@article{SaalMeyerBeutneretal.2018, author = {Saal, S. and Meyer, G. and Beutner, K. and Klingshirn, H. and Strobl, R. and Grill, E. and Mann, E. and K{\"o}pke, S. and Bleijlevens, M.H.C. and Bartoszek, G. and Stephan, A.-J. and Hirt, J. and M{\"u}ller, Martin}, title = {Development of a complex intervention to improve participation of nursing home residents with joint contractures: a mixed-method study}, series = {BMC Geriatrics}, journal = {BMC Geriatrics}, year = {2018}, abstract = {Background Joint contractures in nursing home residents limit the capacity to perform daily activities and restrict social participation. The purpose of this study was to develop a complex intervention to improve participation in nursing home residents with joint contractures. Methods The development followed the UK Medical Research Council framework using a mixed-methods design with re-analysis of existing interview data using a graphic modelling approach, group discussions with nursing home residents, systematic review of intervention studies, structured 2-day workshop with experts in geriatric, nursing, and rehabilitation, and group discussion with professionals in nursing homes. Results Graphic modelling identified restrictions in the use of transportation, walking within buildings, memory functions, and using the hands and arms as the central target points for the intervention. Seven group discussions with 33 residents revealed various aspects related to functioning and disability according the International Classification of Functioning, Disability and Health domains body functions, body structures, activities and participation, environmental factors, and personal factors. The systematic review included 17 studies with 992 participants: 16 randomised controlled trials and one controlled trial. The findings could not demonstrate any evidence in favour of an intervention. The structured 2-day expert workshop resulted in a variety of potential intervention components and implementation strategies. The group discussion with the professionals in nursing homes verified the feasibility of the components and the overall concept. The resulting intervention, Participation Enabling CAre in Nursing (PECAN), will be implemented during a 1-day workshop for nurses, a mentoring approach, and supportive material. The intervention addresses nurses and other staff, residents, their informal caregivers, therapists, and general practitioners. Conclusions In view of the absence of any robust evidence, the decision to use mixed methods and to closely involve both health professionals and residents proved to be an appropriate means to develop a complex intervention to improve participation of and quality of life in nursing home residents. We will now evaluate the PECAN intervention for its impact and feasibility in a pilot study in preparation for an evaluation of its effectiveness in a definitive trial. Trial registration German clinical trials register, reference number DRKS00010037 (12 February 2016).}, language = {en} } @article{KlingshirnMittrachBraitmayeretal.2018, author = {Klingshirn, H. and Mittrach, R. and Braitmayer, K. and Strobl, R. and Bender, A. and Grill, E. and M{\"u}ller, Martin}, title = {RECAPDOC - a questionnaire for the documentation of rehabilitation care utilization in individuals with disorders of consciousness in long-term care in Germany: development and pretesting}, series = {BMC Health Services Research}, volume = {18}, journal = {BMC Health Services Research}, pages = {329}, year = {2018}, abstract = {Background A multitude of different rehabilitation interventions and other specific health care services are offered for individuals with disorders of consciousness in long-term care settings. To investigate the association of those services and patient-relevant outcomes, a specific instrument to document the utilization of those services is needed. The purpose of this study was to develop such a questionnaire administered to caregivers in epidemiological studies or patient registries in Germany. Methods The development process of the RECAPDOC questionnaire was carried out in three steps. Step 1 consisted of a systematic literature review and an online-based expert survey to define the general content. Step 2 was an expert interview to evaluate the preliminary content of the questionnaire. Step 3 was a pretest including cognitive interviews with caregivers. After each step, the results were combined into a new version of the questionnaire. Results The first version of the questionnaire included items on utilization of medical care, medical aids, nursing and therapeutic care. The results of the expert interview led to the integration of five new items and the modification of six other items. The pretest led to some minor modifications of the questionnaire since it was rated as