Position statement on genuine physiotherapy research at German university hospitals.

In addition to patient care, physiotherapy is increasingly important in research at university hospitals. Genuine physiotherapy research plays a decisive role in this. This position statement describes the opportunities, benefits, framework conditions, challenges, and research priorities of genuine physiotherapy research at German university hospitals.

The use of systematic reviews for conducting new studies in physiotherapy research: a meta-research study comparing author guidelines of physiotherapy-related journals.

BACKGROUND: Requiring authors to base their research on a systematic review of the existing literature prevents the generation of redundant scientific studies, thereby avoiding the deprivation of effective therapies for trial participants and the waste of research funds. Scientific medical journals could require this in their author guidelines. While this applies to all areas of research, it is also relevant to physiotherapy and rehabilitation research, which predominantly involve interventional trials in patients. OBJECTIVE: The aim of this study was to determine the extent to which the use of systematic reviews to justify a new trial is already being requested by physiotherapy-related scientific medical journals (PTJs). In addition, a comparison was made between PTJs and scientific medical journals with the highest impact factor in the Science Citation Index Extended (SCIE). METHODS: This meta-research study is based on a systematic examination of the author guidelines of 149 PTJs. The journals were identified and included based on the number of publications with physiotherapy as a keyword in the databases PEDro, and Medline (Pubmed). The included author guidelines were analysed for the extent to which they specified that a new trial should be justified by a systematic review of the literature. Additionally, they were compared with 14 scientific medical journals with the highest impact factor in the SCIE (LJs). RESULTS: In their author guidelines, none of the included PTJs required or recommended the use of a systematic review to justify a new trial. Among LJs, four journals (28.57%), all associated with the Lancet group, required the study justification through a systematic review of the literature. CONCLUSION: Neither PTJs nor LJs require or recommend the use of a systematic review to justify a new trial in their author guidelines. This potentially leaves room for unethical scientific practices and should be critically considered in future research.

Barriers, facilitators and implementation strategies for guideline-adherence in physiotherapy: a scoping review protocol.

INTRODUCTION: Guideline-adherent physiotherapy can improve patient outcomes and reduce costs in the healthcare system. However, although there are numerous guidelines for physiotherapy practice, services are not consistently based on clinical practice guidelines. While various systematic and scoping reviews have highlighted barriers, facilitators and implementation strategies for guideline-adherent practice in other health professions, this scoping review aims to explore the barriers and facilitators for guideline-adherent physiotherapy and summarises the strategies used to implement such practice. METHODS AND ANALYSIS: This scoping review will be based on Arksey and O'Malley's scoping review methodology and the methodological guidance for conducting scoping reviews published by Joanna Briggs Institute. Relevant publications will be first searched from the beginning of June 2023 on the MEDLINE and CINAHL databases before we expand the search to other databases such as EMBASE, the Cochrane Library and PEDro at the end of June 2023. Two reviewers will independently screen the titles and abstracts of all retrieved citations for inclusion against the eligibility criteria before conducting an independent full-text screening. The criteria will be tested on a sample of abstracts before beginning the abstract review to ensure that they are robust enough to capture any articles that may relate. The extracted data will finally be collated and charted to summarise key findings regarding our research question. ETHICS AND DISSEMINATION: This scoping review will provide an extensive overview of the barriers, facilitators and implementation strategies for guideline-adherent physiotherapy. As scoping reviews are a form of secondary data analysis, ethical review is not required. Results will be disseminated through a peer-reviewed publication and stakeholder meetings. TRIAL REGISTRATION NUMBER: This scoping review has been registered on 3 April 2023 on the Open Science Framework under https://doi.org/10.17605/OSF.IO/SEUW6.

Dementia care worker stress associations with unit type, resident, and work environment characteristics: a cross-sectional secondary data analysis of the Swiss Nursing Homes Human Resources Project (SHURP).

