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Silberbauer J, Schidl S, Diermayr G, Schmitz-Hübsch T, Greisberger A. [Scale for the assessment and rating of ataxia (SARA): translation and cultural adaptation to German-speaking areas]. Wien Med Wochenschr 2024; 174:111-122. [PMID: 37093342 PMCID: PMC10959797 DOI: 10.1007/s10354-023-01014-8] [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: 09/26/2022] [Accepted: 03/13/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND/OBJECTIVE The scale for the assessment and rating of ataxia (SARA) is a feasible assessment for the classification and evaluation of therapeutic interventions. In order to provide access to the SARA in German, the aim of this work was to translate the SARA into German and to adapt it according to international guidelines for German-speaking countries. METHOD The process involved six steps. The comprehensibility of the scale was assessed using interviews with potential users. RESULTS A total of nine physiotherapists and six physicians working in various clinical settings were interviewed, seven of them worked in Germany and four each in Austria and Switzerland. The interviews led to a refined version of the translation. The comprehensibility testing revealed no country-specific differences. CONCLUSION A German version of the SARA authorized by the co-author of the original publication, is now available. The results provide methodological insights into the translation process of observation-based standardized assessments.
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Affiliation(s)
- Julia Silberbauer
- Klinische Abteilung für Neurologie, Universitätsklinikum Tulln, Tulln, Österreich
- Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Krems, Österreich
- Fachhochschule Burgenland GmbH, Eisenstadt, Österreich
| | - Sonja Schidl
- Klinische Abteilung für Neurologie, Universitätsklinikum Tulln, Tulln, Österreich
- Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Krems, Österreich
| | - Gudrun Diermayr
- SRH Hochschule Heidelberg, Fakultät für Therapiewissenschaften, Heidelberg, Deutschland
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin, Deutschland
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Krupp S, Wentzel R, Balck F, Willkomm M, Kasper J. [The Lübeck Scale of Basic Mobility : Assessment of geriatric patients with severely impaired mobility]. Z Gerontol Geriatr 2023; 56:470-476. [PMID: 37578519 PMCID: PMC10522745 DOI: 10.1007/s00391-023-02220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/28/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND In the geriatric assessment of mobility, the timed up and go (TUG) test is often used; however, many inpatients are unable to master this test. The Lübeck Scale of Basic Mobility (LSBM) was developed as a performance test for this target group. OBJECTIVE The study investigated the properties of the 7‑task LSBM, which has a scaling at item level based on the 5‑level assessment of impairments according to the ICF. MATERIAL AND METHODS In 77 patients who had not mastered the TUG test at acute geriatric hospital admission, the LSBM was completed at intervals of 7-18 days (t0, t1), including one rating by 2 investigators. For convergent validity, the De Morton Mobility Index (DEMMI) was used. RESULTS The LSBM score and DEMMI score were highly correlated (-0.880, p < 0.001). A floor effect did not occur with LSBM and occurred with DEMMI in 5 patients (6.5%). The predictive validity for predicting coping with TUG test at discharge based on the sum score at t0 was -0.577 for the LSBM, and 0.542 for the DEMMI (Spearman's correlation, p = 0.001). The interrater reliability of the LSBM was 0.983 (p < 0.001), the correlation between test and retest was 0.836 (p < 0.001) and the internal consistency via Cronbach's α was 0.876. The effect size as a measure of change sensitivity was Cohen's d 0.711. CONCLUSION The LSBM facilitates treatment goal setting and allows standardized documentation of even small improvements and deteriorations in patients with reduced basic mobility.
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Affiliation(s)
- Sonja Krupp
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck Geriatriezentrum, Marlistr. 10, 23566, Lübeck, Deutschland.
| | - Robert Wentzel
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck Geriatriezentrum, Marlistr. 10, 23566, Lübeck, Deutschland
| | - Friedrich Balck
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck Geriatriezentrum, Marlistr. 10, 23566, Lübeck, Deutschland
- Abteilung Psychosoziale Medizin und Entwicklungsneurowissenschaften, Med. Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Martin Willkomm
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck Geriatriezentrum, Marlistr. 10, 23566, Lübeck, Deutschland
| | - Jennifer Kasper
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck Geriatriezentrum, Marlistr. 10, 23566, Lübeck, Deutschland
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Stemmer R, Büchler B, Büttner M, Dera-Ströhm C, Klein J, Gianicolo E. Effects of care of multimorbid patients in general practices by advanced practice nurses (FAMOUS): study protocol for a nonrandomized controlled trial. BMC Health Serv Res 2023; 23:501. [PMID: 37198637 DOI: 10.1186/s12913-023-09460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Multimorbidity is a common phenomenon among patients treated in general practices. Key challenges within this group include functional difficulties, polypharmacy, treatment burden, fragmentation of care, reduced quality of life and increased health care utilization. These problems cannot be solved in the short consultation time of a general practitioner (GP) since there is an increasing shortage of GPs. In many countries, advanced practice nurses (APNs) are successfully integrated into primary health care for multimorbid patients. The objective of this study is to examine whether the integration of APNs in the primary care of multimorbid patients in Germany leads to optimized care of the target group and to a reduction in the workload of the GPs. METHODS The intervention includes the integration of APNs into the care for multimorbid patients in general practice for twelve months. Qualifications for APNs include a master's level academic degree and 500 hours of project-specific training. Their tasks include in-depth assessment, preparation, implementation, monitoring and evaluation of a person-centred and evidence-based care plan. In this nonrandomized controlled trial, a prospective multicentre mixed methods study will be performed. The main inclusion criterion was the cooccurrence of three chronic diseases. For data collection in the intervention group (n = 817), routine data from health insurance companies and association of statutory health insurance physicians (ASHIP) will be used, as well as qualitative interviews. In addition, the intervention will be assessed through documentation of the care process and standardized questionnaires using a longitudinal design. The control group (n = 1634) will receive standard care. For the evaluation, routine data from health insurance companies are matched at a ratio of 1:2. Outcomes will be measured using emergency contacts and GP visits, treatment costs, health status of the patients and the satisfaction of parties involved. The statistical analyses will include Poisson regression to compare outcomes between the intervention and control groups. Descriptive and analytical statistical methods will be used in the longitudinal analysis of the intervention group data. Cost analysis will compare total costs and subgroup costs between the intervention and control groups. Qualitative data will be analysed using content analysis. DISCUSSION Challenges to this protocol could include the political and strategic environment as well as the planned number of participants. TRIAL REGISTRATION DRKS00026172 on DRKS.
