Aspekte von Partizipation in der Physiotherapie

Partizipation als Teilhabe an der Gesellschaft, am physiotherapeuti-Entscheidungsprozess und als Partner*innen in der Forschung sind zentrale Aspekte für Patient*innen

Health economic evaluations of interventions to increase physical activity and decrease sedentary behavior at the workplace : a systematic review

Objective The workplace is an ideal setting to implement public health strategies, but economic justification for such interventions is needed. Therefore, we performed a critical appraisal and synthesis of health economic evaluations (HEE) of workplace interventions aiming to increase physical activity (PA) and/or decrease sedentary behavior (SB). Methods A comprehensive search filter was developed using appropriate guidelines, such as the Peer Review of Electronic Search Strategies (PRESS) checklist, and published search algorithms. Six databases and hand searches were used to identify eligible studies. Full HEE of workplace interventions targeting PA/SB were included. Methodological quality was assessed using the Consensus Health Economic Criteria (CHEC) list. Two researchers independently performed all procedures. Hedges' g was calculated to compare intervention effects. Outcomes from HEE were recalculated in 2017 euros and benefit-standardized. Results Eighteen HEE were identified that fulfilled on average 68% of the CHEC list criteria. Most studies showed improvements in PA/SB, but effects were small and thus, their relevance is questionable. Interventions were heterogeneous, no particular intervention type was found to be more effective. HEE were heterogeneous regarding methodological approaches and the selection of cost categories was inconsistent. Indirect costs were the main cost driver. In all studies, effects on costs were subject to substantial uncertainty. Conclusions Due to small effects and uncertain impact on costs, the economic evidence of worksite PA/SB-interventions remains unclear. Future studies are needed to determine effective strategies. The HEE of such interventions should be developed using guidelines and validated measures for productivity costs. Additionally, studies should model the long-term costs and effects because of the long pay-back time of PA/SB interventions

Benefits of short-term training with vibrotactile biofeedback of trunk sway on balance control in multiple sclerosis

Background and Aims: Patients with multiple sclerosis (MS) suffer from diminished balance control. We examined whether 4 sessions of training with vibrotactile biofeedback (VTfb) of trunk sway could improve their balance control and provide a carry-over effect. Methods: Baseline trunk sway was first measured for 15 MS patients. Then they received head mounted VTfb of trunk sway which was directionally active when trunk sway exceeded limits set using the baseline assessments. Stance and gait tasks were trained 2 times weekly for 2 weeks with VTfb. Assessments with VTfb were performed at the end of each week. Two weeks later balance was assessed without VTfb to determine if a carry-over effect was present. Results: Assessments with VTfb showed a significant decrease in trunk sway after 1 and 2 weeks of VTfb training (p<0.02). Carry-over improvements were also present (p<0.02). The greatest effects were found for tests of standing eyes closed stance on foam which resulted in a 59% decreased pitch sway angle (p=0.002) with VTfb and a 51% reduction (p=0.03) carry-over effect. Conclusions: This study indicates that balance control in MS patients improves rapidly after one week of training with VTfb and more slowly subsequently. The carry-over effect lasted at least 2 weeks. Future studies should determine, with more weeks of VTfb training, the time course of the slower balance and carry-over improvements following the first rapid improvement in balance control. We conclude that training with VTfb of trunk sway significantly improves balance control in MS patients, and could possibly reduce falls

What are the economic dimensions of occupational health and how should they be measured? A qualitative study.

BACKGROUND Decision makers want to know if there is a financial benefit in investing scarce resources in occupational health management (OHM). Economic evaluations (EEs) of OHM-strategies try to answer this question. However, EEs of OHM-strategies which are strongly marked by quantitative methods may be limited by contextual, qualitative residuals. Therefore, the objectives of this study were to (1) explore important economic dimensions of OHM and (2) to discuss the methods used in current EEs for measuring these dimensions. METHODS In this explorative qualitative study, OHM-specialists were recruited via the Swiss organisation for health promotion. Thirteen semi-structured interviews were performed from November 2020 until May 2021. Videotapes were transcribed verbatim and organised by using an open coding strategy. Codes were clustered and synthesised as themes (i.e. the dimensions of EEs of OHM) through a mix of inductive and deductive content analysis. Member check with eight participants was accomplished to validate the results. RESULTS The interviews had an average duration of 70.5 min and yielded 609 individual codes. These codes were merged into 28 subcategories which were finally categorised into five main themes: Understanding of OHM, costs, benefits, environmental aspects, and evaluation of OHM. Participants stated that the greater part of costs and benefits cannot be quantified or monetised and thus, considered in quantitative EEs. For example, they see a culture of health as key component for a successful OHM-strategy. However, the costs to establish such a culture as well as its benefits are hard to quantify. Participants were highly critical of the use of absenteeism as a linear measure of productivity. Furthermore, they explained that single, rare events, such as a change in leadership, can have significant impact on employee health. However, such external influence factors are difficult to control. CONCLUSIONS Participants perceived costs and benefits of OHM significantly different than how they are represented in current EEs. According to the OHM-specialists, most benefits cannot be quantified and thus, monetised. These intangible benefits as well as critical influencing factors during the process should be assessed qualitatively and considered in EEs when using them as a legitimation basis vis-à-vis decision makers

