Verbundprojekt im Forschungsverbund Autonomie im Alter
Selbstbestimmt und unterstützt leben im Quartier – Vernetzung, Implementierung und Evaluation von Demenzlotsen
Zeitraum
- August 2019 – Dezember 2021
Leitung
- Dr. Stephanie Heinrich
- Prof. Dr. Gabriele Meyer
Mitarbeit:
- Grünzig, Manuela
- Klatt, Thomas
- Geyer, Jennifer
- Schiller, Christine
Förderung
- Land Sachsen-Anhalt und EFRE
Zusammenfassung
Projektziel ist die Unterstützung und Begleitung von Menschen mit Demenz und ihrer Angehörigen, um ein selbstbestimmtes Leben im Quartier zu ermöglichen. Qualifizierte Demenzlotsen werden Menschen mit Demenz und ihre Angehörigen über die verschiedenen Krankheitsphasen hinweg im Sinne eines Case Managements begleiten und als eine kontinuierliche Kontaktperson Hilfestellungen geben. Beabsichtigt ist, die Bedürfnisse der Menschen mit Demenz zu erfassen, um Ressourcen verfügbar zu machen sowie eine qualitativ hochwertige Versorgung zu sichern. Ein Verbleib in der Häuslichkeit, die Optimierung der Pflegearrangements sowie eine Entlastung der pflegenden Angehörigen soll erreicht werden. Die Evaluation der aufsuchenden Hilfe wird auf der Prozess-, Ergebnis- und gesundheitsökonomischen Ebene durchgeführt.
Das Projektziel schließt im Weiteren den Aufbau und die Pflege einer möglichst barrierefreien und in verständlicher Sprache gestalteten Online-Plattform ein. Diese bietet Informationen zu regionalen Angeboten und Veranstaltungen, zu aktuellem Wissen für Menschen mit Demenz, Angehörigen, interessierten Bürgern sowie professionell Tätigen.
Short title:
- ELISE
Period
- 01.02.2021 - 31.01.2024
Project leader:
Staff member:
- Manuela Grünzig
Funding:
Federal Ministry for Education and Research
Other project partners:
- brain SCC GmbH (coordinator)
- Chair for Business Information Systems/ Corporate Information Management at MLU
- Halle-Neustädter Wohnungsgenossenschaft e.G.
Project content:
The ELISE project aims at developing, piloting and evaluating an IT-supported coordination system for procuring spontaneous support services. The users’ (volunteers and advice seekers) acceptance will be examined as well as the effect on actual everyday work relief. The methods include literature reviews, market analyses, focus group interviews, individual interviews, Delphi method and surveys. The aim is to create an offer that mobilizes spontaneous helpers in the neighborhood, improves participation, generates contacts and relieves the burden of everyday life, and that is rewarding for volunteers.
Short title
- GenDivInfo
Period
- 01 March 2022 – 28 February 2025
Project leader
- Prof. Dr. Anke Steckelberg
Staff members
- PD Dr. Gero Langer
- Dr. Julia Lühnen
- Julia Lauberger, M. Sc.
- Sarah Stanke, M. Sc.
Project partners
- University of Bremen, FB 11, IPP, Dept. of Nursing Evaluation and Implementation Research: Prof. Dr. Birte Berger-Höger
- University of Bremen, Faculty 9 Cultural Studies, Institute of Ethnology and Cultural Studies (IfEK): Dr. Margit E. Kaufmann
Supporting institutions
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinische Fachgesellschaften e.V. (AWMF): Dr. Monika Nothacker
- Working Group Women's Health in Medicine, Psychotherapy and Society (AKF): Prof. Dr. Ingrid Mühlhauser
- German Network Evidence-based Medicine e.V.: Prof. Dr. Dipl. Soz. Tanja Krones -
- Patient representative BPS e.V.: Udo Ehrmann
- Universitäts-Klinikum Hamburg Eppendorf: Prof. Dr. Christoph Heesen
- Women's Health Center Graz, women's health expert: Mag.a Kerstin Pirker
Funding
- Federal Ministry of Health (BMG):"Model projects for the development and testing of gender-specific care concepts as well as prevention and health promotion measures. Module 3 – Interventional studies." (Grant number: 2522FSB12A)
Summary
Background
Medical guidelines can contribute to evidence-based care. However, current guidelines have so far taken little account of the needs of people of different genders and as far as patient participation is concerned, German guidelines still fall short of required international standards. Furthermore, there is a lack of methods for identifying relevant decision-making situations in order to synthesize the necessary evidence in a targeted manner. Altogether, current guidelines do not usually provide all the information necessary for developing evidence-based decision-aids accordingly.
