Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK) provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect.</p> <p>This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of:</p> <p>1 Establishing the effectiveness of core stability training</p> <p>2 Comparing core stability training with standardised physiotherapy exercise</p> <p>3 Exploring underlying mechanisms of change associated with this intervention</p> <p>Methods</p> <p>This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control). All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12), the Functional Reach (forwards and lateral), a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC) Scale. In addition, ultrasound imaging of the abdominal muscles will be performed before and after intervention to assess changes in abdominal musculature at one of the four centres (Plymouth).</p> <p>Discussion</p> <p>This pragmatic trial will assess the effect of these exercise programmes on ambulatory people with MS. It may not be possible to extrapolate the conclusions to those who are non-ambulatory.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01414725">NCT01414725</a></p

How robust are value judgements of health inequality aversion? Testing for framing and cognitive effects

Background: Empirical studies have found that members of the public are inequality averse and value health gains for disadvantaged groups with poor health many times more highly than gains for better off groups. However, these studies typically use abstract scenarios that involve unrealistically large reductions in health inequality, and face-to-face survey administration. It is not known how robust these findings are to more realistic scenarios or anonymous online survey administration. Methods: This study aimed to test the robustness of questionnaire estimates of inequality aversion by comparing the following: (1) small versus unrealistically large health inequality reductions; (2) population-level versus individual-level descriptions of health inequality reductions; (3) concrete versus abstract intervention scenarios; and (4) online versus face to face mode of administration. Fifty-two members of the public participated in face-to-face discussion groups, while 83 members of the public completed an online survey. Participants were given a questionnaire instrument with different scenario descriptions for eliciting aversion to social inequality in health. Results: The median respondent was inequality averse under all scenarios. Scenarios involving small rather than unrealistically large health gains made little difference in terms of inequality aversion, as did population-level rather than individual-level scenarios. However, the proportion expressing extreme inequality aversion fell 19 percentage points when considering a specific health intervention scenario rather than an abstract scenario, and was 11-21 percentage points lower among online public respondents compared to the discussion group. Conclusions: Our study suggests that both concrete scenarios and online administration reduce the proportion expressing extreme inequality aversion but still yield median responses implying substantial health inequality aversion

Stakeholder collaboration in climate-smart agricultural production innovations: insights from the Cocoa industry in Ghana

Although collaboration is vital in addressing global environmental sustainability challenges, research understanding on stakeholder engagement in climate-smart production innovation adoption and implementation, remains limited. In this paper, we advance knowledge about stakeholder collaboration by examining the roles played by stakeholders in scaling up ecological sustainability innovations. Using the illustrative context and case of green cocoa industry in Ghana, the analysis identified three distinctive phases of stakeholder engagement in ecological sustainability innovations implemented from 1960-2017. We highlight defining periods of ecological challenges encompassing the production recovery sustainability initiative phase solely driven by the Ghana Cocoa Board (COCOBOD)–a governmental body responsible for production, processing and marketing of cocoa, coffee and sheanut. During the period, major initiatives were driven by non-governmental organisations in collaboration with COCOBOD to implement the Climate-Smart agriculture scheme in the cocoa sector. The findings have implications for cocoa production research and stakeholder collaboration in environmental innovations adoption

Econometric Modelling: Extensions

AbstractThis chapter is devoted to advanced issues of econometric modelling. The topics covered are, among others, models in willingness to pay space, the meaning of scale heterogeneity in discrete choice models and the application of various information processing rules such as random regret minimisation or attribute non-attendance. Other topics are anchoring and learning effects when respondents move through a sequence of choice tasks as well as different information processing strategies such as lexicographic preferences or choices based on elimination-by-aspects

Developing the Questionnaire

AbstractThis chapter outlines the essential topics for developing and testing a questionnaire for a discrete choice experiment survey. It addresses issues such as the description of the environmental good, pretesting of the survey, incentive compatibility, consequentiality or mitigation of hypothetical bias. For the latter, cheap talk scripts, opt-out reminders or an oath script are discussed. Moreover, the use of instructional choice sets, the identification of protest responses and strategic bidders are considered. Finally, issues related to the payment vehicle and the cost vector design are the subject of this section

