[Germany-Wide Survey on Networking and Cooperation Between Rehabilitation and Self-Help (VERS 2.0): An Overview of Opinions, Contacts and Cooperation of Rehabilitation Institutions in View of Self-Help]. / Deutschlandweite Befragung zur Vernetzung und Kooperation von Rehabilitation und Selbsthilfe (VERS 2.0): Ein Überblick über Meinungen, Kontakte und Kooperationen von Rehabilitationseinrichtungen in Bezug auf Selbsthilfe.

PURPOSE: The study aims to present opinions and knowledge of rehabilitation facilities in Germany about self-help (SH) and to identify initial structures and contacts in the networking of rehabilitation and SH. METHODS: The study is a quantitative observational study. The data were collected cross-sectionally by means of an online survey. Rehabilitation facilities in Germany were included. The convenience sample was collected using different approaches. The questionnaire is based on the survey on "Cooperation and networking of rehabilitation facilities and self-help groups/self-help organisations" (VERS) conducted by the University of Freiburg in 2002. RESULTS: 101 rehabilitation facilities across all 16 German federal states took part in the survey. The survey revealed a positive attitude towards SH and a high proportion of rehabilitation facilities that regularly inform about SH (76.2%) and maintain contacts with self-help associations/self-help clearing houses (74.3%). Information deficits regarding the specific experiences of self-help associations, the working and organisational forms of SH as well as the support opportunities of SH became apparent. CONCLUSION: To strengthen the networking of rehabilitation and SH, information gaps should be closed and transparency and structural conditions for cooperation should be created. The stronger integration of knowledge about SH in educational structures in the health sector, which is desired by the institutions, can be purposeful in the future.

Digitization in health-related self-help - Results of an online survey among self-help organizations in Germany.

Background: Nowadays, much hope and expectations are associated with digitization in the health sector. The digital change also affects health-related self-help. A nationwide survey of self-help organizations (SHOs) aimed to show chances and limitations in the use of interactive IT tools like webforums, online meetings or social media as well as digital infrastructures for their organizational management. In this survey, we also determined whether SHO staff themselves have support and qualification needs with regard to this topic. Design: The online survey was conducted between 14 November and 8 December 2019, i.e., immediately before the outbreak of the Covid-19 pandemic. The questionnaire consisted of 50 questions consisting of 180 single items which could be answered in 30-40 min. After two reminder letters, 119 questionnaires of the SHOs were gathered and analysed. Results: SHOs already have a lot of experience with digital media/tools (e.g., own homepage, social media, cloud computing). Some tools are attested a "high" or "very high" benefit by more than 80% of users. Perceived benefits, however, are also facing a number of problems, ranging from lack of resources to data protection issues. Despite, or even because of the limits of digitization, there is great desire and need for support and further training in SHOs (and self-help groups). Conclusions: At many points in the survey it was shown that digital media can be a useful extension of "traditional" collective self-help. Taking into account the risks and limitations associated with digital tools, SHOs can be central stakeholders in digitization in health-related self-help. Patient or Public Contribution: The study was financially supported by the Federal Ministry of Health, Germany. A detailed representation of the results is publicly available at: https://www.uke.de/dish.

[Gait Training for Lower Limb Amputees - A Systematic Review Based on the Research Pyramid]. / Gangtraining nach Amputation der unteren Extremität ­ Ein systematisches Pyramiden-Review.

BACKGROUND: Lower extremity amputation patients have gait asymmetries which can lead to further complaints in other joints of the body. METHOD: Five relevant databases were systematically searched for studies about gait training methods among people with transtibial and transfemoral amputations, followed by an evaluation of the methodical power of the eight references. Subsequently, the studies were categorized into the evidence classes of the research pyramid. The aim was to give treatment recommendations for this patient group. RESULTS: All training methods show an improvement in gait parameters of the patients. In seven studies at least four different training forms are used within one training intervention. Therefore, a combination of different forms seems promising. A long-term statement among these methods could not be made. Due to the high variability in intervention methods and outcome parameters, an aggregation of data and meta-analyses were not possible. CONCLUSION: The Evidence-Based Amputee Rehabilitation Program provides a good basis for a standardized training method. It should be supplemented with functional dual-task training and education. In further research a specific duration and intensity of such a program needs to be investigated. On top of that further qualitative and observational research is needed to generate statements which optimize the gait training in the physiotherapeutic routine practice.

