Computational case-based redesign for people with ability impairment: Rethinking, reuse and redesign learning for home modification practice

Home modification practice for people with impairments of ability involves redesigning existing residential environments as distinct from the creation of a new dwelling. A redesigner alters existing structures, fittings and fixtures to better meet the occupant's ability requirements. While research on case-based design reasoning and healthcare informatics are well documented, the reasoning and process of redesign and its integration with individual human functional abilities remains poorly understood. Developing a means of capturing redesign knowledge in the form of case documentation online provides a means for integrating and learning from individual case-based redesign episodes where assessment and interventions are naturally linked. A key aim of the research outlined in this thesis was to gain a better understanding of the redesign of spaces for individual human ability with the view to computational modelling. Consequently, the foundational knowledge underpinning the model development includes design, redesign, case-based building design and human functional ability. Case-based redesign as proposed within the thesis, is a method for capturing the redesign context, the residential environment, the modification and the transformational knowledge involved in the redesign. Computational simulation methods are traditionally field dependent. Consequently, part of the research undertaken within this thesis involved the development of a framework for analysing cases within an online case-studies library to validate redesign for individuals and a method of acquiring reuse information so as to be able to estimate the redesign needs of a given population based on either their environment or ability profile. As home modification for people with functional impairments was a novel application field, an explorative action-based methodological approach using computational modelling was needed to underpin a case-based reasoning method. The action-based method involved a process of articulating and examining existing knowledge, suggesting new case-based computational practices, and evaluating the results. This cyclic process led to an improvement cycle that included theory, computational tool development and practical application. The rapid explosion of protocols and online redesign communities that utilise Web technologies meant that a web-based prototype capable of acquiring cases directly from home modification practitioners online and in context was both desirable and achievable. The first online version in 1998-99, encoded home modification redesigns using static WebPages and hyperlinks. This motivated the full-scale more dynamic and robust HMMinfo casestudies prototype whose action-based development is detailed within this thesis. The home modification casestudies library results from the development and integration of a novel case-based redesign model in combination with a Human- Activity-Space computational ontology. These two models are then integrated into a relational database design to enable online case acquisition, browsing, case reuse and redesign learning. The application of the redesign ontology illustrates case reuse and learning, and presents some of the implementation issues and their resolution. Original contributions resulting from this work include: extending case-based design theory to encompass redesign and redesign models, distinguishing the importance of human ability in redesign and the development of the Human-Activity-Space ontology. Additionally all data models were combined and their associated inter-relationships evaluated within a prototype made available to redesign practitioners. v Reflective and practitioner based evaluation contributed enhanced understanding of redesign case contribution dynamics in an online environment. Feedback from redesign practitioners indicated that gaining informed consent to share cases from consumers of home modification and maintenance services, in combination with the additional time required to document a case online, and reticence to go public for fear of critical feedback, all contributed to a less than expected case library growth. This is despite considerable interest in the HMMinfo casestudies website as evidenced by web usage statistics. Additionally the redesign model described in this thesis has practical implications for all design practitioners and educators who seek to create new work by reinterpreting, reconstructing and redesigning spaces

The St George’s Respiratory Questionnaire revisited: a psychometric evaluation

Purpose The St George’s Respiratory Questionnaire (SGRQ) has clearly acquired the status of legacy questionnaire for measuring health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). The main aim of this study was to assess the underlying dimensionality of the SGRQ and to investigate the added value of the empirical weights used to calculate total scores. Methods The official Dutch translation of the SGRQ was completed by 444 COPD patients participating in two clinical studies. These data were used for secondary data analysis in this study. Three complementary statistical methods were used to assess dimensionality: Mokken scale analysis (MSA), parametric multidimensional item response theory (IRT) and bifactor analysis. Additionally, the original SGRQ weighting procedure was compared to IRT-based weighting. Results The results of the MSA and multidimensional item response theory (MIRT) pointed toward a unidimensional structure. The bifactor analyses indicated that there was a strong general factor, but the group factors did have additional value. Nineteen items performed poorly in the MSA, MIRT analysis or both. Shortening the scale from 50 to 31 items did not negatively impact measurement precision. SGRQ total score and IRT-derived scores correlated strongly, 0.90 for the one-parameter model and 0.99 for the two-parameter model. Conclusion The SGRQ contains some multidimensionality, but an abbreviated version can be used as a unidimensional tool in patients with COPD. Subscale scores should be used with care. SGRQ total scores correlated highly with IRT-based scores, and thus, the weighting methods may be used interchangeably to calculate total scores