@article{TsiligianniAlmaKocksetal.2016,
  author    = {Tsiligianni, Ioanna G. and Alma, Harma J. and Kocks, Janwillem W. H. and de Jong, Corina and Jelusic, Danijel and Wittmann, Michael and Schuler, Michael and Schultz, Konrad and Kollen, Boudewijn J. and van der Molen, Thys},
  title     = {Investigating sensitivity, specificity, and area under the curve of the Clinical COPD Questionnaire, COPD Assessment Test, and Modified Medical Research Council scale according to GOLD using St George's Respiratory Questionnaire cutoff 25 (and 20) as reference},
  series = {International Journal of COPD},
  volume    = {11},
  journal   = {International Journal of COPD},
  doi       = {10.2147/COPD.S99793},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-165427},
  pages     = {1045-1052},
  year      = {2016},
  abstract  = {Background: In the GOLD (Global initiative for chronic Obstructive Lung Disease) strategy document, the Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), or modified Medical Research Council (mMRC) scale are recommended for the assessment of symptoms using the cutoff points of CCQ ≥1, CAT ≥10, and mMRC scale ≥2 to indicate symptomatic patients. The current study investigates the criterion validity of the CCQ, CAT and mMRC scale based on a reference cutoff point of St George's Respiratory Questionnaire (SGRQ) ≥25, as suggested by GOLD, following sensitivity and specificity analysis. In addition, areas under the curve (AUCs) of the CCQ, CAT, and mMRC scale were compared using two SGRQ cutoff points (≥25 and ≥20). Materials and methods: Two data sets were used: study A, 238 patients from a pulmonary rehabilitation program; and study B, 101 patients from primary care. Receiver-operating characteristic (ROC) curves were used to assess the correspondence between the recommended cutoff points of the questionnaires. Results: Sensitivity, specificity, and AUC scores for cutoff point SGRQ ≥25 were: study A, 0.99, 0.43, and 0.96 for CCQ ≥1, 0.92, 0.48, and 0.89 for CAT ≥10, and 0.68, 0.91, and 0.91 for mMRC ≥2; study B, 0.87, 0.77, and 0.9 for CCQ ≥1, 0.76, 0.73, and 0.82 for CAT ≥10, and 0.21, 1, and 0.81 for mMRC ≥2. Sensitivity, specificity, and AUC scores for cutoff point SGRQ ≥20 were: study A, 0.99, 0.73, and 0.99 for CCQ ≥1, 0.91, 0.73, and 0.94 for CAT ≥10, and 0.66, 0.95, and 0.94 for mMRC ≥2; study B, 0.8, 0.89, and 0.89 for CCQ ≥1, 0.69, 0.78, and 0.8 for CAT ≥10, and 0.18, 1, and 0.81 for mMRC ≥2. Conclusion: Based on data from these two different samples, this study showed that the suggested cutoff point for the SGRQ (≥25) did not seem to correspond well with the established cutoff points of the CCQ or CAT scales, resulting in low specificity levels. The correspondence with the mMRC scale seemed satisfactory, though not optimal. The SGRQ threshold of ≥20 corresponded slightly better than SGRQ ≥25, recently suggested by GOLD 2015, with the established cutoff points for the CCQ, CAT, and mMRC scale.},
  language  = {en}
}
@article{SchwaabBjarnasonWehrensMengetal.2021,
  author    = {Schwaab, Bernhard and Bjarnason-Wehrens, Birna and Meng, Karin and Albus, Christian and Salzwedel, Annett and Schmid, Jean-Paul and Benzer, Werner and Metz, Matthes and Jensen, Katrin and Rauch, Bernhard and B{\"o}nner, Gerd and Brzoska, Patrick and Buhr-Schinner, Heike and Charrier, Albrecht and Cordes, Carsten and D{\"o}rr, Gesine and Eichler, Sarah and Exner, Anne-Kathrin and Fromm, Bernd and Gielen, Stephan and Glatz, Johannes and Gohlke, Helmut and Grilli, Maurizio and Gysan, Detlef and H{\"a}rtel, Ursula and Hahmann, Harry and Herrmann-Lingen, Christoph and Karger, Gabriele and Karoff, Marthin and Kiwus, Ulrich and Knoglinger, Ernst and Krusch, Christian-Wolfgang and Langheim, Eike and Mann, Johannes and Max, Regina and Metzendorf, Maria-Inti and Nebel, Roland and Niebauer, Josef and Predel, Hans-Georg and Preßler, Axel and Razum, Oliver and Reiss, Nils and Saure, Daniel and von Schacky, Clemens and Sch{\"u}tt, Morten and Schultz, Konrad and Skoda, Eva-Maria and Steube, Diethard and Streibelt, Marco and St{\"u}ttgen, Martin and St{\"u}ttgen, Michaela and Teufel, Martin and Tschanz, Hansueli and V{\"o}ller, Heinz and Vogel, Heiner and Westphal, Ronja},
  title     = {Cardiac rehabilitation in German speaking countries of Europe — evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH — part 2},
  series = {Journal of Clinical Medicine},
  volume    = {10},
  journal   = {Journal of Clinical Medicine},
  number    = {14},
  issn      = {2077-0383},
  doi       = {10.3390/jcm10143071},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-242645},
  year      = {2021},
