Anwendung und Bewertung diagnostischer Verfahren im Rahmen der physiotherapeutischen Tätigkeit

Einleitung: Die fortlaufende Akademisierung in der Physiotherapie hat nicht nur ein sich veränderndes Kompetenzgefüge in dieser Berufsgruppe zur Folge, sondern auch eine Erweiterung der Anforderungen innerhalb der Patientenversorgung. Hierzu zählt zunehmend auch die Fähigkeit der Durchführung und Interpretation strukturierter Assessments und diagnostischer Verfahren. Aus diesem Grund untersucht diese Dissertation exemplarisch, welche Voraussetzungen, Möglichkeiten und Grenzen für die Durchführung und Vermittlung strukturierter Untersuchungsergebnisse in der physiotherapeutischen Arbeit existieren. Methodik: Drei Publikationen aus zwei Studien wurden in diese Dissertation einbezogen. Die erste der beiden Studien verfolgte einen qualitativen Ansatz zur Identifizierung fördernder und hemmender Faktoren für die Implementierung und Weiterentwicklung integrierter Versorgungsstrukturen in der Geriatrie. Im Rahmen dieser Studie wurden 15 teilstrukturierte Interviews mit verschiedenen Angehörigen der Gesundheitsberufe durchgeführt. Bei der zweiten Studie handelte es sich um eine MPG-Prüfung zur Validierung eines sensorbasierten Stuhls zur automatisierten Durchführung des Timed-Up&Go (TUG) Tests. In diese Studie wurden 100 ältere Menschen mit funktionellen Einschränkungen einbezogen. Die Ergebnisse dieser Studie dienten zum einen der Validierung der Messvorrichtung sowie zum anderen im Rahmen einer sekundären Datenanalyse der Analyse der adäquaten oder nicht-adäquaten Selbsteinschätzung eines vorhandenen Sturzrisikos durch die Studienteilnehmer. Ergebnisse: Die Fähigkeit zur Durchführung von strukturierten Assessments konnte als Voraussetzung für eine funktionierende multidisziplinäre Zusammenarbeit identifiziert werden (Publikation 1). Technologische Innovationen können hier helfen, die Durchführung und Auswertung solcher Assessments zu unterstützen und während der Durchführung kurzer und einfacher Tests umfassende Informationen zur Mobilität der Testperson zu liefern (Publikation 2). Für Handlungsbereiche, die stark in die Kompetenzfeldern anderer Berufsgruppen hineinragen, kann die Interpretierbarkeit rein physiotherapeutischer Assessments jedoch an ihre Grenzen stoßen und die Verfügbarkeit von weiteren Informationen notwendig machen (Publikation 3). Schlussfolgerungen: Die Befähigung zur Durchführung von strukturierten Assessments sowie die Integrierung und Kommunikation der Ergebnisse dieser Untersuchungen innerhalb von multidisziplinären Teams stellen zentrale Anforderungen an die Physiotherapie dar. Dabei zeigt sich, dass innerhalb solcher Gefüge die Ergebniskommunikation in alle Richtungen erfolgen muss, um die Handlungsfähigkeit von Physiotherapeuten aufrecht zu erhalten.Introduction: The process of professionalization in the field of physical therapy has made the provision of care more demanding. One of these demands is the ability to conduct and interpret structured assessments and diagnostic procedures. This dissertation showcases the prerequisites, potential and limits of conducting and interpreting such structured assessments in the field of physical therapy. Methods: This dissertation comprises three publications from two studies. The first study employed a qualitative approach to identify facilitators and barriers to implementing integrated care of geriatric patients. As part of this study, 15 semi-structured interviews were conducted with different health professionals in geriatric care. The second study consisted of a validation study for a sensor-equipped chair for the automated measurement of the Timed-Up&Go (TUG) test. Here, 100 participants with limited mobility were recruited. The results of this study were used to validate the measurement system; additionally, a secondary data analysis was performed to evaluate the adequacy or inadequacy of the self-evaluated risk of falling by the participants. Results: The ability to perform structured assessments was identified as an important prerequisite for a functional multidisciplinary collaboration in geriatric care (publication 1). Technological innovations improve the performance and interpretation of such assessments and provide more data on mobility using short and easy-to-perform tests (publication 2). In cases where results are encroach on fields of expertise of other health professions, the interpretability of assessments with a purely physical therapy perspective are limited. Here, the availability of additional information is needed (publication 3). Conclusion: The ability to perform structured assessments and to integrate and communicate results to a multidisciplinary team is a requirement for physical therapy. As this dissertation demonstrates, in such a setting this flow of information needs to work in all directions to ensure the capacity of physical therapists to act in the best interest of their patients

Predictors of falling events in nursing homes: a cross-sectional study in Germany

