@inproceedings{BorchersPetermannKatzenbergeretal.2022, author = {Borchers, Peggy and Petermann, Jenny and Katzenberger, Benedikt and Bauer, Petra and Horstmannshoff, Caren and Lechner, Theresia and M{\"u}ller, Martin and Voigt, Karen}, title = {Physiotherapie bei Schwindel und Gleichgewichtsst{\"o}rungen: haus{\"a}rztliche Verordnung und patientenseitige Inanspruchnahme (Ergebnisse aus der Kohortenstudie MobilE-TRA)}, series = {Deutscher Kongress f{\"u}r Versorgungsforschung (DKVF)}, booktitle = {Deutscher Kongress f{\"u}r Versorgungsforschung (DKVF)}, year = {2022}, language = {de} } @article{BorchersHorstmannshoffKatzenbergeretal.2023, author = {Borchers, Peggy and Horstmannshoff, Caren and Katzenberger, Benedict and Petermann, Jenny and Bauer, Petra and Kiesel, Theresia and M{\"u}ller, Martin and Sanftenberger, Linda and Voigt, Karen}, title = {Verordnung und Inanspruchnahme von Physiotherapie bei Schwindel und/oder Gleichgewichtsst{\"o}rungen: Eine Sekund{\"a}ranalyse aus der Kohortenstudie MobilE-TRA (Versorgungspfade und ihre Auswirkung auf Mobilit{\"a}t, soziale Teilhabe und Lebensqualit{\"a}t bei Schwindel und Gleichgewichtsst{\"o}rungen sowie Gelenkerkrankungen)}, series = {Physioscience}, journal = {Physioscience}, year = {2023}, abstract = {Hintergrund Schwindel und/oder Gleichgewichtsst{\"o}rungen (S/G) sind komplexe Gesundheitsprobleme bei {\"a}lteren Menschen und h{\"a}ufige Beratungsanl{\"a}sse in der Hausarztpraxis. Physiotherapie kann einen positiven Einfluss auf das Gleichgewicht und Sturzrisiko bei Patient*innen mit S/G haben. In der S3-DEGAM-Leitlinie „Akuter Schwindel in der Hausarztpraxis" werden Empfehlungen f{\"u}r Physiotherapie bei bestimmten Schwindeldiagnosen gegeben. Ob haus{\"a}rztliche Physiotherapieverordnungen den Empfehlungen der Leitlinie entsprechen, ist nicht bekannt. Bisher liegen keine Daten vor, wie h{\"a}ufig diese Physiotherapieverordnungen tats{\"a}chlich durch Patient*innen in Anspruch genommen werden. Ziel Ermittlung von Anteil und Inanspruchnahme haus{\"a}rztlich verordneter Physiotherapie bei {\"a}lteren Patient*innen mit S/G innerhalb der Kohortenstudie MobilE-TRA und Untersuchung, ob diese den Empfehlungen der S3-DEGAM-Leitlinie entsprechen. Methode Die Sekund{\"a}ranalyse beruht auf Daten der Kohortenstudie MobilE-TRA, in der Patient*innen ab 65 Jahren mit S/G in 17 Hausarztpraxen in Bayern und Sachsen befragt wurden. Die Datenerhebung fand von 09/2017-10/2019 statt. Die haus{\"a}rztliche Verordnung und patientenseitige Inanspruchnahme von Physiotherapie wurden mittels validierten sowie selbstentwickelten Frageb{\"o}gen erhoben. Die Daten wurden deskriptiv (Mittelwerte, H{\"a}ufigkeiten) und Verteilungsunterschiede mittels exaktem Test nach Fisher analysiert. Ergebnisse Die Stichprobe umfasste 158 Patient*innen mit S/G. 16 \% der Patient*innen hatten aufgrund von S/G Physiotherapie verordnet bekommen. Dabei entsprachen 14,2 \% der Physiotherapieverordnungen den Empfehlungen der S3-DEGAM-Leitlinie. 32 \% (Bayern 53,8 \%; Sachsen 8,3 \%) der Patient*innen hatten die Physiotherapie nicht in Anspruch genommen. Dabei lag ein signifikanter regionaler Verteilungsunterschied (p = 0,030; Phi = 0,487 [95 \% KI = 0,129-0,846]) vor. Schlussfolgerung Mit 16 \% ist die H{\"a}ufigkeit haus{\"a}rztlicher Physiotherapieverordnungen bei S/G in der Altersgruppe der {\"u}ber 65-J{\"a}hrigen vergleichsweise hoch. Die Gr{\"u}nde f{\"u}r die Nichtinanspruchnahme wurden nicht erfasst, weshalb nur Vermutungen bez{\"u}glich des regionalen Unterschiedes angestellt werden konnten (z. B. Verf{\"u}gbarkeit von Physiotherapie). Im Sinne der Planung einer adh{\"a}renten Therapie und zur Vermeidung von Versorgungsunterschieden scheint es sinnvoll, sich zuk{\"u}nftig auch mit Gr{\"u}nden einer Nichtinanspruchnahme von Therapien zu besch{\"a}ftigen.