@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} } @article{MuellerStroblJahnetal.2014, author = {M{\"u}ller, Martin and Strobl, R. and Jahn, K. and Linkohr, B. and Ladwig, K.H. and Mielk, A. and Grill, E.}, title = {Impact of vertigo and dizziness on self-perceived participation and autonomy in older adults: Results from the KORA-Age study}, series = {Quality of life research}, journal = {Quality of life research}, editor = {Springer Link,}, year = {2014}, abstract = {Purpose The impact of vertigo and dizziness on healthy ageing, and especially on participation, is not fully understood. The objective of this study was to investigate the association of vertigo and dizziness with self-perceived participation and autonomy in older non-institutionalised individuals, adjusted for the presence of other health conditions. Specifically, we wanted to investigate the different effects of vertigo and dizziness on specific components of participation, i.e. restrictions in indoor and outdoor autonomy, family role, social life and relationships, and work and education. Methods Data originate from the second wave of the German KORA-Age cohort study collected in 2012. Participation and autonomy was investigated with the Impact on Participation and Autonomy Questionnaire. We used robust regression to analyse the association of vertigo and dizziness with self-perceived participation and autonomy adjusted for covariates. Results A total of 822 participants (49.6 \% female) had a mean age of 78.1 years (SD 6.39). Participation and autonomy were significantly lower in participants with vertigo and dizziness across all domains. Adjusted for age, sex, and chronic conditions, vertigo and dizziness were significantly associated with participation restrictions in all domains except social life and relationships. Conclusion The results of our study indicate that vertigo and dizziness contribute to restrictions in participation and autonomy in individuals of older age. Recognising vertigo and dizziness as independent contributors to loss of autonomy and decreased chances for independent living may create new options for patient care and population health, such as the designing of complex interventions to maintain participation and autonomy.}, language = {en} } @article{MuellerStroblJahnetal.2014, author = {M{\"u}ller, Martin and Strobl, R. and Jahn, K. and Linkohr, B. and Peters, A. and Grill, E.}, title = {Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study}, series = {European journal of public health}, journal = {European journal of public health}, editor = {Oxford Academic,}, year = {2014}, abstract = {Background: Complaints of vertigo and dizziness are common in primary care in the aged. They can be caused by distinct vestibular disorders, but can also be a symptom in other conditions like non-vestibular sensory loss, vascular encephalopathy or anxiety. The aim of this study was to investigate the specific contribution of vertigo and dizziness to the total burden of disability in aged persons when controlling for the presence of other health conditions. Methods: Data originate from the MONICA/KORA study, a population-based cohort. Survivors of the original cohorts who were 65 years and older were examined by telephone interview in 2009. Disability was assessed with the Health Assessment Questionnaire. Logistic regression was used to adjust for potential confounders and additive regression to estimate the contribution of vertigo and dizziness to disability prevalence. Results: Adjusted for age, sex and other chronic conditions, vertigo and dizziness were associated with disability (odds ratio 1.66, 95\% confidence intervals 1.40-1.98). In both men and women between 65 and 79 years, vertigo and dizziness were among the strongest contributors to the burden of disability with a prevalence of 10.5\% (6.6 to 15.1) in men and 9.0\% (5.7 to 13.0) in women. In men, this effect is stable across all age-groups, whereas it decreases with age in women. Conclusions: Vertigo and dizziness independently and relevantly contribute to population-attributable disability in the aged. They are not inevitable consequences of ageing but arise from distinct disease entities. Careful management of vertigo and dizziness might increase population health and reduce disability.}, language = {en} } @article{StroblMuellerThorandetal.2014, author = {Strobl, R. and M{\"u}ller, Martin and Thorand, B. and Linkohr, B. and Autenrieth, C. S. and Peters, A. and Grill, E.