Hintergrund: Neuere Studienergebnisse zeigen, dass Sturzereignisse in Pflegewohnheimen bisher nicht in ausreichendem Maße verhindert werden können. Der Zusammenhang zwischen Sturzereignissen sowie Mobilitätseinschränkungen, Erkrankungen und Body-Mass-Index (BMI) wurde für jeden Faktor bisher einzeln beschrieben; eine komplexere Analyse fehlt. Ziel: Ziel dieser Studie ist es, neben der Sturzinzidenz, Sturzprädiktoren in deutschen Pflegewohnheimen zu ermitteln. Die Untersuchung fokussiert auf das Vorliegen möglicher Sturzprädiktoren von Pflegeheimbewohnern/Pflegeheimbewohnerinnen ab 65 Jahren und versucht, evtl. vorhandene, besonders vulnerable Personengruppen zu identifizieren. Material und Methode: Querschnittserhebung mit 2427 Pflegeheimbewohnern/Pflegeheimbewohnerinnen im 3. und 4. Lebensalter aus 17 deutschen Pflegewohnheimen im Untersuchungszeitraum von 2014 bis 2016. Es wurden umfangreiche Daten zur Mobilität, zu Erkrankungen und BMI sowie zur Versorgung mit Mobilitätshilfsmitteln erhoben und statistisch ausgewertet. Zur Ermittlung multivariater Zusammenhänge wurde ein „classification and regression tree“ angewendet. Ergebnisse: Die Gruppe der Proband*innen stellt sich mit einem Median von 85 Jahren und einem Frauenanteil von 73,8 % dar. Im Erhebungszeitraum von 2014 bis 2016 stürzten 5,5 % der Pflegeheimbewohner*innen. Als mögliche Prädiktoren für Sturzereignisse konnten Einschränkungen in mehreren spezifischen komplexen Bewegungsabläufen sowie ein geringer BMI ≤21,5 kg/m2 ermittelt werden. Die Gruppe der Pflegeheimbewohner*innen mit geringem BMI zeigt Einschränkungen in anderen Bewegungsabläufen als Pflegeheimbewohner*innen der Gruppe, die einen BMI >21,5 kg/m2 aufweisen. Pflegeheimbewohner*innen mit diesen Merkmalen wurden als besonders vulnerable Gruppen identifiziert. Schlussfolgerung: Da die Einschätzung des Sturzrisikos von Pflegeheimbewohnern/Pflegeheimbewohnerinnen auf Basis bisheriger Risikofaktoren nur teilweise erfolgreich erfolgt, scheint die Anwendung geeigneter Testverfahren zur Bestimmung der Mobilität und des BMI angezeigt, um das Sturzrisiko von Pflegeheimbewohnern/Pflegeheimbewohnerinnen belastbar bestimmen und geeignete Maßnahmen ergreifen zu können.Background: The results of recent studies showed that falls in nursing homes cannot be sufficiently prevented. The correlation between falls as well as restriction in mobility, diseases and body mass index (BMI) were so far individually described for each factor but a more complex analysis is lacking. Aim: The aim of this study was to determine fall predictors in German nursing homes in addition to the incidence of falls. The study focused on the presence of possible fall predictors of nursing home residents aged 65 years and over and attempted to identify any particularly vulnerable groups of persons. Material and methods: Overall, 2427 residents living in 17 German nursing homes starting from the age of 65 years were part of a cross-sectional study between 2014 and 2016. Comprehensive data on mobility, supply of walking aids, diseases and BMI were documented and statistically evaluated. A classification and regression tree was used to determine multivariate relationships. Results: The group of participants had a median age of 85 years and a proportion of women of 73.8%. During the survey period 5.5% of the residents fell. As possible predictors for fall events, restrictions in several specific complex movement sequences as well as a low BMI of ≤21.5 kg/m2 could be determined. The group of nursing home residents with a low BMI showed restrictions in other movement sequences than nursing home residents in the group with a BMI >21.5 kg/m2. Nursing home residents with these characteristics were identified as particularly vulnerable groups. Conclusion: The assessment of the risk of falling of nursing home residents on the basis of previous risk factors seems to be only partially successful. Therefore, the application of suitable test procedures to determine mobility and the BMI appears to be appropriate in order to be able to determine the risk of falling of nursing home residents in a reliable manner and to take appropriate measures

High-resolution optical constants of crystalline ammonium nitrate for infrared remote sensing of the Asian Tropopause Aerosol Layer

