Search

Aims To provide a quantitative analysis of eHealth-supported interventions on health outcomes in cardiovascular rehabilitation (CR) maintenance (phase III) in patients with coronary artery disease (CAD) and to identify effective behavioural change techniques (BCTs). Methods and results A systematic review was conducted (PubMed, CINAHL, MEDLINE, and Web of Science) to summarize and synthesize the effects of eHealth in phase III maintenance on health outcomes including physical activity (PA) and exercise capacity, quality of life (QoL), mental health, self-efficacy, clinical variables, and events/rehospitalization. A meta-analysis following the Cochrane Collaboration guidelines using Review Manager (RevMan5.4) was performed. Analyses were conducted differentiating between short-term (≤6 months) and medium/long-term effects (>6 months). Effective behavioural change techniques were defined based on the described intervention and coded according to the BCT handbook. Fourteen eligible studies (1497 patients) were included. eHealth significantly promoted PA (SMD = 0.35; 95%CI 0.02–0.70; P = 0.04) and exercise capacity after 6 months (SMD = 0.29; 95%CI 0.05–0.52; P = 0.02) compared with usual care. Quality of life was higher with eHealth compared with care as usual (SMD = 0.17; 95%CI 0.02–0.32; P = 0.02). Systolic blood pressure decreased after 6 months with eHealth compared with care as usual (SMD = −0.20; 95%CI −0.40–0.00; P = 0.046). There was substantial heterogeneity in the adapted BCTs and type of intervention. Mapping of BCTs revealed that self-monitoring of behaviour and/or goal setting as well as feedback on behaviour were most frequently included. Conclusion eHealth in phase III CR is effective in stimulating PA and improving exercise capacity in patients with CAD while increasing QoL and decreasing systolic blood pressure. Currently, data of eHealth effects on morbidity, mortality, and clinical outcomes are scarce and should be investigated in future studies. Registration PROSPERO: CRD42020203578. Lay summary • This paper reviews the impact of eHealth-supported interventions on health outcomes during cardiovascular rehabilitation maintenance phase III for patients with coronary artery disease, with a meta-analysis performed to differentiate between short-term (≤6 months) and medium/long-term effects (>6 months). Key findings • eHealth interventions in cardiovascular rehabilitation maintenance may be used to increase physical activity and exercise capacity as well as quality of life while reducing systolic blood pressure. • Effective behavioural change techniques used in eHealth interventions may include self-monitoring of behaviour, goal setting, and feedback on behaviour; thus, future studies are needed to define effective eHealth components based on behavioural change theories and associated behavioural change techniques to assist patients with coronary artery disease.

The dynamic nature of the actin cytoskeleton controls many cellular processes and a loss of its plasticity has been linked to accelerated cell ageing. Cofilin is an actin-binding protein that controls actin dynamics and is linked to mitochondrial signalling pathways that control drug resistance and cell death. Here we show that cofilin driven stabilisation of actin dynamics leads to a loss in cell wall integrity, vacuole fragmentation and disruption of lipid homeostasis, lipid droplet accumulation and the promotion of necrosis. Our data suggest that these phenotypes are triggered by the inappropriate activation of Protein Kinase C (PKC) which leads to constitutive MAPK signalling. Cofilin-driven activation of the MAPK Slt2 requires the presence of the voltage dependent anion channel (VDAC), which resides in the mitochondrial outer membrane, referred to as Porin 1 (Por1) in yeast. This provides further evidence for a link between actin regulation and mitochondrial signalling. Porin has recently been implicated in lipid transport and we find that prevention of excessive lipid droplet accumulation, achieved by deleting the LRO1 and DGA1 genes, was sufficient to prevent Slt2 activation and restore cellular homeostasis in actin stabilised cells. These data suggest that the integrity of the actin cytoskeleton is essential to maintain the fidelity of MAPK signalling and that this in turn is crucial for the maintenance of lipid homeostasis and cell health in S. cerevisiae. Our data also suggest that chronic actin stabilisation leads to mitochondrial VDAC-dependent Slt2 activation and altered, pro-death, cell fate in yeast cells.

