Goal Setting In Medical Rehabilitation: A Narrative Review.

Goal setting is an integral part of rehabilitation and the rehabilitation process. The aim of rehabilitation is to optimize functioning. Therefore, rehabilitation professionals and patients together have to determine mutually which aspects of functioning they should aim at. From a clinical view, a formal procedure for setting goals should help to motivate patients, ensure cooperation of rehabilitation team members, help to identify relevant blind spots and provide a system to monitor patient changes. Applying goalsetting in rehabilitation represents a purpose in its own right, as it serves to strengthen the autonomy of patients and is a valuable tool to integrate personal motives, attitudes, meanings into the rehabilitation process. There is evidence that the introduction of goal setting into rehabilitation practice could enhance health-related quality of life and emotional states, especially self-efficacy. Mixed results have been reported regarding the patient motivation as well as activities and participation outcomes.

Why we need an internationally shared rehabilitation definition for clinical research purposes.

PURPOSE: Responding to a recent editorial arguing against defining rehabilitation, we discuss the reasons for developing a classification of rehabilitation for research purposes, its philosophical background and some of the possible risks. WHY DEFINE: Science requires the definition and classification of phenomena to allow replication of experiments and studies, and to allow interpretation and use of the findings. As understanding increases, the definitions can be refined. Defining rehabilitation does run the risk of excluding some interventions or practices that are either considered rehabilitation (perhaps wrongly) or are rehabilitation interventions; when identified, these errors in definition can be remedied. Defining rehabilitation for research purposes should not inhibit but could (possibly) orient research. RISK OF NOT: Without a definition, rehabilitation will remain in a permanent limbo. Experts will (apparently) know what it is, while others are left guessing or failing to comprehend or recognise it. This uncertainty may reassure some people, because all possible interventions are included; we argue that it downgrades the understanding of our field because interventions that are not rehabilitation are, nonetheless, called rehabilitation. In an era of international collaboration, and of undertaking systematic reviews with metanalysis, we need a shared definition. CONCLUSION: Terminology is often controversial, but definition enables progress in understanding such that terms themselves can evolve over time.

[Specific Contribution of Psychosocial Cancer Counselling Centers - Perspectives of the Person Seeking Advice and the Referring Professional]. / Zum spezifischen Versorgungsbeitrag psychosozialer Krebsberatungsstellen ­ Sichtweisen der Ratsuchenden und Zuweisenden.

AIM: The aim of the study is to look at the specific contribution of outpatient cancer counselling centers (OCCC) from the perspective of both the person seeking advice and the referring health care professionals. METHODS: Qualitative design by means of guideline-based face-to-face interviews with cancer patients/relatives and individual telephone interviews with referring health care professionals. RESULTS: A total of 43 persons seeking advice and 30 referring health care professionals were interviewed. With regard to the contents of counselling, psycho-oncological support and help for self-help in combination with social-legal information about additional support services are perceived as central features. In the group of referring physicians, however, there seems to be some uncertainty about what OCCCs (can) provide. CONCLUSION: On the one hand, the results point to a specific core of the services offered by OCCCs, and on the other hand to ambiguous perceptions on the part of the respondents. They may contribute to further sharpening the profile of OCCC and to clarifying their place in the health care system.

[Group Discussions in Health Services Research - Part 2: Reflections on The Concept of Group, Moderation and Analysis of Group Discussions as well as Online Group Discussion]. / Gruppendiskussionen in der Versorgungsforschung ­ Teil 2: Überlegungen zum Begriff der Gruppe, zur Moderation und Auswertung von Gruppendiskussionen sowie zur Methode der Online-Gruppendiskussion.

This article is the second of 2 articles on group discussions in health services research, written by the Qualitative Methods Working Group of the German Network for Health Care Research (DNVF). It starts with theoretical considerations on the concept of groups, and provides specific knowledge about groups in general and the behaviour of individual group members in particular, which is relevant for the design and interpretation of interaction processes in the group context. The following sections deal with the processuality of group discussions, moderation styles and techniques as well as reflections on possible subjects and methods of analysis. Presentation of results and text passages which unveil the interaction structure of several discussion participants are also discussed here. Finally, insights into the special features, potentials and challenges of group discussions via online platforms are provided. Together, the two articles provide an overview of the most important aspects of the application of group discussions in the field of health services research.