Infrared spectroscopic observations have shown that crystalline ammonium nitrate (AN) particles are an abundant constituent of the upper tropospheric aerosol layer which is formed during the Asian summer monsoon period, the so-called Asian Tropopause Aerosol Layer (ATAL). At upper tropospheric temperatures, the thermodynamically stable phase of AN is different from that at 298 K, meaning that presently available room-temperature optical constants of AN, that is, the real and imaginary parts of the complex refractive index, cannot be applied for the quantitative analysis of these infrared measurements. In this work, we have retrieved the first low-temperature data set of optical constants for crystalline AN in the 800–6000 cm−1 wavenumber range with a spectral resolution of 0.5 cm−1. The optical constants were iteratively derived from an infrared extinction spectrum of 1µm sized AN particles suspended in a cloud chamber at 223 K. The uncertainties of the new data set were carefully assessed in a comprehensive sensitivity analysis. We show that our data accurately fit aircraft-borne infrared measurements of ammonium nitrate particles in the ATAL

Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial

BACKGROUND: Frailty is expressed by a reduction in physical capacity, mobility, muscle strength, and endurance. (Pre-)frailty is present in up to 42% of the older surgical population, with an increased risk for peri- and postoperative complications. Consequently, these patients often suffer from a delayed or limited recovery, loss of autonomy and quality of life, and a decrease in functional and cognitive capacities. Since frailty is modifiable, prehabilitation may improve the physiological reserves of patients and reduce the care dependency 12 months after surgery. METHODS: Patients ≥ 70 years old scheduled for elective surgery or intervention will be recruited in this multicenter, randomized controlled study, with a target of 1400 participants with an allocation ratio of 1:1. The intervention consists of (1) a shared decision-making process with the patient, relatives, and an interdisciplinary and interprofessional team and (2) a 3-week multimodal, individualized prehabilitation program including exercise therapy, nutritional intervention, mobility or balance training, and psychosocial interventions and medical assessment. The frequency of the supervised prehabilitation is 5 times/week for 3 weeks. The primary endpoint is defined as the level of care dependency 12 months after surgery or intervention. DISCUSSION: Prehabilitation has been proven to be effective for different populations, including colorectal, transplant, and cardiac surgery patients. In contrast, evidence for prehabilitation in older, frail patients has not been clearly established. To the best of our knowledge, this is currently the largest prehabilitation study on older people with frailty undergoing general elective surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT04418271. Registered on 5 June 2020. Universal Trial Number (UTN): U1111-1253-4820 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13063-022-06401-x

Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial

Background: Frailty is expressed by a reduction in physical capacity, mobility, muscle strength, and endurance. (Pre-) frailty is present in up to 42% of the older surgical population, with an increased risk for peri- and postoperative complications. Consequently, these patients often suffer from a delayed or limited recovery, loss of autonomy and quality of life, and a decrease in functional and cognitive capacities. Since frailty is modifiable, prehabilitation may improve the physiological reserves of patients and reduce the care dependency 12 months after surgery. Methods: Patients >= 70 years old scheduled for elective surgery or intervention will be recruited in this multicenter, randomized controlled study, with a target of 1400 participants with an allocation ratio of 1:1. The intervention consists of (1) a shared decision-making process with the patient, relatives, and an interdisciplinary and interprofessional team and (2) a 3-week multimodal, individualized prehabilitation program including exercise therapy, nutritional intervention, mobility or balance training, and psychosocial interventions and medical assessment. The frequency of the supervised prehabilitation is 5 times/week for 3 weeks. The primary endpoint is defined as the level of care dependency 12 months after surgery or intervention. Discussion: Prehabilitation has been proven to be effective for different populations, including colorectal, transplant, and cardiac surgery patients. In contrast, evidence for prehabilitation in older, frail patients has not been clearly established. To the best of our knowledge, this is currently the largest prehabilitation study on older people with frailty undergoing general elective surgery

Centrality evolution of the charged-particle pseudorapidity density over a broad pseudorapidity range in Pb-Pb collisions at root s(NN)=2.76TeV

Peer reviewe

Chancen & Barrieren in der Mobilen Rehabilitation – eine qualitative Erhebung mit medizinischem Personal, Koordinatoren, Patienten & Angehörigen