feasible and acceptable. The final questionnaire consisted of 29 items covering the domains "living situation", "social insurance status", "utilisation of home health care", "domestic services", "outpatient health care", "specific diagnostic measures", "adaptive technologies", "medical aids" and "utilization of therapies". Also the experience of family support and multidisciplinary collaboration of health professionals is covered. Conclusions The developed questionnaire is a first step to make the situation of patients with disorders of consciousness in the long-term care setting accessible for evaluation in epidemiological studies and in the context of patient registries. However, further reliability and validity studies are needed.}, 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} } @article{KirschBergmannKolleretal.2018, author = {Kirsch, R. and Bergmann, A. and Koller, D. and Leidl, R. and Mansmann, U. and M{\"u}ller, Martin and Sanftenberg, L. and Schelling, J. and Sundmacher, L. and Voigt, Karen and Grill, E.}, title = {Patient trajectories and their impact on mobility, social participation and quality of life in patients with vertigo/dizziness/balance disorders and osteoarthritis (MobilE-TRA): study protocol of an observational, practice-based cohort study}, series = {BMJ Open}, volume = {8}, journal = {BMJ Open}, number = {4}, pages = {e022970}, year = {2018}, abstract = {Introduction Mobility limitations have a multitude of different negative consequences on elderly patients including decreasing opportunities for social participation, increasing the risk for morbidity and mortality. However, current healthcare has several shortcomings regarding mobility sustainment of older adults, namely a narrow focus on the underlying pathology, fragmentation of care across services and health professions and deficiencies in personalising care based on patients' needs and experiences. A tailored healthcare strategy targeted at mobility of older adults is still missing. Objective The objective is to develop multiprofessional care pathways targeted at mobility sustainment and social participation in patients with vertigo/dizziness/balance disorders (VDB) and osteoarthritis (OA) . Methods Data regarding quality of life, mobility limitation, pain, stiffness and physical function is collected in a longitudinal observational study between 2017 and 2019. General practitioners (GPs) recruit their patients with VDB or OA. Patients who visited their GP in the last quarter will be identified in the practice software based on VDB and OA-related International Classification of Diseases 10th Revision. Study material will be sent from the practice to patients by mail. Six months and 12 months after baseline, all patients will receive a mail directly from the study team containing the follow-up questionnaire. GPs fill out questionnaires regarding patient diagnostics, therapy and referrals. Ethics and dissemination The study was approved by the ethical committee of the Ludwig-Maximilians-Universit{\"a}t M{\"u}nchen and of the Technische Universit{\"a}t Dresden. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Results will be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.}, language = {en} } @article{BartoszekFischerMuelleretal.2016, author = {Bartoszek, G. and Fischer, U. and M{\"u}ller, Martin and Strobl, R. and Grill, E. and Nadolny, S. and Meyer, G.}, title = {Outcome measures in older persons with acquired joint contractures: a systematic review and content analysis using the ICF (International Classification of Functioning, Disability and Health) as a reference}, series = {BMC Geriatrics}, journal = {BMC Geriatrics}, editor = {BioMed Central,}, year = {2016}, abstract = {Background: Joint contractures are a common health problem in older persons with significant impact on activities of daily living. We aimed to retrieve outcome measures applied in studies on older persons with joint contractures and to identify and categorise the concepts contained in these outcome measures using the ICF (International Classification of Functioning, Disability and Health) as a reference. Methods: Electronic searches of Medline, EMBASE, CINAHL, Pedro and the Cochrane Library were conducted (1/2002-8/2012). We included studies in the geriatric rehabilitation and nursing home settings with participants aged ≥ 65 years and with acquired joint contractures. Two independent reviewers extracted the outcome measures and transferred them to concepts using predefined conceptual frameworks. Concepts were subsequently linked to the ICF categories. Results: From the 1057 abstracts retrieved, 60 studies met the inclusion criteria. We identified 52 single outcome measures and 24 standardised assessment instruments. A total of 1353 concepts were revealed from the outcome measures; 96.2 \% could be linked to 50 ICF categories in the 2nd level; 3.8 \% were not categorised. Fourteen of the 50 categories (28 \%) belonged to the component Body Functions, 4 (8 \%) to the component Body Structures, 26 (52 \%) to the component Activities and Participation, and 6 (12 \%) to the component Environmental Factors. Conclusions: The ICF is a valuable reference for identifying and quantifying the concepts of outcome measures on joint contractures in older people. The revealed ICF categories remain to be validated in populations with joint contractures in terms of clinical relevance and personal impact.