Background: Clinicians are currently challenged to support older adults to maintain a certain level of Functional Independence (FI). FI is defined as "functioning physically safely and independent from another person, within one's own context". A Core Outcome Set was developed to measure FI. The purpose of this study was to assess discriminative validity of the Core Outcome Set FI (COSFI) in a population of Dutch older adults (≥ 65 years) with different levels of FI. Secondary objective was to assess to what extent the underlying domains 'coping', 'empowerment' and 'health literacy' contribute to the COSFI in addition to the domain 'physical capacity'. Methods: A population of 200 community-dwelling older adults and older adults living in residential care facilities were evaluated by the COSFI. The COSFI contains measurements on the four domains of FI: physical capacity, coping, empowerment and health literacy. In line with the COSMIN Study Design checklist for Patient-reported outcome measurement instruments, predefined hypotheses regarding prediction accuracy and differences between three subgroups of FI were tested. Testing included ordinal logistic regression analysis, with main outcome prediction accuracy of the COSFI on a proxy indicator for FI. Results: Overall, the prediction accuracy of the COSFI was 68%. For older adults living at home and depending on help in (i)ADL, prediction accuracy was 58%. 60% of the preset hypotheses were confirmed. Only physical capacity measured with Short Physical Performance Battery was significantly associated with group membership. Adding health literacy with coping or empowerment to a model with physical capacity improved the model significantly (p < 0.01). Conclusions: The current composition of the COSFI, did not yet meet the COSMIN criteria for discriminative validity. However, with some adjustments, the COSFI potentially becomes a valuable instrument for clinical practice. Context-related factors, like the presence of a spouse, also may be a determining factor in this population. It is recommended to include context-related factors in further research on determining FI in subgroups of older people.
Interdisciplinary multimodal pain therapy (IMPT) is a biopsychosocial treatment approach for patients with chronic pain that comprises at least psychological and physiotherapeutic interventions. Core outcome sets (COSs) are currently developed in different medical fields to standardize and improve the selection of outcome domains, and measurement instruments in clinical trials, to make trial results meaningful, to pool trial results, and to allow indirect comparison between interventions. The objective of this study was to develop a COS of patient-relevant outcome domains for chronic pain in IMPT clinical trials. An international, multiprofessional panel (patient representatives [n = 5], physicians specialized in pain medicine [n = 5], physiotherapists [n = 5], clinical psychologists [n = 5], and methodological researchers [n = 5]) was recruited for a 3-stage consensus study, which consisted of a mixed-method approach comprising an exploratory systematic review, a preparing online survey to identify important outcome domains, a face-to-face consensus meeting to agree on COS domains, and a second online survey (Delphi) establishing agreement on definitions for the domains included. The panel agreed on the following 8 domains to be included into the COS for IMPT: pain intensity, pain frequency, physical activity, emotional wellbeing, satisfaction with social roles and activities, productivity (paid and unpaid, at home and at work, inclusive presentism and absenteeism), health-related quality of life, and patient's perception of treatment goal achievement. The complexity of chronic pain in a biopsychosocial context is reflected in the current recommendation and includes physical, mental, and social outcomes. In a subsequent step, measurement instruments will be identified via systematic reviews.
For older adults, acute hospitalization is a high-risk event with poor health outcomes, including functional decline. In absence of practical guidelines and high quality randomized controlled trials, this Delphi study was conducted. The aim of this study was to obtain consensus on an exercise intervention program, a core outcome set (COS) and handover information to prevent functional decline or restore physical function in acutely hospitalized older patients transitioning from hospital to home. An internal panel of experts in the field of exercise interventions for acutely hospitalized older adults were invited to join the study. In the Delphi study, relevant topics were recognized, statements were formulated and ranked on a 9-point Likert scale in two additional rounds. To reaching consensus, a score of 7–9 was classified as essential. Results were expressed as median and semi-interquartile range (SIQR), and consensus threshold was set at SIQR≤0.5. Fifteen international experts from eight countries participated in the panel. The response rate was 93%, 93% and 80% for the three rounds respectively. After three rounds, consensus was reached on 167 of the 185 (90.3%) statements, of which ninety-five (51.4%) were ranked as essential (median Likert-score ≥7.0, SIQR ≤0.5). This Delphi study provides starting points for developing an exercise intervention, a COS and handover information. The results of this Delphi study can assist physical therapists to provide a tailored exercise intervention for older patients with complex care needs after hospital discharge, to prevent functional decline and/or restore physical function.
