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[english] Objectives: Interprofessional collaboration leads to an improvement in health care. This call for increased interprofessional collaboration has led to national and international recommendations for interprofessional learning and education. The GMA has taken up this challenge and has implemented a working group on “interprofessional education in the health professions” to address this topic. The terminology used to describe collaboration among the health professions seems to vary and does not reflect any clear consensus. The aim of this paper is to identify the different terms used to describe collaboration between health professions and to analyse their use in German journals.Methods: The terms frequently used to describe collaboration between health professionals were identified and defined. German medical journals were then pragmatically analyzed regarding the use of the terms interprof* and interdiszip*.Results: The German terms for interprofessional and interdisciplinary were not used consistently in the journals reviewed.Conclusion: There seems to be no agreement on the use of terms to describe the collaboration between health professions. Consistent terminology should be used as a basis for promoting collaboration and improving understanding among the parties involved.

Background: The STarT-MSK-Tool is an adaptation of the well established STarT-Back-Tool, used to risk-stratify patients with a wider range of musculoskeletal presentations. Objective: To formally translate and cross-culturally adapt the Keele STarT-MSK risk stratification tool into German (STarT-MSKG) and to establish its reliability and validity. Methods: A formal, multi-step, forward and backward translation approach was used. To assess validity patients aged ≥18 years, with acute, subacute or chronic musculoskeletal presentations in the lumbar spine, hip, knee, shoulder, or neck were included. The prospective cohort was used with initial data collected electronically at the point-of-consultation. Retest and 6-month follow-up questionnaires were sent by email. Test-retest reliability, construct validity, discriminative ability, predictive ability and floor or ceiling effects were analysed using intraclass correlation coefficient, and comparisons with a reference standard (Orebro-Musculoskeletal-Pain-Questionnaire: OMPQ) using correlations, ROC-curves and regression models. Results: The participants' (n = 287) mean age was 47 (SD = 15.8) years, 51% were female, with 48.8% at low, 43.6% at medium, and 7.7% at high risk. With ICC = 0.75 (95% CI 0.69; 0.81) test-retest-reliability was good. Construct validity was good with correlations for the STarT-MSKG-Tool against the OMPQ-Tool of rs = 0.74 (95% CI 0.68, 0.79). The ability of the tool [comparison OMPQ] to predict 6-month pain and disability was acceptable with AUC = 0.77 (95% CI 0.71, 0.83) [OMPQ = 0.74] and 0.76 (95% CI 0.69, 0.82) [OMPQ = 0.72] respectively. However, the explained variance (linear/logistic regression) for predicting 6-month pain (21% [OMPQ = 17%]/logistic = 29%) and disability (linear = 20%:[OMPQ = 19%]/logistic = 26%), whilst being comparable to the existing OMPQ reference standard, fell short of the a priori target of ≥30%. Conclusions: The German version of the STarT-MSK-Tool is a valid instrument for use across multiple musculoskeletal conditions and is availabe for use in clinical practice. Comparison with the OMPQ suggests it is a good alternative. [ABSTRACT FROM AUTHOR]

Stratified care for low back pain (LBP) has been shown to be clinically- and cost-effective in the UK, but its transferability to the German healthcare system is unknown. This study explores LBP patients' perspectives regarding future implementation of stratified care, through in-depth interviews (n = 12). The STarT-Back-Tool was completed by participants prior to interviews. Interview data were analysed using Grounded Theory. The overarching theme identified from the data was 'treatment-success', with subthemes of 'assessment and treatment planning', 'acceptance of the questionnaire' and 'contextual factors'. Patients identified the underlying cause of pain as being of great importance (whereas STarT-Back allocates treatment based on prognosis). The integration of the STarT-Back-Tool in consultations was considered helpful as long as it does not disrupt the therapeutic relationship, and was acceptable if tool results are handled confidentially. Results indicate that for patients to find STarT-Back acceptable, the shift from a focus on identifying a cause of pain and subsequent diagnosis, to prediction-orientated treatment planning, must be made clear. Patient 'buy in' is important for successful uptake of clinical interventions, and findings can help to inform future strategies for implementing STarT-Back in the Germany, as well as having potential implications for transferability to other similar healthcare systems. [ABSTRACT FROM AUTHOR]

