Karsten Dreinhöfer
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Zeitschrift Fur Orthopadie Und Unfallchirurgie | 2017
Jochen Schmitt; Toni Lange; Klaus-Peter Günther; Christian Kopkow; Elisabeth Rataj; Christian Apfelbacher; Martin Aringer; Eckhardt Böhle; Hartmut Bork; Karsten Dreinhöfer; Niklaus Friederich; Karl-Heinz Frosch; Sascha Gravius; Erika Gromnica-Ihle; Karl-Dieter Heller; Stephan Kirschner; Bernd Kladny; Hendrik Kohlhof; Michael Kremer; Nicolai Leuchten; M. Lippmann; Jürgen Malzahn; Heiko Meyer; Rainer Sabatowski; Hanns-Peter Scharf; Johannes Stoeve; Richard Wagner; Jörg Lützner
Background and Objectives Knee osteoarthritis (OA) is a significant public health burden. Rates of total knee arthroplasty (TKA) in OA vary substantially between geographical regions, most likely due to the lack of standardised indication criteria. We set out to define indication criteria for the German healthcare system for TKA in patients with knee OA, on the basis of best evidence and transparent multi-stakeholder consensus. Methods We undertook a complex mixed methods study, including an iterative process of systematic appraisal of existing evidence, Delphi consensus methods and stakeholder conferences. We established a consensus panel representing key German national societies of healthcare providers (orthopaedic surgeons, rheumatologists, pain physicians, psychologists, physiotherapists), payers, and patient representatives. A priori defined consensus criteria were at least 70% agreement and less than 20% disagreement among the consensus panel. Agreement was sought for (1) core indication criteria defined as criteria that must be met to consider TKA in a normal patient with knee OA, (2) additional (not obligatory) indication criteria, (3) absolute contraindication criteria that generally prohibit TKA, and (4) risk factors that do not prohibit TKA, but usually do not lead to a recommendation for TKA. Results The following 5 core indication criteria were agreed within the panel: 1. intermittent (several times per week) or constant knee pain for at least 3u200a-u200a6 months; 2. radiological confirmation of structural knee damage (osteoarthritis, osteonecrosis); 3. inadequate response to conservative treatment, including pharmacological and non-pharmacological treatment for at least 3u200a-u200a6 months; 4. adverse impact of knee disease on patients quality of life for at least 3u200a-u200a6 months; 5. patient-reported suffering/impairment due to knee disease. Additional indication criteria, contraindication criteria, and risk factors for adverse outcome were also agreed by a large majority within the multi-perspective stakeholder panel. Conclusion The defined indication criteria constitute a prerequisite for appropriate provision of TKA in patients with knee OA in Germany. In eligible patients, shared-decision making should eventually determine if TKA is performed or not. The next important steps are the implementation of the defined indication criteria, and the prospective investigation of predictors of success or failure of TKA in the context of routine care provision in Germany.
Bundesgesundheitsblatt-gesundheitsforschung-gesundheitsschutz | 2017
Michael Linden; Sebastian Bernert; Ariane Funke; Karsten Dreinhöfer; Michael Jöbges; Ernst von Kardorff; Steffi G. Riedel-Heller; K. Spyra; Heinz Völler; Petra Warschburger; Pia-Maria Wippert
ZusammenfassungDie Lifespan-Forschung untersucht die Entwicklung von Individuen über den gesamten Lebenslauf. Die medizinische Rehabilitation hat nach geltendem Sozialrecht die Aufgabe, chronische Krankheiten abzuwenden, zu beseitigen, zu mindern, auszugleichen, eine Verschlimmerung zu verhüten und Negativfolgen für die Lebensführung zu reduzieren. Dies erfordert in wissenschaftlicher wie in praxisbezogener Hinsicht die Entwicklung einer Lebensspannenperspektive als Voraussetzung für die Klassifikation und Diagnostik chronischer Erkrankungen, die Beschreibung von verlaufsbeeinflussenden Faktoren, kritischen Lebensphasen und Critical Incidents (kritische Verlaufszeitpunkte), die Durchführung von prophylaktischen Maßnahmen, die Entwicklung von Assessmentverfahren zur Erfassung und Bewertung von Verläufen oder Vorbehandlungen, die Auswahl und Priorisierung von Interventionen, eine Behandlungs- und Behandlerkoordination auf der Zeitachse, die Präzisierung der Aufgabenstellung für spezialisierte Rehabilitationsmaßnahmen, wie beispielsweise Rehabilitationskliniken, und als Grundlage für die Sozialmedizin. Aufgrund der Vielfalt der individuellen Risikokonstellationen, Krankheitsverläufe und Behandlungssituationen über die Lebensspanne hinweg, bedarf es in der medizinischen Rehabilitation in besonderer Weise einer personalisierten Medizin, die zugleich rehabilitationsförderliche und -behindernde Umweltfaktoren im Rehabilitationsverlauf berücksichtigt.AbstractLifespan research investigates the development of individuals over the course of life. As medical rehabilitation deals with primary and secondary prophylaxis, treatment, and compensation of chronic illnesses, axa0lifespan perspective is needed for the classification and diagnosis of chronic disorders, the assessment of course modifying factors, the identification of vulnerable life periods and critical incidents, the implementation of preventive measures, the development of methods for the evaluation of prior treatments, the selection and prioritization of interventions, including specialized inpatient rehabilitation, the coordination of therapies and therapists, and for evaluations in social and forensic medicine. Due to the variety of individual risk constellations, illness courses and treatment situations across the lifespan, personalized medicine is especially important in the context of medical rehabilitation, which takes into consideration hindering and fostering factors alike.Lifespan research investigates the development of individuals over the course of life. As medical rehabilitation deals with primary and secondary prophylaxis, treatment, and compensation of chronic illnesses, axa0lifespan perspective is needed for the classification and diagnosis of chronic disorders, the assessment of course modifying factors, the identification of vulnerable life periods and critical incidents, the implementation of preventive measures, the development of methods for the evaluation of prior treatments, the selection and prioritization of interventions, including specialized inpatient rehabilitation, the coordination of therapies and therapists, and for evaluations in social and forensic medicine. Due to the variety of individual risk constellations, illness courses and treatment situations across the lifespan, personalized medicine is especially important in the context of medical rehabilitation, which takes into consideration hindering and fostering factors alike.
Orthopädie und Unfallchirurgie | 2017
Karsten Dreinhöfer; Bernd Kladny; Reinhard Hoffmann
Archive | 2017
Klaus Michael Stürmer; Andreas Roth; Matthias Psczolla; Bernd Kladny; Johannes Flechtenmacher; Reinhard Hoffmann; Karsten Dreinhöfer
Archive | 2017
Matthias Psczolla; Bernd Kladny; Johannes Flechtenmacher; Reinhard Hoffmann; Karsten Dreinhöfer
Archive | 2017
Johannes Flechtenmacher; Bernd Kladny; Matthias Psczolla; Reinhard Hoffmann; Karsten Dreinhöfer
Archive | 2017
Matthias Psczolla; Bernd Kladny; Johannes Flechtenmacher; Reinhard Hoffmann; Karsten Dreinhöfer
Archive | 2017
Matthias Psczolla; Bernd Kladny; Johannes Flechtenmacher; Reinhard Hoffmann; Karsten Dreinhöfer
Archive | 2017
Matthias Psczolla; Bernd Kladny; Johannes Flechtenmacher; Reinhard Hoffmann; Karsten Dreinhöfer
Archive | 2017
Matthias Psczolla; Bernd Kladny; Johannes Flechtenmacher; Reinhard Hoffmann; Karsten Dreinhöfer