Research – Department of Health Sciences

In our aging society, conditions affecting the musculoskeletal system will become more prevalent and will increase overall health care costs. These costs can be reduced when multi-disciplinary primary care settings are present where physicians and other health professionals, such as physiotherapists, occupational therapists and nurses work closely together. An aging society will also bring increased serious pathologies affecting the musculoskeletal system (such as

spinal metastatic cancer or osteoporotic fractures) which need to be spotted by these health professionals. The

recognition of serious pathologies affecting the musculoskeletal system, especially in the early stage of a disease, is a challenging task but is essential as this significantly improves prognosis and outcome. Red flags can help health care professionals as these as are signs and symptoms of serious pathologies that can become apparent during the patient’s interview, physical examination or over the course of treatment. Advanced knowledge about these red flags can improve the chances of a patient being referred (back) to the physician and potentially saving a patient’s life.

Our previous work, on the one hand, has shown that final year physiotherapists students’ red flags knowledge in Europe (including Austria) is low. On the other hand, Austrian general practitioners and orthopaedic surgeons realise the importance that physiotherapists recognise red flags. These results highlighted the need for additional training to improve clinical decision making and to recognise more accurately the presence of red flags.

Our overall aim of this proposal is to develop and test educational clinical vignettes for the physiotherapy profession in Austria in order to increase their knowledge about red flags.

In our first part, we aim to investigate the current knowledge level of red flags in Austrian qualified physiotherapists based on validated clinical vignettes using an online survey. In this survey we also ask how physiotherapists would prefer to learn about red flags.

In the second part medical doctors and physiotherapists will work together to develop new interactive clinical vignettes. These clinical vignettes will then be sent to another group of medical doctors and health professionals, using the HAS consensus

method.

In the third and last part the newly developed clinical vignettes will be used in an educational red flags

intervention for physiotherapists to ensure that the project will have a direct effect on the current physiotherapy profession.

Parkinson’s disease (PD) is the second most common neurodegenerative disease in the elderly population (Gao, 2020). Freezing of Gait (FoG) is a disabling symptom of PD and is defined as a “brief, episodic absence or marked reduction of forward progression of the feet despite the intention to walk” (Giladi, 2008). Compensation strategies such as cueing can reduce FoG severity and improve gait parameters (Ginis, 2018). FoG reduces the patient’s mobility and their independence and has a significantly impact to their quality of life (Walton, 2015). Cues are targets or references that support the execution of a movement (Nieuwboer, 2007). The cueing device that was used in this study, was a wearable non-invasive sternal vibrotactile stimulation device (SVSD). The sensor sole used in this study was a wireless, instrumented (pressure and IMU sensors) insole which recorded the symmetry of the gait pattern and important gait parameters such as step length, cadence or step duration.

The aim of this study was to investigate, if a randomised cross-over study design using a SVSD and the sensor insoles together, while performing the FoG-Score and the 10m walk test, was acceptable for participants. The objective was to gather information and the participants feedback to use in further and larger studies.

With the results of this study, it was shown that this study design is feasible for people with PD. The data from this study can be used to calculate the sample size to conduct a randomized clinical trial.

In the bachelor's degree program for occupational therapists not just the high quality of theoretical training plays a major role, also a high level in practical imparting of professional skills. Being able to gain practical experience across borders promotes personal development and the international knowledge exchange.

A European project partnership therefore focuses primarily on that part of the practical training of occupational therapists for which there are no standardized regulations for cross-country comparison, but which is a crucial part of the training. Educational institutions from four European countries cooperate for this purpose: IBKM gemeinnützige Schulträger GmbH (DE), University of Ruse (BG), Akademia Wychowania Fizycznego we Wroclawiu (PL), ICM Fachhochschule Krems GmbH (AT). The project is funded by the ERASMUS + program (October, 2018 - March, 2021).

