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 - JOUR A1 - Salzwedel, Annett A1 - Völler, Heinz T1 - Cardiac rehabilitation BT - patient-reported outcomes are decisive for success JF - Deutsches Ärzteblatt international : a weekly online journal of clinical medicine and public health Y1 - 2021 U6 - https://doi.org/10.3238/arztebl.m2021.0211 SN - 1866-0452 VL - 118 IS - 29-30 SP - 505 EP - 506 PB - Dt. Ärzte-Verl. CY - Cologne ER - TY - JOUR A1 - Kather, Fritz A1 - Hadzic, Miralem A1 - Hehle, Teresa A1 - Eichler, Sarah A1 - Klein, Julia A1 - Völler, Heinz A1 - Salzwedel, Annett T1 - Test-retest reliability of the Mini Nutritional Assessment- Short Form (MNA-SF) in older patients undergoing cardiac rehabilitation JF - Journal of geriatric cardiology KW - Cardiac rehabilitation KW - Malnutrition KW - Octogenarians KW - Test-retest KW - reliability Y1 - 2020 U6 - https://doi.org/10.11909/j.issn.1671-5411.2020.09.007 SN - 1671-5411 VL - 17 IS - 9 SP - 574 EP - 579 PB - English China Online Journals, ECOJ CY - Windsor [u.a.] 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 - Salzwedel, Annett A1 - Jensen, Katrin A1 - Rauch, Bernhard A1 - Doherty, Patrick A1 - Metzendorf, Maria-Inti A1 - Hackbusch, Matthes A1 - Völler, Heinz A1 - Schmid, Jean-Paul A1 - Davos, Constantinos H. T1 - Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine BT - update of the Cardiac Rehabilitation Outcome Study (CROS-II) JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis. Design A systematic review and meta-analysis. Methods Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included. Resulte Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; retrospective controlled cohort studies HR 0.64, 95% CI 0.53-0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI 0.08-0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI 0.54-0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95% CI 0.36-0.77; two out of 10 controlled cohort studies with neutral results). Conclusion CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation. KW - cardiac rehabilitation KW - cardiac rehabilitation delivery KW - acute coronary KW - syndrome KW - coronary bypass grafting KW - coronary artery disease KW - mortality Y1 - 2020 U6 - https://doi.org/10.1177/2047487320905719 SN - 2047-4873 SN - 2047-4881 VL - 27 IS - 16 SP - 1756 EP - 1774 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Hadzic, Miralem A1 - Eichler, Sarah A1 - Völler, Heinz A1 - Salzwedel, Annett T1 - Akzeptanz und Nutzung eines telemedizinischen Rehabilitationsprogramms für Patienten mit Knie- oder Hüft-Totalendoprothese JF - Bewegungstherapie und Gesundheitssport : B & G ; offizielles Organ des Deutschen Verbandes für Gesundheitssport und Sporttherapie e.V. (DVGS) N2 - Objective of the study: The long-term use of telemedical programs depends not only on their effectiveness, but also on patient acceptance and satisfaction. The effectiveness of telemedical exercise therapy for patients after implantation of a total knee or hip prosthesis and subsequent rehabilitation has already been examined in a randomized controlled study. This article focuses on the patient's acceptance and usage behaviour with regard to the tele-rehabilitation system. Methodology: 48 patients (53 +/- 7 years; 26 women; 35 hip/13 knee TEP) were questioned after a three-month telemedical movement therapy using the Telehealth Usability Questionnaire (TUQ) to determine the acceptance of the technology. The questionnaire consisted of 21 items (seven-point Likert scale) in six scales (e. g. usefulness, quality of interactions, reliability). System-specific questions were summarized on an additional scale. The results were presented as a percentage of the scale (100 estimates complete agreement). The usage behaviour was examined using system-generated process data for training and integrated voice/text messages. Results: The TUQ scales "Usefulness" (Mdn 95.2) and "Ease of use and learnability" (Mdn 92.9) were rated the highest, while "Reliability" (Mdn 57.1) and "Quality of interactions" ( Mdn 71.4) showed the lowest levels. The system-specific scale was placed in the upper quartile (Mdn 85.7). In the first week, 39 patients (81%) and in the second 45 patients (94%) performed at least one training exercise with the system. The proportion of active patients (>= 1 exercise/week) decreased in the further course to 75% (n=36) in the 7th week and 48% (n=23) in the 12th week. The system communication options were initially used frequently after the start of therapy: in the first week, 42 patients (88%) sent messages, 47 patients (98%) received messages from their therapist respectively. In week 7, 9 (19%) and 13 (27%) patients sent/received messages via the system respectively. Conclusion: Most of the patients perceived telemedical movement therapy as useful and user-friendly and seemed to be largely satisfied with the system. This proved to be well suited for short-term use of 6 to 8 weeks following subsequent rehabilitation. N2 - Ziel der Studie: Die langfristige Nutzung telemedizinischer Angebote hängt nicht nur von deren Wirksamkeit, sondern auch von der Akzeptanz und Zufriedenheit der Patienten ab. Für eine telemedizinische Bewegungstherapie für Patienten nach Implantation einer Knie- oder Hüft-Totalendoprothese und erfolgter Anschlussrehabilitation wurde die Wirksamkeit bereits in einer randomisiert kontrollierten Studie untersucht. Dieser Beitrag fokussiert die Akzeptanz und das Nutzungsverhalten der Patienten hinsichtlich des eingesetzten telerehabilitativen Systems. Methodik: Zur Erfassung der Technikakzeptanz wurden 48 Patienten (53±7 Jahre; 26 Frauen; 35 Hüft-/13 Knie-TEP) im Anschluss an eine dreimonatige telemedizinische Bewegungstherapie mittels des Telehealth Usability Questionnaire befragt. Der Fragebogen besteht aus 21 Items (siebenstufige Likert-Skala) in sechs Skalen (z. B. Nützlichkeit, Qualität der Interaktionen, Verlässlichkeit). In einer zusätzlichen Skala wurden systemspezifische Fragen zusammengefasst. Die Ergebnisse wurden als Skalenprozent (100 ≙ vollkommene Zustimmung) dargestellt. Das Nutzungsverhalten wurde anhand systemgenerierter Prozessdaten zum Training sowie zu integrierten Sprach-/Textnachrichten untersucht. Ergebnisse: Die TUQ-Skalen „Nützlichkeit“ (Mdn 95,2) sowie „Benutzerfreundlichkeit und Erlernbarkeit“ (Mdn 92,9) wurden am höchsten bewertet, während die „Verlässlichkeit“ (Mdn 57,1) und „Qualität der Interaktionen“ (Mdn 71,4) die geringsten Ausprägungen zeigten. Die systemspezifische Skala wurde im oberen Quartil eingeordnet (Mdn 85,7). In der ersten Woche führten 39 Patienten (81%), in der zweiten 45 Patienten (94%) mindestens eine Trainingsübung mit dem System durch. Der Anteil aktiver Patienten (≥1 Übung/Woche) reduzierte sich im weiteren Verlauf auf 75% (n=36) in der 7. Woche und 48% (n=23) in der 12. Woche. Die systemeigenen Kommunikationsmöglichkeiten wurden nach Therapiestart zunächst häufig genutzt: in der ersten Woche sendeten 42 Patienten (88%) Nachrichten, 47 Patienten (98%) erhielten Nachrichten von ihrem Therapeuten. In der 7. Woche sendeten/erhielten 9 (19%) bzw. 13 (27%) Patienten Nachrichten über das System. Schlussfolgerung: Die Patienten nahmen die telemedizinische Bewegungstherapie überwiegend als nützlich und benutzerfreundlich wahr und schienen im Wesentlichen mit dem System zufrieden, das sich damit für den kurzfristigen Einsatz von 6 bis 8 Wochen im Anschluss an eine Anschlussrehabilitation als gut geeignet zeigte. T2 - Acceptance and use of a telemedical rehabilitation program for patients with total knee or hip replacement KW - Telemedicine KW - tele-rehabilitation KW - acceptance KW - use KW - orthopaedic KW - rehabilitation KW - Telemedizin KW - Telerehabilitation KW - Akzeptanz KW - Nutzung KW - orthopädische Rehabilitation Y1 - 2022 U6 - https://doi.org/10.1055/a-1714-3629 SN - 1613-0863 SN - 1613-3269 VL - 38 IS - 01 SP - 20 EP - 25 PB - Thieme CY - Stuttgart ER - TY - THES A1 - Salzwedel, Annett T1 - Biopsychosoziale Aspekte der beruflichen Wiedereingliederung nach kardiologischer Rehabilitation Y1 - 2020 CY - Potsdam ER - TY - JOUR A1 - Eichler, Sarah A1 - Salzwedel, Annett A1 - Reibis, Rona A1 - Nothroff, Jörg A1 - Harnath, Axel A1 - Schikora, Martin A1 - Butter, Christian A1 - Wegscheider, Karl A1 - Völler, Heinz T1 - Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation BT - predictors of functional and psychocognitive recovery JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - 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. KW - Cardiac rehabilitation KW - TAVI KW - frailty KW - quality of life KW - exercise capacity Y1 - 2017 U6 - https://doi.org/10.1177/2047487316679527 SN - 2047-4873 SN - 2047-4881 VL - 24 IS - 3 SP - 257 EP - 264 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Reibis, Rona Katharina A1 - Salzwedel, Annett A1 - Falk, Johannes A1 - Völler, Heinz T1 - Berufliche Wiedereingliederung nach akutem Herzinfarkt T1 - Return to Work after Acute Myocardial Infarction JF - Deutsche medizinische Wochenschrift : DMW ; Organ der Deutschen Gesellschaft für Innere Medizin (DGIM) ; Organ der Gesellschaft Deutscher Naturforscher und Ärzte (GDNÄ) N2 - Die berufliche Wiedereingliederung von Patienten nach akutem Herzinfarkt stellt sowohl aus gesellschaftlicher wie auch aus individueller Sicht einen entscheidenden Schritt zur vollständigen Rekonvaleszenz dar. Lediglich 10% der Patienten werden durch kardiale Probleme an der Reintegration behindert. Neben medizinischen und berufsbezogenen Faktoren determinieren insbesondere psychosoziale Parameter eine erfolgreiche Wiederaufnahme der Tätigkeit. Verschiedene Programme der Rentenversicherungsträger werden dabei unterstützend angeboten. N2 - Vocational reintegration provides a key goal for patients after myocardial infarction both from social as well as from individual perspective. Return to work rate is determined by medical parameters such as left ventricular function, residual ischemia and rhythm