Publications by authors named "Christoph Egen"

9 Publications

  • Page 1 of 1

[Translation, Adaptation, Reliability and Validity of the German Version of the Prosthesis Mobility Questionnaire 2.0 (PMQ) on Patients with Major Lower Limb Amputation].

Rehabilitation (Stuttg) 2021 Jul 22. Epub 2021 Jul 22.

Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover.

Purpose: The aim of this prospective validation study was to translate the Prosthesis Mobility Questionnaire 2.0 (PMQ) into German based on a guideline, following by psychometric testing for its validity and reliability using classical test theory.

Methods: The PMQ was translated into German according to ISPOR guidelines using double forward and double backward translations, finalized by pilot testing (N=10). Subsequently, assessment of the validity and reliability was performed from March 2020 to August 2020 on N=61 patients with unilateral lower limb amputation. Construct validity was determined by using the German version of the Locomotor Capabilities Index-5 (LCI-5-D), the Rivermead Mobility Index (RMI), the Timed up and go Test (TUG), and K-levels. Cronbach's alpha was calculated to check internal consistency and discriminatory power was determined by item correlations. Test-retest reliability was calculated using ICC (2,1). Based on the ICC, the minimum detectable difference (MDC) was calculated.

Results: The translation process required small changes after the pilot test. The validation study was performed on N=61 patients (56.59±13.16 years, m/f=38/23). A mean PMQ of 26.23±8.89 points was achieved. Ceilings or floor effects for total score did not appear. Construct validity showed strong positive correlations to LCI-5-D (r=0.74, p<0.001), RMI (r=0.63 p<0.001) as well as k-levels (r=0.61 p<0.001) and moderate negative correlation to TUG (r=- 0.49, p<0.001). Internal consistency was excellent with Cronbach's alpha=0.95). All items showed a value greater than r=0.40 for item-to-total score correlation. Test-retest reliability was excellent with an ICC (2,1)=0.98 with a timespan between T0 and T1 of 3.2±2.83 days. Based on this results, the MDC was 3.40 points.

Conclusion: The German version of the Prosthesis Mobility Questionnaire 2.0 is a valid, reliable patient reported outcome measure (PROM) for measuring mobility and functional ability of patients with exoprosthesis due to unilateral lower limb amputation. It can be used for a German-speaking population.
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http://dx.doi.org/10.1055/a-1506-7603DOI Listing
July 2021

Which factors have an association to the Quality of Life (QoL) of people with acquired Spinal Cord Injury (SCI)? A cross-sectional explorative observational study.

Spinal Cord 2021 Aug 8;59(8):925-932. Epub 2021 Jul 8.

Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany.

Study Design: Cross-sectional explorative observational study.

Objectives: To identify factors which have an association to the self-perceived Quality of Life (QoL) for persons with acquired spinal cord injury (SCI).

Setting: Eight specialized SCI-centers in Germany. The GerSCI survey is the German part of the International Spinal Cord Injury Survey (InSCI).

Methods: Self-disclosure questionnaire, created from the InSCI group, translated and adapted for Germany. The questionnaire collects a very broad range of data and, and due to its design as a self-report, is particularly suitable for the analysis on QoL. Because of the content, which is binding for all participating states, it allows a direct comparability of the results. Included in Germany were 1479 persons with acquired SCI aged 18 years and older.

Results: Various factors were identified with high associations to QoL, including changeable and unchangeable ones, such as those of particular importance: pain, sleep problems, sexual dysfunction, age, and time since onset of SCI. Some results confirmed reports of previous studies, others were surprising.

Conclusion: this study provides an important basis for the planned analysis of the InSCI participating countries in the 6 WHO regions. Germany was able to contribute the largest study population. The concrete study design of InSCI allows us to directly compare data and helps us to improve ourselves within the framework of a "learning health system". Medical measures can be orientated towards the found results, in order to ensure the best possible care and support by the therapeutic team, individually adapted to the person, place of residence and impairment.
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http://dx.doi.org/10.1038/s41393-021-00663-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8338547PMC
August 2021

"Fit for work and life": an innovative concept to improve health and work ability of employees, integrating prevention, therapy and rehabilitation.

