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Drewitz KP, Hasenpusch C, Bernardi C, Brandstetter S, Fisser C, Pielmeier K, Rohr M, Brunnthaler V, Schmidt K, Malfertheiner MV, Apfelbacher CJ. Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): feasibility of a pragmatic randomised controlled trial. BMC Anesthesiol 2023; 23:344. [PMID: 37838669 PMCID: PMC10576359 DOI: 10.1186/s12871-023-02255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/24/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND ICU survivors often suffer from prolonged physical and mental impairments resulting in the so called "Post-Intensive Care Syndrome" (PICS). The aftercare of former ICU patients affected by PICS in particular has not been addressed sufficiently in Germany so far. The aim of this study was to evaluate the feasibility of a pragmatic randomised trial (RCT) comparing an intensive care unit (ICU) follow-up clinic intervention to usual care. METHODS This pilot study in a German university hospital evaluated the feasibility of a pragmatic RCT. Patients were assigned in a 1:1 ratio to an ICU follow-up clinic intervention or to usual care. The concept of this follow-up clinic was previously developed in a participatory process with patients, next of kin, health care professionals and researchers. We performed a process evaluation and determined acceptability, fidelity, completeness of measurement instruments and practicality as feasibility outcomes. The RCT's primary outcome (health-related quality of life) was assessed six months after ICU discharge by means of the physical component scale of the Short-Form-12 self-report questionnaire. RESULTS The pilot study was conducted from June 2020 to May 2021 with 21 and 20 participants in the intervention and control group. Principal findings related to feasibility were 85% consent rate (N = 48), 62% fidelity rate, 34% attrition rate (N = 41) and 77% completeness of outcome measurements. The primary effectiveness outcome (health-related quality of life) could be measured in 93% of participants who completed the study (N = 27). The majority of participants (85%) needed assistance with follow-up questionnaires (practicality). Median length of ICU stay was 13 days and 85% (N = 41) received mechanical ventilation, median Sequential Organ Failure Assessment Score was nine. Six-month follow-up assessment was planned for all study participants and performed for 66% (N = 41) of the participants after 197 days (median). CONCLUSION The participatory developed intervention of an ICU follow-up clinic and the pragmatic pilot RCT both seem to be feasible. We recommend to start a pragmatic RCT on the effectiveness of the ICU follow-up clinic. TRIAL REGISTRATION ClinicalTrials.gov US NLM, NCT04186468, Submission: 02/12/2019, Registration: 04/12/2019, https://clinicaltrials.gov/ct2/show/NCT04186468.
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Affiliation(s)
- Karl Philipp Drewitz
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Claudia Hasenpusch
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christine Bernardi
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - Susanne Brandstetter
- University Children's Hospital Regensburg, University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Katharina Pielmeier
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Magdalena Rohr
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
- University Children's Hospital Regensburg, University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Vreni Brunnthaler
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
- Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10098, Berlin, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany
| | - Maximilian V Malfertheiner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Klinik Donaustauf, Ludwigstr. 68, 93093, Donaustauf, Germany
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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Huemer MT, Kluttig A, Fischer B, Ahrens W, Castell S, Ebert N, Gastell S, Jöckel KH, Kaaks R, Karch A, Keil T, Kemmling Y, Krist L, Leitzmann M, Lieb W, Meinke-Franze C, Michels KB, Mikolajczyk R, Moreno Velásquez I, Pischon T, Schipf S, Schmidt B, Schöttker B, Schulze MB, Stocker H, Teismann H, Wirkner K, Drey M, Peters A, Thorand B. Grip strength values and cut-off points based on over 200,000 adults of the German National Cohort - a comparison to the EWGSOP2 cut-off points. Age Ageing 2023; 52:6998045. [PMID: 36702514 PMCID: PMC9879709 DOI: 10.1093/ageing/afac324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The European Working Group on Sarcopenia in Older People (EWGSOP) updated in 2018 the cut-off points for low grip strength to assess sarcopenia based on pooled data from 12 British studies. OBJECTIVE Comparison of the EWGSOP2 cut-off points for low grip strength to those derived from a large German sample. METHODS We assessed the grip strength distribution across age and derived low grip strength cut-off points for men and women (peak mean -2.5 × SD) based on 200,389 German National Cohort (NAKO) participants aged 19-75 years. In 1,012 Cooperative Health Research in the Region of Augsburg (KORA)-Age participants aged 65-93 years, we calculated the age-standardised prevalence of low grip strength and time-dependent sensitivity and specificity for all-cause mortality. RESULTS Grip strength increased in the third and fourth decade of life and declined afterwards. Calculated cut-off points for low grip strength were 29 kg for men and 18 kg for women. In KORA-Age, the age-standardised prevalence of low grip strength was 1.5× higher for NAKO-derived (17.7%) compared to EWGSOP2 (11.7%) cut-off points. NAKO-derived cut-off points yielded a higher sensitivity and lower specificity for all-cause mortality. CONCLUSIONS Cut-off points for low grip strength from German population-based data were 2 kg higher than the EWGSOP2 cut-off points. Higher cut-off points increase the sensitivity, thereby suggesting an intervention for more patients at risk, while other individuals might receive additional diagnostics/treatment without the urgent need. Research on the effectiveness of intervention in patients with low grip strength defined by different cut-off points is needed.
