@article{EichlerRabeSalzwedeletal.2017,
  author    = {Eichler, Sarah and Rabe, Sophie and Salzwedel, Annett and M{\"u}ller, Steffen and Stoll, Josefine and Tilgner, Nina and John, Michael and Wegschneider, Karl and Mayer, Frank and V{\"o}ller, Heinz},
  title     = {Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement},
  series = {Trials},
  volume    = {18},
  journal   = {Trials},
  publisher = {BioMed Central},
  address   = {London},
  issn      = {1745-6215},
  doi       = {10.1186/s13063-017-2173-3},
  pages     = {1 -- 7},
  year      = {2017},
  abstract  = {Background Total hip or knee replacement is one of the most frequently performed surgical procedures. Physical rehabilitation following total hip or knee replacement is an essential part of the therapy to improve functional outcomes and quality of life. After discharge from inpatient rehabilitation, a subsequent postoperative exercise therapy is needed to maintain functional mobility. Telerehabilitation may be a potential innovative treatment approach. We aim to investigate the superiority of an interactive telerehabilitation intervention for patients after total hip or knee replacement, in comparison to usual care, regarding physical performance, functional mobility, quality of life and pain. Methods/design This is an open, randomized controlled, multicenter superiority study with two prospective arms. One hundred and ten eligible and consenting participants with total knee or hip replacement will be recruited at admission to subsequent inpatient rehabilitation. After comprehensive, 3-week, inpatient rehabilitation, the intervention group performs a 3-month, interactive, home-based exercise training with a telerehabilitation system. For this purpose, the physiotherapist creates an individual training plan out of 38 different strength and balance exercises which were implemented in the system. Data about the quality and frequency of training are transmitted to the physiotherapist for further adjustment. Communication between patient and physiotherapist is possible with the system. The control group receives voluntary, usual aftercare programs. Baseline assessments are investigated after discharge from rehabilitation; final assessments 3 months later. The primary outcome is the difference in improvement between intervention and control group in 6-minute walk distance after 3 months. Secondary outcomes include differences in the Timed Up and Go Test, the Five-Times-Sit-to-Stand Test, the Stair Ascend Test, the Short-Form 36, the Western Ontario and McMaster Universities Osteoarthritis Index, the International Physical Activity Questionnaire, and postural control as well as gait and kinematic parameters of the lower limbs. Baseline-adjusted analysis of covariance models will be used to test for group differences in the primary and secondary endpoints. Discussion We expect the intervention group to benefit from the interactive, home-based exercise training in many respects represented by the study endpoints. If successful, this approach could be used to enhance the access to aftercare programs, especially in structurally weak areas.},
  language  = {en}
}
@article{EichlerSalzwedelRabeetal.2019,
  author    = {Eichler, Sarah and Salzwedel, Annett and Rabe, Sophie and Mueller, Steffen and Mayer, Frank and Wochatz, Monique and Hadzic, Miralem and John, Michael and Wegscheider, Karl and V{\"o}ller, Heinz},
  title     = {The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement},
  series = {JMIR Rehabilitation and Assistive Technologies},
  volume    = {6},
  journal   = {JMIR Rehabilitation and Assistive Technologies},
  number    = {2},
  publisher = {jmir rehab},
  address   = {Toronto},
  issn      = {2369-2529},
  doi       = {10.2196/14236},
  pages     = {12},
  year      = {2019},
  abstract  = {Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare. Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare. Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3\% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints. Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75\%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6\%; P=.01) versus the control group (46.2\%) is of note. Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.},
  language  = {en}
}
@article{EichlerSalzwedelReibisetal.2017,
  author    = {Eichler, Sarah and Salzwedel, Annett and Reibis, Rona and Nothroff, J{\"o}rg and Harnath, Axel and Schikora, Martin and Butter, Christian and Wegscheider, Karl and V{\"o}ller, Heinz},
  title     = {Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation},
  series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology},
  volume    = {24},
  journal   = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology},
  number    = {3},
  publisher = {Sage Publ.},
  address   = {London},
  issn      = {2047-4873},
  doi       = {10.1177/2047487316679527},
  pages     = {257 -- 264},
  year      = {2017},