stability, as well as by occupational requirement profile such as the blue or white collar work, night shifts and the way capacity. Psycho-social factors including depression, self-assessment of their own situation and pre-existing cognitive impairment to a large extent determine the reintegration. Optimally, re-employment should be performed immediately after cardiac rehabilitation in patient after uncomplicated myocardial infarction. After a long hospitalization phase a stepwise inclusion is recommended. In failed reintegration particularly in younger workers retraining should be considered. KW - berufliche Wiedereingliederung KW - Herzinfarkt KW - hamburger model KW - Prädiktoren KW - Rentenversicherung KW - return to work KW - myocardial infarction KW - predictors KW - pension insurance Y1 - 2017 U6 - https://doi.org/10.1055/s-0042-124425 SN - 0012-0472 SN - 1439-4413 VL - 142 SP - 617 EP - 624 PB - Thieme CY - Stuttgart ER - 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 - JOUR A1 - Schulz-Behrendt, Claudia A1 - Salzwedel, Annett A1 - Rabe, Sophie A1 - Ortmann, K. A1 - Völler, Heinz T1 - Aspekte beruflicher und sozialer Wiedereingliederung aus Sicht kardiovaskulär erkrankter Rehabilitanden in besonderen beruflichen Problemlagen T1 - Subjective Aspects of Return to Work and Social Reintegration in Patients with Extensive Work-related Problems in Cardiac Rehabilitation BT - Ergebnisse einer qualitativen Erhebung BT - Results of a Qualitative Investigation JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Ziel: Untersucht wurden subjektive bio-psycho-soziale Auswirkungen chronischer Herz- und Gefäßerkrankungen, Bewältigungsstrategien und Formen sozialer Unterstützung bei Rehabilitanden in besonderen beruflichen Problemlagen (BBPL). Methodik: Für die qualitative Untersuchung wurden 17 Patienten (48,9±7,0 Jahre, 13 männl.) mit BBPL (SIMBO-C>30) in leitfadengestützten Interviews befragt. Die Auswertung erfolgte softwaregestützt nach dem inhaltsanalytischen Ansatz von Mayring. Ergebnisse: Im Rahmen der Krankheitsauswirkungen benannten die Patienten soziale, einschließlich beruflicher Aspekte mit 62% der Aussagen deutlich häufiger als physische oder psychische Faktoren (9 bzw. 29%). Angewandte Bewältigungsstrategien und erfahrene Unterstützungsleistungen richteten sich jedoch überwiegend auf körperliche Einschränkungen (70 bzw. 45%). Schlussfolgerung: Obgleich soziale Krankheitsauswirkungen für die befragten Rehabilitanden subjektiv bedeutsam waren, gelang die Entwicklung geeigneter Bewältigungsstrategien nur unzureichen N2 - Objective This study investigated subjective biopsychosocial effects of coronary heart disease (CHD), coping strategies and social support in patients undergoing cardiac rehabilitation (CR) and having extensive work-related problems. Methods A qualitative investigation was performed in 17 patients (48.9 +/- 7.0 y, 13 male) with extensive work-related problems (SIMBO-C > 30). All patients were interviewed with structured surveys. Data analysis was performed using a software that is based on the content analysis approach of Mayring. Results In regard to effects of disease, patients indicated social aspects including occupational aspects (62 %) more often than physical or mental factors (9 or 29 %). Applied coping strategies and support services are mainly focused on physical impairments (70 or 45 %). Conclusions The development of appropriate coping strategies was insufficient although social effects of disease were subjectively meaningful for patients in CR. KW - cardiac rehabilitation KW - extensive work-related problems KW - social support KW - return to work KW - kardiologische Rehabilitation KW - besondere berufliche Problemlagen KW - soziale Unterstützung KW - berufliche Wiedereingliederung Y1 - 2017 U6 - https://doi.org/10.1055/s-0042-121379 SN - 0034-3536 SN - 1439-1309 VL - 56 IS - 3 SP - 181 EP - 188 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Heidler, Maria-Dorothea A1 - Bidu, Laura A1 - Völler, Heinz A1 - Salzwedel, Annett T1 - Prädiktoren des kognitiven Outcomes beatmeter Frührehabilitationspatienten T1 - Predictors of cognitive outcome in ventilated early rehabilitation patients JF - Der Nervenarzt : Organ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde ; Mitteilungsblatt der Deutschen Gesellschaft für Neurologie N2 - Hintergrund Patienten, die nach gescheitertem Weaning von der Intensivstation in die Frührehabilitation (FR) verlegt werden, weisen neben motorischen Einschränkungen oft auch Defizite in ihrer kognitiven Leistungsfähigkeit auf. Welche patientenseitigen Faktoren das kognitive Outcome am Ende der FR beeinflussen, ist noch unzureichend untersucht. Zielstellung Ermittlung von Prädiktoren auf das kognitive Leistungsvermögen initial beatmeter FR-Patienten. Methode Zwischen 01/2014 und 12/2015 wurden 301 Patienten (68,3 ± 11,4 Jahre, 67 % männlich) einer neurologischen Phase-B-Weaningstation konsekutiv in eine prospektive Beobachtungsstudie eingeschlossen. Zur Ermittlung möglicher Einflussfaktoren auf das kognitive Outcome (operationalisiert mittels Neuromentalindex [NMI]) wurden soziodemografische Daten, kritische Erkrankung, Komorbiditäten, Parameter zu Weaning und Dekanülierung sowie diverse Scores zur Ermittlung funktionaler Parameter erhoben und mittels ANCOVA multivariat ausgewertet. Ergebnisse Insgesamt 248 Patienten (82 %) konnten erfolgreich geweant werden, 155 (52 %) dekanüliert, 75 Patienten (25 %) verstarben, davon 39 (13 %) unter Palliativtherapie. Für die überlebenden Patienten (n = 226) konnten im finalen geschlechts- und altersadjustierten statistischen Modell unabhängige Prädiktoren des NMI bei Entlassung aus der FR ermittelt werden: Wachheit und erfolgreiche Dekanülierung waren positiv mit dem NMI assoziiert, während als kritische Erkrankungen hypoxische Hirnschädigungen, Hirninfarkte und Schädel-Hirn-Traumata einen negativen Einfluss auf die kognitive Leistungsfähigkeit hatten. Das berechnete Modell begründet 57 % der Varianz des NMI (R2 = 0,568) und weist damit eine hohe Erklärungsqualität auf. Schlussfolgerung Aufgrund des erhöhten Risikos für eine verminderte kognitive Leistungsfähigkeit zum Ende der FR sollten vor allem Patienten nach Hypoxie, Hirninfarkt und Schädel-Hirn-Trauma intensiv neuropsychologisch betreut werden. Da weiterhin eine erfolgreiche Dekanülierung mit verbesserten kognitiven Leistungen assoziiert ist, sollte – vor allem bei wachen Patienten – zudem ein zügiges Trachealkanülenmanagement im therapeutischen Fokus stehen. N2 - After weaning failure, patients who are transferred from intensive care units to early rehabilitation centers (ERC) not only suffer from motor deficits but also from cognitive deficits. It is still uncertain which patient factors have an impact on cognitive outcome at the end of early rehabilitation. Investigation of predictors of cognitive performance for initially ventilated early rehabilitation patients. A total of 301 patients (mean age 68.3 +/- 11.4 years, 67% male) were consecutively enrolled in an ERC for a prospective observational study between January 2014 and December 2015. To investigate influencing factors on cognitive outcome operationalized by the neuromental index (NMI), we collected sociodemographic data, parameters about the critical illness, comorbidities, weaning and decannulation as well as different functional scores at admission and discharge and carried out multivariate analyses by ANCOVA. Of the patients 248 (82%) were successfully weaned, 155 (52%) decannulated and 75 patients (25%) died of whom 39 (13%) were under palliative treatment. For the survivors (n = 226) we could identify independent predictors of the NMI at discharge from the ERC in the final sex and age-adjusted statistical model: alertness and decannulation were positively associated with the NMI whereas hypoxia, cerebral infarction and traumatic brain injury had a negative impact on cognitive ability. The model justifies 57% of the variance of the NMI (R-2 = 0.568) and therefore has a high quality of explanation. Because of increased risk of cognitive deficits at discharge of ERC, all patients who suffered from hypoxia, cerebral infarction or traumatic brain injury should be intensively treated by neuropsychologists. Since decannulation is also associated with positive cognitive outcome, a rapid decannulation procedure should also be an important therapeutic target, especially in alert patients. KW - Early rehabilitation KW - Ventilation KW - Decannulation KW - Cognition KW - Neuromental index KW - Frührehabilitation KW - Beatmung KW - Dekanülierung KW - Kognition KW - Neuromentalindex Y1 - 0201 U6 - https://doi.org/10.1007/s00115-017-0311-5 SN - 0028-2804 SN - 1433-0407 VL - 88 SP - 905 EP - 910 PB - Springer CY - New York 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 - TY - JOUR A1 - Salzwedel, Annett A1 - Voeller, Heinz A1 - Reibis, Robert A1 - Bonaventura, Klaus A1 - Behrens, Steffen A1 - Reibis, Rona Katharina T1 - Regionale Versorgungsaspekte des akuten Myokardinfarktes im Nordosten Deutschlands T1 - Regional Aspects in Treatment of Patients with Acute Myocardial Infarction in the North-East of Germany JF - Deutsche medizinische Wochenschrift : DMW ; Organ der Deutschen Gesellschaft für Innere Medizin (DGIM) ; Organ der Gesellschaft Deutscher Naturforscher und Ärzte (GDNÄ) N2 - Background In recent decades, guideline-based therapy of myocardial infarction has led to a considerable reduction in myocardial infarction mortality. However, there are relevant differences in acute care and the extent of infarction mortality. The objective of this survey was to analyze the current care situation of patients with acute myocardial infarction in the region of northeast Germany (Berlin, Brandenburg and Mecklenburg-Vorpommern). Methods Based on pseudonymized data from a statutory health insurance of 1 387 084 persons, a total of 6733 patients with inpatient admission at MI were filtered using the ICD10 code I21 and I22 for 2012. Total