Zoekresultaten

Evaluation of treatment outcome using the Patient Specific Functional Scale in knee osteoarthritis patients undergoing multidisciplinary rehabilitation

ObjectiveFirst, to make an inventory of activity limitations commonly reported by knee osteoarthritis (OA) patients undergoing multidisciplinary rehabilitation. Second, to evaluate treatment outcome using the Patient Specific Functional Scale (PSFS) and compare it to the Western Ontario and McMasters Universities Osteoarthritis Index physical function subscale (WOMAC-pf).DesignAn observational study with assessments before and immediately after multidisciplinary rehabilitation. Five hundred and thirteen patients used the PSFS, a patient-reported tool to identify activity limitations and score the patient's ability to perform the activity on an 11-point Numeric Rating Scale (NRS), to report three activities in which they were limited. Frequencies and percentages of their highest-prioritized activity were calculated and categorized according to the International Classification of Functioning, Disability, and Health (ICF). Paired-samples T-tests were used to analyze the change in ability to perform the activities. Effect sizes of PSFS and WOMAC-pf were compared.ResultsMost patients indicated limitations in walking, walking up/down stairs, prolonged standing, and standing up from a chair. Following these common activities, 26 different activities were identified. The majority of these highest-prioritized activities fell under the first-level ICF category of Mobility. The ability to perform all activities significantly improved after treatment. Effect sizes ranged between 0.60 and 0.97 and were greater than the effect size of the WOMAC-pf (0.41).ConclusionKnee OA patients who undergo multidisciplinary rehabilitation exhibit improvements in performing daily activities. The PSFS is a valuable tool to evaluate patient-specific activity limitations and seems to capture improvements in activity limitations beyond the WOMAC-pf.

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Dutch Sport Federations Changing into Market Oriented Organizations: The Institutional Theory Applied on Three Case Studies

In 2005 and 2006, almost sixty Dutch National Sport Federations (NSFs) participated in a special program for creating a marketing strategy for the next four years. This program was initiated and organized by NOC*NSF (the Dutch Olympic Umbrella Sports Organization). The NSFs had to joint the project to receive funds. For most of them it was the first time they seriously analyzed the market with the aim of developing new programs. The purpose of this paper is to explore to what extent Dutch NSFs are capable to change their structures to become more market oriented and more market responsive in order to write strategic plans. The changed structures are investigated using the "institutional theory" (Tolbert & Zucker, 1996) and are explained by exogenous (market context and institutional context) and endogenous (interests, values, power dependencies, and capacity for action) dynamics from the neo-institutionalist framework (Greenwood & Hinings, 1996). In 2005 NSFs were expected to be in a pre-institutionalized stage, i.e. they were supposed to develop new organizational structures in response to specific problems (Kikulis, 2000). Now, approximately 1½ years after finishing their strategies, the question arises whether they have reached the semi-institutional stage, i.e. whether the new structures or actions are diffused across organizations, yet still subject to change and whether old structures are yet eroding (Kikulis, 2000). Methods Studying the intended structural change of NSFs requires an in-depth study of their social reality and the reactions and interpretations of involved actors, including their applied meanings to certain situations. Greenwood & Hinings (1996) plead for detailed comparative case-studies when studying institutional changes. Therefore three NSFs has been selected: The Royal Dutch Korfball Federation (KorfFed); The Royal Dutch Billiards Federation (BillFed); and the Dutch Jeu de Boules Federation (JeuFed). These three federations differ on size, amount of housed sports, number of associated clubs, sorts of intermediary decision making bodies, employed FTE's, and more. Therefore it is expected that the tempo of institutionalization of the new, market oriented, structures, will differ among them. Sugden & Tomlinson (2002) developed a multi-method style of qualitative research for making sense of the deep, inside information below the surface of everyday life. They call it the "Brighton method. Applying the Brighton method for this research implies that the three cases will be studied with respect to their history, their present marketing actions, their results and the changes in their organization. In-depth interviews, document analysis (policy plans, marketing plans and more), and where possible observations and participations are used to create a critical and investigative view of the organizations in change. Results The KorfFed used the marketing program to further develop existing programs. Although the outcomes of these programs were not new, the program has opened the eyes of the president, director and staff members. They are now conscious of the urgency of a market orientation, and a marketing orientation (a marketing position has already been introduced), and they see opportunities in attracting non-competition playing korfball players. They have, however, not yet reached the phase of semi-institutionalization of the market oriented structures. This can be concluded from the following: - The organization still has an ad-hoc character; - Some board members still make decisions based on their own insights rather than on information from the professional part of the organization; - Decisions to start programs are still grounded on subsidy possibilities rather than on market possibilities. Interest dissatisfaction and power dependencies are the main dynamics that form barriers in the planned organizational change. The BillFed is a federation that covers four disciplines, i.e. pool, snooker, carom, and billiard 3 cushions. The federation used to act upon these four disciplines. The marketing program has made clear that the BillFed should act upon target groups instead of on these disciplines. Therefore, the federation created a vision to reach youth, young adults, as also elderly people. Carrying out this new vision requires a market orientated structure (focus on target groups) instead of an internal orientated structure (focus on discipline groups). This new vision is created on an upper level (general board together with professional staff) in the organization. This federation also introduced a professional marketing position. Unfortunately, the underlying layers remain slightly passive and are not willing to work along the new structures, which mean that the new structures have not been diffused across the whole organization. Interest dissatisfaction, value commitments and power dependencies are the problematic dynamics. The JeuFed used to have a strong competition and tournament (internal) orientation, while many jeu-de-boules players play the game just for fun. The marketing program has created the insight that the just-for-fun players are also an important target group. Hence, 3 projects are developed to make club membership more attractive for all jeu-de-boules players. Since the federation never worked with projects before, they just found out that implementing projects such as these requires new structures. The JeuFed has just arrived in the pre-institutionalized phase, still far away from the semi-institutionalized chapter. Power dependencies and a lack of capacity for change are influencing dynamics in this case. Discussion Although it is already 1½ years ago that Dutch NSFs finished their marketing program, in none of the described cases the new structures have reached the semi-institutional stage. These new structures or actions are not yet diffused across the organizations, and the old structures are not eroding. In all three cases another combination of endogenous dynamics are influencing the process of organizational change. Continuing research is needed to find out whether these federations will ever reach the next stage of institutionalization and which dynamics will play an important role.