  abstract  = {Background: In the last decade, transcatheter aortic valve implantation has become a promising treatment modality for patients with aortic stenosis and a high surgical risk. Little is known about influencing factors of function and quality of life during multicomponent cardiac rehabilitation. Methods: From October 2013 to July 2015, patients with elective transcatheter aortic valve implantation and a subsequent inpatient cardiac rehabilitation were enrolled in the prospective cohort multicentre study. Frailty-Index (including cognition, nutrition, autonomy and mobility), Short Form-12 (SF-12), six-minute walk distance (6MWD) and maximum work load in bicycle ergometry were performed at admission and discharge of cardiac rehabilitation. The relation between patient characteristics and improvements in 6MWD, maximum work load or SF-12 scales were studied univariately and multivariately using regression models. Results: One hundred and thirty-six patients (80.6 +/- 5.0 years, 47.8\% male) were enrolled. 6MWD and maximum work load increased by 56.3 +/- 65.3 m (p < 0.001) and 8.0 +/- 14.9 watts (p < 0.001), respectively. An improvement in SF-12 (physical 2.5 +/- 8.7, p = 0.001, mental 3.4 +/- 10.2, p = 0.003) could be observed. In multivariate analysis, age and higher education were significantly associated with a reduced 6MWD, whereas cognition and obesity showed a positive predictive value. Higher cognition, nutrition and autonomy positively influenced the physical scale of SF-12. Additionally, the baseline values of SF-12 had an inverse impact on the change during cardiac rehabilitation. Conclusions: Cardiac rehabilitation can improve functional capacity as well as quality of life and reduce frailty in patients after transcatheter aortic valve implantation. An individually tailored therapy with special consideration of cognition and nutrition is needed to maintain autonomy and empower octogenarians in coping with challenges of everyday life.},
  language  = {en}
}
@article{EichlerVoellerReibisetal.2020,
  author    = {Eichler, Sarah and V{\"o}ller, Heinz and Reibis, Rona Katharina and Wegscheider, Karl and Butter, Christian and Harnath, Axel and Salzwedel, Annett},
  title     = {Geriatric or cardiac rehabilitation?},
  series = {BMC Cardiovascular Disorders},
  volume    = {20},
  journal   = {BMC Cardiovascular Disorders},
  publisher = {BioMed Central},
  address   = {London},
  issn      = {1471-2261},
  doi       = {10.1186/s12872-020-01452-x},
  pages     = {9},
  year      = {2020},
  abstract  = {Background Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization. Methods From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model. Results After TAVI, 249 patients (80.7 ± 5.1 years, 59.0\% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p <  0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive. Conclusion Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings.},
  language  = {en}
}
@inproceedings{NitardySalzwedelWegscheideretal.2012,
  author    = {Nitardy, Aischa and Salzwedel, Annett and Wegscheider, Karl and Jawari, Amir and Buhlert, Hermann and V{\"o}ller, Heinz},
  title     = {Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve replacement},
  series = {Circulation : an American Heart Association journal},
  volume    = {126},
  booktitle = {Circulation : an American Heart Association journal},
  number    = {21},
  publisher = {Lippincott Williams \& Wilkins},
  address   = {Philadelphia},
  issn      = {0009-7322},
  pages     = {1},
  year      = {2012},
  language  = {en}
}
@article{RingwaldLehmannNiemeyeretal.2014,
  author    = {Ringwald, Juergen and Lehmann, Marina and Niemeyer, Nicole and Seifert, Isabel and Daubmann, Anne and Wegscheider, Karl and Salzwedel, Annett and Luxembourg, Beate and Eckstein, Reinhold and V{\"o}ller, Heinz},
  title     = {Travel habits and complications in patients treated with vitamin K antagonists: A cross sectional analysis},
  series = {Travel medicine and infectious disease},
  volume    = {12},
  journal   = {Travel medicine and infectious disease},
  number    = {3},
  publisher = {Elsevier},
  address   = {Oxford},
  issn      = {1477-8939},
  doi       = {10.1016/j.tmaid.2014.02.006},
  pages     = {258 -- 263},
  year      = {2014},
  abstract  = {Background: Travel-related conditions have impact on the quality of oral anticoagulation therapy (OAT) with vitamin K-antagonists. No predictors for travel activity and for travel-associated haemorrhage or thromboembolic complications of patients on OAT are known. Methods: A standardised questionnaire was sent to 2500 patients on long-term OAT in Austria, Switzerland and Germany. 