[Self-Determination in Medical Rehabilitation - Development of a Conceptual Model for Further Theoretical Discussion]. / Selbstbestimmung in der medizinischen Rehabilitation ­ Erstellung eines konzeptuellen Modells zur weiteren theoretischen Diskussion.

AIM: Aim was to gather theoretical knowledge about self-determination and to develop a conceptual model for medical rehabilitation- which serves as a basis for discussion. METHODS: We performed a literature research in electronic databases. Various theories and research results were adopted and transferred to the context of medical rehabilitation and into a conceptual model. RESULTS: The conceptual model of self-determination reflects on a continuum which forms of self-determination may be present in situations of medical rehabilitation treatments. The location on the continuum depends theoretically on the manifestation of certain internal and external factors that may influence each other. CONCLUSIONS: The model provides a first conceptualization of self-determination focusing on medical rehabilitation which should be further refined and tested empirically.

[Social Work in Medical Rehabilitation - A Review of Current Research]. / Soziale Arbeit in der medizinischen Rehabilitation ­ Eine Literaturübersicht über den aktuellen Stand der Forschung.

BACKGROUND: Quality assurance approaches by the German Statutory Pension Insurance emphasized the need of evidence-based practice for social work in medical rehabilitation. This study aims to show the state of research in rehabilitation science concerning social work and its effectiveness. METHODOLOGY: The review is based on a literature search in 3 databases (Pubmed, Web of Sciences, Scopus) and a hand search in rehabilitation science journals and proceedings. RESULTS: 52 of 176 articles from 2000 to 2016 met the inclusion criteria. Social work is a common service in routine clinical practice with a substantial variation on the institutional level and between indications. Analysis of quality assurance data and observational studies showed negative as well as positive effects. CONCLUSIONS: The results indicate the need of an evidence-based practice of social work in medical rehabilitation.

[Group Discussions in Health Services Research - Part 1: Introduction and Deliberations on Selection of Method and Planning]. / Gruppendiskussionen in der Versorgungsforschung ­ Teil 1: Einführung und Überlegungen zur Methodenwahl und Planung.

Health services researchers focus on the players, structures and impact of health care in "real life". They investigate how social aspects, financing, organizational structures, technologies and personal attitudes affect the process and outcomes of health care. Qualitative research methods are used here, which address how people act according to their unique living conditions (outside the context of experimental studies). Different methods of debriefing groups are essential for qualitative health services research. In 2 subsequent articles, we aim to outline the diverse facets and possible range of implementation of the above-mentioned methods, in order to highlight the potential of debriefing groups in health services research (focus groups or group discussions) using these methods. In the current article, we would like to encourage researchers to reflect on relevant topics such as the selection of an appropriate method, the planning and undertaking of investigations including sampling methods, and questions regarding ethics and privacy. A follow-up article (in preparation) will deal with theoretical considerations of the term "group", as well as with the process of moderating discussions, methods of analyzing data and (qualitative) online research.

[The Update of the Rehabilitation Therapy Standards of the German Pension Assurance]. / Die Aktualisierung der Reha-Therapiestandards der Deutschen Rentenversicherung.

OBJECTIVES: To report on the process of updating the German Pension Insurers' rehabilitation therapy standards (RTS) from 2013 to 2015. METHODS: Four methodical approaches were taken to gather evidence: a) systematic literature searches, b) the formation of expert groups, expert workshops, and online discussion forums to bring together the experiences from clinicians and patients, c) an analysis of the latest KTL data to understand the extent to which the RTS are currently being fulfilled, and d) conceptual consideration of the significance of current developments in rehabilitation in light of the RTS revision. RESULTS: There are now updated versions of all 9 RTS. Over half of the therapy modules are based on scientific evidence. Other modules are based on clinical experience with good clinical-practice standards. The scientific evidence has not changed much overall in the last few years, although there are some indications of higher evidence levels. CONCLUSION: The revised RTS can make a positive contribution to ensuring that rehabilitation is of high quality. Further research is needed to increase the level of evidence - especially regarding the intensity of therapy.

