TY - JOUR A1 - Seckler, Eva A1 - Regauer, Verena A1 - Rotter, Thomas A1 - Bauer, Petra A1 - Müller, Martin T1 - Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review JF - BMC Family Practice N2 - Background: Care pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered. The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC). Methods: A systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies (main project reports) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed. Results: Fourteen studies (seven main project reports and seven process evaluation reports) of the identified 8154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied. The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework. The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good multi-disciplinary communication and individual tailored interventions were identified as facilitators. Conclusions: In the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience. KW - Systematic review KW - Critical pathways KW - Primary health care KW - General practitioners Y1 - 2020 UR - https://doi.org/10.1186/s12875-020-01179-w VL - 21 SP - 113 ER - TY - JOUR A1 - Regauer, Verena A1 - Seckler, Eva A1 - Müller, Martin A1 - Bauer, Petra T1 - Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review JF - BMC Geriatrics N2 - Background Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes. Methods A systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted. Results A total of 20 randomized and 2 non-randomized controlled trials with 1876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms. Conclusion To treat older individuals with VDB, VR in any variation and in addition to CRMs seems to be effective. High-quality randomized trials need to be conducted to inform clinical decision making. Trial registration PROSPERO 2017 CRD42017080291. KW - Aged KW - Aged, 80 and over KW - Dizziness, KW - Mobility limitation KW - Nervous system diseases KW - Physical therapy modalities KW - Postural balance KW - Social participation KW - Treatment outcome KW - Vertigo Y1 - 2020 UR - https://doi.org/10.1186/s12877-020-01899-9 VL - 20 SP - 494 ER - TY - JOUR A1 - Regauer, Verena A1 - Seckler, Eva A1 - Grill, Eva A1 - Ippisch, Richard A1 - Jahn, Klaus A1 - Bauer, Petra A1 - Müller, Martin T1 - Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: a mixed methods study JF - BMC Family Practice N2 - Background Vertigo, dizziness and balance disorders (VDB) are common in older people and cause restrictions in mobility and social participation. Due to a multifactorial aetiology, health care is often overutilised, but many patients are also treated insufficiently in primary care. The purpose of this study was to develop a care pathway as a complex intervention to improve mobility and participation in older people with VDB in primary care. Methods The development process followed the UK Medical Research Council guidance using a mixed-methods design with individual and group interviews carried out with patients, physical therapists (PTs), general practitioners (GPs), nurses working in community care and a multi-professional expert panel to create a first draft of a care pathway (CPW) and implementation strategy using the Consolidated Framework of Implementation Research and the Expert recommendations for Implementing Change. Subsequently, small expert group modelling of specific components of the CPW was carried out, with GPs, medical specialists and PTs. The Behaviour Change Wheel was applied to design the intervention´s approach to behaviour change. To derive theoretical assumptions, we adopted Kellogg´s Logic Model to consolidate the hypothesized chain of causes leading to patient-relevant outcomes. Results Individual interviews with patients showed that VDB symptoms need to be taken more seriously by GPs. Patients demanded age-specific treatment offers, group sessions or a continuous mentoring by a PT. GPs required a specific guideline for diagnostics and treatment options including psychosocial interventions. Specific assignment to and a standardized approach during physical therapy