}, language = {de} } @misc{SecklerVerenaPetraetal.2019, author = {Seckler, Eva and Verena, Kronast and Petra, Bauer and M{\"u}ller, Martin}, title = {Development of a multi-disciplinary care pathway for older patients with vertigo, dizziness and balance disorders in primary care: Individual and focus group interviews to explore different perspectives}, year = {2019}, language = {en} } @article{RegauerSecklerMuelleretal.2020, author = {Regauer, Verena and Seckler, Eva and M{\"u}ller, Martin and Bauer, Petra}, title = {Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review}, series = {BMC Geriatrics}, volume = {20}, journal = {BMC Geriatrics}, pages = {494}, year = {2020}, abstract = {Background Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes. Methods A systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted. Results A total of 20 randomized and 2 non-randomized controlled trials with 1876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms. Conclusion To treat older individuals with VDB, VR in any variation and in addition to CRMs seems to be effective. High-quality randomized trials need to be conducted to inform clinical decision making. Trial registration PROSPERO 2017 CRD42017080291.}, language = {en} } @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} } @article{RegauerSecklerGrilletal.2021, author = {Regauer, Verena and Seckler, Eva and Grill, Eva and Ippisch, Richard and Jahn, Klaus and Bauer, Petra and M{\"u}ller, Martin}, title = {Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: a mixed methods study}, series = {BMC Family Practice}, volume = {22}, journal = {BMC Family Practice}, pages = {89}, year = {2021}, abstract = {Background Vertigo, dizziness and balance disorders (VDB) are common in older people and cause restrictions in mobility and social participation. Due to a multifactorial aetiology, health care is often overutilised, but many patients are also treated insufficiently in primary care. The purpose of this study was to develop a care pathway as a complex intervention to improve mobility and participation in older people with VDB in primary care. Methods The development process followed the UK Medical Research Council guidance using a mixed-methods design with individual and group interviews carried out with patients, physical therapists (PTs), general practitioners (GPs), nurses working in community care and a multi-professional expert panel to create a first draft of a care pathway (CPW) and implementation strategy using the Consolidated Framework of Implementation Research and the Expert recommendations for Implementing Change. Subsequently, small expert group modelling of specific components of the CPW was carried out, with GPs, medical specialists and PTs. The Behaviour Change Wheel was applied to design the intervention´s approach to behaviour change. To derive theoretical assumptions, we adopted Kellogg´s Logic Model to consolidate the hypothesized chain of causes leading to patient-relevant outcomes. Results Individual interviews with patients showed that VDB symptoms need to be taken more seriously by GPs. Patients demanded age-specific treatment offers, group sessions or a continuous mentoring by a PT. GPs required a specific guideline for diagnostics and treatment options including psychosocial interventions. Specific assignment to and a standardized approach during physical therapy were desired by PTs. Nurses favoured a multi-professional documentation system. The structured three-day expert workshop resulted in a first draft of CPW and potential implementation strategies. Subsequent modelling resulted in a CPW with components and appropriate training materials for involved health professionals. A specific implementation strategy is now available. Conclusion A mixed-methods design was suggested to be a suitable approach to develop a complex intervention and its implementation strategy. We will subsequently test the intervention for its acceptability and feasibility in a feasibility study accompanied by a comprehensive process evaluation to inform a subsequent effectiveness trial. Trial Registration The research project is registered in "Projektdatenbank Versorgungsforschung Deutschland" (Project-ID: VfD_MobilE-PHY_17_003910; date of registration: 30.11.2017).