DISTINGUISHING SUBJECTIVE EXPERIENCE FROM OBJECTIVE FACTORS IN DECISION MAKING AND PERCEIVED EFFORT

Abstract We use self-reported and behavioral data from the HomeLab to comment on the theoretical and methodological implications of integrating objective and subjective measures of experience. To illustrate, we will focus on two domains that vary in the nature of objective and subjective measurements examined. One domain will be decision making where subjective measures include subjective probability and utility and the respective objective measures include probability and actual outcomes. The second domain will be activities of daily living where the subjective measure is perceived effort and the objective measures include various data from sensor such as EDA (arousal) and EMG (muscle contraction). The presentation will discuss the benefits of conducting such research in a realistic standardized context such as the HomeLab, which is a fully connected, fully functioning apartment set up as a standardized lab in order to study activities of daily living.

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Pretransplant Comprehensive Geriatric Assessment in Older Patients with Advanced Chronic Kidney Disease

Nephron ◽

10.1159/000517342 ◽

2021 ◽

pp. 1-10

Author(s):

Teddy Novais ◽

Elodie Pongan ◽

Frederic Gervais ◽

Marie-Hélène Coste ◽

Emmanuel Morelon ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Decision Making ◽

Kidney Disease ◽

Activities Of Daily Living ◽

Physical Function ◽

Comprehensive Geriatric Assessment ◽

Daily Living ◽

Older Patients ◽

Advanced Chronic Kidney Disease ◽

Comorbidity Burden

Background: In older patients with advanced chronic kidney disease (CKD), the decision of kidney transplantation (KT) is a challenge for nephrologists. The use of comprehensive geriatric assessment (CGA) is increasingly gaining interest into the process of decision-making about treatment modality choice for CKD. The aim of this study was to assess the prevalence of geriatric impairment and frailty in older dialysis and nondialysis patients with advanced CKD using a pretransplant CGA model and to identify geriatric impairments influencing the geriatricians’ recommendations for KT. Methods: An observational study was conducted with retrospective data from July 2017 to January 2020. Patients aged ≥65 years with advanced CKD, treated or not with dialysis, and referred by the nephrologist were included in the study. The CGA assessed comorbidity burden, cognition, mood, nutritional status, (instrumental) activities of daily living, physical function, frailty, and polypharmacy. Geriatric impairments influencing the geriatricians’ recommendations for KT were identified using univariate and multivariate logistic regressions. Results: 156 patients were included (74.2 ± 3.5 years and 62.2% on dialysis). Geriatric conditions were highly prevalent in both dialysis and nondialysis groups. The rate of geriatric impairments was higher in dialysis patients regarding comorbidity burden, symptoms of depression, physical function, autonomy, and frailty. Geriatrician’s recommendations for KT were as follows: favorable (79.5%) versus not favorable or multidisciplinary discussion needed with nephrologists (20.5%). Dependence for Instrumental Activities of Daily Living (IADL) (odds ratio [OR] = 3.01 and 95% confidence interval [CI] = 1.30–7.31), physical functions (OR = 2.91 and 95% CI = 1.08–7.87), and frailty (OR = 2.66 and 95% CI = 1.07–6.65) were found to be independent geriatric impairments influencing geriatrician’s recommendations for KT. Conclusions: Understanding the burden of geriatric impairment provides an opportunity to direct KT decision-making and to guide interventions to prevent functional decline and preserve quality of life.

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Design of a 5-DOF Rehabilitation Robot Mechanism for Upper Limb and its Kinematics Analysis

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.29-32.293 ◽

2010 ◽

Vol 29-32 ◽

pp. 293-298 ◽

Cited By ~ 1

Author(s):

Zhi Lan ◽

Zhen Liang Li ◽

Ya Li

Keyword(s):

Activities Of Daily Living ◽

Upper Limb ◽

Trajectory Planning ◽

Daily Living ◽

Rehabilitation Robot ◽

Kinematics Analysis ◽

Important Data ◽

Upper Limb Rehabilitation ◽

Set Up ◽

Limb Rehabilitation

A novel 5-DOF upper limb rehabilitation robot, which can implement single joint and multi-joint complex motions and provide activities of daily living (ADL) training for hemiplegic patients, was presented. The solutions of the robot’s kinematics equation were set up by the method of D-H according to the 5-DOF rehabilitation robot for upper limb. Based on the software of ADAMS, the mechanism was simulated and analyzed. Thus the movement of robot is determinate in a certain condition of importation. It offered important data for the trajectory planning and the actual intellective control of rehabilitating robot.