Effects of an antenatal mindfulness-based childbirth and parenting programme on the postpartum experiences of mothers: a qualitative interview study.

BACKGROUND: Applications of mindfulness during the perinatal period have recently been explored and appear to offer a decrease in stress, anxiety and depression during this period. However, it still remains unclear what practical use women make of mindfulness during the postpartum period and the mechanisms through which it works. The subjective experience of mindfulness practice by mothers is not fully understood. The aim of the present study was to explore how women enrolled in a "Mindfulness-Based Childbirth and Parenting programme" experienced mindfulness practice during the postpartum period. METHODS: Ten pregnant women over 18 years of age with singleton pregnancies, no diagnoses of mental illness and participation in a "Mindfulness-Based Childbirth and Parenting programme" were recruited to take part in a postpartum interview. Audio recordings of the interviews were transcribed and analysed thematically based on a phenomenological approach. The transcripts of nine interviews were submitted to a coding process consisting of the identification of words, sentences or paragraphs expressing common ideas. These ideas were classified in codes, each code representing a specific description, function or action (e.g. self-perception, personal organization, formal/informal meditation practice). Progressively, a framework of thematic ideas was extracted from the transcripts, allowing the interviews to be systematically organized and their content analysed in depth. RESULTS: Five themes emerged from the descriptions of practices of mindfulness during the postpartum period: perception of the present moment, breathing, acceptance, self-compassion and the perception of mindfulness as a shelter. CONCLUSION: Mindfulness practices during the postpartum period may contribute to a mother's psychological wellbeing. The perception of mindfulness as a shelter had not previously been reported. Future research could address whether this role is specific to the postpartum period.

Delivering care under uncertainty: Swiss providers' experiences in caring for women with spinal cord injury during pregnancy and childbirth - an expert interview study.

BACKGROUND: When different health problems such as pregnancy and spinal cord injury (SCI) occur together, providing adequate care becomes even more challenging. Women with SCI may encounter a variety of specific problems and symptoms during pregnancy and childbirth, including urinary tract infections, pressure ulcers, constipation, autonomic dysreflexia, and preterm labour. Therefore, expertise from different medical specialties, especially spinal cord medicine and gynaecology are required. What is totally normal for experts of one specialty could cause a problem for experts from another specialty. Therefore, this study aimed to reconstruct the perceptions and experiences of healthcare providers in Switzerland in caring for women with SCI during pregnancy and childbirth. METHODS: The perception and experience of healthcare professionals toward providing care for women with SCI during pregnancy and labour were elicited using qualitative expert interviews and analysed using grounded theory techniques. Fifteen health professionals were interviewed, including gynaecologists (n = 4), midwives (n = 3), physical medicine and rehabilitation professionals (n = 4), urologists (n = 3), and a peer counselor (n = 1). RESULTS: Care delivery experiences of health professionals could be described as a forced reaction to decision making under uncertainty. However, health professionals seemed to express three different attitudes while handling the situation: (i) protective concerned attitude, (ii) 'no big deal' attitude, or (iii) precautionary attitude. The applied strategies were influenced by the conditions of the healthcare system, policies in place, and health professionals' behaviours. Consequently, health professionals faced with uncertainty felt like actors in a fragmented treatment process and called for interdisciplinary collaborations. CONCLUSIONS: Our findings highlight the diversity of perspectives among different healthcare professionals with respect to the approach to care and delivery services for pregnant women with SCI. A need for more specific services, information, guidance, and guidelines for health professionals caring for woman with SCI during pregnancy and childbirth was identified. We strongly recommend further research on the development of integrated care concepts as well as clinical studies for establishing a more profound knowledge base.