The widely accepted model of prevention, including primary, secondary and tertiary prevention, focuses predominantly on diseases. The WHO provides a comprehensive model of health conceptualized on the basis of the International Classification of Functioning, Disability and Health (ICF). This paper develops a conceptual description of prevention aimed at functioning on the basis of the ICF model. Starting from the ICF-based conceptual descriptions of rehabilitation as a health strategy, a conceptual description of functioning prevention has been developed. Prevention aiming at functioning is the health strategy that applies approaches to avoid or reduce risks of impairing bodily functions and structures, activity limitations and participation restrictions; to strengthen the resources of the person; to optimize capacity and performance; to prevent impairments of bodily functions and structures; to prevent activity limitations and participation restrictions; to reduce contextual risk factors and barriers, including personal and environmental factors; to promote and strengthen contextual facilitators, with the goal of enabling people with impairments and people at risk of disability; and to maintain or improve the level of functioning in interactions with the environment. The proposed concept widens the scope of prevention to all aspects of functioning, including contextual factors.

ZusammenfassungDer Teilhabebegriff ist konstitutiv für die Rehabilitation und Rehabilitationsforschung. Ihre aktuellen Definitionen beziehen sich über das Konzept der Funktionsfähigkeit und Behinderung der WHO auf Teilhabe. Das Rahmenrecht für Rehabilitation in Deutschland, das SGB IX, sowie die UN-Behindertenrechtskonvention greifen den Teilhabebegriff explizit auf. Nach einer Charakterisierung der Rehabilitationsforschung thematisiert dieser Beitrag das Spannungsfeld von Selbstbestimmung und gesellschaftlicher Teilhabe, anschließend die gegenwärtige Praxis der Rehabilitationsforschung mit Blick auf partizipative Forschungsansätze und in einem weiteren Abschnitt die Entwicklung von Outcome-Modellen mit explizitem Teilhabebezug.

Soziale Arbeit gilt als ein fester Bestandteil der medizinischen Rehabilitation. Allerdings bestehen bisher unerklärbare Variationen hinsichtlich der Ausgestaltung und Inanspruchnahme ihrer Leistungen sowie Hinweise auf negative Effekte sozialarbeiterischer Leistungen in der medizinischen Rehabilitation. Zudem wurden die theoretischen Grundlagen der Tätigkeiten von Sozialarbeiter*innen in der Rehabilitation bisher nicht ausreichend expliziert. Das in diesem Beitrag vorgestellte Forschungsprojekt „Sozialarbeiterische Wirkmechanismen in der medizinischen Rehabilitation“ (SWIMMER) setzt hier an. Nach einer Erläuterung des Settings der medizinischen Rehabilitation, der Rolle der Sozialen Arbeit in diesem und des methodischen Vorgehens wird das Projekt, dessen Ziele die Erklärung der Variationen und die Entwicklung einer Programmtheorie Sozialer Arbeit in der medizinischen Rehabilitation sind, konzeptionell und theoretisch eingeordnet. Bezugspunkte dieser Auseinandersetzung sind das Tripelmandat, die Theorie Sozialer Arbeit als Wissenschaft und Praxis der Erklärung, Lösung und Vorbeugung sozialer Probleme, die Rehabilitationswissenschaften mit einem Fokus auf der Rehabilitation als Gesundheitsstrategie, die Perspektive der Versorgungsforschung und „evidence-based practice“. Darauf aufbauend werden die Vorannahmen des Projekts dargelegt., Social work is an important part of medical rehabilitation; however, there are unexplained variations in the form and utilization of its services. In addition, there are indications of negative effects of social work services in medical rehabilitation and a lack of a theoretical foundation of these services. The research project presented in this article aims to investigate these problems. After an explanation of the setting of medical rehabilitation and the role of social work in this setting, we introduce the project “Causal assumptions about social work services in medical rehabilitation” (“Sozialarbeiterische Wirkmechanismen in der medizinischen Rehabilitation, SWIMMER”). The project aims to explain the mentioned variations and to develop a program theory of social work in medical rehabilitation. The conceptional and theoretical backgrounds and orientation of the project are presented (threefold mandate, social work and social problems, rehabilitation as a health strategy, the perspective of health services research and evidence-based practice). Based on this, first hypotheses are formulated.

Hintergrund und ZielCOVID-19 stellt eine substanzielle Bedrohung der Gesundheit und in der Folge auch der Lebensbedingungen der Menschen weltweit dar. Die Erkrankung entsteht infolge einer Infektion mit dem neuartigen Coronavirus SARS-CoV-2. Erkenntnisse über molekulare Grundlagen, Pathophysiologie, klinische Charakteristika, Epidemiologie, aber auch Ressourcenbedarf und Outcomes (z. B. Karagiannidis et al. 2020; zur Übersicht s. Website der WHO: https://search.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/) wachsen in beispiellos kurzem Zeitraum weltweit an, auch im Feld der Rehabilitation (vgl. Negrini et al. 2020). Die Erkenntnisse münden in Leitlinien, Policy Briefs oder konkreten Handlungsempfehlungen (vgl. Publikationen des Kompetenznetz Public Health COVID-19, www.public-health-covid19.de).

