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 - TY - JOUR A1 - Müller, Martin A1 - Oberhauser, Cornelia A1 - Fischer, Uli A1 - Bartoszek, Gabriele A1 - Saal, Susanne A1 - Strobl, Ralf A1 - Meyer, Gabriele A1 - Grill, Eva ED - CrossMark, T1 - The PaArticular Scales – A new outcome measure to quantify the impact of joint contractures on activities and participation in individuals in geriatric care: Development and Rasch analysis JF - International Journal of Nursing Studies N2 - Background Joint contractures are frequent conditions in individuals in geriatric care settings and are associated with activity limitations and participation restrictions. As such, relevant intervention programs should address these aspects, and the effectiveness of such programs should be determined by assessing improvement in activities and participation. However, no patient-centred and psychometrically sound outcome measures for this purpose are available so far. Objectives The objectives of this study were to develop and to validate a new outcome measure, the PaArticular Scales, to quantify activities and participation in older individuals with joint contractures. Specific aims were (A) to operationalize the content of an International Classification of Functioning, Disability and Health-based standard set towards meaningful questions and to combine them to a questionnaire and (B) to assess the psychometric properties of the developed questionnaire, in detail to evaluate test–retest reliability, objectivity, internal consistency reliability and criterion validity. Design Operationalization was reached by an expert consensus conference and a subsequent expert Delphi survey. Psychometric properties were assessed in a cross-sectional study. Settings Nursing homes, geriatric rehabilitation facilities. Participants 23 experts (nurses, physicians, physical and occupational therapists) participated in the consensus conference and the Delphi survey. A total of 191 individuals with joint contractures (as confirmed by physician, nurse or physical therapist) between 65 and 102 years, living in nursing homes or as patients in geriatric rehabilitation were enrolled in the cross-sectional study. Methods Rasch Partial Credit Modelling. Results The consensus conference and Delphi survey resulted in a questionnaire with 86 items of the International Classification of Functioning, Disability and Health. Test–retest-reliability among those was acceptable (Cohen's weighted kappa: 0.779). The Rasch analysis revealed two independent interval-scaled scales with 24 items for the Activities scale and 11 items for the Participation scale with high internal consistency reliability. Cronbach's alpha was 0.96 for the Activities scale and 0.92 for the Participation scale. Criterion validity was −0.40 and −0.30 for the Activities scale and for the Participation scale, respectively. Conclusions The PaArticular Scales, a new patient-centred and psychometric sound outcome measures to comprehensively assess the impact of joint contractures in geriatric care, are available now. These developed scales will serve as primary outcomes in a scheduled evaluation of a complex intervention to improve participation and quality of life in nursing home residents with joint contractures. KW - Contractures KW - Nursing homes KW - Social participation KW - Disability evaluation Y1 - 2016 IS - 59 ER - TY - JOUR A1 - Bartoszek, G. A1 - Fischer, U. A1 - Müller, Martin A1 - Strobl, R. A1 - Grill, E. A1 - Nadolny, S. A1 - Meyer, G. ED - BioMed Central, T1 - Outcome measures in older persons with acquired joint contractures: a systematic review and content analysis using the ICF (International Classification of Functioning, Disability and Health) as a reference JF - BMC Geriatrics N2 - Background: Joint contractures are a common health problem in older persons with significant impact on activities of daily living. We aimed to retrieve outcome measures applied in studies on older persons with joint contractures and to identify and categorise the concepts contained in these outcome measures using the ICF (International Classification of Functioning, Disability and Health) as a reference. Methods: Electronic searches of Medline, EMBASE, CINAHL, Pedro and the Cochrane Library were conducted (1/2002-8/2012). We included studies in the geriatric rehabilitation and nursing home