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Affiliation(s)
- Marie-Theres Huemer
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Beate Fischer
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Stefanie Castell
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Nina Ebert
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Dusseldorf, Germany
| | - Sylvia Gastell
- NAKO Study Center South Berlin/Brandenburg, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Karl-Heinz Jöckel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany,State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Yvonne Kemmling
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Karin B Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ilais Moreno Velásquez
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Tobias Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany,Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Core Facility Biobank, Berlin, Germany,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Börge Schmidt
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany,Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Hannah Stocker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Henning Teismann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Kerstin Wirkner
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany,Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Michael Drey
- Department of Medicine IV, University Hospital, LMU Munich, Geriatrics, 80336 Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany,German Center for Diabetes Research (DZD), München-Neuherberg, Germany,Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Barbara Thorand
- Address correspondence to: Prof. Dr. Barbara Thorand. Tel: +49 (0)89/3187-4480.
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von Renteln-Kruse W, Neumann L, Vinyard D, Golgert S, Thiem U, Dapp U. Funktionale Krankheitsfolgen von Menschen im Alter ab 70 Jahren und die Akzeptanz eines neuen Unterstützungs-Netzwerkes, das NetzWerk GesundAktiv (NWGA). Dtsch Med Wochenschr 2022; 147:e116-e127. [PMID: 36323325 PMCID: PMC9668487 DOI: 10.1055/a-1933-7483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Einleitung
Häufigere Pflegebedürftigkeit bei steigender Lebenserwartung ist problematisch. Das NetzWerk GesundAktiv (NWGA) nimmt positive Beeinflussbarkeit der Entwicklung von Pflegebedürftigkeit an. In einer Pilotregion Hamburgs luden gesetzliche Krankenversicherungen ihre Versicherten im Alter ab 70 Jahren zur Teilnahme am NWGA Hilfs- und Betreuungsnetzwerk ein. Hier werden die Ergebnisse der Akzeptanzanalyse dargestellt.
Methoden
Zur Fokussierung auf die Zielgruppe der für die Entwicklung von Pflegebedürftigkeit gefährdeten Personen wurde der LUCAS Funktions-Index (Selbstausfüll-Fragebogen) als Screening für den Grad funktionaler Kompetenz verwendet. Die retrospektive Beobachtungsstudie untersuchte explorativ NWGA Teilnehmende, Ablehnende, Interessenten (Ausschluss, da funktional kompetent) und Non-Responder anhand sozio-demografischer sowie Morbiditätsbezogener Routinedaten. Dafür wurden ICD-Diagnosen anlässlich stationärer Krankenhausaufenthalte, die Anzahl ambulanter Arztkontakte sowie Pflegegrade innerhalb 12 Monaten vor Rekrutierung verwendet.
Ergebnisse
Von 13 100 angeschriebenen Versicherten waren 962 Teilnehmende (7,4 %), 948 Ablehnende (7,2 %), 2437 Interessenten (18,6 %) und 8753 Non-Responder (66,8 %). Bezüglich soziodemografischer Merkmale unterschieden sich diese Gruppen. Die Diagnosen von 5422 Krankenhausaufenthalten zeigten unterschiedlich häufige ICD-Codes funktionaler Beeinträchtigungen. Interessenten waren praktisch nicht pflegebedürftig und wiesen die niedrigste Morbidität auf.
