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 - Mainka, Stefan A1 - Wissel, Jörg A1 - Völler, Heinz A1 - Evers, Stefan T1 - The Use of Rhythmic Auditory Stimulation to Optimize Treadmill Training for Stroke Patients BT - a randomized controlled trial JF - Frontiers in Neurology N2 - The use of functional music in gait training termed rhythmic auditory stimulation (RAS) and treadmill training (TT) have both been shown to be effective in stroke patients (SP). The combination of RAS and treadmill training (RAS-TT) has not been clinically evaluated to date. The aim of the study was to evaluate the efficacy of RAS-TT on functional gait in SR The protocol followed the design of an explorative study with a rater-blinded three arm prospective randomized controlled parallel group design. Forty-five independently walking SP with a hemiparesis of the lower limb or an unsafe and asymmetrical walking pattern were recruited. RAS-TT was carried out over 4 weeks with TT and neurodevelopmental treatment based on Bobath approach (NDT) serving as control interventions. For RAS-TT functional music was adjusted individually while walking on the treadmill. Pre and post-assessments consisted of the fast gait speed test (FGS), a gait analysis with the locometre (LOC), 3 min walking time test (3MWT), and an instrumental evaluation of balance (IEB). Raters were blinded to group assignments. An analysis of covariance (ANCOVA) was performed with affiliated measures from pre-assessment and time between stroke and start of study as covariates. Thirty-five participants (mean age 63.6 +/- 8.6 years, mean time between stroke and start of study 42.1 +/- 23.7 days) completed the study (11 RAS-TT, 13 TT, 11 NDT). Significant group differences occurred in the FGS for adjusted post-measures in gait velocity [F-(2,F- (34)) = 3.864, p = 0.032; partial eta(2) = 0.205] and cadence [F-(2,F- 34) = 7.656, p = 0.002; partial eta(2) = 0.338]. Group contrasts showed significantly higher values for RAS-TT. Stride length results did not vary between the groups. LOC, 3MWT, and IEB did not indicate group differences. One patient was withdrawn from TT because of pain in one arm. The study provides first evidence for a higher efficacy of RAS-TT in comparison to the standard approaches TT and NDT in restoring functional gait in SP. The results support the implementation of functional music in neurological gait rehabilitation and its use in combination with treadmill training. KW - stroke rehabilitation KW - exercise movement techniques KW - music therapy KW - music KW - gait Y1 - 2018 U6 - https://doi.org/10.3389/fneur.2018.00755 SN - 1664-2295 VL - 9 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Hansen, Dominique A1 - Abreu, Ana A1 - Doherty, Patrick A1 - Völler, Heinz T1 - Dynamic strength training intensity in cardiovascular rehabilitation: is it time to reconsider clinical practice? A systematic review JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - When added to endurance training, dynamic strength training leads to significantly greater improvements in peripheral muscle strength and power output in patients with cardiovascular disease, which may be relevant to enhance the patient’s prognosis. As a result, dynamic strength training is recommended in the rehabilitative treatment of many different cardiovascular diseases. However, what strength training intensity should be selected remains under intense debate. Evidence is nonetheless emerging that high-intensity strength training (≥70% of one-repetition maximum) is more effective to increase acutely myofibrillar protein synthesis, cause neural adaptations and, in the long term, increase muscle strength, when compared to low-intensity strength training. Moreover, multiple studies report that high-intensity strength training causes fewer increments in (intra-)arterial blood pressure and cardiac output, as opposed to low-intensity strength training, thus potentially pointing towards sufficient medical safety for the cardiovascular system. The aim of this systematic review is therefore to discuss this line of evidence, which is in contrast to current clinical practice, and to re-open the debate as to what dynamic strength training intensities should actually be applied. KW - Cardiovascular rehabilitation KW - strength training KW - guidelines Y1 - 2019 U6 - https://doi.org/10.1177/2047487319847003 SN - 2047-4873 SN - 2047-4881 VL - 26 IS - 14 SP - 1483 EP - 1492 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Algharably, Engi A. H. A1 - Bolbrinker, Juliane A1 - Lezius, Susanne A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Völler, Heinz A1 - Kreutz, Reinhold T1 - Uromodulin associates with cardiorenal function in patients with hypertension and cardiovascular disease JF - Journal of hypertension N2 - Objective:Common genetic variants in the gene encoding uromodulin (UMOD) have been associated with renal function, blood pressure (BP) and hypertension. We investigated the associations between an important single nucleotide polymorphism (SNP) in UMOD, that is rs12917707-G>T, and estimated glomerular filtration rate (eGFR), BP and cardiac organ damage as determined by echocardiography in patients with arterial hypertension.Methods:A cohort of 1218 treated high-risk patients (mean age 58.5 years, 83% men) with documented cardiovascular disease (81% with coronary heart disease) was analysed.Results:The mean values for 24-h SBP and DBP were 124.714.7 and 73.9 +/- 9.4mmHg; mean eGFR was 77.5 +/- 18.3ml/min per 1.73m(2), mean left ventricular ejection fraction was 59.3 +/- 9.9% and mean left ventricular mass index in men and women was 53.9 +/- 23.2 and 54.9 +/- 23.7g/m(2.7) with 50.4% of patients having left ventricular hypertrophy. A significant association between rs12917707 and eGFR was observed with T-allele carriers showing significantly higher eGFR values (+2.6ml/min per 1.73m(2), P=0.006) than noncarriers. This SNP associated also with left atrial diameter (P=0.007); homozygous carriers of the T-allele had smaller left atrial diameter (-1.5mm) than other genotype groups (P=0.040). No significant associations between rs12917707 and other cardiac or BP phenotypes were observed.Conclusions:These findings extend the previously documented role of UMOD for renal function also to treated high-risk patients with arterial hypertension and reveal a novel association with left atrial remodelling and thus a potential cardiorenal link modulated by UMOD. KW - blood pressure KW - cardiovascular complications KW - chronic kidney disease KW - genetics KW - hypertension KW - kidney function KW - organ damage KW - Tamm-Horsfall protein Y1 - 2017 U6 - https://doi.org/10.1097/HJH.0000000000001432 SN - 0263-6352 SN - 1473-5598 VL - 35 SP - 2053 EP - 2058 PB - Lippincott Williams & Wilkins CY - Philadelphia 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 - 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 - 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 - Völler, Heinz A1 - Heyne, Karen T1 - Evaluation of the Accuracy of the LumiraDx INR Test Using Patients in Receipt of Phenprocoumon Anticoagulation Therapy JF - Point of care : the journal of near-patient testing & technology N2 - Background: The LumiraDx INR Test is a new point-of-care diagnostic test designed to analyze fingerstick blood samples. The test was assessed in patients receiving phenprocoumon (NCT04074980). Methods: Venous plasma international normalized ratio (INR) was measured using the LumiraDx INR Test. LumiraDx INR Test-ascertained capillary whole blood INR was compared with venous plasma INR measured using the IL ACL Elite Pro and Sysmex CS-5100 reference instruments. Results: A total of 102 patients receiving phenprocoumon were recruited. The INR results from venous plasma and capillary whole blood that were analyzed on the LumiraDx INR Test correlated well with those measured using the IL ACL Elite Pro (plasma: n = 25, r = 0.981; capillary blood: n = 74, r = 0.949) and the Sysmex CS-5100 (n = 73, r = 0.950). Conclusions: The LumiraDx INR Test showed high accuracy in analyzing venous plasma and capillary whole blood from patients receiving phenprocoumon. KW - international normalized ratio KW - LumiraDx Platform KW - LumiraDx INR Test KW - oral anticoagulation KW - point-of-care KW - vitamin K antagonist therapy KW - phenprocoumon Y1 - 2020 U6 - https://doi.org/10.1097/POC.0000000000000207 SN - 1533-029X SN - 1533-0303 VL - 19 IS - 3 SP - 72 EP - 76 PB - Lippincott Williams & Wilkins CY - Philadelphia 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 - 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 -