inhospital mortality and 1-year mortality and prognostic parameters were evaluated and analyzed in country comparisons. Results Both the hospital mortality rate and the 1-year mortality rate of the individual countries (Berlin 13.6 resp. 27.5 %, respectively, BRB 13.9 and 27.9 %, MV 14.4 and 29.0 %, respectively) were comparable to the overall rate (13.9 % or 28.0 %) and in the country comparison. In the multiple analysis, the 1-year mortality was determined by the invasive strategy (OR 0.42, 95 % CI 0.35 -0.51, p < 0.001) as well as by the implementation of the guidelines-based secondary prevention (OR 0.14, 95 % CI 0.12 - 0.17, p < 0.001). There were no statistical differences between the three federal states. Conclusion The investigated population of patients with acute MI in Berlin, Brandenburg and Mecklenburg-Vorpommern demonstrated a comparable inpatient and post-hospital care and 1-year prognosis regardless of the federal state assignment. Referral to coronary angiography and adequate implementation of evidence-based medication demonstrated a significant prognostic impact. N2 - Hintergrund In den letzten Jahrzehnten führte die leitliniengerechte Therapie des akuten Myokardinfarktes (MI) zu einer Mortalitätsreduktion in Deutschland, wobei zwischen einzelnen Bundesländern erhebliche Unterschiede beschrieben werden. Ziel war es daher, die aktuelle Versorgungssituation von Patienten mit MI in der Region Nordost-Deutschland (Berlin, Brandenburg [BRB] und Mecklenburg-Vorpommern [MV]) zu untersuchen und Prädiktoren der 1-Jahresmortalität unter Berücksichtigung der regionalen Zuordnung zu identifizieren. Methode Auf Basis pseudonymisierter Abrechnungsdaten einer gesetzlichen Krankenversicherung wurden für das Jahr 2012 anhand des ICD 10-Codes I21 und I22 von 1 387 084 Versicherten insgesamt 6733 Patienten mit stationärer Aufnahme bei MI gefiltert. Neben der Krankenhaus- und 1-Jahresmortalität wurden potenzielle Prognoseprädiktoren unter Berücksichtigung von Komorbiditäten, periinfarziellen Prozeduren und sekundärpräventiver Pharmakotherapie erfasst und im Ländervergleich analysiert. Ergebnisse Sowohl die Krankenhaus- als auch die 1-Jahresmortalitätsrate der einzelnen Länder (Berlin 13,6 resp. 27,5 %, BRB 13,9 resp. 27,9 %, MV 14,4 resp. 29,0 %) war vergleichbar zur Gesamtrate (13,9 % resp. 28,0 %) und im Ländervergleich weitgehend identisch. Die multiple Analyse der Einflussfaktoren auf die 1-Jahresmortalität identifizierte vor allem die Koronarangiografie (OR 0,42, 95 % KI 0,35 – 0,51, p < 0,001) und die Umsetzung der pharmakologischen Leitlinienempfehlungen (OR 0,14, 95 % KI 0,12 – 0,17, p < 0,001) als wesentliche Maßnahmen zur Risikoreduktion. Bei beiden Einflussfaktoren lagen univariat keine statistischen Unterschiede zwischen den drei Bundesländern vor. Schlussfolgerung Die vorliegenden Daten lassen auf eine vergleichbare stationäre und poststationäre Versorgung und 1-Jahresprognose von Patienten mit akutem MI in den Bundesländern Berlin, Brandenburg und Mecklenburg-Vorpommern in der untersuchten Population schließen, wobei insbesondere der Durchführung einer Koronarangiografie und der adäquaten Umsetzung einer leitliniengerechten Pharmakotherapie prognostische Bedeutung zukommt. KW - myocardial infarction KW - hospital mortality KW - federal states KW - secondary data analysis KW - northeast of Germany KW - statutory health insurance Y1 - 2018 U6 - https://doi.org/10.1055/s-0043-123907 SN - 0012-0472 SN - 1439-4413 VL - 143 IS - 8 SP - E51 EP - E58 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Heidler, Maria-Dorothea A1 - Salzwedel, Annett A1 - Jöbges, Michael A1 - Lück, Olaf A1 - Dohle, Christian A1 - Seifert, Michael A1 - von Helden, Andrea A1 - Hollweg, Wibke A1 - Völler, Heinz T1 - Decannulation of tracheotomized patients after long-term mechanical ventilation - results of a prospective multicentric study in German neurological early rehabilitation hospitals JF - BMC Anesthesiology N2 - Background: In the course of neurological early rehabilitation, decannulation is attempted in tracheotomized patients after weaning due to its considerable prognostic significance. We aimed to identify predictors of a successful tracheostomy decannulation. Methods: From 09/2014 to 03/2016, 831 tracheotomized and weaned patients (65.4 +/- 12.9 years, 68% male) were included consecutively in a prospective multicentric observation study. At admission, sociodemographic and clinical data (e.g. relevant neurological and internistic diseases, duration of mechanical ventilation, tracheotomy technique, and nutrition) as well as functional assessments (Coma Recovery Scale-Revised (CRS-R), Early Rehabilitation Barthel Index, Bogenhausener Dysphagia Score) were collected. Complications and the success of the decannulation procedure were documented at discharge. Results: Four hundred seventy patients (57%) were decannulated. The probability of decannulation was significantly negatively associated with increasing age (OR 0.68 per SD = 12.9 years, p < 0.001), prolonged duration of mechanical ventilation (OR 0.57 per 33.2 days, p < 0.001) and complications. An oral diet (OR 3.80; p < 0.001) and a higher alertness at admission (OR 3.07 per 7.18 CRS-R points; p < 0.001) were positively associated. Conclusions: This study identified practically measurable predictors of decannulation, which in the future can be used for a decannulation prognosis and supply optimization at admission in the neurological early rehabilitation clinic. KW - Mechanical ventilation KW - Tracheostomy KW - Decannulation KW - Prognosis Y1 - 2018 U6 - https://doi.org/10.1186/s12871-018-0527-3 SN - 1471-2253 VL - 18 PB - BMC CY - London ER - TY - GEN A1 - Salzwedel, Annett A1 - Hadzic, Miralem A1 - Buhlert, Hermann A1 - Völler, Heinz T1 - Impact of self-assessment of return to work on employable discharge from multi-component cardiac rehabilitation T2 - European heart journal N2 - Impact of self-assessment of return to work on employable discharge from multi-component cardiac rehabilitation. Retrospective unicentric analysis of routine data from cardiac rehabilitation in patients below 65 years of age. Presentation in the "Cardiovascular rehabilitation revisited" high impact abstract session during ESC Congress 2018. Y1 - 2018 SN - 0195-668X SN - 1522-9645 VL - 39 SP - 21 EP - 22 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Salzwedel, Annett A1 - Rabe, Sophie A1 - Zahn, Thomas A1 - Neuwirth, Julia A1 - Eichler, Sarah A1 - Haubold, Kathrin A1 - Wachholz, Anne A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - Nutzerinteresse an mobilen digitalen Assistenzsystemen zur Förderung körperlicher Aktivität bei Studierenden und Mitarbeitern einer Universität T1 - User Interest in Digital Health Technologies to Enhance Physical Activity in Students and Staff of a University JF - Gesundheitswesen N2 - Hintergrund Einem Großteil der Bevölkerung gelingt es trotz ausreichenden Wissens um die protektiven Effekte nicht, ausreichende körperliche Aktivität in den Alltag zu integrieren. Digitale Assistenzsysteme könnten hierbei unterstützend eingesetzt werden. Dies setzt jedoch das Interesse potentieller Nutzer voraus. Methode In einer Online-Befragung wurden im Juni/Juli 2015 Mitarbeiter und Studierende der Universität Potsdam zum individuellen Ausmaß der sportlichen Aktivität, dem Interesse an elektronischer Trainingsunterstützung und weiteren Parametern befragt. Ergebnis 1217 Studierende und 485 Mitarbeiter (67,3 bzw. 67,5% Frauen, 26±4,9 bzw. 42,7±11,7 Jahre) nahmen an der Studie teil. Die empfohlene sportliche Aktivität (≥3 Tage bzw. 150 min/Woche) wurde von 70,1% der Mitarbeiter und 52,7% der Studierenden nicht erreicht. Innerhalb dieser Gruppen zeigten 53,2% (Studierende) bzw. 44,2% (Mitarbeiter), unabhängig von Alter, Geschlecht, BMI bzw. Bildungsniveau, Interesse an einer elektronischen Trainingsunterstützung. Schlussfolgerung Auch in jüngeren Bevölkerungsgruppen mit hohem Bildungsniveau ist die Mehrzahl der Personen unzureichend körperlich aktiv. Ein Interesse an Trainingsunterstützung besteht in etwa der Hälfte dieser sportlich inaktiven Gruppe. Dies legt den Schluss nahe, dass der personalisierte Einsatz mobiler Assistenzsysteme für die positive Beeinflussung des Lebensstils zunehmend an Bedeutung gewinnen könnte. N2 - Introduction Though health-enhancing effects of physical activity are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) technologies might be able to increase the physical activity level. However, the interest of potential users is a mandatory basis for this. Method We conducted an online-survey from 06-07/2015 by asking students and employees from the University of Potsdam for their activity level, interest in mHealth training support and other relevant parameters. Results 1 217 students and 485 employees (67.3 % and 67.5 % female, 26.0 +/- 4.9 and 42.7 +/- 11.7 years, respectively) participated in the survey. 70.1 % of employees and 52.7 % of students did not follow the recommendation for physical activity (3 times per week). 