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Affiliation(s)
- Renate Stemmer
- Faculty of Health Care and Nursing, Catholic University of Applied Sciences Mainz, Mainz, Germany.
| | - Britta Büchler
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Matthias Büttner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christina Dera-Ströhm
- Faculty of Health Care and Nursing, Catholic University of Applied Sciences Mainz, Mainz, Germany
| | - Joachim Klein
- Faculty of Health Care and Nursing, Catholic University of Applied Sciences Mainz, Mainz, Germany
| | - Emilio Gianicolo
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
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Walther LE, Brusis T, Meister E, Blödow A. Aus der Gutachtenpraxis: Zeitgemäße HNO-Begutachtung bei peripheren Vestibulopathien. Teil 2: Vorschläge für neue Bewertungskriterien. Laryngorhinootologie 2023; 102:373-380. [PMID: 37141879 DOI: 10.1055/a-2019-1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Paus A, Grafe M, Stenzel R, Heitmann S, Brümmer W. Eine theoriegeleitete Implementierung von Messinstrumenten in der physiotherapeutischen Versorgung einer Stroke Unit. PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1748-3069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Hintergrund Der Einsatz von Messinstrumenten objektiviert und unterstützt die klinische Entscheidungsfindung von Physiotherapierenden bei Planung, Durchführung und Evaluation einer Therapie. Die dadurch erhaltenen Informationen ermöglichen eine patientenzentrierte Versorgung und haben das Potential, die interprofessionelle Kommunikation zu verbessern. Trotz der genannten Vorteile findet die Nutzung von Messinstrumenten im klinischen Alltag bislang keine ausreichende Anwendung.
Ziel Systematische Implementierung von Messinstrumenten in die physiotherapeutische Versorgung der Stroke Unit des Universitätsklinikums Münster mithilfe des „Implementation of Change Model“. Zudem wird evaluiert, ob durch eine Anwendung des Modells eine gesteigerte Nutzung der Messinstrumente festgestellt werden kann.
Methode Zur Implementierung von Messinstrumenten wurde das Implementation of Change Model schrittweise mit diversen Methoden umgesetzt. Zur Ergebnisevaluation wurden quantitative (Fragebogenerhebung) und qualitative Forschungsmethoden (Fokusgruppendiskussion) angewandt.
Ergebnisse Nach Abschluss der Erprobungsphase, Auswertung der Dokumentation, der Befragungen sowie einer Diskussion zeigte sich, dass durch Anwendung des Implementation of Change Models die Nutzung von Messinstrumenten bei Patient*innen mit Schlaganfall gesteigert werden konnte. Aus Sicht der Befragten nahm die Überzeugung über den klinischen Nutzen von Messinstrumenten zu. Es konnte auch eine subjektive Verbesserung der Qualität der Behandlung festgestellt werden.
Schlussfolgerung Das Implementation of Change Model eignet sich zur systematischen Anwendung durch eine Gruppe von Physiotherapierenden in der Akutversorgung, wodurch sich die Nutzung von Messinstrumenten bei Patient*innen mit Schlaganfall steigerte. Es wird empfohlen, weitere Erkenntnisse mit einer größeren Gruppe von Therapierenden und in anderen Versorgungsbereichen durchzuführen.
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Affiliation(s)
- Annalena Paus
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Marion Grafe
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Romina Stenzel
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Steffen Heitmann
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Werner Brümmer
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
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Werner C, Wolf-Belala N, Nerz C, Abel B, Braun T, Grüneberg C, Thiel C, Büchele G, Muche R, Hendlmeier I, Schäufele M, Dams J, König HH, Bauer JM, Denkinger M, Rapp K. A multifactorial interdisciplinary intervention to prevent functional and mobility decline for more participation in (pre-)frail community-dwelling older adults (PromeTheus): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2022; 22:124. [PMID: 35164686 PMCID: PMC8842871 DOI: 10.1186/s12877-022-02783-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 01/19/2023] Open
Abstract
Background Age-related decline in physical capacity can lead to frailty, associated with an increased vulnerability to adverse health outcomes and greater healthcare utilization. In an aging population, effective strategies to prevent physical decline and frailty, and preserve independence are needed. Prevention programs for vulnerable community-dwelling older adults are, however, often not yet established and implemented in routine practice. Research on the feasibility, implementation, and (cost-)effectiveness of multifactorial, interdisciplinary intervention programs that take advantage of available services of healthcare providers is also limited. The main aim of this study is to evaluate the effectiveness of such an intervention program (PromeTheus) to prevent functional and mobility decline for more participation in community-dwelling (pre-)frail older adults. Methods The study is designed as a three-center, randomized controlled trial with a 12-month intervention period. Four hundred community-dwelling (pre-)frail (Clinical Frailty Scale score 4–6) older adults (≥70 years) will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will receive the PromeTheus program consisting of obligatory home-based physical exercises (Weight-bearing Exercise for Better Balance) accompanied by physiotherapists and facultative counseling services (person-environment-fit, coping with everyday life, nutrition, group-based activities) delivered via existing healthcare structures (e.g., social workers, nutritionists). The CG will receive usual care and a one-time counseling session on recommendations for physical activity and nutrition. Primary outcomes assessed at months 6 and 12 are the function component of the Late-Life Function and Disability Instrument and the University of Alabama at Birmingham Life-Space Assessment. Secondary outcomes are disability, physical capacity and activity, frailty, nutritional status, falls, fear of falling, health status, and psychosocial components. Process and economic evaluations are also conducted. Primary statistical analyses will be based on the intention-to-treat principle. Discussion Compared to usual care, the PromeTheus program is expected to result in higher function and mobility, greater independence and lower need for care, and more participation. As the PromeTheus program draws on existing German healthcare structures, its large-scale translation and delivery will be feasible, if evidence of (cost-)effectiveness and successful implementation can be demonstrated. Trial registration German Clinical Trials Register, . Registered on March 11, 2021.
