Clinimetrics

Walking out of hospital: the rise of ambulatory care, patients’ needs, and related opportunities for physiotherapists

Chloe Schorderet

Factors influencing physical activity behaviour of hospitalised patients - Hanneke Huisman 2022

Inactive behaviour is common during hospital stay and is associated with negative health outcomes. This thesis aimed to contribute to improving patients’ physical activity behaviour during hospitalisation. This thesis investigated barriers and enablers to physical activity behaviour during hospital stay. Moreover, this thesis developed a screening tool to identify older adults at high risk of spending little time active during hospitalisation. If patients at high risk can be identified early after admission, they can be offered interventions aimed at improving their physical activity behaviour. One such intervention is Hospital Fit, a smartphone app connected to an accelerometer. This thesis investigated the potential of Hospital Fit to improve the physical activity behaviour and functional recovery of patients after orthopaedic surgery. Lastly, this thesis optimised and validated an accelerometer algorithm in order to improve the accuracy of physical activity monitoring in hospitalised patients.

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"Back in the saddle": early training in critical care: effects of early training and evaluation of physical function and activity in mechanically ventilated, critically ill adults - Sabrina Grossenbacher-Eggman 2022

This thesis investigated the effects of early training and recovery and studied methods to evaluate physical function and activity in mechanically ventilated, critically ill adults. Early training was found to be safe but did not improve functional outcomes at hospital discharge compared to usual care. Muscle weakness at ICU discharge was associated with subsequent, short-term functional disability. Variations in cardiorespiratory parameters during training were common and mainly associated with training type, mobilisation level, patient participation, and training duration. Thus, therapists are advised to individually tailor and adjust training. To assess patients’ physical function and activity, the German CPAx version was created and tested. The CPAx was equivalent to the original version and valid across three time-points in the pathway of recovery. It may also be used to identify candidates in need of further rehabilitation. Overall, this thesis informs clinical practice and forthcoming research about neuromuscular complications, thereby contribution to improving future management and outcomes for this critically ill population.

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Blended therapy: an innovative approach to implement and promote adherence to physical exercise training in patients with Inflammatory Myopathy - Pierette Baschung-Pfister 2021

The main aims of this thesis were, 1) to develop an interactive tabled-based exercise application, 2) to evaluate the usability of this application, and 3) to test the feasibility of a blended therapy combining this application with face-to-face physiotherapy sessions for patients with an inflammatory myopathy. To know the best training regime for these patients, we performed a systematic review evaluating the application of exercise training principles and accordingly, evidence-based exercise guidelines were developed. Because the measurement properties of commonly used measurement instruments were not yet known, we also evaluated the measurement quality of two strength tests and a German questionnaire about activity limitation.

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Musculoskeletal complaints in musicians: Epidemiology, Phenomenology, and Prevention - Vera Baadjou 2018

Muscoskeletal complaints, such as pain, stiffness and tingling, are common among musicians. Approximately 67% of music students experience these symptoms, which can have a negative impact on the quality of their music and their lives. The risk factors associated with these symptoms in musicians remains unknown. Posture may be a risk factor, but stress and anxiety may also play a role. This study specifically examined the effect of posture according to the Samama method of Mensendieck exercise therapy. There are indications that this posture leads to more favourable muscle activity patterns while making music, which could help prevent symptoms. A multi-centre study involving a randomly selected group of test subjects examined the effect of a programme that combined posture with psychosocial education. The goal was to determine whether students who participated in this programme experienced fewer symptoms and limitations compared to a control group who followed a 10,000 step walking programme. The effect was similar for both groups in that symptoms and limitations appeared to decrease. The music students, however, preferred the biopsychosocial programme. The involvement of music academies in student health policies is extremely important for improving the health of professional musicians.

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Physical therapy in COPD: effects on exacerbations and influence of comorbidity - Emmylou Beekman 2017

This dissertation found physiotherapy to be the most important intervention for COPD patients. Despite encountering several obstacles in the original research design, it can be concluded that the treatment group experienced significantly fewer, shorter, and less severe exacerbations than the control group. Other results included lower costs for society and better quality of life for COPD patients. Interestingly, 90% of COPD patients also suffer from one or more non-related diseases. This study also described the effects of secondary disorders on the treatment provided by physiotherapists and the condition of the patients.

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Work outcome in musculoskeletal diseases: the context of cross-cultural research, intervention and multimorbidity - Antje Neuen 2017

This dissertation focusses on the impact of contextual factors on work outcome in people with locomotor and/or musculoskeletal diseases (MSDs). MSD is a common problem and a leading cause of sickness absence and work disability. It is shown that multimorbidity (the coexistence of two or more chronic diseases in the same individual) is associated with an increased risk of work disability, dependency on welfare benefits, unemployment and sickness absence, particularly if the chronic diseases involved include MSD. The results also indicate that a multidisciplinary treatment approach is associated with resuming work earlier compared to current care regimes. In people with rheumatoid arthritis, the country of residence and gross national product are shown to play a key role in having a job and being at risk for sickness absence and loss of work productivity.

