Objective : The first aim of this study was to determine whether adolescents with asymptomatic Generalized Joint Hypermobility (GJH) have a lower level of physical functioning (physical activity level, muscle strength and performance) compared to non-hypermobile controls. Secondly, to evaluate whether the negative impact of perceived harmfulness on physical functioning was more pronounced in adolescents with asymptomatic GJH. Methods : Cross-sectional study. Sixty-two healthy adolescents (mean age 16.8, range 12-21) participated. Hypermobility (Beighton score), perceived harmfulness (PHODA-youth) and muscle strength (dynamometry), motor performance (Single-Leg-Hop-for-Distance) and physical activity level (PAL) (accelerometry) were measured. Hierarchical regression analyses were used to study differences in physical functioning and perceived harmfulness between asymptomatic GJH and non-hypermobile controls. Results : Asymptomatic GJH was associated with increased knee extensor muscle strength (peak torque/body weight; PT/BW), controlled for age and gender (dominant leg; ß = 0.29; p = .02). No other associations between asymptomatic GJH and muscle strength, motor performance and PAL were found. Perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH. Conclusions : Adolescents with asymptomatic GJH had increased knee extensor muscle strength compared to non-hypermobile controls. No other differences in the level of physical functioning was found and the negative impact of perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH.
Background: To determine whether adolescents with generalized hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (G-HSD/hEDS) show changes in the level of disability, physical functioning, perceived harmfulness and pain intensity after completing multidisciplinary rehabilitation treatment.Methods: Pre-test post-test design. Fourteen adolescents with G-HSD/hEDS participated. The multi-disciplinary rehabilitation treatment consisted of a combination of physical training and exposure in vivo. Physical training aims to improve aerobic capacity, muscle strength and propriocepsis for compensating hypermobility. Exposure in vivo aims to decrease disability and pain-related fear. Pre- and post-treatment assessments were conducted to assess the level of disability, physical functioning (motor performance, muscle strength and physical activity level), perceived harmfulness and pain intensity.Results: After completing multidisciplinary rehabilitation treatment, the adolescents showed a significant and clinically relevant improvement (improvement of 67%, p < 0.01) in functional disability. Furthermore, significant improvements were found in motor performance (p < 0.01), muscle strength (p < 0.05), perceived harmfulness (p < 0.01) and pain intensity (p < 0.01) after completing multidisciplinary rehabilitation treatment.Conclusion: Multidisciplinary rehabilitation treatment leads to a significantly and clinically relevant improvement in the level of disability for adolescents with G-HSD/hEDS. Positive effects were also found in physical functioning, perceived harmfulness and pain intensity. Although the results of this multidisciplinary rehabilitation treatment for adolescents with G-HSD/hEDS are promising, further study is needed to confirm these findings in a randomized design.
This dissertation presents research on customers’ perceptions of cleanliness in service environments. The research contributes to the gap in the literature on cleanliness examined from a customer perspective, and adds to the understanding of environmental cues that influence perceived cleanliness. Part one of the dissertation includes the operationalisation of the concept of perceived cleanliness and the development of an instrument to measure perceived cleanliness. Results showed that perceived cleanliness consists of three dimensions: cleaned, fresh, and uncluttered. Next, the Cleanliness Perceptions Scale (CP-scale) was developed and validated in different service environments, resulting in a 12 item questionnaire that can be used to measure perceived cleanliness in service environments. Part two includes the experimental research on the effects of different environmental cues on perceived cleanliness. It furthermore explores to what extent the effects of these environmental cues on perceived cleanliness can be explained by the concept of priming. The experiments demonstrated that particular environmental cues influence perceived cleanliness: the visible presence of cleaning staff, light colour, light scent, and uncluttered architecture positively influence customers’ perceptions of cleanliness in service environments. Also, empirical support was found for priming as one of the mechanisms involved in the effects.Part three reflects on the implications of the dissertation for theory and practice. The research provides knowledge that is relevant for the fields of facility management, service marketing, social psychology, and environmental psychology. The dissertation improves the understanding of the concept of perceived cleanliness by enabling scholars and practitioners to measure the concept and the effects of particular environmental cues in service environments.
MULTIFILE
