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 - 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 - Müller, Martin A1 - Bartoszek, G. A1 - Beutner, K. A1 - Klingshirn, H. A1 - Saal, S. A1 - Stephan, A.-J. A1 - Strobl, R. A1 - Grill, E. A1 - Meyer, G. ED - NCBI, T1 - Developing and piloting a multifactorial intervention to address participation and quality of life in nursing home residents with joint contractures JF - German medical science N2 - Background: Joint contractures are common problems in frail older people in nursing homes. Irrespective of the exact extent of older individuals in geriatric care settings living with joint contractures, they appear to be a relevant problem. Also, the new emphasis on the syndrome of joint contractures, e. g. by the German statutory long term care insurance, led to an increase in assessment and documentation efforts and preventive interventions in clinical care. However, more attention should be paid to the actual situation of older individuals in nursing homes with prevalent joint contractures, particularly their experience of related activity limitations and participation restrictions. Thus, the aim of this study is 1) to develop a tailored intervention to improve functioning, and especially participation and quality of life in older residents with joint contractures in nursing homes and 2) to test the feasibility of the intervention accompanied by a rigorous process evaluation. Methods: The complex intervention, which will be developed in this project follows the UK Medical Research Council (MRC) framework and integrates the perspectives of all potentially relevant user groups, from the affected individuals to clinicians and researchers. The development process will comprise a systematic literature review, reanalysis of existing data and the integration of the knowledge of the affected individuals and experts. The developed intervention including a comprehensive process evaluation will be pilot tested with residents with joint contractures in three nursing homes. Discussion: The projected study will provide a tailored intervention to improve functioning, participation and quality of life in older residents with joint contractures in nursing homes. With this focus, the intervention will support patient relevant outcomes. The pilot study including process evaluation will offer a first opportunity to indicate the size of the intervention’s effect and prepare further studies. KW - Contractures KW - Aged KW - disabled persons KW - complex interventions KW - participation Y1 - 2018 ER - TY - JOUR A1 - Fischer, U. A1 - Müller, Martin A1 - Strobl, R. A1 - Bartoszek, G. A1 - Meyer, G. A1 - Grill, E. ED - minerva medica, T1 - Prevalence of functioning and disability in older patients with joint contractures: a cross-sectional study JF - European Journal of physical and rehabilitation medicine KW - Contractures KW - Geriatric assessment KW - outcome assessment KW - social participation KW - cross-sectional studies Y1 - 2015 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 - Fischer, U. A1 - Bartoszek, G. A1 - Müller, Martin A1 - Strobl, R. A1 - Meyer, G. A1 - Grill, E. ED - Taylor and Francis online, T1 - Patients' view on health-related aspects of functioning and disability of joint contractures: a qualitative interview study based on the International Classification of Functioning, Disability and Health JF - Disability and Rehabilitation N2 - Purpose: The aim of this study was to identify health-relevant aspects of functioning and disability of persons aged 65 years or older with joint contractures, to link the findings to corresponding ICF categories and to describe the patients’ perspective. Methods: We conducted 43 qualitative, semi-structured, face-to-face interviews with affected persons in two different locations (Witten, Munich) and in three different settings. Data were analyzed using the “meaning condensation procedure” and then linked to ICF categories. Results: From all interviews a total of 2499 single meaning-concepts were extracted which were linked to 324 different ICF categories. The participants in all settings mainly reported problems related to “Mobility of a single joint (b710)”, “Sensation of pain (b280)” and problems related to “Walking (d450)”. Almost all participants reported “Products and technology for personal indoor and outdoor mobility and transportation (e120)” as a relevant environmental factor. Conclusions: From the patients’ perspective, joint contractures have an impact on multifaceted aspects of functioning and disability, mainly body functions, environmental factors and activities and participation. The results of this study will contribute to the development of a standard instrument for measuring functioning, disability and health-relevant aspects for patients with joint contractures. Implications for Rehabilitation Joint contractures are a major cause for the development of disability in older people. Patients’ perspectives and their personal experiences have to be considered when assessing the impact of joint contractures. The International Classification of Functioning, Disability and Health (ICF) is an appropriate framework for describing the patients’ multifaceted experience of joint contractures. KW - joint contracture KW - Geriatrics KW - outcome assessment KW - qualitative research KW - social participation Y1 - 2014 ER - TY - JOUR A1 - Fischer, U. A1 - Müller, Martin A1 - Strobl, R. A1 - Bartoszek, G. A1 - Meyer, G. A1 - Grill, E. ED - Elaine Tilka, Miller T1 - Examining Functioning and Contextual Factors in Individuals with Joint Contractures from the Health Professional Perspective Using the ICF: An International Internet‐Based Qualitative Expert Survey JF - Rehabilitation nursing N2 - Purpose The aim of this study was to identify disease‐related aspects of functioning and disability in people with joint contractures from a health professionals' perspective and to describe the findings, using categories of the International Classification of Functioning, Disability, and Health (ICF). Design An Internet‐based expert survey. Methods We asked international health professionals for typical problems in functioning and important contextual factors of individuals with joint contractures using an Internet‐based open‐ended questionnaire. All answers were linked to the ICF according to established rules. Absolute and relative frequencies of the linked ICF categories were reported. Findings Eighty experts named 1785 meaning units which could be linked to 256 ICF categories. Among the categories, 24.2% belonged to the component Body Functions, 20.7% to Body Structures, 36.3% to Activities