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  <doc>
    <id>1781</id>
    <completedYear>2021</completedYear>
    <publishedYear/>
    <thesisYearAccepted/>
    <language>eng</language>
    <pageFirst>62</pageFirst>
    <pageLast/>
    <pageNumber/>
    <edition/>
    <issue/>
    <volume>22</volume>
    <type>article</type>
    <publisherName/>
    <publisherPlace/>
    <creatingCorporation/>
    <contributingCorporation/>
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    <title language="eng">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</title>
    <abstract language="eng">Background&#13;
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.&#13;
&#13;
Methods&#13;
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.&#13;
&#13;
Results&#13;
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.&#13;
&#13;
Conclusion&#13;
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.&#13;
&#13;
Trial registration&#13;
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).</abstract>
    <parentTitle language="eng">BMC Family Practice</parentTitle>
    <identifier type="url">https://doi.org/10.1186/s12875-021-01410-2</identifier>
    <enrichment key="PeerReviewed">Ja</enrichment>
    <enrichment key="RS_Acronym">MobilE-NET</enrichment>
    <enrichment key="RS_Correlation">Ja</enrichment>
    <enrichment key="RS_ProjectTitle">Munich Network Health Care Research</enrichment>
    <enrichment key="RS_FundingAgency">BMBF</enrichment>
    <enrichment key="RS_GrantNumber">01GY1603C</enrichment>
    <enrichment key="opus.source">publish</enrichment>
    <enrichment key="opus.doi.autoCreate">false</enrichment>
    <enrichment key="opus.urn.autoCreate">true</enrichment>
    <author>Eva Seckler</author>
    <author>Verena Regauer</author>
    <author>Melanie Krüger</author>
    <author>Anna Gabriel</author>
    <author>Joachim Hermsdörfer</author>
    <author>Carolin Niemietz</author>
    <author>Petra Bauer</author>
    <author>Martin Müller</author>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Critical pathways</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Primary health care</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>General practitioners</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Aged</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Vertigo</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Dizziness</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Physical therapy modalities</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Implementation science</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Feasibility studies</value>
    </subject>
    <collection role="institutes" number="">Fakultät für Angewandte Gesundheits- und Sozialwissenschaften</collection>
    <collection role="institutes" number="">Zentrum für Forschung, Entwicklung und Transfer</collection>
    <thesisPublisher>Technische Hochschule Rosenheim</thesisPublisher>
  </doc>
  <doc>
    <id>1780</id>
    <completedYear>2021</completedYear>
    <publishedYear/>
    <thesisYearAccepted/>
    <language>eng</language>
    <pageFirst>89</pageFirst>
    <pageLast/>
    <pageNumber/>
    <edition/>
    <issue/>
    <volume>22</volume>
    <type>article</type>
    <publisherName/>
    <publisherPlace/>
    <creatingCorporation/>
    <contributingCorporation/>
    <belongsToBibliography>0</belongsToBibliography>
    <completedDate>--</completedDate>
    <publishedDate>--</publishedDate>
    <thesisDateAccepted>--</thesisDateAccepted>
    <title language="eng">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</title>
    <abstract language="eng">Background&#13;
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.&#13;
&#13;
Methods&#13;
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.&#13;
&#13;
Results&#13;
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.&#13;
&#13;
Conclusion&#13;
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.&#13;
&#13;
Trial Registration&#13;
The research project is registered in “Projektdatenbank Versorgungsforschung Deutschland” (Project-ID: VfD_MobilE-PHY_17_003910; date of registration: 30.11.2017).</abstract>
    <parentTitle language="eng">BMC Family Practice</parentTitle>
    <identifier type="url">https://doi.org/10.1186/s12875-021-01441-9</identifier>
    <enrichment key="PeerReviewed">Ja</enrichment>
    <enrichment key="RS_Acronym">MobilE-NET</enrichment>
    <enrichment key="RS_Correlation">Ja</enrichment>
    <enrichment key="RS_ProjectTitle">Munich Network Health Care Research</enrichment>
    <enrichment key="RS_FundingAgency">BMBF</enrichment>
    <enrichment key="RS_GrantNumber">01GY1603C</enrichment>
    <enrichment key="opus.source">publish</enrichment>
    <enrichment key="opus.doi.autoCreate">false</enrichment>
    <enrichment key="opus.urn.autoCreate">true</enrichment>
    <author>Verena Regauer</author>
    <author>Eva Seckler</author>
    <author>Eva Grill</author>
    <author>Richard Ippisch</author>
    <author>Klaus Jahn</author>
    <author>Petra Bauer</author>
    <author>Martin Müller</author>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Critical Pathways</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Implementation Science</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Primary Health Care</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Aged</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Vertigo</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Dizziness</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>General Practitioners</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Physical Therapy Modalities</value>
    </subject>
    <collection role="institutes" number="">Fakultät für Angewandte Gesundheits- und Sozialwissenschaften</collection>
    <collection role="institutes" number="">Zentrum für Forschung, Entwicklung und Transfer</collection>
    <thesisPublisher>Technische Hochschule Rosenheim</thesisPublisher>
  </doc>
</export-example>
