Sandra Fahrenkrog’s research while affiliated with Charité Universitätsmedizin Berlin and other places

Introduction The proportion of children and young people in Germany who have problematic media use has increased, particularly as a result of the coronavirus pandemic. The presence of comorbidities such as anxiety disorders, depression, sleep disorders, impulsivity and lack of social skills are interdependent with media addiction. Medical rehabilitation is suitable for the long-term care of children and adolescents with media addiction. As part of the MeKi study, a rehabilitation program for children and adolescents with media addiction is being developed and piloted in a cooperating rehabilitation clinic. The trial is registered under DRKS-ID: DRKS00034461, Medienabhängigkeit bei Kindern und Jugendlichen—Entwicklung, Pilotierung und Evaluation eines nachhaltigen, integrativen Rehabilitationskonzepts. Methodes and analysis As part of a mixed methods design a multimodal rehabilitation concept for children and adolescents with media addiction will be developed in a preparation phase based on the results of a scoping review as well as interviews and focus groups with affected children and adolescents, their parents and experts. In a trial phase the concept will be implemented with a planned sample of 80 Children and adolescents over a period of 1.5 years and evaluated by means of a results evaluation using a questionnaire survey and a process evaluation using interviews and focus groups. Discussion The lack of a standardized definition for problematic media use in children and adolescents complicates both the scientific discourse and the practical care of those affected. Furthermore, there are currently only a few therapeutic offers and these are only available in the acute sector. The development and piloting of a rehabilitation program for children and adolescents with media addiction is intended to provide sustainable rehabilitative care, which is to be transferred to other clinics after the end of the project. Trial registration The trial is registered under DRKS-ID: DRKS00034461, Medienabhängigkeit bei Kindern und Jugendlichen—Entwicklung, Pilotierung und Evaluation eines nachhaltigen, integrativen Rehabilitationskonzepts.

Background Medical rehabilitation for children and adolescents in Germany has been strengthened in recent years, including facilitated admission of parents/caregivers, leading to an increase in the number of ‘accompanying persons’ in the rehabilitation setting. The aim of this study was to explore the roles of accompanying persons in rehabilitation, taking into account the perspectives of different stakeholders. Methods Semi-structured interviews were conducted with 12 accompanying persons at the beginning and the end of rehabilitation, as well as 18 healthcare providers with different areas of expertise. Data were analysed deductively and inductively using framework analysis. Results In addition to the topics of pre-rehabilitation-information and the general conflicting character of accompanying persons, three role categories could be identified within the rehab setting: Accompanying persons as child-caregiver , self-caregiver and clients of care . These roles are associated with different demands, needs and tasks. Conclusions Our findings suggest that the concept of ‚accompanying person' should be further developed. Both clinical staff and accompanying persons themselves should become more aware of the different role-requirements. Greater consideration of the different needs and resources of accompanying persons is essential to provide sustainable support for both children and caregivers.

Background The rates of coronary angiograms (CA) and related procedures (percutaneous intervention [PCI]) are significantly higher in Germany than in other Organisation for Economic Co-ordination and Development (OECD) countries. The current guidelines recommend non-invasive diagnosis of coronary heart disease (CHD); CA should only have a limited role in choosing the appropriate revascularisation procedure. The aim of the present study was to explore whether improvements in guideline adherence can be achieved through the implementation of regional treatment pathways. We chose four regions of Germany with high utilisation of CAs for the study. Here we report the results of the concomitant qualitative study. Methods General practitioners and specialist physicians (cardiologists, hospital-based cardiologists, emergency physicians, radiologists and nuclear medicine specialists) caring for patients with suspected CHD were invited to develop regional treatment pathways. Four academic departments provided support for moderation, provision of materials, etc. The study team observed session discussions and took notes. After the development of the treatment pathways, 45 semi-structured interviews were conducted with the participating physicians. Interviews and field notes were transcribed verbatim and underwent qualitative content analysis. Results Pathway development received little support among the participants. Although consensus documents were produced, the results were unlikely to improve practice. The participants expressed very little commitment to change. Although this attempt clearly failed in all study regions, our experience provides relevant insights into the process of evidence appraisal and implementation. A lack of organisational skills, ignorance of current evidence and guidelines, and a lack of feedback regarding one’s own clinical behaviour proved to be insurmountable. CA was still seen as the diagnostic gold standard by most interviewees. Conclusions Oversupply and overutilisation can be assumed to be present in study regions but are not immediately perceived by clinicians. The problem is unlikely to be solved by regional collaborative initiatives; optimised resource planning within the health care system combined with appropriate economic incentives might best address these issues.