Diskussion
Die Ergebnisse weisen darauf hin, dass Beeinträchtigungen insbesondere motorischer und kognitiver Funktionen sowie soziodemografische Merkmale die NWGA-Akzeptanz beeinflussen. Die Ansprache zur Teilnahme sollte entsprechend differenziert verbessert werden. Die Berücksichtigung funktionaler Störungen als Krankheitsfolgen und Schrittmacher von Pflegebedürftigkeit könnte Gesundheitsförderung und Prävention im Alter generell stärken. Das Interesse für präventive Aktivitäten war unter den 70-jährigen und älteren Menschen nennenswert häufig.
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Affiliation(s)
- Wolfgang von Renteln-Kruse
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
- Emeritus, Zentrum für Innere Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Lilli Neumann
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
| | - Dominic Vinyard
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
| | - Stefan Golgert
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
| | - Ulrich Thiem
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
- Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Ulrike Dapp
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
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Identification of Patients with Similar Gait Compensating Strategies Due to Unilateral Hip Osteoarthritis and the Effect of Total Hip Replacement: A Secondary Analysis. J Clin Med 2021; 10:jcm10102167. [PMID: 34067864 PMCID: PMC8156609 DOI: 10.3390/jcm10102167] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/29/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022] Open
Abstract
Despite good clinical functional outcome, deficits in gait biomechanics exist 2 years after total hip replacement surgery. The aims of this research were (1) to group patients showing similar gait adaptations to hip osteoarthritis and (2) to investigate the effect of the surgical treatment on gait kinematics and external joint moments. In a secondary analysis, gait data of 51 patients with unilateral hip osteoarthritis were analyzed. A k-means cluster analysis was performed on scores derived via a principal component analysis of the gait kinematics. Preoperative and postoperative datasets were statistically tested between clusters and 46 healthy controls. The first three principal components incorporated hip flexion/extension, pelvic tilt, foot progression angle and thorax tilt. Two clusters were discriminated best by the peak hip extension during terminal stance. Both clusters deviated from healthy controls in spatio-temporal, kinematic and kinetic parameters. The cluster with less hip extension deviated significantly more. The clusters improved postoperatively but differences to healthy controls were still present one year after surgery. A poor preoperative gait pattern in patients with unilateral hip osteoarthritis is associated with worse gait kinematics after total hip replacement. Further research should focus on the identification of patients who can benefit from an adapted or individualized rehabilitation program.
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Rohr M, Brandstetter S, Bernardi C, Fisser C, Drewitz KP, Brunnthaler V, Schmidt K, Malfertheiner MV, Apfelbacher CJ. Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2021; 7:90. [PMID: 33785064 PMCID: PMC8007452 DOI: 10.1186/s40814-021-00796-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Intensive care unit (ICU) survivors often suffer from cognitive, physical and mental impairments, known as post-intensive care syndrome (PICS). ICU follow-up clinics may improve aftercare of these patients. There is a lack of evidence whether or which concept of an ICU follow-up clinic is effective. Within the PINA study, a concept for an ICU follow-up clinic was developed and will be tested in a pilot randomised controlled trial (RCT), primarily to evaluate the feasibility and additionally the potential efficacy. Methods/design Design: Pilot RCT with intervention and control (usual care) arms plus mixed-methods process evaluation. Participants: 100 ICU patients (50 per arm) of three ICUs in a university hospital (Regensburg, Germany), ≥ 18 years with an ICU stay of > 5 days, a sequential organ failure assessment (SOFA) score > 5 during the ICU stay and a life expectancy of more than 6 months. Intervention: The intervention will contain three components: information, consultation and networking. Information will be available in form of an intensive care guide for patients and next of kin at the ICU and phone support during follow-up. For consultation, patients will visit the ICU follow-up clinic at least once during the first 6 months after discharge from ICU. During these visits, patients will be screened for symptoms of PICS and, if required, referred to specialists for further treatment. The networking part (e.g. special referral letter from the ICU follow-up clinic) aims to provide a network of outpatient care providers for former ICU patients. Feasibility Outcomes: Qualitative and quantitative evaluation will be used to explore reasons for non-participation and the intervention´s acceptability to patients and caregivers. Efficacy Outcomes: Health-related quality of life (HRQOL) will be assessed as primary outcome by the physical component score (PCS) of the Short-Form 12 Questionnaire (SF-12). Secondary outcomes encompass further patient-reported outcomes. All outcomes are assessed at 6 months after discharge from ICU. Discussion The PINA study will determine feasibility and potential efficacy of a complex intervention in a pilot RCT to enhance follow-up care of ICU survivors. The pilot study is an important step for further studies in the field of ICU aftercare and especially for the implementation of a pragmatic multi-centre RCT. Trial registration ClinicalTrials.gov, NCT04186468. Submitted 2 December 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00796-1.
