Publications by authors named "Ines Buchholz"

13 Publications

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Translation and adaptation of the German version of the Veterans Rand-36/12 Item Health Survey.

Health Qual Life Outcomes 2021 May 4;19(1):137. Epub 2021 May 4.

University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.

Background: The translated and culturally adapted German version of the Veterans Rand 36 Items Health Survey (VR-36), and its short form, the VR-12 counterpart, were validated in a German sample of orthopedic (n = 399) and psychosomatic (n = 292) inpatient rehabilitation patients.

Methods: The instruments were analyzed regarding their acceptance, distributional properties, validity, responsiveness and ability to discriminate between groups by age, sex and clinically specific groups. Eligible study participants completed the VR-36 (n = 169) and the VR-12 (n = 177). They also completed validated patient-reported outcome measures (PROs) including the Euroqol-5 Dimensions 5 Level (EQ-5D-5L); Depression, Anxiety and Stress Scale (DASS); Hannover Functional Abilities Questionnaire (HFAQ); and CDC Healthy Days. The VR-12 and the VR-36 were compared to the reference instruments MOS Short Form-12 Items Health Survey (SF-12) version 1.0 and MOS Short Form-36 Items Health Survey (SF-36) version 1.0, using percent of completed items, distributional properties, correlation patterns, distribution measures of known groups validity, and effect size measures.

Results: Item non-response varied between 1.8%/1.1% (SF/RE) and 6.5%/8.6% (GH/GH). PCS was normally distributed (Kolmogorov-Smirnov tests: p > 0.05) with means, standard deviations and ranges very similar between SF-36 (37.5 ± 11.7 [13.8-66.1]) and VR-36 (38.5 ± 10.1 [11.7-67.8]), SF-12 (36.9 ± 10.9 [15.5-61.6]) and VR-12 (36.2 ± 11.5 [12.7-59.3]). MCS was not normally distributed with slightly differing means and ranges between the instruments (MCS: 36.2 ± 14.2 [12.9-66.6], MCS: 39.0 ± 15.6 [2.0-73.2], MCS: 37.2 ± 13.8 [8.4-70.2], MCS: 39.0 ± 12.3 [17.6-65.4]). Construct validity was established by comparing correlation patterns of the MCS and PCS with measures of physical and mental health. For both PCS and MCS there were moderate (≥ 0.3) to high (≥ 0.5) correlations with convergent (PCS: 0.55-0.76, MCS: 0.60-0.78) and small correlations (< 0.1) with divergent (PCS: < 0.12, MCS: < 0.16) self-report measures. Known-groups validity was demonstrated for both VR-12 and VR-36 (MCS and PCS) via comparisons of distribution parameters with significant higher mean PCS and MCS scores in both VR instruments found in younger patients with fewer sick days in the last year and a shorter duration of rehabilitation.

Conclusions: The psychometric analysis confirmed that the German VR is a valid and reliable instrument for use in orthopedic and psychosomatic rehabilitation. Yet further research is needed to evaluate its usefulness in other populations.
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May 2021

Facilitators and barriers in anorexia nervosa treatment initiation: a qualitative study on the perspectives of patients, carers and professionals.

J Eat Disord 2021 Feb 27;9(1):28. Epub 2021 Feb 27.

Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf, Martinistr. 52, W37, 20246, Hamburg, Germany.

Background: An early psychotherapeutic treatment of anorexia nervosa (AN) is crucial for a good prognosis. In order to improve treatment initiation, knowledge about facilitators and barriers to treatment is needed.

Objective: Against this background, we aimed to identify facilitators and barriers from the perspectives of patients, carers and professionals using a qualitative approach.

Method: To this end, semi-structured interviews were conducted in triads of female patients with AN aged 14 years and older at the beginning of their first psychotherapeutic treatment, their carers, and referring health care professionals. A modified Grounded Theory approach was used for analysis.

Results: In total, 22 interviews were conducted (n = 6 adults, n = 4 adolescents, 4 full triads). The duration of untreated AN ranged between 30 days and 25.85 years (M = 3.06 ± 8.01 years). A wide spectrum of facilitators and barriers within the patient, the social environment, the health care system and the society were identified. Most prominent factors were 'recognizing and addressing' by close others, 'waiting times and availability' and 'recommendations and referrals' by health care professionals. 'Positive role models for treatment' were perceived as a specific facilitative social influence. Facilitators were more frequently mentioned than barriers and most of the factors seem to hold potential for modifiability.

