[The Lübeck Scale of Basic Mobility : Assessment of geriatric patients with severely impaired mobility]. / Die Lübecker Skala der Basis-Mobilität : Assessment schwer in ihrer Mobilität beeinträchtigter geriatrischer Patienten.

BACKGROUND: In the geriatric assessment of mobility, the timed up and go (TUG) test is often used; however, many inpatients are unable to master this test. The Lübeck Scale of Basic Mobility (LSBM) was developed as a performance test for this target group. OBJECTIVE: The study investigated the properties of the 7­task LSBM, which has a scaling at item level based on the 5­level assessment of impairments according to the ICF. MATERIAL AND METHODS: In 77 patients who had not mastered the TUG test at acute geriatric hospital admission, the LSBM was completed at intervals of 7-18 days (t0, t1), including one rating by 2 investigators. For convergent validity, the De Morton Mobility Index (DEMMI) was used. RESULTS: The LSBM score and DEMMI score were highly correlated (-0.880, p < 0.001). A floor effect did not occur with LSBM and occurred with DEMMI in 5 patients (6.5%). The predictive validity for predicting coping with TUG test at discharge based on the sum score at t0 was -0.577 for the LSBM, and 0.542 for the DEMMI (Spearman's correlation, p = 0.001). The interrater reliability of the LSBM was 0.983 (p < 0.001), the correlation between test and retest was 0.836 (p < 0.001) and the internal consistency via Cronbach's α was 0.876. The effect size as a measure of change sensitivity was Cohen's d 0.711. CONCLUSION: The LSBM facilitates treatment goal setting and allows standardized documentation of even small improvements and deteriorations in patients with reduced basic mobility.

[One-Year Course of Geriatric Rehabilitation Candidates with and Without Outpatient Geriatric Rehabilitation Care (AGRV)]. / Ein-Jahres-Verlauf geriatrischer Rehabilitations-Kandidaten mit und ohne Ambulante Geriatrische Rehabilitative Versorgung (AGRV).

PURPOSE: The multicentre, prospective, controlled cohort study examines whether geriatric patients with or without participation in outpatient geriatric rehabilitation (AGRV) in Schleswig-Holstein differ with regard to the characteristics of independence, mobility, pain intensity, quality of life, need for support, changing their place of residence or utilization of hospital treatment or other forms of non-pharmaceutical therapy in the course of one year. METHODS: Between May 2013 and April 2016 patients for whom geriatricians had recommended AGRV at five locations were interviewed four times within a year by telephone. The data were analyzed regarding the development within the groups as well as under the aspect of the different types of medical care (AGRV performed/not performed). RESULTS: At the beginning and in the second half of the study period, the two groups (122 persons without AGRV, 283 with at least 15 days of AGRV) did not differ significantly in any of the outcome parameters, and the null hypothesis (no difference between the groups in the Barthel Index after one year) was accepted. Patients with AGRV achieved faster progress in terms of their mobility and quality in life. CONCLUSION: AGRV enables many rehabilitation patients to improve their mobility more quickly. If the speed of achieving the therapeutic goal is of minor importance, outpatient physiotherapy and ergotherapy is sufficient for many patients. The Barthel Index is of limited use for follow-up of AGRV candidates.

[Positioning the hand to act-Validation of the 8-point reaching range test]. / Die Hand positionieren, um zu agieren ­ Validierung des 8-Punkte-Greifraum-Tests.

BACKGROUND: The standardized geriatric assessment of the upper extremities is often limited to measurement of hand strength. The only other instrument mentioned in the S1 guidelines on level 2 geriatric assessment is the 20 cents test (20-C-T); however, in addition to strength and fine motor skills, successful hand placement is a prerequisite for self-care. OBJECTIVE: The 8­point reaching range test (8P-GRT) was developed for standardized separate testing of sides in a seated person concerning hand positioning relevant to daily living. The purpose of the study was to determine quality criteria of the 8P-GRT in geriatric hospital patients. MATERIAL AND METHODS: Between 31 July 2019 and 23 September 2019, a total of 82 inpatients were examined at the Hospital Red Cross Lübeck Geriatrics Center using the 8P-GRT, shoulder pain and disability index (SPADI), a questionnaire on self-care activities corresponding to the hand positions of the 8P-GRT, hand strength measurement and the 20-C­T. RESULTS: The interrater reliability was 0.99 and the retest reliability was 0.95 for the right side and 0.90 for the left side. On the individual level a ceiling effect (both sides score 8) occurred in 4.1% (n = 3) but no floor effect was observed. The internal consistency (Cronbach's alpha) of the two-factorial test according to factor analysis was 0.78 (right) and 0.76 (left). Each of the other tests correlated more closely with the 8P-GRT on the right side, whereby the correlation was highest with the abovenamed questionnaire (-0.72), followed by the SPADI (-0.60). CONCLUSION: A standardized survey of hand strength, fine motor skills and active positioning of the hand (e.g., 8P-GRT) synthesizes the main aspects of upper extremity functioning into an overall picture.