997 questionnaires were received (responder rate 39.9\%). Ordinal or logistic regression models with travel activity before and after onset of OAT or travel-associated haemorrhages and thromboembolic complications as outcome measures were applied. Results: 43.4\% changed travel habits since onset of OAT with 24.9\% and 18.5\% reporting decreased or increased travel activity, respectively. Long-distance worldwide before OAT or having suffered from thromboembolic complications was associated with reduced travel activity. Increased travel activity was associated with more intensive travel experience, increased duration of OAT, higher education, or performing patient self-management (PSM). Travel-associated haemorrhages or thromboennbolic complications were reported by 6.5\% and 0.9\% of the patients, respectively. Former thromboennbolic complications, former bleedings and PSM were significant predictors of travel-associated complications. Conclusions: OAT also increases travel intensity. Specific medical advice prior travelling to prevent complications should be given especially to patients with former bleedings or thromboennbolic complications and to those performing PSM. (C) 2014 Elsevier Ltd. All rights reserved.},
  language  = {en}
}
@article{SalzwedelNosperRoehrigetal.2014,
  author    = {Salzwedel, Annett and Nosper, Manfred and Roehrig, Bernd and Linck-Eleftheriadis, Sigrid and Strandt, Gert and V{\"o}ller, Heinz},
  title     = {Outcome quality of in-patient cardiac rehabilitation in elderly patients - identification of relevant parameters},
  series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology},
  volume    = {21},
  journal   = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology},
  number    = {2},
  publisher = {Sage Publ.},
  address   = {London},
  issn      = {2047-4873},
  doi       = {10.1177/2047487312469475},
  pages     = {172 -- 180},
  year      = {2014},
  abstract  = {Background: Outcome quality management requires the consecutive registration of defined variables. The aim was to identify relevant parameters in order to objectively assess the in-patient rehabilitation outcome. Methods: From February 2009 to June 2010 1253 patients (70.9 +/- 7.0 years, 78.1\% men) at 12 rehabilitation clinics were enrolled. Items concerning sociodemographic data, the impairment group (surgery, conservative/interventional treatment), cardiovascular risk factors, structural and functional parameters and subjective health were tested in respect of their measurability, sensitivity to change and their propensity to be influenced by rehabilitation. Results: The majority of patients (61.1\%) were referred for rehabilitation after cardiac surgery, 38.9\% after conservative or interventional treatment for an acute coronary syndrome. Functionally relevant comorbidities were seen in 49.2\% (diabetes mellitus, stroke, peripheral artery disease, chronic obstructive lung disease). In three key areas 13 parameters were identified as being sensitive to change and subject to modification by rehabilitation: cardiovascular risk factors (blood pressure, low-density lipoprotein cholesterol, triglycerides), exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure, angina pectoris) and subjective health (IRES-24 (indicators of rehabilitation status): pain, somatic health, psychological well-being and depression as well as anxiety on the Hospital Anxiety and Depression Scale). Conclusion: The outcome of in-patient rehabilitation in elderly patients can be comprehensively assessed by the identification of appropriate key areas, that is, cardiovascular risk factors, exercise capacity and subjective health. This may well serve as a benchmark for internal and external quality management.},
  language  = {en}
}
@article{SalzwedelReibisHadzicetal.2019,
  author    = {Salzwedel, Annett and Reibis, Rona Katharina and Hadzic, Miralem and Buhlert, Hermann and V{\"o}ller, Heinz},
  title     = {Patients' expectations of returning to work, co-morbid disorders and work capacity at discharge from cardiac rehabilitation},
  series = {Vascular Health and Risk Management},
  volume    = {15},
  journal   = {Vascular Health and Risk Management},
  publisher = {Dove Medical Press},
  address   = {Albany, Auckland},
  issn      = {1176-6344},
  doi       = {10.2147/VHRM.S216039},
  pages     = {301 -- 308},
  year      = {2019},
  abstract  = {Objective: We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR). Methods: We analyzed routine data of 884 patients (52±7 years, 76\% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, W{\"u}rzburger screening) at admission to CR were considered. Results: A negative occupational prognosis was detected in 384 patients (43\%). Out of these, 368 (96\%) expected not to return to work after CR and/or were unemployed before CR at 29\% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P<0.01; 6MWT: 380 m vs 421 m, P<0.01) and were more likely to receive a depression diagnosis (12\% vs 3\%, P<0.01), as well as higher levels on the HADS. At discharge from CR, 21\% of this group (n=81) were fit for work (vs 35\% of patients with a normal occupational prognosis (n=175, P<0.01)). Sick leave before the cardiac event (OR 0.4, 95\% CI 0.2-0.6, P<0.01), negative occupational expectations (OR 0.4, 95\% CI 0.3-0.7, P<0.01) and depression (OR 0.3, 95\% CI 0.1-0.8, P=0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated. Conclusion: Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients' occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care.},