Purpose: Responding to a recent editorial arguing against defining rehabilitation, we discuss the reasons for developing a classification of rehabilitation for research purposes, its philosophical background and some of the possible risks. Why define: Science requires the definition and classification of phenomena to allow replication of experiments and studies, and to allow interpretation and use of the findings. As understanding increases, the definitions can be refined. Defining rehabilitation does run the risk of excluding some interventions or practices that are either considered rehabilitation (perhaps wrongly) or are rehabilitation interventions; when identified, these errors in definition can be remedied. Defining rehabilitation for research purposes should not inhibit but could (possibly) orient research. Risk of not: Without a definition, rehabilitation will remain in a permanent limbo. Experts will (apparently) know what it is, while others are left guessing or failing to comprehend or recognise it. This uncertainty may reassure some people, because all possible interventions are included; we argue that it downgrades the understanding of our field because interventions that are not rehabilitation are, nonetheless, called rehabilitation. In an era of international collaboration, and of undertaking systematic reviews with metanalysis, we need a shared definition. Conclusion: Terminology is often controversial, but definition enables progress in understanding such that terms themselves can evolve over time.

Objective To develop a revised version of the International Classification of Service Organization in Rehabilitation (ICSO-R). Design Qualitative study. Subjects Not applicable Methods: The revision was based on testing the first version of the ICSO-R; 2 discussion rounds invited by the ICSO-R working group of the Standardized Rehabilitation Reporting Subcommittee of the World Health Organization Liaison committee of the International Society of Physical and Rehabilitation Medicine, and a call for corrections from a group of international experts. Results The resulting ICSO-R 2.0 version is composed of 2 dimensions (formerly 3); the Provider dimension and the Service delivery dimension. The categories of the Funding dimension from the first version of ICSO-R were incorporated into each of the other dimensions. The Provider dimension now consists of 9 categories and the Service delivery dimension consists of 14 categories. Subcategories have been added to 7 categories: governance/leadership, funding of provider, target groups, location of service delivery, setting, rehabilitation team, and funding of service delivery. Conclusion This updated version of ICSO-R provides a prerequisite for rehabilitation service organization assessment and implementation projects, reporting of contextual influences in clinical trials and many other aspects. In addition, ICSO-R 2.0 can be used for several purposes, e.g. to analyse and compare the provision of rehabilitation services in health systems and to support the quality management of rehabilitation services. However, the development of value sets for each (sub)category and further validation studies are still needed.

In the non-destructive determination of material properties, the utilization of ultrasound has proven to be a viable tool. In the presented paper, a laser is used to create broadband acoustic waves in plate-shaped specimens by applying the photoacoustic effect. The waves are detected using a purpose-built ultrasonic transducer that is based on piezoceramics instead of the commonly used piezoelectric polymer films. This new transducer concept allows for detection of ultrasonic waves up to 10 MHz with high sensitivity, thereby allowing the characterization of highly damping materials such as polymers. The recorded data are analysed using different methods to obtain information on the propagation modes transmitted along the specimen. In an inverse procedure, the gained results are compared to simulations, yielding approximations for the specimen's material properties.

Background The Mother-Generated Index (MGI) assesses postnatal quality of life (QoL) without providing a predefined checklist, thus offering mothers the opportunity to identify areas of life affected by having a baby. Aim To identify: (a) details and particularities of areas of life affected after childbirth and thus specific domains defining postnatal quality of life; (b) changes in the importance of domains specifying QoL within the first weeks postpartum; and (c) the potential role of cultural differences with regard to the nature of QoL definitions. Methods Prospective, cross-cultural, longitudinal survey. We applied a qualitative content analysis to Mother-Generated Index data collected in Switzerland and Germany using combined deductively and inductively category building. Results Women participated at three days (n = 124) and six and a half weeks (n = 82) postpartum. Eleven domains were identified, each with several subdomains: ‘physical well-being’ (e.g. fatigue), ‘psychological well-being’ (e.g. happiness, emotional confusion), ‘general well-being’, ‘motherhood’ (e.g. bonding with the baby), ‘family and partnership’ (e.g. time for partner and children), ‘social life’ (e.g. friends, being isolated), ‘everyday life’ (e.g. organisation daily routine), ‘leisure’ (e.g. less time), ‘work life’ (e.g. worries about job), ‘financial issues’ (e.g. less money), and further aspects. The most frequently indicated domains were ‘motherhood’ and ‘family and partnership’. Differences between the stages of assessment and countries were identified. Discussion Mothers faced challenges in defining their new role but welcomed the slowdown in the rhythm of life and experienced overwhelming maternal feelings. Conclusion Our findings suggest that postnatal quality of life is a concept that changes over time and differs between countries.

