quality of life research}, journal = {Quality of life research}, editor = {Springer Link,}, year = {2014}, abstract = {Purpose The impact of vertigo and dizziness on healthy ageing, and especially on participation, is not fully understood. The objective of this study was to investigate the association of vertigo and dizziness with self-perceived participation and autonomy in older non-institutionalised individuals, adjusted for the presence of other health conditions. Specifically, we wanted to investigate the different effects of vertigo and dizziness on specific components of participation, i.e. restrictions in indoor and outdoor autonomy, family role, social life and relationships, and work and education. Methods Data originate from the second wave of the German KORA-Age cohort study collected in 2012. Participation and autonomy was investigated with the Impact on Participation and Autonomy Questionnaire. We used robust regression to analyse the association of vertigo and dizziness with self-perceived participation and autonomy adjusted for covariates. Results A total of 822 participants (49.6 \% female) had a mean age of 78.1 years (SD 6.39). Participation and autonomy were significantly lower in participants with vertigo and dizziness across all domains. Adjusted for age, sex, and chronic conditions, vertigo and dizziness were significantly associated with participation restrictions in all domains except social life and relationships. Conclusion The results of our study indicate that vertigo and dizziness contribute to restrictions in participation and autonomy in individuals of older age. Recognising vertigo and dizziness as independent contributors to loss of autonomy and decreased chances for independent living may create new options for patient care and population health, such as the designing of complex interventions to maintain participation and autonomy.}, language = {en} } @article{MuellerStroblJahnetal.2014, author = {M{\"u}ller, Martin and Strobl, R. and Jahn, K. and Linkohr, B. and Peters, A. and Grill, E.}, title = {Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study}, series = {European journal of public health}, journal = {European journal of public health}, editor = {Oxford Academic,}, year = {2014}, abstract = {Background: Complaints of vertigo and dizziness are common in primary care in the aged. They can be caused by distinct vestibular disorders, but can also be a symptom in other conditions like non-vestibular sensory loss, vascular encephalopathy or anxiety. The aim of this study was to investigate the specific contribution of vertigo and dizziness to the total burden of disability in aged persons when controlling for the presence of other health conditions. Methods: Data originate from the MONICA/KORA study, a population-based cohort. Survivors of the original cohorts who were 65 years and older were examined by telephone interview in 2009. Disability was assessed with the Health Assessment Questionnaire. Logistic regression was used to adjust for potential confounders and additive regression to estimate the contribution of vertigo and dizziness to disability prevalence. Results: Adjusted for age, sex and other chronic conditions, vertigo and dizziness were associated with disability (odds ratio 1.66, 95\% confidence intervals 1.40-1.98). In both men and women between 65 and 79 years, vertigo and dizziness were among the strongest contributors to the burden of disability with a prevalence of 10.5\% (6.6 to 15.1) in men and 9.0\% (5.7 to 13.0) in women. In men, this effect is stable across all age-groups, whereas it decreases with age in women. Conclusions: Vertigo and dizziness independently and relevantly contribute to population-attributable disability in the aged. They are not inevitable consequences of ageing but arise from distinct disease entities. Careful management of vertigo and dizziness might increase population health and reduce disability.}, language = {en} } @article{GrillStruppMuelleretal.2014, author = {Grill, E. and Strupp, M. and M{\"u}ller, Martin and Jahn, K.}, title = {Health services utilization of patients with vertigo in primary care: a retrospective cohort study}, series = {Journal of neurology}, journal = {Journal of neurology}, editor = {Springer Link,}, year = {2014}, abstract = {Vertigo and dizziness count among the most frequent symptoms in outpatient practices. Although most vestibular disorders are manageable, they are often under- and misdiagnosed in primary care. This may result in prolonged absence from work, increased resource use and, potentially, in chronification. Reliable information on health services utilization of patients with vertigo in primary care is scarce. Retrospective cohort study in patients referred to a tertiary care balance clinic. Included patients had a confirmed diagnosis of benign paroxysmal positional vertigo (BPPV), Meni{\`e}re's disease (MD), vestibular paroxysmia (VP), bilateral vestibulopathy (BVP), vestibular migraine (VM), or psychogenic vertigo (PSY). All previous diagnostic and therapeutic measures prior to the first visit to the clinic were recorded. 