The implementation of a bachelor degree in Interprofessional Health Care at the University of Heidelberg, Germany, has fostered the need to evaluate the impact of this innovative programme. The University of the West of England Interprofessional Questionnaire (UWE-IP) was developed for longitudinal evaluation of an interprofessional curriculum. The UWE-IP consists of 35 items in four scales: “Communication and Teamwork Scale,” “Interprofessional Learning Scale,” “Interprofessional Interaction Scale,” and “Interprofessional Relationships Scale.” The UWE-IP was translated to German according to international guidelines. Psychometrics were assessed: reliability of the four scales was tested with Cronbach‘s alpha and confirmatory factor analysis was performed to examine the underlying factor structure. The sample consisted of 326 datasets. Reliability for the scales was between 0.75 and 0.90. The underlying factor structure showed a good fit. We conclude that the German UWE-IP shows good psychometrics and recommend its use for evaluation of interprofessional learning activities. These results add to the body of knowledge on evaluation instruments in interprofessional education. [ABSTRACT FROM PUBLISHER]

A correction to the article "Statistical Inference Through Estimation: Recommendations From the International Society of Physiotherapy Journal Editors," by M. R. Elkins et al, that was published in a 2022 issue is presented.

Over the past five years, the development of interprofessional education programmes has been gaining momentum in Germany fostering the need to evaluate these with appropriate instruments. Instead of developing a new instrument for evaluation purposes, the Readiness for Interprofessional Learning Scale (RIPLS) was chosen, as it is a widespread instrument that has been used in a variety of different educational settings and countries. The German version of the RIPLS was administered in two sites to health professional students in Heidelberg and Freiburg, Germany. Cronbach’s alpha was used to examine internal consistency. Confirmatory factor analysis (CFA) was performed for confirmation of the underlying factor structure of the RIPLS-D. In total, 531 questionnaires were analysed. The instrument showed overall reliability (0.81) and low reliability (< 0.7) in the subscales. The underlying factor structure could not be confirmed. These results contribute further evidence on deficits with the RIPLS. Despite known issues, the RIPLS continues to be translated and applied. This paper highlights the problematic issues in the RIPLS-D and does not recommend its use. [ABSTRACT FROM AUTHOR]

Background and Objective: The STarT Back stratified primary care approach has demonstrated clinical and cost effectiveness in the UK, and is commonly used by General Practitioners (GPs). However, it remains unknown how this approach could be implemented into the German healthcare system. The aim of this study was therefore to explore the views and perceptions of German GPs in respect to using a stratified primary care for low back pain (LBP). Methods: A 90-minute think-tank workshop was conducted with 14 male and five female GPs, during which the STarT-Back-Screening-Tool (SBST) and related research evidence was presented. This was followed by two focus groups, based on a semi-structured interview guideline to identify potential implementation barriers and opportunities. Discussions were audiotaped, transcribed and coded using a content analysis approach. Results: For the three deductively developed main themes, 15 subthemes emerged: (1) application of the SBST, with the following subthemes: which health profession should administer it, patients known to the GP practice, the reason for the GP consultation, scoring the tool, the tool format, and the anticipated impact on GP practice; (2) psychologically informed physiotherapy, with subthemes including: provision by a physiotherapist, anticipated impact, the skills of physiotherapists, management of patients with severe psychosocial problems, referral and remuneration; (3) the management of low-risk patients, with subthemes including: concern about the appropriate advising health professional, information and media, length of consultation, and local exercise venues. Conclusions: The attitudes of GPs towards stratified primary care for LBP indicated positive support for pilot-testing in Germany. However, there were mixed reactions to the ability of German physiotherapists to manage high-risk patients and handle their complex clinical needs. GPs also mentioned practical difficulties in providing extended advice to low-risk patients, which nevertheless could be addressed by involvement of specifically trained medical assistants. [ABSTRACT FROM AUTHOR]