settings with participants aged ≥ 65 years and with acquired joint contractures. Two independent reviewers extracted the outcome measures and transferred them to concepts using predefined conceptual frameworks. Concepts were subsequently linked to the ICF categories. Results: From the 1057 abstracts retrieved, 60 studies met the inclusion criteria. We identified 52 single outcome measures and 24 standardised assessment instruments. A total of 1353 concepts were revealed from the outcome measures; 96.2 % could be linked to 50 ICF categories in the 2nd level; 3.8 % were not categorised. Fourteen of the 50 categories (28 %) belonged to the component Body Functions, 4 (8 %) to the component Body Structures, 26 (52 %) to the component Activities and Participation, and 6 (12 %) to the component Environmental Factors. Conclusions: The ICF is a valuable reference for identifying and quantifying the concepts of outcome measures on joint contractures in older people. The revealed ICF categories remain to be validated in populations with joint contractures in terms of clinical relevance and personal impact. KW - joint contracture KW - Aged KW - Outcome KW - Geriatric rehabilitation Y1 - 2016 ER - TY - JOUR A1 - Bartoszek, Gabriele A1 - Fischer, Uli A1 - Clarmann von Clarenau, Stephan A1 - Grill, Eva A1 - Mau, Wilfried A1 - Meyer, Gabriele A1 - Strobl, Ralf A1 - Thiesemann, Rüdiger A1 - Nadolny, Stephan A1 - Müller, Martin ED - Science direct, T1 - Development of an International Classification of Functioning, Disability and Health (ICF)-based standard set to describe the impact of joint contractures on participation of older individuals in geriatric care settings JF - Archives of gerontology and geriatrics N2 - Introduction Joint contractures are characterized as impairment of the physiological movement of joints due to deformity, disuse or pain and have major impact especially for older individuals in geriatric care. Some measures for the assessment of the impact of joint contractures exist. However, there is no consensus on which aspects should constantly be measured. Our objective was to develop a standard-set based on the ICF for describing functioning and disability in older individuals with joint contractures in geriatric care settings, giving special emphasis to activities and participation. Methods The ICF-based standard set was developed in a formal decision-making and consensus process and based on an adapted version of the protocol to develop ICF Core Sets. These are sets of categories from the ICF, serving as standards for the assessment, communication and reporting of functioning and health for clinical studies, clinical encounters and multi-professional comprehensive assessment and management. Results Twenty-three experts from Germany and Switzerland selected 105 categories of the ICF component Activities and Participation for the ICF-based standard set. The largest number of categories was selected from the chapter Mobility (50 categories, 47.6%). Conclusions The standard set for older individuals with joint contractures provides health professionals with a standard for describing patients’ activity limitations and participation restrictions. The standard set also provides a common basis for the development of patient-centered measures and intervention programs. The preliminary version of the ICF-based standard set will be tested in subsequent studies with regard to its psychometric properties. KW - joint contracture KW - older people KW - activities of daily living KW - social participation Y1 - 2015 VL - 61 ER - TY - JOUR A1 - Müller, Martin A1 - Peters, A. A1 - Doring, A. A1 - Ladwig, K.-H. A1 - Holle, R. A1 - Meisinger, C. A1 - Linkohr, B. A1 - Autenrieth, C. A1 - Baumeister, S. A1 - Behr, J. A1 - Bergner, A. A1 - Bickel, H. A1 - Bidlingmaier, M. A1 - Dias, A. A1 - Emeny, R.T. A1 - Fischer, B. A1 - Grill, E. A1 - Gorzelniak, L. A1 - Hansch, H. A1 - Heidbreder, S. A1 - Heier, M. A1 - Horsch, A. A1 - Huber, D. A1 - Huber, R.M. A1 - Jorres, R.A. A1 - Kaab, S. A1 - Karrasch, A1 - Kirchberger, A1 - Klug, A1 - Kranz, A1 - Kruch, A1 - Lacruz, A1 - Lang, A1 - Mielk, A1 - Nowak, A1 - Schneider, A1 - Schulz, A1 - Seidel, A1 - Strobl, A1 - Thorand, A1 - Wende, A1 - Weidenhammer, A1 - Zimmermann, A1 - Wichmann, ED - Springer Nature, T1 - Multimorbidity and successful aging: the population-based KORA-Age study JF - Zeitschrift für Gerontologie und Geriatrie N2 - Background Multimorbidity in the older population is well acknowledged to negatively affect health-related quality of life (HRQL). Several studies have examined the independent effects of single diseases; however, little research has focused on interaction between diseases. The purpose of this study was to assess the impact of six self-reported major conditions and their combinations on HRQL measured by the EQ-5D. Methods The EQ-5D was administered in the population-based KORA-Age study of 4,565 Germans aged 65 years or older. A generalised additive regression model was used to assess the effects of chronic conditions on HRQL and to account for the nonlinear associations with age and body mass index (BMI). Disease interactions were identified by a forward variable selection method. Results The conditions with the greatest negative impact on the EQ-5D index were the history of a stroke (regression coefficient -11.3, p < 0.0001) and chronic bronchitis (regression coefficient -8.1, p < 0.0001). Patients with both diabetes and coronary disorders showed more impaired HRQL than could be expected from their separate effects (coefficient of interaction term -8.1, p < 0.0001). A synergistic effect on HRQL was also found for the combination of coronary disorders and stroke. The effect of BMI on the mean EQ-5D index was inverse U-shaped with a maximum at around 24.8 kg/m2. Conclusions There are important interactions between coronary problems, diabetes mellitus, and the history of a stroke that negatively affect HRQL in the older German population. Not only high but also low BMI is associated with impairments in health status. KW - Body Mass Index KW - Chronic Condition KW - Questionnaire Respondent KW - Disease Interaction KW - Coronary Problem Y1 - 2018 ER - TY - JOUR A1 - Strobl, R. A1 - Müller, Martin A1 - Thorand, B. A1 - Linkohr, B. A1 - Autenrieth, C. S. A1 - Peters, A. A1 - Grill, E. ED - Elsevier, T1 - Men benefit more from midlife leisure-time physical activity than women regarding the development of late-life disability--results of the KORA-Age study JF - science direct N2 - 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 KW - Aged KW - Aged 80 and over KW - physical activity KW - Disability evaluation Y1 - 2014 ER - TY - JOUR A1 - Peters, A. A1 - Doring, A. A1 - Ladwig, K.-H. A1 - Meisinger, C. A1 - Linkohr, B. A1 - Autenrieth, C. A1 - Baumeister, S.E. A1 - Behr, J. A1 - Bergner, A. A1 - Bickel, H. A1 - Bidlingmaier, M. A1 - Dias, A. A1 - Emeny, R.T. A1 - Fischer, B. A1 - Grill, E. A1 - Gorzelniak, L. A1 - Hansch, H. A1 - Heidbreder, S. A1 - Heier, M. A1 - Horsch, A. A1 - Huber, D. A1 - R. M., Huber A1 - Jorres, R.A. A1 - Kaab, S. A1 - Karrasch, S. A1 - Kirchberger, I. A1 - Klug, G. A1 - Kranz, B. A1 - Kuch, B. A1 - Lacruz, M.E. A1 - Lang, O. A1 - Mielck, A. A1 - Nowak, D. A1 - Perz, S. A1 - Schneider, A. A1 - Schulz, H. A1 - Müller, Martin A1 - Seidl, H. A1 - Strobl, R. A1 - Thorand, B. A1 - Wende, R. A1 - Weidenhammer, W. A1 - Zimmermann, A.-K. A1 - Wichmann, H.-E. A1 - Holle, R. ED - BioMed Central, T1 - Multimorbidity and successful aging: the population-based KORA-Age study JF - Health and quality of life outcomes N2 - Background Multimorbidity in the older population is well acknowledged to negatively affect health-related quality of life (HRQL). Several studies have examined the independent effects of single diseases; however, little research has focused on interaction between diseases. The purpose of this study was to assess the impact of six self-reported major conditions and their combinations on HRQL measured by the EQ-5D. Methods The EQ-5D was administered in the population-based KORA-Age study of 4,565 Germans aged 65 years or older. A generalised additive regression model was used to assess the effects of chronic conditions on HRQL and to account for the nonlinear associations with age and body mass index (BMI). Disease interactions were identified by a forward variable selection method. Results The conditions with the greatest negative impact on the EQ-5D index were the history of a stroke (regression coefficient -11.3, p < 0.0001) and chronic bronchitis (regression coefficient -8.1, p < 0.0001). Patients with both diabetes and coronary disorders showed more impaired HRQL than could be expected from their separate effects (coefficient