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Affiliation(s)
- Christian Werner
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
| | | | - Corinna Nerz
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Bastian Abel
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Tobias Braun
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Reiner Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ingrid Hendlmeier
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Martina Schäufele
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Michael Denkinger
- Institute for Geriatric Research, Ulm University, Ulm, Germany.,Agaplesion Bethesda Clinic, Ulm, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
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Brodowski H, Strutz N, Mueller-Werdan U, Kiselev J. Categorizing fear of falling using the survey of activities and fear of falling in the elderly questionnaire in a cohort of hospitalized older adults: A cross-sectional design. Int J Nurs Stud 2021; 126:104152. [PMID: 34923318 DOI: 10.1016/j.ijnurstu.2021.104152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fear of falling is commonly assessed using the Activities-specific Balance Confidence Scale which is an instrument to measure balance confidence, based on the assumption that fear of falling is due to the absence of balance confidence. The "Survey of Activities and Fear of Falling in the Elderly" measures the concept of fear of falling more directly on a scale of 0.0 and 3.0 points. However, there are no valid cut-off points that might help practitioners to interpret "Survey of Activities and Fear of Falling in the Elderly" scores. The aim of this study was to identify such cut-off points and distinguish between low, moderate and high fear of falling, in relation to balance confidence. METHOD In this cross-sectional study different cut-off point schemes for classifying fear of falling scores as low, moderate or high were compared with F-values in ANOVA using the cut-off point scheme as an independent variable and the balance confidence scores as a dependent variable. The analysis was performed using data from a cohort of 98 hospitalized older adults. RESULTS Using the Activities-specific Balance Confidence Scale as a reference tool, values of 0.6 and 1.4 were identified as optimal cut-off points for low, moderate and high fear of falling. CONCLUSIONS This study was the first to systematically classify fear of falling using the "Survey of Activities and Fear of Falling in the Elderly". This classification can assist health practitioners to interpret fear of falling score and guide clinical decision making. Registration: The study is registered with the German Clinical Trials Register (DRKS00010773, date of registration 2016/05/07, date of recruitment 2016/11/07).
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Affiliation(s)
- Hanna Brodowski
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Luebeck, Germany; Geriatrics Research Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Nicole Strutz
- Geriatrics Research Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ursula Mueller-Werdan
- Geriatrics Research Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Joern Kiselev
- Geriatrics Research Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Coppers A, Möller JC, Marks D. Psychometric properties of the short form of the Stroke Impact Scale in German-speaking stroke survivors. Health Qual Life Outcomes 2021; 19:190. [PMID: 34332592 PMCID: PMC8325839 DOI: 10.1186/s12955-021-01826-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The short form of the Stroke Impact Scale (SF-SIS) consists of eight questions and provides an overall index of health-related quality of life after stroke. The goal of the study was the evaluation of construct validity, reliability and responsiveness of the SF-SIS for the use in German-speaking stroke patients in rehabilitation. Methods The SF-SIS, the Stroke Impact Scale 2.0 (SIS 2.0), EQ-5D-5L, National Institutes of Health Stroke Scale (NIHSS) and de Morton Mobility Index were assessed in 150 inpatients after stroke, with a second measurement two weeks later for the analyses of responsiveness. In 55 participants, the test–retest-reliability was assessed one week after the first measurement. The study was designed following the recommendations of the COSMIN initiative. Results The correlations of the SF-SIS with the SIS 2.0 (ρ = 0.90), as well as the EQ-5D-5L (ρ = 0.79) were high, as expected. There was adequate discriminatory ability of the SF-SIS index between patients who were less and more severely affected by stroke, as assessed by the NIHSS. Exploratory factor analysis indicated a two-factor structure of the SF-SIS explaining 59.9% of the total variance, providing better model fit in the confirmatory factor analysis than the one-factorial structure. Analyses of test–retest-reliability showed an intraclass correlation coefficient of 0.88 (95% CI 0.75–0.94). Hypotheses concerning responsiveness were not confirmed due to lower correlations between the assessments change scores. Conclusion Results of this analysis of the SF-SIS’s psychometric properties are matching with the validity analysis of the English original version, confirming the high correlations with the Stroke Impact Scale and the EQ-5D-5L. Examination of structural validity did not confirm the presumed unidimensionality of the scale and found evidence of an underlying two-factor solution with a physical and cognitive domain. Sufficient test–retest reliability and internal consistency were found. In addition, this study provides first results for the responsiveness of the German version. Trial registration The study was registered at the German Clinical Trials Register. Trial registration number: DRKS00011933, date of registration: 07.04.2017
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Affiliation(s)
- Anna Coppers
- Center for Neurological Rehabilitation, Hauptstrasse 2, 8588, Zihlschlacht, Switzerland.
| | - Jens Carsten Möller
- Center for Neurological Rehabilitation, Hauptstrasse 2, 8588, Zihlschlacht, Switzerland.,Department of Neurology, Philipps University, Baldingerstr, 35043, Marburg, Germany
| | - Detlef Marks
- Center for Neurological Rehabilitation, Hauptstrasse 2, 8588, Zihlschlacht, Switzerland
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Braun T, Marks D, Thiel C, Grüneberg C. A generic outcome assessment of mobility capacity in neurorehabilitation: measurement properties of the de Morton Mobility Index. BMC Neurol 2021; 21:298. [PMID: 34320926 PMCID: PMC8317343 DOI: 10.1186/s12883-021-02327-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Mobility capacity is a key outcome domain in neurorehabilitation. The de Morton Mobility Index (DEMMI), an established and generic outcome assessment of mobility capacity in older patients, is promising for use in neurorehabilitation. The aim of this study was to examine the measurement properties of the DEMMI in rehabilitation inpatients with neurological conditions. Methods Cross-sectional study including a mixed sample of adult inpatients in a neurorehabilitation hospital. Structural validity, unidimensionality and measurement invariance (Rasch analysis), construct validity, internal consistency reliability, and inter-rater reliability of the DEMMI (scale range: 0–100 points) were established. The minimal detectable change, the 95% limits of agreement, and possible floor and ceiling effects were calculated to indicate interpretability. Results We analyzed validity (n = 348) and reliability (n = 133) in two samples. In both samples, the majority of participants had a sub-acute stroke or Parkinson’s disease. Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 59.4, P = 0.074). There was no relevant measurement invariance by disease group. Hypotheses-based correlation analyses (DEMMI and other functional outcome assessments) showed sufficient construct validity. Internal consistency reliability (Cronbach’s alpha = 0.94) and inter-rater reliability (intraclass correlation coefficient = 0.94; 95% confidence interval: 0.91–0.95) were sufficient. The minimal detectable change with 90% confidence was 15.0 points and the limits of agreement were 39%. No floor or ceiling effects were observed. Conclusions Results indicate sufficient measurement properties of the DEMMI in rehabilitation inpatients with neurological conditions. The DEMMI can be used as a generic outcome assessment of mobility capacity in neurorehabilitation. Trial registration German Clinical Trials Register (DRKS00004681). Registered May 6, 2013. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02327-0.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany. .,IB University of Health and Social Sciences, Study Center Cologne, Cologne, Germany.