[Self-assessment of daily activities using the Duruöz Hand Index-Validation of the German translation]. / Selbstbeurteilung von Alltagsaktivitäten mittels Duruöz-Hand-Index ­ Validierung der deutschen Übersetzung.

BACKGROUND: Independence in activities of daily living depends to a large extent on the upper extremities; however, the instruments widely used in geriatrics to assess self-care abilities do not allow a focus on this body region. In order to map the fluctuating course of hand function-dependent daily living skills with a self-assessment instrument, rheumatologists have developed the Duruöz Hand Index (DHI). OBJECTIVE: The German translation authorized by Duruöz was tested for its applicability in the assessment of geriatric outpatient and day hospital patients and test quality criteria were determined. MATERIAL AND METHODS: Study participants completed the DHI three times. A postgraduate student blinded to the results performed an anamnesis and examination. The geriatric team made an inter-professional assessment of hand function-related daily living skills twice with at least 2­week intervals. RESULTS: Data collection was performed from 16 November 2016 to 27 April 2017 on 101 geriatric day hospital or outpatient patients. Retest reliability was high (0.937), as was internal consistency (Cronbach's α 0.949). Difficulty with activities of daily living correlated more closely with joint mobility (Keitel Index) and fine motor skills (20 cents test) than with hand strength. CONCLUSION: The DHI provides a survey of difficulties with activities of daily living that is focused on the upper extremities. Because about one in three patients required assistance (answering follow-up questions, reading aloud) despite the exclusion of patients with more severely impaired cognition and vision, the examiner should remain present.

Antibodies against neural antigens in patients with acute stroke: joint results of three independent cohort studies.

BACKGROUND AND PURPOSE: Ischemic stroke (IS) and hemorrhagic stroke (HemS) typically lead to a breakdown of the blood-brain barrier with neural antigen presentation. This presentation could potentially generate destructive auto-immune responses. Pre-existing antineuronal and antiglial antibodies (AA), predominantly NMDA receptor antibodies, have been reported in patients with stroke. This article summarizes three independent prospective studies, the Lübeck cohort (LC), Barcelona cohort (BC), and Heidelberg cohort (HC), exploring the frequency and clinical relevance of AA in patients with acute stroke (AS). METHODS: In all cohorts together, 344 consecutive patients admitted with AS (322 × IS, 22 × HemS) were screened for AA in serum at admission. Clinical outcome parameters as well as a second AA screening were available at 30 days in the LC or at 90 days in the BC. A control group was included in the BC (20 subjects free from neurological disease) and the HC (78 neurological and ophthalmological patients without evidence for stroke). RESULTS: The rate of positivity for AA was similar in control subjects and AS patients (13%, 95% CI [7%, 22%] vs. 13%, 95% CI [10%, 17%]; p = 0.46) with no significant difference between cohorts (LC 25/171, BC 12/75, HC 9/98). No patient had developed new AA after 30 days, whereas 2 out of 60 patients had developed new AA after 90 days. AA positive patients did not exhibit significant differences to AA negative patients in stroke subtype (LC, BC), initial stroke severity (BC, LC, HC), infarct volume (BC), and functional status at admission (BC, LC, HC) and follow-up (BC, LC). CONCLUSIONS: AS does not induce AA to a relevant degree. Pre-existing AA can be found in the serum of stroke patients, but they do not have a significant association with clinical features and outcomes.

[The "Lübeck Worlds of Movement Model"-multidimensional prevention in inpatient care institutions through a program promoting physical activity]. / Das "Lübecker Modell Bewegungswelten" ­ Multidimensionale Prävention in stationären Pflegeeinrichtungen durch ein bewegungsförderndes Programm.

In inpatient care there is a need for prevention and health promotion offers that are specific to the target group. In the course of implementing the Prevention Act, those interventions should be chosen for sustainable implementation that are conceptually sound, standardized, workable, low-threshold, and demonstrably effective.The "Lübeck Worlds of Movement Model" is a physically, cognitively, and socially activating prevention program for elderly people in need of care that was developed by the Lübeck Geriatrics Research Group (FGL). It has been implemented in inpatient care facilities since the end of 2015. It takes multimorbidity into account in a multidimensional intervention approach and is characterized by comprehensive motor-cognitive promotion as well as long-term attractiveness.In accordance with sports science principles, exercises were integrated into a "world of movement," making each training session a "cognitive excursion." Twice weekly, one-hour group training is supplemented by individual training to achieve the recommended minimum of 150 min of moderate exercise weekly. The topic-related content encourages seniors to share and exchange stories.So far, standardized planning and documentation sheets have been developed to design training sessions for 17 worlds of movement. More than a thousand of these completed sheets have been sent to the FGL by coaches after completion of the training and addition of comments. Based on these records and on-site feedback, continuous further development of the model is intended, considering findings made in the fields of sports science, nursing science, and geriatrics/gerontology. This includes the extension of the range of topics as well as further differentiation of the offer according to the individual capability of every participating senior citizen.