The aim is to develop and pilot-test a concept for developing gender-specific and gender-sensitive medical guidelines, taking into consideration the diversity and vulnerability on the basis of which evidence-based decision-making tools can be provided. The knowledge transfer of the best available evidence for the different target groups in the healthcare system is to be optimized by the new procedure.
Methods
Development of a concept to extend guideline processes for the provision of evidence-based decision-aids and guidelines that are gender-diverse.
The process for preparing evidence-based guidelines (S3 guidelines) will be extended to include in particular gender-specific needs and preferences as well as the content requirements of decision-aids throughout the entire process. Care will be taken to set up a guideline group that is gender (diversity) sensitive / and fairly composed. The preferences and values of the target group will be identified using systematic searches and, if necessary empirical methods. For the systematic searches, generic search strategies will be provided, which the guideline groups can adjust to the respective topics. In addition, a guidance for a scoping review will be established to identify the relevant decision-making situations.
On this basis, guideline groups can reach a consensus on key issues and prioritize outcome parameters. In this context, all available options should be considered in the sense of evidence-based decision-aids. Evidence synthesis will be provided (via external methodologists) using the GRADE methodology. Gender-specific and sensitive recommendations will be generated for each decision-making situation.
Pilot-testing of the concept using the example of a decision-making situation on non-hormonal contraceptives
Pilot-testing of the modified guideline process will be carried out with guideline authors on the basis of assessing decision-making situations concerning non-hormonal contraceptives. The guideline process will be fully implemented until a consensus about the key issues has been reached in order to then create exemplary evidence syntheses and generate recommendations. The feasibility of the concept will be tested with the aid of participatory observations, feedback and focus groups.
Adaptation and pilot-testing of an interactive e-learning training program
Existing curricula will be supplemented by aspects of the gender-specific and gender-sensitive development of guidelines and evidence-based health information (EBHI), then transferred in modular form to an interactive e-learning program. In particular, the requirements of patient representatives will be taken into account and their tasks, roles and strategies for the inclusion of the diverse interests and needs of the target group will be addressed. The training program will be tested with regard to possible user problems by people who fulfil the criteria for participating in the guideline group and then optimized.
Development and pilot-testing of appropriate gender-diversity decision-aids
Based on the criteria for EBHI, a template for an evidence-based decision-aid in modular form will be developed, which can be adapted to a web-based interactive format. Using the template, a module for a decision-aid regarding contraceptives will be created as an example. The overall concept will then be reviewed on the basis of the comparison of whether all the necessary information about the guideline process is provided. This will be followed by an assessment by patient representatives and experts and by testing the decision-aid in the target group.
Expected results
At the end of the project, a manual for the development of gender-specific guidelines and decision-aids will be available. The newly developed procedure for setting up patient-oriented guidelines and templates for decision-aids will be developed so generically that they can be used for other issues and diseases and can thus be implemented in the system in the long term. The modular form of the training program means that it can be adapted and extended and it is planned to consolidate it via the German Network Evidence-based Medicine. In the future, the optimization of knowledge management will play a decisive role in achieving the goals for promoting health literacy and informed decisions.
Short title
- MundZaRR
Period
- June 2019 to Febr. 2024
Project leader
Project assistant
Funding
- Innovation Commission of the Federal Joint Committee Berlin – Registration No.: 01VSF18021
Abstract
The aim is to develop and evaluate a nurse-assisted dental support concept for the oral hygiene and care of residents in residential care facilities for the elderly (care level 3 – 5) in order to improve quality of life in relation to oral health.
The primary hypothesis: The reinstruction and remotivation of the nursing staff with the help of dental assistants following the instructions of dentists will improve the quality of life in relation to oral health of residents with care level 3 -5.
