TY - CHAP A1 - Ragai, A1 - Schwabenbauer, A1 - Eser, A1 - Müller, ED - ASME, T1 - Effect of Process Parameters on the Electrically-Assisted Sintered Iron-Copper Powder Metals BT - Volume 2: Advanced Manufacturing T2 - ASME 2018 International Mechanical Engineering Congress and Exposition N2 - Electric-current-assisted sintering (ECAS) is a novel process that can potentially replace the conventional sintering method. It is hypothesized that the process can reduce the sintering time and can be used in situ; thus, can be more cost effective. The purpose of this research is to investigate the effect of direct current on the sintered properties of iron-copper powder metal. Experiments were conducted at various conditions to determine the optimal process parameters for this particular powder metal. The parameters investigated were electric current levels and energizing time. Experiments also included sintering the powder using a conventional furnace. Samples from both types of experiments were compared to determine the metallurgical differences due to the sintering process. Mechanical and microstructure examination were conducted to aid in determining the feasibility of ECAS. KW - Electric-current-assisted sintering Y1 - 2018 SN - 978-0-7918-5201-9 U6 - https://doi.org/10.1115/IMECE2018-86891 ER - TY - JOUR A1 - Lampart, Patricia A1 - Gemperli, Armin A1 - Baumberger, Michael A1 - Bersch, Ines A1 - Prodinger, Birgit A1 - Schmitt, Klaus A1 - Scheel-Sailer, Anke T1 - Administration of assessment instruments during the first rehabilitation of patients with spinal cord injury: a retrospective chart analysis. JF - Spinal Cord N2 - Objectives To examine which professionals administered which assessment instruments in which patient in clinical practice during first rehabilitation after newly acquired spinal cord injury (SCI) and the differences in the frequencies of different assessments between patient groups. Setting Specialized SCI acute care and rehabilitation clinic. Methods Patients after SCI, aged 18 years and above, admitted for first rehabilitation between December 2014 and December 2015 were analyzed. Descriptive statistics of 54 selected assessments. p values based on the χ 2 test were calculated for assessments used in both paraplegic and tetraplegic patients. Results One hundred and nineteen patients were screened. Forty-one assessments were administered, of which 10 on average more than once per patient. The most frequently used assessments were Spinal Cord Independence Measure III (7.7 times per patient), Skin Assessment (3.6 times), and Manual Muscle Test (3.2 times for Lower Extremities; 2.5 times for Upper Extremities). The American Spinal Injury Association Impairment Scale was administered on average 1.9 times per patient. More variation in the number of assessments per patient was observed in patients with complete and incomplete lesions compared to patients with paraplegia and tetraplegia. Conclusion Assessments covering neurological functioning, mobility, and self-care are used in clinical practice during first rehabilitation of patients with SCI, while others covering autonomic functioning, pain, participation, or quality of life are still missing. Based on these observations and national and international requirements, a meaningful standard for an assessment toolkit, applicable in general and in specific subgroups, needs to be defined and implemented. KW - spinal cord injury (SCI) KW - rehabilitation KW - assessment instruments Y1 - 2018 UR - https://doi.org/10.1038/s41393-017-0039-x VL - 56 IS - 4 SP - 322 EP - 331 PB - Springer Nature ER - TY - JOUR A1 - Fellinghauer, Carolina Saskia A1 - Prodinger, Birgit A1 - Tennant, Alan T1 - The Impact of Missing Values and Single Imputation upon Rasch Analysis Outcomes: A Simulation Study JF - Journal of Applied Measurement N2 - Imputation becomes common practice through availability of easy-to-use algorithms and software. This study aims to determine if different imputation strategies are robust to the extent and type of missingness, local item dependencies (LID), differential item functioning (DIF), and misfit when doing a Rasch analysis. Four samples were simulated and represented a sample with good metric properties, a sample with LID, a sample with DIF, and a sample with LID and DIF. Missing values were generated with increasing proportion and were either missing at random or completely at random. Four imputation techniques were applied before Rasch analysis