A blended electronic illness management and recovery program for people with severe mental illness : qualitative process evaluation alongside a randomized controlled trial

Background: We conducted a trial to test the electronic Illness Management and Recovery (e-IMR) intervention to provide conclusions on the potential efficacy of eHealth for people with severe mental illness (SMI). In the e-IMR intervention, we used the standard IMR program content and methodology and combined face-to-face sessions with internet-based strategies on the constructed e-IMR internet platform. During the trial, the e-IMR platform was sparsely used. Objective: This study aimed to evaluate the added value of the e-IMR intervention and the barriers and facilitators that can explain the low use of the e-IMR platform. Methods: This process evaluation was designed alongside a multicenter, cluster randomized controlled trial. In this study, we included all available participants and trainers from the intervention arm of the trial. Baseline characteristics were used to compare users with nonusers. Qualitative data were gathered at the end of the semistructured interviews. Using theoretical thematic analyses, the data were analyzed deductively using a pre-existing coding frame. Results: Out of 41 eligible participants and 14 trainers, 27 participants and 11 trainers were interviewed. Of the 27 participants, 10 were identified as users. eHealth components that had added value were the persuasive nature of the goal-tracking sheets, monitoring, and the peer testimonials, which had the potential to enhance group discussions and disclosure by participants. The low use of the e-IMR platform was influenced by the inflexibility of the platform, the lack of information technology (IT) resources, the group context, participants' low computer skills and disabilities, and the hesitant eHealth attitude of the trainers. Conclusions: The extent of eHealth readiness and correlations with vulnerabilities in persons with SMI need further investigation. This study shows that flexible options were needed for the use of e-IMR components and that options should be provided only in response to a participant's need. Use of the e-IMR intervention in the future is preconditioned by checking the available IT resources (such as tablets for participants) providing computer or internet guidance to participants outside the group sessions, evaluating the eHealth attitude and skills of trainers, and tailoring eHealth training to increase the skills of future e-IMR trainers

Study protocol of the TIRED study:A randomised controlled trial comparing either graded exercise therapy for severe fatigue or cognitive behaviour therapy with usual care in patients with incurable cancer

Background: Fatigue is a common and debilitating symptom for patients with incurable cancer receiving systemic treatment with palliative intent. There is evidence that non-pharmacological interventions such as graded exercise therapy (GET) or cognitive behaviour therapy (CBT) reduce cancer-related fatigue in disease-free cancer patients and in patients receiving treatment with curative intent. These interventions may also result in a reduction of fatigue in patients receiving treatment with palliative intent, by improving physical fitness (GET) or changing fatigue-related cognitions and behaviour (CBT). The primary aim of our study is to assess the efficacy of GET or CBT compared to usual care (UC) in reducing fatigue in patients with incurable cancer. Methods: The TIRED study is a multicentre three-armed randomised controlled trial (RCT) for incurable cancer patients receiving systemic treatment with palliative intent. Participants will be randomised to GET, CBT, or UC. In addition to UC, the GET group will participate in a 12-week supervised exercise programme. The CBT group will receive a 12-week CBT intervention in addition to UC. Primary and secondary outcome measures will be assessed at baseline, post-intervention (14 weeks), and at follow-up assessments (18 and 26 weeks post-randomisation). The primary outcome measure is fatigue severity (Checklist Individual Strength subscale fatigue severity). Secondary outcome measures are fatigue (EORTC-QLQ-C30 subscale fatigue), functional impairments (Sickness Impact Profile total score, EORTC-QLQ-C30 subscale emotional functioning, subscale physical functioning) and quality of life (EORTC-QLQ-C30 subscale QoL). Outcomes at 14 weeks (primary endpoint) of either treatment arm will be compared to those of UC participants. In addition, outcomes at 18 and 26 weeks (follow-up assessments) of either treatment arm will be compared to those of UC participants. Discussion: To our knowledge, the TIRED study is the first RCT investigating the efficacy of GET and CBT on reducing fatigue during treatment with palliative intent in incurable cancer patients. The results of this study will provide information about the possibility and efficacy of GET and CBT for severely fatigued incurable cancer patients

Exploring the provision and motives behind the adoption of health-promotion programmes in professional football clubs across four European countries