The existing dental concept for the care of older (and/or disabled) people stipulates that dentists conduct a regular 6-monthly evaluation of the oral health and hygiene status of care-dependent people. It also provides for the nursing staff to receive instruction based on a form sheet and for any necessary referral recommendations for dental therapy. The aim of this current project is the short-term development and medium-term testing of individualized assigned care reinstruction and remotivation measures for nursing staff who deal with oral hygiene and care. These measures are to be conducted with the help of dental assistants following the instructions of dentists. The long-term target is to improve the oral health related quality of life and the oral health of residents in care facilities for the elderly and to reduce dental-related emergencies and comorbidity by expanding the AuB concept as described.
Short Title
- PartEngO
Duration
- March 2022 - February 2025
Principal investigator
- PD Dr. med. Heike Schmidt, Department of Radiation Oncology, University Hospital Halle (Saale), Krukenberg Cancer Center and Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale)
- Prof. Dr. Anke Steckelberg, Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg
Ethical and legal project lead
- Prof. Dr. Henning Rosenau, Interdisciplinary Center Medicine – Ethics – Law, Faculty of Law and Economics, Martin Luther University Halle-Wittenberg
Medical project lead
- Prof. Dr. med. Haifa Kathrin Al-Ali, Krukenberg Cancer Center Halle
Scientific staff
- Felicia Steffen, Dipl.-Jur.
- Thomas Nordhausen, M.Sc.
- Dr. Christiane Luderer
Funding
- Stiftung Deutsche Krebshilfe, Förderschwerpunktprogramm „Ethische Verantwortung in der modernen Krebsmedizin“ (FKZ: 70114359)
Registration
- German Clinical Trials Register: DRKS00028470
- StudyBox: ST-U140
Clinical cooperations
- University Hospital for Internal Medicine IV, University Hospital Halle (Saale), Krukenberg Cancer Center, Halle (Saale)
- University Hospital for Internal Medicine I, University Hospital Halle (Saale), Krukenberg Cancer Center, Halle (Saale)
- University Clinic and Polyclinic for Radiation Therapy, University Hospital Halle (Saale), Krukenberg Cancer Center, Halle (Saale)
- University Clinic and Polyclinic for Urology, University Hospital Halle (Saale), Krukenberg Cancer Center, Halle (Saale)
- Krukenberg Cancer Center, Medical Clinic II, Carl-von-Basedow Clinic Saalekreis, Merseburg
- Oncologic Center St. Elisabeth and St. Barbara Halle (Saale), Halle (Saale)
- Clinic for Urology, Martha-Maria Hospital Halle-Dölau, Halle (Saale)
- Radiation Clinic, University Hospital Erlangen, Erlangen
- Urological Clinic, University Hospital Erlangen, Erlangen
Summary
Background:
Although modern cancer medicine allows the treatment of very old patients, the transferability of therapy recommendations of current guidelines to individual cases is limited due to age-related heterogeneity, e. g. reflected in the number and severity of comorbidities or different physical and cognitive functioning. In addition to health and context-related factors, older cancer patients also differ in terms of their attitudes regarding quality of life, existential issues, and treatment related expectations. Shared decision-making (SDM) integrates these individual aspects and values to ensure the legally and ethically required right of patients’ self-determination. Prerequisites of SDM are the assessment of personal resources and risk factors and the exploration of values and preferences, to enable individual assessment and appropriate communication of the benefits and risks of different therapy options. Based on this approach patients can be empowered to participate in the decision making process.
Aim:
This project aims to further develop and pilot an interprofessional concept to promote SDM in clinical practice with a special focus on ethical and legal aspects for vulnerable patients with complex health problems.
Methods:
The study design comprises a controlled, consecutive multicenter approach comparing two PEF interventions for elderly cancer patients with standard care in nine German clinics.
Three groups are consecutively recruited and compared:
- Pre (control group, n=67): Receives standard care.
- Post (intervention group, n=67): Receives comprehensive geriatric assessment of individual risk factors and resources (comorbidities, medication, physical function, nutritional status, cognition, emotional and social situation, independence, quality of life) in addition to standard care. The results of the assessment will be summarized, discussed with the patients, and, in combination with individual preferences, incorporated into the decision-making consultations. Participating patients also receive supporting materials in form of Question Prompt Lists. The interprofessional care team will be trained in SDM in geriatric oncology. Training topics include: Communication with the older patients and specific risk communication, exploration of patient preferences, guideline-based consultation, and structured documentation of the decision-making consultations.Furthermore, the intervention comprises decision coaching from trained nurses. The nurses will eventually also participate in decision-making consultations and support patients during or after decision-making.