and deviation of the results and the quality of fit compared. Imputation strategies showed good performance with less than 15% of missingness. The analysis with missing values performed best in recovering statistical estimates. The best strategy, when doing a Rasch analysis, is the analysis with missing values. If for some reason imputation is necessary, we recommend using the expectation-maximization algorithm. KW - Local item dependencies (LID) KW - Differential item functioning (DIF) KW - Imputation techniques KW - Rasch analysis Y1 - 2018 VL - 19 IS - 1 SP - 1 EP - 25 PB - JAM Press ER - TY - JOUR A1 - Ehrmann, Cristina A1 - Prodinger, Birgit A1 - Gmünder, Hans Peter A1 - Hug, Kerstin A1 - Bickenbach, Jerome E. A1 - Stucki, Gerold T1 - Describing Functioning in People Living With Spinal Cord Injury in Switzerland: A Graphical Modeling Approach JF - Archives of Physical Medicine and Rehabilitation N2 - Objective: To describe functioning in people living with spinal cord injuries (SCI) in Switzerland. Design: Secondary analysis of cross-sectional survey data. Setting Community, Switzerland. Participants: Individuals (N=1549) 16 years of age or older with a history of traumatic or nontraumatic SCI and permanently residing in Switzerland. Interventions: Not applicable. Main Outcome Measures: Functioning was operationalized through 4 domains: (1) impairments in body functions; (2) impairments in mental functions; (3) independence in performing activities; and (4) performance problems in participation. Results: Univariate analysis indicated a high prevalence of problems in 5 areas: (1) housework; (2) climbing stairs; (3) tiredness; (4) spasticity; and (5) chronic pain. Graphical modeling showed a strong association among the four domains of functioning. Moreover, we found that the differences in the dependence structures were significant between the paraplegia SCI population and the tetraplegia SCI population. Conclusions: This study is a first study in the epidemiology of functioning of people living with SCI in Switzerland. Using univariate and graphical modeling approaches, we proposed an empirical foundation for developing hypotheses on functioning in each domain and category that could inform health systems on people’s health needs. KW - DAG (directed acrylic graph) KW - ICF KW - SCI (Spinal cord injuries) Y1 - 2018 UR - https://doi.org/10.1016/j.apmr.2018.04.015 VL - 99 IS - 10 SP - 1965 EP - 1981 PB - Elsevier ER - TY - JOUR A1 - Prodinger, Birgit A1 - Taylor, Paul T1 - Improving quality of care through patient-reported outcome measures (PROMs): expert interviews using the NHS PROMs Programme and the Swedish quality registers for knee and hip arthroplasty as examples JF - BMC Health Services Research N2 - Background: Patient reported outcome measures (PROMs) have been integrated in national quality registries or specific national monitoring initiatives to inform the improvement of quality of care on a national scale. However there are many unanswered questions, such as: how these systems are set up, whether they lead to improved quality of care, which stakeholders use the information once it is available. The aim of this study was to examine supporting and hindering factors relevant to integrating patient-reported outcome measures (PROMs) in selected health information systems (HIS) tailored toward improving quality of care across the entire health system. Methods: First, a systematic search and review was conducted to outline previously identified factors relevant to the integration of PROMs in the selected HIS. A social network analysis was performed to identify networks of experts in these systems. Second, expert interviews were conducted to discuss and elaborate on the identified factors. Directive content analysis was applied using a HIS Evaluation Framework as the frame of reference. This framework is structured into four components: Organization, Human, Technology, and Net benefits. Results: The literature review revealed 37 papers for the NHS PROMs Programme and 26 papers for the SHPR and SKAR: Five networks of researchers were identified for the NHS PROMs Programme and 1 for the SHPR and SKAR. Seven experts related to the NHS PROMs Programme and 3 experts related to the SKAR and SHPR participated in the study. The main themes which revealed in relation to Organization were Governance and Capacity building; to Human: Reporting and Stakeholder Engagement; to Technology: the Selection and Collection of