The availability of evidence to support rehabilitation has been a long-standing challenge. We believe that now is the time to start a systematic process of improvement. For this reason, Cochrane rehabilitation is producing an effort to improve the methodology used to generate evidence. Two Cochrane Rehabilitation Methodology Meetings (CRMM) have been performed (Paris, France, July 2018; Kobe, Japan, June 2019) and 2 others programmed (Milan, Italy, February 2020; Orlando, USA, March 2020). All material discussed during CRMMs is published. In this issue we have the papers from the Kobe CRMM about blinding, current reporting standards for population and comparison groups, and the protocol of the RCT Rehabilitation Checklists (RCTRACK) project.The articles published in this issue aim to help the rehabilitation scientific community to move forward, to improve the process of generating evidence in rehabilitation, and to strengthen our field as presented to the general scientific community. To accomplish these goals we need to clearly describe our methods and our approach to future rehabilitation research. Not all fields of study can apply the same methodology in science, but each field must define its research methodology and demonstrate the characteristics that make it a specific field of inquiry.

Hintergrund: Soziale Arbeit ist fester Bestandteil der Praxis medizinischer Rehabilitation. Ihr Ziel ist die Verbesserung der sozialen Teilhabe [ref:1]. Aufgrund der Forderung nach einer qualitativen Weiterentwicklung der Praxis im Gesundheitswesen und der Diskussion um Evidenzbasierung steht[zum vollständigen Text gelangen Sie über die oben angegebene URL], 17. Deutscher Kongress für Versorgungsforschung (DKVF)

Johannes Sperzel,1 Ingo Staudacher,2 Olaf Goeing,3 Martin Stockburger,4 Thorsten Meyer,5 Ana Sofia Oliveira Gonçalves,6 Hanna Sydow,6 Tonio Schoenfelder,6 Volker Eric Amelung6 1Department of Cardiology, Hospital Kerckhoff Klinik GmbH, Bad Nauheim, Germany; 2Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, Germany; 3Department of Cardiology, Sana-Hospital Lichtenberg, Berlin, Germany; 4Medical Department I, Havelland Kliniken GmbH, Nauen, Germany; 5Department of Public Health, Universität Bielefeld, Bielefeld, Germany; 6Institute for Applied Health Services Research, inav – privates Institut für angewandte Versorgungsforschung GmbH, Berlin, GermanyWe read with great interest the article “Wearable cardioverter defibrillators for the prevention of sudden cardiac arrest: a health technology assessment and patient focus group study” by Ettinger et al. The authors conclude that wearable cardioverter defibrillators (WCDs) seem to be fairly safe in the short-to-medium term, but the quality of the available evidence is low. They also state that – according to their study inclusion criteria – they were not able to identify studies to assess the clinical effectiveness of the WCD. Given the importance of WCD for its target population and considering our clinical expertise, we see a particular need to clarify some points of this article.Author's ReplySabine Ettinger,1 Michal Stanak,1 Piotr Szymański,2 Claudia Wild,1 Romana Tandara Haček,3 Darija Erčević,3 Renata Grenković,3 Mirjana Huić31Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria; 2Institute of Cardiology, Warsaw, Poland; 3Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, CroatiaWe read the letter to the editor with regard to our published paper on “Wearable cardioverter defibrillators for the prevention of sudden cardiac arrest: a health technology assessment and patient focus group study” and gladly take the opportunity to appropriately address and clarify the issues that were raised.View the original paper byEttinger and colleagues.&nbsp

Zusammenfassung: Anfang 2015 hat die ZBW ihre Strategie 2015–2020 verabschiedet. Nach einer kurzen Darstellung der Ausgangslage, stellt dieser Beitrag den Prozess der Strategieentwicklung sowie die dabei gemachten Erfahrungen vor. Anschließend werden die wichtigsten Prioritäten der Strategie beschrieben, bevor im letzten Abschnitt auf die Umsetzung der Strategie eingegangen wird. Der Prozess der Strategieentwicklung in der ZBW zeichnete sich dadurch aus, dass er gänzlich ohne externe Begleitung stattgefunden hat und zudem durch eine ausgewogene Steuerungsbalance zwischen Bottom-up und Top-down gekennzeichnet war.

