TY - JOUR A1 - Baritello, Omar A1 - Salzwedel, Annett A1 - Sündermann, Simon A1 - Niebauer, Josef A1 - Völler, Heinz T1 - The Pandora's Box of frailty assessments: Which is the best for clinical purposes in TAVI patients? A critical review JF - Journal of Clinical Medicine N2 - Frailty assessment is recommended before elective transcatheter aortic valve implantation (TAVI) to determine post-interventional prognosis. Several studies have investigated frailty in TAVI-patients using numerous assessments; however, it remains unclear which is the most appropriate tool for clinical practice. Therefore, we evaluate which frailty assessment is mainly used and meaningful for ≤30-day and ≥1-year prognosis in TAVI patients. Randomized controlled or observational studies (prospective/retrospective) investigating all-cause mortality in older (≥70 years) TAVI patients were identified (PubMed; May 2020). In total, 79 studies investigating frailty with 49 different assessments were included. As single markers of frailty, mostly gait speed (23 studies) and serum albumin (16 studies) were used. Higher risk of 1-year mortality was predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95% confidence interval (CI) 6.50–33.30) and lower serum albumin level (highest HR: 3.12; 95% CI 1.80–5.42). Composite indices (five items; seven studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95% CI 2.71–86.10) and 1-year mortality (highest OR: 2.75; 95% CI 1.55–4.87). In conclusion, single markers of frailty, in particular gait speed, were widely used to predict 1-year mortality. Composite indices were appropriate, as well as a comprehensive assessment of frailty. View Full-Text KW - frailty tool KW - TAVI KW - older patients KW - elderly KW - cardiology KW - mortality Y1 - 2021 U6 - https://doi.org/10.3390/jcm10194506 SN - 2077-0383 VL - 10 SP - 1 EP - 17 PB - MDPI CY - Basel, Schweiz ET - 19 ER - TY - GEN A1 - Baritello, Omar A1 - Salzwedel, Annett A1 - Sündermann, Simon A1 - Niebauer, Josef A1 - Völler, Heinz T1 - The Pandora's Box of frailty assessments: Which is the best for clinical purposes in TAVI patients? A critical review T2 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe N2 - Frailty assessment is recommended before elective transcatheter aortic valve implantation (TAVI) to determine post-interventional prognosis. Several studies have investigated frailty in TAVI-patients using numerous assessments; however, it remains unclear which is the most appropriate tool for clinical practice. Therefore, we evaluate which frailty assessment is mainly used and meaningful for ≤30-day and ≥1-year prognosis in TAVI patients. Randomized controlled or observational studies (prospective/retrospective) investigating all-cause mortality in older (≥70 years) TAVI patients were identified (PubMed; May 2020). In total, 79 studies investigating frailty with 49 different assessments were included. As single markers of frailty, mostly gait speed (23 studies) and serum albumin (16 studies) were used. Higher risk of 1-year mortality was predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95% confidence interval (CI) 6.50–33.30) and lower serum albumin level (highest HR: 3.12; 95% CI 1.80–5.42). Composite indices (five items; seven studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95% CI 2.71–86.10) and 1-year mortality (highest OR: 2.75; 95% CI 1.55–4.87). In conclusion, single markers of frailty, in particular gait speed, were widely used to predict 1-year mortality. Composite indices were appropriate, as well as a comprehensive assessment of frailty. View Full-Text T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 765 KW - frailty tool KW - TAVI KW - older patients KW - elderly KW - cardiology KW - mortality Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-550440 SN - 1866-8364 VL - 10 SP - 1 EP - 17 PB - Universitätsverlag Potsdam CY - Potsdam ET - 19 ER - TY - JOUR A1 - Brehmer, Nataliia A1 - Wolff, Lara Luisa A1 - Völler, Heinz A1 - Salzwedel, Annett T1 - Was bestimmt die subjektiven Erwerbsaussichten nach einem akuten kardialen Ereignis? BT - eine qualitative Studie mit kardiologischen RehabilitandInnen