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Improvement in Activities of Daily Living Using the Freehand: A System Designed for People with Tetraplegia

British Journal of Occupational Therapy ◽

10.1177/030802260306600305 ◽

2003 ◽

Vol 66 (3) ◽

pp. 113-117 ◽

Cited By ~ 1

Author(s):

Julie Esnouf ◽

Paul Taylor ◽

John Hobby

Keyword(s):

Activities Of Daily Living ◽

Functional Ability ◽

Daily Living ◽

Tendon Transfer ◽

Hand Function ◽

International Classification ◽

Home Work ◽

Set Up ◽

Implanted Device ◽

At Home

The Freehand system is an implanted device for people with C5/6 tetraplegia, international classification 0, 1 and 2. The implant is designed to improve hand function, particularly in those who lack voluntary muscles suitable for tendon transfer. This study investigated how the Freehand system was being used at home, work and leisure. Twelve participants, who were assessed, implanted and trained with the Freehand system, were reviewed against their preoperative goals. Prior to surgery, eight activities of daily living goals that the participant would like to perform with the Freehand system were selected by him or her. Each task was assessed in three sections: the set-up of the task, the performance and the take-down. The amount of assistance for each section was recorded. This was repeated after training had been completed and daily use established. Each participant was also asked to state a preference on how the tasks would be completed, whether with the system or by the method prior to surgery. The results of this study show an improvement in the participants' functional ability in their selected goals when using the Freehand system. The preference for using the Freehand system to complete tasks applied to 84% of the total 96 tasks chosen by the 12 participants in this study.

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Effect of occupation-based interventions in patients with haematopoietic malignancies undergoing chemotherapy: A pilot randomised controlled trial

Hong Kong Journal of Occupational Therapy ◽

10.1177/1569186118818680 ◽

2018 ◽

Vol 31 (2) ◽

pp. 97-105

Author(s):

Akira Sagari ◽

Yuta Ikio ◽

Nobuko Imamura ◽

Kayoko Deguchi ◽

Toko Sakai ◽

...

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Randomised Controlled Trial ◽

Activities Of Daily Living ◽

Daily Living ◽

Controlled Trial ◽

Intervention Group ◽

Pilot Randomised Controlled Trial ◽

Randomised Controlled

Background/objective Chemotherapy for cancer negatively affects activities of daily living and quality of life. This study aimed to validate and compare the efficacy of two different interventions in patients with haematopoietic malignancies undergoing chemotherapy: (1) occupation-based interventions, designed using the Aid for Decision-making in Occupation Choice (ADOC) (an iPAD application) and (2) impairment-based interventions. ADOC helps promote decision-making during activities and participation in occupation-based goal setting. The impairment-based intervention group served as the comparison group and underwent impairment-based interventions focusing on dysfunction. Methods In this single-blinded pilot randomised controlled trial, 19 participants received an occupation-based intervention (n = 9) or an impairment-based intervention (n = 10). The treatment period comprised two sessions. Recruitment, compliance and outcome completion rates were calculated for the study. Effect sizes were examined for outcomes regarding physical performance, instrumental activities of daily living and quality of life as evaluated by a blinded assessor. Results In this study, 24.8% (28/113) of the eligible patients with haematopoietic malignancies were enrolled, and 67.9% (19/28) of these were retained up to the post-assessment stage. Recruitment (25%) and compliance (68%) rates were satisfactory. The Functional Assessment of Cancer Therapy-General emotional well-being and total scores were significantly higher for the occupation-based intervention group than for the impairment-based intervention group (both p < 0.05; d = 0.54, d = 0.51, respectively). Other outcomes showed no significant differences. Conclusion Occupation-based interventions designed using the ADOC application were useful for patients with haematopoietic malignancies.

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First Insights on Value-Based Healthcare of Elders Using ICHOM Older Person Standard Set Reporting

10.21203/rs.2.11700/v2 ◽

2020 ◽

Author(s):

Wei-Ju Lee ◽

Li-Ning Peng ◽

Chi-Hung Lin ◽

Shinn-Zong Lin ◽

Ching-Hui Loh ◽

...