Inclusion criteria:
Patients ≥ 70 years with first diagnosed or recurrent/advanced hemato-oncological and solid tumors or with brain metastases of different primary tumors.
Outcomes:
Primary endpoint of the evaluation is the extent of the patient's involvement in decision-making, assessed by the Multifocal approach to the 'sharing' in Shared Decision Making instrument (MAPPIN'SDM) and a patient-based assessment (MAPPIN-Qpatient). Secondary endpoints include physician perceptions of patient involvement (MAPPIN-Qphysician), agreement on MAPPIN ratings between MAPPIN-Qpatient, MAPPIN-Qphysician, and decision regret, quality of life, independence, treatment discontinuation, and clinical course. In addition, a process evaluation focuses on the feasibility and required resources of the intervention as well as on its acceptance and benefit from the participants' perspective.
Expected results:
We expect findings regarding potential benefits of the intervention for patients to improve participation and informed decision-making with relevance for clinical practice. In this context, potential needs for optimization of the ethically, legally, and medically relevant process of SDM may be identified.
A feasible interprofessional concept to prepare and implement informed SDM will be developed and evaluated with relevance for clinical practice as well as interprofessional teaching, education, and training. Due to its generic approach, this concept is transferable to complex decision-making situations in older cancer patients and can contribute to the support of patient-centered oncological care. In case of a positive evaluation, implementation studies and a health economic analysis are planned.
Short title:
- PEKo 2.0 Hospital
- PEKo 2.0 Outpatient Setting
Duration:
- May 2021 until February 2023
Principal investigator:
- Prof. Dr. phil. Gabriele Meyer
Scientific staff:
- Dr. Christin Richter
- Natalie Nguyen
Partners:
- University of Cologne
- University of Lübeck
- Fulda University of Applied Sciences
Funding:
- Techniker Krankenkasse “Technicians’ Health Insurance Fund”, Hamburg
Further details can be found here: https://peko-gegen-gewalt.de/ (in German)
Summary:
Violence in care is a relevant issue not only in inpatient long-term care, but also in hospitals and outpatient settings. However, the needs for targeted prevention measures are as diverse as the settings themselves. Building on the previous PEKo violence prevention project, the PEKo 2.0 project "Violence Prevention in Hospitals and Outpatient Settings" aims to develop sustainable violence prevention concepts with employees in a participatory manner and to implement them in hospitals and outpatient organizations as well as to evaluate them scientifically. The guiding principles are transparency and participation, a systematic approach, and sustainable integration into facility structures.
Hospital setting
The project will be carried out in twelve hospitals at the study sites in Cologne, Lübeck, Fulda and Halle (Saale). The following standardized intervention components will guide action while maintaining the participatory character of the project:
- Kick-off event in the participating hospitals
- Appointment of PEKo representatives as contact person(s)
- Formation of a hospital-internal PEKo team with interested employees
- Monthly PEKo team meetings moderated by study team members
- Quarterly, cross-facility meetings of representatives of the PEKo teams (PEKo circles)
Outpatient setting
Unlike in the inpatient setting, the project in the outpatient setting proceeds in two phases.
1) In the first phase, a violence prevention concept is developed within six months with representatives of various outpatient organizations (outpatient care services, counseling centers, self-help groups/volunteer organizations).
2) In the second phase, this violence prevention concept will be implemented on a demand-oriented basis in nine organizations at the three study centers Cologne, Fulda and Halle over a project period of 12 months.
Focus groups, individual interviews, standardized surveys and a structured evaluation of the study documentation will be conducted as part of the process evaluation.