JF - Das Gesundheitswesen : Sozialmedizin, Gesundheits-System-Forschung, public health, öffentlicher Gesundheitsdienst, medizinischer Dienst N2 - Einleitung  Mehr als ein Drittel der PatientInnen im berufsfähigen Alter in der kardiologischen Anschlussrehabilitation (AR) sind von besonderen beruflichen Problemlagen (BBPL) betroffen. Die BBPL sind durch eine negative subjektive Erwerbsprognose (SE) determiniert, die wiederum auf eine deutlich reduzierte Wahrscheinlichkeit der beruflichen Wiedereingliederung hindeutet. Diese Studie hatte die Exploration von persönlich bestimmenden Faktoren der SE zum Ziel, um Impulse für die patientInnenzentrierte Betreuung in der AR ableiten zu können. Methoden  Die monozentrische explorative qualitative Studie basierte auf leitfadengestützten Einzelinterviews mit PatientInnen der kardiologischen AR. Hierfür wurden 20 PatientInnen mit BBPL (Hauptstichprobe) und 5 ohne BBPL (Kontraststichprobe) in QIV/2021 eingeschlossen. Die Stichprobenauswahl erfolgte nach dem Prinzip des theoretischen Samplings mit sich überschneidender Rekrutierungs- und Auswertungsphase. Die Auswertung erfolgte mittels thematischer Analyse, wobei die Interviews sinngemäß auf Aussagen (Codes) reduziert und anschließend in Schlüsselthemen zusammengefasst wurden. Ergebnisse Insgesamt wurden sieben Schlüsselthemen generiert. Die ersten beiden umfassen (1) umwelt- und (2) personenbezogene Aspekte (z. B. (1): Personalsituation, Auswirkungen der Pandemie; (2) Selbstwahrnehmung, Arbeitsplatzeinflüsse). Die weiteren Themen schließen (4) krankheitsbezogene Vorerfahrungen (z. B. Erfahrungen mit Gesundheitssystem, familiäre Prädisposition) und (5) Zukunftsvorstellungen (z. B. Prioritätenänderung, Rauchentwöhnung) ein. Darüber hinaus wurden drei spezifische Themen identifiziert: (5) die Gesundheitswahrnehmung einschließlich der empfundenen Belastbarkeit, (6) die Veränderbarkeit der Arbeitsbedingungen und (7) die Angst, wieder zu erkranken. Alle befragten RehabilitandInnen planten die Rückkehr in die Berufstätigkeit sowie umfassende Veränderungen des Gesundheitsverhaltens im Privatleben und am Arbeitsplatz. Schlussfolgerung Im Zusammenhang mit der BBPL wurden psychosoziale Aspekte deutlich häufiger thematisiert als medizinische. Auffallend war zudem, dass alle befragten RehabilitandInnen den beruflichen Wiedereinstieg planten, auch bei negativer SE. Diese wurde durch Faktoren bestimmt, die als Folge einer Neubewertung der persönlichen Prioritäten nach stattgehabten Akutereignis zu betrachten sind. Zur Unterstützung der Krankheitsverarbeitung sowie zur Förderung der Teilhabe einschließlich des Wiedereinstiegs in das Berufsleben scheint die interprofessionelle Erarbeitung eines individuell-differenzierten Handlungsplans mit Nachsorgeoptionen in der kardiologischen AR für die betroffenen PatientInnen sinnvoll. Y1 - 2022 U6 - https://doi.org/10.1055/s-0042-1753584 SN - 0941-3790 SN - 1439-4421 VL - 84 IS - 08/09 SP - 710 EP - 711 PB - Thieme CY - Stuttgart ER - TY - GEN A1 - Davos, C. H. A1 - Doherty, P. A1 - Voller, Heinz A1 - Salzwedel, Annett A1 - Saure, D. A1 - Metzendorf, M. I. A1 - Jensen, K. A1 - Schmid, J. P. A1 - Rauch, B. T1 - The prognostic effect of cardiac rehabilitation in the era of acute revascularization and statin therapy: the cardiac rehabilitation outcome study (CROS) T2 - European heart journal Y1 - 2016 SN - 0195-668X SN - 1522-9645 VL - 37 SP - 645 EP - 645 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Dissmann, R. A1 - Cromme, L. J. A1 - Salzwedel, Annett A1 - Taborski, U. A1 - Kunath, J. A1 - Gaebler, F. A1 - Heyne, K. A1 - Völler, Heinz T1 - Computer aided dosage management of phenprocoumon anticoagulation therapy Clinical validation JF - Hämostaseologie : Organ der Gesellschaft für Thrombose- und Hämostaseforschung e.V. (GTH) N2 - A recently developed multiparameter computer-aided expert system (TheMa) for guiding anticoagulation with phenprocoumon (PPC) was validated by a prospective investigation in 22 patients. The PPC-INR-response curve resulting from physician guided dosage was compared to INR values calculated by "twin calculation" from TheMa recommended dosage. Additionally, TheMa