of interaction term -8.1, p < 0.0001). A synergistic effect on HRQL was also found for the combination of coronary disorders and stroke. The effect of BMI on the mean EQ-5D index was inverse U-shaped with a maximum at around 24.8 kg/m2. Conclusions There are important interactions between coronary problems, diabetes mellitus, and the history of a stroke that negatively affect HRQL in the older German population. Not only high but also low BMI is associated with impairments in health status. KW - Aging KW - Multimorbidity KW - KORA Study Y1 - 2011 ER - TY - JOUR A1 - Grill, E. A1 - Furman, J.M. A1 - Alghwiri, A.A. A1 - Müller, Martin A1 - Whitney, S.L. ED - Bárány Society, T1 - Using core sets of the international classification of functioning, disability and health (ICF) to measure disability in vestibular disorders: study protocol JF - Journal of vestibular research N2 - Symptom frequency and severity in vestibular disorders often do not correlate well with patients' restrictions of activities of daily living and limitations of participation. Due to the lack of appropriate patient reported outcome measures (PRO), the extent of limitations and restrictions is mostly unknown. The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification to evaluate all aspects of health and disability. An ICF-based measure, the Vestibular and Participation Measure (VAP), was recently proposed. Also, an ICF Core Set for vertigo, dizziness and balance disorders was developed to describe what aspects of functioning should be measured. This study protocol describes the development and cross-cultural validation of a new measure, the VAP-extended (VAP-e), based on VAP and ICF Core Set on three continents. To determine objectivity and cross-cultural validity of the VAP and to find potentially redundant items, Rasch models will be used. The VAP-e will be created by modifying or adding items from the Activities and Participation and Environmental Factors component of the ICF Core Set. Reliability, objectivity and responsiveness of the VAP-e will be tested. KW - Vertigo KW - Dizziness KW - Quality of life KW - Activities of daily living Y1 - 2013 IS - 23(6) ER - TY - JOUR A1 - Müller, Martin A1 - Whitney, S. L. A1 - Alghwiri, A. A1 - Alshebber, K. A1 - Strobl, R. A1 - Aghadir, A. A1 - Almomani, M. O. A1 - Furman, J. M. A1 - Grill, E. ED - PlumX Metrics, T1 - Subscales of the vestibular activities and participation questionnaire could be applied across cultures JF - European journal of epidemiology N2 - 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. KW - Dizziness KW - Vertigo KW - Quality of life KW - Activities of daily living KW - social participation Y1 - 2018 ER - TY - JOUR A1 - Müller, Martin A1 - Grill, E. A1 - Furman, J.M. A1 - Alghwiri, A.A. A1 - Whitney, S.L. ED - IOS Press content Library, T1 - Using core sets of the international classification of functioning, disability and health (ICF) to measure disability in vestibular disorders: study protocol JF - Barany Society June 10, 2012 Symposium on Measures for Level of Functioning and Quality of Life in People with Vestibular Disorders N2 - Symptom frequency and severity in vestibular disorders often do not correlate well with patients' restrictions of activities of daily living and limitations of participation. Due to the lack of appropriate patient reported outcome measures (PRO), the extent of limitations and restrictions is mostly unknown. The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification to evaluate all aspects of health and disability. An ICF-based measure, the Vestibular and Participation Measure (VAP), was recently proposed. Also, an ICF Core Set for vertigo, dizziness and balance disorders was developed to describe what aspects of functioning should be measured. This study protocol describes the development and cross-cultural validation of a new measure, the VAP-extended (VAP-e), based on VAP and ICF Core Set on three continents. To determine objectivity and cross-cultural validity of the VAP and to find potentially redundant items, Rasch models will be used. The VAP-e will be created by modifying or adding items from the Activities and Participation and Environmental Factors component of the ICF Core Set. Reliability, objectivity and responsiveness of the VAP-e will be tested. KW - Dizziness KW - Vertigo KW - Quality of life Y1 - 2012 ER -