Based on a comparative study that dealt with the framework conditions of training, practices of recognition and the position of occupational therapists in the social security system in the participating countries, a common training basis for the practical training of occupational therapists was developed.

With the EUPRAC curriculum that has been created, the project team combines the claim to be able to provide guidelines for the barrier-free completion of internships in order to open up new perspectives on the European labor market for young people in a way that is practical and exemplary for other agents.

In many countries, midwives are experts in caring for healthy pregnant women. Studies have demonstrated that continuous midwifery-led and evidence-based care models are safer and more effective than traditional obstetric care models. However, to achieve this, it is essential that midwives know, interpret, and put into practice the latest research findings. This ensures safe, transparent, effective and efficient healthcare and that the standards of midwifery care meet the expectations of pregnant women, their families and society.

The implementation of evidence-based midwifery practice in Austria continues to be a professional challenge. It has been suggested that many health professionals find it difficult to implement evidence into their daily work, as they have to come to terms with competing priorities. Numerous organisational and individual barriers influence the implementation and acceptance of evidence-based practice. Studies indicate that barriers include a lack of resources and skills as the most common obstacles to the implementation and use of evidence in midwifery practice.

Our aim was to provide SMEs providing midwifery services with the skills and resources to overcome the reported barriers to implementing the principles of evidence-based practice. We developed a teaching and learning concept tailored for practicing midwives, which enabled them to acquire the necessary skills to develop practical, sustainable, and successful strategies for the implementation of research findings in their daily practice. After completing a 40-hour qualification seminar, all participating midwives reported that they felt more confident in interpreting and using research evidence. They also stated that this was a complex process and that they would need more practice to master the newly acquired skills. In addition, they commented that the newly acquired skills and knowledge will assist them in their decision-making process, when advsing women during pregnancy, labour and the postnatal period.

The project is funded by the Austrian Research Promotion Agency.

The project was led by Prof. (FH) Mona Dür, PhD, MSc, the IMC University of Applied Sciences Krems. The SMARAGD project was a collaboration between the IMC University of Applied Sciences Krems, SYNYO GmbH, University of Graz, Johannes Kepler University Linz, Medical University of Graz, Know-Center GmbH Research Center for Data-Driven Business & Big Data Analytics and University of Vienna. SMARAGD was funded by the Austrian Research Funding Agency (FFG).

The rapid spread of intelligent machines and systems is leading to massive changes in the workplace. Their use can be accompanied by both positive and negative changes in working conditions, with increased user-friendliness, but also with additional burden. For example, hospital information systems are installed world wide to support health professionals in accessing, processing and interpreting their patients’ health data. This human-computer interaction is often experienced as an additional burden in daily work of health professionals and is also detrimental to the quality of treatment. So far, there has not been a professional group-specific aggregation and visualisation of health data for occupational therapists and physical therapists.

The aims of the SMARAGD project were to develop exemplary technical components for the intelligent aggregation and visualisation of health data of patients relevant for occupational therapists and physical therapists and to test them in the sense of a feasibility study.

Different designs and methods were applied. Qualitative and quantitative research methods were employed to determine which information is relevant for occupational therapists and physical therapists and whether this information is needed in original, aggregated or visualised form. Anonymised data sets were used to develop and test possibilities of aggregating or visualising health data. The feasibility study included investigations of technical feasibility, user-friendliness and the legal framework.

The results include an overview of the specific information that is relevant for occupational therapists and physiotherapists and the required format of its presentation. Further results are drafts of components of an intelligent aggregation and visualisation of health data, the assessment of their technical feasibility and a report on the legal application requirements and limits for the intelligent aggregation and visualisation of health data in clinical practice. Detailed results will be published soon.

Further information is available at www.smaragdprojekt.at .

The Josef Ressel Centre runs from September 2016 to August 2021.