and Participation, and 18.8% to Environmental Factors. Conclusion Health professionals addressed a large variety of functional problems and multifaceted aspects due to the symptom joint contractures. Clinical Relevance International health professionals reported a large variety of aspects of functioning and health, which are related to joint contractures KW - joint contracture KW - disability KW - rehabilitation Y1 - 2014 ER - TY - JOUR A1 - Müller, Martin A1 - Strobl, R. A1 - Jahn, K. A1 - Linkohr, B. A1 - Ladwig, K.H. A1 - Mielk, A. A1 - Grill, E. ED - Springer Link, T1 - Impact of vertigo and dizziness on self-perceived participation and autonomy in older adults: Results from the KORA-Age study JF - Quality of life research N2 - Purpose The impact of vertigo and dizziness on healthy ageing, and especially on participation, is not fully understood. The objective of this study was to investigate the association of vertigo and dizziness with self-perceived participation and autonomy in older non-institutionalised individuals, adjusted for the presence of other health conditions. Specifically, we wanted to investigate the different effects of vertigo and dizziness on specific components of participation, i.e. restrictions in indoor and outdoor autonomy, family role, social life and relationships, and work and education. Methods Data originate from the second wave of the German KORA-Age cohort study collected in 2012. Participation and autonomy was investigated with the Impact on Participation and Autonomy Questionnaire. We used robust regression to analyse the association of vertigo and dizziness with self-perceived participation and autonomy adjusted for covariates. Results A total of 822 participants (49.6 % female) had a mean age of 78.1 years (SD 6.39). Participation and autonomy were significantly lower in participants with vertigo and dizziness across all domains. Adjusted for age, sex, and chronic conditions, vertigo and dizziness were significantly associated with participation restrictions in all domains except social life and relationships. Conclusion The results of our study indicate that vertigo and dizziness contribute to restrictions in participation and autonomy in individuals of older age. Recognising vertigo and dizziness as independent contributors to loss of autonomy and decreased chances for independent living may create new options for patient care and population health, such as the designing of complex interventions to maintain participation and autonomy. KW - Aged KW - Aged and over 80 KW - participation KW - autonomy KW - chronic conditions KW - vertigo KW - dizziness Y1 - 2018 ER - TY - JOUR A1 - Müller, Martin A1 - Strobl, R. A1 - Jahn, K. A1 - Linkohr, B. A1 - Peters, A. A1 - Grill, E. ED - Oxford Academic, T1 - Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study JF - European journal of public health N2 - Background: Complaints of vertigo and dizziness are common in primary care in the aged. They can be caused by distinct vestibular disorders, but can also be a symptom in other conditions like non-vestibular sensory loss, vascular encephalopathy or anxiety. The aim of this study was to investigate the specific contribution of vertigo and dizziness to the total burden of disability in aged persons when controlling for the presence of other health conditions. Methods: Data originate from the MONICA/KORA study, a population-based cohort. Survivors of the original cohorts who were 65 years and older were examined by telephone interview in 2009. Disability was assessed with the Health Assessment Questionnaire. Logistic regression was used to adjust for potential confounders and additive regression to estimate the contribution of vertigo and dizziness to disability prevalence. Results: Adjusted for age, sex and other chronic conditions, vertigo and dizziness were associated with disability (odds ratio 1.66, 95% confidence intervals 1.40–1.98). In both men and women between 65 and 79 years, vertigo and dizziness were among the strongest contributors to the burden of disability with a prevalence of 10.5% (6.6 to 15.1) in men and 9.0% (5.7 to 13.0) in women. In men, this effect is stable across all age-groups, whereas it decreases with age in women. Conclusions: Vertigo and dizziness independently and relevantly contribute to population-attributable disability in the aged. They are not inevitable consequences of ageing but arise from distinct disease entities. Careful management of vertigo and dizziness might increase population health and reduce disability. KW - Dizziness KW - Vertigo KW - disability Y1 - 2018 ER - TY - JOUR A1 - Grill, E. A1 - Strupp, M. A1 - Müller, Martin A1 - Jahn, K. ED - Springer Link, T1 - Health services utilization of patients with vertigo in primary care: a retrospective cohort study JF - Journal of neurology N2 - Vertigo and dizziness count among the most frequent symptoms in outpatient practices. Although most vestibular disorders are manageable, they are often under- and misdiagnosed in primary care. This may result in prolonged absence from work, increased resource use and, potentially, in chronification. Reliable information on health services utilization of patients with vertigo in primary care is scarce. Retrospective cohort study in patients referred to a tertiary care balance clinic. Included patients had a confirmed diagnosis of benign paroxysmal positional vertigo (BPPV), Menière’s disease (MD), vestibular paroxysmia (VP), bilateral vestibulopathy (BVP), vestibular migraine (VM), or psychogenic vertigo (PSY). All previous diagnostic and therapeutic measures prior to the first visit to the clinic were recorded. 2,374 patients were included (19.7 % BPPV, 12.7 % MD, 5.8 % VP, 7.2 % BVP, 14.1 % VM, 40.6 % PSY), 61.3 % with more than two consultations. Most frequent diagnostic measures were magnetic resonance imaging (MRI, 76.2 %, 71 % in BPPV) and electrocardiography (53.5 %). Most frequent therapies were medication (61.0 %) and physical therapy (41.3 %). 37.3 % had received homoeopathic medication (39 % in BPPV), and 25.9 % were treated with betahistine (20 % in BPPV). Patients had undergone on average 3.2 (median 3.0, maximum 6) diagnostic measures, had received 1.8 (median 2.0, maximum 8) therapies and 1.8 (median 1.0, maximum 17) different drugs. Diagnostic subgroups differed significantly regarding number of diagnostic measures, therapies and drugs. The results emphasize the need for establishing systematic training to improve oto-neurological skills in primary care services not specialized on the treatment of dizzy patients. KW - Primary health care KW - Vertigo KW - Dizziness KW - Utilization Y1 - 2014 ER -