were desired by PTs. Nurses favoured a multi-professional documentation system. The structured three-day expert workshop resulted in a first draft of CPW and potential implementation strategies. Subsequent modelling resulted in a CPW with components and appropriate training materials for involved health professionals. A specific implementation strategy is now available. Conclusion A mixed-methods design was suggested to be a suitable approach to develop a complex intervention and its implementation strategy. We will subsequently test the intervention for its acceptability and feasibility in a feasibility study accompanied by a comprehensive process evaluation to inform a subsequent effectiveness trial. Trial Registration The research project is registered in “Projektdatenbank Versorgungsforschung Deutschland” (Project-ID: VfD_MobilE-PHY_17_003910; date of registration: 30.11.2017). KW - Critical Pathways KW - Implementation Science KW - Primary Health Care KW - Aged KW - Vertigo KW - Dizziness KW - General Practitioners KW - Physical Therapy Modalities Y1 - 2021 UR - https://doi.org/10.1186/s12875-021-01441-9 VL - 22 SP - 89 ER - TY - JOUR A1 - Seckler, Eva A1 - Regauer, Verena A1 - Krüger, Melanie A1 - Gabriel, Anna A1 - Hermsdörfer, Joachim A1 - Niemietz, Carolin A1 - Bauer, Petra A1 - Müller, Martin T1 - Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation JF - BMC Family Practice N2 - Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered). KW - Critical pathways KW - Primary health care KW - General practitioners KW - Aged KW - Vertigo KW - Dizziness KW - Physical therapy modalities KW - Implementation science KW - Feasibility studies Y1 - 2021 UR - https://doi.org/10.1186/s12875-021-01410-2 VL - 22 SP - 62 ER - TY - JOUR A1 - Regauer, Verena A1 - Seckler, Eva A1 - Campbell, Craig A1 - Phillips, Amanda A1 - Rotter, Thomas A1 - Bauer, Petra A1 - Müller, Martin T1 - German translation and pre-testing of Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC) JF - Implementation Science Communications N2 - Background Implementation frameworks may support local implementation strategies with a sound theoretical foundation. The Consolidated Framework for Implementation Research (CFIR) facilitates identification of contextual barriers and facilitators, and the Expert Recommendations for Implementing Change (ERIC) allows identifying adequate implementation strategies. Both instruments are already used in German-speaking countries; however, no standardised and validated translation is available thus far. The aim of this study was to translate the CFIR and ERIC framework into German, in order to increase the use of these frameworks and the adherence to evidence-based implementation efforts in German-speaking countries. Methods The translation of the original versions of the CFIR and ERIC framework was guided by the World Health Organisation’s recommendations for the process of translating and adapting both conceptual frameworks. Accordingly, a four-step process was employed: first, forward translation from English into German was conducted by a research team of German native speakers with fluent knowledge of the English language. Second, a bilingual expert panel comprising one researcher with German as his mother tongue and expert command of the English language and one English language expert and university teacher reviewed the translation and discussed inconsistencies with the initial translators. Third, back-translation into English was conducted by an English native speaking researcher. The final version was pre-tested with 12 German researchers and clinicians who were involved in implementation projects using cognitive interviews. Results The translation and review process revealed some inconsistencies between the original version and the German translations. All issues could be solved by discussion. Central aspects of the items were confirmed in 60 to 70% of the items, and modifications were proposed in 30% of the items. Finally, we revised one CFIR-item heading after pre-testing. The final version was given consent by all involved