Background: Although evidence based treatment approaches for acute low back pain are available, the prevention of persistent disabling symptoms remains a challenge. Subgroup targeted treatment using adequate screening tools may be a key component for the development of new treatment concepts and is demonstrating promising early evidence. The Keele STarT Back Screening Tool is a practical instrument, developed to stratify patients with back pain according to their risk of persistent disabling symptoms. The aim of this study was to translate and cross-culturally adapt the STarT tool into German (STarT-G) and to investigate its psychometric properties. Methods: The translation was performed according to internationally accepted guidelines and pretested to assess face validity among patients. Psychometric testing was then performed within a cross-sectional cohort of adult patients attending physiotherapy practices for back pain. Patients completed a booklet containing STarT-G and 5 reference standard questionnaires. Measurement properties of the STarT-G were explored including construct validity, floor and ceiling effects, and discriminative abilities. Results: The pretests (n=25) showed good face validity including strong comprehension and acceptability of the STarT-G with only item 5 (fear avoidance) manifesting some ambiguities. The questionnaires were sent to 74 and completed by 50 patients (68%) of whom mean age was 46 (SD 14.5) years and 52% were male. Spearman’s rank correlations for construct validity ranged from 0.35 to 0.56. AUCs for discriminative ability ranged from 0.79 to 0.91. Neither floor nor ceiling effects were observed. There were 28 (57%) participants defined as low risk, 17 (35%) as medium risk, and 4 (8%) as high risk. Conclusion: STarT-G is linguistically valid for German speaking countries. For the selected population, the correlations indicate acceptable validity and AUC showed satisfying discrimination. Data for psychometric properties have to be confirmed in a large scale study with a representative sample. [ABSTRACT FROM AUTHOR]

Background: The implementation of a bachelor degree in “Interprofessional Health Care” at the University of Heidelberg, Germany has fostered the need to evaluate the impact of this innovative programme. The Readiness for Interprofessional Learning Scale (RIPLS) was developed by Parsell and Bligh (1999) to assess student’s attitudes towards interprofessional education. The RIPLS consists of 19 items and four subscales were identified by McFadyen (J Interprof Care 19:595–603, 2005): “teamwork and collaboration”, “negative professional identity”, “positive professional identity” and “roles and responsibilities”. The RIPLS has been translated into a number of languages and used in a variety of different educational settings. A German version of the RIPLS was not available. Aim of the study was the translation of the RIPLS into German and testing of internal consistency. Methods: The RIPLS was translated to German according to international guidelines and its psychometric properties were assessed in two online surveys with two different samples a) health care graduates and b) health care students. Descriptive analysis (mean, SD, corrected item-total correlation) of the Readiness for Interprofessional Learning Scale – German (RIPLS-D) was performed for item characteristics and Cronbach’s Alpha was calculated for internal consistency of overall and subscales of the RIPLS-D. Results: Each sample consisted of 76 datasets. Reliability for the RIPLS-D overall scale was 0.83 in both samples. The subscales displayed internal consistency between 0.42 and 0.88. Corrected item-total correlation showed low values in two subscales in the sample of graduates. Conclusions: While the overall RIPLS-D scale is reliable, several subscales showed low values and should be used with caution to measure readiness for interprofessional learning in the German health care context. Internal consistency of the instrument does not seem to be given in health care professionals at different stages of their professional career. In particular the sub-scale “roles and responsibilities” was problematic. For these reasons, the RIPLS-D cannot be recommended for use to assess this concept. [ABSTRACT FROM AUTHOR]

The aim of the study was to identify factors that predict impairment in daily life for patients of working age with knee complaints 6 months after receiving physiotherapy. A prospective, multicentre observational study was conducted in private physiotherapy practices. Patients ( n = 237) aged 18-65 years with a physiotherapy referral because of knee complaints were studied. Treatment was documented on a standardized form by the physiotherapists and was not influenced by the investigators. The 16-item version of the Musculoskeletal Function Assessment Questionnaire was used as primary outcome measure. Baseline scores for impairment in daily life, symptom characteristics, socio-demographic and psychosocial factors, physical activity, nicotine consumption and comorbidities were investigated as possible predictors of recovery. Predictors identified by multiple linear regression were: self-prognosis on work ability, mental resources, obesity, diagnostic subgroup anterior knee pain and the comorbidities rheumatoid arthritis and diabetes. An active primary therapy approach enhanced recovery. Variables explained 38% of variance (adjusted R2). The knowledge of the identified factors supports the setting of therapy goals together with the patient. Therefore, only a short questionnaire is necessary. Moreover, the results underpin the importance of an active therapy plan. [ABSTRACT FROM AUTHOR]