Assessment of musculoskeletal pain in dance focusing on dance-style related differences.

Objectives: Pain in dance may be related to the high specific load on the musculoskeletal system caused by dance techniques. Up to the present, data on pain-relevant aspects considering the dance style as a contributing factor to pain occurrence in dance are still pending. The aim of this study was to analyze and compare dance-style specific pain with regard to prevalence, localization, subjective pain perception, duration, frequency, temporary dynamics and pain evaluation in dancers of the two popular dance styles (ballet and contemporary dance).Methods: The quantitative cross-sectional observation study with descriptive focus was carried out in n = 64 classical (ballet) dancers (B) and n = 81 jazz/modern/contemporary dancers (JMC). All participants were non-professional dancers. The data were collected by using an online questionnaire consisting of existing pain assessments adapted for dance.Results: Above all, differences were found in the comparison of the dancers' body regions. While the lower extremity was particularly affected in ballet dancers (B) (right calf, p = 0.04; forefoot and toes, p < 0.01), dancers of the JMC were more frequently affected by pain in the head and trunk (neck, p < 0.01; upper back, p < 0.01) and the upper extremity (shoulders, p < 0.01; wrists, p < 0.01; left elbow, p = 0.03). More than 65% of the dancers (B and JMC) reported pain in the context of dancing within the recent 3 and 12 months. Further parallels in the two dance styles could be observed in the subjective sensation of pain, the temporal course and the evaluation of pain.Conclusion: In the overall view of pain aspects, the parallels between the investigated dance styles prevail, which dominate in the aspects of pain prevalence, subjective perception, temporal progression, and pain evaluation. This allows the careful conclusion that the dance style performed is of limited importance for the pain aspects mentioned. The differences must be taken into account in future prevention measures.

[Musculoskeletal Pain in Dance: Prevalence, Localisation and Development Over Time in Amateur Dancers and Professional Dance Teachers]. / Muskuloskelettale Schmerzen im Tanz: Prävalenz, Lokalisationen und zeitlicher Verlauf bei Tänzerinnen mit Amateurstatus und ihren hauptberuflich tätigen Lehrkräften.

BACKGROUND: Pain in sport occurs both as a result of acute injuries and in the form of chronic pain due to overuse or misuse. Pain often occurs in dance and is associated with the high specific strain on the musculoskeletal system caused by dance techniques. There is a lack of data on pain-relevant aspects in semi-professional and ambitious popular sports. This applies to dancers and (professional) dance teachers alike. This study aimed to determine pain with regard to prevalence, localisation and development over time in female dancers (T) and dance teachers (TP) engaged in non-professional dance. METHODS: This descriptive quantitative cross-sectional observational study was conducted with semi-professional dancers (n = 153) and professional dance teachers (n = 149) in the context of a fully structured anonymous online survey. RESULTS: More than 70 % of the respondents reported pain in the musculoskeletal system occurring in the context of dancing both within the last 3 and 12 months, with the lower back and knee joints being most frequently and strongly affected. Regarding the development over time, both T and TP predominantly suffered from pain that lasted for more than six months and occurred frequently. In TP, the pain lasted longer, was more likely to occur at rest and was more often associated with limited mobility and resilience compared with the T group. DISCUSSION: Regarding prevalence and localisation of pain, the available results are comparable with previous study results from the professional field, both in the TP and T areas. Health risks and (professional) restrictions associated with them are mainly caused by chronic pain development in TP. Therefore, the treatment and management of chronic pain conditions in the healthcare of TP can be very important with regard to their professional participation.