MULTIFILE
The pressure on the European health care system is increasing considerably: more elderly people and patients with chronic diseases in need of (rehabilitation) care, a diminishing work force and health care costs continuing to rise. Several measures to counteract this are proposed, such as reduction of the length of stay in hospitals or rehabilitation centres by improving interprofessional and person-centred collaboration between health and social care professionals. Although there is a lot of attention for interprofessional education and collaborative practice (IPECP), the consortium senses a gap between competence levels of future professionals and the levels needed in rehabilitation practice. Therefore, the transfer from tertiary education to practice concerning IPECP in rehabilitation is the central theme of the project. Regional bonds between higher education institutions and rehabilitation centres will be strengthened in order to align IPECP. On the one hand we deliver a set of basic and advanced modules on functioning according to the WHO’s International Classification of Functioning, Disability and Health and a set of (assessment) tools on interprofessional skills training. Also, applications of this theory in promising approaches, both in education and in rehabilitation practice, are regionally being piloted and adapted for use in other regions. Field visits by professionals from practice to exchange experiences is included in this work package. We aim to deliver a range of learning materials, from modules on theory to guidelines on how to set up and run a student-run interprofessional learning ward in a rehabilitation centre. All tested outputs will be published on the INPRO-website and made available to be implemented in the core curricula in tertiary education and for lifelong learning in health care practice. This will ultimately contribute to improve functioning and health outcomes and quality of life of patients in rehabilitation centres and beyond.
The aim of the project is to design, test, refine and deploy a new assessment tool focusing on individual Future Literacy of students. Future Literacy is the ability to produce and process complex visions of the future and make sense thereof. FL is therefore an essential component of any 21st Century Skills set, in the sense that it focuses on the ability of students to prepare themselves for uncertainty and unexpected challenges. At present, the competing concepts of 21st Century Skills have a common denominator in the core idea of fostering personal development of "T-shaped individuals" who have depth in a particular field and breadth in their skill set and thinking. The students' individual ability to "use the future": make sense of emergent reality, deal with complex problems, make decisions based on collective intelligence, plan and prepare for the future, is as important in making educational choices as in taking educated bets concerning their professional, personal and political futures. The project outcome: a new tool for FL assessment will test the feasibility of rigorous measurement, and assessment of FL, to inform better curriculum design and methodological development.
Examining in-class activities to facilitate academic achievement in higher educationThere is an increasing interest in how to create an effective and comfortable indoor environment for lecturers and students in higher education. To achieve evidence-based improvements in the indoor environmental quality (IEQ) of higher education learning environments, this research aimed to gain new knowledge for creating optimal indoor environmental conditions that best facilitate in-class activities, i.e. teaching and learning, and foster academic achievement. The academic performance of lecturers and students is subdivided into short-term academic performance, for example, during a lecture and long-term academic performance, during an academic course or year, for example. First, a systematic literature review was conducted to reveal the effect of indoor environmental quality in classrooms in higher education on the quality of teaching, the quality of learning, and students’ academic achievement. With the information gathered on the applied methods during the literature review, a systematic approach was developed and validated to capture the effect of the IEQ on the main outcomes. This approach enables research that aims to examine the effect of all four IEQ parameters, indoor air quality, thermal conditions, lighting conditions, and acoustic conditions on students’ perceptions, responses, and short-term academic performance in the context of higher education classrooms. Next, a field experiment was conducted, applying the validated systematic approach, to explore the effect of multiple indoor environmental parameters on students and their short-term academic performance in higher education. Finally, a qualitative case study gathered lecturers’ and students’ perceptions related to the IEQ. Furthermore, how these users interact with the environment to maintain an acceptable IEQ was studied.During the systematic literature review, multiple scientific databases were searched to identify relevant scientific evidence. After the screening process, 21 publications were included. The collected evidence showed that IEQ can contribute positively to students’ academic achievement. However, it can also affect the performance of students negatively, even if the IEQ meets current standards for classrooms’ IEQ conditions. Not one optimal IEQ was identified after studying the evidence. Indoor environmental conditions in which students perform at their best differ and are task depended, indicating that classrooms should facilitate multiple indoor environmental conditions. Furthermore, the evidence provides practical information for improving the