}, language = {en} } @article{MuellerBartoszekBeutneretal.2015, author = {M{\"u}ller, Martin and Bartoszek, G. and Beutner, K. and Klingshirn, H. and Saal, S. and Stephan, A.-J. and Strobl, R. and Grill, E. and Meyer, G.}, title = {Developing and piloting a multifactorial intervention to address participation and quality of life in nursing home residents with joint contractures}, series = {German medical science}, journal = {German medical science}, editor = {NCBI,}, year = {2015}, abstract = {Background: Joint contractures are common problems in frail older people in nursing homes. Irrespective of the exact extent of older individuals in geriatric care settings living with joint contractures, they appear to be a relevant problem. Also, the new emphasis on the syndrome of joint contractures, e. g. by the German statutory long term care insurance, led to an increase in assessment and documentation efforts and preventive interventions in clinical care. However, more attention should be paid to the actual situation of older individuals in nursing homes with prevalent joint contractures, particularly their experience of related activity limitations and participation restrictions. Thus, the aim of this study is 1) to develop a tailored intervention to improve functioning, and especially participation and quality of life in older residents with joint contractures in nursing homes and 2) to test the feasibility of the intervention accompanied by a rigorous process evaluation. Methods: The complex intervention, which will be developed in this project follows the UK Medical Research Council (MRC) framework and integrates the perspectives of all potentially relevant user groups, from the affected individuals to clinicians and researchers. The development process will comprise a systematic literature review, reanalysis of existing data and the integration of the knowledge of the affected individuals and experts. The developed intervention including a comprehensive process evaluation will be pilot tested with residents with joint contractures in three nursing homes. Discussion: The projected study will provide a tailored intervention to improve functioning, participation and quality of life in older residents with joint contractures in nursing homes. With this focus, the intervention will support patient relevant outcomes. The pilot study including process evaluation will offer a first opportunity to indicate the size of the intervention's effect and prepare further studies.}, language = {en} } @article{FischerMuellerStrobletal.2015, author = {Fischer, U. and M{\"u}ller, Martin and Strobl, R. and Bartoszek, G. and Meyer, G. and Grill, E.}, title = {Prevalence of functioning and disability in older patients with joint contractures: a cross-sectional study}, series = {European Journal of physical and rehabilitation medicine}, journal = {European Journal of physical and rehabilitation medicine}, editor = {minerva medica,}, year = {2015}, language = {en} } @article{MuellerWhitneyAlghwirietal.2015, author = {M{\"u}ller, Martin and Whitney, S. L. and Alghwiri, A. and Alshebber, K. and Strobl, R. and Aghadir, A. and Almomani, M. O. and Furman, J. M. and Grill, E.}, title = {Subscales of the vestibular activities and participation questionnaire could be applied across cultures}, series = {European journal of epidemiology}, journal = {European journal of epidemiology}, editor = {PlumX Metrics,}, year = {2015}, abstract = {Objectives The objective of this study was to assess the objectivity, cross-cultural validity, and convergent validity of the Vestibular Activities and Participation (VAP) questionnaire among four countries, Germany, United States, Jordan, and Saudi Arabia. Study Design and Setting This was a cross-sectional study conducted in four specialized outpatient dizziness clinics in Germany, United States, Jordan, and Saudi Arabia. Results A total of 453 participants were included in the study. The Rasch analysis revealed two separate subscales. Subscale 1 items included focusing attention, lying down, standing, bending, lifting and carrying objects, and sports. Subscale 2 items included walking long distances, climbing, running, moving around within buildings other than home, using transportation, and driving. The Pearson product-moment correlation between the Dizziness Handicap Inventory and the summary score of the VAP subscale 1 was 0.66 and was 0.64 for subscale 2. Conclusion Owing to its shortness and intercultural adaptability, the new two-scale version of the VAP questionnaire lends itself to clinical practice and research across countries to estimate the effect of vertigo and dizziness on activity limitation and participation restrictions. Psychometrically sound summary scores can be calculated. More extended versions of the VAP can be used for comprehensive clinical assessment where summary scores are not needed or a more detailed documentation is warranted.