Johannes Sperzel,1 Ingo Staudacher,2 Olaf Goeing,3 Martin Stockburger,4 Thorsten Meyer,5 Ana Sofia Oliveira Gonçalves,6 Hanna Sydow,6 Tonio Schoenfelder,6 Volker Amelung6 1Department of Cardiology, Hospital Kerckhoff Klinik GmbH, Bad Nauheim, Germany; 2Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, Germany; 3Department of Cardiology, Sana-Hospital Lichtenberg, Berlin, Germany; 4Medical Department I, Havelland Kliniken GmbH, Nauen, Germany; 5Department of Public Health, Universität Bielefeld, Bielefeld, Germany; 6inav – privates Institut für angewandte Versorgungsforschung GmbH, Berlin, GermanySince the authors’ reply to our critical appraisal did not properly address the points we raised, we still see need for further clarification. The wearable cardioverter defibrillator (WCD) is not an adequate substitute for an implantable cardioverter defibrillator (ICD). The authors state that both can be compared immediately post-myocardial infarction (MI). According to the current guidelines, primary prevention of sudden cardiac death with the ICD within 40 days after MI is generally not indicated.1 Therefore, we disagree with the authors’ proposal of conducting such a trial. In this context, the authors mentioned the VEST trial, which compares a WCD population and one receiving medical treatment. There is explicitly no comparison to an ICD population.View the original paper by Sperzeland colleagues.

Introduction/Background Cochrane Rehabilitation Field (CR) is a worldwide network aiming to act as a bridge between Cochrane and Rehabilitation community and stakeholders. CR specific goals are to undertake Knowledge Translation and to progress the methods for evidence synthesis in order to make them appropriate with the needs of people with disabilities and daily clinical rehabilitation practice. The aim of this paper is to describe the Organization and Functioning of the Field. Material and method Currently, 294 people from 52 different countries are part of CR. The organization includes: Director (responsible for the Knowledge Translation strategy); Coordinator (responsible of the Networking Strategy); Executive Committee; Advisory Board. Results The Communication Committee created the website (http://www.rehabilitation.cohrane.org) and is in charge of constantly updating it. It set up a YouTube channel, a Facebook page and a Twitter account. It is also responsible for the preparation of the Newsletter and of the production and dissemination of blogshots, a concise synthesis of the main message of Cochrane Evidence in Rehabilitation. The Publication Committee has been working on the creation of Cochrane Corners in rehabilitation National and International scientific journals. The Education Committee is responsible for the preparation of Cochrane sessions and workshops at Rehabilitation Meetings, 4 Workshops and 10 sessions at National and International Meetings have been realized so far. The Reviews Committee has been selecting all Cochrane Reviews relevant for rehabilitation, it has been developed and tested a systematic search strategy which is providing material for the other Committees. The Methodology Committee has been working for the improvement of the methods to synthesize evidence. Conclusion Cochrane Rehabilitation is growing fast and more and more people are joining the different committees with the aim to obtain the same results of disseminating evidences.

There is a need for a comprehensive classification system of health-related rehabilitation services. For conceptual clarity our aim is to provide a health-related conceptual description of the term "rehabilitation service". First, we introduce a common understanding of the term "rehabilitation", based on the current definition in the World Health Organization's World Report on Disability, and a conceptual description of rehabilitation agreed upon by international Physical and Rehabilitation Medicine organizations. From a health perspective, rehabilitation can be regarded as a general health strategy with the aim of enabling persons with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning. Secondly, we distinguish different meanings of the term "service", that have originated in management literature. It is important to distinguish between micro, meso and macro level uses of the term "service". On a meso level, which is central for the classification of rehabilitation services, 2 aspects of a service, i.e. an offer of an intangible product and an organizational setting in which the offer is upheld, are both essential. The results of this conceptual analysis are used to develop a conceptual description of health-related rehabilitation, which is set out at the end of this paper. This conceptual description may provide the basis of a classification of health-related rehabilitation services, and is open for comments and discussion.