J Rehabil Med 2021 May 31;53(5):jrm00199. Epub 2021 May 31.

Department of Rehabilitation Medicine, Coordination Centre for Rehabilitation Research, Hannover Medical School, Carl-Neuberg-Str. 1, DE-30625 Hannover, Germany.

Objectives: To set up a comprehensive health programme for employees, with needs-based allocation to preventive and rehabilitative measures; and to evaluate the effects of the programme on work ability and sick leave.

Design: Prospective single-group observational study.

Methods: Employees of a university hospital were invited to participate in needs-based interventions of preventive or rehabilitative character. Allocation followed screening questionnaires, anamnesis and clinical examination. The selection of a preventive or rehabilitative measure appropriate to the needs of the patient followed screening questionnaires, anamnesis and clinical examination. Preventive offers can include back training courses, water gymnastics or stress management exercises. Rehabilitative measures can include 3-6 weeks in- or outpatient rehabilitation or one week intensive outpatient rehabilitation. The main outcome parameters were work ability and sick leave duration.

Results: At this time of the project included 1,547 participants, who applied voluntarily to enter the programme. The mean age of participants was 44.3 years (standard deviation (SD) 10.3 years), and 72.0% were female. Needs-based allocation to a prevention (n=1,218) or a rehabilitation group (n=329) was effective, and enabled formation of 2 groups with different needs. Overall, more than half of the employees participating in the programme reported sick leave within the last 3 months. Participants in the preventive measures group reported significantly lower duration of sick leave than those in the rehabilitation group. Employees in the rehabilitation group had significantly lower work ability (Work Ability Index (WAI) 30.4 vs 36.6), but higher effects at 6-month follow-up (WAI 33.4 (standardized effect size (SES) 0.51) vs 37.9 (SES 0.17)). In the prevention group mean sick leave reduced significantly from 1.9 to 1.3 weeks (p < 0.001) during the previous 3-month period, whereas in the rehabilitation group it reduced from 2.7 to 1.5 (p < 0.001) weeks.

Conclusion: Implementation of the comprehensive health programme was successful, using the multimodal infrastructure of a university hospital. Allocation to suitable interventions in occupational health programmes following screening, anamnesis and clinical examination is an appropriate way to meet participants' needs. The programme resulted in improved work ability and less sick leave.
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http://dx.doi.org/10.2340/16501977-2822DOI Listing
May 2021

Combination of acupuncture and medical training therapy on tension type headache: Results of a randomised controlled pilot study.

Cephalalgia 2021 Jul 9;41(8):879-893. Epub 2021 Feb 9.

Department for Rehabilitation Medicine, Hannover Medical School, Hannover, Germany.

Objectives: The aim of this study was to compare the effects of acupuncture and medical training therapy alone and in combination with those of usual care on the pain sensation of patients with frequent episodic and chronic tension-type headache.

Design: This was a prospective single-centre randomised controlled trial with four balanced treatment arms. The allocation was carried out by pre-generated randomisation lists in the ratio 1:1:1:1 with different permutation block sizes.

Setting: The study was undertaken in the outpatient clinic of Rehabilitation Medicine of the Hannover Medical School. Ninety-six adult patients with tension-type headache were included and randomised into usual care (n = 24), acupuncture (n = 24), medical training (n = 24), and combination of acupuncture and medical training (n = 24). One patient was excluded from analysis because of withdrawing her/his consent, leaving 95 patients for intention to treat analysis. Each therapy arm consisted of 6 weeks of treatment with 12 interventions. Follow-up was at 3 and 6 months.

Main Outcome Measures: Pain intensity (average, maximum and minimum), frequency of headache, responder rate (50% frequency reduction), duration of headache and use of headache medication. The combination of acupuncture and medical training therapy significantly reduced mean pain intensity compared to usual care (mean = -38%, standard deviation = 25%,  = 0.012). Comparable reductions were observed for maximal pain intensity (-25%, standard deviation = 20%, 0.014) and for minimal pain intensity (-35%, standard deviation = 31%, 0.03). In contrast, neither acupuncture nor medical training therapy differed significantly from usual care. No between-group differences were found in headache frequency, mean duration of headache episodes, and pain medication intake. At 3 months, the majority of all patients showed a reduction of at least 50% in headache frequency. At 6 months, significantly higher responder rates were found in all intervention groups compared to usual care.