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Innovative training programs for frail elderly in the skilling up stage - Slavko Rogan 2016

This thesis examines the implementation of training options in the field of long-term care (LTC) for elderly in need of care. New and innovative training programs consisting of whole body vibration with stochastic resonance (SR-WBV) and exergaming / video gaming (VG) are in focus to verify how these training regimes may be used in the field of LTC for elderly in need of care. To verify this innovative training program, the following steps were conducted: systematic gathering of information regarding the effects of whole body vibration (WBV) from scientific publications to acquire empirical knowledge, from which evidence is generated. In order to verify the validity of these findings, at the beginning a feasibility study with Go-Go and Slow-Go participants was conducted. Subsequently a feasibility study with No-Go elderly was carried out. Then the main study was conducted, wherein the effects after SR-WBV and VG were studied in No-Go elderly. Finally a validity study was carried out, where the RehaWatch® system was compared with the GAITRite® system.

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Multimorbidity challenges physical activity: Implications for targeting patient treatment - Sarah Dörenkamp 2016

Nearly two million Dutch people suffer from more than one chronic disease (multimorbidity). This dissertation shows that treatment results in people with intermittent claudication are worse if they suffer from multimorbidity. Seventy per cent of physiotherapists do not apply disease-specific treatment guidelines if people suffer from multimorbidity. This is found to be favourable as physiotherapists in daily practice are shown to be more successful than those in controlled studies. When comparing similar patient populations (1.440 patients in clinical studies and 3.513 patients in regular physiotherapeutic care settings), the increase in walking distance after six months of supervised walking training turned out to be 25% higher in patients treated by physiotherapists in regular care settings.

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Application and integration of the International Classification of Functioning, Disability and Health (ICF) in vocational rehabilitation - Monika Finger 2015

Work is a central aspect in people’s lives and is one of the most powerful social determinants of health, as stated by the WHO. Work is also widely associated with being integrated into society and economic self-sufficiency. For many people in western culture, their job also represents a source for self-confidence, self-worth, social status and is even related to the person’s identity. From the perspective of society, economic consequences of illness and disease and the costs of disability benefits are increasing. According to the OECD (Organisation for Economic Co-operation and Development), in 2008 the total cost of sickness absence and both sickness and disability benefits were on average equivalent to about 2% of gross domestic product (GDP). While these facts lead policy makers and health care providers to increasingly encourage workers to stay at work or to return to work as early as possible after enduring an injury or sickness, strategies on how to achieve this differ depending on the respective political and social system and the economy. One key element of disability management and policy that is gaining more and more attention in the last decade is vocational rehabilitation. The increasing interest in vocational rehabilitation and the return-to-work process has led to the development of a wide range of interventions and vocational rehabilitation programs. Nevertheless, few common standards for identifying, evaluating and monitoring work-related abilities and problems are used. This lack of a common understanding of functioning not only hampers the exchange of information within a setting, but also hinders an efficient communication between different stakeholders, e.g. clinicians, payers, employers and politicians. The International Classification of Functioning, Disability and Health (ICF), endorsed by the World Health Assembly in May 2001 provides a reference framework for conceptualizing, describing and documenting human functioning in the context of health in a standardized way. Therefore it is expected that the ICF could provide a common language and foundation to define standards in vocational rehabilitation, too. The overall objective of this thesis is to introduce and evaluate the ICF as a reference framework of functioning in the field of vocational rehabilitation, and to develop ICF-based tools to facilitate the clinical integration of the ICF in vocational rehabilitation. To answer the overall objectives three specific aims will be looked at: (1) to establish content validity of the ICF as a reference framework of functioning in vocational rehabilitation, (2) to develop an international standard and methodological approach for creating ICF-based applications in vocational rehabilitation, and (3) to apply ICF based tools in a clinical case example in vocational rehabilitation.

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Aspects of joint protection education in people with rheumatoid arthritis - Karin Niedermann 2010

This PhD thesis is about joint protection education in people with rheumatoid arthritis (RA). This included seven scientific articles, presented in the chapters 2-8.

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Psychosocial factors and physical inactivity in type 2 diabetes - Berber Koopmans 2008

Pressure ulcer prevention in cardiac surgery patients - Johanna Feuchtinger 2005

The Introduction, presents the practice problem underlying this dissertation. The rate of pressure ulcer among cardiac surgery patients has been described in the literature a.s between 4.7% and 29.5%. In light of a pressure ulcer rate o.f >30% and the development of serious decubitus in the Department for Cardiovascular Surgery at the University Hospital Freiburg: in the years 1999/2000, research projects were initiated to improve the situation. Also ln the Introduction, the risk factors involved in the occurrence of pressure ulcers are discussed on the basis of Defloor's "conceptuali scheme depictiing factors in the etiology of pressure sores" Knowledge with regard to the development of pressure ulcers is discussed. The, current state of scientific discussions of risk assessment instruments and requirements for prevention are presented, as is the spezial situation of cardiosurgical patients in connection with the development of a pressure ulcer. ihe Introduction closes with a presentation of the study projects.

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