[The "Lübeck Worlds of Movement Model"-results of the effects evaluation]. / Das "Lübecker Modell Bewegungswelten" ­ Ergebnisse der Effektevaluation.

BACKGROUND: There are few standardized and evaluated intervention programs for elderly people in need of care that consider motor, cognitive and social aspects. Therefore, the "Lübeck Worlds of Movement Model" was developed by the Lübeck Geriatrics Research Group as a multidimensional standardized intervention program for continuous use in the nursing home. OBJECTIVES: The model was evaluated for its effects over the course of one year in the areas of self-care competence (primary endpoint), mobility, coordination, flexibility, strength, endurance, and cognition. The results are presented in this article. MATERIALS AND METHODS: The sample recruitment took place in 6 nursing homes in Kiel (control group) and 10 in Lübeck (intervention group). Care-dependent senior citizens from the neighborhood were also allowed to participate. Inclusion criteria were the ability to walk at least 6 m independently and the cognitive and sensory capacities to follow the group training. The evaluation study had 255 subjects. To verify the effects of the intervention, various tests were performed at baseline and after 3, 6, 9, and 12 months: Barthel Index, Timed Up and Go, 4­meter walk test, Romberg stand, one-leg stand, 20-Cents Test, 8­Point Reach Test, hand force, 5­Chair-Rise Test, 2­Minute Step Test, and Six-Item Screener. RESULTS: Comparison of the control group with the subjects who had participated in at least half of the training sessions (per-protocol analysis) showed the highest effect size in the multivariate analysis of variance after one year for the Barthel index, followed by the Timed Up and Go, cumulated over all times for the Romberg stand and 5­Chair-Rise Test. The maximum effect measured over the entire assessment occurred after 6 months (partial eta square ηp2 = 0.332). CONCLUSIONS: The model developed preventive effects on all investigated dimensions over the course of a year, but with differences in intensity and time of maximum effect. The motivation for long-term participation was high.

[Timed up and go test for fingers in the form of the 20 cents test. Psychometric criteria of a simple performance test of fine motor skills]. / "Timed up and go" für die Finger in Form des 20-Cents-Tests. Psychometrische Gütekriterien eines einfachen Feinmotorik-Performance-Tests.

BACKGROUND: Although many activities depend on intact fine motor skills no standardized assessment has been broadly established. The 20 cents test (20-C-T) was developed in 2009 and takes less than 5 mins. The quality criteria were investigated within the framework of this study. PATIENTS AND METHODS: A total of 300 geriatric patients participated in the study. The classification of occupational therapists based on standardized anamnesis and clinical examination served as the gold standard. Physiotherapists blinded to the study particulars applied the 20-C-T. RESULTS: Every fourth patient suffered from deficits in fine motor skills relevant to everyday life. The 20-C-T correlated with the clinical severity level and was also feasible for patients with intermediate impairment of cognition or vision. Handedness, age and sex were without significant influence. Intrarater and interrater reliability were good. CONCLUSION: Standardized testing of fine motor skills should be included in geriatric screening and basic assessment. The quality criteria of the 20-C-T show that it can be used for this purpose. Further diagnostic steps are recommended whenever a geriatric patient needs more than 40 s for the task.

[Non-pharmaceutical therapy of candidates for geriatric rehabilitation: Non-pharmaceutical therapy prescribed by SHI-accredited doctors after application for outpatient geriatric rehabilitative care]. / Heilmittelversorgung geriatrischer Rehabilitationskandidaten in Schleswig-Holstein: Vertragsärztlich verordnete Heilmitteltherapie nach Beantragung ambulanter geriatrischer rehabilitativer Versorgung.

BACKGROUND: The rejection of an application for ambulant geriatric rehabilitation (AGRV) is usually justified by the argument that non-pharmaceutical therapy prescribed by doctors accredited by social housing institutions (SHI) would suffice. The reality in healthcare during the 6 months following an application is unknown. METHODS: In this study 203 patients who had made an application for AGRV in the second half of 2010 in Flensburg, Lübeck or Ratzeburg were interviewed by telephone. RESULTS: The survey revealed that 25.7% of the applications for AGRV had been rejected. The majority of these patients received no ambulant non-pharmaceutical therapy (e.g. physical therapy, physiotherapy, occupational therapy, speech therapy or psychological therapy), less than 20% received more than 12 therapy sessions and in most cases exclusively physiotherapy. The 141 successful AGRV applicants received additional ambulant therapies of a similar magnitude. CONCLUSION: The difference between the intensified interdisciplinary therapy offered in the AGRV and additionally and the offer to rejected applicants is substantial.

IT-based information management in health care networks: the MedoCom approach.

Transinstitutional information systems support collaboration beyond the borders of single health care institutions. Information management in health care networks aims at establishing systematic information processing in order to contribute to the network's strategic goals. Health care networks can be characterized by complex and even conflicting goal systems. Our objective is to propose a framework, which describes organizational characteristics of health care networks. The framework is used to deduce effects of network characteristics on information management. Concluding, we present an architectural approach of a management platform for health care networks. The framework as well as the management platform are parts of our MedoCom approach.