53.2 % (students) and 44.2 % (employees), independent of age, sex, BMI and level of education or professional qualification, indicated their interest in mHealth technology offering training support. Conclusion Even in a younger population with higher education, most respondents reported an insufficient level of physical activity. About half of them indicated their interest in training support. Therefore, the use of personalized mHealth technology may be of increasing significance for a positive change of lifestyle. KW - physical activity KW - digital health KW - prevention KW - lifestyle KW - mHealth KW - körperliche Aktivität KW - digitale Gesundheit KW - Prävention KW - Lebensstil KW - mobile Assistenzsysteme Y1 - 2018 U6 - https://doi.org/10.1055/s-0043-103951 SN - 0941-3790 SN - 1439-4421 VL - 80 IS - 11 SP - 1023 EP - 1025 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Salzwedel, Annett A1 - Heidler, Maria-Dorothea A1 - Meng, Karin A1 - Schikora, Martin A1 - Wegscheider, Karl A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - Impact of cognitive performance on disease-related knowledge six months after multi-component rehabilitation in patients after an acute cardiac event JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background Although associations between cardiovascular diseases and cognitive impairment are well known, the impact of cognitive performance on the success of patient education as a core component of cardiac rehabilitation remains insufficiently investigated so far. Design Prospective observational study in two inpatient cardiac rehabilitation centres between September 2014 and August 2015 with a follow-up six months after cardiac rehabilitation. Method At admission to and discharge from cardiac rehabilitation, the cognitive performance of 401 patients (54.5 ± 6.3 years, 80% men) following an acute coronary syndrome and/or coronary artery bypass graft was tested using the Montreal Cognitive Assessment. Patients’ disease-related knowledge was determined using a quiz (22 items for medical knowledge and 12 items for healthy lifestyle and behaviour) at both times and at follow-up. The change in knowledge after cardiac rehabilitation was analysed in multivariable regression models. Potentially influencing parameters (e.g. level of education, medication, cardiovascular risk factors, coronary artery bypass graft, comorbidities, exercise capacity) were considered. Results During cardiac rehabilitation, disease-related knowledge was significantly enhanced in both scales. At follow-up, the average level of medical knowledge was significantly reduced, while lifestyle knowledge remained at a stable level. The maintenance of knowledge after cardiac rehabilitation was predominantly predicted by prior knowledge, cognitive performance at discharge from cardiac rehabilitation and, in the case of medical knowledge, by coronary artery bypass graft. Conclusion Patient education in cardiac rehabilitation led to enhanced disease-related knowledge, but the maintenance of this essentially depended on patients’ cognitive performance, especially after coronary artery bypass graft. Therefore, patient education concepts in cardiac rehabilitation should be reconsidered and adjusted as needed. KW - Mild cognitive impairment KW - cardiac rehabilitation KW - patient education KW - coronary artery disease KW - secondary prevention Y1 - 2020 U6 - https://doi.org/10.1177/2047487318791609 SN - 2047-4873 SN - 2047-4881 VL - 26 IS - 1 SP - 46 EP - 55 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Salzwedel, Annett A1 - Haubold, Kathrin A1 - Barnack, Beate A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - Indikatoren der Ergebnisqualität kardiologischer Rehabilitation Ergebnisse einer Delphi-Befragung von Mitgliedern der Deutschen Gesellschaft für Prävention und Rehabilitation von Herz- und Kreislauferkrankungen e. V. (DGPR) JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Ziel der Studie Die vorliegende Untersuchung beinhaltete die explorative Erfassung potenzieller Indikatoren der Ergebnisqualität der kardiologischen Rehabilitation (CR) für Patienten unter 65 Jahren. Methoden In einer 4-stufigen webbasierten Delphi-Befragung (04-07/2016) von in der CR tätigen Ärzten[2] , Psychologen und Sport-/Physiotherapeuten wurden Parameter der körperlichen Leistungsfähigkeit, der Sozialmedizin, der subjektiven Gesundheit und kardiovaskuläre Risikofaktoren hinsichtlich ihrer Eignung als Qualitätsindikator bewertet. Ergebnisse Von 44 vorgegebenen wie auch von den Teilnehmern vorgeschlagenen Parametern wurden 21 Parameter (48%), die Hälfte davon psychosoziale Faktoren, als potenzielle Qualitätsindikatoren ausgewählt, wobei lediglich für das Rauchverhalten, den Blutdruck, das LDL-Cholesterin und die max. Belastbarkeit im Belastungs-EKG ein Konsens (Zustimmung>75% der Befragten) erzielt wurde. Schlussfolgerung Die Wahl der Qualitätsindikatoren durch die Experten erfolgte mehrheitlich mit nur geringer Einigkeit. Eine klinische und wissenschaftliche Evaluierung der gewählten Parameter ist daher zwingend erforderlich. N2 - Objective The present investigation aimed an explorative acquisition of potential performance measures for quantifying the quality of cardiac rehabilitation (CR) for patients under 65 years of age. Methods A 4-level web based Delphi survey of physicians, psychologists, and sports or physiotherapists in CR was conducted from April to July in 2016. The experts assessed several parameters of physical performance, social medicine, subjective health and cardiovascular risk factors regarding their suitability as performance measures of CR. Results Of the 44 predetermined as well as by the participants proposed parameters, 21 parameters (48%) were selected as potential performance measures. Half of these were psychosocial factors. Merely, smoking habits, blood pressure, LDL-cholesterol and maximum capacity on exercise-ECG achieved a consensus (agreement>75% of the respondents). Conclusions The experts’ choice of performance measures was little consistent. Therefore, a clinical investigation and scientific evaluation of the predefined parameters is essential. T2 - Quality Performance Measures in Cardiac RehabilitationResults of a Delphi Survey of Members of the German Society for Prevention and Rehabilitation of Cardiovascular Diseases (DGPR) KW - cardiac rehabilitation KW - quality assurance KW - performance measures KW - outcome KW - expert survey KW - kardiologische Rehabilitation KW - Qualitätsindikatoren KW - Ergebnisqualität KW - Rehabilitationserfolg KW - Expertenbefragung Y1 - 2018 U6 - https://doi.org/10.1055/s-0044-101048 SN - 0034-3536 SN - 1439-1309 VL - 58 IS - 1 SP - 31 EP - 38 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Haupt, T. A1 - Wolschke, M. A1 - Rabe, Sophie A1 - Scholz, I. A1 - Smurawski, A. A1 - Salzwedel, Annett A1 - Thomas, F. A1 - Reich, H. A1 - Völler, Heinz A1 - Liebach, J. A1 - Eichler, Sarah T1 - ReMove-It – Entwicklung einer telemedizinisch assistierten Bewegungstherapie für die Rehabilitation nach Intervention an der unteren Extremität T1 - ReMove-It - Development of telemedicine assisted Movement Therapy for Rehabilitation after lower Extremity Intervention JF - B&G Bewegungstherapie und Gesundheitssport N2 - Knie- und Hüftgelenksarthrose zählen zu den zehn häufigsten Einzeldiagnosen in orthopädischen Praxen. Die Wirksamkeit einer stationären Rehabilitation für Patienten nach Knie- oder Hüft-Totalendoprothese (TEP) ist in mehreren Studien belegt. Dennoch stellt die mittel- und langfristige Nachhaltigkeit zum Erhalt des Therapieerfolges eine große Herausforderung dar. Das Ziel des Projekts ReMove-It ist es, einen Wirksamkeitsnachweis für eintelemedizinisch assistiertes Interventionstraining für Patienten nach einem operativen Eingriff an den unteren Extremitäten zu erbringen. In dem Beitrag wird anhand von Erfahrungsberichten dargestellt, wie das interaktive Übungsprogramm für Knie- und Hüft-TEP-Patienten entwickelt und das telemedizinische Assistenzsystem MeineReha® in den Behandlungsalltag von drei Rehakliniken integriert wurde. Ebenso werden der Aufbau und Ablauf der klinischen Studie dargestellt und das System aus Sicht der beteiligten Ärzte, und Therapeuten bewertet. N2 - Knee and hip joint arthrosis are among the ten most common diagnoses in orthopedic clinics. The effectiveness of inpatient rehabilitation after a total knee or hip replacement has been documented by numerous studies. However, the mid-term and long-term sustainability of a therapeutic success poses a big challenge. The aim of the project ReMove-is to provide a proof of concept for telemedical assisted intervention training for patients after an operation to their lower extremities. This article, based on testimonies, describes how the interactive exercise program for total knee and hip replacement patients was developed and how the telemedical assistance system MeineReha (R) is integrated into the day-to-day treatment of rehabilitation clinics. Similarly, the composition and execution of the clinical study is described and the system evaluated from the view of doctors and therapists. KW - Computer-assisted home training KW - simplicity KW - patient-friendly operation system KW - direct feedback KW - motion analysis KW - communication KW - supervising therapist KW - rehabilitation KW - temporal and spatial independence (flexibility) KW - high self-motivation Y1 - 2017 U6 - https://doi.org/10.1055/s-0043-118139 SN - 1613-0863 SN - 1613-3269 VL - 33 IS - 5 SP - 221 EP - 226 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Reibis, Rona Katharina A1 - Salzwedel, Annett A1 - Abreu, Ana A1 - Corra, Ugo A1 - Davos, Constantinos A1 - Döhner, Wolfram A1 - Doherty, Patrick A1 - Frederix, Ines A1 - Hansen, Dominique A1 - Iliou, Marie Christine A1 - Vigorito, Carlo A1 - Völler, Heinz T1 - The importance of return to work BT - How to achieve optimal reintegration in ACS patients JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - The vocational reintegration of patients after an acute coronary syndrome is a crucial step towards complete convalescence from the social as well as the individual point of view. Return to work rates are determined by medical parameters such as left ventricular function, residual ischaemia and heart rhythm stability, as well as by occupational requirement profile such as blue or white collar work, night shifts and the ability to commute (which is, in part, determined by physical fitness). Psychosocial factors including depression, self-perceived health situation and pre-existing cognitive impairment determine the reintegration rate to a significant extent. Patients at risk of poor vocational outcomes should be identified in the early period of rehabilitation to avoid a reintegration failure and to prevent socio-professional exclusion with adverse psychological and financial consequences. A comprehensive healthcare pathway of acute coronary