Solving domain-specific problems with computational thinking

Computational thinking (CT) skills are crucial for every modern profession in which large amounts of data are processed. In K-12 curricula, CT skills are often taught in separate programming courses. However, without specific instructions, CT skills are not automatically transferred to other domains in the curriculum when they are developed while learning to program in a separate programming course. In modern professions, CT is often applied in the context of a specific domain. Therefore, learning CT skills in other domains, as opposed to computer science, could be of great value. CT and domain-specific subjects can be combined in different ways. In the CT literature, a distinction can be made among CT applications that substitute, augment, modify or redefine the original subject. On the substitute level, CT replaces exercises but CT is not necessary for reaching the learning outcomes. On the redefining level, CT changes the questions that can be posed within the subject, and learning objectives and assessment are integrated. In this short paper, we present examples of how CT and history, mathematics, biology and language subjects can be combined at all four levels. These examples and the framework on which they are based provide a guideline for design-based research on CT and subject integration.

Toward live domain-specific languages

Live programming is a style of development characterized by incremental change and immediate feedback. Instead of long edit-compile cycles, developers modify a running program by changing its source code, receiving immediate feedback as it instantly adapts in response. In this paper, we propose an approach to bridge the gap between running programs and textual domain-specific languages (DSLs). The first step of our approach consists of applying a novel model differencing algorithm, tmdiff, to the textual DSL code. By leveraging ordinary text differencing and origin tracking, tmdiff produces deltas defined in terms of the metamodel of a language. In the second step of our approach, the model deltas are applied at run time to update a running system, without having to restart it. Since the model deltas are derived from the static source code of the program, they are unaware of any run-time state maintained during model execution. We therefore propose a generic, dynamic patch architecture, rmpatch, which can be customized to cater for domain-specific state migration. We illustrate rmpatch in a case study of a live programming environment for a simple DSL implemented in Rascal for simultaneously defining and executing state machines.

Move and be moved

Dynamic body feedback is used in dance movement therapy (DMT), with the aim to facilitate emotional expression and a change of emotional state through movement and dance for individuals with psychosocial or psychiatric complaints. It has been demonstrated that moving in a specific way can evoke and regulate related emotions. The current study aimed to investigate the effects of executing a unique set of kinetic movement elements on an individual mover’s experience of happiness. A specific sequence consisting of movement elements that recent studies have related to the feeling of happiness was created and used in a series of conditions. To achieve a more realistic reflection of DMT practice, the study incorporated the interpersonal dimension between the dance movement therapist (DMTh) and the client, and the impact of this interbodily feedback on the emotional state of the client. This quantitative study was conducted in a within-subject design. Five male and 20 female participants (mean age = 20.72) participated in three conditions: a solo executed movement sequence, a movement sequence executed with a DMTh who attuned and mirrored the movements, and a solo executed movement sequence not associated with feelings of happiness. Participants were only informed about the movements and not the feelings that may be provoked by these movements. The effects on individuals were measured using the Positive and Negative Affect Schedule and visual analog scales. Results showed that a specific movement sequence based on movement elements associated with happiness executed with a DMTh can significantly enhance the corresponding affective state. An additional finding of this study indicated that facilitating expressed emotion through movement elements that are not associated with happiness can enhance feelings such as empowerment, pride, and determination, which are experienced as part of positive affect. The results show the impact of specific fullbody movement elements on the emotional state and the support outcome of DMT on emotion regulation.