Replacing canes with an elasticated orthotic-garment in chronic stroke patients - The influence on gait and balance. A series of N-of-1 trials

Objective:To investigate the effect of replacing canes with an elasticated orthotic-garment on balanceand gait-function in chronic stroke survivors.Design:Experimental, N-of-1 series with a replicated, ABC design with randomised phase duration in ahome setting.Participants:Four cane using chronic stroke survivors (P1-4).Interventions:Phase A (9e12 weeks) cane-walking“as usual”to establish baseline values; Phase B (9e16weeks) intervention: orthotic-garment worn throughout the day with maximal cane-use reduction;Phase C (9e10 weeks) participant-determined follow-up: either no walking-aid, orthotic-garment orcane.Outcome measures:Primary: Functional-Gait-Assessment (FGA), Secondary: Trunk-sway during walkingmeasured as Total-Angle-Area (TAA�2) in frontal and sagittal-planes, both measured weekly.Results:Visual and statistical analysis of results showed significant improvements in FGA from phase Ato B in all participants. Improvement continued in phase C in P2, stabilized in P1 and P4 and deterioratedin P3. A Minimal-Clinical-Important-Difference of 6 points-change was achieved in P2&P4. Trunk-swayreduced during walking, indicating increased stability, in two participants from phase A to B and in threeparticipants from A to C but no TAA changes were statistically significant. In phase C participant-selectedwalking-aids were: P1 cane-usage reduced by 25%, P2 independent-walking with no assistive-device, S3usual cane-usage, P4 orthotic-garment with reduced cane-usage 2-3 days-a-week, usual cane-usage 4e5days.Conclusions:Although walking ability is multifactorial these results indicate that the choice of walking-aids can have a specific and clinically relevant impact on gait following stroke.“Hands-free”assistive-devices may be more effective than canes in improving gait-function in somepatients

Characteristics of improvements in balance control using vibro-tactile biofeedback of trunk sway for multiple sclerosis patients

Background and aims: Previously, we determined that training with vibrotactile feedback (VTfb) of trunk sway improves MS patients’ balance impairment. Here, we posed 5 questions: 1) How many weeks of VTfb training are required to obtain the best short-term carry over effect (CoE) with VTfb? 2) How long does the CoE last once VTfb training terminates? 3) Is the benefit similar for stance and gait? 4) Is position or velocity based VTfb more effective in reducing trunk sway? 5) Do patients’ subjective assessments of balance control improve? Methods: Balance control of 16 MS patients was measured with gyroscopes at the lower trunk. The gyroscopes drove directionally active VTfb in a head-band. Patients trained twice per week with VTfb for 4 weeks to determine when balance control with and without VTfb stopped improving. Thereafter, weekly assessments without VTfb over 4 weeks and at 6 months determined when CoEs ended. Results: A 20% improvement in balance to normal levels occurred with VTfb. Short term CoEs improved from 15 to 20% (p ≤0.001). Medium term (1–4 weeks) CoEs were constant at 19% (p ≤0.001). At 6 months improvement was not significant, 9%. Most improvement was for lateral sway. Equal improvement occurred when angle position or velocity drove VTfb. Subjectively, balance improvements peaked after 3 weeks of training (32%, p ≤0.05). Conclusions: 3–4 weeks VTfb training yields clinically relevant sway reductions and subjective improvements for MS patients during stance and gait. The CoEs lasted at least 1 month. Velocity-based VTfb was equally effective as position-based VTf