parties. Conclusions Now, two validated and tested implementation frameworks to guide implementation efforts are available in the German language and can be used to increase the application of agreed-on implementation strategies into practice. KW - Implementation science KW - Implementation strategies KW - Knowledge translation strategies KW - Consolidated Framework for Implementation Research KW - Expert Recommendations for Implementing Change Y1 - 2021 UR - https://doi.org/10.1186/s43058-021-00222-w VL - 2 SP - 120 ER - TY - JOUR A1 - Bauer, Petra A1 - Ittlinger, Sabine T1 - Physiotherapieschüler im Team mit Kollegiaten. Umsetzung des Lernfeldes »Der Jugendliche« am Gesundheitstag der neunten Klassen eines Gymnasiums JF - Zeitschrift für Physiotherapeuten KW - Physiotherapie KW - Ausbildung Physiotherapie Y1 - 2013 IS - 04/2013 PB - Pflaum Verlag CY - München ER - TY - CHAP A1 - Bauer, Petra A1 - Krewer, Carmen A1 - Golaszweski, Stefan A1 - König, Eberhard A1 - Müller, Friedemann T1 - Functional electrical stimulation assisted cycling – Therapeutic effects on patients with subacute hemiparesis after stroke T2 - Paracelsus Universität Salzburg, Science get together, Juni 2012 KW - Functional Electrical Stimulation KW - Therapeutic Effects KW - Assisted Active Cycling KW - Hemiparesis Y1 - 2012 ER - TY - CHAP A1 - Bergmann, Jeannine A1 - Krewer, Carmen A1 - Bauer, Petra A1 - Jahn, Klaus A1 - König, Eberhard A1 - Müller, Friedemann T1 - Effekte von Roboter-unterstützter Gangtherapie auf die Pusher-Symptomatik – Zwischenauswertung einer randomisiert kontrollierten Therapiestudie. T2 - 23. Jahrestagung der deutschen Gesellschaft für Neurorehabilitation 2013. Neurologie & Rehabilitation, 6 KW - Roboterunterstützte Gangtherapie KW - Pusher- Symptomatik KW - Randomisiert kontrollierte Therapiestudie Y1 - 2013 SP - 377 (EP1-06) ER - TY - CHAP A1 - Bergmann, Jeannine A1 - Krewer, Carmen A1 - Bauer, Petra A1 - Riener, Robert A1 - Müller, Friedemann T1 - Eine randomisierte kontrollierte Pilotstudie zur Effektivität von virtueller Realität in der roboterassistierten Gangtherapie von Patienten nach Schlaganfall. T2 - 5. Gemeinsame Jahrestagung der deutschen Gesellschaft für Neurorehabilitation und der deutschen Gesellschaft für Neurotraumatologie und klinische Neurorehabilitation, Singen, 04.-06.12.2014 KW - Roboterunterstützte Gangtherapie KW - Schlaganfall KW - Randomisiert kontrollierte Pilotstudie Y1 - 2014 ER - TY - JOUR A1 - Bauer, Petra A1 - Krewer, Carmen A1 - Golaszweski, Stefan A1 - König, Eberhard A1 - Müller, Friedemann T1 - Functional electrical stimulation assisted active cycling – Therapeutic effects in patients with hemiparesis from 7 days to 6 months after stroke. A randomized controlled pilot study. JF - Archives of Physical Medicine and Rehabilitation KW - Functional electrical stimulation KW - Assisted active cycling KW - Hemiparesis KW - Randomized controlled pilot study Y1 - 2015 IS - 96/2 SP - 188 EP - 196 ER - TY - JOUR A1 - Bauer, Petra A1 - Krewer, Carmen T1 - Performance Oriented Mobility Assessment. Balance und Gang beurteilen. JF - Zeitschrift für Physiotherapeuten KW - Performance Oriented Mobility Assessment KW - Balance und Gang KW - Physiotherapie Y1 - 2016 IS - 11/2016 SP - 36 EP - 42 PB - Pflaum Verlag CY - München ER - TY - JOUR A1 - Bauer, Petra A1 - Müller, Martin A1 - Kronast, Verena A1 - Seckler, Eva T1 - Bundesregierung fördert Versorgungsforschung. MobilE-PHY – physiotherapeutische Interventionen für ältere Menschen mit Schwindel und Gleichgewichtsstörungen JF - Zeitschrift für Physiotherapeuten KW - Schwindel- und Gleichgewichtsstörungen KW - Physiotherapeutische Intervention KW - Versorgungsforschung Y1 - 2018 IS - 01/2018 SP - 42 EP - 44 PB - Pflaum Verlag CY - München 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 - Bergmann, Jeannine A1 - Bauer, Petra A1 - Volkening, Katharina A1 - Krewer, Carmen A1 - Müller, Friedemann T1 - Virtual reality-enriched gait training to improve motivation and rehabilitation outcome in subacute stroke patients T2 - 20th European Stroke Conference, Hamburg, Germany, May 2011 KW - Virtual Reality KW - Subacute stroke patients KW - Rehabilitation outcome Y1 - 2011 ER - TY - JOUR A1 - Schomacher, Jochen A1 - Bauer, Petra A1 - Meyer, Morten T1 - Clinical Reasoning als Beitrag zur Professionalisierung der PT JF - Manuelle Therapie N2 - Diese Arbeit geht im Rahmen der qualitativen Forschung der Frage nach, was deutschsprachige Physiotherapeuten unter dem Begriff Clinical Reasoning verstehen. Clinical Reasoning und das angewandte Forschungsdesign werden erläutert. Die Ergebnisse zeigen ein uneinheitliches Verständnis von Clinical Reasoning und ein hohes Maß an Selbstreflexion als Ausdruck der Unsicherheit beim physiotherapeutischen Handeln. Es besteht Unzufriedenheit mit der Qualität der Grundausbildung, die nur unzureichende Kompetenz für die Berufsausübung vermittelt. Dafür notwendig und förderungsbedürftig sind bewusstes, strukturiertes und dokumentiertes Handeln. Clinical Reasoning muss ein wesentlicher Bestandteil der physiotherapeutischen Ausbildung werden. KW - Physiotherapie KW - Manuelle Therapie KW - Clinical Reasoning KW - Professionalisierung der PT Y1 - 2006 IS - 10/2006 SP - 3 EP - 12 ER - TY - JOUR A1 - Bauer, Petra A1 - Borkert, Susanne A1 - Hirschmann, Eike A1 - Kesselring, Jürg A1 - Coenen, Michaela T1 - Beschreibung der Funktionsfähigkeit von Menschen mit Multipler Sklerose. Identifikation von relevanten ICF-Kategorien für Menschen mit Multipler Sklerose aus Sicht der Physiotherapeuten. JF - Zeitschrift für Physiotherapeuten KW - Multiple Sklerose KW - Physiotherapie bei MS KW - ICF- Kategorien Y1 - 2012 IS - 03/2012 PB - Pflaum Verlag CY - München ER - TY - JOUR A1 - Bauer, Petra A1 - Krewer, Carmen A1 - Michaela, Coenen T1 - Beschreibung der Funktionsfähigkeit einer Patientin mit MS: Diskussion der Ergebnisse der Expertenbefragung am Beispiel von Frau W. JF - Zeitschrift für Physiotherapeuten KW - Funktionsfähigkeit mit MS KW - Expertenbefragung KW - Multiple Sklerose Y1 - 2012 IS - 03/2012 PB - Pflaum Verlag CY - München ER - TY - CHAP A1 - Döringer, Tobias A1 - Horstmannshoff, Caren A1 - Kiesel, Theresia A1 - Schädler, A1 - Voigt, Karen A1 - Müller, Martin A1 - Bauer, Petra T1 - Entwicklung und Evaluierung einer evidenzbasierten Schulung zur physiotherapeutischen Versorgung von Patient*innen mit Schwindel und/oder Gleichgewichtsstörungen im Rahmen eines Versorgungspfades T2 - 7. Forschungssymposium Physiotherapie N2 - Hintergrund Schwindel und/oder Gleichgewichtsstörungen (SG) sind häufige Symptome bei älteren Menschen und beeinträchtigen das tägliche Leben erheblich. Physiotherapie kann eine wichtige Komponente in der Behandlung von SG sein. Aufgrund der multifaktoriellen Ursachen sind die physiotherapeutische Diagnostik und Therapie komplex, werden aber in der Ausbildung kaum thematisiert. Klar strukturierte und evidenzbasierte Schulungen für die differentialdiagnostische Herangehensweise können den Clinical-Reasoning-Prozess und die Therapie von SG verbessern. Eine entsprechende evidenzbasierte Schulung wurde in einem Interventionszweig der multizentrischen Cluster-RCT MobilE-PHY2 begleitend zu einem Decision Tree (DT) für den Clinical-Reasoning-Prozess in der Physiotherapie konzipiert und durchgeführt. Methodik Die Schulung wurde aus den Ergebnissen der Pilotstudie (MobilE-PHY1) und deren Prozessevaluation sowie auf der Grundlage einer dreitägigen Fortbildung von und mit einem Schwindelexperten entwickelt. Inhalte waren die Anwendung des DT, theoretische Grundlagen über Schwindel sowie praktische Übungsanteile. Bei der eintägigen Schulung konnten die Physiotherapeut*innen entweder online oder in Präsenz teilnehmen. Zudem wurde eine Online-Lernplattform bereitgestellt, die neben umfassendem Vor- und Nachbereitungsmaterial die Möglichkeit bot, Feedback z. B. in Form einer Videoanalyse zu bekommen. Die Evaluation erfolgte durch Fragebögen und leitfadengestützte Interviews und ist Teil der Prozessevaluation von MobilE-PHY2. Die Auswertung ab Juni 2023 wird im Mixed-Methods-Design nach Rädiker stattfinden. Ergebnis und Schlussfolgerung Es konnten neun Physiotherapiepraxen am Studienstandort Bayern in die