}, language = {en} } @article{FischerBartoszekMuelleretal.2014, author = {Fischer, U. and Bartoszek, G. and M{\"u}ller, Martin and Strobl, R. and Meyer, G. and Grill, E.}, title = {Patients' view on health-related aspects of functioning and disability of joint contractures: a qualitative interview study based on the International Classification of Functioning, Disability and Health}, series = {Disability and Rehabilitation}, journal = {Disability and Rehabilitation}, editor = {Taylor and Francis online,}, year = {2014}, abstract = {Purpose: The aim of this study was to identify health-relevant aspects of functioning and disability of persons aged 65 years or older with joint contractures, to link the findings to corresponding ICF categories and to describe the patients' perspective. Methods: We conducted 43 qualitative, semi-structured, face-to-face interviews with affected persons in two different locations (Witten, Munich) and in three different settings. Data were analyzed using the "meaning condensation procedure" and then linked to ICF categories. Results: From all interviews a total of 2499 single meaning-concepts were extracted which were linked to 324 different ICF categories. The participants in all settings mainly reported problems related to "Mobility of a single joint (b710)", "Sensation of pain (b280)" and problems related to "Walking (d450)". Almost all participants reported "Products and technology for personal indoor and outdoor mobility and transportation (e120)" as a relevant environmental factor. Conclusions: From the patients' perspective, joint contractures have an impact on multifaceted aspects of functioning and disability, mainly body functions, environmental factors and activities and participation. The results of this study will contribute to the development of a standard instrument for measuring functioning, disability and health-relevant aspects for patients with joint contractures. Implications for Rehabilitation Joint contractures are a major cause for the development of disability in older people. Patients' perspectives and their personal experiences have to be considered when assessing the impact of joint contractures. The International Classification of Functioning, Disability and Health (ICF) is an appropriate framework for describing the patients' multifaceted experience of joint contractures.}, language = {en} } @article{FischerMuellerStrobletal.2014, author = {Fischer, U. and M{\"u}ller, Martin and Strobl, R. and Bartoszek, G. and Meyer, G. and Grill, E.}, title = {Examining Functioning and Contextual Factors in Individuals with Joint Contractures from the Health Professional Perspective Using the ICF: An International Internet-Based Qualitative Expert Survey}, series = {Rehabilitation nursing}, journal = {Rehabilitation nursing}, editor = {Elaine Tilka, Miller}, year = {2014}, abstract = {Purpose The aim of this study was to identify disease-related aspects of functioning and disability in people with joint contractures from a health professionals' perspective and to describe the findings, using categories of the International Classification of Functioning, Disability, and Health (ICF). Design An Internet-based expert survey. Methods We asked international health professionals for typical problems in functioning and important contextual factors of individuals with joint contractures using an Internet-based open-ended questionnaire. All answers were linked to the ICF according to established rules. Absolute and relative frequencies of the linked ICF categories were reported. Findings Eighty experts named 1785 meaning units which could be linked to 256 ICF categories. Among the categories, 24.2\% belonged to the component Body Functions, 20.7\% to Body Structures, 36.3\% to Activities and Participation, and 18.8\% to Environmental Factors. Conclusion Health professionals addressed a large variety of functional problems and multifaceted aspects due to the symptom joint contractures. Clinical Relevance International health professionals reported a large variety of aspects of functioning and health, which are related to joint contractures}, language = {de} }