| | - Detlef Marks
- Physiotherapy Department, Rehaklinik Zihlschlacht, Hauptstr. 2, 8588, Zihlschlacht, Switzerland
| | - Christian Thiel
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.,Faculty of Sports Science, Training and Exercise Science, Ruhr-University Bochum, Bochum, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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Responsiveness and interpretability of commonly used outcome assessments of mobility capacity in older hospital patients with cognitive spectrum disorders. Health Qual Life Outcomes 2021; 19:68. [PMID: 33648508 PMCID: PMC7923341 DOI: 10.1186/s12955-021-01690-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background In older hospital patients with cognitive spectrum disorders (CSD), mobility should be monitored frequently with standardised and psychometrically sound measurement instruments. This study aimed to examine the responsiveness, minimal important change (MIC), floor effects and ceiling effects of commonly used outcome assessments of mobility capacity in older patients with dementia, delirium or other cognitive impairment. Methods In a cross-sectional study that included acute older hospital patients with CSD (study period: 02/2015–12/2015), the following mobility assessments were applied: de Morton Mobility Index (DEMMI), Hierarchical Assessment of Balance and Mobility (HABAM), Performance Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed test, 5-times chair rise test, 2-min walk test, Timed Up and Go test, Barthel Index mobility subscale, and Functional Ambulation Categories. These assessments were administered shorty after hospital admission (baseline) and repeated prior to discharge (follow-up). Global rating of mobility change scales and a clinical anchor of functional ambulation were used as external criteria to determine the area under the curve (AUC). Construct- and anchor-based approaches determined responsiveness. MIC values for each instrument were established from different anchor- and distribution-based approaches. Results Of the 63 participants (age range: 69–94 years) completing follow-up assessments with mild (Mini Mental State Examination: 19–24 points; 67%) and moderate (10–18 points; 33%) cognitive impairment, 25% were diagnosed with dementia alone, 13% with delirium alone, 11% with delirium superimposed on dementia and 51% with another cognitive impairment. The follow-up assessment was performed 10.8 ± 2.5 (range: 7–17) days on average after the baseline assessment. The DEMMI was the most responsive mobility assessment (all AUC > 0.7). For the other instruments, the data provided conflicting evidence of responsiveness, or evidence of no responsiveness. MIC values for each instrument varied depending on the method used for calculation. The DEMMI and HABAM were the only instruments without floor or ceiling effects. Conclusions Most outcome assessments of mobility capacity seem insufficiently responsive to change in older hospital patients with CSD. The significant floor effects of most instruments further limit the monitoring of mobility alterations over time in this population. The DEMMI was the only instrument that was able to distinguish clinically important changes from measurement error. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015.
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Braun T, Marks D, Thiel C, Menig A, Grüneberg C. An investigation of the measurement properties of the de Morton Mobility Index for measuring mobility capacity in hospital patients with Parkinson's disease. Clin Rehabil 2020; 35:423-435. [PMID: 33172299 PMCID: PMC7944422 DOI: 10.1177/0269215520966472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the measurement properties of the de Morton Mobility Index (DEMMI), a performance-based clinical outcome assessment of mobility capacity, in hospital patients with Parkinson's disease. DESIGN Cross-sectional study. PARTICIPANTS Hospital patients with Parkinson's disease. MAIN OUTCOME MEASURE(S) Structural validity and unidimensionality (Rasch analysis), construct validity, internal consistency reliability, and inter-rater reliability of the de Morton Mobility Index (scale range: 0-100 points) were established. The minimal detectable change, the 95% limits of agreement and possible floor and ceiling effects were calculated to indicate interpretability. RESULTS We analysed validity (n = 100; mean age: 70 years; 71% male) and reliability (n = 47; mean age: 71 years; 68% male) in two samples. The mean Hoehn and Yahr stage was 3.2 and the mean disease duration was 12 years in both samples. Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 21.49, P = 0.122). Seventy-three percent of hypotheses on construct validity were confirmed. Internal consistency reliability (Cronbach's alpha = 0.91) and inter-rater reliability (intraclass correlation coefficient = 0.88; 95% confidence interval: 0.80 to 0.93) were sufficient. The minimal detectable change with 90% confidence was 17.5 points and the limits of agreement were 31%. No floor or ceiling effects were observed. The mean administration time was 6.6 minutes. CONCLUSION This study provides evidence of unidimensionality, sufficient internal consistency reliability, inter-rater reliability, construct validity, and feasibility of the de Morton Mobility Index in hospital patients with Parkinson's disease. TRIAL REGISTRATION German Clinical Trials Register (DRKS00004681). Registered May 6, 2013.