Disease Progression and Changes in Physical Activity in Patients with Chronic Obstructive Pulmonary Disease.

RATIONALE: Little is known about the role of physical activity in the course of chronic obstructive pulmonary disease (COPD). OBJECTIVES: To assess changes in physical activity in COPD in relation to severity stages and changes in other disease components, and to evaluate the longitudinal association between sustained physical inactivity and disease progression. METHODS: In this prospective cohort study, we measured physical activity (multisensory armband), airflow obstruction (FEV1), health status (St. George's Respiratory Questionnaire), exercise capacity (6-min-walk distance [6MWD]), muscle mass (fat-free mass [FFM]), and systemic inflammation (fibrinogen and high-sensitivity C-reactive protein) over a 3-year period in 137 patients with COPD and 26 with chronic bronchitis (normal spirometry). MEASUREMENTS AND MAIN RESULTS: Independent of baseline disease severity, steps per day, total daily energy expenditure, and (daily) physical activity level (PAL) decreased by 393, 76 kcal, and 0.04 per year, respectively. The decline in PAL was significantly associated with a decline in FEV1 and an increase in St. George's Respiratory Questionnaire total score. Changes in 6MWD, FFM, and inflammatory markers were not associated with changes in PAL. Independent of FEV1, sustained physical inactivity (i.e., PAL(T0andT1) < 1.40) was related to a greater decline in 6MWD and FFM compared with that in patients with some level of activity (i.e., PAL(T0and/orT1) ≥ 1.40; difference, 17 m/yr and 0.87 kg/yr, respectively). CONCLUSIONS: Over time, physical activity substantially decreases across all severity stages of COPD, and this decline is paralleled by a worsening of lung function and health status. Sustained physical inactivity is associated with a progression of exercise intolerance and muscle depletion.

Applying for, reviewing and funding public health research in Germany and beyond.

Public health research is complex, involves various disciplines, epistemological perspectives and methods, and is rarely conducted in a controlled setting. Often, the added value of a research project lies in its inter- or trans-disciplinary interaction, reflecting the complexity of the research questions at hand. This creates specific challenges when writing and reviewing public health research grant applications. Therefore, the German Research Foundation (DFG), the largest independent research funding organization in Germany, organized a round table to discuss the process of writing, reviewing and funding public health research. The aim was to analyse the challenges of writing, reviewing and granting scientific public health projects and to improve the situation by offering guidance to applicants, reviewers and funding organizations. The DFG round table discussion brought together national and international public health researchers and representatives of funding organizations. Based on their presentations and discussions, a core group of the participants (the authors) wrote a first draft on the challenges of writing and reviewing public health research proposals and on possible solutions. Comments were discussed in the group of authors until consensus was reached. Public health research demands an epistemological openness and the integration of a broad range of specific skills and expertise. Applicants need to explicitly refer to theories as well as to methodological and ethical standards and elaborate on why certain combinations of theories and methods are required. Simultaneously, they must acknowledge and meet the practical and ethical challenges of conducting research in complex real life settings. Reviewers need to make the rationale for their judgments transparent, refer to the corresponding standards and be explicit about any limitations in their expertise towards the review boards. Grant review boards, funding organizations and research ethics committees need to be aware of the specific conditions of public health research, provide adequate guidance to applicants and reviewers, and ensure that processes and the expertise involved adequately reflect the topic under review.

[Environmental factors and the promotion of participation. The Perspective of medical rehabilitation]. / Umweltfaktoren und Teilhabeförderung. Die Perspektive der medizinischen Rehabilitation.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF), as well as the main goal of enabling participation, are of fundamental importance for medical rehabilitation. According to the logic of the ICF and its underlying multidimensional model of functioning and disability, the participation of a person can be influenced by modelling environmental factors. OBJECTIVES: This article presents environmental factors as defined by the ICF in the context of medical rehabilitation and aims to answer to what extent environmental factors are already involved in medical rehabilitation and if there are further environmental factors with the potential of being involved in interventions for improvement of participation. MATERIALS AND METHODS: An analysis of documents with relevance to medical rehabilitation was done. Text passages that referred to environmental factors were linked to the environmental factor codes of the ICF. RESULTS AND CONCLUSIONS: The ICF and its underlying model of functioning and disability provide a conceptual framework both for making the current usage of environmental factors apparent and for deriving and developing new intervention approaches with the involvement of environmental factors. The analysis of documents showed that environmental factor codes vary in how well they are represented in these documents. There are environmental factor codes that are barely or not at all represented, but do have potential to contribute to the improvement of participation.