Conclusion: Overall, the findings suggest that early intervention approaches for AN should not only address patients and the health care system, but may also involve carers and successfully treated former patients.

Trial Registration: Identifier: NCT03713541 .
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February 2021

Psychometric properties of the EQ-5D-5L: a systematic review of the literature.

Qual Life Res 2021 Mar 7;30(3):647-673. Epub 2020 Dec 7.

Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany.

Purpose: Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ-5D-5L) has not yet had such extensive experience. This systematic review summarizes the available published scientific evidence on the psychometric properties of the EQ-5D-5L.

Methods: Pre-determined key words and exclusion criteria were used to systematically search publications from 2011 to 2019. Information on study characteristics and psychometric properties were extracted: specifically, EQ-5D-5L distribution (including ceiling and floor), missing values, reliability (test-retest), validity (convergent, known-groups, discriminate) and responsiveness (distribution, anchor-based). EQ-5D-5L index value means, ceiling and correlation coefficients (convergent validity) were pooled across the studies using random-effects models.

Results: Of the 889 identified publications, 99 were included for review, representing 32 countries. Musculoskeletal/orthopedic problems and cancer (n = 8 each) were most often studied. Most papers found missing values (17 of 17 papers) and floor effects (43 of 48 papers) to be unproblematic. While the index was found to be reliable (9 of 9 papers), individual dimensions exhibited instability over time. Index values and dimensions demonstrated moderate to strong correlations with global health measures, other multi-attribute utility instruments, physical/functional health, pain, activities of daily living, and clinical/biological measures. The instrument was not correlated with life satisfaction and cognition/communication measures. Responsiveness was addressed by 15 studies, finding moderate effect sizes when confined to studied subgroups with improvements in health.

Conclusions: The EQ-5D-5L exhibits excellent psychometric properties across a broad range of populations, conditions and settings. Rigorous exploration of its responsiveness is needed.
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March 2021

Tumorbedingte Fatigue - Prozessevaluation eines Seminars der Universitätsmedizin Greifswald.

Pflege 2021 Feb 30;34(1):41-49. Epub 2020 Nov 30.

Abteilung Methoden der Community Medicine, Universitätsmedizin Greifswald.

Cancer-related fatigue - Process evaluation of a seminar of the University Medicine Greifswald Fatigue is the most common and stressful symptom in cancer patients and their relatives. The patient information center (PIZ) of the University Medicine Greifswald enables patients to learn how to deal with fatigue and to understand their disease. The fatigue seminar is well accepted by seminar participants, but it is rarely taken up by patients. The primary objective of this observational study was to find out how well-known this seminar is, whether it is recommended to patients and what the reasons for missing referrals are.

Methods: Medical and nursing staff of all 13 wards of the Oncology Centre was surveyed by means of a self-developed questionnaire. The questions were analyzed on a single item level. Descriptive statistics and measures of correlation were determined.

Results: The fatigue seminar of the PIZ is hardly known to the n = 115 respondents and / or is not always recommended to those affected. Where the PIZ has been present in the past, the knowledge about fatigue is higher and the seminar is better known. Screening instruments are hardly used for diagnostics.

Conclusions: The fatigue seminar needs to be promoted in a better way. In order to increase its popularity, it should be presented both to the psychological staff and on the wards. The systematic inclusion of screening instruments in the treatment path of cancer patients and the inclusion of the fatigue seminar in the range of treatment for patients with distressing fatigue symptoms should be discussed.
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February 2021

Adequacy of care provision in long-term home nursing arrangements: A triangulation of three perspectives.

Nurs Open 2020 09 2;7(5):1634-1642. Epub 2020 Jul 2.

Department Methods Institute for Community Medicine University Medicine Greifswald Greifswald Germany.

Background: A growing proportion of older people in Germany receive long-term care from informal and professional caregivers at home. Their personal assessment of the individual care situation is scarcely considered.

Aim: This study aimed to explore the subjective views of care recipients, informal and professional caregivers on the adequacy of care provision in long-term home care arrangements.

Design And Methods: Qualitative semi-structured face-to-face interviews were conducted with ten care recipients, ten professional caregivers and eight informal caregivers to capture their perspectives on the adequacy of the care received and delivered. Qualitative content analysis was applied using MAXQDA software.