PROMs and Data linkage. In relation to Net benefits, system-specific considerations are presented. Conclusion: Both examples succeeded in integrating PROMs into HIS on a national scale. The lack of an established standard on what change PROMs should be achieved by an intervention limits their usefulness for monitoring quality of care. Whether the PROMs data collected within these systems can be used in routine clinical practice is considered a challenge in both countries. KW - Health information system evaluation KW - Quality registry KW - Oxford hip score KW - Oxford knee score KW - EQ-5D Y1 - 2018 UR - https://doi.org/10.1186/s12913-018-2898-z VL - 18 SP - 87 PB - Springer Nature ER - TY - JOUR A1 - Adroher, Núria Duran A1 - Prodinger, Birgit A1 - Fellinghauer, Carolina Saskia A1 - Tennant, Alan ED - Public Library of Science, T1 - All metrics are equal, but some metrics are more equal than others: A systematic search and review on the use of the term 'metric' JF - PLoS One N2 - Objective: To examine the use of the term ‘metric’ in health and social sciences’ literature, focusing on the interval scale implication of the term in Modern Test Theory (MTT). Materials and methods: A systematic search and review on MTT studies including ‘metric’ or ‘interval scale’ was performed in the health and social sciences literature. The search was restricted to 2001–2005 and 2011–2015. A Text Mining algorithm was employed to operationalize the eligibility criteria and to explore the uses of ‘metric’. The paradigm of each included article (Rasch Measurement Theory (RMT), Item Response Theory (IRT) or both), as well as its type (Theoretical, Methodological, Teaching, Application, Miscellaneous) were determined. An inductive thematic analysis on the first three types was performed. Results: 70.6% of the 1337 included articles were allocated to RMT, and 68.4% were application papers. Among the number of uses of ‘metric’, it was predominantly a synonym of ‘scale’; as adjective, it referred to measurement or quantification. Three incompatible themes ‘only RMT/all MTT/no MTT models can provide interval measures’ were identified, but ‘interval scale’ was considerably more mentioned in RMT than in IRT. Conclusion: ‘Metric’ is used in many different ways, and there is no consensus on which MTT metric has interval scale properties. Nevertheless, when using the term ‘metric’, the authors should specify the level of the metric being used (ordinal, ordered, interval, ratio), and justify why according to them the metric is at that level. KW - Metrics KW - MTT assay KW - Database Searching KW - Psychometrics Y1 - 2018 UR - https://doi.org/10.1371/journal.pone.0193861 VL - 13 IS - 3 SP - e0193861 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Rastall, Paul A1 - Kalra, Dipak A1 - Wooldridge, Darren A1 - Carpenter, Iain ED - Thieme E-Journals, T1 - Documenting Routinely What Matters to People: Standardized Headings for Health Records of Patients with Chronic Health Conditions JF - Applied Clinical Informatics N2 - Objective Specifying the content in electronic health records (EHRs) through standardized headings based on international reference classifications will facilitate their semantic interoperability. The objective of this study was to specify potential chapter headings for EHRs aligned with the World Health Organization's (WHO) International Classification of Functioning, Disability, and Health (ICF) based on the perspectives of people living with chronic health conditions, carers, and professionals. Methods A multistage process was established including (1) a patient workshop, (2) an online survey of both patients and carers, and (3) an online consultation with patient and professional bodies. The ICF served as a starting point. Based on the first stage, a first draft of the headings was developed and further refined based on the feedback at each stage. We examined in a fourth step whether items from existing assessment tools support the operationalization of the identified headings. Therefore, we used the WHO Disability Assessment Schedule 2.0 (WHODAS2.0), a patient-reported instrument, and interRAI, a clinician-administered instrument. Results The first workshop was attended by eight people, the survey was completed by 250 persons, and the online consultation received detailed feedback by 18 professional bodies. This study resulted in 16 potential chapter headings for EHRs which capture aspects related to the body, such as