Refine
Year of publication
Document Type
- Article (peer reviewed) (59)
- Conference Proceeding (28)
- Contribution to a Periodical (7)
- Other (6)
- Report (3)
Has Fulltext
- no (103)
Is part of the Bibliography
- no (103)
Keywords
- Vertigo (12)
- Dizziness (11)
- Holzbau (10)
- Schallmesstechnik (10)
- Aged (8)
- Schwindel (8)
- ICF (7)
- Physiotherapie (7)
- outcome assessment (7)
- Classification (6)
Background Free movement of the limbs is a prerequisite of mobility and autonomy in old age. Joint contractures, i.e. restrictions in full range of motion of any joint due to deformity, disuse or pain, are common problems of frail older people, particularly in nursing home residents.
Contractures are among the most unexplored and underreported syndromes in clinical and homecare settings. Epidemiological studies indicate a wide range of prevalence of joint contractures in older individuals between 20% and 80%. This variation is due to different definitions of contracture and varying diagnostic criteria or data collection methods, different research settings, sample size and study participants? characteristics.
The aetiology of joint contractures is multifaceted. In older people contractures may be caused by a variety of health conditions and situations, but immobility due to an acute injury or disease seems to be the major risk factor. Upper limb joint contractures may result in loss of ability to dress or eat independently while lower limb contractures may lead to instability and inability to walk independently and higher risk of bed confinement.
Joint contractures further increase the risk of other adverse patient outcomes like pain, pressure ulcers and risk of falls. Thus, joint contractures are a major cause for excess disability in older people with a significant impact on overall quality of life and functioning. Preventive and rehabilitation interventions targeting joint contractures may decrease morbidity, increase functioning and quality of life, and, ultimately, prevent long-term disability. In the United States of America, presence of joint contractures is an established indicator of quality of care in nursing facilities.
In Germany, joint contracture risk assessment and prevention have recently been defined as a quality indicator of nursing home care that should be regularly monitored by experts from the statutory health insurance system. Nursing homes are obliged to report whether they regularly assess the risk of joint contracture and administer relevant preventive measures. In clinical settings, joint contractures are assessed by measuring the range of motion.
However, from a patient- and nursing-oriented perspective the relevance of a systematic registration of contractures in care-dependent older people is unclear unless their impact on functioning is understood. Contracture assessment is only an intermediate step in the evaluation of patient-relevant outcomes such as quality of life, functioning, and the ability to participate in everyday life and social participation. Arguably, a clinical definition of joint contracture is difficult because the contracture?s severity is determined by the consequences on activities of daily living, quality of life and social participation. In addition, there is no consensus on aspects most relevant to the affected individuals.
A variety of functional measures is currently used for the assessment and evaluation of geriatric patients. To date, there is no consensus on common concepts for the choice of outcome measures specifically for evaluating the impact of interventions targeted on joint
Background Vertigo and dizziness are among the most common health problems in medical practice [1, 2, 3, 4, 5]. Vertigo and dizziness include both consequences of disease as well as definable disease entities such as benign paroxysmal positional vertigo, Meniere?s disease, or vestibular migraine.
Irrespective of the various causes and underlying health conditions, vertigo and dizziness have significant impact on functioning and overall quality of life of the affected individuals To give some examples, the most common peripheral-vestibular disorder benign paroxysmal positioning vertigo - which is also the most frequent type of vestibular disorder - causes brief rotatory vertigo attacks, mainly triggered by rapid head movements, e.g. when turning around in the bed or lacing shoes.
Central-peripheral disorders, which may be caused by brain ischemia, multiple sclerosis, or other permanent or transient brain lesions, can make vertigo attacks lasting from minutes to even weeks [6]. In addition, vertigo and dizziness are a considerable burden to economy and health care [4, 7, 8]. Precondition of effective management and treatment of potentially disabling conditions like vertigo is - besides careful diagnosis of the underlying condition -the assessment of outcomes which are relevant to the patient.
This is not only important to monitor treatment effects but also to set goals and to plan therapy [6]. As summarized by Morris et al. [9] outcome measures in vertigo vary by the entities they are addressing, such as subjective experience of disability or signs and symptoms. Most of them reflect either the patients? or health professionals? experience.
