@article{KlingshirnMuellerBeutneretal.2020, author = {Klingshirn, Hanna and M{\"u}ller, Martin and Beutner, Katrin and Hirt, Julian and Strobl, Ralf and Grill, Eva and Meyer, Gabriele and Saal, Susanne}, title = {Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: a process evaluation of a cluster-randomised pilot trial}, series = {BMC Geriatrics}, volume = {20}, journal = {BMC Geriatrics}, pages = {270}, year = {2020}, abstract = {Background Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation. Methods The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis. Results Seven nursing homes (n = 4 intervention groups, n = 3 control groups) in two regions of Germany took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: "good"; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nurses. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers. Conclusion The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning are needed to support the facilitators during implementation in the main trial. Trial registration German clinical trials register, DRKS00010037. Registered 12 February 2016.}, language = {en} } @article{NguyenThalhammerBeutneretal.2019, author = {Nguyen, Natalie and Thalhammer, Regina and Beutner, Katrin and Saal, Susanne and Servaty, Ricarda and Klingshirn, Hanna and Icks, Andrea and Freyberg, Kristina and Vomhof, Markus and Mansmann, Ulrich and Le, Lien and M{\"u}ller, Martin and Meyer, Gabriele}, title = {Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185]}, series = {Trials}, volume = {20}, journal = {Trials}, pages = {305}, year = {2019}, abstract = {Background: Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study. Methods/design: This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators' workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents' participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents' quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost-utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation. Discussion: We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals.}, language = {en} } @article{SaalKlingshirnBeutneretal.2019, author = {Saal, Susanne and Klingshirn, Hanna and Beutner, Katrin and Strobl, Ralf and Grill, Eva and M{\"u}ller, Martin and Meyer, Gabriele}, title = {Improved participation of older people with joint contractures living in nursing homes: feasibility of study procedures in a cluster-randomised pilot trial}, series = {Trials}, volume = {20}, journal = {Trials}, pages = {411}, year = {2019}, abstract = {Background: Acquired joint contractures have a significant impact on functioning and quality of life in nursing home residents. There is very limited evidence on measures for prevention and treatment of disability due to joint contractures. We have developed the PECAN intervention (Participation Enabling CAre in Nursing) to improve social participation in nursing home residents. A cluster-randomised pilot trial was conducted to assess the feasibility of study procedures in preparation for a main trial according to the UK Medical Research Council (MRC) framework. Methods: Nursing homes in two regions of Germany were randomly allocated either to the intervention or optimised standard care (control group). All residents with joint contractures aged > 65 years were eligible for the study. The residents' data were collected through structured face-to-face interviews by blinded assessors at baseline, after 3 and 6 months. The primary outcome was social participation, measured by a subscale of the PaArticular Scales. Secondary outcomes included activities and instrumental activities of daily living, health-related quality of life, falls and fall-related consequences. Data on the trial feasibility were collected via documentation forms. Results: Seven out of 12 nursing homes agreed to participate and remained in the trial. Of 265 residents who fulfilled the inclusion criteria, 129 were randomised either to the intervention (n = 64) or control group (n = 65) and analysed. A total of 109 (85\%) completed the trial after 6 months. The mean age was 85.7 years (SD 7.0), 80\% were women. The severity of the residents' disability differed across the clusters. The completion rate was high (> 95\%), apart from the Instrumental Activities of Daily Living Scale. Some items of the PaArticular Scales were not easily understood by residents. The frequency of falls did not differ between study groups. Conclusion: Our data confirmed the feasibility of the overall study design. We also revealed the need to improve the procedures for the recruitment of residents and for data collection before implementation into a main trial. The next step will be an adequately powered main trial to assess the effectiveness and cost-effectiveness of the intervention.}, language = {en} } @article{ProdingerShawRudmanetal.2012, author = {Prodinger, Birgit and Shaw, L. and Rudman, D. L. and Townsend, E.}, title = {Arthritis-related occupational therapy: Making invisible ruling relations visible using institutional ethnography}, series = {British Journal of Occupational Therapy}, volume = {75}, journal = {British Journal of Occupational Therapy}, number = {10}, pages = {463 -- 470}, year = {2012}, abstract = {Introduction: Occupational therapists' intention of enabling women with rheumatoid arthritis to participate in everyday life is fraught with challenges in everyday practice. Method: Inspired by institutional ethnography, this paper aims to make explicit how the work of occupational therapists in an outpatient rheumatology hospital setting is governed within invisible, ruling relations. An analytical description of the first author's clinical experience was a standpoint from which to explicate how occupational therapy is coordinated to the ruling relations of the Austrian health care system. Findings: Occupational therapy practice and research are ruled within a positivist, body-focused, medical apparatus, which renders largely invisible occupational therapists' knowledge of enabling people to engage in occupations that are meaningful to them. Conclusion: Occupational therapists have professional power that can be asserted by strategically using occupational therapy specific knowledge and language in textually mediated practices, from assessments and case files to media images, to give greater visibility and influence to the profession's work of enabling occupation.}, language = {en} }