Christine Rungg, Aloisia Angermair, Ursula Costa, Sabrina Neururer, Markus Moosbrugger, Waltraud Buchberger, Melanie Kriegseisen-Peruzzi and Susanne Perkhofer
This pilot study at the University Hospital of Innsbruck aimed to interview employees in order to optimise the treatment of patients with dementia. Available data concerning prevalence of dementia in this hospital were analysed and show a slight increase in numbers.
Nurses at one inpatient department and one outpatient clinic completed a standardized questionnaire developed by the German Institute for Applied Nursing Research (dip, 2012). Dementia is a highly relevant topic for the participating nursing staff. Results show potential for improvement in pain management, assurance of continuity of services, and communication skills.
Nursing staff responded questions about emotional burden, based in their work with this group of patients. The emotional burden was rated as being higher in the inpatient department. Participants from both departments expressed their wish for better involvement of dementia clients’ relatives in the clinical work. Finally, the nursing staff’s needs for educational support was surveyed.
Additionally, six members of the patient transport service participated in a focus group interview. Specific types of burden related to handling patients with dementia, as well as wishes and requirements for improvement related to the patient transport for persons with dementia were expressed.
The survey shows both, the current state and further potential for improvement of the treatment of patients with dementia at the University Hospital of Innsbruck. Based on the results of this survey a continuing education programme meeting staff needs was developed as one of the measures resulting in the project aiming to improve the treatment of patients with dementia.
In the period 2011 – 2013, 13 care support points were set up in Mecklenburg-West Pomerania. They are the joint responsibility of all health and long-term care insurance funds and local government.
Between July and November 2013, data on organisation and personnel were collected in respect of the care support points and their advisory staff. Questions were asked about reasons for visiting a care support point, the subject matter of any counselling and demographic data on the users. Data were collected using questionnaires and interviews. Descriptive statistics were used to analyse quantitative data, the interviews were evaluated by analysis of their content.
The results show a heterogenic picture of adviser training. Most users made contact with the care support points by telephone. General information on long-term care insurance was frequently sought. In 2015, care support points were consulted much more frequently than in 2014. The partners describe the networking involved as time-consuming; any synergy effects to date were estimated to be limited.
More network structures need to be created if those in need of care and assistance as supplied by care counselling based on case management are to be reached in future. What is called for are firm, written contracts with no personal bias, assigning care support points with the role of central actors at the regional level, able to produce neutral, independent organization and coordination of the necessary assistance. A guarantee of continuity of provision would fulfill the requirements of the kind of procedure involved in case management. Regardless of the number of professional providers and informal carers participating.
Hannes Außermaier, Ursula Margarethe Costa, Maria Essmeister and Gudrun Diermayr
Wheelchair users often encounter barriers reducing community mobility and participation in societal life. Information on barrier-free routes may improve mobility and therefore societal participation. In addition to technical prerequisites, a routing system will only be effective and used by the target group, if the development process is based on their perceptions and needs. The aim of the study was therefore to collect data on barriers from the viewpoint of wheelchair users in Vienna.
A multiprofessional team conducted three focus group discussions with 22 wheelchair users from Vienna (maximum variation sampling, wheelchair-bound individuals and assistants). Data were analyzed qualitatively using inductive and deductive content analysis. The International Classification of Functioning, Disability and Health, and the Occupational Performance Model (Australia) served as guiding frameworks during deductive data analysis. Barriers within the physical environment were further subcategorized.
Barriers identified in all three groups could be assigned mainly to physical and socio-cultural environments. Most important physical barriers were ground conditions, curbstones and gradients. Other barriers were related to one’s own body, other people in the environment, and lack of information on structural conditions.
Our results underline the benefit of participatory research and they demonstrate the complexity of barriers encountered by wheelchair users in the community. A routing system provides information to wheelchair users enabling them to avoid physical barriers in the community and to stakeholders enabling them to reduce and remove barriers in public spaces.
