@article{SecklerRegauerKruegeretal.2021, author = {Seckler, Eva and Regauer, Verena and Kr{\"u}ger, Melanie and Gabriel, Anna and Hermsd{\"o}rfer, Joachim and Niemietz, Carolin and Bauer, Petra and M{\"u}ller, Martin}, title = {Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation}, series = {BMC Family Practice}, volume = {22}, journal = {BMC Family Practice}, pages = {62}, year = {2021}, abstract = {Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council's Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28\%, PT practices: 39\%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs' adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients' treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).}, language = {en} } @article{HorstmannshoffSkudlikPetermannetal.2023, author = {Horstmannshoff, Caren and Skudlik, Stefanie and Petermann, Jenny and Kiesel, Theresia and D{\"o}ringer, Tobias and Crispin, Alexander and Hermsd{\"o}rfer, Joachim and K{\"o}berlein‑Neu, Juliane and Jahn, Klaus and Sch{\"a}dler, Stefan and Bauer, Petra and Voigt, Karen and M{\"u}ller, Martin}, title = {Effectiveness of an evidence-based care pathway to improve mobility and participation in older patients with vertigo and balance disorders in primary care (MobilE-PHY2): study protocol for a multicentre cluster-randomised controlled trial}, series = {BMC Trials}, volume = {24}, journal = {BMC Trials}, pages = {91}, year = {2023}, abstract = {Background Vertigo, dizziness or balance disorders (VDB) are common leading symptoms in older people, which can have a negative impact on their mobility and participation in daily live, yet, diagnosis is challenging and specific treatment is often insufficient. An evidence-based, multidisciplinary care pathway (CPW) in primary care was developed and pilot tested in a previous study. The aim of the present study is to evaluate the effectiveness and safety of the CPW in terms of improving mobility and participation in community-dwelling older people with VDB in primary care. Methods For this multicentre cluster randomised controlled clinic trial, general practitioners (GP) will be recruited in two regions of Germany. A total of 120 patients over 60 years old with VDB will be included. The intervention is an algorithmized CPW. GPs receive a checklist for standardise clinical decision making regarding diagnostic screening and treatment of VDB. Physiotherapists (PT) receive a decision tree for evidence-based physiotherapeutic clinical reasoning and treatment of VDB. Implementation strategies comprises educational trainings as well as a workshop to give a platform for exchange for the GPs and PTs, an information meeting and a pocket card for home care nurses and informal caregivers and telephone peer counselling to give all participants the capability, opportunity and the motivation to apply the intervention. In order to ensure an optimised usual care in the control group, GPs get an information meeting addressing the national guideline. The primary outcome is the impact of VDB on participation and mobility of patients after 6 month follow-up, assessed using the Dizziness Handicap Inventory (DHI) questionnaire. Secondary outcomes are physical activity, static and dynamic balance, falls and fear of falling as well as quality of life. We will also evaluate safety and health economic aspects of the intervention. Behavioural changes of the participants as well as barriers, facilitating factors and mechanisms of impact of the implementation will be investigated with a comprehensive process evaluation in a mixed-methods design. Discussion With our results, we aim to improve evidence-based health care of community-dwelling older people with VDB in primary care.}, language = {en} } @inproceedings{HorstmannshoffBorchersLechneretal.2022, author = {Horstmannshoff, Caren and Borchers, Peggy and Lechner, Theresia and Petermann, Jenny and Skudlik, Stefanie and D{\"o}ringer, Tobias and Crispin, Alexander and Hermsd{\"o}rfer, Joachim and K{\"o}berlein-Neu, Juliane and Bauer, Petra and Voigt, Karen and M{\"u}ller, Martin}, title = {Wirksamkeit und Sicherheit eines evidenzbasierten Versorgungspfades zur Verbesserung von Mobilit{\"a}t und Teilhabe f{\"u}r {\"a}ltere Patient*innen mit Schwindel- und/oder Gleichgewichtsst{\"o}rungen in der Prim{\"a}rversorgung}, series = {21. Deutscher Kongress f{\"u}r Versorgungsforschung (DKVF)}, booktitle = {21. Deutscher Kongress f{\"u}r Versorgungsforschung (DKVF)}, year = {2022}, language = {de} }