}, language = {en} } @article{RegauerSecklerCampbelletal.2021, author = {Regauer, Verena and Seckler, Eva and Campbell, Craig and Phillips, Amanda and Rotter, Thomas and Bauer, Petra and M{\"u}ller, Martin}, title = {German translation and pre-testing of Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC)}, series = {Implementation Science Communications}, volume = {2}, journal = {Implementation Science Communications}, pages = {120}, year = {2021}, abstract = {Background Implementation frameworks may support local implementation strategies with a sound theoretical foundation. The Consolidated Framework for Implementation Research (CFIR) facilitates identification of contextual barriers and facilitators, and the Expert Recommendations for Implementing Change (ERIC) allows identifying adequate implementation strategies. Both instruments are already used in German-speaking countries; however, no standardised and validated translation is available thus far. The aim of this study was to translate the CFIR and ERIC framework into German, in order to increase the use of these frameworks and the adherence to evidence-based implementation efforts in German-speaking countries. Methods The translation of the original versions of the CFIR and ERIC framework was guided by the World Health Organisation's recommendations for the process of translating and adapting both conceptual frameworks. Accordingly, a four-step process was employed: first, forward translation from English into German was conducted by a research team of German native speakers with fluent knowledge of the English language. Second, a bilingual expert panel comprising one researcher with German as his mother tongue and expert command of the English language and one English language expert and university teacher reviewed the translation and discussed inconsistencies with the initial translators. Third, back-translation into English was conducted by an English native speaking researcher. The final version was pre-tested with 12 German researchers and clinicians who were involved in implementation projects using cognitive interviews. Results The translation and review process revealed some inconsistencies between the original version and the German translations. All issues could be solved by discussion. Central aspects of the items were confirmed in 60 to 70\% of the items, and modifications were proposed in 30\% of the items. Finally, we revised one CFIR-item heading after pre-testing. The final version was given consent by all involved parties. Conclusions Now, two validated and tested implementation frameworks to guide implementation efforts are available in the German language and can be used to increase the application of agreed-on implementation strategies into practice.}, language = {en} } @inproceedings{HorstmannshoffSkudlikPetermannetal.2022, author = {Horstmannshoff, Caren and Skudlik, Stefanie and Petermann, Jenny and Lechner, Theresia 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 Partizipation f{\"u}r {\"a}ltere Patient*innen mit Schwindel und Gleichgewichtsst{\"o}rungen in der Prim{\"a}rversorgung}, series = {23. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin}, booktitle = {23. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin}, year = {2022}, language = {de} } @inproceedings{BorchersPetermannKatzenbergeretal.2022, author = {Borchers, Peggy and Petermann, Jenny and Katzenberger, Benedict and Bauer, Petra and Horstmannshoff, Caren and Lechner, Theresia and M{\"u}ller, Martin and Voigt, Karen}, title = {Haus{\"a}rztliche Verordnung und patientenseitige Inanspruchnahme von Physiotherapie bei Patient*innen mit Schwindel- und/oder Gleichgewichtsst{\"o}rungen - Ergebnisse aus der Kohortenstudie MobilE-TRA}, series = {Kongress Deutsche Gesellschaft f{\"u}r Allgemeinmedizin und Familienmedizin (DEGAM)}, booktitle = {Kongress Deutsche Gesellschaft f{\"u}r Allgemeinmedizin und Familienmedizin (DEGAM)}, year = {2022}, language = {de} }