Suomi

Peer reviewe

A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation

Background: In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently left with physical and psychological changes that can profoundly affect their functional ability, independence, and social participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and environmentally enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology, we developed an information communication technology–enhanced Personalized Self-Managed rehabilitation System (PSMrS) for stroke survivors with integrated insole sensor technology within an “intelligent shoe.”. The intervention model was based around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback, self-efficacy, and knowledge transfer. Objective: To understand the conditions under which this technology-based rehabilitation solution would most likely have an impact on the motor behavior of the user, what would work for whom, in what context, and how. We were interested in what aspects of the system would work best to facilitate the motor behavior change associated with self-managed rehabilitation and which user characteristics and circumstances of use could promote improved functional outcomes. Methods: We used a Realist Evaluation (RE) framework to evaluate the final prototype PSMrS with the assumption that the intervention consists of a series of configurations that include the Context of use, the underlying Mechanisms of change and the potential Outcomes or impacts (CMOs). We developed the CMOs from literature reviews and engagement with clinicians, users, and caregivers during a series of focus groups and home visits. These CMOs were then tested in five in-depth case studies with stroke survivors and their caregivers. Results: While two new propositions emerged, the second importantly related to the self-management aspects of the system. The study revealed that the system should also encourage independent use and the setting of personalized goals or activities. Conclusions: Information communication technology that purports to support the self-management of stroke rehabilitation should give significant consideration to the need for motivational feedback that provides quantitative, reliable, accurate, context-specific, and culturally sensitive information about the achievement of personalized goal-based activities

RCTs: How compatible are they with policy-making?

Randomised controlled trials (RCTs) have been promoted as a means of improving policy-making by testing new policies. While testing before full-scale roll-out is commendable, this paper discusses the challenges of using RCTs in contemporary (national) health policy-making in England. There are at least two challenges in particular that are currently underrepresented in the debate: The first arises from the complexity of many policies which are often too diffuse and unclear in focus to allow for the clear distinction between a policy ‘mechanism’ and its context to be drawn that is required for a RCT. The second challenge relates to the timing of RCTs, which tend to take place either too early in the life of a policy to be meaningful or too late to have an effect on policy formulation. We therefore encourage policy-makers and researchers to be clear about the types of uncertainties ‘field experiments’ are meant to address which may be addressed better by other types of knowledge generation

Functioning and disability in multiple sclerosis from the patient perspective

Multiple sclerosis (MS) has a great impact on functioning and disability. The perspective of those who experience the health problem has to be taken into account to obtain an in-depth understanding of functioning and disability. The objective was to describe the areas of functioning and disability and relevant contextual factors in MS from the patient perspective. A qualitative study using focus group methodology was performed. The sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for data analysis. Identified concepts were linked to International Classification of Functioning, Disability and Health (ICF) categories according to established linking rules. Six focus groups with a total of 27 participants were performed. In total, 1327 concepts were identified and linked to 106 ICF categories of the ICF components Body Functions, Activities and Participation and Environmental Factors. This qualitative study reports on the impact of MS on functioning and disability from the patient perspective. The participants in this study provided information about all physical aspects and areas of daily life affected by the disease, as well as the environmental factors influencing their lives

Use of UKCAT scores in student selection by UK medical schools, 2006-2010

<p>Abstract</p> <p>Background</p> <p>The United Kingdom Clinical Aptitude Test (UKCAT) is a set of cognitive tests introduced in 2006, taken annually before application to medical school. The UKCAT is a test of aptitude and not acquired knowledge and as such the results give medical schools a standardised and objective tool that all schools could use to assist their decision making in selection, and so provide a fairer means of choosing future medical students.</p> <p>Selection of students for UK medical schools is usually in three stages: assessment of academic qualifications, assessment of further qualities from the application form submitted via UCAS (Universities and Colleges Admissions Service) leading to invitation to interview, and then selection for offer of a place. Medical schools were informed of the psychometric qualities of the UKCAT subtests and given some guidance regarding the interpretation of results. Each school then decided how to use the results within its own selection system.</p> <p>Methods</p> <p>Annual retrospective key informant telephone interviews were conducted with every UKCAT Consortium medical school, using a pre-circulated structured questionnaire. The key points of the interview were transcribed, 'member checked' and a content analysis was undertaken.</p> <p>Results</p> <p>Four equally popular ways of using the test results have emerged, described as Borderline, Factor, Threshold and Rescue methods. Many schools use more than one method, at different stages in their selection process. Schools have used the scores in ways that have sought to improve the fairness of selection and support widening participation. Initially great care was taken not to exclude any applicant on the basis of low UKCAT scores alone but it has been used more as confidence has grown.</p> <p>Conclusions</p> <p>There is considerable variation in how medical schools use UKCAT, so it is important that they clearly inform applicants how the test will be used so they can make best use of their limited number of applications.</p

A theory-grounded framework of Open Source Software adoption in SMEs

This is a post-peer-review, pre-copyedit version of an article published in European Journal of Information Systems. The definitive publisher-authenticated version Macredie, RD and Mijinyawa, K (2011), "A theory-grounded framework of Open Source Software adoption in SMEs", European Journal of Informations Systems, 20(2), 237-250 is available online at: http://www.palgrave-journals.com/ejis/journal/v20/n2/abs/ejis201060a.html.The increasing popularity and use of Open Source Software (OSS) has led to significant interest from research communities and enterprise practitioners, notably in the small business sector where this type of software offers particular benefits given the financial and human capital constraints faced. However, there has been little focus on developing valid frameworks that enable critical evaluation and common understanding of factors influencing OSS adoption. This paper seeks to address this shortcoming by presenting a theory-grounded framework for exploring these factors and explaining their influence on OSS adoption, with the context of study being small- to medium-sized Information Technology (IT) businesses in the U.K. The framework has implications for this type of business – and, we will suggest, more widely – as a frame of reference for understanding, and as tool for evaluating benefits and challenges in, OSS adoption. It also offers researchers a structured way of investigating adoption issues and a base from which to develop models of OSS adoption. The study reported in this paper used the Decomposed Theory of Planned Behaviour (DTPB) as a basis for the research propositions, with the aim of: (i) developing a framework of empirical factors that influence OSS adoption; and (ii) appraising it through case study evaluation with 10 U.K. Small- to medium-sized enterprises in the IT sector. The demonstration of the capabilities of the framework suggests that it is able to provide a reliable explanation of the complex and subjective factors that influence attitudes, subjective norms and control over the use of OSS. The paper further argues that the DTPB proved useful in this research area and that it can provide a variety of situation-specific insights related to factors that influence the adoption of OSS