Short title
- PRO-LQ
Project leaders
Clinical leader
- Prof. Dr. med. Vordermark
Project assistant
Partners
- University Clinic and Polyclinic for Radiation Therapie, Halle (Saale)
- Central Services 1 - Information and Communication, University Clinic Halle (Saale)
- Krukenberg Cancer Center, University Clinic Halle (Saale)
- Evaluation Software Development
Funding
- European Fond for Regional Development (EFRE)
Abstract
Background
The assessment of patient-reported, health-related quality of life (HRQOL=Health-Related Quality of Life) provides relevant information about how cancer patients experience their illness and therapy and what strain this places on them. It helps to involve the patieneets’ perspective more in the treatment process. Although many studies verify the benefit of systematic supportive therapy, up to now a standard assessment of HRQOL does not take place in most clinics. One reason for this is the fact that incorporating it in the clinical routine would amount to a complex intervention for which many aspects, components and involved people would have to be taken into account. Therefore, a scientifically based, carefully planned and structured approach is essential.
Aim
This project aims to plan, conduct and evaluate the implementation of the electronic assessment of HRQOL in an oncological department and according to scientific standards. Based on the knowledge gained during the process evaluation, a guideline for the implementation in other clinical settings is to be developed.
Methods
The project will be carried out in five stages: 1. Identification of optimization requirements and department-specific support factors and barriers to implementation through a current status analysis with internship as observer, documentation analysis and survey; 2. Selection of tools and development of treatment paths for relevant findings of the HRQOL assessment (e.g. for specific symptoms); 3. Development and implementation of a training session for clinic personnel on how to deal with the electronic HRQOL assessment; 4. Step-by-step implementation accompanied by continuous monitoring; 5. Evaluation of the success of the implementation by means of documentation analysis, assessment of patient satisfaction by means of a survey, and creating the guideline for the implementation.
Expected findings
The project is expected to provide knowledge about setting-specific supportive factors and barriers to the implementation of the electronic assessment of HRQOL. These will serve as a basis for creating a guideline for the implementation in other clinical settings. The guideline is to be tested within the framework of a subsequent multicentered study in order to improve the generalizability and to promote the use of further implementations of routine HRQOL assessment in various departments.
Short title:
- Progeleit
Duration:
- July 2023 until December 2025
Principal investigator:
- Prof. Dr. Gabriele Meyer
Scientific staff:
- Dr. Almuth Berg
- Dr. Christin Richter
Funding:
- Federal state of Saxony-Anhalt, Germany
- Own resources
Progeleit is a sub-project of the CoPreP - Collaboration for Pandemic Preparedness consortium
Summary:
Immediately at the beginning of the SARS-CoV-2 pandemic, there was a demand for the nursing home setting to create a solid clinical-epidemiological database in order to enable empirically and evidence-based action. The RKI's surveillance system approach reached its clearly recognisable limits here and was unsuitable to serve as a source of information for the setting. No clinically relevant conclusions could be drawn about the impact of the pandemic and the measures taken to control it on resident-relevant health outcomes, causes of death, social participation and dignity violations.
In preparation for the next pandemic threat situation in Saxony-Anhalt, Germany - with its almost 700 nursing homes and more than 29,000 residents - a study protocol that can be activated immediately is to be developed, which defines tried and tested approaches to data collection (such as sentinel, registers, surveys) to a consented set of outcome variables and sets out data protection, flow, analysis, processing and feedback to decision-makers. The methods used include literature syntheses, focus groups and expert interviews. Finally, the protocol is agreed with relevant stakeholders to ensure its acceptance and feasibility.
Short title
- PPE
Period
- April 2018 – March 2021
Project tetam leader in Halle
Staff members
Consortium leader
- Prof. Dr. Jonas Schreyögg, Hamburg Center for Health Economics (HCHE)
Other consortium partners
- Techniker Krankenkasse (Hamburg)
Funding
- Joint Federal Committee Innovation Fund (Reg.-No.: 01VSF17038)
Abstract
The PPE project is investigating the relation between quality and outcome of nursing care and nurse staffing levels. So-called routine data from hospitals and health insurance companies that are usually used for documentation and billing, will be evaluated. To include the subjectively experienced treatment quality, patients will be asked about their stay in hospital.
The findings can supply valuable information about how the hospitals can use their nursing staff to achieve the best nursing care. The results can also be used by health policy makers to utilize subsidies for care improvement in the best possible way.