The JRZ is dedicated to creating the basis for research in "real-world settings" to assess the real and individual therapy process. The research centre develops new methodological approaches for evidence-based and personalised music therapy in neurological rehabilitation in phase C. (See www.neuroreha.at/phasenmodell.html)

The international research team of the JRC interprets "personalisation" from a humanistic-anthropological point of view and is methodologically oriented - among other things - to principles of social neuroscience, with the central question of how people interact.

Clinical case reports often contain descriptions of interpersonal resonance experiences. The research team interprets these descriptions as expressions of the existential need to understand and be understood.

One research goal is to find out under which conditions such resonance can be fostered in the therapeutic context and how therapists can train their compassion for it.

Another special feature is to bring the laboratory to the bedside in "real world settings" and synchronise different data (videography, ECG, EEG, biomarkers, etc.).

Three coordinated projects are being carried out

Project 1: Right Period: Patients need recovery periods between therapies; how can this be recognised? How can they be planned?

Aim: more precise individualised therapy planning based on chronobiological rhythms and questionnaires developed within the framework of the JRZ for self-assessment and assessment by others.

Perspective: more efficient therapies - better outcomes - cost savings.

Project 2: Right Moment: in every therapy there are special moments that are crucial for therapy progress.

Aim: To recognise and induce therapeutically special moments as a basis for therapy progress.

Perspective: Insights into the neurobiological mechanisms of successful therapeutic interaction. Achieve the status of one of the leading research teams in the field of music therapy and social neuroscience.

Project 3: Empathy: Therapists need special sensitivity & training for such moments of encounter.

Aim: Development of valid measurement methods, as well as targeted training of empathy in MT.

Perspective: valid training & maintenance of empathy in all GESWISS professional groups.

The project is funded by Josef Ressel Centre Programme of the Christian Doppler Research Association, by NÖGUS, ProMente Reha and by s-team solutions GmbH.

Over the last decade personalised medicine has become increasingly important in the fields of pharmacogenetics, pharmacogenomics, clinical diagnostics, and in particular chronopharmacology, which is concerned with the optimal point in time for drug delivery. However, with respect to therapeutic interventions (in a clinical context), there has been virtually no inquiry into the most beneficial time to give therapy in relation to a patient’s chronobiological rhythms. This project focused on the question of the ideal time to administer therapy in relation to individual biological rhythms, measured using heart rate variability (HRV).

The primary aim was to establish how individual circadian and ultradian rhythms could be represented most effectively by means of HRV analysis.

The project was financed by the Science and Research Department (K 3) of the Province of Lower Austria.

Ability for empathy applies in therapeutic work as essential factor of the relationship between patient and therapist and as crucial component during recovery. It is seen as a key factor in (musica-)therapeutic work to establish a confident, therapeutic relationship between patient and therapist. Within this framework the therapist’s empathic care leads to a reduction of the opponent’s anxiety or rather stress reaction and enables a transformation into relaxation. In order to understand these processes it is necessary to explore empathy phenomenon. The focus of this project was the change of oxytocin-level in organisms in consequence of a empathic reaction caused by video sequences from clinic-therapeutic context.

The Project was co-funded by the NÖGUS.

Brain injuries bring about a variety of physical and psychological complaints. The site and severity of the brain lesion is always a decisive factor for the patient’s outlook in terms of disability.

Additionally, damage to the pathways between the brain centres can cause dysfunction in communication between them, and therefore secondary functional loss and processing problems. This results in neurological disorders such as poor concentration, attention and alertness.

Music therapy can establish new communication paths in the brain and is therefore a promising form of therapy for rebuilding communication structures between brain centres. This process is of central importance in every course of neuro- rehabilitation therapy.

The primary aim of the research was to determine the changes in brain activity (frontal lobe, hippocampus and cerebellum) and behaviour that can be brought about in vegetative state patients by means of music therapy. The project also examined if there are any links between changes in brain activity and behaviour.

The project was co-financed by Niederösterreichischer Gesundheits- und Sozialfonds (NÖGUS).