was used to predict the optimal time to perform surgery or invasive procedures after interruption of anticogulation therapy. Results: Comparison of physician and TheMa guided anticoagulation showed almost identical accuracy by three quantitative measures: Polygon integration method (area around INR target) 616.17 vs. 607.86, INR hits in the target range 166 vs. 161, and TTR (time in therapeutic range) 63.91 vs. 62.40 %. After discontinuation of anticoagulation therapy, calculating the INR phase-out curve with TheMa INR prognosis of 1.8 was possible with a standard deviation of 0.50 +/- 0.59 days. Conclusion: Guiding anticoagulation with TheMa was as accurate as Physician guided therapy. After interruption of anticoagulant therapy, TheMa may be used for calculating the optimal time performing operations or initiating bridging therapy. KW - Oral anticoagulation therapy KW - warfarin KW - phenprocoumon KW - computer aided dosage KW - expert system Y1 - 2014 U6 - https://doi.org/10.5482/HAMO-13-06-0030 SN - 0720-9355 VL - 34 IS - 3 SP - 226 EP - 232 PB - Schattauer CY - Stuttgart ER - TY - JOUR A1 - Dobberke, Jeanette A1 - Baritello, Omar A1 - Hadzic, Miralem A1 - Völler, Heinz A1 - Eichler, Sarah A1 - Salzwedel, Annett T1 - Test-retest reliability of center of pressure measures for postural control assessment in older cardiac patients JF - Gait & posture : official journal of Gait and Clinical Movement Analysis Society (GCMAS) and European Society of Movement Analysis in Adults and Children (ESMAC) N2 - Background Elderly patients are a growing population in cardiac rehabilitation (CR). As postural control declines with age, assessment of impaired balance is important in older CR patients in order to predict fall risk and to initiate counteracting steps. Functional balance tests are subjective and lack adequate sensitivity to small differences, and are further subject to ceiling effects. A quantitative approach to measure postural control on a continuous scale is therefore desirable. Force plates are already used for this purpose in other clinical contexts, therefore could be a promising tool also for older CR patients. However, in this population the reliability of the assessment is not fully known. Research question Analysis of test-retest reliability of center of pressure (CoP) measures for the assessment of postural control using a force plate in older CR patients. Methods 156 CR patients (> 75 years) were enrolled. CoP measures (path length (PL), mean velocity (MV), and 95% confidence ellipse area (95CEA)) were analyzed twice with an interval of two days in between (bipedal narrow stance, eyes open (EO) and closed (EC), three trials for each condition, 30 s per trial), using a force plate. For test-retest reliability estimation absolute differences (& UDelta;: T0-T1), intraclass correlation coefficients (ICC) with 95% confidence intervals, standard error of measurement and minimal detectable change were calculated. Results Under EO condition ICC were excellent for PL and MV (0.95) and good for 95CEA (0.88) with & UDelta; of 10.1 cm (PL), 0.3 cm/sec (MV) and 1.5 cm(2 )(95CEA) respectively. Under EC condition ICC were excellent (> 0.95) for all variables with larger & UDelta; (PL: 21.7 cm; MV: 0.7 cm/sec; 95CEA: 2.4 cm(2)) Significance In older CR patients, the assessment of CoP measures using a force plate shows good to excellent test retest reliability. KW - Cardiac rehabilitation KW - Older patients KW - Postural control KW - Test-retest KW - reliability KW - Force plate Y1 - 2022 U6 - https://doi.org/10.1016/j.gaitpost.2021.12.011 SN - 0966-6362 SN - 1879-2219 VL - 92 SP - 359 EP - 363 PB - Elsevier Science CY - Amsterdam ER - TY - JOUR A1 - Eichler, Sarah A1 - Rabe, Sophie A1 - Salzwedel, Annett A1 - Mueller, Steffen A1 - Stoll, Josefine A1 - Tilgner, Nina A1 - John, Michael A1 - Wegscheider, Karl A1 - Mayer, Frank A1 - Völler, Heinz T1 - Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement: study protocol for a multicenter, superiority, no-blinded randomized controlled trial JF - Trials N2 - 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. KW - Telerehabilitation KW - Home-based KW - Total hip replacement KW - Total knee replacement KW - Exercise therapy KW - Aftercare Y1 - 2017 U6 - https://doi.org/10.1186/s13063-017-2173-3 SN - 1745-6215 VL - 18 PB - BioMed Central CY - London ER - TY - GEN A1 - Eichler, Sarah A1 - Rabe, Sophie A1 - Salzwedel, Annett A1 - Müller, Steffen A1 - Stoll, Josefine A1 - Tilgner, Nina A1 - John, Michael A1 - Wegschneider, Karl A1 - Mayer, Frank A1 - Völler, Heinz T1 - Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement BT - Study protocol for a multicenter, superiority, no-blinded randomized controlled trial N2 - 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. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 353 KW - Aftercare KW - Exercise therapy KW - Home-based KW - Telerehabilitation KW - Total hip replacement KW - Total knee replacement Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-403702 ER - TY - JOUR A1 - Eichler, Sarah A1 - Rabe, Sophie A1 - Salzwedel, Annett A1 - Müller, Steffen A1 - Stoll, Josefine A1 - Tilgner, Nina A1 - John, Michael A1 - Wegschneider, Karl A1 - Mayer, Frank A1 - Völler, Heinz T1 - Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement BT - Study protocol for a multicenter, superiority, no-blinded randomized controlled trial JF - Trials N2 - 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. KW - Telerehabilitation KW - Home-based KW - Total hip replacement KW - Total knee replacement KW - Exercise therapy KW - Aftercare Y1 - 2017 U6 - https://doi.org/10.1186/s13063-017-2173-3 SN - 1745-6215 VL - 18 SP - 1 EP - 7 PB - BioMed Central CY - London ER - TY - JOUR A1 - Eichler, Sarah A1 - Salzwedel, Annett A1 - Harnath, Axel A1 - Butter, Christian A1 - Wegscheider, Karl A1 - Chiorean, Mihai A1 - Völler, Heinz A1 - Reibis, Rona Katharina T1 - Nutrition and mobility predict all-cause mortality in patients 12 months after transcatheter aortic valve implantation JF - Clinical research in cardiology : official journal of the German Cardiac Society. N2 - The aim of the study was to determine pre-interventional predictors for all-cause mortality in patients after transcatheter aortic valve implantation (TAVI) with a 12-month follow-up. From 10/2013 to 07/2015, 344 patients (80.9 +/- 5.0 years, 44.5% male) with an elective TAVI were consecutively enrolled prospectively in a multicentre cohort study. Prior to the intervention, sociodemographic parameters, echocardiographic data and comorbidities were documented. All patients performed a 6-min walk test, Short Form 12 and a Frailty Index (score consisting of activities of daily living, cognition, nutrition and mobility). Peri-interventional complications were documented. Vital status was assessed over telephone 12 months after TAVI. Predictors for all-cause mortality were identified using a multivariate regression model. At discharge, 333 patients were alive (in-hospital mortality 3.2%; n = 11). During a follow-up of 381.0 +/- 41.9 days, 46 patients (13.8%) died. The non-survivors were older (82.3 +/- 5.0 vs. 80.6 +/- 5.1 years; p = 0.035), had a higher number of comorbidities (2.6 +/- 1.3 vs. 2.1 +/- 1.3; p = 0.026) and a lower left ventricular ejection fraction (51.0 +/- 13.6 vs. 54.6 +/- 10.6%; p = 0.048). Additionally, more suffered from diabetes mellitus (60.9 vs. 44.6%; p = 0.040). While the global Frailty Index had no predictive power, its individual components, particularly nutrition (OR 0.83 per 1 pt., CI 0.72-0.95; p = 0.006) and mobility (OR 5.12, CI 1.64-16.01; p = 0.005) had a prognostic impact. Likewise, diabetes mellitus (OR 2.18, CI 1.10-4.32; p = 0.026) and EuroSCORE (OR 1.21 per 5%, CI 1.07-1.36; p = 0.002) were associated with a higher risk of all-cause mortality. Besides EuroSCORE and diabetes mellitus, nutrition status and mobility of patients scheduled for TAVI offer prognostic information for 1-year all-cause mortality and should be advocated in the creation of contemporary TAVI risk scores. KW - TAVI KW - Frailty KW - Mortality KW - Malnutrition KW - Mobility Y1 - 2018 U6 - https://doi.org/10.1007/s00392-017-1183-1 SN - 1861-0684 SN - 1861-0692 VL - 107 IS - 4 SP - 304 EP - 311 PB - Springer CY - Heidelberg ER -