Background
In hospitals, the quality of nursing care can have a relevant influence on the quality and success of treatment. The nurse-patient-ratio must be seen as a structural component and is at the same time a prerequisite for the quality of care. It outlines the number of patients that one nurse must care for and provides information about the care intensity. It is also interesting to discover whether the care provided corresponds to the needs of the patients. The success of the nursing care can be seen after the patient has been discharged, for example from the physical condition of the patient (through so-called care-sensitive outcome indicators).
Knowledge about the relation between the care intensity in hospital and care-sensitive outcome indicators provide a basis on which the quality (of care) in hospitals can be improved and in which departments/wards more staff must be allocated in order to ensure high-quality and safe care. By introducing minimum standards in the allocation of staff to care-sensitive departments/wards, it might be possible to provide more certainty for the patients when selecting a hospital and also improve the patient orientation.
To date, the relation between the staffing levels and patient-related outcomes has rarely been empirically examined. Previous research dealt mainly with patient-related outcomes that could be proven during the stay in hospital. In contrast, the perspective of post-discharge care and the patient perspective have been largely neglected.
Objective
The PPE study investigates the relation between the staffing levels in German hospitals and the post-discharge outcomes of the patients cared for there. A further aim is to determine nurse-patient-ratios, particularly with regard to the care-sensitive departments/wards where an increase in staff levels might achieve the best improvement in care quality.
Methods
Care-sensitive patient outcomes will be identified systematically from the literature. Indicators that can be recorded not only during, but also after hospitalization are of particular interest. These indicators are collected from the billing data of inpatient and outpatient service providers. In addition, a standardized questionnaire will be used to collect information from the patient's perspective with regard to the quality of care on the ward and adverse events and conditions of care that occurred after the hospitalization.
Subsequently, these data can be put in relation to the nurse-patient-ratio. Information regarding staffing on the wards will be taken from the hospitals’ quality reports.
Abbreviated title
- R2D
Subject area
- Healthcare research – discharge management
Time
- January 2024 until December 2026
Consortium partners
- Prof. Dr. Vera Winter, University of Wuppertal (consortium management)
- Martin-Luther-University Halle-Wittenberg (MLU)
- German Hospital Institute (DKI)
- HGZ Cardiovascular Center Bad Bevensen (HGZ)
- TK insurance (TK)
- University of Hamburg (UHH)
Project management MLU
Project members MLU
- Dr. Steffen Fleischer
- Susan Gottschalk, M.Sc.
Funding
The Federal Joint Committee (G-BA) Innovation fund funds the project (funding reference 01VSF23035).
Abstract
Background
Cardiovascular diseases account for a significant proportion of all cases of illness in Germany and often require specialist treatment in hospital. For the quality of care, it is very important to organise the transition between inpatient and subsequent outpatient care as effectively, seamlessly and continuously as possible through effective discharge management. Although there is a framework agreement on discharge management, its implementation varies across hospitals and challenges the quality of transition between care providers. There are currently no standardised implementation regulations for discharge management for cardiovascular diseases.
Objective and research questions
The aim of the project is to analyse the implementation, influencing factors and effects of discharge management in cardiologic care in order to derive recommendations for efficient and effective discharge management.
Main questions:
- What is the status of the implementation of discharge management in cardiologic care?
- How are structures and resources (e.g. qualitative and quantitative staffing as well as capacities of and cooperation with other stakeholders) related to the implementation and success of discharge management in cardiologic care?
- What barriers and facilitators exist from the perspective of the stakeholders involved in discharge management?
- How does the implementation of discharge management influence the quality and continuity of cardiologic care?
Method
- Planning, implementation and analysis of a nationwide hospital survey on the implementation, continuity and quality of discharge management in cardiologic care.
- Planning, implementation and analysis of a patient survey on the quality of discharge management and continuity in cardiologic care.
- Analysis of routine data on influencing factors and effectiveness of discharge management with regard to the quality and continuity of cardiologic care.
- Conducting individual and group interviews with stakeholders involved in discharge management (experts) regarding factors that promote and hinder the implementation, continuity and quality of discharge management in cardiologic care.
The Institute of Health and Nursing Science (IGPW) of the MLU Faculty of Medicine is responsible for preparing, conducting and analysing the expert interviews in the project. The IGPW is also involved in preparing the hospital survey, preparing the patient survey, interpreting, and disseminating the results.