Adrian Roesner, Frauke Ackenhausen, Ralf Eberhardt, Ulrike Gundlach, Jonas Marquardt, Sebastian Voigt-Radloff and Axel Schäfer
Recent health insurance statistics show that low back pain (LBP) takes the first place in individual diagnoses according to sick leave statistics. As stated by the German back pain study of 2003/2006, long-term prevalence amounts to a total of 74 % to 85 %. In the case of acute unspecific LRS guidelines, recommend the use of non-steroidal anti-inflammatory drugs and patient education in order to motivate the patient to retain an active lifestyle, to stay physically active and to inform the patient about the background of the symptoms. Studies about the current medical supply situation in Germany show injections and passive therapy methods are part of the standard care, whereas educational measures are generally not applied.
A Cochrane Review indicates the effectiveness of educational measures that have a duration of 2 hours. Education in the recommended intensity can probably not be realized by health care practitioners within the time framework set aside for treatment and advice. Because of their range of services and their professional competence physical and occupational therapists appear to be predestined for this type of education as intervention.
In order to assess the potential of such an intervention for a later more extensive efficacy study a feasibility study should be carried out first. The focus is on assessing the feasibility and the evaluation of intervention education.
Christian Müller, Sindy Lautenschläger and Sebastian Voigt-Radloff
In Germany, four to five million community-dwelling people aged 65 years or older fall every year. The presented potential analysis evaluates the potential of occupational therapy-led physical exercise programs and home environment adaptations to reduce the frequency of falling and as well as intrinsic and extrinsic risk factors for falling of older people living at home.
The potential analysis was compiled according to a method guideline (p.11-22) available as follows: http://www.cochrane. de/news/leitfaden-f%C3%BCr-gesundheitsfachberufe-mai-2013. The research question of fall prevention was considered as very relevant for health care and specified according to the PICOS-system. A Cochrane review was systematically searched and the body of evidence was assessed using the GRADE-system. In addition, studies after the search period of the Cochrane review were identified using the search strategy of this review. Both the studies within and after the review were assessed regarding their transferability to the German health care context.
Corpus of evidence
A Cochrane review from 2012 revealed that occupational therapy-led physical exercise programs reduced the frequency of falling of older people living at home (7 studies, 951 participants, 0.68 RaR; 95%-KI [0.58-0.80]), the number of fallers (6 studies, 714 participants, 0.78 RaR, 95%-KI [0.64-0.94]) and the fractures (6 studies, 810 participants, 0.34 RaR, 95%-KI [0.18-0.63]). Further studies showed that home environment adaptation programs significantly reduced the number of falls (4 studies, 1443 participants, 0.69 RaR, 95%-KI [0.55-0.86]) and the number of fallers (5 studies, 1153 participants, 0.79 RaR, 95%-KI [0.70-0.91]). However, direct implementation into the German healthcare context is not recommendable.
Implication for research
It is recommended (1) to manualise identified home environment adaptation programmes for the German healthcare context and (2) to pilot-test the physical exercise programmes ‘LiFE’ with regard to theoretical framework, acceptance, applicability and feasibility and to examine both interventions as part of a feasibility study. If this trial results in a feasible treatment programme well accepted by patients and their treating occupational therapists, a large-scaled randomized clinical trial in terms of comparative effectiveness research may follow.
Thomas Friedli, Peter M. Villiger and Brigitte E. Gantschnig
People with chronic diseases are often limited in their workability. Evaluating and enabling workability is central in rehabilitation. The aim of this study was to evaluate validity and utility of workability assessments in German for persons with chronic diseases.
The study is a systematic review. First, we systematically searched for literature in the databases Medline, CINAHL, PsycInfo, Cochrane HTA Database, DARE, CCMed, Sowiport, and BASE using following keywords: evaluation tool, chronic disease, workability, validity, and utility. Then, we evaluated the content and the quality of the studies based on criteria and decided if they were included.
In total, validity and utility of eight workability assessments are described based on 74 studies. The assessments are: Productivity Costs Questionnaire (iPCQ), Work Instability Scale for Rheumatoid Arthritis (RA-WIS), Screening-Instrument Arbeit und Beruf (SIBAR), Screening-Instrument zur Feststellung des Bedarfs an medizinisch-beruflich orientierten Maßnahmen in der medizinischen Rehabilitation (SIMBO), Valuation of Lost Productivity Questionnaire (VOLP), Work Ability Index (WAI/ABI), Work Limitations Questionnaire (WLQ), and Work Productivity and Activity Impairment Questionnaire (WPAI).