Prevalence, localization, perception and management of pain in dance: an overview.

Background and aims Pain is a highly complex bio-psychosocial phenomenon that may present a (potential) health risk and either occurs as a warning sign or a symptom of injury. It cannot be ruled out that these rising or changing requirements in dance of all styles, are reflected in health-related outcomes such as pain. The aim of this narrative review article is to outline an overview of prevalence and localization, concepts of performance pain and injury pain, pain perception and pain management in dance. At that consequences of pain and influencing factors focusing on different dance styles or forms of professionalism are discussed. Methods The databases CINAHL, Cochrane, Google Scholar, Medline, MeSH and Web of Science were screened for relevant articles. Results Pain prevalence in dance is very high. Pain localizations can be related to high dance-specific mechanical stress on the musculoskeletal system. Depending on the pain characteristics, dancers perceive pain as "positive" (performance pain) or "negative" (injury pain). Concerning pain attitudes and management, dancers show an increasing pain tolerance. Pain seems to be accepted as a necessity, often ignored and dancing is continued despite pain. Conclusions The findings of this article suggest that occurrence of pain, pain perception, coping with pain and pain history appear to be connected to dance-specific mechanical stress as well as to socialization in dance culture. In dance, effects of pain on health seem to be associated with characteristics of pain and pain behavior. Implications The results highlight the high relevance of pain in dance and the need to take into account preventive as well as rehabilitative measures.

Mirror therapy for improving motor function after stroke.

BACKGROUND: Mirror therapy is used to improve motor function after stroke. During mirror therapy, a mirror is placed in the person's midsagittal plane, thus reflecting movements of the non-paretic side as if it were the affected side. OBJECTIVES: To summarise the effectiveness of mirror therapy compared with no treatment, placebo or sham therapy, or other treatments for improving motor function and motor impairment after stroke. We also aimed to assess the effects of mirror therapy on activities of daily living, pain, and visuospatial neglect. SEARCH METHODS: We searched the Cochrane Stroke Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED, PsycINFO and PEDro (last searched 16 August 2017). We also handsearched relevant conference proceedings, trials and research registers, checked reference lists, and contacted trialists, researchers and experts in our field of study. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and randomised cross-over trials comparing mirror therapy with any control intervention for people after stroke. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials based on the inclusion criteria, documented the methodological quality, assessed risks of bias in the included studies, and extracted data. We assessed the quality of the evidence using the GRADE approach. We analysed the results as standardised mean differences (SMDs) or mean differences (MDs) for continuous variables, and as odds ratios (ORs) for dichotomous variables. MAIN RESULTS: We included 62 studies with a total of 1982 participants that compared mirror therapy with other interventions. Of these, 57 were randomised controlled trials and five randomised cross-over trials. Participants had a mean age of 59 years (30 to 73 years). Mirror therapy was provided three to seven times a week, between 15 and 60 minutes for each session for two to eight weeks (on average five times a week, 30 minutes a session for four weeks).When compared with all other interventions, we found moderate-quality evidence that mirror therapy has a significant positive effect on motor function (SMD 0.47, 95% CI 0.27 to 0.67; 1173 participants; 36 studies) and motor impairment (SMD 0.49, 95% CI 0.32 to 0.66; 1292 participants; 39 studies). However, effects on motor function are influenced by the type of control intervention. Additionally, based on moderate-quality evidence, mirror therapy may improve activities of daily living (SMD 0.48, 95% CI 0.30 to 0.65; 622 participants; 19 studies). We found low-quality evidence for a significant positive effect on pain (SMD -0.89, 95% CI -1.67 to -0.11; 248 participants; 6 studies) and no clear effect for improving visuospatial neglect (SMD 1.06, 95% CI -0.10 to 2.23; 175 participants; 5 studies). No adverse effects were reported. AUTHORS' CONCLUSIONS: The results indicate evidence for the effectiveness of mirror therapy for improving upper extremity motor function, motor impairment, activities of daily living, and pain, at least as an adjunct to conventional rehabilitation for people after stroke. Major limitations are small sample sizes and lack of reporting of methodological details, resulting in uncertain evidence quality.