Kurztitel
- VIN
Zeitraum
- November 2021 - Oktober 2023
Projektleitung Standort Halle:
Mitarbeiter:
Konsortialpartner:
- VirtuaLounge GmbH, Braunschweig
Förderung
- „TDG - Translationsregion für digitalisierte Gesundheitsversorgung“ im Rahmen des BMBF Programms „WIR! - Wandel durch Innovation in der Region“ (FKZ: 03WIR3105A)
Zusammenfassung
Hintergrund: Etwa 23 Millionen Personen in Deutschland sind von chronischen Schmerzen betroffen. Therapeutisch werden vorwiegend schmerzlindernde Medikamente eingesetzt, bei deren dauerhafter Einnahme nicht selten das Risiko einer Abhängigkeit besteht. Die aktuelle Forschung untersucht physiotherapeutische Behandlungsansätze für Menschen mit chronischen Schmerzen als Alternativen zur medikamentösen Behandlung, u.a. die Spiegeltherapie. Die Ergebnisse zeigen, dass Spiegeltherapie unter der Annahme schmerzlindernd wirkt, Funktionsvertrauen in schmerzbetroffene Körperabschnitte zu initiieren und schmerzerhaltende Verschaltungsmuster beteiligter Hirnzentren zu reorganisieren. Ein weiterer Ansatz ist der Einsatz von Virtueller Realität (VR) in der Bewegungstherapie. Es wird davon ausgegangen, dass das „Eintauchen“ in virtuelle Spielewelten von der Schmerzwahrnehmung ablenkt und so eine Schmerzreduktion erzielt wird.
Das Behandlungsverfahren der Virtuell Invertierten Neurotherapie (VIN) führt Komponenten der Spiegeltherapie und des Einsatzes von VR zusammen.
Projektziel: Ziel des Vorhabens ist es, eine anwendungsreife technische Lösung zur Umsetzung der VIN zu entwickeln und diese in einem supervidierten Heimanwendungsprogramm für Patientinnen und Patienten mit chronischen Schmerzen auf Eignung zu überprüfen sowie erste Hinweise zur Wirksamkeit zu gewinnen.
Methodik: Ausgehend von einer systematischen Literaturübersicht wird ein logisches Modell zur Wirkweise der VIN, ein Interventionsprotokoll sowie ein Pilotierungs- und Evaluationskonzept entwickelt. Von Beginn an werden in Form eines Projektbeirates Menschen mit chronischen Schmerzen sowie Therapeutinnen und Therapeuten in die inhaltliche und technische Entwicklung der Intervention einbezogen. Die Virtuell Invertierte Neurotherapie VIN-Umsetzung wird anschließend in einer randomisierten Pilotstudie erprobt. Hierfür werden 20 Personen mit chronischen primären oder sekundären muskuloskelettalen/neuropathischen Schmerzen im Alter von mind. 18 Jahren, die bei abgeschlossener Diagnostik und konstantem Behandlungsregime in den vergangenen 3 Monaten keine multimodale Therapie oder operative Eingriffe erhielten, in die Studie eingeschlossen. Ein hinreichendes Sehvermögen und die selbstständige Bewältigung des Alltags sollte für die Studienteilnahme gegeben sein. Die Kontrollgruppe erhält Spiegeltherapie in supervidierter Heimanwendung ohne digitale Umsetzung. Experimental- und Kontrollintervention umfassen 6 Wochen. Eine begleitende Prozessevaluation untersucht u.a. den Umsetzungsgrad und Barrieren der Anwendung.
Ausblick: Die Pilotstudie liefert erste Hinweise zur Wirksamkeit der VIN als Heimanwendung für Patientinnen und Patienten mit chronischen Schmerzen. Erkenntnisse zur Umsetzbarkeit der Intervention, der Rekrutierungs- und Implementierungsstrategien sowie der Datenerhebungsprozesse werden für die Planung einer nachfolgenden Wirksamkeitsstudie gewonnen. Lassen die Ergebnisse auf die Anwendbarkeit und Wirksamkeit der VIN schließen, kann in einem nächsten Schritt der Einsatz von VIN für weitere Therapiezielstellungen erprobt werden.
Stichworte
- Logisches Modell zur Wirkweise
- randomisierte Pilotierungsstudie
- digitale Spiegeltherapie
- Heimanwendung
- Chronischer Schmerz