syndrome patients is initiated by cardiac rehabilitation, which includes specific algorithms and assessment tools for risk stratification and occupational restitution. As the first in its kind, this review addresses determinants and legal aspects of reintegration of patients experiencing an acute coronary syndrome, and offers practical advice on reintegration strategies particularly for vulnerable patients. It presents different approaches and scientific findings in the European countries and serves as a recommendation for action. KW - Return to work KW - acute coronary syndrome KW - predictors KW - pension insurance Y1 - 2019 U6 - https://doi.org/10.1177/2047487319839263 SN - 2047-4873 SN - 2047-4881 VL - 26 IS - 13 SP - 1358 EP - 1369 PB - Sage Publ. CY - London ER - TY - GEN A1 - Salzwedel, Annett A1 - Völler, Heinz A1 - Reibis, Rona Katharina T1 - Vocational reintegration in coronary heart disease patients - the holistic approach of the WHO biopsychosocial concept T2 - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology Y1 - 2019 U6 - https://doi.org/10.1177/2047487319850699 SN - 2047-4873 SN - 2047-4881 VL - 26 IS - 13 SP - 1383 EP - 1385 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Salzwedel, Annett A1 - Wegscheider, Karl A1 - Schulz-Behrendt, Claudia A1 - Dörr, Gesine A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - No impact of an extensive social intervention program on return to work and quality of life after acute cardiac event: a cluster-randomized trial in patients with negative occupational prognosis JF - International archives of occupational and environmental health N2 - Objectives To examine the effectiveness of extensive social therapy intervention during inpatient multi-component cardiac rehabilitation (CR) on return to work and quality of life in patients with low probability of work resumption after an acute cardiac event. Methods Patients after acute cardiac event with negative subjective expectations about return to work or unemployment (n = 354) were included and randomized in clusters of 3-6 study participants. Clusters were randomized for social counseling and therapy led by a social worker, six sessions of 60 min each in 3 weeks, or control group (usual care: individual counseling meeting by request). The return to work (RTW) status and change in quality of life (QoL, short form 12: Physical and Mental Component Summary PCS and MCS) 12 months after discharge from inpatient CR were outcome measures. Results The regression model for RTW showed no impact of the intervention (OR 1.1, 95% CI 0.6-2.1, P = 0.79; n = 263). Predictors were unemployment prior to CR as well as higher anxiety values at discharge from CR. Likewise, QoL was not improved by social therapy (linear mixed model: Delta PCS 0.3, 95% CI - 1.9 to 2.5; P = 0.77; n = 177; Delta MCS 0.7, 95% CI - 1.9 to 3.3; P = 0.58; n = 215). Conclusions In comparison to usual care, an intensive program of social support for patients during inpatient cardiac rehabilitation after an acute cardiac event had no additional impact on either the rate of resuming work or quality of life. KW - Social work KW - Cardiac rehabilitation KW - Return to work KW - Quality of life KW - Acute coronary syndrome KW - RCT Y1 - 2019 U6 - https://doi.org/10.1007/s00420-019-01450-3 SN - 0340-0131 SN - 1432-1246 VL - 92 IS - 8 SP - 1109 EP - 1120 PB - Springer CY - New York ER - TY - JOUR A1 - Salzwedel, Annett A1 - Reibis, Rona Katharina A1 - Heidler, Maria-Dorothea A1 - Wegscheider, Karl A1 - Völler, Heinz T1 - Determinants of Return to Work After Multicomponent Cardiac Rehabilitation JF - Archives of Physical Medicine and Rehabilitation N2 - Objectives: To explore predictors of return to work in patients after acute coronary syndrome and coronary artery bypass grafting, taking into account cognitive performance, depression, physical capacity, and self-assessment of the occupational prognosis. Design: Observational, prospective, bicentric. Setting: Postacute 3-week inpatient cardiac rehabilitation (CR). Participants: Patients (N=401) <65 years of age (mean 54.5 +/- 6.3y), 80% men. Interventions: Not applicable. Main Outcome Measures: Status of return to work (RTW) 6 months after discharge from CR. Results: The regression model for RTW showed negative associations for depression (odds ratio 0.52 per SD, 95% confidence interval 0.36-0.76, P=.001), age (odds ratio 0.72, 95% confidence interval 0.52-1.00, P=.047), and in particular for a negative subjective occupational prognosis (expected incapacity for work odds ratio 0.19, 95% confidence interval 0.06-0.59, P=.004; unemployment odds ratio 0.08, 95% confidence interval 0.01-0.72, P=.024; retirement odds ratio 0.07, 95% confidence interval 0.01-0.067, P=.021). Positive predictors were employment before the cardiac event (odds ratio 9.66, 95% confidence interval 3.10-30.12, P<.001), capacity to work (fit vs unfit) at discharge from CR (odds ratio 3.15, 95% confidence interval 1.35-7.35, P=.008), and maximum exercise capacity (odds ratio 1.49, 95% confidence interval 1.06-2.11, P=.022). Cognitive performance had no effect. KW - Acute coronary syndrome KW - Cardiac rehabilitation KW - Coronary artery bypass grafting KW - Motivation KW - Rehabilitation KW - Return to work Y1 - 2019 U6 - https://doi.org/10.1016/j.apmr.2019.04.003 SN - 0003-9993 SN - 1532-821X VL - 100 IS - 12 SP - 2399 EP - 2402 PB - Elsevier CY - Philadelphia ER - TY - JOUR A1 - Eichler, Sarah A1 - Völler, Heinz A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Butter, Christian A1 - Harnath, Axel A1 - Salzwedel, Annett T1 - Geriatric or cardiac rehabilitation? BT - Predictors of treatment pathways in advanced age patients after transcatheter aortic valve implantation JF - BMC Cardiovascular Disorders N2 - 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. KW - TAVI KW - Treatment pathways KW - Frailty KW - Geriatric rehabilitation Y1 - 2019 U6 - https://doi.org/10.1186/s12872-020-01452-x SN - 1471-2261 VL - 20 PB - BioMed Central CY - London ER - TY - JOUR A1 - Zoch-Lesniak, Beate A1 - Dobberke, Jeanette A1 - Schlitt, Axel A1 - Bongarth, Christa A1 - Glatz, Johannes A1 - Spörl-Dönch, Sieglinde A1 - Koran, Iryna A1 - Völler, Heinz A1 - Salzwedel, Annett T1 - Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age BT - Results of the Prospective Observational Multicenter Registry OutCaRe JF - Archives of Rehabilitation Research and Clinical Translation N2 - 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. KW - Cardiac rehabilitation KW - Outcome measures KW - Cardiovascular diseases Y1 - 2019 U6 - https://doi.org/10.1016/j.arrct.2020.100043 SN - 2590-1095 VL - 2 PB - Elsevier CY - Amsterdam ER - TY - JOUR A1 - Salzwedel, Annett A1 - Koran, Iryna A1 - Langheim, Eike A1 - Schlitt, Axel A1 - Nothroff, Jörg A1 - Bongarth, Christa A1 - Wrenger, Markus A1 - Sehner, Susanne A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Völler, Heinz T1 - Patient-reported outcomes predict return to work and health-related quality of life six months after cardiac rehabilitation BT - Results from a German multi-centre registry (OutCaRe) JF - PLoS ONE N2 - Background Multi-component cardiac rehabilitation (CR) is performed to achieve an improved prognosis, superior health-related quality of life (HRQL) and occupational resumption through the management of cardiovascular risk factors, as well as improvement of physical performance and patients’ subjective health. Out of a multitude of variables gathered at CR admission and discharge, we aimed to identify predictors of returning to work (RTW) and HRQL 6 months after CR. Design Prospective observational multi-centre study, enrolment in CR between 05/2017 and 05/2018. Method Besides general data (e.g. age, sex, diagnoses), parameters of risk factor management (e.g. smoking, hypertension), physical performance (e.g. maximum exercise capacity, endurance training load, 6-min walking distance) and patient-reported outcome measures (e.g. depression, anxiety, HRQL, subjective well-being, somatic and mental health, pain, lifestyle change motivation, general self-efficacy, pension desire and self-assessment of the occupational prognosis using several questionnaires) were documented at CR admission and discharge. These variables (at both measurement times and as changes during CR) were analysed using multiple linear regression models regarding their predictive value for RTW status and HRQL (SF-12) six months after CR. Results Out of 1262 patients (54±7 years, 77% men), 864 patients (69%) returned to work. Predictors of failed RTW were primarily the desire to receive pension (OR = 0.33, 95% CI: 0.22–0.50) and negative self-assessed occupational prognosis (OR = 0.34, 95% CI: 0.24–0.48) at CR discharge, acute coronary syndrome (OR = 0.64, 95% CI: 0.47–0.88) and comorbid heart failure (OR = 0.51, 95% CI: 0.30–0.87). High educational level, stress at work and physical and mental HRQL were associated with successful RTW. HRQL was determined predominantly by patient-reported outcome measures (e.g. pension desire, self-assessed health prognosis, anxiety, physical/mental HRQL/health, stress, well-being and self-efficacy) rather than by clinical parameters or physical performance. Conclusion Patient-reported outcome measures predominantly influenced return to work and HRQL in patients with heart disease. Therefore, the multi-component CR approach focussing on psychosocial support is crucial for subjective health prognosis and occupational resumption. Y1 - 2020 U6 - https://doi.org/10.1371/journal.pone.0232752 SN - 1932-6203 VL - 15 IS - 5 PB - Plos 1 CY - San Francisco 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 - JOUR A1 - Marx, R. A1 - Philips, H. A1 - Bassenge, D. A1 - Nosper, M. A1 - Roehrig, B. A1 - Linck-Eleftheriadis, S. A1 - Strandt, G. A1 - Salzwedel, Annett A1 - Pabst, F. T1 - Progress of Rehabilitation for Cardiac Patients Depending on the Degree of Self-Sufficiency at Admission JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Zusammenfassung