}, title = {Men benefit more from midlife leisure-time physical activity than women regarding the development of late-life disability--results of the KORA-Age study}, series = {science direct}, journal = {science direct}, editor = {Elsevier,}, year = {2014}, abstract = {Objective Encouraging physical activity is an important public health measure to reduce disability prevalence in the aged. The aims of this study were to determine the association between midlife physical activity and late-life disability and to investigate gender-specific differences. Method This data originates from the KORA-Age cohort, a follow-up in 2008 of the MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases)/KORA (Cooperative Health Research in the Region of Augsburg) S1-S4 surveys (1984-2001) situated in Augsburg, a city in Southern Germany. We applied a multivariable hurdle model to investigate the association of physical activity and disability. Results We analysed 3333 persons with a mean follow-up of 18 ± 5.5 years. Using hurdle models, moderate activity and high activity had a protective effect on the occurrence of disability (OR (odds ratio) = 0.80 and 0.73), but not on severity (i.e. number of limitations). We observed a strong gender-specific difference in this association, with men benefitting more from exercise. Conclusion Elevated physical activity reduces the risk of becoming disabled and postpones the onset of disability by several years, but we could not show an effect on the severity of disability. In addition, men seem to benefit more from leisure-time physical activity than women}, language = {en} } @article{RoehrigStroblMuelleretal.2014, author = {Roehrig, N. and Strobl, R. and M{\"u}ller, Martin and Perz, S. and Kaab, S. and Martens, E. and Peters, A. and Linkohr, B. and Grill, E.}, title = {Directed acyclic graphs helped to identify confounding in the association of disability and electrocardiographic findings: results from the KORA-Age study}, series = {Journal of clinical epidemiology}, journal = {Journal of clinical epidemiology}, editor = {PlumX Metrics,}, year = {2014}, abstract = {Objectives To examine the association between electrocardiographic (ECG) findings and disability status in older adults. Study Design and Setting KORA-Age, a population-based cross-sectional study of the MONICA/KORA project, a randomized sample from Southern Germany of people aged 65 years or older. Results A total of 534 (51.5\%) of 1,037 participants were characterized as disabled. Disabled participants were on average 4.5 years older than those who were not disabled. Crude associations of left-axis deviation, ventricular conduction defects, atrial fibrillation, and QT prolongation with disability status were significant (P < 0.05). In models controlled for age and sex, these effects remained constant except for QT prolongation. In the models adjusted for the minimal sufficient adjustment set (consisting of the variables sex, physical activity, age, obesity, diabetes, education, heart diseases, income, lung diseases, and stroke) identified by a directed acyclic graph (DAG), no significant association could be shown. Conclusion Associations between specific ECG findings and disability were found in unadjusted analysis and logistic models adjusted for age and sex. However, when adjusting for other possible confounders identified by the DAG, all these associations were no longer significant. It is important to adequately identify confounding in such settings.}, language = {en} } @article{GrillMuellerQuittanetal.2011, author = {Grill, E. and M{\"u}ller, Martin and Quittan, M. and Fialka-Moser, V. and Strobl, R. and Kostanjsek, N. and Stucki, G.}, title = {Brief ICF Core Sets for the acute hospital}, series = {Journal of Rehabilitation Medicine}, journal = {Journal of Rehabilitation Medicine}, editor = {Medical Journals Limited,}, year = {2011}, abstract = {Objective: To identify candidate categories for brief International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in the acute hospital. Design: Prospective multi-centre cohort study. Patients: Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in acute hospitals. Methods: Functioning and contextual factors were coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables. Results: A total of 391 patients were included in the study (91 neurological, 109 cardiopulmonary, 191 musculoskeletal), mean age 63.4 years, 50.1\% female. Selection yielded 33 categories for neurological, 31 for cardiopulmonary, and 30 for musculoskeletal. Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the ICF categories most relevant for the practical assessment and monitoring of functioning in patients with acute neurological, cardiopulmonary, and musculoskeletal conditions.}, language = {en} }