Sebastian Voigt-Radloff

Einführung: Forschungs- und Innovationspotenziale in den Gesundheitsfachberufen

In order to address the increasing complexity and continuously changing needs and demands in the German healthcare system, there is a need to strengthen knowledge translation, evidence-based practice and the conduct of clinical trials in the field of allied health professions. An interdisciplinary working group representing the fields of nursing, midwifery, physiotherapy, occupational therapy and speech therapy developed a guide and a concept for seminars to provide potential analyses for research and innovations in the allied health professions in Germany. These potential analyses compare the current state of health care delivery for specific health problems and the corpus of evidence for the effectiveness of related interventions. Thus innovations can be identified which might improve client-centred healthcare in Germany. The introductory paper briefly reports the activities and results of the working group, describes the international context of transferring research into practice and outlines possibilities for the future development of coordinated research strategies in Germany. The following papers consist of five potential analyses: (1) Advanced Practice Nursing (APN) in long-term care; (2) giving birth in an upright position; (3) treadmill training for patients with Parkinsons disease; (4) training of everyday activities after stroke; and (5) communication training for patients with aphasia.

Potential analysis of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain / Potentialanalyse der multidisziplinären biopsychosozialen Rehabilitation für Patienten/-innen mit chronischen Rückenschmerzen

Abstract Health problem The prevalence of low back pain ranges from 74 to 85%, almost everybody in Germany suffers from low back pain once in his or her life. The recurrence rate within twelve months is 62%, which often leads to inability to work and reduction in earning capacity. The rate of chronic manifestation of low back pain is 5%. Subsequent loss of mobility and functional disability lowers quality of life and participation in private life and at work. Evidence A recent Cochrane review (Kamper et al., 2014) analysed six (outcome disability) and seven (outcome pain) studies with 722 and 821 participants respectively and showed that multidisciplinary rehabilitation compared to usual care has a small, but clinically relevant effect (pain: SMD -0,21 [CI 95% -0,37; -0,04]; disability: SMD -0,23 [CI 95% -0,4; -0,06]). There is a lack of evidence about the intervention conception, patient-centred outcomes and the cost effectiveness. Implication for research Prior to a randomised controlled trial a feasibility study about individualised multidisciplinary biopsychosocial rehabilitation compared to usual care considering people with chronic low back pain at employable age in Germany is needed. The applicability of available manuals, patient-centred outcomes and cost effectiveness should be explored.

Potential analysis for patient education in acute non-specific low back pain / Potenzialanalyse zur Patienten/-innenedukation bei akuten unspezifischen lumbalen Rückenschmerzen

Abstract Health problem Recent health insurance statistics show that low back pain (LBP) takes the first place in individual diagnoses according to sick leave statistics. As stated by the German back pain study of 2003/2006, long-term prevalence amounts to a total of 74 % to 85 %. In the case of acute unspecific LRS guidelines, recommend the use of non-steroidal anti-inflammatory drugs and patient education in order to motivate the patient to retain an active lifestyle, to stay physically active and to inform the patient about the background of the symptoms. Studies about the current medical supply situation in Germany show injections and passive therapy methods are part of the standard care, whereas educational measures are generally not applied. Evidence A Cochrane Review indicates the effectiveness of educational measures that have a duration of 2 hours. Education in the recommended intensity can probably not be realized by health care practitioners within the time framework set aside for treatment and advice. Because of their range of services and their professional competence physical and occupational therapists appear to be predestined for this type of education as intervention. Research recommendations In order to assess the potential of such an intervention for a later more extensive efficacy study a feasibility study should be carried out first. The focus is on assessing the feasibility and the evaluation of intervention education.