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Affiliation(s)
- Tobias Braun
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Detlef Marks
- Physiotherapy Department, Rehaklinik Zihlschlacht, Zihlschlacht, Thurgau, Switzerland
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany.,Faculty of Sports Science, Training and Exercise Science, Ruhr-University Bochum, Bochum, Germany
| | - Alexandra Menig
- Occupational Therapy Department, Rehaklinik Zihlschlacht, Zihlschlacht, Switzerland
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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Reliability, validity, interpretability and responsiveness of the DEMMI mobility index for Brazilian older hospitalized patients. PLoS One 2020; 15:e0230047. [PMID: 32187212 PMCID: PMC7080236 DOI: 10.1371/journal.pone.0230047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 02/20/2020] [Indexed: 11/19/2022] Open
Abstract
AIM To translate and adapt cross-culturally the De Morton Mobility Index from English to Brazilian Portuguese. Furthermore, to test the content validity, reliability, construct validity, interpretability and responsiveness for older hospitalized patients. METHODS After we carried out the translation and the cross-cultural adaptation of the De Morton Mobility Index and its administration instructions according to international guidelines, the content validity of De Morton Mobility Index was tested by experienced physiotherapists. In the sequence, the reliability, construct validity, interpretability and responsiveness were tested in a test-retest design with 93 older patients hospitalized in ward for clinical reasons. The reliability was tested by Cronbach's alpha coefficient (internal consistency), standard error measurement (agreement), and interclass correlation coefficients (intra and inter-examiner reliability). The construct validity was tested by Pearson's correlation between the De Morton Mobility Index score and the number of steps. Interpretability was analyzed by determining the minimum detectable change and the floor and ceiling effects (frequency of maximum and minimum scoring). Responsiveness was analyzed by effect size. RESULTS The Brazilian version of the De Morton Mobility Index was made and adapted. The internal consistency (α = 0.89), reliability intra-(ICC = 0.94) and inter-examiners (ICC = 0.82), agreement were all adequate. The De Morton Mobility Index is validity when correlated with number of steps (r = 0.46). Floor or ceiling effects (<15%) were not observed and the responsiveness was high (ES = 3.65). CONCLUSION The De Morton Mobility Index has shown adequate reliability, validity, interpretability and responsiveness for the evaluation of the mobility of older hospitalized patients.
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Braun T, Grüneberg C, Süßmilch K, Wiessmeier M, Schwenk I, Eggert S, Machleit-Ebner A, Harras I, Thiel C. An augmented prescribed exercise program (APEP) to improve mobility of older acute medical patients - a randomized, controlled pilot and feasibility trial. BMC Geriatr 2019; 19:240. [PMID: 31470815 PMCID: PMC6716827 DOI: 10.1186/s12877-019-1246-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/12/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is inconclusive evidence for the effectiveness of additional exercise in older hospital patients. The aims of this study were (1) to assess the feasibility of an augmented prescribed exercise program (APEP) in older acute medical patients and (2) to measure the potential effects of APEP on mobility capacity in order to assess the feasibility of a large full-scale study. METHODS We conducted a single-center, prospective, parallel-group, single-blinded, randomized (1:1) controlled pilot and feasibility trial. Participants were recruited from acute geriatric wards of a general hospital. Key inclusion criteria were: age ≥ 65 years and walking ability. Key exclusion criteria were severe cognitive impairment and medical restriction for physical exercise interventions. Both groups received usual care, including physiotherapy. Intervention group participants were scheduled for additional exercise sessions (20-30 min, 4-5x/week). Feasibility of the trial design was assessed along pre-defined criteria for process, resources and management. Feasibility of the APEP intervention was analyzed by means of adherence, compliance and safety. Outcomes were measured at baseline and prior to hospital discharge. The primary outcome was mobility capacity (de Morton Mobility Index; DEMMI). Secondary outcomes were walking ability, physical endurance, fear of falling, frailty and length of stay. RESULTS Thirty-five participants were recruited (recruitment rate 20.3%). We lost 7 participants to follow-up (retention rate: 80%). Intervention group participants (n = 17) each participated in 5.3 ± 2.2 additional exercise sessions (mean duration: 23.2 ± 4.0 min; mean adherence rate 78% ± 26%). No severe adverse events occurred during study assessments or APEP sessions. There were no statistically significant differences in mean change scores in any outcome measure. A sample of 124 participants would be required to detect a difference of 4 DEMMI points (ES = 0.45) with a power of 80%. CONCLUSIONS This small feasibility RCT indicates that an APEP intervention may be safe and feasible in older acute medical patients. APEP may possibly induce small to moderate effects on mobility, but the clinical relevance of these effects may be limited. These results inform the planning of a larger-scale phase III study. TRIAL REGISTRATION German Clinical Trials Register ( DRKS00011262 ). Registered 27 October 2016.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Kirsten Süßmilch
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- Evangelische Krankenhausgemeinschaft Herne/Castrop-Rauxel gGmbH, Division of Physiotherapy, Castrop-Rauxel, Germany
| | - Max Wiessmeier
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Isabel Schwenk
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Sarah Eggert
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Annika Machleit-Ebner
- Evangelische Krankenhausgemeinschaft Herne/Castrop-Rauxel gGmbH, Clinical Trials Center, Wiescherstraße 24, 44623 Herne, Germany
| | - Irene Harras
- Evangelische Krankenhausgemeinschaft Herne/Castrop-Rauxel gGmbH, Therapeutic management, Wiescherstraße 24, 44623 Herne, Germany
| | - Christian Thiel
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- Ruhr-University Bochum, Faculty of Sports Science, Training and Exercise Science, Bochum, Germany
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Braun T, Thiel C, Schulz RJ, Grüneberg C. Reliability of mobility measures in older medical patients with cognitive impairment. BMC Geriatr 2019; 19:20. [PMID: 30674278 PMCID: PMC6343264 DOI: 10.1186/s12877-019-1036-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/14/2019] [Indexed: 01/06/2023] Open
Abstract