emotions, motivation, sleep, and memory or thoughts, to being involved in social life, such as mobility, social activities, and finances, as well as to the care process, such as understanding of health issues and treatment or care priorities and goals. When using the WHODAS2.0 and interRAI together, they capture all except one of the proposed headings. Conclusion The identified headings provide a high level structure for the standardized recording, use, and sharing of information. Once implemented, these headings have the potential to facilitate the delivery of personalized care planning for patients with long-term health problems. KW - Patient's perspective KW - electronic health records KW - international classification of functioning KW - disability and health Y1 - 2018 UR - https://doi.org/10.1055/s-0038-1649488 VL - 9 IS - 2 SP - 348 EP - 365 ER - TY - JOUR A1 - Hopfe, Maren A1 - Stucki, Gerold A1 - Bickenbach, Jerome E. A1 - Prodinger, Birgit T1 - Accounting for what matters to patients in the G-DRG System: A stakeholder’s perspective on integrating functioning information JF - Health Services Insights N2 - Functioning information constitutes a relevant component for determining patients’ service needs and respective resource use. Diagnosis-Related Group (DRG) systems can be optimized by integrating functioning information. First steps toward accounting for functioning information in the German DRG (G-DRG) system have been made; yet, there is no systematic integration of functioning information. The G-DRG system is part of the health system; it is embedded in and as such dependent on various stakeholders and vested interests. This study explores the stakeholder’s perspective on integrating functioning information in the G-DRG system. A qualitative interview study was conducted with national stakeholders in 4 groups of the G-DRG system (health policy, administration, development, and consultations). Interviews were analyzed using inductive thematic analysis. In total, 14 interviews were conducted (4 administration and 10 consultation group). Three main themes were identified: (1) functioning information in the G-DRG system: opportunities and obstacles, (2) general aspects concerning optimizing G-DRG systems by integrating additional information, and (3) ideas and requirements on how to proceed. The study offers insights into the opportunities and obstacles of integrating functioning information in the G-DRG system. The relevance of functioning information was evident. However, the value of functioning information for the G-DRG system was seen critically. Integrating functioning information alone does not seem to be sufficient and a systems approach is needed. KW - G-DRG System KW - Functioning information KW - Stakeholder interviews Y1 - 2018 UR - https://doi.org/10.1177%2F1178632918796776 IS - 11 SP - 1 EP - 10 ER - TY - JOUR A1 - Bergmann, Jeannine A1 - Krewer, Carmen A1 - Bauer, Petra A1 - König, Alexander A1 - Riener, Robert A1 - Müller, Friedemann T1 - Virtual reality to augment robot-assisted gait training in non-ambulatory patients with a subacute stroke: a pilot randomized controlled trial JF - European Journal of Physical and Rehabilitation Medicine N2 - BACKGROUND: Active performance is crucial for motor learning, and, together with motivation, is believed to be associated with a better rehabilitation outcome. Virtual reality (VR) is an innovative approach to engage and motivate patients during training. There is promising evidence for its efficiency in retraining upper limb function. However, there is insufficient proof for its effectiveness in gait training. AIM: To evaluate the acceptability of robot-assisted gait training (RAGT) with and without VR and the feasibility of potential outcome measures to guide the planning of a larger randomized controlled trial (RCT). DESIGN: Single-blind randomized controlled pilot trial with two parallel arms. SETTING: Rehabilitation hospital. POPULATION: Twenty subacute stroke patients (64±9 years) with a Functional Ambulation Classification (FAC) ≤2. METHODS: Twelve sessions (over 4 weeks) of either VR-augmented RAGT (intervention group) or standard RAGT (control group). Acceptability of the interventions (drop-out rate, questionnaire), patients’ motivation (Intrinsic Motivation Inventory [IMI], individual mean walking time), and feasibility of potential outcome measures (completion rate and response to interventions) were determined. RESULTS: We found high acceptability