The Efficacy of Movement Representation Techniques for Treatment of Limb Pain--A Systematic Review and Meta-Analysis.

UNLABELLED: Relatively new evidence suggests that movement representation techniques (ie, therapies that use the observation and/or imagination of normal pain-free movements, such as mirror therapy, motor imagery, or movement and/or action observation) might be effective in reduction of some types of limb pain. To summarize the evidence regarding the efficacy of those techniques, a systematic review with meta-analysis was performed. We searched Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, Physiotherapy Evidence Database, and OT-seeker up to August 2014 and hand-searched further relevant resources for randomized controlled trials that studied the efficacy of movement representation techniques in reduction of limb pain. The outcomes of interest were pain, disability, and quality of life. Study selection and data extraction were performed by 2 reviewers independently. We included 15 trials on the effects of mirror therapy, (graded) motor imagery, and action observation in patients with complex regional pain syndrome, phantom limb pain, poststroke pain, and nonpathological (acute) pain. Overall, movement representation techniques were found to be effective in reduction of pain (standardized mean difference [SMD] = -.82, 95% confidence interval [CI], -1.32 to -.31, P = .001) and disability (SMD = .72, 95% CI, .22-1.22, P = .004) and showed a positive but nonsignificant effect on quality of life (SMD = 2.61, 85% CI, -3.32 to 8.54, P = .39). Especially mirror therapy and graded motor imagery should be considered for the treatment of patients with complex regional pain syndrome. Furthermore, the results indicate that motor imagery could be considered as a potential effective treatment in patients with acute pain after trauma and surgery. To date, there is no evidence for a pain reducing effect of movement representation techniques in patients with phantom limb pain and poststroke pain other than complex regional pain syndrome. PERSPECTIVE: In this systematic review we synthesize the evidence for the efficacy of movement representation techniques (ie, motor imagery, mirror therapy, or action observation) for treatment of limb pain. Our findings suggest effective pain reduction in some types of limb pain. Further research should address specific questions on the optimal type and dose of therapy.

Utilisation of rheumatology care services in Germany: the case of physical therapy and self-help groups.

Physical Therapy (PT) and self-help groups (SHG) are important components of health care in rheumatic diseases. The utilisation of PT and SHG by patients with rheumatic diseases may be influenced by several factors. The aim of this study is to summarize the evidence on PT and SHG utilisation of patients with rheumatic diseases in Germany. We systematically searched the MEDLINE-database for studies that evaluated the utilisation and factors that possibly influence the utilisation of PT and SHG. Eight studies were found for PT-utilisation and one for SHG-utilisation. Between 25 and 59 percent of patients with rheumatic diseases received PT services. Several individual and contextual factors that may influence the utilisation could be identified. In conclusion, evidence exists for wide variations in the utilisation of PT services and an underuse of such services among patients with rheumatic diseases in Germany. By contrast, little evidence exists on the utilisation of SHG.

Research Pyramid: a new evidence-based practice model for occupational therapy.

In the campaign to implement evidence-based practice, the current single-hierarchy model of levels of evidence fails to incorporate at parity all types of research evidence that are valuable in the practice of occupational therapy. A new model, originally developed by Borgetto et al. (2007) and modified and expanded, is presented. By separating the evidence-level criteria of internal and external validity, by incorporating explicitly the evidence provided by qualitative studies, and by retaining the critical notion of rigor, a pyramidal evidence model emerges. This model, the Research Pyramid, aligns itself with the revised model of evidence-based medicine and, more important, with the basic modes of clinical reasoning in occupational therapy. It constitutes a beginning attempt to order evidence-based practice in accordance with the epistemology of the profession. It may better guide occupational therapy research and meta-synthesis and their incorporation into practice decisions.

[Nursing and self-help in the context of chronic illness and disability]. / Pflege und Selbsthilfe im Kontext von chronischer Krankheit und Behinderung.