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Affiliation(s)
- M Rohr
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.
| | - S Brandstetter
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.,University Children's Hospital Regensburg, University of Regensburg, Klinik St. Hedwig, Steinmetzstr., 1-3, 93049, Regensburg, Germany
| | - C Bernardi
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - C Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - K P Drewitz
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - V Brunnthaler
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - K Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, 10117, Berlin, Germany.,Institute of General Practice and Family Medicine, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany
| | - M V Malfertheiner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - C J Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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van Drongelen S, Wesseling M, Holder J, Meurer A, Stief F. Knee Load Distribution in Hip Osteoarthritis Patients After Total Hip Replacement. Front Bioeng Biotechnol 2020; 8:578030. [PMID: 33072728 PMCID: PMC7534409 DOI: 10.3389/fbioe.2020.578030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/28/2020] [Indexed: 11/22/2022] Open
Abstract
Reduced external knee adduction moments in the second half of stance after total hip replacement have been reported in hip osteoarthritis patients. This reduction is thought to shift the load from the medial to the lateral knee compartment and as such increase the risk for knee osteoarthritis. The knee adduction moment is a surrogate for the load distribution between the medial and lateral compartments of the knee and not a valid measure for the tibiofemoral contact forces which are the result of externally applied forces and muscle forces. The purpose of this study was to investigate whether the distribution of the tibiofemoral contact forces over the knee compartments in unilateral hip osteoarthritis patients 1 year after receiving a primary total hip replacement differs from healthy controls. Musculoskeletal modeling on gait was performed in OpenSim using the detailed knee model of Lerner et al. (2015) for 19 patients as well as for 15 healthy controls of similar age. Knee adduction moments were calculated by the inverse dynamics analysis, medial and lateral tibiofemoral contact forces with the joint reaction force analysis. Moments and contact forces of patients and controls were compared using Statistical Parametric Mapping two-sample t-tests. Knee adduction moments and medial tibiofemoral contact forces of both the ipsi- and contralateral leg were not significantly different compared to healthy controls. The contralateral leg showed 14% higher medial tibiofemoral contact forces compared to the ipsilateral (operated) leg during the second half of stance. During the first half of stance, the lateral tibiofemoral contact force of the contralateral leg was 39% lower and the ratio 32% lower compared to healthy controls. In contrast, during the second half of stance the forces were significantly higher (39 and 26%, respectively) compared to healthy controls. The higher ratio indicates a changed distribution whereas the increased lateral tibiofemoral contact forces indicate a higher lateral knee joint loading in the contralateral leg in OA patients after total hip replacement (THR). Musculoskeletal modeling using a detailed knee model can be useful to detect differences in the load distribution between the medial and lateral knee compartment which cannot be verified with the knee adduction moment.