Background When different health problems such as pregnancy and spinal cord injury (SCI) occur together, providing adequate care becomes even more challenging. Women with SCI may encounter a variety of specific problems and symptoms during pregnancy and childbirth, including urinary tract infections, pressure ulcers, constipation, autonomic dysreflexia, and preterm labour. Therefore, expertise from different medical specialties, especially spinal cord medicine and gynaecology are required. What is totally normal for experts of one specialty could cause a problem for experts from another specialty. Therefore, this study aimed to reconstruct the perceptions and experiences of healthcare providers in Switzerland in caring for women with SCI during pregnancy and childbirth. Methods The perception and experience of healthcare professionals toward providing care for women with SCI during pregnancy and labour were elicited using qualitative expert interviews and analysed using grounded theory techniques. Fifteen health professionals were interviewed, including gynaecologists (n = 4), midwives (n = 3), physical medicine and rehabilitation professionals (n = 4), urologists (n = 3), and a peer counselor (n = 1). Results Care delivery experiences of health professionals could be described as a forced reaction to decision making under uncertainty. However, health professionals seemed to express three different attitudes while handling the situation: (i) protective concerned attitude, (ii) ‘no big deal’ attitude, or (iii) precautionary attitude. The applied strategies were influenced by the conditions of the healthcare system, policies in place, and health professionals’ behaviours. Consequently, health professionals faced with uncertainty felt like actors in a fragmented treatment process and called for interdisciplinary collaborations. Conclusions Our findings highlight the diversity of perspectives among different healthcare professionals with respect to the approach to care and delivery services for pregnant women with SCI. A need for more specific services, information, guidance, and guidelines for health professionals caring for woman with SCI during pregnancy and childbirth was identified. We strongly recommend further research on the development of integrated care concepts as well as clinical studies for establishing a more profound knowledge base. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0976-y) contains supplementary material, which is available to authorized users.

Objective. A proposal for a conceptual description of rehabilitation was made in 2007 based on the International Classification of Functioning, Disability and Health. This conceptual description should foster the development of a common understanding of rehabilitation and its professions. The present paper aims to report on the development and current state of the discussions about this conceptual description and to provide the current version, which has been adopted by different European professional and scientific organizations. Methods. First, the history of the development of the conceptual description of rehabilitation is reported. Secondly, suggestions for modifications or amendments are introduced, and the resulting phrases and terms are presented and discussed. Discussion and conclusion. One major change to the conceptual description of rehabilitation is the explicit integration of the perspective of the disabled person. The relationship between person and provider is characterized as a partnership. However, it is argued that quality of life should not be introduced as a primary goal of rehabilitation. This conceptual description can foster a common understanding of the rehabilitation professions and provide a point of departure for clarifying the role of different professions and services within the broad field of rehabilitation. It can also serve to position rehabilitation as a major health strategy and to sharpen the perception of rehabilitation among external stakeholders.

Physical and Rehabilitation Medicine (PRM) is an independent medical specialty focusing on the improvement of functioning. A shared understanding of concepts is of vital importance for integrated action in this field. The aim of the present paper is to provide a conceptual model of PRM, to give background on its development and adoptions, and to explain the choice of terms, phrases, and concepts. It is based on the terms and concepts of the International Classification of Functioning, Disability and Health (ICF) that provides a widely accepted conceptual model and taxonomy of human functioning. Based on the White Book on Physical and Rehabilitation Medicine in Europe of 2006 a first proposal for a conceptual description of rehabilitation has been published in 2007. This proposal has been subjected to comments for modifications and amendments. E.g. it was underlined that PRM can apply both a health condition perspective including curative approaches and measures aiming at body functions and structures and a multi-dimensional and multi-professional team approach aiming to optimize functioning from a comprehensive functioning and disability perspective. The interaction between the PRM specialist and the person should be characterized as a partnership. PRM specialists work across all areas of health services and across all age groups. In summary, the specialty of PRM is characterized as the medicine of functioning.

Introduction/Background The introduction of the ICF model as a basis for rehabilitation provides new perspectives on rehabilitation practices. According to the ICF, participation can be enhanced via different pathways, including interventions on environmental factors. Aim of the presented project was to systematically compile present knowledge on environmental factors that could be a target for interventions in inpatient rehabilitation to improve patient participation. Material and method First, we have conducted a document analysis comprising icf core sets, clinical rehabilitation guidelines or standards, and health classifications on interventions to identify the array of rehabilitation interventions related to environmental factors. Second, these interventions were linked to the ICF environmental factor codes resulting in a linking table that can be used to identify commonalities and potential blind spots of possible intervention targets. Third, after the conduction of an expert workshop eight focus groups with rehabilitation professionals from different fields of inpatient medical rehabilitation were conducted. Fourth, another two expert workshops were conducted to develop a list of possible targets for the development of interventions and recommended course of action for future projects. Results The project resulted in a substantial number of different recommendations. They relate to the fields of new technologies, to measures that help to sustain rehabilitation effects in daily living, to the work place, to the reference to language and cultural diversity, to the home environment of the patients, to matters of de-acceleration, to individualisation of rehabilitation, to the way patients deal with their own resources and roles, to explicit environmental strains, and to the specific use of products and technologies. Conclusion This project used a theoretical perspective on rehabilitation to inspire new approaches to rehabilitation interventions that target environmental factors with the aim to improve participation of patients. A substantial number of proposals have been developed that could be used as a starting points for further projects.

