Artikel
Development and feasibility testing of a multi-disciplinary care pathway in primary care to improve mobility and participation of older patients with vertigo, dizziness and balance disorders [MobilE-PHY]
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Autoren
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Eva Seckler
- Rosenheim Technical University of Applied Sciences, Department of Research and Development, Rosenheim, Germany
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Verena Kronast
- Technische Hochschule Rosenheim, Forschung und Entwicklung, Rosenheim, Germany
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Petra Bauer
- Rosenheim Technical University of Applied Sciences, Department of Research and Development, Rosenheim, Germany; Rosenheim Technical University of Applied Sciences, Faculty of Applied Health and Social Sciences, Rosenheim, Germany
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Martin Müller
- Rosenheim Technical University of Applied Sciences, Department of Research and Development, Rosenheim, Germany; Rosenheim Technical University of Applied Sciences, Faculty of Applied Health and Social Sciences, Rosenheim, Germany
| Veröffentlicht: | 2. Oktober 2019 |
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Gliederung
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Background and objective: Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community in Germany and are associated with mobility and ADL limitations and participation restrictions. Nevertheless, primary care for affected individuals is still not optimal. It is well established that older patients with VDB benefit from physical therapy, however the conditions of successful integration in routine primary care practice in Germany have not been investigated so far. A promising approach are care pathways (CPWs) that have the potential to reduce treatment errors and to optimize patient outcomes by translating evidence into local practice.
Thus, the objective of this study is to optimize primary care and promote the integration of evidence-based physical therapy for older adults with VDB by developing and feasibility testing a CPW in order to improve participation and mobility.
Methods: The project follows the UK MRC’s guidance for developing and evaluating complex interventions and will cover the first two steps, Development and Feasibility.
In the Development Phase, two systematic reviews were carried out. The first was conducted to identify quality of evidence of physical therapy interventions and related intervention components, which may have the potential to improve mobility and participation in older patients with VDB in primary care. The second aimed to identify barriers and facilitators of successful implementation of CPWs in primary care. To explore the local conditions for implementation, the health professionals and the consumers’ perspective regarding experiences and needs towards accessibility and availability of medical care was discovered by individual semi-structured qualitative interviews with general practitioners (GPs), physical therapists (PTs), nurses working in community care services as well as with patients with VDB. In order to inform the development of an implementation strategy for a feasibility study, we carried out a focus group interview among GPs and PTs to address the issue of multi-professional communication. The project specific CPW and its potential implementation strategies were developed and consented in a multi-disciplinary expert conference in 2018 based on the synthesis of hitherto existing findings of the project.
The feasibility study is a practice-based prospective cohort study to evaluate the developed CPW for older patients with VDB by implementing the intervention in different primary care practices. Data collection at three measurement points by questionnaires (DHI, EQ-5D-5L), performance test (miniBEST) and actigraphy is planned. The feasibility study will be accompanied by a comprehensive process evaluation to investigate the implementation process including recruitment of participants, delivery of the intervention and data collection procedures, to evaluate the acceptability of the interventions and data collection procedures and to examine potential logistical and organizational problems of the study.
Results:
- a diagnostic guideline for GPs
- an educational training for GPs including an update on recent diagnostic and therapeutic developments for VDB in older patients, and an introduction into the use of the diagnostic guideline
- a paper-based algorithm (=CPW) that describes evidence-based treatment and referral options as well as specific time lines for follow-up
- an educational training for local PTs, which cooperate with the GP practices, on specific evidence-based therapeutic techniques
It is expected that the project will result in an acceptable and feasible intervention that has the potential to improve mobility and participation of affected people.
Discussion and practical implications: This project focuses on development and feasibility testing of a CPW as complex intervention in primary care setting to improve mobility and social participation of older individuals with VDB by improving the integration of effective physical therapy interventions.
The results of feasibility study and process evaluation will be used to further develop the intervention and to plan a subsequent main trial to assess effectiveness and safety of the CPW.
Furthermore, the developed intervention might be a blueprint for developing multi-disciplinary CPWs for other health conditions related to mobility limitations and participation restrictions in primary care, such as joint or cardiovascular diseases.
Development and implementation of CPWs has to consider a multitude of barriers by including different perspectives and most of them might be modified by careful intervention and implementation design.