of repetitive VR-augmented RAGT. The drop-out rate was 1/11 in the intervention and 4/14 in the control group. Patients of the intervention group spent significantly more time walking in the robot than the control group (per session and total walking time; P<0.03). In both groups, motivation measured with the IMI was high over the entire intervention period. The felt pressure and tension significantly decreased in the intervention group (P<0.01) and was significantly lower than in the control group at the last therapy session (r=-0.66, P=0.005). The FAC is suggested as a potential primary outcome measure for a definitive RCT, as it could be assessed in all patients and showed significant response to interventions (P<0.01). We estimated a sample size of 44 for a future RCT. CONCLUSIONS: VR-augmented RAGT resulted in high acceptability and motivation, and in a reduced drop-out rate and an extended training time compared to standard RAGT. This pilot trial provides guidance for a prospective RCT on the effectiveness of VR-augmented RAGT. CLINICAL REHABILITATION IMPACT: VR might be a promising approach to enrich and improve gait rehabilitation after stroke. KW - Virtual reality KW - Robot-assisted gait training KW - Subacute stroke KW - Pilot randomized controlled trial Y1 - 2018 UR - https://doi.org/10.23736/S1973-9087.17.04735-9 VL - 2018 IS - 3 SP - 397 EP - 407 ET - 54 ER - TY - CHAP A1 - Armengaud, Erik A1 - Macher, Georg A1 - Massoner, Alexander A1 - Frager, Sebastian A1 - Adler, Rasmus A1 - Schneider, Daniel A1 - Longo, Simone A1 - Melis, Massimiliano A1 - Groppo, Riccardo A1 - Villa, Federica A1 - O’Leary, Padraig A1 - Bambury, Kevin A1 - Anita, Finnegan A1 - Zeller, Marc A1 - Höfig, Kai A1 - Papadopoulos, Yiannis A1 - Hawkins, Richard A1 - Kelly, Tim T1 - DEIS: Dependability Engineering Innovation for Industrial CPS T2 - Advanced Microsystems for Automotive Applications 2017 N2 - The open and cooperative nature of Cyber-Physical Systems (CPS) poses new challenges in assuring dependability. The DEIS project (Dependability Engineering Innovation for automotive CPS. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 732242, see http://www.deis-project.eu) addresses these challenges by developing technologies that form a science of dependable system integration. In the core of these technologies lies the concept of a Digital Dependability Identity (DDI) of a component or system. DDIs are modular, composable, and executable in the field facilitating (a) efficient synthesis of component and system dependability information over the supply chain and (b) effective evaluation of this information in-the-field for safe and secure composition of highly distributed and autonomous CPS. The paper outlines the DDI concept and opportunities for application in four industrial use cases. KW - Industrial CPS KW - Dependability Engineering KW - Automotive Applications Y1 - 2018 SP - 151 EP - 163 PB - Springer CY - Cham ER - TY - JOUR A1 - Jäger, Christoph G. A1 - Borchardt, D. T1 - Longitudinal patterns and response lengths of algae in riverine ecosystems: A model analysis emphasising benthic-pelagic interactions JF - Journal of Theoretical Biology N2 - In riverine ecosystems primary production is principally possible in two habitats: in the benthic layer by sessile algae and in the surface water by planktonic algae being transported downstream. The relevance of these two habitats generally changes along the rivers' continuum. However, analyses of the interaction of algae in these two habitats and their controlling factors in riverine ecosystems are, so far, very rare. We use a simplified advection-diffusion model system combined with ecological process kinetics to analyse the interaction of benthic and planktonic algae and nutrients along idealised streams and rivers at regional to large scales. Because many of the underlying processes affecting algal dynamics are influenced by depth, we focus particularly on the impact of river depth on this interaction. At constant environmental conditions all state variables approach stable spatial equilibria along the river, independent of the boundary conditions at the upstream end. Because our model is very robust against changes of turbulent diffusion and stream velocity, these spatial equilibria can be analysed by a simplified ordinary differential equation (ode) version of our model. This model variant reveals that at shallower river depths, phytoplankton can exist only when it is