The present study aimed to measure physical activity in patients with chronic obstructive pulmonary disease (COPD) to: 1) identify the disease stage at which physical activity becomes limited; 2) investigate the relationship of clinical characteristics with physical activity; 3) evaluate the predictive power of clinical characteristics identifying very inactive patients; and 4) analyse the reliability of physical activity measurements. In total, 163 patients with COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I-IV; BODE (body mass index, airway obstruction, dyspnoea, exercise capacity) index score 0-10) and 29 patients with chronic bronchitis (normal spirometry; former GOLD stage 0) wore activity monitors that recorded steps per day, minutes of at least moderate activity, and physical activity levels for 5 days (3 weekdays plus Saturday and Sunday). Compared with patients with chronic bronchitis, steps per day, minutes of at least moderate activity and physical activity levels were reduced from GOLD stage II/BODE score 1, GOLD stage III/BODE score 3/4 and from GOLD stage III/BODE score 1, respectively. Reliability of physical activity measurements improved with the number of measured days and with higher GOLD stages. Moderate relationships were observed between clinical characteristics and physical activity. GOLD stages III and IV best predicted very inactive patients. Physical activity is reduced in patients with chronic obstructive pulmonary disease from Global Initiative for Chronic Obstructive Lung Disease stage II/ body mass index, airway obstruction, dyspnoea, exercise capacity score 1. Clinical characteristics of patients with chronic obstructive pulmonary disease only incompletely reflect their physical activity.

Back pain is considered as one of the most frequent disturbances of health. The available study aimed at the evaluation of the test-retest reliability of fundamental questions on the occurrence and severity of back pain that have been widely used in international population surveys.Four hundred and eighty-seven inhabitants of Lübeck/Germany aged 18 to 74 were mailed a first questionnaire on back pain. All respondents were resent the identical questionnaire two weeks after initial mailing. Additionally, they received a questionnaire on selected back pain items covering the time interval between the test and retest survey to identify cases with instable answering patterns due to back pain related changes, exclusively.One hundred and seventy-nine respondents took part in both the test and retest survey (response rate 36.8%) and were included in our reliability analyses. Respondents of the first questionnaire were of higher social status than the nonrespondents. Dependent on scale level, Cohen's kappa, quadratic weighted kappa, and intraclass correlation coefficients were computed, respectively.All evaluated questions reached good up to very good reliability scores.

Physical activity is reduced in patients with chronic obstructive pulmonary disease (COPD). COPD has a systemic component that includes significant extrapulmonary effects that may contribute to its severity in individual patients.To investigate the association of extrapulmonary effects of the disease and its comorbidities with reduced physical activity in patients with COPD.In a cross-sectional study, 170 outpatients with COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages I-IV; BODE [body mass index, airway obstruction, dyspnea, and exercise capacity] score 0-10) underwent a series of tests. Physical activity was assessed over 5 to 6 consecutive days by using a multisensor accelerometer armband that records steps per day and the physical activity level (total daily energy expenditure divided by whole-night sleeping energy expenditure). Cardiovascular status was assessed by echocardiography, vascular Doppler sonography, and levels of N-terminal pro-B-type natriuretic peptide. Mental status, metabolic/muscular status, systemic inflammation, and anemia were assessed by Beck Depression Inventory, bioelectrical impedance analysis, handgrip strength, high-sensitivity C-reactive protein/fibrinogen, and hemoglobin, respectively.In a multivariate linear regression analysis using either steps per day or physical activity level as a dependent variable, the extrapulmonary parameters that were associated with reduced physical activity in patients with COPD independently of GOLD stages or BODE score were N-terminal pro-B-type natriuretic peptide levels, echocardiographically measured left ventricular diastolic function, and systemic inflammation.Higher values of systemic inflammation and left cardiac dysfunction are associated with reduced physical activity in patients with COPD.