  abstract  = {Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients' groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for "distress management" and "lifestyle changes". PE is able to increase patients' knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients' groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.},
  language  = {en}
}
@article{HaydenLimbachSchuleretal.2021,
  author    = {Hayden, Markus C. and Limbach, Matthias and Schuler, Michael and Merkl, Steffen and Schwarzl, Gabriele and Jakab, Katalin and Nowak, Dennis and Schultz, Konrad},
  title     = {Effectiveness of a three-week inpatient pulmonary rehabilitation program for patients after COVID-19: a prospective observational study},
  series = {International Journal of Environmental Research and Public Health},
  volume    = {18},
  journal   = {International Journal of Environmental Research and Public Health},
  number    = {17},
  issn      = {1660-4601},
  doi       = {10.3390/ijerph18179001},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-245170},
  year      = {2021},
  abstract  = {For COVID-19 patients who remain symptomatic after the acute phase, pulmonary rehabilitation (PR) is recommended. However, only a few studies have investigated the effectiveness of PR, especially considering the duration between the acute phase of COVID-19 and the onset of rehabilitation, as well as the initial severity. This prospective observational study evaluated the efficacy of PR in patients after COVID-19. A total of 120 still-symptomatic patients referred for PR after overcoming acute COVID-19 were asked to participate, of whom 108 (mean age 55.6 ± 10.1 years, 45.4\% female) consented. The patients were assigned to three groups according to the time of referral and initial disease severity (severe acute; severe after interval; mild after interval). The primary outcome was dyspnea. Secondary outcomes included other respiratory disease symptoms, physical capacity, lung function, fatigue, quality of life (QoL), depression, and anxiety. Furthermore, patients rated the overall effectiveness of PR and their subjective change in health status. At the end of PR, we detected improvements with large effect sizes in exertional dyspnea, physical capacity, QoL, fatigue, and depression in the overall group. Other parameters changed with small to medium effect sizes. PR was effective after acute COVID-19 in all three groups analyzed.},
  language  = {en}
}
@article{AlmadeJongJelusicetal.2016,
  author    = {Alma, Harma and de Jong, Corina and Jelusic, Danijel and Wittmann, Michael and Schuler, Michael and Flokstra-de Blok, Bertine and Kocks, Janwillem and Schultz, Konrad and van der Molen, Thys},
  title     = {Health status instruments for patients with COPD in pulmonary rehabilitation: defining a minimal clinically important difference},
  series = {npj Primary Care Respiration Medicine},
  volume    = {26},
  journal   = {npj Primary Care Respiration Medicine},
  number    = {16041},
  doi       = {10.1038/npjpcrm.2016.41},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-166327},
  year      = {2016},
  abstract  = {The minimal clinically important difference (MCID) defines to what extent change on a health status instrument is clinically relevant, which aids scientists and physicians in measuring therapy effects. This is the first study that aimed to establish the MCID of the Clinical chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St George's Respiratory Questionnaire (SGRQ) in the same pulmonary rehabilitation population using multiple approaches. In total, 451 COPD patients participated in a 3-week Pulmonary Rehabilitation (PR) programme (58 years, 65\% male, 43 pack-years, GOLD stage II/III/IV 50/39/11\%). Techniques used to assess the MCID were anchor-based approaches, including patient-referencing, criterion-referencing and questionnaire-referencing, and the distribution-based methods standard error of measurement (SEM), 1.96SEM and half standard deviation (0.5s.d.). Patient- and criterion-referencing led to MCID estimates of 0.56 and 0.62 (CCQ); 3.12 and 2.96 (CAT); and 8.40 and 9.28 (SGRQ). Questionnaire-referencing suggested MCID ranges of 0.28-0.61 (CCQ), 1.46-3.08 (CAT) and 6.86-9.47 (SGRQ). The SEM, 1.96SEM and 0.5s.d. were 0.29, 0.56 and 0.46 (CCQ); 3.28, 6.43 and 2.80 (CAT); 5.20, 10.19 and 6.06 (SGRQ). Pooled estimates were 0.52 (CCQ), 3.29 (CAT) and 7.91 (SGRQ) for improvement. MCID estimates differed depending on the method used. Pooled estimates suggest clinically relevant improvements needing to exceed 0.40 on the CCQ, 3.00 on the CAT and 7.00 on the SGRQ for moderate to very severe COPD patients. The MCIDs of the CAT and SGRQ in the literature might be too low, leading to overestimation of treatment effects for patients with COPD.},
  language  = {en}
}