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, 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 - 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 - TY - JOUR A1 - Saal, Susanne A1 - Beutner, Katrin A1 - Bogunski, Julia A1 - Obermüller, Kathrin A1 - Müller, Martin A1 - Grill, Eva A1 - Meyer, Gabriele ED - Oxford Academic, T1 - Interventions for the prevention and treatment of disability due to acquired joint contractures in older people: a systematic review JF - Age and Ageing N2 - Background acquired joint contractures have significant effects on quality of life and functioning. Objective to determine the effects of interventions to prevent and treat disabilities in older people with acquired joint contractures. Methods systematic search (last 8/2016) via Cochrane Library, PubMed, EMBASE, PEDro, CINAHL, trial registries, reference lists of retrieved articles and scientific congress pamphlets. Controlled and randomised controlled trials in English or German comparing an intervention with another intervention or standard care were included. Two independent researchers performed the selection of publications, data extraction and critical appraisal. Results seventeen studies with 992 participants met the inclusion criteria: 16 randomised controlled trials and 1 controlled trial (nursing homes = 4, community settings = 13). The methodological quality of the studies varied. Splints were examined in four studies, stretching exercises in nine studies, and ultrasound, passive movement therapy, bed-positioning and group exercise were each examined in one study. Studies on splints revealed inconclusive results regarding joint mobility or spasticity. Five of seven studies that assessed active stretching programmes for healthy older people reported statistically significant effects on joint mobility in favour of the intervention. Pain, quality of life, activity limitations and participation restrictions were rarely assessed. Conclusion the evidence for the effectiveness of interventions to prevent and treat disability due to joint contractures is weak, particularly for established nursing interventions such as positioning and passive movement. Better understanding is required regarding the delivery of interventions, such as their intensity and duration. In addition to functional issues, activities and social participation should also be studied as outcomes. KW - ultrasonography KW - elderly KW - disability KW - muscle spasticity Y1 - 2018 IS - 46 ER - TY - JOUR A1 - Saal, Susanne A1 - Klingshirn, Hanna A1 - Beutner, Katrin A1 - Strobl, Ralf A1 - Grill, Eva A1 - Müller, Martin A1 - Meyer, Gabriele T1 - Improved participation of older people with joint contractures living in nursing homes: feasibility of study procedures in a cluster-randomised pilot trial JF - Trials N2 - Background: Acquired joint contractures have a significant impact on functioning and quality of life in nursing home residents. There is very limited evidence on measures for prevention and treatment of disability due to joint contractures. We have developed the PECAN intervention (Participation Enabling CAre in Nursing) to improve social participation in nursing home residents. A cluster-randomised pilot trial was conducted to assess the feasibility of study procedures in preparation for a main trial according to the UK Medical Research Council (MRC) framework. Methods: Nursing homes in two regions of Germany were randomly allocated either to the intervention or optimised standard care (control group). All residents with joint contractures aged > 65 years were eligible for the study. The residents’ data were collected through structured face-to-face interviews by blinded assessors at baseline, after 3 and 6 months. The primary outcome was social participation, measured by a subscale of the PaArticular Scales. Secondary outcomes included activities and instrumental activities of daily living, health-related quality of life, falls and fall-related consequences. Data on the trial feasibility were collected via documentation forms. Results: Seven out of 12 nursing homes agreed to participate and remained in the trial. Of 265 residents who fulfilled the inclusion criteria, 129 were randomised either to the intervention (n = 64) or control group (n = 65) and analysed. A total of 109 (85%) completed the trial after 6 months. The mean age was 85.7 years (SD 7.0), 80% were women. The severity of the residents’ disability differed across the clusters. The completion rate was high (> 95%), apart from the Instrumental Activities of Daily Living Scale. Some items of the PaArticular Scales were not easily understood by residents. The frequency of falls did not differ between study groups. Conclusion: Our data confirmed the feasibility of the overall study design. We also revealed the need to improve the procedures for the recruitment of residents and for data collection before implementation into a main trial. The next step will be an adequately powered main trial to assess the effectiveness and cost-effectiveness of the intervention. KW - Joint contractures KW - Nursing homes KW - Participation KW - Complex intervention KW - Cluster-randomised pilot trial KW - Feasibility trial Y1 - 2019 UR - https://doi.org/10.1186/s13063-019-3522-1 VL - 20 SP - 411 ER - TY - JOUR A1 - Müller, Martin A1 - Meyer, Gabriele T1 - ZEFQ im Gespräch mit Prof. Dr. rer. medic. Martin Müller zum Thema „Robotik in der Pflege“ JF - Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen KW - Robotik in der Pflege Y1 - 2019 UR - https://doi.org/10.1016/j.zefq.2019.07.002 VL - 144-145 SP - 60 EP - 61 ER - TY - JOUR A1 - Nguyen, Natalie A1 - Thalhammer, Regina A1 - Beutner, Katrin A1 - Saal, Susanne A1 - Servaty, Ricarda A1 - Klingshirn, Hanna A1 - Icks, Andrea A1 - Freyberg, Kristina A1 - Vomhof, Markus A1 - Mansmann, Ulrich A1 - Le, Lien A1 - Müller, Martin A1 - Meyer, Gabriele T1 - Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185] JF - Trials N2 - Background: Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study. Methods/design: This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators’ workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents’ participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents’ quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost–utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation. Discussion: We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals. KW - Joint contractures KW - Participation KW - Activities KW - Nursing homes KW - International Classification of Functioning KW - Disability and Health (ICF) KW - Complex intervention KW - Multicentre cluster randomised controlled trial Y1 - 2019 UR - https://doi.org/10.1186/s13063-019-3384-6 VL - 20 SP - 305 ER -