Perceived needs and experiences with healthcare services of women with spinal cord injury during pregnancy and childbirth - a qualitative content analysis of focus groups and individual interviews.

BACKGROUND: Women after a spinal cord injury (SCI), who decide to get pregnant and to become mothers, have special health care service needs. This study aims to identify the perceived service needs of woman with SCI during pregnancy and childbirth in Switzerland and to reconstruct their experiences of healthcare service utilization based on their accounts. METHODS: A qualitative content analysis based on focus groups and individual interviews was conducted. 17 mothers with SCI who had given birth following SCI within the past 15 years participated. The data were transcribed verbatim before content analyses were carried out. Primary data was collected from August 2012 to September 2013 at the Swiss Paraplegic Research Centre, Nottwil; the University of Lausanne and at the homes of the participants. RESULTS: Mothers reported a broad spectrum of medical needs, including the need for access to improved integrated care. They also reported difficulties finding providers with knowledge of both paraplegiology (i.e. spinal cord medicine) and gynaecology. Mothers preferred using local health care services and regular birth hospitals, and reported receiving no additional benefit from the services of specialised SCI centres during pregnancy. A pre-existing provider-patient relationship was helpful for optimizing care processes. CONCLUSION: This study showed that pregnant women with SCI have various perceived healthcare needs and health care service use. Effective programs to improve these women's access to integrated care during pregnancy and childbirth and policies requiring the provision of specific pregnancy information and pre-birth services are necessary.

Quantifying yeast lipidomics by high-performance thin-layer chromatography (HPTLC) and comparison to mass spectrometry-based shotgun lipidomics.

Lipidomic analysis in diverse biological settings has become a frequent tool to increase our understanding of the processes of life. Cellular lipids play important roles not only as being the main components of cellular membranes, but also in the regulation of cell homeostasis as lipid signaling molecules. Yeast has been harnessed for biomedical research based on its good conservation of genetics and fundamental cell organisation principles and molecular pathways. Further application in so-called humanised yeast models have been developed which take advantage of yeast as providing the basics of a living cell with full control over heterologous expression. Here we present evidence that high-performance thin-layer chromatography (HPTLC) represents an effective alternative to replace cost intensive mass spectrometry-based lipidomic analyses. We provide statistical comparison of identical samples by both methods, which support the use of HPTLC for quantitative analysis of the main yeast lipid classes.

To Remind or Not to Remind During Recruitment? An Analysis of an Online Panel in Germany.

Objective: To explore the role of reminders in recruiting and maintaining participation in an online panel. Methods: 50,045 individuals from five German federal states were invited by regular mail to participate in the online study "Health-Related Beliefs and Healthcare Experiences in Germany." Those who did not respond to the first attempt received a postal reminder. Comparisons of sociodemographic characteristics and responses were made between first-attempt respondents and those who enrolled after the second letter. Results: After the initial letter, 2,216 (4.4%, 95%CI: 4.3%-4.6%) registered for the study; after a reminder 1,130 (2.5%, 2.3%-2.6% of those reminded) enrolled. Minor sociodemographic differences were observed between the groups and the content of the responses did not differ. Second-attempt respondents were less likely to participate in subsequent questionnaires: 67.3% of first-attempt vs. 43.3% of second-attempt respondents participated in their fourth survey. Recruitment costs were 79% higher for second-attempt respondents. Conclusion: While reminders increased the number of participants, lower cost-effectiveness and higher attrition of second-attempt respondents support the use of single invitation only for studies with a similar design to ours when the overall participation is low.