Studie eingeschlossen werden. Aus diesen nahmen 17 Therapeut*innen an den insgesamt drei Schulungen teil. Es wurden zehn Therapeut*innen online und sieben in Präsenz geschult. Basierend auf Interviews mit sechs Therapeut*innen sowie dreizehn Fragebögen werden wichtige Erkenntnisse gewonnen, inwiefern die Schulung (begleitend zum DT) eine geeignete Methode darstellt, die evidenzbasierte physiotherapeutische Versorgung für Patient*innen mit SG zu verbessern. Zudem können Vor- und Nachteile der Online- und Präsenzlehre diskutiert werden. KW - Schwindel KW - Physiotherapie KW - Schulung KW - Evidenzbasierte Praxis KW - Versorgungspfad Y1 - 2023 ER - TY - CHAP A1 - Horstmannshoff, Caren A1 - Kiesel, Theresia A1 - Döringer, Tobias A1 - Voigt, Karen A1 - Bauer, Petra A1 - Müller, Martin T1 - Care pathway for evidence-based healthcare of patients with vertigo, dizziness or balance disorders in primary care. First results of the mixed-methods process evaluation T2 - 7. Forschungssymposium Physiotherapie N2 - BACKGROUND Vertigo, dizziness or balance disorders (VDB) affect the mobility and participation of many older people and are also one of the most frequent reasons for visiting the general practitioner's (GP) practice due to multifactorial causes. Physiotherapy (PT) can be crucial for the complex care of people with VDB but is rarely prescribed by GPs. So we developed an evidence-based, multidisciplinary care pathway as a complex intervention following the UK Medical Research Council guideline, which was piloted and is now being evaluated for effectiveness, accompanied by a process evaluation. METHOD The care pathway of the multicentre cluster-RCT (MobilE-PHY2) included decision aids and training for PTs and GPs in the intervention group and optimised standard care in the control group. A mixed-methods process evaluation following Grant’s framework for designing process evaluations examined barriers, facilitating factors and mechanisms of impact in recruiting and reaching participants, implementing the intervention and the response of all participants. Therefore, a logic model was developed illustrating the relationship between the planned work to implement the intervention, the expected mechanism of impact (based on the behaviour change wheel as a change theory), the intended results (output, outcome and impact), and categories of possible influencing factors. The underlying assumption is that a behavioural change in PT and GP is a prerequisite for a change in patient behaviour, which can lead to improved mobility and participation (outcome of MobilE-PHY2). Guided interviews were conducted with patients before the intervention and after six months and with PTs and GPs after six months. Additionally, the training evaluations, completed decision aids and structural questionnaires will be analysed from June 2023. RESULTS AND CONCLUSION At one study site, a total of 37 patients, 17 PTs and nine GPs were included. Interviews were conducted with 16 patients, six PTs and GPs. In the intervention group, 12 PTs and 18 GPs completed decision aids, 13 PTs and two GPs completed evaluation forms, and eight PTs and four GPs completed structural data. The preliminary results of the process evaluation will be reported at the Congress. The results are intended to give indications for a broad implementation of the care pathway, including and promoting physiotherapy and therefore contributing to improved evidence-based healthcare for older people with VDB. KW - process evaluation KW - vertigo KW - cluster-RCT KW - primary care Y1 - 2023 ER - TY - JOUR A1 - Hösl, Matthias A1 - Schupfinger, Alexander A1 - Klich, Luisa A1 - Geest, Linda A1 - Bauer, Petra A1 - V. Bonfert, Michaela A1 - Afifi, Faik K. A1 - Nader, Sean A1 - Berweck, Steffen T1 - Relationship between kinematic gait quality and caregiver-reported everyday mobility in children and youth with spastic Cerebral Palsy JF - European Journal of Paediatric Neurology N2 - Background: 3D gait analysis (3DGA) is a common assessment in Cerebral Palsy (CP) to quantify the extent of movement abnormalities. Yet, 3DGA is performed