@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} } @article{PottDreischulteKolleretal.2024, author = {Pott, Claudia and Dreischulte, Tobias and Koller, Daniela and Fegl, Marlene and Langemeyer, J{\"u}rgen and Bauer, Petra}, title = {Development of an interprofessional diagnostic toolkit to enhance outside walking gait-related participation of people after stroke in Germany: study protocol of an ongoing multi-methods study}, series = {BMJ Open}, volume = {14}, journal = {BMJ Open}, number = {9}, doi = {10.1136/bmjopen-2024-084316}, pages = {7}, year = {2024}, abstract = {Introduction: Persons after stroke experience limitations in activities of daily living even in the chronic phase. Many patients who had a stroke report mobility limitations with loss of social roles such as reduced gait- related participation. International best- practice recommendations for patients who had a stroke include interprofessional diagnostics as a core element for goal setting and intervention planning to improve social participation. Interprofessional diagnostics has not yet been implemented in Germany. Methods and analysis: The aim is to develop an interprofessional diagnostic toolkit. This will be done in a multi- step process: first, an integrative review is conducted to synthesise the literature. Second, the experiences regarding diagnostics and walking outside is captured in focus groups with persons after stroke, relatives and health professionals. Third, a toolkit for the interprofessional diagnostic process of gait- related- participation will be developed based on the results of the previous steps in a future workshop. Fourth, the results of each work package will be integrated into the iterative development process for evaluation and implementation. All steps will be performed in accordance with the respective reporting guidelines. Ethics and dissemination: This study has been approved by the ethics committee at the Ludwig Maximilians University (LMU), Germany and is overseen by LMU-Medical Institutional Review Board. Written informed consent will be obtained from all participants. Results will be disseminated through knowledge exchange with stakeholders and in peer- reviewed journal publications, scientific conferences, formal and informal reports. Stakeholders, patients and providers will be involved in most steps of the development from the beginning, which will facilitate later implementation at a larger scale. Trial registration number: German Register Clinical Trials/Deutsches Register Klinischer Studien DRKS00032389.}, language = {en} } @inproceedings{HorstmannshoffKieselDoeringeretal.2023, author = {Horstmannshoff, Caren and Kiesel, Theresia and D{\"o}ringer, Tobias and Voigt, Karen and Bauer, Petra and M{\"u}ller, Martin}, title = {Care pathway for evidence-based healthcare of patients with vertigo, dizziness or balance disorders in primary care. First results of the mixed-methods process evaluation}, series = {7. Forschungssymposium Physiotherapie}, booktitle = {7. Forschungssymposium Physiotherapie}, year = {2023}, abstract = {BACKGROUND Vertigo, dizziness or balance disorders (VDB) affect the mobility and participation of many older people and are also one of the most frequent reasons for visiting the general practitioner's (GP) practice due to multifactorial causes. Physiotherapy (PT) can be crucial for the complex care of people with VDB but is rarely prescribed by GPs. So we developed an evidence-based, multidisciplinary care pathway as a complex intervention following the UK Medical Research Council guideline, which was piloted and is now being evaluated for effectiveness, accompanied by a process evaluation. METHOD The care pathway of the multicentre cluster-RCT (MobilE-PHY2) included decision aids and training for PTs and GPs in the intervention group and optimised standard care in the control group. A mixed-methods process evaluation following Grant's framework for designing process evaluations examined barriers, facilitating factors and mechanisms of impact in recruiting and reaching participants, implementing the intervention and the response of all participants. Therefore, a logic model was developed illustrating the relationship between the planned work to implement the intervention, the expected mechanism of impact (based on the behaviour change wheel as a change theory), the intended results (output, outcome and impact), and categories of possible influencing factors. The underlying assumption is that a behavioural change in PT and GP is a prerequisite for a change in patient behaviour, which can lead to improved mobility and participation (outcome of MobilE-PHY2). Guided interviews were conducted with patients before the intervention and after six months and with PTs and GPs after six months. Additionally, the training evaluations, completed decision aids and structural questionnaires will be analysed from June 2023. RESULTS AND CONCLUSION At one study site, a total of 37 patients, 17 PTs and nine GPs were included. Interviews were conducted with 16 patients, six PTs and GPs. In the intervention group, 12 PTs and 18 GPs completed decision aids, 13 PTs and two GPs completed evaluation forms, and eight PTs and four GPs completed structural data. The preliminary results of the process evaluation will be reported at the Congress. The results are intended to give indications for a broad implementation of the care pathway, including and promoting physiotherapy and therefore contributing to improved evidence-based healthcare for older people with VDB.}, language = {en} } @misc{HorstmannshoffSchmidleBaueretal.2025, author = {Horstmannshoff, Caren and Schmidle, Stephanie and Bauer, Petra and M{\"u}ller, Martin}, title = {Impact of an evidence-based care pathway on the physical activity level in older adults with vertigo, dizziness, and balance disorders}, doi = {10.3205/25ebm053}, year = {2025}, language = {en} } @misc{SecklerKronastBaueretal.2019, author = {Seckler, Eva and Kronast, Verena and Bauer, Petra and M{\"u}ller, Martin}, title = {Barriers and Facilitators of multi-disciplinary care pathways in primary care: A Systematic Review}, year = {2019}, language = {en} } @misc{HorstmannshoffBorchersVoigtetal.2025, author = {Horstmannshoff, Caren and Borchers, Peggy and Voigt, Karen and M{\"u}ller, Martin and Bauer, Petra}, title = {The Impact of Physiotherapy in a Care Pathway on the Impairment of Mobility and Participation in Older Individuals with Vertigo}, doi = {10.82161/fbn5-pg94}, pages = {1}, year = {2025}, language = {en} }