Ziel der Studie: Es existieren kaum Publikationen uber das Rehabilitationsergebnis kardiologischer Patienten unter Berucksichtigung eines erhohten medizinischen, pflegerischen und therapeutischen Versorgungsaufwands (Barthel-Index70). Es war Ziel der Studie, die in einem Zeitraum von 2 Jahren aufgenommen Rehabilitanden (n=387) einer gesetzlichen Krankenkasse, aufgeteilt in jeweils eine Gruppe selbstversorgender und versorgungsaufwandiger Patienten, bezuglich ihrer Unterschiede in dem Rehabilitationsergebnis zu uberprufen. Methodik: In Abhangigkeit des Versorgungsaufwandes wurde das Rehabilitationsergebnis sowie Unterschiede im Verlauf hinsichtlich der korperlichen Leistungsfahigkeit, des emotionalen Status und der Aktivitaten des taglichen Lebens, gemessen an Barthelindex, FIM-Index, HADS-Werten, Komplikationen, Funktionsuntersuchungen, Belastungstests, Rehabilitationsdauer und Entlassungsform, gepruft. Ergebnisse: Die in Hinblick auf medizinischen, pflegerischen und therapeutischen Aufwand versorgungsaufwandigen Patienten waren alter, langer im Krankenhaus und in der Rehabilitation, sie hatten mehr Komplikationen und deutlich mehr Begleiterkrankungen. Sie wurden haufiger ins Akutkrankenhaus verlegt. Sie hatten eine hohere Steigerungsrate der Selbstversorgungsindices und eine relevante Steigerung bei den Belastungstests. Schlussfolgerung: Ein hoher Versorgungsaufwand multimorbider kardiologischer Patienten ist keine Kontraindikation gegen eine Rehabilitation, da auch bei dieser Patientengruppe die tragerspezifischen Rehabilitationsziele erreicht wurden. Abstract Introduction: There are hardly any publications about the outcome of cardiac rehabilitation considering patients with an increased need for medical, nursing and therapeutic care. The aim of this study, which consecutively included n=387 statutory health insurance inpatients over a period of 2 years, was to find out differences in outcome in self-care patients (Barthel index>70) as compared to patients with a need for complex care (Barthel index70). Methods: Rehabilitation outcomes concerning physical capacity, emotional status and activities of daily living as measured by Barthel index, FIM index, HADS, clinical complications, exercise test, duration of rehabilitation and form of dismission were analyzed and compared between both groups. Results: The inpatients with a Barthel index 70 at admission were older, had a longer stay in hospital and in rehabilitation, developed more complications and more often suffered from concomitant diseases. They were readmitted to hospital more often. They showed a comparatively higher increase in indices of self-care and a significant increase in physical performance tests. Conclusion: Higher medical care expenses of multimorbid cardiac inpatients are no contraindication against rehabilitation, because even in this group the specific rehabilitation aims of the healthcare payers can be reached. KW - kardiologische Rehabilitation KW - Rehabilitationspotenzial KW - Qualitatssicherung KW - Versorgungsaufwandig KW - Multimorbiditat KW - cardiac rehabilitation KW - rehabilitation potential KW - quality assurance KW - complex care KW - multimorbidity Y1 - 2016 U6 - https://doi.org/10.1055/s-0041-111524 SN - 0034-3536 SN - 1439-1309 VL - 55 SP - 34 EP - 39 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Reibis, Rona Katharina A1 - Salzwedel, Annett A1 - Buhlert, Hermann A1 - Wegscheider, Karl A1 - Eichler, Sarah A1 - Völler, Heinz T1 - Impact of training methods and patient characteristics on exercise capacity in patients in cardiovascular rehabilitation JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Aim We aimed to identify patient characteristics and comorbidities that correlate with the initial exercise capacity of cardiac rehabilitation (CR) patients and to study the significance of patient characteristics, comorbidities and training methods for training achievements and final fitness of CR patients. Methods We studied 557 consecutive patients (51.76.9 years; 87.9% men) admitted to a three-week in-patient CR. Cardiopulmonary exercise testing (CPX) was performed at discharge. Exercise capacity (watts) at entry, gain in training volume and final physical fitness (assessed by peak O-2 utilization (VO2peak) were analysed using analysis of covariance (ANCOVA) models. Results Mean training intensity was 90.7 +/- 9.7% of maximum heart rate (81% continuous/19% interval training, 64% additional strength training). A total of 12.2 +/- 2.6 bicycle exercise training sessions were performed. Increase of training volume by an average of more than 100% was achieved (difference end/beginning of CR: 784 +/- 623 wattsxmin). In the multivariate model the gain in training volume was significantly associated with smoking, age and exercise capacity at entry of CR. The physical fitness level achieved at discharge from CR as assessed by VO2peak was mainly dependent on age, but also on various factors related to training, namely exercise capacity at entry, increase of training volume and training method. Conclusion CR patients were trained in line with current guidelines with moderate-to-high intensity and reached a considerable increase of their training volume. The physical fitness level achieved at discharge from CR depended on various factors associated with training, which supports the recommendation that CR should be offered to all cardiac patients. KW - Cardiac rehabilitation KW - exercise tests KW - cardiorespiratory fitness KW - multivariate modelling Y1 - 2016 U6 - https://doi.org/10.1177/2047487315600815 SN - 2047-4873 SN - 2047-4881 VL - 23 SP - 452 EP - 459 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Salzwedel, Annett A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Eichler, Sarah A1 - Buhlert, Hermann A1 - Kaminski, Stefan A1 - Völler, Heinz T1 - Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation JF - Clinical research in cardiology : official journal of the German Cardiac Society. N2 - Return to work (RTW) is a pivotal goal of cardiac rehabilitation (CR) in patients after acute cardiac event. We aimed to evaluate cardiopulmonary exercise testing (CPX) parameters as predictors for RTW at discharge after CR. We analyzed data from a registry of 489 working-age patients (51.5 +/- A 6.9 years, 87.9 % men) who had undergone inpatient CR predominantly after percutaneous coronary intervention (PCI 62.6 %), coronary artery bypass graft (CABG 17.2 %), or heart valve replacement (9.0 %). Sociodemographic and clinical parameters, noninvasive cardiac diagnostic (2D echo, exercise ECG, 6MWT) and psychodiagnostic screening data, as well as CPX findings, were merged with RTW data from the German statutory pension insurance program and analyzed for prognostic ability. During a mean follow-up of 26.5 +/- A 11.9 months, 373 (76.3 %) patients returned to work, 116 (23.7 %) did not, and 60 (12.3 %) retired. After adjustment for covariates, elective CABG (HR 0.68, 95 % CI 0.47-0.98; p = 0.036) and work intensity (per level HR 0.83, 95 % CI 0.73-0.93; p = 0.002) were negatively associated with the probability of RTW. Exercise capacity in CPX (in Watts) and the VE/VCO2-slope had independent prognostic significance for RTW. A higher work load increased (HR 1.17, 95 % CI 1.02-1.35; p = 0.028) the probability of RTW, while a higher VE/VCO2 slope decreased (HR 0.85, 95 % CI 0.76-0.96; p = 0.009) it. CPX also had prognostic value for retirement: the likelihood of retirement decreased with increasing exercise capacity (HR 0.50, 95 % CI 0.30-0.82; p = 0.006). KW - Cardiac rehabilitation KW - Prognosis KW - Exercise capacity KW - Coronary disease KW - Social medicine Y1 - 2016 U6 - https://doi.org/10.1007/s00392-015-0917-1 SN - 1861-0684 SN - 1861-0692 VL - 105 SP - 257 EP - 267 PB - Springer CY - Heidelberg ER - TY - GEN A1 - Reibis, R. A1 - Kuehl, U. A1 - Salzwedel, Annett A1 - Rasawieh, M. A1 - Wegschweider, K. A1 - Völler, Heinz T1 - Return to work after endomyocardial biopsy in patients with suspected viral myocarditis T2 - European heart journal Y1 - 2016 SN - 0195-668X SN - 1522-9645 VL - 37 SP - 728 EP - 728 PB - Oxford Univ. Press CY - Oxford 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 - GEN A1 - Völler, Heinz A1 - Heidler, Maria-Dorothea A1 - Rieck, Angelika A1 - Schikora, Martin A1 - Haubold, Kathrin A1 - Joebges, Michael A1 - Salzwedel, Annett T1 - Prevalence of mild cognitive impairment in patients after an acute coronary syndrome in cardiac rehabilitation T2 - European heart journal Y1 - 2016 SN - 0195-668X SN - 1522-9645 VL - 37 SP - 543 EP - 543 PB - Oxford Univ. Press CY - Oxford ER - TY - GEN A1 - Völler, Heinz A1 - Eichler, Sarah A1 - Harnath, A. A1 - Nothroff, Jörg A1 - Butter, Christian A1 - Schikora, Martin A1 - Wegscheider, Karl A1 - Salzwedel, Annett T1 - Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation (TAVI) - course of functioning and quality of life T2 - European heart journal Y1 - 2016 SN - 0195-668X SN - 1522-9645 VL - 37 SP - 542 EP - 542 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Rauch, Bernhard A1 - Davos, Constantinos H. A1 - Doherty, Patrick A1 - Saure, Daniel A1 - Metzendorf, Maria-Inti A1 - Salzwedel, Annett A1 - Völler, Heinz A1 - Jensen, Katrin A1 - Schmid, Jean-Paul T1 - The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS) JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. Design Structured review and meta-analysis. Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later. Results Out of n=18,534 abstracts, 25 studies were identified for final evaluation (RCT: n=1; pCCS: n=7; rCCS: n=17), including n=219,702 patients (after ACS: n=46,338; after CABG: n=14,583; mixed populations: n=158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations. Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation. KW - Rehabilitation KW - acute coronary syndrome KW - coronary bypass grafting KW - coronary artery disease KW - mortality KW - hospital readmission Y1 - 2016 U6 - https://doi.org/10.1177/2047487316671181 SN - 2047-4873 SN - 2047-4881 VL - 23 SP - 1914 EP - 1939 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Eichler, Sarah A1 - Salzwedel, Annett A1 - Rabe, Sophie A1 - Mueller, Steffen A1 - Mayer, Frank A1 - Wochatz, Monique A1 - Hadzic, Miralem A1 - John, Michael A1 - Wegscheider, Karl A1 - Völler, Heinz T1 - The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement BT - Randomized Controlled Trial JF - JMIR Rehabilitation and Assistive Technologies N2 - 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. KW - telerehabilitation KW - home-based KW - total hip replacement KW - total knee replacement KW - exercise therapy KW - aftercare KW - rehabilitation Y1 - 2019 U6 - https://doi.org/10.2196/14236 SN - 2369-2529 VL - 6 IS - 2 PB - jmir rehab CY - Toronto ER - TY - JOUR A1 - Salzwedel, Annett A1 - Reibis, Rona Katharina A1 - Hadzic, Miralem A1 - Buhlert, Hermann A1 - Völler, Heinz T1 - Patients’ expectations of returning to work, co-morbid disorders and work capacity at discharge from cardiac rehabilitation JF - Vascular Health and Risk Management N2 - 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, Würzburger 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. KW - cardiac rehabilitation KW - return to work KW - work capacity KW - negative expectation KW - occupational prognosis Y1 - 2019 U6 - https://doi.org/10.2147/VHRM.S216039 SN - 1176-6344 SN - 1178-2048 VL - 15 SP - 301 EP - 308 PB - Dove Medical Press CY - Albany, Auckland ER - TY - JOUR A1 - Reibis, Rona Katharina A1 - Kühl, Uwe A1 - Salzwedel, Annett A1 - Rasawieh, Mortesa A1 - Eichler, Sarah A1 - Wegscheider, Karl A1 - Völler, Heinz T1 - Return to work in heart failure patients with suspected viral myocarditis JF - SAGE Open Medicine N2 - Background: Endomyocardial biopsy is considered as the gold standard in patients with suspected myocarditis. We aimed to evaluate the impact of bioptic findings on prediction of successful return to work. Methods: In 1153 patients (48.9 ± 12.4 years, 66.2% male), who were hospitalized due to symptoms of left heart failure between 2005 and 2012, an endomyocardial biopsy was performed. Routine clinical and laboratory data, sociodemographic parameters, and noninvasive and invasive cardiac variables including endomyocardial biopsy were registered. Data were linked with return to work data from the German statutory pension insurance program and analyzed by Cox regression. Results: A total of 220 patients had a complete data set of hospital and insurance information. Three quarters of patients were virus-positive (54.2% parvovirus B19, other or mixed infection 16.7%). Mean invasive left ventricular ejection fraction was 47.1% ± 18.6% (left ventricular ejection fraction <45% in 46.3%). Return to work was achieved after a mean interval of 168.8 ± 347.7 days in 220 patients (after 6, 12, and 24 months in 61.3%, 72.2%, and 76.4%). In multivariate regression analysis, only age (per 10 years, hazard ratio, 1.27; 95% confidence interval, 1.10–1.46; p = 0.001) and left ventricular ejection fraction (per 5% increase, hazard ratio, 1.07; 95% confidence interval, 1.03–1.12; p = 0.002) were associated with increased, elevated work intensity (heavy vs light, congestive heart failure, 0.58; 95% confidence interval, 0.34–0.99; p < 0.049) with decreased probability of return to work. None of the endomyocardial biopsy–derived parameters was significantly associated with return to work in the total group as well as in the subgroup of patients with biopsy-proven myocarditis. Conclusion: Added to established predictors, bioptic data demonstrated no additional impact for return to work probability. Thus, socio-medical evaluation of patients with suspected myocarditis furthermore remains an individually oriented process based primarily on clinical and functional parameters. KW - Return to work KW - rehabilitation KW - endomyocardial biopsy KW - prediction KW - myocarditis Y1 - 2017 U6 - https://doi.org/10.1177/2050312117744978 SN - 2050-3121 VL - 5 PB - Sage CY - Thousand Oaks, Calif. 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 - Salzwedel, Annett A1 - Rabe, Sophie A1 - Zahn, Thomas A1 - Neuwirth, Julia A1 - Eichler, Sarah A1 - Haubold, Kathrin A1 - Wachholz, Anne A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - User Interest in Digital Health Technologies to Encourage Physical Activity BT - Results of a Survey in Students and Staff of a German University JF - JMIR. Mhealth & Uhealth N2 - Background: Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. Objective: The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. Methods: We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. Results: A total of 1217 students (67.30%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1% (340/485) of employees and 52.67% (641/1217) of students. Within these groups, 53.2% (341/641 students) and 44.2% (150/340 employees)—independent of age, sex, body mass index (BMI), and level of education or professional qualification—indicated an interest in mHealth fitness apps. Conclusions: Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle. KW - physical activity KW - telemedicine KW - primary prevention KW - healthy lifestyle Y1 - 2017 U6 - https://doi.org/10.2196/mhealth.7192 VL - 5 IS - 4 PB - JMIR Publications CY - Toronto ER - TY - JOUR A1 - Röhrig, Bernd A1 - Salzwedel, Annett A1 - Linck-Eleftheriadis, Sigrid A1 - Völler, Heinz A1 - Nosper, Manfred T1 - Outcome Based Center Comparisons in Inpatient Cardiac Rehabilitation Results from the EVA-Reha (R) Cardiology Project JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Background: So far, for center comparisons in inpatient cardiac rehabilitation (CR), the objective outcome quality was neglected because of challenges in quantifying the overall success of CR. In this article, a multifactorial benchmark model measuring the individual rehabilitation success is presented. Methods: In 21 rehabilitation centers, 5 123 patients were consecutively enrolled between 01/2010 and 12/2012 in the prospective multicenter registry EVA-Reha (R) Cardiology. Changes in 13 indicators in the areas cardiovascular risk factors, physical performance and subjective health during rehabilitation were evaluated according to levels of severity. Changes were only rated for patients who needed a medical intervention. Additionally, the changes had to be clinically relevant. Therefore Minimal Important Differences (MID) were predefined. Ratings were combined to a single score, the multiple outcome criterion (MEK). Results: The MEK was determined for all patients (71.7 +/- 7.4 years, 76.9 % men) and consisted of an average of 5.6 indicators. After risk adjustment for sociodemographic and clinical baseline parameters, MEK was used for center ranking. In addition, individual results of indicators were compared with means of all study sites. Conclusion: With the method presented here, the outcome quality can be quantified and outcome-based comparisons of providers can be made. KW - outcome quality KW - quality assurance KW - cardiac rehabilitation KW - benchmark KW - profiling Y1 - 2015 U6 - https://doi.org/10.1055/s-0034-1395556 SN - 0034-3536 SN - 1439-1309 VL - 54 IS - 1 SP - 45 EP - 52 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Völler, Heinz A1 - Salzwedel, Annett A1 - Nitardy, Aischa A1 - Buhlert, Hermann A1 - Treszl, Andras A1 - Wegscheider, Karl T1 - Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve implantation JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background Transcatheter aortic-valve implantation (TAVI) is an established alternative therapy in patients with severe aortic stenosis and a high surgical risk. Despite a rapid growth in its use, very few data exist about the efficacy of cardiac rehabilitation (CR) in these patients. We assessed the hypothesis that patients after TAVI benefit from CR, compared to patients after surgical aortic-valve replacement (sAVR). Methods From September 2009 to August 2011, 442 consecutive patients after TAVI (n=76) or sAVR (n=366) were referred to a 3-week CR. Data regarding patient characteristics as well as changes of functional (6-min walk test. 6-MWT), bicycle exercise test), and emotional status (Hospital Anxiety and Depression Scale) were retrospectively evaluated and compared between groups after propensity score adjustment. Results Patients after TAVI were significantly older (p<0.001), more female (p<0.001), and had more often coronary artery disease (p=0.027), renal failure (p=0.012) and a pacemaker (p=0.032). During CR, distance in 6-MWT (both groups p0.001) and exercise capacity (sAVR p0.001, TAVI p0.05) significantly increased in both groups. Only patients after sAVR demonstrated a significant reduction in anxiety and depression (p0.001). After propensity scores adjustment, changes were not significantly different between sAVR and TAVI, with the exception of 6-MWT (p=0.004). Conclusions Patients after TAVI benefit from cardiac rehabilitation despite their older age and comorbidities. CR is a helpful tool to maintain independency for daily life activities and participation in socio-cultural life. KW - Cardiac rehabilitation KW - emotional status KW - functional capacity KW - surgical aortic valve replacement (sAVR) KW - transcatheter aortic valve implantation (TAVI) Y1 - 2015 U6 - https://doi.org/10.1177/2047487314526072 SN - 2047-4873 SN - 2047-4881 VL - 22 IS - 5 SP - 568 EP - 574 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Salzwedel, Annett A1 - Wegscheider, Karl A1 - Herich, Lena A1 - Rieck, Angelika A1 - Strandt, Gert A1 - Völler, Heinz T1 - Impact of clinical and sociodemographic patient characteristics on the outcome of cardiac rehabilitation in older patients JF - Aging clinical and experimental research N2 - Background Cardiac rehabilitation (CR) seeks to simultaneously improve several outcome parameters related to patient risk factors, exercise capacity and subjective health. A single