subsidised by detaching benthic algae, and in turn, at deeper river depths, benthic algae can exist only in low biomasses which are subsidised by sinking planktonic algae. We generalise the spatial dynamics of the model system using different conditions at the upstream end of the model, which mimic various natural or anthropogenic factors (pristine source, dam, inflow of a waste water treatment plant, and dilution from e.g. a tributary) and analyse how these scenarios influence different aspects of the longitudinal spatial dynamics of the full spatial model: the relation of spatial equilibrium to spatial maximum, the distance to the spatial maximum, and the response length. Generally, our results imply that shallow systems recover within significantly shorter distances from spatially distinct disturbances when compared to deep systems, independent of the type of disturbance. KW - Nutrients KW - Light KW - Longitudinal gradient KW - Resilience Y1 - 2018 UR - https://doi.org/10.1016/j.jtbi.2018.01.009 VL - 442 SP - 66 EP - 78 ER - TY - CHAP A1 - Goeller, Toni A1 - Wenninger, Marc A1 - Schmidt, Jochen T1 - Towards Cost-Effective Utility Business Models - Selecting a Communication Architecture for the Rollout of New Smart Energy Services T2 - Proceedings of the 7th International Conference on Smart Cities and Green ICT Systems - Volume 1: SMARTGREENS N2 - The IT architecture for meter reading and utility services is at the core of new business models and has a decisive role as an enabler for resource efficiency measures. The communication architecture used by those services has significant impact on cost, flexibility and speed of new service rollout. This article describes how the dominant system model for meter reading came about, what alternative models exist, and what trade-offs those models have for rollout of new services by different stakeholders. Control of a self learning home automation system by dynamic tariff information (Real-Time-Pricing) is given as an application example. KW - Smart Meter, Advanced Metering Infrastructure, AMI Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:861-opus4-8332 SN - 978-989-758-292-9 SP - 231 EP - 237 PB - SciTePress ER - TY - JOUR A1 - Kovacs, E. A1 - Strobl, R. A1 - Phillips, A. A1 - Stephan, A.-J. A1 - Müller, Martin A1 - Gensichen, J. A1 - Grill, E. T1 - Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care JF - Journal of General Internal Medicine N2 - 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. KW - Evidence- based medicine KW - Implementation KW - General practitioner KW - Intervention KW - Harvest plot Y1 - 2018 UR - https://doi.org/10.1007/s11606-018-4435-5 VL - 33 SP - 1142 EP - 1154 ER - TY - JOUR A1 - Kirsch, R. A1 - Bergmann, A. A1 - Koller, D. A1 - Leidl, R. A1 - Mansmann, U. A1 - Müller, Martin A1 - Sanftenberg, L. A1 - Schelling, J. A1 - Sundmacher, L. A1 - Voigt, Karen A1 - Grill, E. T1 - 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 JF - BMJ Open N2 - 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-Universität München and of the Technische Universität 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. KW - Vertigo KW - Dizziness KW - Balance Disorders KW - Osteoarthritis KW - Cohort Study Y1 - 2018 UR - http://dx.doi.org/10.1136/bmjopen-2018-022970 VL - 8 IS - 4 SP - e022970 ER - TY - JOUR A1 - Klingshirn, H. A1 - Mittrach, R. A1 - Braitmayer, K. A1 - Strobl, R. A1 - Bender, A. A1 - Grill, E. A1 - Müller, Martin T1 - 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 JF - BMC Health Services Research N2 - 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. KW - Questionnaire development KW - Cognitive Interview KW - Pretest KW - Rehabilitation KW - Long-term care KW - Disorder of consciousness KW - Vegetative state KW - Minimaly conscious state Y1 - 2018 UR - https://doi.org/10.1186/s12913-018-3153-3 VL - 18 SP - 329 ER - TY - JOUR A1 - Saal, S. A1 - Meyer, G. A1 - Beutner, K. A1 - Klingshirn, H. A1 - Strobl, R. A1 - Grill, E. A1 - Mann, E. A1 - Köpke, S. A1 - Bleijlevens, M.H.C. A1 - Bartoszek, G. A1 - Stephan, A.-J. A1 - Hirt, J. A1 - Müller, Martin T1 - Development of a complex intervention to improve participation of nursing home residents with joint contractures: a mixed-method study JF - BMC Geriatrics N2 - 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). KW - Contractures KW - Nursing homes KW - Social participation KW - Disability and health Y1 - 2018 UR - https://doi.org/10.1186/s12877-018-0745-z ER -