Results: All groups highlighted that they perceive an of care, even though their explanations differed. The underprovision was mainly described regarding the quality rather than quantity of services. It occurs especially in interpersonal relationships and social inclusion, where the gap between the self-perceived current situation and the desires of those affected is most prominent. The ambivalent impact of home care on social participation becomes apparent. Perceptions of an of care range from the view that it appears mainly with respect to informal care to the statement that it is currently non-existent or generally impossible. of care is experienced as serious whenever the interviewees face the challenge of preserving existing abilities or regaining certain skills.
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September 2020

Correlation of Ductoscopic and Histopathological Findings and Their Relevance as Predictors for Malignancy: A German Multicenter Study.

Anticancer Res 2020 Apr;40(4):2185-2190

Department of Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany.

Background/aim: The study aimed at investigating the correlation between ductoscopic and histopathological findings and clarify whether the former allow for accurate prediction of malignancy.

Patients And Methods: The prospective national multi-center study covered a sample of 224 patients with pathologic nipple discharge. A total of 214 patients underwent ductoscopy with subsequent extirpation of the mammary duct. The ductoscopic findings were categorized according to shape, number, color and surface structure of lesions and vascularity and compared to the histological results and analyses.

Results: Ductoscopy revealed lesions in 134 of 214 patients (62.2%). The criteria "multiple versus solitary lesion" differed significantly between malignant and benign lesions. All other criteria were not statistically significant. Malignant tumors were more frequently presented as multiple lesions, benign lesions or masses as solitary lesions (80% vs. 24.8%; p=0.018).

Conclusion: The ductoscopic criterion "solitary vs. multiple lesion" appears to have a low diagnostic prediction of malignancy or benignity.
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April 2020

Facilitators and barriers in anorexia nervosa treatment initiation (FABIANA): study protocol for a mixed-methods and multicentre study.

BJPsych Open 2019 Oct 21;5(6):e92. Epub 2019 Oct 21.

Professor, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.

Background: Anorexia nervosa is a serious disorder, which often takes a chronic course. Early treatment leads to a significantly better prognosis and prevents chronicity. However, existing evidence on facilitators and barriers in anorexia nervosa treatment initiation is scarce.

Aims: Against this background, the FABIANA study ( Identifier: NCT03713541) aims to (a) identify potentially modifiable facilitators and barriers from the perspectives of adolescent and adult patients with anorexia nervosa, carers and physicians, (b) develop and test an instrument for the combined assessment of multiple key facilitators and barriers, and (c) quantify the effect of potentially modifiable versus non-modifiable key facilitators and barriers on the duration of untreated illness (DUI) in patients with anorexia nervosa.

Method: FABIANA is an observational, mixed-method-study divided into three consecutive substudies each corresponding to one of the study aims. All three substudies will include female patients with anorexia nervosa aged 14 years and older at the beginning of their first psychotherapeutic anorexia nervosa treatment. The qualitative substudy I and the quantitative substudy III will additionally include carers and involved physicians. The recruitment will take place at 20 cooperating study centres throughout Germany, which provide in-patient or out-patient anorexia nervosa specialist care. The DUI will be calculated based on the month of illness onset as determined in validated interviews on lifetime anorexia nervosa symptoms and the therapist-reported date of treatment initiation.

Conclusions: Strengths and limitations of the retrospective assessment of the DUI will be discussed. The findings of the FABIANA study will contribute to the development of evidence-based early-intervention approaches and the prevention of a chronic course of illness.

Trial Registration: Identifier: NCT03713541.

Declaration Of Interest: None.
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October 2019

Concepts of health in long-term home care: An empirical-ethical exploration.

Nurs Ethics 2020 Aug 30;27(5):1187-1200. Epub 2019 Aug 30.

University Medicine Greifswald, Germany.

Background: Concepts of health have been widely discussed in the philosophy and ethics of medicine. Parallel to these theoretical debates, numerous empirical research projects have focused on subjective concepts of health and shown their significance for individuals and society at various levels. Only a few studies have so far investigated the concepts of health of non-professionals and professionals involved in long-term home care and discussed these empirical perspectives regarding moral responsibilities.