Zusammenfassung Hintergrund und Zielstellung Für einen langfristigen und nachhaltigen Rehaerfolg bei chronisch erkrankten Kindern und Jugendlichen wurde mit Inkrafttreten des Flexirentengesetzes unter anderem die Durchführung der Rehanachsorge für Kinder und Jugendliche ermöglicht. Für die Umsetzung und Nutzung von Rehanachsorgeprogrammen gilt es, verschiedene Barrieren und Herausforderungen zu überwinden und involvierte Akteur*innen rollenspezifisch mit einzubeziehen. Ziel der qualitativen Studie war es, die Perspektiven von Kinderärzt*innen und Rehaklinikmitarbeiter*innen hinsichtlich des Wissensstandes, des Bedarfs sowie der Barrieren in Bezug auf Nachsorgeangebote für Kinder und Jugendliche zu untersuchen. Methodik Es wurden 20 semistrukturierte Telefoninterviews mit niedergelassenen Kinder- und Jugendärzt*innen (N=10) sowie Rehaklinikmitarbeiter*innen (N=10) geführt. Die Daten wurden audiodigital aufgenommen, anonymisiert transkribiert und inhaltsanalytisch ausgewertet. Ergebnisse Sowohl die niedergelassenen Ärzt*innen als auch die Klinikmitarbeiter*innen sind positiv gegenüber dem Konzept der Rehanachsorge eingestellt. Mangelnde Informationen, fehlende Kommunikationswege, knappe zeitliche Ressourcen und unklare Verantwortungsbereiche sind Gründe für die zurückhaltende Nutzung von Rehanachsorgeangeboten. Schlussfolgerung Rehanachsorgeangebote für Kinder und Jugendliche stellen eine essentielle Ergänzung zur medizinischen Rehabilitation dar. Barrieren und Herausforderungen im Zugang und der Nutzung sollten zunächst aus der Perspektive von Versorger*innen beleuchtet und berücksichtigt werden. Eine gezielte Informationspolitik zu bestehenden Nachsorgeangeboten sowie eine standardisierte Regelung der Zuständigkeiten können eine Umsetzung und Nutzung von Rehanachsorgeangeboten fördern und die jeweiligen Akteur*innen entlasten.

Background and Aim The management of chronic low back pain is a persisting challenge for multidisciplinary biopsychosocial rehabilitation (MBR). A promising approach to improve the effectiveness is better individual tailoring of the therapeutic minutes to the impairment. We designed a questionnaire-based algorithm to identify individual risk profiles, which allows physicians and patients to decide upon the kind and amount of suitable and adequate therapeutic components of MBR. Our aim was to test whether the algorithm leads to a shift in the therapeutic components depending on the impairment, which should significantly increase the functional capacity of the rehabilitants 6 months after the end of rehabilitation. Methods Between January and November 2016, a controlled clinical trial with a sequential arrangement of study groups and 3 measurement time points (start of rehabilitation, end of rehabilitation and 6-month follow-up) was conducted. The control group (CG) passed through the standard inpatient MBR. In the intervention group (IG)the MBR components were matched to the individual risk-profiles determined via a new algorithm. The shift of therapeutic minutes is displayed via boxplots. The primary outcome was statistically tested by applying an analysis of covariance. All secondary outcomes are presented descriptively. Results Of 169 patients in total, 85 were assigned to the CG and 84 to the IG. Complete data concerning the primary outcome were available for 76 (89.4%) patients in the CG and 75 (89.3%) patients in the IG. Compared to the CG, the boxplots for the IG show a better fit of therapeutic minutes according to the impairments. For example, in the IG, the mean value of psychological therapies was about 120 min if they were impaired and 44.3 min if not. In contrast, impaired tested patients of the CG shown mean values of those therapies of about 96.6 min and 50.6 min if not. The baseline adjusted mean difference in functional capacity was significantly (p=0.047) improved by 4.4 points (95% CI: 0.063–8.465) in favor of the IG. . Main limitation is lack of randomization. In order to avoid inadequate therapy recommendations, the physician had the decision-making authority over the therapies. Conclusion The application of the developed algorithm for individual adaptation of the MBR increases the effectiveness of rehabilitation in terms of functional capacity.