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While Communicative Language Teaching (CLT) is recognised as an effective approach worldwide, its implementation in foreign language (FL) classrooms remains difficult. Earlier studies have identified factors impeding CLT implementation, such as a lack of communicative lesson materials or teachers' more traditional views on language learning. In the Netherlands, CLT goals have been formulated at the national level, but are not always reflected in daily FL teaching and assessment practice. As constructive alignment between learning goals, classroom activities and assessments is a precondition for effective teaching, it is important to gain a deeper understanding of the degree of alignment in Dutch FL curricula and the factors influencing it. The current study therefore aims to take a systematic inventory of classroom practices regarding the translation of national CLT goals into learning activities and assessments. Findings revealed that teaching activities and classroom assessments predominantly focused on grammar knowledge and vocabulary out of context and, to a lesser extent, on reading skills. External factors, such as teaching and testing materials available, and conceptual factors, such as teachers' conceptions of language learning, were identified to contribute to the observed lack of alignment. Assessments in particular seem to exert a negative washback effect on CLT implementation.
Students who experience high well-being are better able to developthemselvesand performwithin their educational program. Personal resources can be developed with interventions and more developed personal resources can contribute to well-being. However, it is not yet sufficiently clear what theseinterventions should look like to be effective. Therefore, this study focuses on formulating design principles for interventions aimed at developing four personal resources of honorsstudents: self-efficacy, optimism, inquiry mindedness, and self-regulation. Data were collectedviafocus groups. Data showed that design principles for interventions to develop those four personal resources differsomewhat, but also have several aspects in common: they combine group and individual activities, students are taught basic skills to help them directing their own development, they have an ongoing character and consist of recurring activities. The design principles can be used to design interventions to enhancehonors students’personal resources. Further research is needed into the design and effects of these interventions and possible generalisationof the design principles to other contexts.
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Across all health care settings, certain patients are perceived as ‘difficult’ by clinicians. This paper’s aim is to understand how certain patients come to be perceived and labelled as ‘difficult’ patients in community mental health care, through mixed-methods research in The Netherlands between June 2006 and October 2009. A literature review, a Delphi-study among experts, a survey study among professionals, a Grounded Theory interview study among ‘difficult’ patients, and three case studies of ‘difficult’ patients were undertaken. Analysis of the results of these qualitative and quantitative studies took place within the concept of the sick role, and resulted in the construction of a tentative explanatory model. The ‘difficult’ patient-label is associated with professional pessimism, passive treatment and possible discharge or referral out of care. The label is given by professionals when certain patient characteristics are present and a specific causal attribution (psychological, social or moral versus neurobiological) about the patient’s behaviours is made. The status of ‘difficult’ patient is easily reinforced by subsequent patient and professional behaviour, turning initial unusual help-seeking behaviour into ‘difficult’ or ineffective chronic illness behaviour, and ineffective professional behaviour. These findings illustrate that the course of mental illness, or at least the course of patients’ contact with mental health professionals and services, is determined by patient and professional and reinforced by the social and mental health care system. This model adds to the broader sick role concept a micro-perspective in which attribution and learning principles are incorporated. On a practical level, it implies that professionals need to look into their own role in the perpetuation of difficult behaviours as described here.
Background: Patient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning. Objective: This study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. Methods The study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up. Results: Both the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes. Conclusions: The stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy.
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Background: Patient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning. Objective: This study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. Methods: The study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up. Results: Both the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes. Conclusions: The stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy.
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Discussions on policy and management initiatives to facilitate individuals throughout working careers take place without sufficient insight into how career paths are changing, how these changes are related to a modernization of life course biographies, and whether this leads to increased labour market transitions. This paper asks how new, flexible labour market patterns can best be analyzed using an empirical, quantitative approach. The data used are from the career module of the Panel Study of Belgian Households (PSBH). This module, completed by almost 4500 respondents consists of retrospective questions tracing lengthy and even entire working life histories. To establish any changes in career patterns over such extended periods of time, we compare two evolving methodologies: Optimal Matching Analysis (OMA) and Latent Class Regression Analysis (LCA). The analyses demonstrate that both methods show promising potential in discerning working life typologies and analyzing sequence trajectories. However, particularities of the methods demonstrate that not all research questions are suitable for each method. The OMA methodology is appropriate when the analysis concentrates on the labour market statuses and is well equipped to make clear and interpretable differentiations if there is relative stability in career paths during the period of observation but not if careers become less stable. Latent Class has the strength of adopting covariates in the clustering allowing for more historically connected types than the other methodology. The clustering is denser and the technique allows for more detailed model fitting controls than OMA. However, when incorporating covariates in a typology, the possibilities of using the typology in later, causal, analyses is somewhat reduced.
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