Potential analysis for research on occupational therapy-led physical exercise programmes and home environment adaptation programmes to prevent falls for elderly people living at home / Potenzialanalyse zu ergotherapeutischen körperlichen Trainingsprogrammen und Wohnraumanpassungen zur Vermeidung von Stürzen bei zu Hause lebenden älteren Menschen

Abstract Background In Germany, four to five million community-dwelling people aged 65 years or older fall every year. The presented potential analysis evaluates the potential of occupational therapy-led physical exercise programs and home environment adaptations to reduce the frequency of falling and as well as intrinsic and extrinsic risk factors for falling of older people living at home. Methods The potential analysis was compiled according to a method guideline (p.11-22) available as follows: http://www.cochrane. de/news/leitfaden-f%C3%BCr-gesundheitsfachberufe-mai-2013. The research question of fall prevention was considered as very relevant for health care and specified according to the PICOS-system. A Cochrane review was systematically searched and the body of evidence was assessed using the GRADE-system. In addition, studies after the search period of the Cochrane review were identified using the search strategy of this review. Both the studies within and after the review were assessed regarding their transferability to the German health care context. Corpus of evidence A Cochrane review from 2012 revealed that occupational therapy-led physical exercise programs reduced the frequency of falling of older people living at home (7 studies, 951 participants, 0.68 RaR; 95%-KI [0.58-0.80]), the number of fallers (6 studies, 714 participants, 0.78 RaR, 95%-KI [0.64-0.94]) and the fractures (6 studies, 810 participants, 0.34 RaR, 95%-KI [0.18-0.63]). Further studies showed that home environment adaptation programs significantly reduced the number of falls (4 studies, 1443 participants, 0.69 RaR, 95%-KI [0.55-0.86]) and the number of fallers (5 studies, 1153 participants, 0.79 RaR, 95%-KI [0.70-0.91]). However, direct implementation into the German healthcare context is not recommendable. Implication for research It is recommended (1) to manualise identified home environment adaptation programmes for the German healthcare context and (2) to pilot-test the physical exercise programmes ‘LiFE’ with regard to theoretical framework, acceptance, applicability and feasibility and to examine both interventions as part of a feasibility study. If this trial results in a feasible treatment programme well accepted by patients and their treating occupational therapists, a large-scaled randomized clinical trial in terms of comparative effectiveness research may follow.

Potential analyses for research on occupational therapy-led training of activities of daily living in stroke patients

HEALTH PROBLEMnEvery year about 200,000 people in Germany suffer from a first stroke and 65,000 persons from a recurrent stroke. Stroke is one of the major causes of acquired life-long disability. It is associated with multiple limitations in functioning, activities of daily living and social participation. People with stroke must develop and apply considerable coping and adaptation strategies to manage the consequences of disabilities in daily life. Insufficient adaptations may result in social isolation, depressive disorders, need for medical and nursing care and subsequently lead to increasing costs for care. Thus occupational therapy-led treatment addressing social participation as well as skills training, adaptation strategies and assistive technology for activities of daily living is essential for stroke patients after hospital discharge.nnnCORPUS OF EVIDENCEnBased on nine randomised comparisons, a Cochrane review from 2006 revealed that occupational therapy-led training after stroke had positive effects on personal activities of daily living (8 studies; 961 participants; 0.18 SMD; 95 % CI [0.04 to 0.32]), on extended activities of daily living (6 studies; 847 participants; 0.21 SMD; 95 % CI [0.03 to 0.39]), and on poor outcome (7 studies; 1,065 participants; odds ratio 0.67; 95 % CI [0.51 to 0.87]). However, direct implementation into the German healthcare context is not recommendable due to (1) different settings and heterogeneity within the primary studies, (2) lack of manualisation of treatment programmes and (3) insufficient evaluation of client-oriented outcomes.nnnIMPLICATION FOR RESEARCHnIt is recommended to manualise client-centred standardised modules of a stage-specific occupational therapy-led training of activities of daily living and to pilot-test this intervention programme in a feasibility study. If this trial results in a set of reliable and valid client-oriented outcome measurements applicable within the German care context and in a feasible treatment programme well accepted by stroke patients and their treating occupational therapists, a large-scaled randomised clinical trial in terms of comparative effectiveness research may follow.