Background: Clinicians are currently challenged to support older adults to maintain a certain level of Functional Independence (FI). FI is defined as "functioning physically safely and independent from another person, within one's own context". A Core Outcome Set was developed to measure FI. The purpose of this study was to assess discriminative validity of the Core Outcome Set FI (COSFI) in a population of Dutch older adults (≥ 65 years) with different levels of FI. Secondary objective was to assess to what extent the underlying domains 'coping', 'empowerment' and 'health literacy' contribute to the COSFI in addition to the domain 'physical capacity'. Methods: A population of 200 community-dwelling older adults and older adults living in residential care facilities were evaluated by the COSFI. The COSFI contains measurements on the four domains of FI: physical capacity, coping, empowerment and health literacy. In line with the COSMIN Study Design checklist for Patient-reported outcome measurement instruments, predefined hypotheses regarding prediction accuracy and differences between three subgroups of FI were tested. Testing included ordinal logistic regression analysis, with main outcome prediction accuracy of the COSFI on a proxy indicator for FI. Results: Overall, the prediction accuracy of the COSFI was 68%. For older adults living at home and depending on help in (i)ADL, prediction accuracy was 58%. 60% of the preset hypotheses were confirmed. Only physical capacity measured with Short Physical Performance Battery was significantly associated with group membership. Adding health literacy with coping or empowerment to a model with physical capacity improved the model significantly (p < 0.01). Conclusions: The current composition of the COSFI, did not yet meet the COSMIN criteria for discriminative validity. However, with some adjustments, the COSFI potentially becomes a valuable instrument for clinical practice. Context-related factors, like the presence of a spouse, also may be a determining factor in this population. It is recommended to include context-related factors in further research on determining FI in subgroups of older people.
Background The Self-Expression Emotion Regulation in Art Therapy Scale (SERATS) was developed as art therapy lacked outcome measures that could be used to monitor the specific effects of art therapy. Although the SERATS showed good psychometric properties in earlier studies, it lacked convergent validity and thus construct validity. Method To test the convergent validity of the SERATS correlation was examined with the EES (Emotional Expressivity Scale), Emotion Regulation Strategies for Artistic Creative Activities Scale (ERS-ACA) and Healthy-Unhealthy Music Scale (HUMS). Patients diagnosed with a Personality Disorder, and thus having self-regulation and emotion regulation problems (n = 179) and a healthy student population (n = 53) completed the questionnaires (N = 232). Results The SERATS showed a high reliability and convergent validity in relation to the ERS-ACA approach strategies and self-development strategies in both patients and students and the HUMS healthy scale, in patients. Hence, what the SERATS measures is highly associated with emotion regulation strategies like acceptance, reappraisal, discharge and problem solving and with improving a sense of self including self-identity, increased self-esteem and improved agency as well as the healthy side of art making. Respondents rated the SERATS as relatively easy to complete compared to the other questionnaires. Conclusion The SERATS is a valid, useful and user-friendly tool for monitoring the effect of art therapy that is indicative of making art in a healthy way that serves positive emotion regulation and self-development.
Background There currently is no field test available for measuring maximal exercise capacity in people with stroke. Objective To determine the feasibility, reproducibility and validity of the Shuttle Test (ST) to measure exercise capacity in people with stroke. Design Longitudinal study design. Setting Rehabilitation department, day care centres from a nursing home and private practices specialized in neuro rehabilitation. Subjects People with subacute or chronic stroke. Interventions A standardized protocol was used to determine feasibility, reproducibility and validity of the 10-meter Shuttle Test (10mST). Main measures Number of shuttles completed, 1stVentilatory Threshold (1stVT). Results The associations of the number of shuttles completed and cardiopulmonary capacity as measured with a portable gas analyser were r > 0.7, confirming good convergent validity in subacute and chronic people with stroke. Criterion validity, however, indicates it is not a valid test for measuring maximal cardiopulmonary capacity (VO2max). Only 60% of participants were able to reach the 1stVT. Higher cardiopulmonary capacity and a higher total score of the lower extremity Motricity Index contributed significantly to a higher number of shuttles walked (p = 0.001). Conclusions The Shuttle Test may be a safe and useful exercise test for people after stroke, but may not be appropriate for use with people who walk slower than 2 km/h or 0.56 m/s.