Background Mobility is a key indicator of physical functioning in older people, but there is limited evidence of the reliability of mobility measures in older people with cognitive impairment. This study aimed to examine the test-retest reliability and measurement error of common measurement instruments of mobility and physical functioning in older patients with dementia, delirium or other cognitive impairment. Methods A cross-sectional study was performed in a geriatric hospital. Older acute medical patients with cognitive impairment, indicated by a Mini-Mental State Examination (MMSE) score of ≤24 points, were assessed twice within 1 day by a trained physiotherapist. The following instruments were applied: de Morton Mobility Index, Hierarchical Assessment of Balance and Mobility, Performance-Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed, 5-times chair rise test, 2-min walk test, timed up and go test, Barthel Index mobility subscale and Functional Ambulation Categories. As appropriate, the intraclass correlation coefficient (ICC), Cohen’s kappa, standard error of measurement, limits of agreement and minimal detectable change (MDC) values were estimated. Results Sixty-five older acute medical patients with cognitive impairment participated in the study (mean age: 82 ± 7 years; mean MMSE: 20 ± 4, range: 10 to 24 points). Some participants were physically or cognitively unable to perform the gait speed (46%), 2-min walk (46%), timed up and go (51%) and chair rise (75%) tests. ICC and kappa values were above 0.9 in all instruments except for the gait speed (ICC = 0.86) and chair rise (ICC = 0.72) measures. Measurement error is reported for each instrument. The absolute limits of agreement ranged from 11% (de Morton Mobility Index and Hierarchical Assessment of Balance and Mobility) to 35% (chair rise test). Conclusions The test-retest reliability is sufficient (> 0.7) for group-comparisons in all examined instruments. Most mobility measurements have limited use for individual monitoring of mobility over time in older hospital patients with cognitive impairment because of the large measurement error (> 20% of scale width), even though relative reliability estimations seem sufficient (> 0.9) for this purpose. Trial registration German Clinical Trials Register (DRKS00005591). Registered 2 February 2015. Electronic supplementary material The online version of this article (10.1186/s12877-019-1036-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Christian Thiel
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.,Faculty of Sports Science, Training and Exercise Science, Ruhr-University Bochum, Bochum, Germany
| | - Ralf-Joachim Schulz
- Department of Geriatric Medicine, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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Thiel C, Braun T, Grüneberg C. [Physical training as core component of multimodal treatment of older frail people-study protocol of a randomized controlled pilot study]. Z Gerontol Geriatr 2018; 52:45-60. [PMID: 30206744 DOI: 10.1007/s00391-018-1443-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinical practice guidelines recommend a multimodal intervention based on standardized screening for the treatment of frailty, which includes physical exercise as the main component. This study protocol describes a planned randomized controlled pilot study to evaluate the feasibility of a main study and first assessment of the effects of a multimodal, resource-oriented intervention program on frailty in older people. METHODS AND ANALYSES A total of 50 community-dwelling older men and women with frailty, ≥65 years of age, will be randomly allocated to the intervention or control group. The intervention group receives usual care and a multimodal intervention program. This program consists of a multidimensional screening, verbal counselling, written instructions on individual functional and health status, a home-based physical exercise program (high-intensity functional exercise program, HIFE), and support related to cognition, mood, risk of falling, medication, nutrition and self-care as required. The control group participants will receive usual care only. The feasibility will be assessed by indicators for processes, resources and management (practicability), as well as for acceptance, safety and possible effects of the intervention. The frailty index and secondary clinical endpoints will be assessed before and after the 3‑month intervention, as well as after a 3-month follow-up to estimate the effects. Data will be analyzed according to the intention-to-treat principle. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committee of the German Physiotherapy Association (ref. number: 2017-02). Outcomes will be disseminated in a peer-reviewed journal and at specialist conferences. TRIAL REGISTRATION NUMBER German Clinical Trial Register: DRKS00011831.
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Affiliation(s)
- Christian Thiel
- Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Deutschland.
| | - Tobias Braun
- Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Deutschland
| | - Christian Grüneberg
- Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Deutschland
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Braun T, Grüneberg C, Thiel C, Schulz RJ. Measuring mobility in older hospital patients with cognitive impairment using the de Morton Mobility Index. BMC Geriatr 2018; 18:100. [PMID: 29685107 PMCID: PMC5913915 DOI: 10.1186/s12877-018-0780-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mobility is a key outcome in older patients with cognitive impairment. The de Morton Mobility Index (DEMMI) is an established measure of older people’s mobility that is promising for use in older patients with cognitive impairment. The aim of this study was to examine the DEMMI’s psychometric properties in older patients with dementia, delirium or other cognitive impairment. Methods This cross-sectional study was performed in a geriatric hospital and includes older acute medical patients with cognitive impairment indicated by a Mini Mental State Examination (MMSE) score ≤ 24 points. A Rasch analysis was performed to check the DEMMI’s unidimensionality. Construct validity was assessed by testing 13 hypotheses about expected correlations between the DEMMI and outcome measures of similar or related constructs, and about expected differences of DEMMI scores between groups differing in mobility related characteristics. Administration times were recorded. Results A sample of 153 patients with mild (MMSE 19–24 points; 63%) and moderate (MMSE: 10–18 points; 37%) cognitive impairment was included (age range: 65–99 years; mean MMSE: 19 ± 4, range: 8–24 points; diagnosis of dementia and delirium: 40% and 18%, respectively). Rasch analysis indicated unidimensionality with an overall fit to the model (P = 0.107). Internal consistency reliability was excellent (Cronbach’s alpha = 0.92). Eleven out of 13 (85%) hypotheses on construct validity were confirmed. The DEMMI showed good feasibility, and no adverse events occurred. The mean administration time of 5 min (range: 1–10) was not influenced by the level of cognitive impairment. In contrast to some other comparator instruments, no floor or ceiling effects were evident for the DEMMI. Conclusions Results indicate sufficient psychometric properties of the DEMMI in older patients with cognitive impairment. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015. Electronic supplementary material The online version of this article (10.1186/s12877-018-0780-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Braun
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany. .,University of Cologne, Medical Faculty, Cologne, Germany. .,St. Marien-Hospital, Department of Geriatric Medicine, Cologne, Germany.