Ziel: Um das Konzept der mobilen Rehabilitation in Deutschland (MoRe) zu verbessern und zu erweitern, war das Ziel der vorliegenden Studie, bestehende Problem- und Handlungsfelder zu identifizieren und daraus Lösungsansätze zu entwickeln. Zur Erhebung von Problemen und Barrieren in der MoRe wurden leitfadengestützte Interviews mit den an der Versorgung beteiligten Akteuren (Medizinisches Personal, Koordinatoren, Patienten und Angehörige) durchgeführt. Es ließen sich fünf Problemfelder in der MoRe identifizieren: Terminkoordination, Kommunikation und Informationsweitergabe, Zusammenarbeit mit Externen, Dokumentation und Rahmenbedingungen. Die berichteten Probleme des medizinischen Personals und der Koordinatoren stimmten dabei weitestgehend überein. Die in der MoRe auftretenden Barrieren decken sich zu großen Teilen mit den generell in der Pflegepraxis diskutierten Handlungsfeldern. Für einzelne Barrieren können technische Entwicklungen einen geeigneten Lösungsansatz darstellen.   Chances and Barriers in Mobile Rehabilitation – a Qualitative Study with Health Professionals, Coordinators, Patients and Family Members In order to further develop and broaden the concept of mobile rehabilitation in Germany, the aim of this study was to identify existing problems and fields of actions and to derive solutions for them. To identify problems and barriers in mobile rehabilitation, guided interviews were performed with all health professionals and coordinators involved in mobile rehabilitation as well as with patients and family members. Five areas associated with specific problems could be identified: Coordination of appointments, communication and information flow, collaboration with external organizations, documentation and regulatory conditions. The presented fields of problems were identical between health professionals and coordinators to a great extent. The detected problems corresponded to those problems articulated in other fields of care such as ambulatory nursing. Solutions for these problems could include technology-based developments. JEL–Klassifizierung: I1

Die Rolle der Physiotherapie bei der Versorgung chronischer Erkrankungen. Internationale Erfahrungen und nationale Defizite

Das Potenzial für die Versorgung und das Management chronischer Erkrankungen ist in Deutschland bei weitem nicht ausgeschöpft. Dies betrifft insbesondere die Integration von Sektoren, Disziplinen und Professionen. Der Blick in die Niederlande und nach Großbritannien hat gezeigt, dass in diesen Ländern die Physiotherapie stärker in die Versorgung und das Management chronischer Erkrankungen involviert ist. Ein offensichtlicher Ansatzpunkt für die Berücksichtigung der Physiotherapie ist nach diesen Erfahrungen die Integration in multiprofessionelle Teams zur Optimierung der Versorgungsstruktur. Die Physiotherapie kann jedoch darüber hinaus auch einen wesentlichen Beitrag zur Schaffung evidenzbasierter Entscheidungsgrundlagen und vor allem bei der Unterstützung des Selbstmanagements der Erkrankten spielen. Eine wesentliche Voraussetzung für die stärkere Rolle der Physiotherapie bei der Versorgung und beim Management chronischer Erkrankungen sind jedoch tiefgehende Reformen in der physiotherapeutischen Ausbildung. Die im Ausland völlig selbstverständliche Akademisierung der physiotherapeutischen Profession ist daher auch in Deutschland überfällig.   The Role of Physiotherapy in the Treatment of Chronic Diseases – International Experience, and Shortcomings in Germany The care and management of chronic diseases, particularly in terms of multidisciplinary care, in Germany has not reached its full potential. In comparison to the health care systems of the Netherlands and the UK, the German system has been less effective in involving physiotherapists in the structured care and management of chronic diseases, even though this multidisciplinary approach has been shown to improve chronic care. Furthermore, physiotherapy can contribute considerably to the development of evidence-based guidelines for chronic care and can assist patients and relatives in the self-management of their conditions. This, however, requires a fundamental reform in both the training and education of physical therapists. The emergence of graduate and doctoral programmes for physiotherapists in Germany lags behind the academic development of physiotherapy in other countries

Facilitators and barriers to the implementation of prehabilitation for frail patients into routine health care: a realist review

Abstract Background Despite evidence supporting the effectiveness of prehabilitation as a new preoperative care pathway to optimise perioperative outcomes, its implementation into routine health care is widely pending. Frail patients might particularly benefit from prehabilitation interventions, but facilitating and hindering factors need to be considered in the implementation process. Thus, our aim was to derive a programme theory on what prehabilitation programmes work for frail patients in what circumstances and why. Methods Following Pawson’s realist review approach, preliminary programme theories on facilitators and barriers were established. General and topic-specific databases were searched systematically for facilitators and barriers to the implementation of prehabilitation for frail patients. Articles were included if they dealt with multimodal prehabilitation programmes prior to surgery in a frail population and if they contained information on facilitators and barriers during the implementation process in the full text. Based on these articles, refined programme theories were generated. Results From 2,609 unique titles, 34 were retained for the realist synthesis. Facilitating factors included the individualisation of prehabilitation programmes to meet the patients’ needs and abilities, multimodality, adaption to the local setting and health care system, endorsement by an ambassador and sharing of responsibilities among a multidisciplinary team. Central barriers for frail patients were transportation, lack of social support, and inadequate, overwhelming information provision. Conclusions Implementing prehabilitation as a new care pathway for frail patients requires organisational readiness and adaptability to the local setting. On an individual level, a clear understanding of responsibilities and of the intervention’s goal among patients and providers are necessary. Added attention must be paid to the individualisation to fit the needs and restrictions of frail patients. This makes prehabilitation a resource-intense, but promising intervention for frail surgery patients. Trial registration PROSPERO (CRD42022335282)