score, the multiple outcome criterion (MOC), comprised of alterations in 13 outcome variables was used to measure the overall success of CR in an older population. As this success depends on the older patient's characteristics at the time of admission to CR, we attempted to determine the most important influences. Methods The impact of baseline characteristics on the success of CR, measured by MOC, was analysed using a mixed model for 1,220 older patients (70.9 +/- A 7.0 years, 78.3 % men) who enrolled in 12 CR clinics. A multitude of potentially influential baseline patient characteristics was considered including sociodemographic variables, comorbidity, duration of hospital stay, exercise capacity, cardiovascular risk factors, emotional status, and laboratory and echocardiographic data. Results Overall, CR was successful, as indicated by the mean value of the MOC (0.6 +/- A 0.45; min -1.0, max 2.0; positive values denoting improvement, negative ones deterioration). Examples of association with negative MOC values included smoking (MOC -0.15, p < 0.001), female gender (MOC -0.07, p = 0.049), and a longer hospital stay (MOC -0.03, p = 0.03). An example of association with positive MOC value was depression score (MOC 0.06, p = 0.003). Further associations included maximal exercise capacity, blood pressure, heart rate and the rehabilitation centre attended. Conclusion Our results emphasize the necessity to take into consideration baseline characteristics when evaluating the success of CR and setting treatment targets for older patients. KW - Cardiac rehabilitation KW - Composite outcome measure KW - Predictors KW - Rehabilitation success KW - Older patients Y1 - 2015 U6 - https://doi.org/10.1007/s40520-014-0283-2 SN - 1594-0667 SN - 1720-8319 VL - 27 IS - 3 SP - 315 EP - 321 PB - Springer CY - New York ER - TY - CHAP A1 - Völler, Heinz A1 - Eichler, Sarah A1 - Harnath, Axel A1 - Kamke, Wolfram A1 - Butter, Christian A1 - Kraehe, Mathias A1 - Schikora, Martin A1 - Jachczyk, J. A1 - Salzwedel, Annett T1 - Case management in patients after TAVI: are frailty and exercise capacitiy predictors for decision making process? T2 - European heart journal Y1 - 2015 SN - 0195-668X SN - 1522-9645 VL - 36 SP - 635 EP - 635 PB - Oxford Univ. Press CY - Oxford ER - TY - CHAP A1 - Völler, Heinz A1 - Salzwedel, Annett A1 - Reibis, Rona Katharina A1 - Eichler, Sarah A1 - Buhlert, Hermann A1 - Kaminski, Stefan A1 - Wegscheider, Karl T1 - Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation T2 - European heart journal Y1 - 2015 SN - 0195-668X SN - 1522-9645 VL - 36 SP - 635 EP - 636 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Salzwedel, Annett A1 - Rieck, Angelika A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - Routine initial exercise stress testing for treatment stratification in comprehensive cardiac rehabilitation JF - International journal of rehabilitation research N2 - 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. KW - disease severity KW - exercise stress test KW - multimodal cardiac rehabilitation KW - rehabilitation outcome KW - therapy volume Y1 - 2015 U6 - https://doi.org/10.1097/MRR.0000000000000133 SN - 0342-5282 SN - 1473-5660 VL - 38 IS - 4 SP - 344 EP - 349 PB - Lippincott Williams & Wilkins CY - Philadelphia ER - TY - JOUR A1 - Roehrig, B. A1 - Nosper, M. A1 - Linck-Eleftheriadis, S. A1 - Strandt, G. A1 - Salzwedel, Annett A1 - Völler, Heinz T1 - Method of the assessment of patients Outcome in cardiac rehabilitation by means of quality indicators - a description of the method JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Introduction: Cardiac rehabilitation is designed for patients suffering from cardiovascular diseases or functional disabilities. The aim of a cardiac rehabilitation is to improve overall physical health, psychological well-being, physical function, the ability to participate in social life and help patients to change their habits. Regarding the heterogeneity of these aims measuring of the effect of cardiac rehabilitation is still a challenge. This study recommends a concept to assess the effects of cardiac rehabilitation regarding the individual change of relevant quality indicators. Methods: With EVA-Reha; cardiac rehabilitation the Medical Advisory Service of Statutory Health Insurance Funds in Rhineland-Palatinate, Alzey (MDK Rheinland-Pfalz) developed a software to collect data set including sociodemographic and diagnostic data and also the results of specific assessments. The project was funded by the Techniker Krankenkasse, Hamburg, and supported by participating rehabilitation centers. From 01. July 2010 to 30. June 2011 1309 patients (age 71.5 years, 76.1% men) from 13 rehabilitation centers were consecutively enrolled. 13 quality indicators in 3 scales were developed for evaluation of cardiac rehabilitation: 1) cardiovascular risk factors (blood pressure, LDL cholesterol, triglycerides), 2) exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure [NYHA classification], and angina pectoris [CCS classification]) and 3) subjective health (IRES-24: pain, somatic health, psychological wellbeing and depression as well as anxiety on the HADS). The study was prospective; data of patients were assessed at entry and discharge of rehabilitation. To measure the success of rehabilitation each parameter was graded in severity classes at entry and discharge. For each of the 13 quality indicators changes of severity class were rated in a rating matrix. For indicators without a requirement for medical care neither at entry nor at discharge no rating was performed. Results: The grading into severity classes as well as the minimal important differences were given for the 13 quality indicators. The result of rehabilitation can be demonstrated in suitable form by means of rating of the 13 quality indicators according to a clinical population. The rating model differs well between clinically changed and unchanged patients for the quality indicators. Conclusion: The result of cardiac rehabilitation can be assessed with 13 quality indicators measured at entry and discharge of the rehabilitation program. If a change into a more favorable category at the end of rehabilitation could be achieved it was counted as a success. The 13 quality indicators can be used to assess the individual result as well as the result of a population - e.g. all patients of a clinic in a specific time period. In addition, the assessment and rating of relevant quality indicators can be used for comparisons of rehabilitation centers. KW - cardiac rehabilitation KW - quality indicator KW - outcome KW - success KW - quality management Y1 - 2014 U6 - https://doi.org/10.1055/s-0033-1341457 SN - 0034-3536 SN - 1439-1309 VL - 53 IS - 1 SP - 31 EP - 37 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Salzwedel, Annett A1 - Nosper, Manfred A1 - Roehrig, Bernd A1 - Linck-Eleftheriadis, Sigrid A1 - Strandt, Gert A1 - Völler, Heinz T1 - Outcome quality of in-patient cardiac rehabilitation in elderly patients - identification of relevant parameters JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - 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. KW - Cardiac rehabilitation KW - quality management KW - outcome measures Y1 - 2014 U6 - https://doi.org/10.1177/2047487312469475 SN - 2047-4873 SN - 2047-4881 VL - 21 IS - 2 SP - 172 EP - 180 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Ringwald, Juergen A1 - Lehmann, Marina A1 - Niemeyer, Nicole A1 - Seifert, Isabel A1 - Daubmann, Anne A1 - Wegscheider, Karl A1 - Salzwedel, Annett A1 - Luxembourg, Beate A1 - Eckstein, Reinhold A1 - Völler, Heinz T1 - Travel habits and complications in patients treated with vitamin K antagonists: A cross sectional analysis JF - Travel medicine and infectious disease N2 - 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. KW - Vitamin k-antagonists KW - Oral anticoagulation KW - Travel KW - Patient self-management Y1 - 2014 U6 - https://doi.org/10.1016/j.tmaid.2014.02.006 SN - 1477-8939 SN - 1873-0442 VL - 12 IS - 3 SP - 258 EP - 263 PB - Elsevier 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 - CHAP A1 - Völler, Heinz A1 - Salzwedel, Annett A1 - Reibis, Rona Katharina A1 - Kaminski, S. A1 - Buhlert, Hermann A1 - Eichler, Sarah A1 - Wegscheider, Karl T1 - Age and fitness level are strongest limitations of exercise capacity during inpatient cardiac rehabilitation T2 - European heart journal Y1 - 2014 SN - 0195-668X SN - 1522-9645 VL - 35 SP - 899 EP - 899 PB - Oxford Univ. Press CY - Oxford ER - TY - CHAP A1 - Nitardy, Aischa A1 - Salzwedel, Annett A1 - Wegscheider, Karl A1 - Jawari, Amir A1 - Buhlert, Hermann A1 - Völler, Heinz T1 - Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve replacement T2 - Circulation : an American Heart Association journal KW - Cardiac rehabilitation KW - TAVI KW - Transcatheter Aortic Valve Implantation KW - Aortic valve KW - Exercise tests Y1 - 2012 SN - 0009-7322 SN - 1524-4539 VL - 126 IS - 21 PB - Lippincott Williams & Wilkins CY - Philadelphia ER - TY - JOUR A1 - Salzwedel, Annett A1 - Heidler, Maria-Dorothea A1 - Haubold, Kathrin A1 - Schikora, Martin A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Jöbgens, Michael A1 - Völler, Heinz T1 - Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation JF - Vascular Health and Risk Management N2 - Introduction: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. Methods: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. Results: At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95% confidence interval 1.07–2.79; P = 0.03) and heavy workloads (OR 2.18, 95% confidence interval 1.42–3.36; P < 0.01). Conclusion: The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE. KW - cardiac rehabilitation KW - cognitive impairment KW - prevalence KW - acute coronary event KW - patient education Y1 - 2017 U6 - https://doi.org/10.2147/VHRM.S121086 SN - 1176-6344 SN - 1178-2048 VL - 13 SP - 55 EP - 60 PB - Dove Medical Press Ltd CY - Albany, Auckland ER -