| | - Christian Grüneberg
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
| | - Christian Thiel
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
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Braun T, Marks D, Thiel C, Grüneberg C. Reliability and validity of the de Morton Mobility Index in individuals with sub-acute stroke. Disabil Rehabil 2018; 41:1561-1570. [PMID: 29397785 DOI: 10.1080/09638288.2018.1430176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To establish the validity and reliability of the de Morton Mobility Index (DEMMI) in patients with sub-acute stroke. METHODS This cross-sectional study was performed in a neurological rehabilitation hospital. We assessed unidimensionality, construct validity, internal consistency reliability, inter-rater reliability, minimal detectable change and possible floor and ceiling effects of the DEMMI in adult patients with sub-acute stroke. RESULTS The study included a total sample of 121 patients with sub-acute stroke. We analysed validity (n = 109) and reliability (n = 51) in two sub-samples. Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 12.37, p = 0.577). All hypotheses on construct validity were confirmed. Internal consistency reliability (Cronbach's alpha = 0.94) and inter-rater reliability (intraclass correlation coefficient = 0.95; 95% confidence interval: 0.92-0.97) were excellent. The minimal detectable change with 90% confidence was 13 points. No floor or ceiling effects were evident. CONCLUSIONS These results indicate unidimensionality, sufficient internal consistency reliability, inter-rater reliability, and construct validity of the DEMMI in patients with a sub-acute stroke. Advantages of the DEMMI in clinical application are the short administration time, no need for special equipment and interval level data. The de Morton Mobility Index, therefore, may be a useful performance-based bedside test to measure mobility in individuals with a sub-acute stroke across the whole mobility spectrum. Implications for Rehabilitation The de Morton Mobility Index (DEMMI) is an unidimensional measurement instrument of mobility in individuals with sub-acute stroke. The DEMMI has excellent internal consistency and inter-rater reliability, and sufficient construct validity. The minimal detectable change of the DEMMI with 90% confidence in stroke rehabilitation is 13 points. The lack of any floor or ceiling effects on hospital admission indicates applicability across the whole mobility spectrum of patients with sub-acute stroke.
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Affiliation(s)
- Tobias Braun
- a Department of Applied Health Sciences, Physiotherapy Program, Hochschule für Gesundheit, University of Applied Sciences , Bochum , Germany
| | - Detlef Marks
- b Physiotherapy Department , Rehaklinik Zihlschlacht , Zihlschlacht , Switzerland
| | - Christian Thiel
- a Department of Applied Health Sciences, Physiotherapy Program, Hochschule für Gesundheit, University of Applied Sciences , Bochum , Germany
| | - Christian Grüneberg
- a Department of Applied Health Sciences, Physiotherapy Program, Hochschule für Gesundheit, University of Applied Sciences , Bochum , Germany
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[Mobility of elderly people : Progress in assessment and intervention]. Z Gerontol Geriatr 2016; 49:363-5. [PMID: 27342102 DOI: 10.1007/s00391-016-1089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dasenbrock L, Berg T, Lurz S, Beimforde E, Diekmann R, Sobotka F, Bauer JM. [The De Morton Mobility Index for evaluation of early geriatric rehabilitation]. Z Gerontol Geriatr 2016; 49:398-404. [PMID: 27259707 DOI: 10.1007/s00391-016-1061-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 02/16/2016] [Accepted: 03/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The timed up and go (TUG) test and the Tinetti test are most frequently used in Germany to document the success of rehabilitation in early geriatric rehabilitation. However, there has been some uncertainty whether these instruments can describe the entire spectrum of mobility with adequate precision and whether they can be successfully applied for repeated assessments during rehabilitation. Against this background the De Morton Mobility Index (DEMMI) has been developed and validated. OBJECTIVE The aim of this study was to evaluate the suitability of the DEMMI compared to the TUG and Tinetti tests in early geriatric rehabilitation. MATERIAL AND METHODS Ceiling and floor effects of the DEMMI, the TUG test, the Tinetti test and the Barthel Index (BI) were determined. Correlations were calculated using the Spearman correlation coefficient. Effects on the DEMMI were estimated through multiple linear regression. RESULTS A total of 144 patients with an average age of 84.91 years (SD ±5.77) and 65.97 % females participated in this study. The mean value for the DEMMI was 33.45 (SD ±15.37) points at admission and 43.90 (SD ±15.55) at discharge (n = 144). Floor effects were observed in the TUG test in 84.72 % (n = 122) of patients at admission and in 60.42 % (n = 87) at discharge. The DEMMI, Tinetti test and BI showed no floor or ceiling effects. The correlation between the DEMMI and the TUG test was -0.48 at admission and -0.49 at discharge, between the DEMMI and the Tinetti test 0.75 and 0.82, respectively and between the DEMMI and the BI 0.54 and 0.66, respectively (p < 0,01). CONCLUSION Significant correlations with the TUG test, the Tinetti test and the BI, together with the lack of floor and ceiling effects provide evidence that the DEMMI is an appropriate tool to assess mobility in early geriatric rehabilitation. The lack of floor and ceiling effects appears to make the DEMMI a superior tool compared to the TUG test.
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Affiliation(s)
- L Dasenbrock
- Universitätsklinik für Geriatrie am Klinikum Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland.
| | - T Berg
- Universitätsklinik für Geriatrie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - S Lurz
- Universitätsklinik für Geriatrie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - E Beimforde
- Universitätsklinik für Geriatrie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - R Diekmann
- Universitätsklinik für Geriatrie am Klinikum Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - F Sobotka
- Abteilung Epidemiologie und Biometrie im Department Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - J M Bauer
- Universitätsklinik für Geriatrie am Klinikum Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland.,Universitätsklinik für Geriatrie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
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[Hierarchical assessment of balance and mobility : German translation and cross-cultural adaptation]. Z Gerontol Geriatr 2016; 49:386-97. [PMID: 26861790 DOI: 10.1007/s00391-016-1026-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/21/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The hierarchical assessment of balance and mobility (HABAM) is an internationally established clinical mobility test which has good psychometric properties, allows an easy assessment of mobility and the graphical illustration of change over time in geriatric patients. The aims of this study were the translation and cross-cultural adaptation of the English original HABAM into the German language as well as a preliminary analysis of the practicability and construct validity of the HABAM. MATERIAL AND METHODS The HABAM was translated into German following international guidelines. A prefinal version was clinically tested by physiotherapists in two geriatric hospitals over a period of 5 weeks. In order to make a final revision of the German HABAM version, structured in-depth feedback was obtained from the seven therapists who had used the HABAM most often. RESULTS A total of 18 physiotherapists used the HABAM for 47 elderly inpatients for the initial assessment. The translated items and instructions seemed comprehensible but problems occurred concerning the conducting and documentation of the HABAM. Modifications led to the final German HABAM version and 85 % of the HABAM assessments were performed within ≤ 10 min. There was a correlation of rs= 0.71 with the Tinetti test and of rs = 0.68 with the Barthel index. CONCLUSION A German HABAM version is now accessible for use in clinical practice. The results of a preliminary psychometric analysis indicate a potentially good practicability and sufficient construct validity. A comprehensive analysis of psychometric properties is pending.