The results revealed the availability of eight workability assessments for persons with chronic diseases in German language. They have strengths and weaknesses in relation to the construct, purpose, application, and evidence base. These could be the base for choice of an assessment. Overall, we suggest using workability assessment in order to meet the legal requirements for the use of standardized assessments and the increasing demand to establish evidence of the effectiveness of interventions.
Paola Origlia Ikhilor, Tabea Brändle, Salome Pulver and Elisabeth Kurth
Perinatal health disadvantage of migrants is exacerbated in presence of language barriers. Interpreting has the potential to optimize both, communication and outcome of mother and child. In Switzerland, a regional midwifery network provides access to telephone interpreting services although it is not remunerated by health insurances, and thus, is often impeded. This study examined usefulness, areas of use and difficulties of telephone interpreting in home postpartum care by midwives.
Data was collected between September 2013 and March 2016 by midwives of the network. The questionnaire contained multiplechoice questions, a visual analogue scale and free-text fields.
46 questionnaires were evaluated. 10 out of 29 specially trained midwives exerted the service. Telephone interpreting was primarily used to record women’s concerns and provide information. The main topics were the somatic health of mother and child, breastfeeding, and more rarely psychosocial issues and information on care provision. Achieved understanding, increased women’s satisfaction and improved health competence were the perceived advantages in using the service. Difficulties, especially with the extra time needed for the consultation, insufficient telephone connection and professionality of the telephone interpreter, were stated less often. Overall, the midwives estimated the benefits of telephone interpreting for the quality of care with 7.4 out of 10 possible points.
Although telephone interpreting improved the quality of care, midwives did infrequently use it. Specific training and video interpreting have the potential to increase the quality of the interpreted conversations and to minimize possible hurdles. Psychosocial issues should be addressed more intensively.
Andrea Koppitz, Veronika Waldboth, Jutta Dreizler and Lorenz Imhof
Sensing, observing and interpreting the symptoms of persons suffering from dementia is very challenging. The difficulties lie in their restricted capacity to communicate and irregular transitions from a chronic-stable to an acute-critical condition both in the course of their symptoms and in the slow but continuous process of deterioration.
The aim of this integrative literature review was to identify the symptoms dementia patients present in the final twelve months of their lives and to identify instruments for symptom assessment. To this end, a comprehensive literature search within the electronic databases Medline® (PubMed), Cinahl® (EBSCO), PsycINFO® (OVID) and Cochrane Library for systematic reviews® and for clinical trials® in both German and English was performed including publications from January 2000 to July 2012.
Six symptoms were identified as frequent and common in the end-of-life phase of people with dementia: respiratory distress, pain, mood swings, restricted mobility, restricted food and fluid intake and behavioural and psychosocial symptoms. Knowledge of atypical symptom manifestation requires critical reflection about perceptions and observations, interpretation of these observations, development of assumptions and location within the context of everyday life in the meaning of clinical reasoning.
Women often suffer from urinary incontinence after childbirth. Pelvic floor muscle training is an evidenced-based intervention to prevent urinary incontinence and improve its symptoms
The primary purpose of this study was to determine if there is a change in the activation of the pelvic floor muscles with different extrinsic parameters (barefoot versus unstable shoe). Second, we wanted to define variables that can be measured reliably and correlated with pelvic floor activity.
Data of 15 women who were 8 weeks to 6 months postpartum were analyzed. Two conditions (“barefoot” and “kyBoot”) were tested, with each participant performing three different tasks: walking, standing with an active pelvic floor, and standing with a passive pelvic floor. Three-dimensional kinematics of the body were recorded. Activity of the abdominal, back, and gluteal muscles was measured using surface electromyography (EMG). The activity of the pelvic floor was recorded using a vaginal electrode. Maximum pelvic floor activity was compared for each condition, and correlations among pelvic floor activity, kinematic variables, and skeletal muscle activity were determined.
The maximum activity of the pelvic floor while walking was significantly higher when participants were barefoot than when they were wearing kyBoot shoes. For the standing trials, no significant differences between the conditions were detected. No surrogate marker was found to measure the pelvic floor activity.
With regard to the pelvic floor musculature, no recommendation is possible in favor of or against wearing unstable shoes. Technical developments are necessary to provide solutions to reliably measure the pelvic floor activity.