This study mapped existing health-promotion provisions targeting adults in professional football clubs across England, the Netherlands, Norway, and Portugal, and explored motives behind the clubs’ adoption of the European Fans in Training (EuroFIT) programme. We surveyed top-tier football clubs in the four countries and interviewed representatives from football clubs and the clubs’ charitable foundation who delivered EuroFIT. The findings showed large between-country differences, with football clubs in England reporting far greater healthy lifestyle provision than other countries. Relatively few health-promotion programmes targeted adults, particularly in the Netherlands, Portugal, and Norway. Club representatives reported that the motives for adopting the EuroFIT programme often involved adhering to both the social objectives of the football club or club’s foundation and business-related objectives. They viewed the scientific evidence and evaluation underpinning EuroFIT as helpful in demonstrating the value and potential future impact of both the programme and the clubs’ wider corporate social responsibility provision

ManuVis-2: Een test voor manuele vaardigheden voor slechtziende kinderen (3 – 11 jaar)

In deze handleiding wordt de ManuVis-2 beschreven, een test die ontwikkeld is voor het meten van de fijne motoriek bij slechtziende kinderen in de leeftijdsgroepen van 3 jaar tot 11 jaar. Om deze test in de klinische praktijk te kunnen gebruiken zijn referentie data verzameld bij een normgroep van in Nederland wonende slechtziende kinderen. Deze nieuwe ManuVis-2 is een aanvulling op de in 2002 verschenen ManuVis-1(1). De beschrijving van de testitems zoals die vastgelegd was in de ManuVis-1 voor de leeftijdsgroep 6 -11 jaar is enigszins aangepast en er zijn meer gegevens verzameld voor de normering, waardoor de uitkomsten betrouwbaarder zijn. Daarnaast is de test uitgebreid met normwaarden voor 4 en 5 jarigen en is een item set toegevoegd voor driejarigen. Behalve gegevens van slechtziende kinderen zijn ook gegevens van normaalziende kinderen verzameld om deze met elkaar te kunnen vergelijken. Deze test kan zowel gebruikt worden om te bepalen of een slechtziend kind anders scoort dan zijn of haar slechtziende leeftijdsgenoten als ook om te volgen of een kind na interventie vooruitgaat en om de ontwikkeling van een kind dat ouder wordt te monitoren. Voor de ManuVis-2 uitgave zijn nieuwe gegevens verzameld die een bijdrage leveren aan de betrouwbaarheid en validiteit van de ManuVis en het leeftijdsdomein is uitgebreid

ManuVis-2:An assessment instrument for fine-motor skills of children with visual impairment (3- 11 years)

In deze handleiding wordt de ManuVis-2 beschreven, een test die ontwikkeld is voor het meten van de fijne motoriek bij slechtziende kinderen in de leeftijdsgroepen van 3 jaar tot 11 jaar. Om deze test in de klinische praktijk te kunnen gebruiken zijn referentie data verzameld bij een normgroep van in Nederland wonende slechtziende kinderen.Deze nieuwe ManuVis-2 is een aanvulling op de in 2002 verschenen ManuVis-1(1).De beschrijving van de testitems zoals die vastgelegd was in de ManuVis-1 voor de leeftijdsgroep 6 -11 jaar is enigszins aangepast en er zijn meer gegevens verzameld voor de normering, waardoor de uitkomsten betrouwbaarder zijn. Daarnaast is de test uitgebreid met normwaarden voor 4 en 5 jarigen en is een item set toegevoegd voor driejarigen. Behalve gegevens van slechtziende kinderen zijn ook gegevens van normaalziende kinderen verzameld om deze met elkaar te kunnen vergelijken.Deze test kan zowel gebruikt worden om te bepalen of een slechtziend kind anders scoort dan zijn of haar slechtziende leeftijdsgenoten als ook om te volgen of een kind na interventie vooruitgaat en om de ontwikkeling van een kind dat ouder wordt te monitoren.Voor de ManuVis-2 uitgave zijn nieuwe gegevens verzameld die een bijdrage leveren aan de betrouwbaarheid en validiteit van de ManuVis en het leeftijdsdomein is uitgebreid

Learning new letter-like writing patterns explicitly and implicitly in children and adults

