Although systematic reviews are considered as central components in evidence-based practice, they currently face an important challenge to keep up with the exponential publication rate of clinical trials. After initial publication, only a minority of the systematic reviews are updated, and it often takes multiple years before these results become accessible. Consequently, many systematic reviews are not up to date, thereby increasing the time-gap between research findings and clinical practice. A potential solution is offered by a living systematic reviews approach. These types of studies are characterized by a workflow of continuous updates which decreases the time it takes to disseminate new findings. Although living systematic reviews are specifically designed to continuously synthesize new evidence in rapidly emerging topics, they have also considerable potential in slower developing domains, such as rehabilitation science. In this commentary, we outline the rationale and required steps to transition a regular systematic review into a living systematic review. We also propose a workflow that is designed for rehabilitation science.
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Richtlijnen vormen een belangrijke bron voor zorgprofessionals om evidence-based te kunnen handelen. Richtlijnen zijn veelal gebaseerd op systematic reviews, waarbij alle beschikbare wetenschappelijke literatuur over een bepaald onderwerp systematisch beoordeeld wordt op de kwaliteit van de onderzoeken. Dit artikel gaat over wat er aan bod komt bij een systematic review.
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OBJECTIVE: The World Health Organization (WHO) recently proposed an Integrated Care for Older People approach to guide health systems and services in better supporting functional ability of older people. A knowledge gap remains in the key elements of integrated care approaches used in health and social care delivery systems for older populations. The objective of this review was to identify and describe the key elements of integrated care models for elderly people reported in the literature.DESIGN: Review of reviews using a systematic search method.METHODS: A systematic search was performed in MEDLINE and the Cochrane database in June 2017. Reviews of interventions aimed at care integration at the clinical (micro), organisational/service (meso) or health system (macro) levels for people aged ≥60 years were included. Non-Cochrane reviews published before 2015 were excluded. Reviews were assessed for quality using the Assessment of Multiple Systematic Reviews (AMSTAR) 1 tool.RESULTS: Fifteen reviews (11 systematic reviews, of which six were Cochrane reviews) were included, representing 219 primary studies. Three reviews (20%) included only randomised controlled trials (RCT), while 10 reviews (65%) included both RCTs and non-RCTs. The region where the largest number of primary studies originated was North America (n=89, 47.6%), followed by Europe (n=60, 32.1%) and Oceania (n=31, 16.6%). Eleven (73%) reviews focused on clinical 'micro' and organisational 'meso' care integration strategies. The most commonly reported elements of integrated care models were multidisciplinary teams, comprehensive assessment and case management. Nurses, physiotherapists, general practitioners and social workers were the most commonly reported service providers. Methodological quality was variable (AMSTAR scores: 1-11). Seven (47%) reviews were scored as high quality (AMSTAR score ≥8).CONCLUSION: Evidence of elements of integrated care for older people focuses particularly on micro clinical care integration processes, while there is a relative lack of information regarding the meso organisational and macro system-level care integration strategies.
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Adaptieve expertise en flexibiliteit zijn belangrijke competenties. Professionals zullen moeten meebewegen met veranderende werkomstandigheden en in staat zijn om die veranderingen vorm te geven. Dit (ontwerp)onderzoek vindt plaats in innovatieve leerwerkomgevingen in bachelor- en masteropleidingen en beschrijft en verklaart de werking van deze innovaties m.b.t. de ontwikkeling van adaptieve expertise.Doel Adaptatwork wil inzicht geven in werkzame mechanismes in en praktische tools ontwerpen voor de ontwikkeling van adaptieve expertise tijdens werkplekleren. Resultaten Wetenschappelijke kennis over de ontwikkeling van adaptieve expertise in hoger onderwijs Praktijkkennis en expertise voor het hoger onderwijs Toepasbare producten voor docenten en stakeholders Looptijd 01 juli 2020 - 31 december 2023 Aanpak Reviews naar adaptieve expertise en mechanismes die dat bevorderen, casestudies, meta-analyse en valorisatie. Wonen 3.0 Het project Wonen 3.0 dient als casus voor dit onderzoek. In deze leerwerkomgeving wordt praktisch onderzoek uitgevoerd op de vraagstukken van de maatschappij rondom het thema wonen in de setting van een modern leerwerkbedrijf. Bedrijven en instellingen, onderzoekers en studenten (als young professionals) ontwikkelen hierin samen nieuwe inzichten en werkende oplossingen. Het onderwijs is gebaseerd op challenge-based learning.
Adaptieve expertise en flexibiliteit zijn belangrijke competenties. Professionals zullen moeten meebewegen met veranderende werkomstandigheden en in staat zijn om die veranderingen vorm te geven. Dit (ontwerp)onderzoek vindt plaats in innovatieve leerwerkomgevingen in bachelor- en masteropleidingen en beschrijft en verklaart de werking van deze innovaties m.b.t. de ontwikkeling van adaptieve expertise.
Physical rehabilitation programs revolve around the repetitive execution of exercises since it has been proven to lead to better rehabilitation results. Although beginning the motor (re)learning process early is paramount to obtain good recovery outcomes, patients do not normally see/experience any short-term improvement, which has a toll on their motivation. Therefore, patients find it difficult to stay engaged in seemingly mundane exercises, not only in terms of adhering to the rehabilitation program, but also in terms of proper execution of the movements. One way in which this motivation problem has been tackled is to employ games in the rehabilitation process. These games are designed to reward patients for performing the exercises correctly or regularly. The rewards can take many forms, for instance providing an experience that is engaging (fun), one that is aesthetically pleasing (appealing visual and aural feedback), or one that employs gamification elements such as points, badges, or achievements. However, even though some of these serious game systems are designed together with physiotherapists and with the patients’ needs in mind, many of them end up not being used consistently during physical rehabilitation past the first few sessions (i.e. novelty effect). Thus, in this project, we aim to 1) Identify, by means of literature reviews, focus groups, and interviews with the involved stakeholders, why this is happening, 2) Develop a set of guidelines for the successful deployment of serious games for rehabilitation, and 3) Develop an initial implementation process and ideas for potential serious games. In a follow-up application, we intend to build on this knowledge and apply it in the design of a (set of) serious game for rehabilitation to be deployed at one of the partners centers and conduct a longitudinal evaluation to measure the success of the application of the deployment guidelines.