BACKGROUND: Although caring for residents with dementia in nursing homes is associated with various stressors for care workers, the role of the unit type, and particularly the proportion of residents with dementia, remains unclear. This study aimed to explore associations between unit type and care worker stress, taking into account additional potential stressors. METHODS: This cross-sectional study was a secondary data analysis in the Swiss Nursing Homes Human Resources Project, which included data from 3,922 care workers from 156 Swiss nursing homes. Care workers' stress was measured with a shortened version of the Health Professions Stress Inventory. Generalized estimating equation models were used to assess care worker stress and its relationships with three unit types (special care units and others with high or low proportions of residents with dementia), work environment factors, and aggressive resident behavior. RESULTS: After including all potential stressors in the models, no significant differences between the three unit types regarding care worker stress were found. However, increased care worker stress levels were significantly related to lower ratings of staffing and resources adequacy, the experience of verbal aggression, and the observation of verbal or physical aggression among residents. CONCLUSIONS: Although the unit type plays only a minor role regarding care worker stress, this study confirms that work environment and aggressive behavior of residents are important factors associated with work-related stress. To prevent increases of care worker stress, interventions to improve the work environment and strengthen care workers' ability to cope with aggressive behavior are suggested.

Are depression and anxiety determinants or indicators of quality of life in breast cancer patients?

Depression and anxiety are associated with a decline of health-related quality of life (QoL) in breast cancer patients, and the present study aims to investigate the longitudinal relationship of depression and anxiety with QoL in breast cancer patients. Depression and anxiety (HADS) as well as QoL (EORTC QLQ-C30) were assessed at baseline and six-month follow-up in 118 breast cancer patients and analysed using cross-lagged partial correlation analysis (CLPC). There were significant partial correlations between depression and anxiety at baseline and physical functioning, emotional functioning and "global health and QoL" at six-month follow-up (range of pr = -0.197 and -0.392; p < 0.05). "Global health and QoL" at baseline was significantly correlated with depression and anxiety at follow-up (pr = -0.207 and -0.327; p < 0.05). Cognitive functioning at baseline was significantly associated with anxiety at follow-up (pr = -0.248; p < 0.01). CLPC analysis of two models (depression and anxiety determining QoL vs. QoL determining depression and anxiety) did not show significant results. Hence, in breast cancer patients, depression and anxiety are closely related to QoL and the observed correlations suggest a complex interrelation in which depression and anxiety have to be regarded as indicators of QoL rather than determinants.

Influence of cross-linked arabinoxylans on the postprandial blood glucose response in rats.

Viscous dietary fibers are well established to reduce the blood glucose response to a meal. In this study, arabinoxylans, the most abundant dietary fiber in most cereals, were extracted under alkaline conditions and cross-linked by using laccase. Cross-linking of the arabinoxylans led to gel formation and increased in vitro viscosity almost 100-fold after drying and rehydration. To determine the ability of these cross-linked arabinoxylans to blunt the postprandial blood glucose curve of a meal, arabinoxylans, either native or cross-linked, and either prehydrated or not, were fed to rats as part of a meal, and blood glucose was monitored at intervals after the meal. Cellulose, a nonviscous fiber, served as a control. Cross-linked, but not native, arabinoxylans significantly reduced the area under the blood glucose time curve 5-9% relative to cellulose, indicating that they remained viscous within the gastrointestinal tract, and thus likely provide the health benefits found with other viscous fibers.

Analysis of LV lead position in cardiac resynchronization therapy using different imaging modalities.