Objectives: To identify the subjective concepts of the health of non-professionals (care recipients, informal caregivers) and professionals (registered nurses) involved in long-term home care and to discuss them against the background of existing normative guidelines addressing non-professionals and professionals' responsibilities and rights concerning health.

Research Design: A qualitative design was chosen to explore subjective concepts of health. Data were collected by semi-structured interviews; content analysis was applied according to Mayring.

Participants And Research Context: Twenty-eight interviews were conducted with non-professionals and professionals in long-term home care arrangements in Northern Germany.

Ethical Considerations: Ethics approval was obtained from the Institutional Review Board at the University Medicine Greifswald (BB123/16).

Findings: Non-professionals and professionals consider health as a capability that enables them to participate in social activities and live their own lives according to their preferences. The former regard health particularly as a feeling and an attitude, the latter as the absence of disease with a focus on mental and emotional well-being. Both groups highlight the unsurpassable value of health and the personal responsibility for it.

Discussion: Normative guidelines applicable to practice in long-term home care discuss responsibilities and rights unevenly and raise several problems regarding non-professionals and professionals' subjective concepts of health.

Conclusion: Individuals' concepts of health are relevant for the subsequent interpretation of rights and responsibilities and should, thus, be reflected upon to address health-related needs effectively.
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August 2020

Relationships and burden: An empirical-ethical investigation of lived experience in home nursing arrangements.

Bioethics 2019 05 8;33(4):448-456. Epub 2019 Apr 8.

Institute of Ethics and History of Medicine, University Medicine Greifswald, University of Greifswald, Greifswald, Germany.

Quantitative research has called attention to the burden associated with informal caregiving in home nursing arrangements. Less emphasis has been placed, however, on care recipients' subjective feelings of being a burden and on caregivers' willingness to carry the burden in home care. This article uses empirical material from semi-structured interviews conducted with older people affected by multiple chronic conditions and in need of long-term home care, and with informal and professional caregivers, as two groups of relevant others. The high burden of home-care arrangements is unanimously stressed by all three groups involved in the triangle of care. An empirical-ethical investigation of what can be legitimately expected from family members and informal caregivers, informed by Frith's symbiotic empirical ethics approach, was undertaken. Key tenets from the special goods theory and nursing professionalism are used as analytical tools. The study concludes that the current situation may hinder professional development and can reinforce feelings of being a burden to relevant others.
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May 2019

A Systematic Review of Studies Comparing the Measurement Properties of the Three-Level and Five-Level Versions of the EQ-5D.

Pharmacoeconomics 2018 06;36(6):645-661

Institute for Community Medicine, University Medicine of Greifswald, Greifswald, Germany.

Background: Since the introduction of the five-level version of the EQ-5D (5L), many studies have comparatively investigated the measurement properties of the original three-level version (3L) with the 5L version.

Objective: The aim of this study was to consolidate the available evidence on the performance of both instruments.

Methods: A systematic literature search of studies in the English and German languages was conducted (2007-January 2018) using the PubMed, EMBASE, and PsycINFO (EBSCO) databases, as well as the EuroQol Research Foundation website. Data were extracted and assessed on missing values, distributional properties, informativity indices (Shannon's H' and J'), inconsistencies, responsiveness, and test-retest reliability.

Results: Twenty-four studies were included in the review. Missing values and floor effects (percentage reporting the worst health state) were found to be negligible for both 3L and 5L (< 5%). From 18 studies, inconsistencies ranged from 0 to 10.6%, although they were generally well below 5%, with 9 studies reporting the most inconsistencies for Usual Activities (mean percentage 4.1%). Shannon's indices were always higher for 5L than for 3L, and all but three studies reported lower ceiling effects ('11111') for 5L than for 3L. There is mixed and insufficient evidence on responsiveness and test-retest reliability, although results on index values showed better performance for 5L on test-retest reliability.

Conclusion: Overall, studies showed similar or better measurement properties of the 5L compared with the 3L, and evidence indicated moderately better distributional parameters and substantial improvement in informativity for the 5L compared with the 3L. Insufficient evidence on responsiveness and test-retest reliability implies further research is needed.
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June 2018

Ductoscopic detection of intraductal lesions in cases of pathologic nipple discharge in comparison with standard diagnostics: the German multicenter study.

Oncol Res Treat 2014 17;37(11):628-32. Epub 2014 Oct 17.

Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Ernst-Moritz-Arndt-Universität, Greifswald, Germany.

Background: According to the literature, ductoscopy is gaining increasing importance in the diagnosis of intraductal anomalies in cases of pathologic nipple discharge. In a multicenter study, the impact of this method was assessed in comparison with that of standard diagnostics.

Patients And Methods: Between 09/2006 and 05/2009, a total of 214 patients from 7 German breast centers were included. All patients underwent elective ductoscopy and subsequent ductal excision because of pathologic nipple discharge. Ductoscopy was compared with the following standard diagnostics: breast sonography, mammography, magnetic resonance imaging (MRI), galactography, cytologic nipple swab, and ductal lavage cytology. The histological and imaging results were compared and contrasted to the results obtained from the nipple swab and cytologic assessment.

Results: Sonography had the highest (82.9%) sensitivity, followed by MRI (82.5%), galactography (81.3%), ductoscopy (71.2%), lavage cytology (57.8%), mammography (57.1%), and nipple swab (22.8%). Nipple swabs had the highest (85.5%) specificity, followed by lavage cytology (85.2%), ductoscopy (49.4%), galactography (44.4%), mammography (33.3%), sonography (17.9%), and MRI (11.8%).

Conclusion: Currently, ductoscopy provides a direct intraoperative visualization of intraductal lesions. Sensitivity and specificity are similar to those of standard diagnostics. The technique supports selective duct excision, in contrast to the unselective technique according to Urban. Therefore, ductoscopy extends the interventional/diagnostic armamentarium.
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July 2015

Measuring changes in health over time using the EQ-5D 3L and 5L: a head-to-head comparison of measurement properties and sensitivity to change in a German inpatient rehabilitation sample.

Qual Life Res 2015 Apr 30;24(4):829-35. Epub 2014 Oct 30.

Institute of Community Medicine, University of Greifswald, Greifswald, Germany,

Purpose: To compare measurement properties and sensitivity to change of the standard version of the EQ-5D (3L) with a newly developed 5-level version (5L) in a multicenter sample of German rehabilitation inpatients (n = 230).

Methods: Rehabilitation patients (n = 114 orthopedic, n = 54 psychosomatic, n = 62 rheumatic) were asked to complete both versions of the EQ-5D and several other questionnaires at the beginning of, the end of and 3 month after inpatient rehabilitation. 3L and 5L were compared regarding missing values, ceiling effects, redistribution properties, informativity and sensitivity to change.

Results: There were nearly no missing values in both questionnaires. Ceiling effects were 1.6 % points to 16.4 % points lower on average for the 5L. For psychosomatic patients, ceiling effects for 5L were as high as in the general German population. Absolute informativity (mean 5L: 1.76, 3L: 1.06) and relative informativity (5L: 0.76, 3L: 0.67) were both higher for 5L. 5L could better detect both positive and negative health changes in most dimensions and patient samples. Overall, patients made better use of the response levels of the 5L. Average proportion of inconsistent responses between 3L and 5L was 6.1 %.

Conclusions: Cross-sectionally and longitudinally, 5L was associated with an improved ability to detect health changes over time, reduced ceiling effects, and improved discriminatory power. Overall, these findings were in line with previous study outcomes, although differing in magnitude. Since the sample size is moderate and generalizability of the reported results is unclear, further comparisons in other patient populations will be informative and should be encouraged.
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April 2015

[Descriptors and predictors of rehabilitation goals of medical rehabilitation patients].

Psychother Psychosom Med Psychol 2014 Sep 16;64(9-10):364-72. Epub 2014 May 16.

Abteilung Methoden, Institut für Community Medicine, Universitätsmedizin Greifswald.

Commonly agreed aims make rehabilitation treatment processes more individual, patient-centred and participatory. Since treatment needs of patients can be highly individual, it is to assume that aims also vary considerably. The article examines which aims orthopedic, oncological and psychosomatic patients set for themselves prior to the rehabilitation and to what extent differences in aims can be explained by personal characteristics. The analyses based on the intervention arm of a randomized controlled study (N=1 342) showed that the most common aims are comparable with similar results of other studies. Differences in aims could be attributed to demographic, diagnostic and health-related characteristics. Further studies should examine whether patients with demonstrably worse treatment prognosis for success have different aims than patients with a favourable prognosis.
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September 2014