Background and Objective: From observational studies, there is only sparse information available on the predictors of development of impairment in daily life for patients receiving physiotherapy. Therefore, our aim was to identify factors which predict impairment in daily life for patients with back pain 6 months after receiving physiotherapy. Methods: We conducted a prospective cohort study with 6-month follow-up. Patients were enrolled for treatment in private physiotherapy practices. Patients with a first physiotherapy referral because of thoracic or low back pain, aged 18 to 65 years were included. Primary outcome impairment was measured utilising the 16-item version of the Musculoskeletal Function Assessment Questionnaire. Therapy was documented on a standardized form. Baseline scores for impairment in daily life, symptom characteristics, sociodemographic and psychosocial factors, physical activity, nicotine consumption, intake of analgesics, comorbidity and delivered primary therapy approach were investigated as possible predictors. Univariate and multiple linear regression analyses were performed. Results: A total of 792 patients participated in the study (59% female, mean age 44.4 (SD 11.4), with 6-month follow-up results available from 391 patients. In univariate analysis 17 variables reached significance. In multiple linear regression identified predictors were: impairment in daily life before therapy, mental disorders, duration of the complaints, self-prognosis on work ability, rheumatoid arthritis, age, form of stress at work and physical activity. The variables explain 34% of variance (adjusted R2, p<0.001). Conclusions: With minimal information available from observational studies on the predictors of development of back problems for physiotherapy patients, this study adds new knowledge for forming appropriate referral guidelines. Impairment in daily life before therapy, mental disorder as comorbidity and the duration of the complaints can be named as outstanding factors. The results of this study can be used to facilitate comparison of patient therapy goals with the prognosis in everyday practice. [ABSTRACT FROM AUTHOR]

Laws regulating education of most health professional groups in Germany today mean that curricula re-profiling in response to changing priorities in the practice environment is a significant challenge. Legally dictated theoretical and clinical requirements for the vocational training of health professionals leaves little room for re-profiling in response to movements such as interprofessional education. An educational innovation was needed that worked within existing structures in Germany. The result was a formal collaboration between the Academy for Health Professionals and the University of Heidelberg allowing students undertaking vocational training to also complete a university degree in parallel. The aim of this article is to describe the curriculum development for the Bachelor of Science - Interprofessional Health Care. This article outlines an evidence-based approach to the process to curriculum development that resulted in a competency-based degree offering comprehensive interprofessional education at undergraduate level for healthcare students based in Germany. [ABSTRACT FROM AUTHOR]

Background: The current standard to evaluate the presence of somatosensory dysfunctions is quantitative sensory testing, but its clinical utility remains limited. Low-cost and time-efficient clinical sensory testing (CST) batteries have thus been developed. Recent studies show moderate to substantial reliability in populations with neuropathic pain. This study evaluates the inter- and intra-tester reliability of people with spine-related leg and arm pain, representing mixed pain mechanisms., Methods: Fifty-three patients with spine-related leg (n = 41) and arm pain (n = 12) attended three CST sessions. The CST battery consisted of eleven tests, determining loss and gain of sensory nerve function. CST was performed by the same investigator twice and by an additional investigator to determine inter- and intra-tester reliability. Fleiss' (inter-tester) and Cohen's (intra-tester) kappa were calculated for dichotomized and intraclass correlation coefficients (ICC) for continuous outcomes., Results: Fleiss' kappa varied among modalities from fair to substantial (κ = 0.23-0.66). Cold, warm, and vibration detection thresholds and cold and pressure pain thresholds reached kappa >0.4 (moderate to substantial reliability). Cohen's kappa ranged from moderate to substantial (κ = 0.45-0.66). The reliability of the windup ratio was poor (ICC <0.18)., Conclusion: CST modalities with moderate to substantial inter-tester reliability could be of benefit as a screening tool. The moderate to substantial intra-tester reliability for all sensory modalities (except windup ratio) supports their potential use in clinical practice and research to monitor somatosensory changes over time in patients with spine-related limb pain of mixed pain mechanisms., Significance: We already know that most modalities of clinical sensory test (CST) batteries achieve moderate to substantial inter- and intra-tester reliability in populations with neuropathic pain. This study evaluates the reliability of a CST battery in populations with mixed pain mechanisms. We found inter-tester reliability varied from poor to substantial for sensory modalities, questioning the value of some CST modalities. The CST battery showed moderate to substantial intra-tester reliability, suggesting its usefulness to monitor sensory changes over time in this cohort., (© 2024 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