OBJECTIVES: This study sought to evaluate whether left ventricular (LV) lead position in cardiac resynchronization therapy (CRT) can be determined by myocardial deformation imaging during LV pacing and to compare imaging techniques for analysis of LV lead position. BACKGROUND: LV lead position has a significant impact on effectiveness of CRT, but clinically applicable methods to determine LV lead position are less defined. METHODS: In 56 patients (53 +/- 5 years, 34 men) undergoing CRT, fluoroscopy and 2 myocardial deformation imaging-based approaches were applied to determine the LV lead position. Myocardial deformation imaging-based techniques were used to determine 1) the segment with maximal temporal difference of peak circumferential strain before and while on biventricular CRT; and 2) the segment with earliest peak systolic circumferential strain during pure LV pacing. Twelve-month echocardiography was performed to determine LV remodeling and improvement in function. Optimal LV lead position was defined as concordance or immediate neighboring of the determined LV lead position to the segment with latest systolic strain prior to CRT. RESULTS: LV lead position determined during LV pacing correlated to the position determined by fluoroscopy (kappa = 0.761). Patients with optimal LV lead position had greater improvement in LV ejection fraction and decrease in end-diastolic volume than those with nonoptimal LV lead position (12 +/- 4% vs. 7 +/- 3%, p < 0.001, and 28 +/- 13 ml vs. 14 +/- 8 ml, p < 0.001, respectively). Determination of the LV lead position based on myocardial deformation imaging during LV pacing showed greater discriminatory power for improvement of ejection fraction (difference optimal vs. nonoptimal lead position group: 4.64 +/- 1.01 ml; p < 0.001) than deformation imaging with biventricular pacing (3.03 +/- 1.08 ml; p = 0.007) and fluoroscopy (2.22 +/- 1.12 ml; p = 0.053). CONCLUSIONS: Myocardial deformation imaging during LV pacing allows determination of the LV lead position in CRT. Improvement in LV function and remodeling as indicators of optimal LV lead position can be best predicted by LV lead position analysis during LV pacing. (Left Ventricular Lead Position in Cardiac Resynchronization Therapy; NCT00748735).

Patients' needs and experiences at breast cancer diagnosis: how perceived threat influences the physician-patient interaction.

Physician-patient interaction at breast cancer diagnosis can only succeed if physicians know what patients want. To investigate patients' needs and experiences we conducted semistructured interviews with eight patients. Verbatim transcripts were analyzed according to grounded theory and a typological approach. Patients' needs and experiences concurred with a patient-centered approach in many aspects. The threat perceived by patients following diagnosis strongly influenced their needs and experiences. Three different types of patients were identified: emotionally needy, active, and trustful, adaptive. The typology identified in this study may help physicians to adequately adapt their behavior.

Guiding principles for payment system reform: commentary on "Achieving cost control, care coordination, and quality improvement through incremental payment system reform".

The focus of healthcare payment reform must be on the "value equation"--improving the quality of care while reducing or controlling costs. Adhering to key principles related to value will yield successful payment transformation and result in more coordinated care and improved patient outcomes. Actionable data and information for setting goals and measuring progress is an essential element.

Communication matters: the impact of communication and participation in decision making on breast cancer patients' depression and quality of life.

OBJECTIVE: This study explored the impact of breast cancer patients' experiences of physician-patient communication and participation in decision making on patient depression and quality of life three and six months after primary treatment. METHODS: Participants were 135 German breast cancer patients, recruited within a week after the beginning of treatment. Women were asked to complete a self-administered questionnaire at baseline and three and six months later. RESULTS: Patients who rated their level of information at baseline as high were less depressed after three (p=.010) and six months (p<.001) and experienced higher quality of life after three (p<.001) and six months (p=.049). Patients who participated as much as they had wanted were more satisfied with the decision making process (p<.001) and had lower depression scores three months later (p=.005). The level of participation itself (passive, collaborative, active) and the treatment type had no impact. CONCLUSION: The findings reveal the significance of physician-patient communication and stress the meaning of baseline depression for later adjustment. PRACTICE IMPLICATIONS: A high level of information and tailoring the involvement in decision making to patients' desired level can help patients to better cope with their illness. Physicians should assess and treat depression early in cancer treatment.

Information and decision making: patients' needs and experiences in the course of breast cancer treatment.