The promotion and maintenance of independence of chronically ill or handicapped people are particular objectives of professional nursing as well as coping in self-help groups. Accordingly, nursing and self-help may complement each other in the care for chronically ill or handicapped people. Evidence suggests that self-help groups contribute to health related knowledge, mutual aid and social support as well as modifications of attitudes of the group members and their social environment. They disburden the primary social networks and families of the afflicted persons and reinforce the "intelligent" utilisation of the professional services of the health care system. Nevertheless, the integration of self-help initiatives in the health care system is precarious. The co-operation between self-help groups and the professional health care system is characterised by an imbalance between medical laymen and experts. Nursing staff in hospitals are important co-operation partners and contact persons for self-help groups. To understand better the effects of self-help groups, longitudinal studies with non-randomised comparison groups are needed. Further research should address the questions, how larger proportions of the population can be involved in self-help activities and how the relevance of self-help differs in various diagnosis groups. Research in the area of self-help is fragmented; research promotion and co-ordination in this area appear to be necessary.

[Advantages of cooperation with self-help organisations for out-patient physicians]. / Welchen Nutzen sehen niedergelassene Arzte in der Zusammenarbeit mit der Selbsthilfe?

AIM OF THE STUDY: Self-help groups and organisations are important contributors to the provision of rheumatological care. No systematic studies exist thus far on the cooperation between professional care providers and the German Rheumatism League, the most significant patient organisation for rheumatoid patients. METHODS: To gain information about the extent of the co-operation between rheumatologists and the German Rheumatism League and to estimate the benefits of the co-operation, a survey was conducted among German rheumatologists in the out-patient sector (n = 787). RESULTS: The response rate was 40.7%. As many as 98.7% of the rheumatologists were informed about self-help initiatives, with 78.1% receiving this information from their own patients. Regular or frequent co-operation with self-help initiatives was reported by 46%. Among the physicians with experience in co-operation, 84.1% wished more contact with self-help initiatives, compared with only 61.9% of non-experienced physicians. The benefit of the activities of the Rheumatism League was highly appreciated: the long-term training of functional capacity was evaluated as helpful by 73.4%; the training for coping with pain by 62.2%; the occupational therapy groups by 60.6%; the patient-education groups by 61.6%; and the self-help groups by 56.3%. The benefit of co-operation was appreciated more by rheumatologists experienced in co-operation than by rheumatologist without specific experience: on a rating scale from 1 (little benefit) to 6 (high benefit) the former group scored an average of 3.7, the latter an average of 2.7. DISCUSSION AND CONCLUSIONS: In spite of the relatively low response rate (40.7%), the results cover a relevant part of rheumatologists in the out-patient sector. The more experience physicians have with co-operation, the higher they estimate the benefits of co-operation with the Rheumatism League. This underlines the necessity of technical information about self-help initiatives and the promotion of contacts and co-operation in the rheumatological out-patient sector.

[An activating state and active citizen groups in the German health care system]. / Aktivierender Staat und aktive Bürgergesellschaft im deutschen Gesundheitswesen.

This paper discusses the question, to what extent concepts of an enabling state are realised in the German health policy and wether they meet active citizens with corresponding competencies. The analysis is based on a review of the literature referring to the promotion and development of the self-help movement and citizen participation in the German health care system. The results show, that since 1999 the following enabling health policy measures were adopted: the promotion of independent patient advisory services and shared decision-making, the enactment of participation rules in the rehabilitation system and the compulsory subsidy for self-help groups, self-help organisations and clearing houses for self-help. The active engagement of the citizens both as co-producers of health on the individual level and as participants in processes of communication and decision-making on the system level is still restricted to a small part of the population. An enabling health policy and a broad citizen participation are still in the beginning, but they have the potential to strengthen each other and to realise synergetic effects. Even though some corresponding institutions were already established and attitudes of the health care professionals start to alter, the question wether the health policy will change from a welfare producing state to an enabling state cannot be answered completely yet.