design of experimental studies, helps researchers in identifying relevant parameters, and lists methods to examine the influence of the IEQ on users.The measurement methods deduced from the included studies of the literature review, were used for the development of a systematic approach measuring classroom IEQ and students’ perceived IEQ, internal responses, and short-term academic performance. This approach allowed studying the effect of multiple IEQ parameters simultaneously and was tested in a pilot study during a regular academic course. The perceptions, internal responses, and short-term academic performance of participating students were measured. The results show associations between natural variations of the IEQ and students’ perceptions. These perceptions were associated with their physiological and cognitive responses. Furthermore, students’ perceived cognitive responses were associated with their short-term academic performance. These observed associations confirm the construct validity of the composed systematic approach. This systematic approach was then applied in a field experiment, to explore the effect of multiple indoor environmental parameters on students and their short-term academic performance in higher education. A field study, with a between-groups experimental design, was conducted during a regular academic course in 2020-2021 to analyze the effect of different acoustic, lighting, and indoor air quality (IAQ) conditions. First, the reverberation time was manipulated to 0.4 s in the intervention condition (control condition 0.6 s). Second, the horizontal illuminance level was raised from 500 to 750 lx in the intervention condition (control condition 500 lx). These conditions correspond with quality class A (intervention condition) and B (control condition), specified in Dutch IEQ guidelines for school buildings (2015). Third, the IAQ, which was ~1100 ppm carbon dioxide (CO2), as a proxy for IAQ, was improved to CO2 concentrations under 800 ppm, meeting quality class A in both conditions. Students’ perceptions were measured during seven campaigns with a questionnaire; their actual cognitive and short-term academic performances were evaluated with validated tests and an academic test, composed by the lecturer, as a subject-matter-expert on the taught topic, covered subjects discussed during the lecture. From 201 students 527 responses were collected and analyzed. A reduced RT in combination with raised HI improved students’ perceptions of the lighting environment, internal responses, and quality of learning. However, this experimental condition negatively influenced students’ ability to solve problems, while students' content-related test scores were not influenced. This shows that although quality class A conditions for RT and HI improved students’ perceptions, it did not influence their short-term academic performance. Furthermore, the benefits of reduced RT in combination with raised HI were not observed in improved IAQ conditions. Whether the sequential order of the experimental conditions is relevant in inducing these effects and/or whether improving two parameters is already beneficial, is unknownFinally, a qualitative case study explored lecturers’ and students’ perceptions of the IEQ of classrooms, which are suitable to give tutorials with a maximum capacity of about 30 students. Furthermore, how lecturers and students interact with this indoor environment to maintain an acceptable IEQ was examined. Eleven lecturers of the Hanze University of Applied Sciences (UAS), located in the northern part of the Netherlands, and twenty-four of its students participated in three focus group discussions. The findings show that lecturers and students experience poor thermal, lighting, acoustic, and IAQ conditions which may influence teaching and learning performance. Furthermore, maintaining acceptable thermal and IAQ conditions was difficult for lecturers as opening windows or doors caused noise disturbances. In uncomfortable conditions, lecturers may decide to pause earlier or shorten a lecture. When students experienced discomfort, it may affect their ability to concentrate, their emotional status, and their quality of learning. Acceptable air and thermal conditions in classrooms will mitigate the need to open windows and doors. This allows lecturers to keep doors and windows closed, combining better classroom conditions with neither noise disturbances nor related distractions. Designers and engineers should take these end users’ perceptions into account, often monitored by facility management (FM), during the renovation or construction of university buildings to achieve optimal IEQ conditions in higher education classrooms.The results of these four studies indicate that there is not a one-size fits all indoor environmental quality to facilitate optimal in-class activities. Classrooms’ thermal environment should be effectively controlled with the option of a local (manual) intervention. Classrooms’ lighting conditions should also be adjustable, both in light color and light intensity. This enables lecturers to adjust the indoor environment to facilitate in-class activities optimally. Lecturers must be informed by the building operator, for example, professionals of the Facility Department, how to change classrooms’ IEQ settings. And this may differ per classroom because each building, in which the classroom is located, is operated differently apart from the classroom location in the building, exposure to the environment, and its use. The knowledge that has come available from this study, shows that optimal indoor environmental conditions can positively influence lecturers’ and students’ comfort, health, emotional balance, and performance. These outcomes have the capacity to contribute to an improved school climate and thus academic achievement.