OBJECTIVE: This study explored breast cancer patients' preferences and experiences in receiving information and decision making in the course of the first 6 months of cancer treatment. METHODS: Participants were 135 German breast cancer patients, recruited within a week of either surgery or the beginning of neo-adjuvant chemotherapy. Women were asked to complete a self-explanatory questionnaire at baseline and 3 and 6 months later. RESULTS: There was a significant decrease in the importance of specific information needs. The quality of received information through the physician was rated significantly better at baseline than 6 months later. Nearly half of all patients changed their decision making preference at least at one assessment point. Shared decision making rarely took place in the first 6 months of treatment. CONCLUSION: Breast cancer patients' information needs and decision making preferences can change during treatment. Future research should analyse which patients change their decision making preference under which circumstances. PRACTICE IMPLICATIONS: Physicians need to investigate the decision making preferences and information needs of their patients in the course of treatment. Patient oriented communication skills might be helpful to meet patients' preferences and needs.

Concordance between patients' desired and actual decision-making roles in breast cancer care.

This study explored breast cancer patients' preferences and experiences for participation in treatment decision making as well as the concordance between patients' actual and desired decision making. The interplay between depression, anxiety and decision-making preferences was also examined.A consecutive sample of primary breast cancer patients was recruited within a week of either surgery or the beginning of neo-adjuvant chemotherapy in two breast cancer centres in Germany. Women were asked to complete a self-explanatory questionnaire. Most patients (40.2%) of the 137 participants preferred the physician to make the treatment decision. A total of 63.4% were able to fulfil their preferred decision-making role. Breast cancer patients who wanted the physician to make the decision and patients who wanted to make the decision on their own were more likely to have their preferences met than patients who wished to share the decision (p < 0.01). Availability of treatment choice and the level of depression influenced the preferred decision-making preference. Limited concordance between desired and actual decision making of patients with collaborative decision-making preferences suggests the need for better communication and physician training on shared decision making.

Implementation of a severity-adjusted diagnosis-related groups payment system in a large health plan: implications for pay for performance.

This article describes the implementation of the All Patient Refined Diagnosis Related Group (APR-DRG) inpatient payment system in a large regional commercial payer. The APR-DRG system replaced the Plan's current All-Payer DRG (AP-DRG) payment methodology on December 1, 2006, and is part of a strategic hospital payment redesign that will enable the Plan to control costs, increase pricing transparency for customers and providers, and reward hospital quality and efficiency. On the basis of modeled results using 2005 data, we found that the APR-DRG payment system using cost-based weights will do a better job of linking inpatient severity and use of resources to payments. The transition to the cost-based APR-DRG methodology with enhanced clinical specificity will also support measurement of hospital quality and efficiency in the Plan's performance improvement programs.

Intravenous thrombolysis for acute ischaemic stroke in a hospital without a specialised neuro-intensive care unit.

BACKGROUND: Treatment with intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) is recommended for selected patients with acute ischaemic stroke. We evaluated the feasibility and safety of this treatment in clinical practice in a hospital without a specialised neuro-intensive care unit. METHODS: We prospectively studied all patients who were treated with i.v. rt-PA for ischaemic stroke at our hospital between January 2001 and June 2002. The selection criteria corresponded to those published by the NINDS [1] and ECASS [2] groups. Time intervals between stroke symptom onset, hospital arrival and treatment with rt-PA were measured. A modified NIH stroke scale was used to assess clinical outcome 24 hours after stroke onset and before discharge. Cerebral computed tomography was performed prior to thrombolysis and again if the neurological status failed to improve or deteriorated. RESULTS: Thrombolytic therapy was administered to 15 acute ischaemic stroke patients, 13 men and two women with a median age of 69 years. The median time from stroke onset to rt-PA therapy was 135 minutes and from arrival in the emergency room to the start of thrombolysis 74 minutes. Ten patients exhibited early clinical improvement, defined as a decrease in NIHSS score by 4 points at 24 hours. Further improvement until discharge was observed in nine of these ten patients. One patient developed a non-fatal intracerebral haemorrhage. Another patient with severe stroke and clinical failure of thrombolysis died after 25 days. CONCLUSIONS: This study in a small patient population suggests that thrombolysis with rt-PA for acute ischaemic stroke is feasible without excess risk in a hospital experienced in the management of stroke patients, with a neurological consultant service but without a specialised neuro-intensive care unit (NICU). The outcome in this small series of patients corresponds to the results described in the randomised trials.