Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany.
Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377, Munich, Germany.
BMC Fam Pract. 2021 May 12;22(1):89. doi: 10.1186/s12875-021-01441-9.
Vertigo, dizziness and balance disorders (VDB) are common in older people and cause restrictions in mobility and social participation. Due to a multifactorial aetiology, health care is often overutilised, but many patients are also treated insufficiently in primary care. The purpose of this study was to develop a care pathway as a complex intervention to improve mobility and participation in older people with VDB in primary care.
The development process followed the UK Medical Research Council guidance using a mixed-methods design with individual and group interviews carried out with patients, physical therapists (PTs), general practitioners (GPs), nurses working in community care and a multi-professional expert panel to create a first draft of a care pathway (CPW) and implementation strategy using the Consolidated Framework of Implementation Research and the Expert recommendations for Implementing Change. Subsequently, small expert group modelling of specific components of the CPW was carried out, with GPs, medical specialists and PTs. The Behaviour Change Wheel was applied to design the intervention´s approach to behaviour change. To derive theoretical assumptions, we adopted Kellogg´s Logic Model to consolidate the hypothesized chain of causes leading to patient-relevant outcomes.
Individual interviews with patients showed that VDB symptoms need to be taken more seriously by GPs. Patients demanded age-specific treatment offers, group sessions or a continuous mentoring by a PT. GPs required a specific guideline for diagnostics and treatment options including psychosocial interventions. Specific assignment to and a standardized approach during physical therapy were desired by PTs. Nurses favoured a multi-professional documentation system. The structured three-day expert workshop resulted in a first draft of CPW and potential implementation strategies. Subsequent modelling resulted in a CPW with components and appropriate training materials for involved health professionals. A specific implementation strategy is now available.
A mixed-methods design was suggested to be a suitable approach to develop a complex intervention and its implementation strategy. We will subsequently test the intervention for its acceptability and feasibility in a feasibility study accompanied by a comprehensive process evaluation to inform a subsequent effectiveness trial.
The research project is registered in "Projektdatenbank Versorgungsforschung Deutschland" (Project-ID: VfD_MobilE-PHY_17_003910; date of registration: 30.11.2017).
眩晕、头晕和平衡障碍（VDB）在老年人中很常见，导致他们的活动能力和社会参与受到限制。由于病因的多因素性，医疗保健往往被过度利用，但许多患者在初级保健中也得不到充分治疗。本研究的目的是制定一条护理途径，作为一种复杂的干预措施，以改善初级保健中患有 VDB 的老年人的活动能力和参与度。
该发展过程遵循英国医学研究理事会的指导，采用混合方法设计，对患者、物理治疗师（PTs）、全科医生（GPs）、社区护理护士以及多专业专家小组进行个体和小组访谈，以使用综合实施研究框架和专家实施变革建议创建护理途径（CPW）和实施策略的初稿。随后，对 CPW 的特定组件进行了小型专家小组建模，参与者包括 GPs、医学专家和 PTs。应用行为改变车轮来设计干预措施的行为改变方法。为了得出理论假设，我们采用 Kellogg 的逻辑模型来整合导致患者相关结果的假设因果链。
对患者的个体访谈表明，GP 应更认真对待 VDB 症状。患者要求提供特定于年龄的治疗方案、小组课程或由 PT 进行持续指导。GP 需要特定的诊断和治疗选择指南，包括心理社会干预。PTs 希望在物理治疗中进行特定的分配和标准化方法。护士赞成多专业的文件系统。经过结构化的为期三天的专家研讨会，制定了 CPW 的初稿和潜在的实施策略。随后的建模为涉及的卫生专业人员制定了 CPW 及其培训材料。现在有了一个特定的实施策略。
混合方法设计被认为是开发复杂干预措施及其实施策略的合适方法。我们随后将在一项可行性研究中测试该干预措施的可接受性和可行性，并进行全面的过程评估，为随后的有效性试验提供信息。
该研究项目在"Projektdatenbank Versorgungsforschung Deutschland"（项目 ID：VfD_MobilE-PHY_17_003910；注册日期：2017 年 11 月 30 日）中注册。
