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.
Marianne Frech, Martin Nagl-Cupal, Agnes Leu, Gisela C. Schulze, Anna-Maria Spittel and Steffen Kaiser
Children and adolescents with caring responsibility who are looking after a family member or a person close are often hiding from the view of the public. They are not well recognised from professionals from health care, education and social services. Several research as well as support programmes have been initiated within the last years. It became obvious that the term ‘young carers’ was translated in various ways into German and connected with different attributes. An integral understanding is yet of high relevance for the international dialogue as well as for the transfer from theory to practice.
The aim of this article is to analyse and conceptualize the use of different terminologies for ‘young carers’ by professionals when providing support for these young people. A definition for the target population was developed for German speaking countries that will provide the groundwork for the scientific and public discourse.
The analysis illustrated the various use of terms as well as defining key characteristics – the presence of an ill person that needs support, the age of these young people, the tasks they perform as well as the involved high responsibility.
Not all children of family members or persons close who have an illness or impairment perform a support role. Only part of these young people take on caring tasks and provide support on a significant level.
The analysis showed the need for a clarification of the terms used in German speaking countries for ‘young carers’. A commonly applied definition enables an identification of the target group by professionals and the persons concerned. Additionally, it facilitates the alignment to the proceeding international discourse.
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.
Eva-Maria Panfil, Zdenka Volmajer and Jan Taeymans
The key criteria for identification of pressure ulcer risk are mobility and activity. In practice and research, it is currently not possible to assess these criteria with reliable instruments. New technical methods allow a quantified metric measurement of the mobility of patients lying in bed. However, it is unclear how to interpret such data. Therefore, the aim of this systematized literature review was to identify (i) reference values for frequencies of movements during sleep, and (ii) critical values for the clinical diagnosis of pressure ulcer risk. A literature search was conducted in the MedLine, CINAHL, Trip Database, the Cochrane Library, PEDro, Google Scholar databases and by handsearching the reference lists of eligible manuscripts for the period 2008-2013. One review and nine primary studies were selected. Pressure ulcer risk studies showed poor methodological quality while they showed a high heterogeneity of the measurement methods for the detection of movement during sleep. This observed heterogeneity did not allow to compare the study results. Less studies reported reference values compared to studies reporting correlations with pathological conditions such as sleep quality and pressure ulcer risk. After critically reviewing the studies, no valid data on the frequency of movement during sleep and on critical values for the clinical diagnosis of pressure ulcer risk was found. To interpret the results of a new measurement method and its efficacy, more diagnostic studies and high-quality randomized controlled trials are needed.
Rebekka Erdin, Irina Iljuschin and Jessica Pehlke-Milde
Psychosocial resources of parents are vital for the health and development of their children. Families in stressful circumstances should receive early seamless care to strengthen their parental resources. Independent midwives provide ambulant postpartum care in most families in Switzerland, and hence could play an important role in the early assessment and care of families at risk.
Comprehensive routine data of Swiss independent midwives were used for secondary analysis. Frequencies of known psychosocial risk factors were derived and compared to other data sources. Group comparisons were made with respect to family characteristics and midwifery care.
Only some of the considered risk factors are representable in the midwives‘ data. 18.6% of all families have one and 6.25% have multiple such representable risk factors. Immigrant mothers from developing and emerging countries, very young or older mothers and large families are thereby particularly often affected. Burdened families receive more home visits, but have a later onset of ambulant postpartum care. They suffer more often from breast-feeding problems and are more frequently referred to other disciplines.
Independent midwives in Switzerland document some of the known psychosocial risk factors and adapt their care in routine practice. The collection of data with a better coverage of the known psychosocial risk factors, ideally using validated assessment instruments, is recommended, and further research is required for a more in-depth understanding of the current interdisciplinary collaboration and the needs of families and care providers.
The article focuses on topics, approaches, and methodological perspectives of qualitative intervention research developing within an experimental science-oriented research environment. Recent stroke rehabilitation studies from physical, occupational and speechlanguage therapy and nursing sciences predominantly utilize qualitative content summary, largely without reference to established qualitative research approaches. A majority of these studies is characterized by inventories of topics covered by research participants in interviews and focus groups. Based on existing typologies of qualitative findings, opportunities for developing the complexity and explanatory power of qualitative intervention research are discussed. A more thorough methodological foundation and quality control are important tasks for future development.
Hannes Aftenberger, Gabriele Schwarze, Beate Salchinger and Angelika Rother
The International Classification of Functioning Disability and Health (ICF) provides the language and a framework applying a unified and standardized form to describe health and conditions related to health. Teams who work in an interdisciplinary and multi professional way, as it is the case in neuro rehabilitation, can profit from integrating the ICF. The aim of this paper was to show how well implemented the ICF is in Austria with occupational therapists, speech and language therapists and physiotherapists working in neuro rehabilitation.