A handwriting task was used to test the assumption that explicit learning is dependent on age and working memory, while implicit learning is not. The effect of age was examined by testing both, typically developing children (5–12 years old, n = 81) and adults (n = 27) in a counterbalanced within-subjects design. Participants were asked to repeatedly write letter-like patterns on a digitizer with a non-inking pen. Reproduction of the pattern was better after explicit learning compared to implicit learning. Age had positive effects on both explicit and implicit learning; working memory did not affect learning in either conditions. These results show that it may be more effective to learn writing new letter-like patterns explicitly and that an explicit teaching method is preferred in mainstream primary education

Measurement of action planning in children, adolescents, and adults : A comparison between 3 tasks

Purpose: To compare age-related action planning performance on 3 different tasks, focusing on differences in task complexity. Methods: A total of 119 participants were divided across 6 age groups (4-5, 6-7, 8-9, 10-12, 14-16, and 20-22 years). Participants performed 3 action planning tasks: the overturned cup task, the bar transport task, and the sword task. Anticipatory planning was assessed via the proportion of comfortable end postures. Results: The increase in proportion of comfortable end postures developed more gradually for the overturned cup task with earlier ceiling effect (6 years) than for the other 2 tasks (10 years and no ceiling). The overturned cup task correlated fairly with the other tasks; the bar transport task and sword task correlated moderately. Conclusions: All 3 tasks can be used to measure aspects of action planning but outcomes vary. Therefore, we recommend combining these tasks in assessments of individual children to obtain a good indication of action planning development

The Reasons behind the (Non)Use of Feedback Reports for Quality Improvement in Physical Therapy: A Mixed-Method Study.

To explain the use of feedback reports for quality improvements by the reasons to participate in quality measuring projects and to identify barriers and facilitators.Mixed methods design.In 2009-2011 a national audit and feedback system for physical therapy (Qualiphy) was initiated in the Netherlands. After each data collection round, an evaluation survey was held amongst its participants. The evaluation survey data was used to explain the use of feedback reports by studying the reasons to participate with Qualiphy with correlation measures and logistic regression. Semi-structured interviews with PTs served to seek confirmation and disentangle barriers and facilitators.Analysis of 257 surveys (response rate: 42.8%) showed that therapists with only financial reasons were less likely to use feedback reports (OR = 0.24;95%CI = 0.11-0.52) compared to therapists with a mixture of reasons. PTs in 2009 and 2010 were more likely to use the feedback reports for quality improvement than PTs in 2011 (OR = 2.41;95%CI = 1.25-4.64 respectively OR = 3.28;95%CI = 1.51-7.10). Changing circumstances in 2011, i.e. using EHRs and financial incentives, had a negative effect on the use of feedback reports (OR = 0.40, 95%CI = 0.20-0.78). Interviews with 12 physical therapists showed that feedback reports could serve as a tool to support and structure quality improvement plans. Barriers were distrust and perceived self-reporting bias on indicator scores.Implementing financial incentives that are not well-specified and well-targeted can have an adverse effect on using feedback reports to improve quality of care. Distrust is a major barrier to implementing quality systems

Learning of writing letter-like sequences in children with physical and multiple disabilities

This study compared implicit and explicit learning instructions in hand writing. Implicit learning is the ability to acquire a new skill without a corresponding increase in knowledge about the skill. In contrast, explicit learning uses declarative knowledge to build up a set of performance rules that guide motor performance or skills. Explicit learning is dependent on working memory, implicit learning is not. Therefore, implicit learning was expected to be easier than explicit learning in children in special education, given their expected compromised working memory. Two groups of children (5–12 years) participated, children in special education with physical or multiple disabilities (study group, n = 22), and typically developing controls (n = 32). Children learned to write letter-like patterns on a digitizer by tracking a moving target (implicitly) and verbal instruction (explicitly). We further tested visual working memory, visual-motor integration, and gross manual dexterity. Learning curves were similar for both groups in both conditions; children in the study group did learn both implicitly and explicitly. Motor performance was related to the writing task. In contrast to our hypothesis, visual working memory was not an important factor in the explicit condition. These results shed new light on the conceptual difference between implicit and explicit learning, and the role of working memory therein