Phantom limb pain following amputation is highly prevalent as it affects up to 80% of amputees. Many amputees suffer from phantom limb pain for many years and experience major limitations in daily routines and quality of life. Conventional pharmacological interventions often have negative side-effects and evidence regarding their long-term efficacy is low. Central malplasticity such as the invasion of areas neighbouring the cortical representation of the amputated limb contributes to the occurrence and maintenance of phantom limb pain. In this context, alternative, non-pharmacological interventions such as mirror therapy that are thought to target these central mechanisms have gained increasing attention in the treatment of phantom limb pain. However, a standardized evidence-based treatment protocol for mirror therapy in patients with phantom limb pain is lacking, and evidence for its effectiveness is still low. Furthermore, given the chronic nature of phantom limb pain and suggested central malplasticity, published studies proposed that patients should self-deliver mirror therapy over several weeks to months to achieve sustainable effects. To achieve this training intensity, patients need to perform self-delivered exercises on a regular basis, which could be facilitated though the use of information and communication technology such as telerehabilitation. However, little is known about potential benefits of using telerehabilitation in patients with phantom limb pain, and controlled clinical trials investigating effects are lacking. The present thesis presents the findings from the ‘PAtient Centered Telerehabilitation’ (PACT) project, which was conducted in three consecutive phases: 1) creating a theoretical foundation; 2) modelling the intervention; and 3) evaluating the intervention in clinical practice. The objectives formulated for the three phases of the PACT project were: 1) to conduct a systematic review of the literature regarding important clinical aspects of mirror therapy. It focused on the evidence of applying mirror therapy in patients with stroke, complex regional pain syndrome and phantom limb pain. 2) to design and develop a clinical framework and a user-centred telerehabilitation for mirror therapy in patients with phantom limb pain following lower limb amputation. 3) to evaluate the effects of the clinical framework for mirror therapy and the additional effects of the teletreatment in patients with phantom limb pain. It also investigated whether the interventions were delivered by patients and therapists as intended.
The past decades have shown an accelerated development of technology-enhanced or digital education. Although an important and recognized precondition for study success, still little attention has been paid to examining how an affective learning climate can be fostered in online training programs. Besides gaining insight into the dynamics of affective learning itself it is of vital importance to know what predicts trainees’ intention to transfer new knowledge and skills to other contexts. The present study investigated the influence of five affective learner characteristics from the transfer literature (learner readiness, motivation to learn, expected positive outcomes, expected negative outcomes, personal capacity) on trainees’ pre-training transfer intention. Participants were 366 adult students enrolled in an online course in information literacy in a distance learning environment. As information literacy is a generic competence, applicable in various contexts, we developed a novel multicontextual transfer perspective and investigated within one single study the influence of the abovementioned variables on pre-training transfer intention for both the students’ Study and Work contexts. The hypothesized model has been tested using structural equation modeling. The results showed that motivation to learn, expected positive personal outcomes, and learner readiness were the strongest predictors. Results also indicated the benefits of gaining pre-training insight into the specific characteristics of multiple transfer contexts, especially when education in generic competences is involved. Instructional designers might enhance study success by taking affective transfer elements and multicontextuality into account when designing digital education.
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The textiles and apparel industry is a major contributor to economic development while at the same time being one of the most polluting industries due to its lengthy supply chain and resource intensive production operations. To address these sustainability challenges, digitalization is seen as one of the potential solutions. Using the lens of sustainability and digitalization in Supply Chain Management (SCM), this paper analyses the sustainability and digitalization status of Dutch textile and apparel firms. We used a mixed methodology of quantitative text mining of 94 Dutch textile and apparel firms as well as qualitative thematic and coding analysis of experts’ views and opinions on sustainability and digitalization in the Dutch textiles and apparel industry. Quantitative analysis of website data shows that Dutch textile and apparel firms predominantly communicate the environmental, to a lesser extent social, and least of all economic sustainability factors. Keyword analysis also shows that the use of technological keyword indicators is less prominent, while certain technologies such as IoT, sensors and blockchain correlate mostly to environmental sustainability factors. Moreover, qualitative analysis reveals that to address sustainability via digitalization, it is important to link sustainability goals to Key Performance Indicators, which requires data for traceability. We recommend firms to: (1) re-evaluate their business models and assess the extent traceability can be incorporated in their sustainability strategy; (2) enhance stakeholder collaboration within and outside the supply chain to utilize traceability; and (3) proactively use traceability information to improve transparency and accountability to meet legal requirements and address greenwashing. This study contributes to literature by showing the importance of traceability for (a) linking sustainability and digitalization in SCM, b) achieving the ultimate goals of transparency and accountability, and c) predicting demand and supply to address overproduction and waste in the textiles and apparel sector.
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