Background: Stratified care has the potential to be efficient in addressing the physical and psychosocial components of low back pain (LBP) and optimise treatment outcomes essential in low-income countries. This study aimed to investigate the perceptions of physiotherapists and patients in Nigeria towards stratified care for the treatment of LBP, exploring barriers and enablers to implementation., Methods: A qualitative design with semistructured individual telephone interviews for physiotherapists and patients with LBP comprising research evidence and information on stratified care was adopted. Preceding the interviews, patients completed the Subgroups for Targeted Treatment tool. The interviews were recorded, transcribed and analysed following grounded theory methodology., Results: Twelve physiotherapists and 13 patients with LBP participated in the study (11 female, mean age 42.8 (SD 11.47) years). Seven key categories emerged: recognising the need for change, acceptance of innovation, resistance to change, adapting practice, patient's learning journey, trusting the therapist and needing conviction . Physiotherapists perceived stratified care to be a familiar approach based on their background training. The prevalent treatment tradition and the patient expectations were seen as major barriers to implementation of stratified care by the physiotherapists. Patients see themselves as more informed than therapists realise, yet they need conviction through communication and education to cooperate with their therapist using this approach. Viable facilitators were also identified as patients' trust in the physiotherapist and adaptations in terms of training and modification of the approach to enhance its use., Conclusion: Key barriers identified are the patients' treatment expectations and physiotherapists' adherence to the tradition of practice. Physiotherapists might facilitate implementation of the stratified care by communication, hierarchical implementation and utilisation of patients' trust. Possibilities to develop a consensus on key strategies to overcome barriers and on utilisation of facilitators should be tested in future research., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: The Musculoskeletal Health Questionnaire (MSK-HQ) was developed to measure the health status of patients with various musculoskeletal conditions across multiple settings including rehabilitation., Aim: Formal translation and cross-cultural adaptation of the MSK-HQ into German (MSK-HQG), to determine test-retest-reliability, standard error of measurement (SEM), smallest detectable change (SDC), construct validity, responsiveness, minimal important change (MIC), and to test for floor or ceiling effects., Design: Cohort study with six weeks follow-up., Setting: Seven physiotherapy clinics/rehabilitation centres., Population: Patients with a referral for physiotherapy indicating musculoskeletal complaints of the spine or extremities., Methods: Translation and cross-cultural adaptation were carried out in accordance with guidelines provided by the developers. As reference standards we used pain intensity (0-10 numeric rating scale), quality of life (EQ5D-5L) and disability measures (RMDQ, NDI, WOMAC and SPADI) that were combined using z-scores., Results: On 100 patients (age 44.8±13.4 years, 66% female) the test-retest-reliability intraclass correlation coefficient was 0.87 (95% CI 0.72; 0.93) and for construct validity correlation with the combined disability measure was rs=-0.81 (95% CI -0.88, -0.72), the SEM was 3.4, the SDC (individual) 9.4, and the MIC 8.5., Conclusions: Overall, the study provides evidence for good reliability and validity for the MSK-HQG. Further studies in different settings and diagnostic subgroups should follow to better understand the psychometric properties of this measure in primary care, rehabilitation and specialist care settings., Clinical Rehabilitation Impact: The results demonstrate that the MSK-HQG has sufficient psychometric properties for use in musculoskeletal research and practice. However, the SDC should be kept in mind when using the tool for individual patients. The MSK-HQG has the advantage of being a single instrument that can measure musculoskeletal health status across different pain sites, reducing the burden from the use of multiple tools.

Objectives: Interprofessional collaboration leads to an improvement in health care. This call for increased interprofessional collaboration has led to national and international recommendations for interprofessional learning and education. The GMA has taken up this challenge and has implemented a working group on "interprofessional education in the health professions" to address this topic. The terminology used to describe collaboration among the health professions seems to vary and does not reflect any clear consensus. The aim of this paper is to identify the different terms used to describe collaboration between health professions and to analyse their use in German journals., Methods: The terms frequently used to describe collaboration between health professionals were identified and defined. German medical journals were then pragmatically analyzed regarding the use of the terms interprof* and interdiszip*., Results: The German terms for interprofessional and interdisciplinary were not used consistently in the journals reviewed., Conclusion: There seems to be no agreement on the use of terms to describe the collaboration between health professions. Consistent terminology should be used as a basis for promoting collaboration and improving understanding among the parties involved.