As an example, the frequently used Dizziness Handicap Inventory [10] addresses the patients? experience of the consequences of vertigo on daily living. Most outcome measures are developed and validated on the basis of empirical findings or professional experience [11].
However, none of them refer to a common theoretical framework. A theoretical framework is fundamental for defining an Outcome measurement and helps to ensure that the whole potential spectrum of issues is reflected [12]. In addition to the lack of theoretical foundation there is still no agreement on standards used to measure outcomes in patients with vertigo.
This is illustrated by a recently published Cochrane Review in the field of vestibular rehabilitation which noted 15 different outcome measures of patients? complaints in 21 studies [13]. To address both these issues, the Integrated Center for Research and Treatment of Vertigo, Balance and Ocular Motor Disorders ( IFB LMU ) at the Ludwig-Maximilians-Universität in Munich set up a project that aims to develop an international standard for the description of functioning and disability in patients with vertigo and dizziness based on the International Classification of Functioning, Disability and Health (ICF).
With the ICF, which is part of the family of international classifications of the World Health Organisation (WHO), there is a common theoretical framework for describing and measuring health and disability.
The ICF models the individuals' functioning and health as a complex interaction between a health condition.
Objective: To identify candidate categories for brief International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in the acute hospital.
Design: Prospective multi-centre cohort study.
Patients: Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in acute hospitals.
Methods: Functioning and contextual factors were coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables.
Results: A total of 391 patients were included in the study (91 neurological, 109 cardiopulmonary, 191 musculoskeletal), mean age 63.4 years, 50.1% female. Selection yielded 33 categories for neurological, 31 for cardiopulmonary, and 30 for musculoskeletal.
Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the ICF categories most relevant for the practical assessment and monitoring of functioning in patients with acute neurological, cardiopulmonary, and musculoskeletal conditions.
Objective: To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in early post-acute rehabilitation facilities.
Design: Prospective multi-centre cohort study.
Patients: Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in early post-acute rehabilitation facilities.
Methods: Functioning was coded using the ICF. The criterion for selecting candidate categories for the ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables.
Results: A total of 165 patients were included in the study (67 neurological, 37 cardiopulmonary, 61 musculoskeletal), mean age 67.5 years, 46.1% female. Selection yielded 38 categories for neurological, 32 for cardiopulmonary, and 31 for musculoskeletal.
Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the assessment and monitoring of functioning in patients undergoing early post-acute rehabilitation for neurological, cardiopulmonary, and musculoskeletal conditions.
Objective: To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and clinical measurement of functioning in older patients in early post-acute rehabilitation facilities.
Design: Prospective multi-centre cohort study. Patients: Older patients receiving rehabilitation interventions in early post-acute rehabilitation facilities.
Methods: Functioning was coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables.
Results: A total of 209 patients were included in the study, mean age 80.4 years, 67.0% female. Selection yielded a total of 29 categories for the functioning part and 9 categories for the contextual part of the ICF.
Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the clinical assessment and monitoring of functioning in older patients undergoing early post-acute rehabilitation.
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.
In this contribution a method for the prediction of the radiated sound out of the velocity field of a vibrating ceiling is presented. The numerical method was validated via measurements on a real structure using a pp-probe. It is based on Integral Transform techniques and can be applied in the postprocessing of a FEM simulation
(harmonic analysis) [1]. The method was verified by measurements on the real structure and can be used for parametrical studies.
Rounding off the Parts 1 and 2 of this publication nomograms, based on dimensionless parameters, can be developed to predict the sound radiation of light weight slabs. Hereby different sets of geometry as well as different configurations of ceilings can be studied in order to describe the acoustical and dynamical behaviour of wooden ceilings.
In order to set up guidelines for the design of light-weighted ceilings for timber constructions to be used by engineers in practice, investigations based on both measurements and numerical models have been carried out [1, 2, 3].
The setup and the calibration of the numerical model of the structure are outlined briefly.
A semi-analytical approach for the prediction of radiated sound is presented, which is based on Integral Transform Methods. The method can be applied in the post processing of a Finite Element computation.