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Affiliation(s)
- Stefan van Drongelen
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Orthopaedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany
| | - Mariska Wesseling
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jana Holder
- Orthopaedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany
| | - Andrea Meurer
- Orthopaedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany
| | - Felix Stief
- Orthopaedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany.,Goethe University Frankfurt, Frankfurt, Germany
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7
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Krist L, Keller T, Sebald L, Yesil-Jürgens R, Ellert U, Reich A, Becher H, Heuschmann PU, Willich SN, Keil T, Liman TG. The Montreal Cognitive Assessment (MoCA) in a population-based sample of Turkish migrants living in Germany. Aging Ment Health 2019; 23:30-37. [PMID: 29171956 DOI: 10.1080/13607863.2017.1396577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Data on cognitive testing in migrants in Germany are scarce. We aimed to evaluate the Montreal Cognitive Assessment (MoCA) in Turkish migrants in Berlin and its association with demographics and health-related variables. METHOD For this cross-sectional study, a random sample of persons with Turkish names was drawn from the registration-office. Cognitive function was assessed using the MoCA; 0 = worst, 30 = best total score. Multivariable linear regression models were calculated to determine associated factors with the total MoCA-score. RESULTS In our analyses we included 282 participants (50% female), mean age 42.3 ± 11.9 years (mean ± standard deviation (SD)). The mean ± SD MoCA score was 23.3 ± 4.3. In the multivariable analysis, higher education (ß = 2.68; p < 0.001), and chosing the German version of the MoCA (ß = -1.13; p = 0.026), were associated with higher MoCA-scores, whereas higher age (ß = -0.08; p = 0.002) was associated with lower MoCA scores. CONCLUSION In our study, a higher educational level, lower age, and German as the preferred test language (as compared to Turkish) were positively associated with the cognitive performance of Berliners with Turkish roots. To examine neurocognitive health of migrants, longitudinal population-based and clinical cohort studies that specifically compare migrants and their descendants with the original population of their home countries are required.
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Affiliation(s)
- Lilian Krist
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Theresa Keller
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Lisa Sebald
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Rahsan Yesil-Jürgens
- b Department of Epidemiology and Health Monitoring , Robert Koch-Institute Berlin , Berlin , Germany
| | - Ute Ellert
- b Department of Epidemiology and Health Monitoring , Robert Koch-Institute Berlin , Berlin , Germany
| | - Andreas Reich
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Heiko Becher
- c Institute for Medical Biometry an Epidemiology , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Peter U Heuschmann
- d Institute of Clinical Epidemiology and Biometry , University of Würzburg , Würzburg , Germany
| | - Stefan N Willich
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Thomas Keil
- a Institute For Social Medicine, Epidemiology and Health Economics , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Thomas G Liman
- e Center for Stroke Research Berlin , Charité-Universitätsmedizin Berlin , Berlin , Germany.,f Department of Neurology , Charité-Universitätsmedizin Berlin , Berlin , Germany
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Gaertner B, Wagner M, Luck T, Buttery AK, Fuchs J, Busch MA. Normative data for the Digit Symbol Substitution Test in a population-based sample aged 65-79 years: Results from the German Health Interview and Examination Survey for Adults (DEGS1). Clin Neuropsychol 2018; 32:114-132. [PMID: 29911493 DOI: 10.1080/13854046.2018.1484168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide normative data for the Digit Symbol Substitution Test (DSST) of the Wechsler Adult Intelligence Scale, 3rd edition (WAIS-III) in a population-based sample of community-dwelling older adults in Germany according to age, sex, and level of education. METHOD The sample comprised 1385 participants aged 65-79 years from the nationwide representative 'German Health Interview and Examination Survey for Adults' (DEGS1, 2008-2011). Participants with known cognitive impairment or dementia, other medical conditions affecting cognition, or currently using psychotropic drugs were excluded. Educational level was categorized as low, medium, and high according to the Comparative Analyses of Social Mobility in Industrial Nations (CASMIN) scale. Normative values for the DSST according to age, sex, and level of education were estimated by multiple linear regression using population weights. RESULTS Mean age was 71.1 years, 48.6% were men and low, medium, and high education levels were 62.8, 24.6, and 12.6%, respectively. Younger age, female sex, and higher level of education were significantly associated with higher DSST scores. Regression-based normative data for the DSST is provided according to age, sex, and level of education. In addition, a normative score calculator is provided. CONCLUSIONS These are the first age-, sex-, and education-specific normative data for older individuals for the DSST of the WAIS-III in Germany. These normative data will enable future population-level analyses on impaired cognitive function according to DSST.