Roadmap für strombasierte Kraftstoffe 03EIV116A-G

Synthetische Kraftstoffe können die Defossilisierung des Verkehrssektors mit vorantreiben. Besonders bei hohen Transportvolumina oder für große Entfernungen sind diese Kraftstoffe eine vielversprechende Option, etwa in der Luft- und Schifffahrt oder zu Teilen im Schwerlastverkehr. Auf Basis von Strom aus erneuerbaren Energien hergestellte Kraftstoffe sollen in Zukunft entscheidend dazu beitragen, die CO2-Bilanz zu verbessern und Klimaneutralität im Verkehrssektor zu erreichen. Die Forschung dockt damit an die Schnittstelle zwischen Energie- und Verkehrssektor an. Im Rahmen der BMWK-Forschungsinitiative Energiewende im Verkehr (EiV) haben von 2018 bis 2023 insgesamt 16 industriegeführte F&E-Projekte die Entwicklung synthetischer Kraftstoffe für den Luft-, See- und Straßenverkehr deutlich vorangebracht. In den Projekten wurde eine Vielzahl verschiedener Kraftstoffe, Herstellverfahren und Anwendungen betrachtet. Dabei war es die Aufgabe der „Begleitforschung Energiewende im Verkehr“ (BEniVer), als einer der 16 EiV-Projektverbünde, die Projektergebnisse der technischen Forschungsvorhaben der Förderinitiative auf Basis eigenständiger wissenschaftlicher Analysen vergleichbar zu machen. Dazu wurden einheitliche Rahmenannahmen und Methodikleitfäden entwickelt. Die Ergebnisse der Forschungsprojekte wurden in einer Gesamtbetrachtung zusammengeführt und dienten als Grundlage für technische, ökonomische und ökologische Bewertungen. Dabei beruhten die technologie-orientierten Bottom-Up-Analysen auf den neuesten Forschungsarbeiten. Diese wurden mit systemorientierten Top-Down-Analysen des Energie- und Verkehrssystems sowie möglichen Transformationspfaden auf dem Weg zur Klimaneutralität kombiniert. Weitere Analysen zur Akzeptanz und zur Markteinführung adressieren zudem gesellschaftliche Dimensionen und Auswirkungen der Einführung von strombasierten Kraftstoffen. Auf Basis der ganzheitlichen Analysen wurden Schlussfolgerungen abgeleitet. Als Ergebnis der langjährigen und fachübergreifende Begleitung der EiV-Forschungsvorhaben ist mit der Roadmap für strombasierte Kraftstoffe ein Leitfaden entstanden mit Handlungsoptionen für die Erforschung, Entwicklung, Produktion und Markteinführung dieser Kraftstoffe

Forschungsinitiative Energiewende im Verkehr, Kurzbericht zur „Roadmap für strombasierte Kraftstoffe“ 03EIV116A-G

Synthetische Kraftstoffe können die Defossilisierung des Verkehrssektors mit vorantreiben. Besonders bei hohen Transportvolumina oder für große Entfernungen sind diese Kraftstoffe eine vielversprechende Option, etwa in der Luft- und Schifffahrt oder zu Teilen im Schwerlastverkehr. Auf Basis von Strom aus erneuerbaren Energien hergestellte Kraftstoffe sollen in Zukunft entscheidend dazu beitragen, die CO2-Bilanz zu verbessern und Klimaneutralität im Verkehrssektor zu erreichen. Die Forschung dockt damit an die Schnittstelle zwischen Energie- und Verkehrssektor an. Im Rahmen der BMWK-Forschungsinitiative Energiewende im Verkehr (EiV) haben von 2018 bis 2023 insgesamt 16 industriegeführte F&E-Projekte die Entwicklung synthetischer Kraftstoffe für den Luft-, See- und Straßenverkehr deutlich vorangebracht. In den Projekten wurde eine Vielzahl verschiedener Kraftstoffe, Herstellverfahren und Anwendungen betrachtet. Dabei war es die Aufgabe der „Begleitforschung Energiewende im Verkehr“ (BEniVer), als einer der 16 EiV-Projektverbünde, die Projektergebnisse der technischen Forschungsvorhaben der Förderinitiative auf Basis eigenständiger wissenschaftlicher Analysen vergleichbar zu machen. Dazu wurden einheitliche Rahmenannahmen und Methodikleitfäden entwickelt. Die Ergebnisse der Forschungsprojekte wurden in einer Gesamtbetrachtung zusammengeführt und dienten als Grundlage für technische, ökonomische und ökologische Bewertungen. Dabei beruhten die technologie-orientierten Bottom-Up-Analysen auf den neuesten Forschungsarbeiten. Diese wurden mit systemorientierten Top-Down-Analysen des Energie- und Verkehrssystems sowie möglichen Transformationspfaden auf dem Weg zur Klimaneutralität kombiniert. Weitere Analysen zur Akzeptanz und zur Markteinführung adressieren zudem gesellschaftliche Dimensionen und Auswirkungen der Einführung von strombasierten Kraftstoffen. Auf Basis der ganzheitlichen Analysen wurden Schlussfolgerungen abgeleitet. Als Ergebnis der langjährigen und fachübergreifende Begleitung der EiV-Forschungsvorhaben ist mit der Roadmap für strombasierte Kraftstoffe ein Leitfaden entstanden mit Handlungsoptionen für die Erforschung, Entwicklung, Produktion und Markteinführung dieser Kraftstoffe

Préhabilitation en chirurgie de résection pulmonaire et en chirurgie viscérale

Auf Empfehlung des Universitätsspitals Basel haben vier Studentinnen für ihre zwei Bachelor-Thesen die Evidenz zur Prähabilitation in der Lungenresektions- und Viszeralchirurgie zusammengetragen. Die Ergebnisse sind eindeutig.Sur recommandation de l’Hôpital universitaire deBâle, quatre étudiantes ont rassemblé les données probantes concernant la préhabilitation en chirurgie de résection pulmonaire et en chirurgie viscérale, dans le cadre de deux mémoires de Bachelor. Les résultats sont clairs