2,374 patients were included (19.7 \% BPPV, 12.7 \% MD, 5.8 \% VP, 7.2 \% BVP, 14.1 \% VM, 40.6 \% PSY), 61.3 \% with more than two consultations. Most frequent diagnostic measures were magnetic resonance imaging (MRI, 76.2 \%, 71 \% in BPPV) and electrocardiography (53.5 \%). Most frequent therapies were medication (61.0 \%) and physical therapy (41.3 \%). 37.3 \% had received homoeopathic medication (39 \% in BPPV), and 25.9 \% were treated with betahistine (20 \% in BPPV). Patients had undergone on average 3.2 (median 3.0, maximum 6) diagnostic measures, had received 1.8 (median 2.0, maximum 8) therapies and 1.8 (median 1.0, maximum 17) different drugs. Diagnostic subgroups differed significantly regarding number of diagnostic measures, therapies and drugs. The results emphasize the need for establishing systematic training to improve oto-neurological skills in primary care services not specialized on the treatment of dizzy patients.}, language = {en} } @article{RoehrigStroblMuelleretal.2014, author = {Roehrig, N. and Strobl, R. and M{\"u}ller, Martin and Perz, S. and Kaab, S. and Martens, E. and Peters, A. and Linkohr, B. and Grill, E.}, title = {Directed acyclic graphs helped to identify confounding in the association of disability and electrocardiographic findings: results from the KORA-Age study}, series = {Journal of clinical epidemiology}, journal = {Journal of clinical epidemiology}, editor = {PlumX Metrics,}, year = {2014}, abstract = {Objectives To examine the association between electrocardiographic (ECG) findings and disability status in older adults. Study Design and Setting KORA-Age, a population-based cross-sectional study of the MONICA/KORA project, a randomized sample from Southern Germany of people aged 65 years or older. Results A total of 534 (51.5\%) of 1,037 participants were characterized as disabled. Disabled participants were on average 4.5 years older than those who were not disabled. Crude associations of left-axis deviation, ventricular conduction defects, atrial fibrillation, and QT prolongation with disability status were significant (P < 0.05). In models controlled for age and sex, these effects remained constant except for QT prolongation. In the models adjusted for the minimal sufficient adjustment set (consisting of the variables sex, physical activity, age, obesity, diabetes, education, heart diseases, income, lung diseases, and stroke) identified by a directed acyclic graph (DAG), no significant association could be shown. Conclusion Associations between specific ECG findings and disability were found in unadjusted analysis and logistic models adjusted for age and sex. However, when adjusting for other possible confounders identified by the DAG, all these associations were no longer significant. It is important to adequately identify confounding in such settings.}, language = {en} } @article{KovacsStroblPhillipsetal.2018, author = {Kovacs, E. and Strobl, R. and Phillips, A. and Stephan, A.-J. and M{\"u}ller, Martin and Gensichen, J. and Grill, E.}, title = {Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care}, series = {Journal of General Internal Medicine}, volume = {33}, journal = {Journal of General Internal Medicine}, pages = {1142 -- 1154}, year = {2018}, abstract = {Background As clinical practice guidelines represent the most important evidence-based decision support tool, several strategies have been applied to improve their implementation into the primary health care system. This study aimed to evaluate the effect of intervention methods on the guideline adherence of primary care providers (PCPs). Methods The studies selected through a systematic search in Medline and Embase were categorised according to intervention schemes and outcome indicator categories. Harvest plots and forest plots were applied to integrate results. Results The 36 studies covered six intervention schemes, with single interventions being the most effective and distribution of materials the least. The harvest plot displayed 27 groups having no effect, 14 a moderate and 21 a strong effect on the outcome indicators in the categories of knowledge transfer, diagnostic behaviour, prescription, counselling and patient-level results. The forest plot revealed a moderate overall effect size of 0.22 [0.15, 0.29] where single interventions were more effective (0.27 [0.17, 0.38]) than multifaceted interventions (0.13 [0.06, 0.19]). Discussion Guideline implementation strategies are heterogeneous. Reducing the complexity of strategies and tailoring to the local conditions and PCPs' needs may improve implementation and clinical practice.}, language = {en} }