in laboratories and may thus be of debatable significance to everyday life. Aim The aim was to assess the relationship between kinematic gait abnormality and everyday mobility in ambulatory children and youth with spastic CP. Methods: 73 paediatric and juvenile patients with uni- or bilateral spastic CP (N = 21 USCP, N = 52, BSCP, age: 4–20 y, GMFCS I-III) underwent a 3DGA, while the MobQues47 Questionnaire quantified caregiver-reported mobility. We calculated the Gait Profile Score (GPS), a metric that summarizes how far the lower limb joint angles during walking deviate from those of matched controls. Results: The GPS correlated well with indoor and outdoor mobility (rho = −0.69 and −0.70, both p < 0.001) and the relationships were not significantly different for USCP and BSCP. Still, mobility was lower in BSCP (p < 0.001) and more compromised outdoors (p = 0.002). Indoor mobility could be predicted by walking speed, GPS and age (adj. R2 = 0.62). Outdoor mobility was best predicted by walking speed and GPS (adj. R2 = 0.60). The additive explained variance by the GPS was even higher outdoors than indoors (17.1% vs. 11.4%). Conclusions: Measuring movement deviations with 3DGA seems equally meaningful in uni- and bilaterally affected children and has considerable relevance for real-life ambulation, particurlarly outdoors, where children with spastic CP typically face greater difficulties. Therapeutic strategies that achieve faster walking and reduction of kinematic deviations may increase outdoor mobility. KW - Cerebral palsy KW - Mobility KW - Gait analysis KW - Gait profile score Y1 - 2023 UR - https://doi.org/10.1016/j.ejpn.2022.11.009 VL - 42 SP - 88 EP - 96 ER - TY - CHAP A1 - Horstmannshoff, Caren A1 - Kiesel, Theresia A1 - Borchers, Peggy A1 - Döringer, Tobias A1 - Bauer, Petra A1 - Voigt, Karen A1 - Müller, Martin T1 - Wirksamkeit und Sicherheit eines evidenzbasierten Versorgungspfades zur Verbesserung von Mobilität und Partizipation für ältere Patient*innen mit Schwindel und Gleichgewichtsstörungen (VDB) in der Primärversorgung: Eine multizentrische cluster-randomisierte kontrollierte Studie T2 - Tag der Forschung TH Rosenheim KW - Schwindel KW - evidenzbasierter Versorgungspfad KW - komplexe Intervention KW - Primärversorgung Y1 - 2023 ER - TY - CHAP A1 - Kiesel, Theresia A1 - Breitwieser, Anita A1 - Brettner, Stephanie A1 - Schmidle, Stephanie A1 - Bursch, Theresa A1 - Freise, Laura A1 - Schneider, Elena A1 - Kölzer, Brigitte A1 - Hammerschmidt, Thomas A1 - Robert, Sebastian A1 - Ittlinger, Sabine A1 - Bauer, Petra T1 - HERO – HEalth University @ TH ROsenheim Förderkonzept zur Gewinnung und Entwicklung von wissenschaftlichem, insbesondere professoralem Personal T2 - Tag der Forschung TH Rosenheim KW - Personalentwicklung KW - professorales Personal KW - FH Personal KW - Förderkonzept Y1 - 2023 ER - TY - JOUR A1 - Horstmannshoff, Caren A1 - Skudlik, Stefanie A1 - Petermann, Jenny A1 - Kiesel, Theresia A1 - Döringer, Tobias A1 - Crispin, Alexander A1 - Hermsdörfer, Joachim A1 - Köberlein‑Neu, Juliane A1 - Jahn, Klaus A1 - Schädler, Stefan A1 - Bauer, Petra A1 - Voigt, Karen A1 - Müller, Martin T1 - Effectiveness of an evidence-based care pathway to improve mobility and participation in older patients with vertigo and balance disorders in primary care (MobilE-PHY2): study protocol for a multicentre cluster-randomised controlled trial JF - BMC Trials N2 - Background Vertigo, dizziness or balance disorders (VDB) are common leading symptoms in older people, which can have a negative impact on their mobility and participation in daily live, yet, diagnosis is challenging and specific treatment is often insufficient. An evidence-based, multidisciplinary care pathway (CPW) in primary care was developed and pilot tested in a previous study. The aim of the present study is to evaluate the effectiveness and safety of the CPW in terms of improving mobility and participation in community-dwelling older people with VDB in primary care. Methods For this multicentre cluster randomised controlled clinic trial, general practitioners (GP) will be