Thus as a first step the structure, consisting of a timber slab, a floating floor and a suspended ceiling, is built up in a Finite Element model, where the material properties of wood and the characteristics of the system are considered.
The model is parameterized in order to enable computations with varying geometry and material parameters and calibrated with the help of measurements using model updating techniques.
The velocity pattern resulting out of the FEM computation is transformed from the spatial into the wavenumber domain and from the time into the frequency domain using Fourier Transform Methods. Applying this velocity pattern as a boundary condition to the Helmholtz Equation, which results out of the Fourier Transform of the wave equation, the wavenumbers, which fulfil the radiation condition, can be selected and the pressure field in the adjacent acoustic fluid can be computed.
Due to the properties of the Fourier-Transform the radiated sound power can be calculated efficiently in the transformed domain out of pressure and velocity.
In a second part of the contribution the model for the air cushion in the suspended ceiling is discussed, where a FSI-model for the acoustic fluid and the structure is compared against engineering approaches using simplifications concerning mass distribution and transfer impedances between the individual nodes at the interface
Numerical models for the prediction of vibroacoustical characteristics of light-weighted ceilings
(2013)
In order to set up guidelines for the design of light-weighted ceilings for timber constructions to be used by engineers in practice, investigations based on both measurements and numerical models have been carried out within the cooperative research project “VibWood”.
In this contribution the setup and the calibration of the numerical model of the structure as well as the prediction of radiated sound are discussed, where a special focus is set on a dimensionless description in order to deduce information for a wide range of system’s specifications.
The structure, consisting of a timber slab, a floating floor and a suspended ceiling, is built up in a Finite Element model, where the material properties of wood and the characteristics of the system (e.g.support conditions, contact phenomena dynamic properties of individual parts) are considered.
The model is parameterized in order to enable computations with varying geometry and material parameters.
After calibrating the FE-model with the help of measurements using model updating techniques dimensionless parameters are defined based on the Buckingham-π- Theorem and computations are carried out in order to specify guidelines for various systems. The radiation of sound is computed in a post processing using Integral Transform Methods.
Die mithilfe der Abklingmethode ermittelten Verlustfaktoren sind bei mehreren Eigenfrequenzen pro Frequenzband zuverlässig. Die Ergebnisse der Resonanzbreitenmethode beziehen sich dagegen auf die Eigenfrequenzen und sind nur bei einer geringen Modenüberlappung zuverlässig. Beide Methoden sind gleichwertig, wenn mehrere Eigenschwingungen im Frequenzband vorhanden sind und die Modenüberlappung gleichzeitig gering ist. Für einseitig überlagerte Resonanzkurven wurde eine einfache Alternative der Resonanzbreitenmethode vorgeschlagen.
Die Ergebnisse wurden im Rahmen des gemeinsam von der TU München, der HS Rosenheim und dem ift Rosenheim durchgef¨uhrten DFG-AiF Forschungsvorhabens ”Vibroakustik im Planungsprozess für Holzbauten” erarbeitet. Das IGF-Vorhaben 17328N/1 der Forschungsvereinigung HS Rosenheim wurde über die AiF im Rahmen des Programms zur Förderung der Industriellen Gemeinschaftsforschung (IGF) vom Bundesministerium für Wirtschaft und Energie aufgrund eines Beschlusses des Deutschen Bundestages gefördert.
Es wurden Stoßstellendämm-Maße Kij für verschiedene Bauteilverbindungen von BSPH-Elementen gemessen. Diese zeigen eine gute Übereinstimmung zu anderen Werten aus der Literatur.
Bei den Stoßstellen wurde der Einfluss von Elastomerlagern untersucht.
Die Ergebnisse zeigen einen deutlichen Einfluss auf die Kij. Eine Berechnung der Kij mithilfe von Kopplungsverlustfaktoren ηij, welche aus einem SEAModell resultieren, zeigen eine ausreichende Übereinstimmung.
Weitere Schritte der Modellierung zur Überprüfung dieser Erkenntnisse und zur Abbildung von Elastomeren sind notwendig. Der Beitrag ist Teil des gemeinsam von der TU München, der HS Rosenheim und dem ift Rosenheim durchgeführten DFG-AiF Forschungsvorhabens Vibroakustik im Planungsprozess für Holzbauten.
