TY - JOUR A1 - Müller, Martin A1 - Grill, E. A1 - Strobl, R. ED - Medical Journals Limited, T1 - Goals of patients with rehabilitation needs in acute hospitals: goal achivement is an indicator for improved functioning JF - Journal of Rehabilitation Medicine N2 - Objective: To identify goals of patients with rehabilitation needs in the acute hospital setting using the International Classification of Functioning, Disability and Health (ICF), to examine association of goal achievement with improvement in overall functioning, and to examine whether ICF Core Sets for the acute hospital cover patients goals. Design: Multi-centre cohort study. Patients: A total of 397 patients (50% female, mean age 63 years) from 5 hospitals in Austria, Switzerland and Germany. Methods: A semi-structured questionnaire was used to assess patient goals and goal achievement. Overall functioning from the patients' and health professionals' perspective was assessed on a numerical rating scale. Improvement in functioning was calculated using a residualized gain score. Association between goal achievement and improvement in overall functioning was assessed with logistic regression. Results: A total of 397 patients reported achievement of at least 1 goal. Eighty-eight percent of the goals were translated into categories of the ICF. Logistic regression analyses revealed significant association between goal achievement and overall functioning. Conclusion: The ICF might be useful to identify and structure patient's goals in acute hospital care. The association between goal achievement and improved functioning underlines that it is essential to involve the patient in the process of planning rehabilitation interventions in acute hospitals. KW - Advance care planning KW - Classification KW - Cohort study KW - ICF KW - Intensive Care KW - Outcome assessment Y1 - 2018 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 - 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 - 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 - CHAP A1 - Krause, Harald A1 - Strobl, Thomas A1 - Wirnsberger, Markus T1 - Einfache Lüftungssysteme für Wohngebäude – Untersuchungen in einer Forschungswohnung T2 - Konferenzband Int. Passivhaustagung 2018 N2 - Besonders einfache Lüftungssysteme sind heute vor allem in der Sanierung wichtig. In einer Vielzahl von Messreihen hat sich gezeigt, dass das System der zentralen Zulufteinbringung mit Verteilung über aktive Überströmer im Hinblick auf den Schadstoffaufbau und der sich einstellenden Luftqualität ausreichend funktioniert. KW - Passivhaus KW - Wohnungslüftung Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:861-opus4-9492 ER - TY - JOUR A1 - Klingshirn, Hanna A1 - Müller, Martin A1 - Beutner, Katrin A1 - Hirt, Julian A1 - Strobl, Ralf A1 - Grill, Eva A1 - Meyer, Gabriele A1 - Saal, Susanne T1 - Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: a process evaluation of a cluster-randomised pilot trial JF - BMC Geriatrics N2 - Background Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation. Methods The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis. Results Seven nursing homes (n = 4 intervention groups, n = 3 control groups) in two regions of Germany took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: “good”; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nurses. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers. Conclusion The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning are needed to support the facilitators during implementation in the main trial. Trial registration German clinical trials register, DRKS00010037. Registered 12 February 2016. KW - Joint contractures KW - Nursing homes KW - Participation KW - Complex intervention KW - Cluster-randomised controlled trials KW - Pilot study KW - Implementation strategy KW - Process evaluation Y1 - 2020 UR - https://doi.org/10.1186/s12877-020-01655-z VL - 20 SP - 270 ER -