recruited in two regions of Germany. A total of 120 patients over 60 years old with VDB will be included. The intervention is an algorithmized CPW. GPs receive a checklist for standardise clinical decision making regarding diagnostic screening and treatment of VDB. Physiotherapists (PT) receive a decision tree for evidence-based physiotherapeutic clinical reasoning and treatment of VDB. Implementation strategies comprises educational trainings as well as a workshop to give a platform for exchange for the GPs and PTs, an information meeting and a pocket card for home care nurses and informal caregivers and telephone peer counselling to give all participants the capability, opportunity and the motivation to apply the intervention. In order to ensure an optimised usual care in the control group, GPs get an information meeting addressing the national guideline. The primary outcome is the impact of VDB on participation and mobility of patients after 6 month follow-up, assessed using the Dizziness Handicap Inventory (DHI) questionnaire. Secondary outcomes are physical activity, static and dynamic balance, falls and fear of falling as well as quality of life. We will also evaluate safety and health economic aspects of the intervention. Behavioural changes of the participants as well as barriers, facilitating factors and mechanisms of impact of the implementation will be investigated with a comprehensive process evaluation in a mixed-methods design. Discussion With our results, we aim to improve evidence-based health care of community-dwelling older people with VDB in primary care. KW - Dizziness KW - Vertigo KW - Balance disorder KW - Complex intervention KW - Primary care KW - Care pathway KW - Multicentre cluster randomised controlled trial KW - Mobility KW - Physiotherapy Y1 - 2023 UR - https://doi.org/10.1186/s13063-022-07017-x VL - 24 SP - 91 ER - TY - CHAP A1 - Horstmannshoff, Caren A1 - Borchers, Peggy A1 - Lechner, Theresia A1 - Petermann, Jenny A1 - Skudlik, Stefanie A1 - Döringer, Tobias A1 - Crispin, Alexander A1 - Hermsdörfer, Joachim A1 - Köberlein-Neu, Juliane A1 - Bauer, Petra A1 - Voigt, Karen A1 - Müller, Martin T1 - Wirksamkeit und Sicherheit eines evidenzbasierten Versorgungspfades zur Verbesserung von Mobilität und Teilhabe für ältere Patient*innen mit Schwindel- und/oder Gleichgewichtsstörungen in der Primärversorgung T2 - 21. Deutscher Kongress für Versorgungsforschung (DKVF) KW - Gleichgewichtsstörung KW - Versorgungspfad KW - Komplexe Intervention KW - Schwindel KW - Mobilität KW - Multizentrische randomisierte kontrollierte Studie KW - Physiotherapie KW - Primärversorgung Y1 - 2022 UR - https://dx.doi.org/10.3205/22dkvf413 ER - TY - CHAP A1 - Horstmannshoff, Caren A1 - Skudlik, Stefanie A1 - Petermann, Jenny A1 - Lechner, Theresia A1 - Bauer, Petra A1 - Voigt, Karen A1 - Müller, Martin T1 - Wirksamkeit und Sicherheit eines evidenzbasierten Versorgungspfades zur Verbesserung von Mobilität und Partizipation für ältere Patient*innen mit Schwindel und Gleichgewichtsstörungen in der Primärversorgung T2 - 23. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin KW - Gleichgewichtsstörung KW - Versorgungspfad KW - Komplexe Intervention KW - Schwindel KW - Mobilität KW - Multizentrische randomisierte kontrollierte Studie KW - Physiotherapie KW - Primärversorgung Y1 - 2022 UR - https://dx.doi.org/10.3205/22ebm070 ER - TY - CHAP A1 - Borchers, Peggy A1 - Petermann, Jenny A1 - Katzenberger, Benedict A1 - Bauer, Petra A1 - Horstmannshoff, Caren A1 - Lechner, Theresia A1 - Müller, Martin A1 - Voigt, Karen T1 - Hausärztliche Verordnung und patientenseitige Inanspruchnahme von Physiotherapie bei Patient*innen mit Schwindel- und/oder Gleichgewichtsstörungen - Ergebnisse aus der Kohortenstudie MobilE-TRA T2 - Kongress Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) KW - Kohortenstudie KW - Schwindel KW - Physiotherapie KW - Leitlinie KW - Inanspruchnahme Y1 - 2022 UR - https://dx.doi.org/10.3205/22degam167 ER - TY - CHAP A1 - Horstmannshoff, Caren A1 - Lechner, Theresia A1 - Schädler, Stefan A1 - Voigt, Karen A1 - Müller, Martin A1 - Bauer, Petra T1 - Handlungsempfehlung zur evidenzbasierten physiotherapeutischen Versorgung von Patient*innen mit Schwindel- und/oder Gleichgewichtsstörungen im Rahmen eines Versorgungspfades in der Primärversorgung T2 - 6. Forschungssymposium der Deutschen Gesellschaft für Physiotherapiewissenschaft (DGPTW) KW - Gleichgewichtsstörung KW - Schwindel KW - Physiotherapie KW - Handlungsempfehlung KW - Versorgungspfad KW - Primärversorgung Y1 - 2022 ER - TY - CHAP A1 - Borchers, Peggy A1 - Petermann, Jenny A1 - Katzenberger, Benedikt A1 - Bauer, Petra A1 - Horstmannshoff, Caren A1 - Lechner, Theresia A1 - Müller, Martin A1 - Voigt, Karen T1 - Physiotherapie bei Schwindel und Gleichgewichtsstörungen: hausärztliche Verordnung und patientenseitige Inanspruchnahme (Ergebnisse aus der Kohortenstudie MobilE-TRA) T2 - Deutscher Kongress für Versorgungsforschung (DKVF) KW - Kohortenstudie KW - Schwindel KW - Physiotherapie KW - Leitlinie KW - Inanspruchnahme Y1 - 2022 UR - https://dx.doi.org/10.3205/22dkvf452 ER - TY - JOUR A1 - Borchers, Peggy A1 - Horstmannshoff, Caren A1 - Katzenberger, Benedict A1 - Petermann, Jenny A1 - Bauer, Petra A1 - Kiesel, Theresia A1 - Müller, Martin A1 - Sanftenberger, Linda A1 - Voigt, Karen T1 - Verordnung und Inanspruchnahme von Physiotherapie bei Schwindel und/oder Gleichgewichtsstörungen: Eine Sekundäranalyse aus der Kohortenstudie MobilE-TRA (Versorgungspfade und ihre Auswirkung auf Mobilität, soziale Teilhabe und Lebensqualität bei Schwindel und Gleichgewichtsstörungen sowie Gelenkerkrankungen) JF - Physioscience N2 - Hintergrund Schwindel und/oder Gleichgewichtsstörungen (S/G) sind komplexe Gesundheitsprobleme bei älteren Menschen und häufige Beratungsanlässe in der Hausarztpraxis. Physiotherapie kann einen positiven Einfluss auf das Gleichgewicht und Sturzrisiko bei Patient*innen mit S/G haben. In der S3-DEGAM-Leitlinie „Akuter Schwindel in der Hausarztpraxis“ werden Empfehlungen für Physiotherapie bei bestimmten Schwindeldiagnosen gegeben. Ob hausärztliche Physiotherapieverordnungen den Empfehlungen der Leitlinie entsprechen, ist nicht bekannt. Bisher liegen keine Daten vor, wie häufig diese Physiotherapieverordnungen tatsächlich durch Patient*innen in Anspruch genommen werden. Ziel Ermittlung von Anteil und Inanspruchnahme hausärztlich verordneter Physiotherapie bei älteren Patient*innen mit S/G innerhalb der Kohortenstudie MobilE-TRA und Untersuchung, ob diese den Empfehlungen der S3-DEGAM-Leitlinie entsprechen. Methode Die Sekundäranalyse beruht auf Daten der Kohortenstudie MobilE-TRA, in der Patient*innen ab 65 Jahren mit S/G in 17 Hausarztpraxen in Bayern und Sachsen befragt wurden. Die Datenerhebung fand von 09/2017–10/2019 statt. Die hausärztliche Verordnung und patientenseitige Inanspruchnahme von Physiotherapie wurden mittels validierten sowie selbstentwickelten Fragebögen erhoben. Die Daten wurden deskriptiv (Mittelwerte, Häufigkeiten) und Verteilungsunterschiede mittels exaktem Test nach Fisher analysiert. Ergebnisse Die Stichprobe umfasste 158 Patient*innen mit S/G. 16 % der Patient*innen hatten aufgrund von S/G Physiotherapie verordnet bekommen. Dabei entsprachen 14,2 % der Physiotherapieverordnungen den Empfehlungen der S3-DEGAM-Leitlinie. 32 % (Bayern 53,8 %; Sachsen 8,3 %) der Patient*innen hatten die Physiotherapie nicht in Anspruch genommen. Dabei lag ein signifikanter regionaler Verteilungsunterschied (p = 0,030; Phi = 0,487 [95 % KI = 0,129–0,846]) vor. Schlussfolgerung Mit 16 % ist die Häufigkeit hausärztlicher Physiotherapieverordnungen bei S/G in der Altersgruppe der über 65-Jährigen vergleichsweise hoch. Die Gründe für die Nichtinanspruchnahme wurden nicht erfasst, weshalb nur Vermutungen bezüglich des regionalen Unterschiedes angestellt werden konnten (z. B. Verfügbarkeit von Physiotherapie). Im Sinne der Planung einer adhärenten Therapie und zur Vermeidung von Versorgungsunterschieden scheint es sinnvoll, sich zukünftig auch mit Gründen einer Nichtinanspruchnahme von Therapien zu beschäftigen. KW - Kohortenstudie KW - Schwindel KW - Physiotherapie KW - Leitlinie KW - Inanspruchnahme Y1 - 2023 ER -