Scale heterogeneity and its implications for discrete choice analysis

This paper shows how researchers can make incorrect interpretations of models that include heterogeneity in error variance (scale) if they do not recognize the implications of parameter estimates being conflated with scale. The research contribution is to define best practice management of scale heterogeneity in discrete choice experiments and to empirically demonstrate issues that arise when best practice is ignored. We illustrate the problem using data from two discrete choice experiments, showing that reported parameters vary due to arbitrary normalization decisions. We report examples of papers where authors fall into this trap, potentially leading to erroneous evaluation of models. (JEL C52, Q51)

Assessing the cost-effectiveness of invasive species management: a decision tool for biodiversity conservation

Invasive species threaten biodiversity in Australia. One of these species is the introduced root pathogen Phytophthora cinnamomi, which harms native and commercial plant species. Disease caused by this pathogen was listed as a key threatening process under the Commonwealth's Environment Protection and Biodiversity Conservation Act in 2000. There is considerable uncertainty regarding the best management strategies to address invasive species like Phytophthora cinnamomi; particularly where the efficacy of control methods is unknown. How should environmental managers decide whether management strategies are worthwhile or cost-effective? We demonstrate the use of a tool that can address these management challenges: the Investment Framework for Environmental Resources (INFFER). INFFER was designed to help environmental managers achieve the most valuable environmental outcomes with the limited resources they have available. The framework involves a systematic assessment of the trade-offs between variables such as asset value, likelihood that private individuals will adopt management or behavioural changes, delays in the realisation of benefits, and sources of uncertainty due to potential technical failure or socio-political risks. We present an application of INFFER to assess the cost-effectiveness of management strategies to address Phytophthora cinnamomi in the Fitzgerald River National Park, a national park in the South-West Botanical Province of Western Australia. The Fitzgerald River National Park is one of the largest parks in Australia, and has high conservation value because of its high floral diversity and numbers of endemic species. The model was developed in collaboration with park stakeholders, including park rangers, management and research officers, and members of a local natural resource management group. We found that despite uncertainty regarding the efficacy of existing containment and eradication methods, management strategies aimed at containing existing Phytophthora cinnamomi infestations and preventing future infestations, resulted in significantly greater benefits than costs (Benefit: Cost Index = 3.02). This result supports investment of public conservation funds to control Phytophthora cinnamomi in the Fitzgerald River National Park. A sensitivity analysis identified the need for better biophysical data to quantify the impact of management works, and demonstrated how uncertain funding environments prevent confidence in the accomplishment of project goals, through an inability to assure the future maintenance and upkeep of management works. Our analysis demonstrates the importance of using a rigorous decision support tool like INFFER to assess investment decisions when there is uncertainty regarding conservation benefits

Concern about threatened species and ecosystem disservices underpin public willingness to pay for ecological restoration

Public preferences for ecological restoration can be revealed through environmental valuation studies that aim to measure willingness to pay. However, respondents' environmental views will often influence the conclusions drawn from such studies. We conducted a national survey of perceptions of the benefits and perverse outcomes arising from ecological restoration using a dichotomous choice payment card. Using interval regression to estimate willingness to pay, we find that there are respondents who will perceive mostly biodiversity benefits from restoration, with a particular interest in threatened species recovery. We find that this eco‐centric view of the benefits of restoration also increases the dollar amount that respondents are willing to pay to support restoration activities. A proportion of respondents also perceive restoration as having negative impacts, with concerns orientated towards increased fire, decreased farmland productivity, and groundwater availability. Perceptions of the potential effects of restoration on land productivity had a significant negative influence on the amount of money respondents were willing to pay. These findings are useful for targeting outreach in order to garner public support for ecological restoration