EXACT: EXercise or Advice after ankle fraCTure. Design of a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Ankle fractures are common. Management of ankle fractures generally involves a period of immobilisation followed by rehabilitation to reduce pain, stiffness, weakness and swelling. The effects of a rehabilitation program are still unclear. However, it has been shown that important components of rehabilitation programs may not confer additional benefits over exercise alone. The primary aim of this trial is to determine the effectiveness and cost-effectiveness of an exercise-based rehabilitation program after ankle fracture, compared to advice alone.</p> <p>Methods/Design</p> <p>A pragmatic randomised trial will be conducted. Participants will be 342 adults with stiff, painful ankles after ankle fracture treated with immobilisation. They will be randomly allocated using a concealed randomisation procedure to either an <it>Advice </it>or <it>Rehabilitation </it>group. Participants in the <it>Advice </it>group will receive verbal and written advice about exercise at the time of removal of immobilisation. Participants in the <it>Rehabilitation </it>group will be provided with a 4-week rehabilitation program that is designed, monitored and progressed by a physiotherapist, in addition to verbal and written advice. Outcomes will be measured by a blinded assessor at 1, 3 and 6 months. The primary outcomes will be activity limitation and quality-adjusted life years.</p> <p>Discussion</p> <p>This pragmatic trial will determine if a rehabilitation program reduces activity limitation and improves quality of life, compared to advice alone, after immobilisation for ankle fracture.</p

Mary's Powers of Imagination

One common response to the knowledge argument is the ability hypothesis. Proponents of the ability hypothesis accept that Mary learns what seeing red is like when she exits her black-and-white room, but they deny that the kind of knowledge she gains is propositional in nature. Rather, she acquires a cluster of abilities that she previously lacked, in particular, the abilities to recognize, remember, and imagine the color red. For proponents of the ability hypothesis, knowing what an experience is like simply consists in the possession of these abilities. Criticisms of the ability hypothesis tend to focus on this last claim. Such critics tend to accept that Mary gains these abilities when she leaves the room, but they deny that such abilities constitute knowledge of what an experience is like. To my mind, however, this critical strategy grants too much. Focusing specifically on imaginative ability, I argue that Mary does not gain this ability when she leaves the room for she already had the ability to imagine red while she was inside it. Moreover, despite what some have thought, the ability hypothesis cannot be easily rescued by recasting it in terms of a more restrictive imaginative ability. My purpose here is not to take sides in the debate about physicalism, i.e., my criticism of the ability hypothesis is not offered in an attempt to defend the anti-physicalist conclusion of the knowledge argument. Rather, my purpose is to redeem the imagination from the misleading picture of it that discussion of the knowledge argument has fostered

Grounding, Analysis, and Russellian Monism

Few these days dispute that the knowledge argument demonstrates an epistemic gap between the physical facts and the facts about experience. It is much more contentious whether that epistemic gap can be used to demonstrate a metaphysical gap of a kind that is inconsistent with physicalism. In this paper I will explore two attempts to block the inference from an epistemic gap to a metaphysical gap – the first from the phenomenal concept strategy, the second from Russellian monism – and suggest how the proponent of the knowledge argument might respond to each of these challenges. In doing so, I will draw on recent discussions of grounding and essence in the metaphysics literature

The twilight of the Liberal Social Contract? On the Reception of Rawlsian Political Liberalism

This chapter discusses the Rawlsian project of public reason, or public justification-based 'political' liberalism, and its reception. After a brief philosophical rather than philological reconstruction of the project, the chapter revolves around a distinction between idealist and realist responses to it. Focusing on political liberalism’s critical reception illuminates an overarching question: was Rawls’s revival of a contractualist approach to liberal legitimacy a fruitful move for liberalism and/or the social contract tradition? The last section contains a largely negative answer to that question. Nonetheless the chapter's conclusion shows that the research programme of political liberalism provided and continues to provide illuminating insights into the limitations of liberal contractualism, especially under conditions of persistent and radical diversity. The programme is, however, less receptive to challenges to do with the relative decline of the power of modern states

Constitutivism

A brief explanation and overview of constitutivism

Rasch model analysis of the Depression, Anxiety and Stress Scales (DASS)

<p>Abstract</p> <p>Background</p> <p>There is a growing awareness of the need for easily administered, psychometrically sound screening tools to identify individuals with elevated levels of psychological distress. Although support has been found for the psychometric properties of the Depression, Anxiety and Stress Scales (DASS) using classical test theory approaches it has not been subjected to Rasch analysis. The aim of this study was to use Rasch analysis to assess the psychometric properties of the DASS-21 scales, using two different administration modes.</p> <p>Methods</p> <p>The DASS-21 was administered to 420 participants with half the sample responding to a web-based version and the other half completing a traditional pencil-and-paper version. Conformity of DASS-21 scales to a Rasch partial credit model was assessed using the RUMM2020 software.</p> <p>Results</p> <p>To achieve adequate model fit it was necessary to remove one item from each of the DASS-21 subscales. The reduced scales showed adequate internal consistency reliability, unidimensionality and freedom from differential item functioning for sex, age and mode of administration. Analysis of all DASS-21 items combined did not support its use as a measure of general psychological distress. A scale combining the anxiety and stress items showed satisfactory fit to the Rasch model after removal of three items.</p> <p>Conclusion</p> <p>The results provide support for the measurement properties, internal consistency reliability, and unidimensionality of three slightly modified DASS-21 scales, across two different administration methods. The further use of Rasch analysis on the DASS-21 in larger and broader samples is recommended to confirm the findings of the current study.</p