The present paper is a follow-up project of the APPEAR study. An extended questionnaire, which has been sent to 109 therapists working in Austrian neurologic rehabilitation facilities forms the basis for the results presented here.
64 questionnaires were returned from occupational therapists, speech and language therapists and physio therapists and were used for evaluation. 50% of the therapists who answered the questionnaire (n=25) stated that the ICF has already been implemented in their institution. Therapists often applied ICF (n=35) when using common documentation systems. Additionally, therapists consider the ICF an aid to support interdisciplinary and multi professional work. The therapists also stated (n=27) that they are not satisfied with the ICF when inpatients become outpatients.
Many therapists answering the questionnaire consider the ICF an important tool for optimizing the rehabilitation process. Barriers contributing to hindering an implementation of the ICF should be eliminated in the future. In order to achieve that aim, institutions should provide time and financial resources to further the education of their employees.
Patrick Heldmann, Thomas Schöttker-Königer and Axel Schäfer
Objective: Measurement of activity and participation related outcomes play an important role in rehabilitation of low back pain. Therefore the „Patient Specific Functional Scale»(PSFS) was developed to assess individual, patient related activities. The aim of this study is the cultural adaptation and validation of the PSFS for German speaking countries.
Method: A cultural translation and adaptation process was carried out in accordance with standardized guidelines. The internal and external responsiveness and the construct validity adjustment to the German version pertaining to patients with lumbar back pain was examined in comparison to the «Oswestry Disability Index»(ODI).
Results: In both groups the PSFS proved itself to be more sensitive in comparison to the ODI. The internal responsiveness of ODI improved ES= -0.75), (non-improved ES= -0.38). PSFS (improved ES= 1.96), (non-improved ES 0.77). The external responsiveness of ODI (AUC= 0.59), of PSFS (AUC= 0.83) (P= 0.0068). Constructs of both measurement instruments have a weak and a moderate correlation on measuring point 1 (r= -0.28) and 2 (r= -0.58).
Conclusion: The German version of PSFS proves itself to be a feasible model and a method of high sensitivity in evaluating changes in the functional ability of patients with lumbar back pain. The instrument can be recommended to be used in clinical practice.
In Switzerland, 39% of nursing home residents have a dementia related disease. Behavioral symptoms are increasingly observed as dementia progresses. These symptoms impair patients’ quality of life and are distressing to family caregivers and nurses. A person-centered approach, which includes the resident’s individual biography, reduces such symptoms. The most current literature describes how therapists include biographical information in designated therapies. However person-centered care takes place not only in specific activities. Nurses are responsible for their patients’ care 24 hours a day.
The goal of this study is to explore how nurses include biographical information in their daily care.
Data were collected from qualitative interviews with registered nurses (n=10) in a nursing home and analysed according to the Charmaz Grounded Theory approach.
The inclusion of the personal biography in daily care appears as a continuous, repetitive process with three main categories: “negotiating”, “connecting” and “being-in-good-hands”. Nurses in this study report that they can trigger positive reactions and reduce behavioral symptoms by means of meaningful interventions, when connected to the residents’ biography. Meaningful interventions can support residents in making contact to their current everyday life, acting independently and perceiving self-efficacy (= connecting). To initiate meaningful interventions, nurses need to connect biographical information to current experiences of the resident (= negotiating). This requires a thorough understanding of the residents’ situation. Nurses obtain an in-depth understanding through caring relationships, which are characterized by continuity of care and a mutual dialogue, where needs and experiences are shared, understood and evaluated (= being-in-good-hands).
Yvonne Treusch, Nadine Saxer, Theresa Witschi and Julie Page
So far, few studies exist concerning the professional contribution and effects of occupational therapy in people with depression. This contrasts the practical and quantitative contribution of this form of therapy.
To reconstruct the specific contribution of occupational therapy in treating people with depression from a patient perspective.
Half-standardized interviews with 10 patients of a Swiss day clinic before and after their stay were evaluated with a qualitative content analysis.
The analysis resulted in three phases that are traversed by the persons concerned in the course of the occupational therapy process. The dimensions considered as essential of occupational therapy namely activity, group, and therapist fulfilled different functions in each phase.
Occupational therapy plays a central role in the treatment of people with depression. While at the beginning of the depression activities within occupational therapy have a more distracting character, activities related to everyday life are more important later in the therapy process. The differentiated perception of different stages in people with depression allows the development of symptom-specific, user-oriented services.