Das IGF-Vorhaben 17328 N/1 der Forschungsvereinigung HS Rosenheim wurde über die AiF im Rahmen des Programms zur Förderung der Industriellen Gemeinschaftsforschung (IGF) vom Bundesministerium für Wirtschaft und Energie aufgrund eines Beschlusses des Deutschen Bundestages gefördert.
A trend towards lightweight structures, e.g. timber structures, is noticeable in civil engineering, which implies the necessity to predict vibroacoustic characteristics like the transmission of structure-borne sound in order to fulfil requirements regarding serviceability. This contribution focuses on the investigation of junctions of building components e.g. between wall and ceiling. It is part of a joint research project with the aim to catalogue the coupling for a variety of junctions. The resulting database may serve to predict the transmission of structure-borne sound which is typically carried out either using a Finite Element (FEM) approach, suitable for the low frequency range, or by means of energy methods like the Statistical Energy Analysis (SEA) for the high frequency range. Therefore the so-called mid frequency gap emerges, which is examined and attempted to be closed. In this context SEA-averaging techniques are applied in the postprocessing of FEM calculations to obtain an adapted “SEAlike” approach. By varying the subsystems to be excited it is possible to determine Energy Influence Coefficients (EIC), which describe the specific energy content of the different subsystems with respect to the input power. Using this hybrid approach vibroacoustic predictions can be performed also in the mid frequency range. Inverting the EIC-matrix Coupling Loss Factors as well as Damping Loss Factors of the different subsystems can be calculated if the subsystem definition fulfils the SEA-requirements. The application of the method in combination to a classical SEA calculation and to laboratory measurements is presented.
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.
Within the scope of the research project "VibWood", operational vibration analyses of timber floor constructions were carried out. In order to understand the vibration behaviour of and the sound transmission through the layers of the constructions the coupling between them was investigated. The transfer function from the point of excitation to a pattern of receiving positions located on each of the layers of the construction was measured using a swept sine excitation. As a result, the frequency range of decoupling between the base floor and the floating floor and between the base floor and the suspended ceiling could be identified and the individual vibration behavior analyzed. The measurements also included the radiated sound power from the suspended ceiling. There is indication that there is not necessarily a correlation between the eigenmodes of the suspended ceiling and the maxima of the radiated sound power
Im Rahmen des AIF-Forschungsprojektes VibWood werden im Deckenprüfstand der HS Rosenheim unterschiedliche Holzdeckenkonstruktionen hinsichtlich ihres Schwingungsverhaltens im Bereich zwischen 4 Hz und 200 Hz untersucht. Parallel dazu werden diese Holzdeckenkonstruktionen an der TU München mittels FE-Berechnungen modelliert. Für die Untersuchungen steht ein Prüfstand zur Verfügung, welcher die Möglichkeit bietet, Decken oder Deckenelemente mit Abmessungen von max. 5,5 m x 5,5 m auf einer Stahlwinkelkonsole aufzulagern. Die Deckenelemente können so durch Messung der Übertragungsfunktionen hinsichtlich ihrer Schwingungsformen untersucht werden. Ein Ziel der Untersuchungen ist es, die tieffrequenten Schwingungen von Holzdecken mit Hilfe von Schwingungstilgern deutlich zu reduzieren. Es werden erste Ergebnisse der Validierung der FE-Modelle vorgestellt, insbesondere der Einfluss der Auflagerung der Deckenelemente auf die Übertragungsfunktion. Weiterhin werden Messergebnisse für unterschiedliche Anregungsarten diskutiert
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.
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.
This paper deals with the preparation of the Small GEO mission and the accommodation of a GPS receiver as an experiment. The expected benefits of using the GPS receiver for Small GEO are explained. The feasibility of using GPS for position determination is investigated by simulation using a MosaicGNSS receiver, which was stimulated by a Spirent RF signal generator. A procedure, how to evaluate flight data on ground is outlined. Success criteria of the experiment and the minimal size of the downlink stream required and reserved for the receiver TM are presented.