OBJECTIVE Rehabilitation is 1 of 4 main health strategies. The World Report on Disability identifies deficits in rehabilitation care for people with disabilities as an important barrier to full inclusion in society or to achieve optimal functioning. In order to overcome such deficits, to close gaps in national and/or regional rehabilitation systems, and to develop appropriate rehabilitation services, it is crucial to define uniform criteria and a widely accepted language to describe and classify rehabilitation services. The aim of this paper was therefore to develop a list of dimensions and categories to describe the organization of health-related rehabilitation services. METHODS The classification is based on a series of expert workshops including members of the International and European Society of Physical Medicine and Rehabilitation. RESULTS The proposed classification has 2 levels (dimensions and categories). The upper level distinguishes 3 dimensions: the service provider (with 9 categories), the funding of the service (with 3 categories), and the service delivery (8 subcategories). A further specification of the categories in a 3-level classification (including value sets) is needed. CONCLUSION This paper is an intermediate step towards development of a classification system with distinct categories and dimensions.

Background Women after a spinal cord injury (SCI), who decide to get pregnant and to become mothers, have special health care service needs. This study aims to identify the perceived service needs of woman with SCI during pregnancy and childbirth in Switzerland and to reconstruct their experiences of healthcare service utilization based on their accounts. Methods A qualitative content analysis based on focus groups and individual interviews was conducted. 17 mothers with SCI who had given birth following SCI within the past 15 years participated. The data were transcribed verbatim before content analyses were carried out. Primary data was collected from August 2012 to September 2013 at the Swiss Paraplegic Research Centre, Nottwil; the University of Lausanne and at the homes of the participants. Results Mothers reported a broad spectrum of medical needs, including the need for access to improved integrated care. They also reported difficulties finding providers with knowledge of both paraplegiology (i.e. spinal cord medicine) and gynaecology. Mothers preferred using local health care services and regular birth hospitals, and reported receiving no additional benefit from the services of specialised SCI centres during pregnancy. A pre-existing provider-patient relationship was helpful for optimizing care processes. Conclusion This study showed that pregnant women with SCI have various perceived healthcare needs and health care service use. Effective programs to improve these women’s access to integrated care during pregnancy and childbirth and policies requiring the provision of specific pregnancy information and pre-birth services are necessary.

A retrospective interview study of mothers with spinal cord injuries (SCIs) who gave birth over the last 15 years. To identify the medical complications of women with SCIs during pregnancy and childbirth in Switzerland and to describe how they dealt with these complications. Swiss Paraplegic Research in Nottwil, the University of Lausanne and participants’ homes. Data were collected by self-reported questionnaires and descriptive analysis was conducted. Seventeen women with SCIs who gave birth to 23 children were included. Thirteen of the women were paraplegics and four were tetraplegics. All of them practiced an independent bladder management. Three women changed their bladder management techniques during pregnancy. Five women reported an increased bladder evacuation frequency during pregnancy, and six women reported a new onset or increase in incontinence. We observed no significant increase in bowel dysfunction or skin breakdown due to their pregnancies. Ten women were hospitalised during the course of their pregnancies. Aside from urinary tract infections/pyelonephritis, women were hospitalised for falls, hypertension, pneumonia, preeclampsia, pre-term labour or tachycardia. The results of our study clearly demonstrated that, although medical complications are not infrequent during pregnancy in women with SCIs, pregnancy and delivery in this group of women are possible without posing intolerable risks to the mothers or the children. Urological problems seemed to be the most frequent complication during pregnancy.

We surveyed the attitudes of medical practitioners towards evidence-based medicine (EBM) and characterized those with an interest in participating in EBM courses. A random sample of 900 outpatient care doctors stratified by level and field of specialization was surveyed by means of a postal questionnaire. Importance of knowledge on information management, a positive attitude towards EBM and not yet doing critical appraisal were significant predictors of interest in participating in EBM courses. Low participation rates of outpatient care doctors in EBM courses are not due to attitudinal or general motivational problems. Although possible predictors of interest in participation could be specified, further factors contributing to actual participation need to be identified.

The total syntheses of eight members of the palmarumycin family have been achieved, with identification of the absolute stereochemistry for three of these natural products. In addition, the ras-farnesyl transferase inhibitor (-)-preussomerin G has been synthesized, achieving the first enantioselective route for accessing this family of natural products. Highlights of the synthetic work include an asymmetric epoxidation of a cyclic enone in excellent yield and enantiomeric excess and a potentially biomimetic oxidative spirocyclization for the introduction of the bis-spiroketal array unique to the preussomerin natural products.