Conclusions: In contrast to monotherapy, only the combination of acupuncture and medical training therapy was significantly superior in reduction of pain intensity compared to usual care. Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.
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http://dx.doi.org/10.1177/0333102421989620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217893PMC
July 2021

[Spinal Cord Injury in Germany - a Survey on the Living and Care Situation of People with Spinal Cord Injury].

Rehabilitation (Stuttg) 2020 Aug 21;59(4):205-213. Epub 2020 Jan 21.

Klinik für Rehabilitationsmedizin, Medizinische Hochschule.

Purpose: Multiple organizations like UN and WHO call for the collection of internationally comparable data on living and supply conditions of people with disabilities. Furthermore, reliable national data are necessary for ensuring appropriate care. Regarding patients with Spinal Cord Injury (SCI) in Germany, only data on diagnostics or therapeutic interventions is currently available. The International Spinal Cord Injury Survey aims at collecting reliable data of people with SCI in 21 countries and developing recommendations for actions to be taken by policy-makers and other decision-makers.

Methods: In 2017, eight specialized SCI-centers across Germany sent a standardized questionnaire to their patients who had diagnosis of SCI, and were older than 18 years (n=5,598). The questionnaire could be completed paper-based or online.

Results: 1,479 patients participated in the study and were included in data analysis. On average, participants were 55.3 years (SD=14.6) old, ¾ were male. The mean time of onset of paralysis was 13.9 years. Two thirds of the spinal cord injury causes were traumatic. In 51.2% SCI was classified as paraplegia. The most frequently cited health problem was sexual dysfunction. Medical treatment for this problem was rarely used. Serious environmental barriers were the inadequate accessibility of private households and public places. 42.5% of the respondents in working age were employed, which is 10% less than in Switzerland.

Discussion: Serious problems in environmental barriers, medical care and labor market participation were identified for people with SCI. The results will be reported to and discussed with political decision makers and further actors to create solutions. This requires extensive efforts, like modification in building law and home support.
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http://dx.doi.org/10.1055/a-1071-5935DOI Listing
August 2020

[Factors Influencing Access to Follow-Up Rehabilitation].

Rehabilitation (Stuttg) 2020 Jun 4;59(3):141-148. Epub 2019 Nov 4.

Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover.

Purpose: Identification of patient-related influencing factors on access to follow-up rehabilitation METHODS: Partially standardized, written survey of patients between the ages of 18 and 65 in 3 acute hospitals in Hanover, who were assigned to one of the following six defined indication groups on the basis of their diagnosis: (1) surgically treated bone fractures, (2) knee and hip endoprosthesis, (3) malignant disease from visceral surgery, (4) heart disease without surgical intervention, (5) heart disease with surgical intervention, and (6) stroke. In addition to personal information (such as age and gender) personal rehabilitation goals, rehabilitation motivation, disease processing, functioning, state of health, the knowledge of right to request and suffrage and the personal desire to start a follow-up rehabilitation were raised.

Results: Of the 1,227 patients surveyed, 42.5% received follow-up rehabilitation. The percentages between the groups of diagnoses varied widely and were lowest after conservatively treated heart disease (3.2%) and highest after knee and hip joint replacement (98.1%). Including cases with a follow-up rehabilitation relevant diagnosis (n=1,000), the proportion of persons with rehabilitation increased to 51.7% (p<0.001). Reasons for an untreated follow-up rehabilitation were in rare cases the rejection by the payer (0.7%), the rejection by the patient (1.6%) or the lack of rehabilitation ability (3.3%). However in most cases the application remained without further differentiation (28.5%). The most important factor influencing follow-up rehabilitation access were diagnosis. Compared to knee- and hip endoprosthesis, the patients from other relevant diagnosis groups had a much lower chance to start a follow-up rehabilitation (OR from 0,01 up to 0,07; p<0,001). The desire of the patient showed the second most and significant influence to get follow-up rehabilitation (OR=8.18; p<0.001).