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Affiliation(s)
- Beate Gaertner
- a Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany
| | - Michael Wagner
- b Department of Psychiatry and Psychotherapy , University of Bonn , Bonn , Germany.,c German Center for Neurodegenerative Diseases (DZNE) , Bonn , Germany
| | - Tobias Luck
- d Department of Economic and Social Sciences , University of Applied Sciences Nordhausen , Nordhausen , Germany
| | - Amanda K Buttery
- a Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany.,e Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - Judith Fuchs
- a Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany
| | - Markus A Busch
- a Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany
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Warner LM, Wolff JK, Spuling SM, Wurm S. Perceived somatic and affective barriers for self-efficacy and physical activity. J Health Psychol 2017; 24:1850-1862. [PMID: 28810450 DOI: 10.1177/1359105317705979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
According to Bandura's social-cognitive theory, perceptions of somatic and affective barriers are sources of self-efficacy. This longitudinal study compares general indicators of health barriers with measures of perceived somatic and affective barriers to predict self-efficacy and accelerometer-assessed physical activity in a subsample of n = 153 (selected at random from N = 310) community-dwelling German older adults. Perceived somatic and affective barriers longitudinally predicted physical activity mediated by self-efficacy, whereas general health barriers did not. Perceived health barriers to physical activity might be more important than more objective health barriers for older adults' physical activity levels.
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Affiliation(s)
| | | | | | - Susanne Wurm
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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Vergleichbarkeit von Studien epidemiologischer Alternsforschung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:662-78. [DOI: 10.1007/s00103-016-2342-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Brach M, Moschny A, Bücker B, Klaaßen-Mielke R, Trampisch M, Wilm S, Platen P, Hinrichs T. Recruiting hard-to-reach subjects for exercise interventions: a multi-centre and multi-stage approach targeting general practitioners and their community-dwelling and mobility-limited patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:6611-29. [PMID: 24317380 PMCID: PMC3881130 DOI: 10.3390/ijerph10126611] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 11/24/2022]
Abstract
The general practitioner (GP)’s practice appears to be an ideal venue for recruiting community-dwelling older adults with limited mobility. This study (Current Controlled Trials ISRCTN17727272) aimed at evaluating the recruiting process used for a multi-centre exercise intervention (HOMEfit). Each of six steps resulted in an absolute number of patients (N1–N6). Sex and age (for N4–N6) and reasons for dropping out were assessed. Patient database screening (N1–N3) at 15 GP practices yielded N1 = 5,990 patients aged 70 and above who had visited their GP within the past 6 months, N2 = 5,467 after exclusion of institutionalised patients, N3 = 1,545 patients eligible. Using a pre-defined limitation algorithm in order to conserve the practices’ resources resulted in N4 = 1,214 patients (80.3 ± 5.6 years, 68% female), who were then officially invited to the final assessment of eligibility at the GP’s practice. N5 = 434 patients (79.5 ± 5.4 years, 69% female) attended the practice screening (n = 13 of whom had not received an official invitation). Finally, N6 = 209 (79.8 ± 5.2 years, 74% female) were randomised after they were judged eligible and had given their written informed consent to participate in the randomised controlled trial (overall recruitment rate: 4.4%). The general strategy of utilising a GP’s practice to recruit the target group proved beneficial. The data and experiences presented here can help planners of future exercise-intervention studies.
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Affiliation(s)
- Michael Brach
- Institute of Sport and Exercise Science, University of Muenster, 48149 Muenster, Germany
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +49-251-833-2326; Fax: +49-251-833-4862
| | - Anna Moschny
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, 44801 Bochum, Germany; E-Mails: (A.M.); (P.P.)
| | - Bettina Bücker
- Institute of General Practice and Family Medicine, Witten/Herdecke University, 58448 Witten, Germany; E-Mail:
- Institute of General Practice, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany; E-Mail:
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiolgy, Ruhr-University Bochum, 44801 Bochum, Germany; E-Mails: (R.K.-M.); (M.T.)
| | - Matthias Trampisch
- Department of Medical Informatics, Biometry and Epidemiolgy, Ruhr-University Bochum, 44801 Bochum, Germany; E-Mails: (R.K.-M.); (M.T.)
| | - Stefan Wilm
- Institute of General Practice, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany; E-Mail:
| | - Petra Platen
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, 44801 Bochum, Germany; E-Mails: (A.M.); (P.P.)
| | - Timo Hinrichs
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, 44801 Bochum, Germany; E-Mails: (A.M.); (P.P.)
- Impairment Control, Capacity Building & Health Maintenance Unit, Swiss Paraplegic Research, 6207 Nottwil, Switzerland; E-Mail:
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Gößwald A, Lange M, Dölle R, Hölling H. Die erste Welle der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:611-9. [DOI: 10.1007/s00103-013-1671-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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