  language  = {en}
}
@article{SalzwedelRieckReibisetal.2015,
  author    = {Salzwedel, Annett and Rieck, Angelika and Reibis, Rona Katharina and V{\"o}ller, Heinz},
  title     = {Routine initial exercise stress testing for treatment stratification in comprehensive cardiac rehabilitation},
  series = {International journal of rehabilitation research},
  volume    = {38},
  journal   = {International journal of rehabilitation research},
  number    = {4},
  publisher = {Lippincott Williams \& Wilkins},
  address   = {Philadelphia},
  issn      = {0342-5282},
  doi       = {10.1097/MRR.0000000000000133},
  pages     = {344 -- 349},
  year      = {2015},
  abstract  = {There is evidence of substantial benefit of cardiac rehabilitation (CR) for patients with low exercise capacity at admission. Nevertheless, some patients are not able to perform an initial exercise stress test (EST). We aimed to describe this group using data of 1094 consecutive patients after a cardiac event (71 +/- 7 years, 78\% men) enrolled in nine centres for inpatient CR. We analysed sociodemographic and clinical variables (e.g. cardiovascular risk factors, comorbidities, complications at admission), amount of therapy (e.g. exercise training, nursing care) and the results of the initial and the final 6-min walking test (6MWT) with respect to the application of an EST. Fifteen per cent of patients did not undergo an EST (non-EST group). In multivariable analysis, the probability of obtaining an EST was higher for men [odds ratio (OR) 1.89, P=0.01], a 6MWT (per 10 m, OR 1.07, P<0.01) and lower for patients with diabetes mellitus (OR 0.48, P<0.01), NYHA-class III/IV (OR 0.27, P<0.01), osteoarthritis (OR 0.39, P<0.01) and a longer hospital stay (per 5 days, OR 0.87, P=0.02). The non-EST group received fewer therapy units of exercise training, but more units of nursing care and physiotherapy than the EST group. However, there were no significant differences between both groups in the increase of the 6MWT during CR (123 vs. 108 m, P=0.122). The present study confirms the feasibility of an EST at the start of CR as an indicator of disease severity. Nevertheless, patients without EST benefit from CR even if exercising less. Thus, there is a justified need for individualized, comprehensive and interdisciplinary CR.},
  language  = {en}
}
@inproceedings{VoellerEichlerHarnathetal.2015,
  author    = {V{\"o}ller, Heinz and Eichler, Sarah and Harnath, Axel and Kamke, Wolfram and Butter, Christian and Kraehe, Mathias and Schikora, Martin and Jachczyk, J. and Salzwedel, Annett},
  title     = {Case management in patients after TAVI: are frailty and exercise capacitiy predictors for decision making process?},
  series = {European heart journal},
  volume    = {36},
  booktitle = {European heart journal},
  publisher = {Oxford Univ. Press},
  address   = {Oxford},
  issn      = {0195-668X},
  pages     = {635 -- 635},
  year      = {2015},
  language  = {en}
}
@inproceedings{VoellerSalzwedelReibisetal.2015,
  author    = {V{\"o}ller, Heinz and Salzwedel, Annett and Reibis, Rona Katharina and Eichler, Sarah and Buhlert, Hermann and Kaminski, Stefan and Wegscheider, Karl},
  title     = {Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation},
  series = {European heart journal},
  volume    = {36},
  booktitle = {European heart journal},
  publisher = {Oxford Univ. Press},
  address   = {Oxford},
  issn      = {0195-668X},
  pages     = {635 -- 636},
  year      = {2015},
  language  = {en}
}
@inproceedings{VoellerSalzwedelReibisetal.2014,
  author    = {V{\"o}ller, Heinz and Salzwedel, Annett and Reibis, Rona Katharina and Kaminski, S. and Buhlert, Hermann and Eichler, Sarah and Wegscheider, Karl},
  title     = {Age and fitness level are strongest limitations of exercise capacity during inpatient cardiac rehabilitation},
  series = {European heart journal},
  volume    = {35},
  booktitle = {European heart journal},
  publisher = {Oxford Univ. Press},
  address   = {Oxford},
  issn      = {0195-668X},
  pages     = {899 -- 899},
  year      = {2014},
  language  = {en}
}
@article{ZochLesniakDobberkeSchlittetal.2020,
  author    = {Zoch-Lesniak, Beate and Dobberke, Jeanette and Schlitt, Axel and Bongarth, Christa and Glatz, Johannes and Sp{\"o}rl-D{\"o}nch, Sieglinde and Koran, Iryna and V{\"o}ller, Heinz and Salzwedel, Annett},
  title     = {Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age},
  series = {Archives of Rehabilitation Research and Clinical Translation},
  volume    = {2},
  journal   = {Archives of Rehabilitation Research and Clinical Translation},
  publisher = {Elsevier},
  address   = {Amsterdam},
  issn      = {2590-1095},
  doi       = {10.1016/j.arrct.2020.100043},
  pages     = {14},
  year      = {2020},
  abstract  = {Objective: To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality. Design: Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany. Setting: Comprehensive 3-week CR.},
  language  = {en}
}