Conclusions: The diagnosis was identified as the most important criterion for follow-up rehabilitation access. No measurable factors of functioning seem to have a big influence. Therefore, the individual doctor's decision to submit an application is of particular importance. Especially because of the low level of medical knowledge on the indication catalog of the German pension insurance, the medical treatment based on professional experience as well as the lack of further education possibilities (Gottschling-Lang, 2016), it can be assumed that the follow-up rehabilitation is less standardized and systematic. In order to ensure a need-based patient care, assessment procedures should be established and the training and continuing education of physicians should be supplemented with the topic of follow-up rehabilitation.
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http://dx.doi.org/10.1055/a-1011-2629DOI Listing
June 2020

People with Spinal Cord Injury in Germany.

Am J Phys Med Rehabil 2017 02;96(2 Suppl 1):S66-S70

From the Department for Rehabilitation Medicine, Hannover Medical School, Germany (MB, CE, CG); and Manfred-Sauer-Foundation Lobbach, Germany (VG).

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http://dx.doi.org/10.1097/PHM.0000000000000584DOI Listing
February 2017

Rehabilitation Services Provision and Payment.

Am J Phys Med Rehabil 2017 Feb;96(2 Suppl 1):S35-S40

From the Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany (CG, MB, CE); and Manfred-Sauer-Stiftung, Lobbach, Germany (VG).

Persons with spinal cord injury (SCI) experience disability and have significant need for rehabilitation. To deliver appropriate rehabilitation, interventions and programs suitable services must exist. A prerequisite for system improvement is a description of rehabilitation services. The aim of this paper was to develop a rehabilitation service framework for SCI. Additionally, principles and models of payment of rehabilitation services will be discussed. Health-related rehabilitation services should be available along the continuum of care and implemented at all levels of health care. The three most important types of services are acute, postacute, and long-term rehabilitation services. Health-related rehabilitation services for patients with SCI must be able to provide high-quality equipment and a well-trained, highly specialized and multiprofessional team of rehabilitation workers. The principles of payment for SCI rehabilitation services vary according to the organization of health care systems, which primarily depends on the sources of money (eg, from national health care systems, other health insurances, or out of pocket). Funding systems and payment criteria may influence service provision and justice in service delivery. It is important to analyze the provision of rehabilitation services and the related funding system using uniform assessment and evaluation tools.
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http://dx.doi.org/10.1097/PHM.0000000000000668DOI Listing
February 2017

Early Workplace Intervention to Improve the Work Ability of Employees with Musculoskeletal Disorders in a German University Hospital-Results of a Pilot Study.

Healthcare (Basel) 2016 Sep 7;4(3). Epub 2016 Sep 7.

Company Physician, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.

Health promotion is becoming increasingly important in work life. Healthcare workers seem to be at special risk, experiencing musculoskeletal disorders (MSD); their situation is strongly influenced by demographic changes. The aim of this study is to evaluate the feasibility and outcome of a worksite intervention. In a one-group pretest-posttest design, 118 employees of a hospital were recruited from 2010 to 2011. The raised parameters were satisfaction with the program, work ability (Work Ability Index), and sickness absence (provided by human resource management). Patient-reported questionnaire data was raised at baseline (t1) and after three months (t2). Sickness leave was evaluated in the period six months prior to and six months after the intervention. Means, frequencies, standardized effect sizes (SES), analysis of variance, and regression analysis were carried out. Participants were found to be highly satisfied. Work ability increased with moderate effects (SES = 0.34; p < 0.001) and prognosis of gainful employment (SES = -0.19; p ≤ 0.047) with small effects. Days of MSD-related sickness absence were reduced by 38.5% after six months. The worksite intervention program is transferable to a hospital setting and integration in occupational health management is recommended. The use of a control group is necessary to demonstrate the effectiveness.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041065PMC
http://dx.doi.org/10.3390/healthcare4030064DOI Listing
September 2016
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