Erworbene Kontrakturen der Gelenke im höheren Lebensalter

Gnass, Irmela; Bartoszek, Gabriele; Thiesemann, Rüdiger; Meyer, Gabriele

doi:10.1007/s00391-009-0089-6

Cited by 27 publications

(7 citation statements)

References 36 publications

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“…Joint contractures are characterized by restrictions in physiological joint mobility and can even result in immobility [ 1 ]. Joint contractures have a wide range of causes, including immobility, pain, and neurological conditions [ 2 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Development of a complex intervention to improve participation of nursing home residents with joint contractures: a mixed-method study

et al. 2018

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BackgroundJoint contractures in nursing home residents limit the capacity to perform daily activities and restrict social participation. The purpose of this study was to develop a complex intervention to improve participation in nursing home residents with joint contractures.MethodsThe development followed the UK Medical Research Council framework using a mixed-methods design with re-analysis of existing interview data using a graphic modelling approach, group discussions with nursing home residents, systematic review of intervention studies, structured 2-day workshop with experts in geriatric, nursing, and rehabilitation, and group discussion with professionals in nursing homes.ResultsGraphic modelling identified restrictions in the use of transportation, walking within buildings, memory functions, and using the hands and arms as the central target points for the intervention. Seven group discussions with 33 residents revealed various aspects related to functioning and disability according the International Classification of Functioning, Disability and Health domains body functions, body structures, activities and participation, environmental factors, and personal factors. The systematic review included 17 studies with 992 participants: 16 randomised controlled trials and one controlled trial. The findings could not demonstrate any evidence in favour of an intervention. The structured 2-day expert workshop resulted in a variety of potential intervention components and implementation strategies. The group discussion with the professionals in nursing homes verified the feasibility of the components and the overall concept. The resulting intervention, Participation Enabling CAre in Nursing (PECAN), will be implemented during a 1-day workshop for nurses, a mentoring approach, and supportive material. The intervention addresses nurses and other staff, residents, their informal caregivers, therapists, and general practitioners.ConclusionsIn view of the absence of any robust evidence, the decision to use mixed methods and to closely involve both health professionals and residents proved to be an appropriate means to develop a complex intervention to improve participation of and quality of life in nursing home residents. We will now evaluate the PECAN intervention for its impact and feasibility in a pilot study in preparation for an evaluation of its effectiveness in a definitive trial.Trial registrationGerman clinical trials register, reference number DRKS00010037 (12 February 2016).

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Section: Introductionmentioning

confidence: 99%

Development of a complex intervention to improve participation of nursing home residents with joint contractures: a mixed-method study

et al. 2018

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“…(4) A recently performed systematic review [15] will be updated and re-analysed to extract categories of the ICF from the outcome measures used.…”

Section: Methodsmentioning

confidence: 99%

Impact of joint contractures on functioning and social participation in older individuals – development of a standard set (JointConFunctionSet): study protocol

et al. 2013

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BackgroundJoint contractures are frequent in older individuals in geriatric care settings. Even though they are used as indicator of quality of care, there is neither a common standard to describe functioning and disability in patients nor an established standardized assessment to describe and quantify the impact of joint contractures on patients’ functioning. Thus, the aim of our study is (1) to develop a standard set for the assessment of the impact of joint contractures on functioning and social participation in older individuals and (2) to develop and validate a standardized assessment instrument for describing and quantifying the impact of joint contractures on the individuals’ functioning.MethodsThe standard set for joint contractures integrate the perspectives of all potentially relevant user groups, from the affected individuals to clinicians and researchers. The development of this set follows the methodology to develop an International Classification of Functioning Disability and Health (ICF) Core Set and involves a formal decision-making and consensus process. Evidence from four preparatory studies will be integrated including qualitative interviews with patients, a systematic review of the literature, a survey with health professionals, and a cross sectional study with patients affected by joint contractures. The assessment instrument will be developed using item-response-theory models. The instrument will be validated.DiscussionThe standard set for joint contractures will provide a list of aspects of functioning and health most relevant for older individuals in geriatric care settings with joint contractures. This list will describe body functions, body structures, activities and participation and related environmental factors. This standard set will define what aspects of functioning should be assessed in individuals with joint contractures and will be the basis of the new assessment instrument to evaluate the impact of joint contractures on functioning and social participation.

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“…Recent research has shown that activity limitations and participation restrictions in self-care, mobility or leisure activities are the most relevant aspects from the viewpoint both of older people with contractures living in nursing homes or in the community and of health-care experts [4–7]. Despite that, the structural impairment in terms of range of motion of the affected joint is still the most frequently reported outcome measure in clinical studies on joint contractures [8–10]. The number of older individuals affected varies because there is no standardised definition of joint contractures, the diagnostic criteria differ, and settings and populations vary [11].…”

Section: Introductionmentioning

confidence: 99%

“…The first project included the identification of aspects related to functioning and disability of those affected to develop a standardised instrument for assessing the impact of joint contractures [4–8, 11, 13–17]. Based on the findings of the first project, we developed and piloted the complex intervention Participation Enabling Care in Nursing (PECAN) to improve participation and activities in nursing home residents with joint contractures [10, 18, 19].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185]

Nguyen

Thalhammer

Beutner

et al. 2019

Trials

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Background Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study. Methods/design This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators’ workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents’ participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents’ quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost–utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation. Discussion We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals. Trial registration DRKS, DRKS00015185 . Registered on 1 August 2018. Universal Trial Number U1111–1218-1555. Registered on 26 July 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3384-6) contains supplementary material, which is available to authorized users.

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Erworbene Kontrakturen der Gelenke im höheren Lebensalter

Cited by 27 publications

References 36 publications

Development of a complex intervention to improve participation of nursing home residents with joint contractures: a mixed-method study

Development of a complex intervention to improve participation of nursing home residents with joint contractures: a mixed-method study

Impact of joint contractures on functioning and social participation in older individuals – development of a standard set (JointConFunctionSet): study protocol

Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185]

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