Examining in-class activities to facilitate academic achievement in higher educationThere is an increasing interest in how to create an effective and comfortable indoor environment for lecturers and students in higher education. To achieve evidence-based improvements in the indoor environmental quality (IEQ) of higher education learning environments, this research aimed to gain new knowledge for creating optimal indoor environmental conditions that best facilitate in-class activities, i.e. teaching and learning, and foster academic achievement. The academic performance of lecturers and students is subdivided into short-term academic performance, for example, during a lecture and long-term academic performance, during an academic course or year, for example. First, a systematic literature review was conducted to reveal the effect of indoor environmental quality in classrooms in higher education on the quality of teaching, the quality of learning, and students’ academic achievement. With the information gathered on the applied methods during the literature review, a systematic approach was developed and validated to capture the effect of the IEQ on the main outcomes. This approach enables research that aims to examine the effect of all four IEQ parameters, indoor air quality, thermal conditions, lighting conditions, and acoustic conditions on students’ perceptions, responses, and short-term academic performance in the context of higher education classrooms. Next, a field experiment was conducted, applying the validated systematic approach, to explore the effect of multiple indoor environmental parameters on students and their short-term academic performance in higher education. Finally, a qualitative case study gathered lecturers’ and students’ perceptions related to the IEQ. Furthermore, how these users interact with the environment to maintain an acceptable IEQ was studied.During the systematic literature review, multiple scientific databases were searched to identify relevant scientific evidence. After the screening process, 21 publications were included. The collected evidence showed that IEQ can contribute positively to students’ academic achievement. However, it can also affect the performance of students negatively, even if the IEQ meets current standards for classrooms’ IEQ conditions. Not one optimal IEQ was identified after studying the evidence. Indoor environmental conditions in which students perform at their best differ and are task depended, indicating that classrooms should facilitate multiple indoor environmental conditions. Furthermore, the evidence provides practical information for improving the design of experimental studies, helps researchers in identifying relevant parameters, and lists methods to examine the influence of the IEQ on users.The measurement methods deduced from the included studies of the literature review, were used for the development of a systematic approach measuring classroom IEQ and students’ perceived IEQ, internal responses, and short-term academic performance. This approach allowed studying the effect of multiple IEQ parameters simultaneously and was tested in a pilot study during a regular academic course. The perceptions, internal responses, and short-term academic performance of participating students were measured. The results show associations between natural variations of the IEQ and students’ perceptions. These perceptions were associated with their physiological and cognitive responses. Furthermore, students’ perceived cognitive responses were associated with their short-term academic performance. These observed associations confirm the construct validity of the composed systematic approach. This systematic approach was then applied in a field experiment, to explore the effect of multiple indoor environmental parameters on students and their short-term academic performance in higher education. A field study, with a between-groups experimental design, was conducted during a regular academic course in 2020-2021 to analyze the effect of different acoustic, lighting, and indoor air quality (IAQ) conditions. First, the reverberation time was manipulated to 0.4 s in the intervention condition (control condition 0.6 s). Second, the horizontal illuminance level was raised from 500 to 750 lx in the intervention condition (control condition 500 lx). These conditions correspond with quality class A (intervention condition) and B (control condition), specified in Dutch IEQ guidelines for school buildings (2015). Third, the IAQ, which was ~1100 ppm carbon dioxide (CO2), as a proxy for IAQ, was improved to CO2 concentrations under 800 ppm, meeting quality class A in both conditions. Students’ perceptions were measured during seven campaigns with a questionnaire; their actual cognitive and short-term academic performances were evaluated with validated tests and an academic test, composed by the lecturer, as a subject-matter-expert on the taught topic, covered subjects discussed during the lecture. From 201 students 527 responses were collected and analyzed. A reduced RT in combination with raised HI improved students’ perceptions of the lighting environment, internal responses, and quality of learning. However, this experimental condition negatively influenced students’ ability to solve problems, while students' content-related test scores were not influenced. This shows that although quality class A conditions for RT and HI improved students’ perceptions, it did not influence their short-term academic performance. Furthermore, the benefits of reduced RT in combination with raised HI were not observed in improved IAQ conditions. Whether the sequential order of the experimental conditions is relevant in inducing these effects and/or whether improving two parameters is already beneficial, is unknownFinally, a qualitative case study explored lecturers’ and students’ perceptions of the IEQ of classrooms, which are suitable to give tutorials with a maximum capacity of about 30 students. Furthermore, how lecturers and students interact with this indoor environment to maintain an acceptable IEQ was examined. Eleven lecturers of the Hanze University of Applied Sciences (UAS), located in the northern part of the Netherlands, and twenty-four of its students participated in three focus group discussions. The findings show that lecturers and students experience poor thermal, lighting, acoustic, and IAQ conditions which may influence teaching and learning performance. Furthermore, maintaining acceptable thermal and IAQ conditions was difficult for lecturers as opening windows or doors caused noise disturbances. In uncomfortable conditions, lecturers may decide to pause earlier or shorten a lecture. When students experienced discomfort, it may affect their ability to concentrate, their emotional status, and their quality of learning. Acceptable air and thermal conditions in classrooms will mitigate the need to open windows and doors. This allows lecturers to keep doors and windows closed, combining better classroom conditions with neither noise disturbances nor related distractions. Designers and engineers should take these end users’ perceptions into account, often monitored by facility management (FM), during the renovation or construction of university buildings to achieve optimal IEQ conditions in higher education classrooms.The results of these four studies indicate that there is not a one-size fits all indoor environmental quality to facilitate optimal in-class activities. Classrooms’ thermal environment should be effectively controlled with the option of a local (manual) intervention. Classrooms’ lighting conditions should also be adjustable, both in light color and light intensity. This enables lecturers to adjust the indoor environment to facilitate in-class activities optimally. Lecturers must be informed by the building operator, for example, professionals of the Facility Department, how to change classrooms’ IEQ settings. And this may differ per classroom because each building, in which the classroom is located, is operated differently apart from the classroom location in the building, exposure to the environment, and its use. The knowledge that has come available from this study, shows that optimal indoor environmental conditions can positively influence lecturers’ and students’ comfort, health, emotional balance, and performance. These outcomes have the capacity to contribute to an improved school climate and thus academic achievement.