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Braun T, Marks D, Thiel C, Zietz D, Zutter D, Grüneberg C. Effects of additional, dynamic supported standing practice on functional recovery in patients with sub-acute stroke: a randomized pilot and feasibility trial. Clin Rehabil 2015; 30:374-82. [PMID: 25952591 DOI: 10.1177/0269215515584801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 04/06/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the feasibility and preliminary effectiveness of additional dynamic versus static passive standing performed by patients with sub-acute stroke supervised by trained helpers. DESIGN Assessor blinded, randomized pilot and feasibility trial. SETTING Neurological rehabilitation centre. PARTICIPANTS Non-ambulatory participants in the sub-acute phase after stroke. INTERVENTION Usual care plus additional standing training, consisting of either dynamic standing practice in a modified standing frame (intervention group, n=14) or static standing practice in a conventional standing frame (control group, n=14) for 5 weeks. MAIN MEASURES Feasibility was assessed through occurrence of adverse events, patient satisfaction and operability of the technical device handled by trained helpers. Preliminary effectiveness was assessed with the Berg Balance Scale (primary outcome) and other measures of physical functioning. RESULTS Trained helpers were capable to apply the intervention, and no adverse events occurred. Both groups were comparable at baseline. Within-group changes tended to be higher for the intervention group, but did not reach a significant level except for the Functional Ambulation Categories. Specifically, median pre-post improvements in the Berg Balance Scale tended to be higher in the dynamic (20, inter quartile range (IQR): 2-33 points) than in the static standing group (4.5, IQR: 0-16 points; U=62; P=0.052; effect size=0.478). CONCLUSIONS In severely affected individuals after stroke, dynamic supported standing practice can be performed safely by trained helpers. In a larger-scale phase III study, a total of 116 patients would be needed to prove the preliminary effectiveness found in this study.
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Affiliation(s)
- Tobias Braun
- Hochschule für Gesundheit, Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany Rehaklinik Zihlschlacht, Neurorehabilitation Centre, Zihlschlacht, Switzerland
| | - Detlef Marks
- Rehaklinik Zihlschlacht, Neurorehabilitation Centre, Zihlschlacht, Switzerland
| | - Christian Thiel
- Hochschule für Gesundheit, Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
| | - Dörte Zietz
- Hochschule für Gesundheit, Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
| | - Daniel Zutter
- Rehaklinik Zihlschlacht, Neurorehabilitation Centre, Zihlschlacht, Switzerland
| | - Christian Grüneberg
- Hochschule für Gesundheit, Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
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Braun T, Schulz RJ, Reinke J, van Meeteren NL, de Morton NA, Davidson M, Thiel C, Grüneberg C. Reliability and validity of the German translation of the de Morton Mobility Index (DEMMI) performed by physiotherapists in patients admitted to a sub-acute inpatient geriatric rehabilitation hospital. BMC Geriatr 2015; 15:58. [PMID: 25935559 PMCID: PMC4424447 DOI: 10.1186/s12877-015-0035-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobility is a key outcome in geriatric rehabilitation. The de Morton Mobility Index (DEMMI) is an internationally well-established, unidimensional measure of mobility with good psychometric properties. The aim of this study was to examine the reliability and construct validity of the German translation of the DEMMI in geriatric inpatients. METHODS This cross-sectional study included patients admitted to a sub-acute inpatient geriatric rehabilitation hospital (reliability sample: N = 33; validity sample: N = 107). Reliability, validity, and unidimensionality were investigated. RESULTS Inter-rater reliability between two graduate physiotherapists was excellent, with intra-class correlation coefficient of 0.94 (95% confidence interval: 0.88-0.97). The minimal detectable change with 90% confidence was 9 points. Construct validity for the DEMMI was evidenced by significant moderate to strong correlations with other measures of mobility and related constructs (Performance Oriented Mobility Assessment: rho = 0.89; Functional Ambulation Categories: rho = 0.70; six-minute walk test: rho = 0.73; gait speed: rho = 0.67; Falls Efficacy Scale International: rho = -0.68). Known-groups validity was indicated by significant DEMMI mean group differences between independent versus dependent walkers and walking aid users versus non-users. Unidimensionality of the German DEMMI translation was confirmed by Rasch analysis. CONCLUSIONS The German translation of the DEMMI is a unidimensional instrument producing valid and reproducible measurement of mobility in an inpatient geriatric rehabilitation setting.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Physiotherapy Program, Hochschule für Gesundheit, Universitätsstr. 105, 44789, Bochum, Germany. .,University of Cologne, Medical Faculty, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Ralf-Joachim Schulz
- Department of Geriatric Medicine, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany.
| | - Julia Reinke
- Catholic Clinic Bochum, Ruhr-University Bochum, Marien-Hospital Wattenscheid, Parkstr. 15, 44866, Bochum, Germany.
| | - Nico L van Meeteren
- Health~Holland, Topsector Life Sciences and Health, 2509, The Hague, The Netherlands. .,CAPHRI, Maastricht University, Minderbroedersberg 4-6, 6211 LK, Maastricht, The Netherlands.
| | - Natalie A de Morton
- Donvale Rehabilitation Hospital, Ramsay Health, 1119 Doncaster Road, Donvale, VIC, 3111, Australia.
| | - Megan Davidson
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Christian Thiel
- Department of Applied Health Sciences, Physiotherapy Program, Hochschule für Gesundheit, Universitätsstr. 105, 44789, Bochum, Germany.
| | - Christian Grüneberg
- Department of Applied Health Sciences, Physiotherapy Program, Hochschule für Gesundheit, Universitätsstr. 105, 44789, Bochum, Germany.
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