Keyword(s):

Decision Making ◽

Cognitive Impairment ◽

Activities Of Daily Living ◽

Outcome Measures ◽

Daily Living ◽

Place Of Death ◽

Older Person ◽

Cross Sectional ◽

Standard Set ◽

Prospective Longitudinal

Abstract Background: Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset.Methods: The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0–10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points. Results: Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease severity (OR 0.40, 95% CI 0.21–0.76, p=0.005) or cognitive impairment (OR 0.49, 95%CI 0.27–0.87, p=0.014) were less likely to have high value-based healthcare status. Conclusions: The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to whole person-focused goals. This study identified advanced age, chronic disease and cognitive impairment as important barriers to achieving high value-based healthcare status.

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THE DEMOGRAPHIC PROFILE AND TASK PERFORMANCE OF LOW VISION LEARNERS ATTENDING INCLUSIVE SCHOOLS IN KAKAMEGA COUNTY, KENYA

European Journal of Public Health Studies ◽

10.46827/ejphs.v3i2.29 ◽

2020 ◽

Vol 3 (2) ◽

Author(s):

Doreen Ashioya ◽

Teresa Okoth

Keyword(s):

Activities Of Daily Living ◽

Task Performance ◽

Daily Living ◽

Low Vision ◽

Poor Performance ◽

Inclusive Schools ◽

Key Factor ◽

The Status ◽

Functional Vision ◽

Set Up

Background: Task performance of the low vision learners is a key factor in influencing their comfort while at school and possibly cubing the increasing school dropouts in these schools. Purpose: This study aimed at investigating the task performance of low vision learners attending inclusive schools in Kakamega County. Setting: The study was conducted in public primary inclusive schools which hosts low vision learners in Kakamega County, Kenya. Methods: A census survey identified 21 low vision learners attending 11 primary public inclusive schools in Kakamega County. Out of the 21 low vision learners who were selected, 19 (90.5%) were assessed. The participants were guided to respond to a functional vision questionnaire, the LV Prasad Functional Vision Questionnaire, which was meant to elicit their ease of performing activities of daily living. Data was entered into SPSS version 25 software and analyzed using descriptive statistics. Data was summarized and presented using tables. Results: There were 13 (68.4%) males and 6 (31.6%) females who participated in this study. Participants were aged between 10 and 21 years old. The mean age was 14 while the modal age was 13 years. The highest number of low vision learners, six (31.6%), were in grade eight while the lowest number recorded, one each (5.3%), were in grades two and three. There was poor performance in the activities of daily living among the participants, which majorly included difficulty in participation in sports and games (78.9%), reading (89.5%) and orientation and mobility (57.9%). The findings enabled the study to determine the status of day-to-day task -performance at school. Conclusion: Most low vision learners attending inclusive schools have difficulty in performance of activities of daily living hence the need to device ways of addressing their visual demands in an inclusive school set-up. Article visualizations:<img src="/-counters-/edu_01/0720/a.php" alt="Hit counter" />

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Importance of blinding and expectations in opioid-induced constipation: evidence from a randomized controlled trial

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0115 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Mette Sieg ◽

Esben Bolvig Mark ◽

Asbjørn Mohr Drewes ◽

Lene Vase

Keyword(s):

Psychological Factors ◽

Subjective Experience ◽

Controlled Trial ◽

Strong Association ◽

Gastrointestinal Transit ◽

Objective Measures ◽

Subjective Measures ◽

Treatment Expectations ◽

Gastrointestinal Transit Time ◽

Double Blinded

Abstract Objectives Previous studies have found little association between objective measures and the subjective experience of opioid-induced constipation. The subjective experience of opioid-induced constipation may be influenced by treatment expectations. While most trials control for treatment expectations through blinding, success rate is generally low. This study aimed to explore the association between objective measures and the subjective experience of opioid-induced constipation, while considering blinding success and treatment expectations, and other psychological factors. Methods Data from a randomized, double-blinded, placebo-controlled crossover trial including 21 healthy male participants was analyzed. Participants received either placebo, tapentadol, or oxycodone (in equipotent doses) for 14 days. They were assessed on objective and subjective measures of opioid-induced constipation (gastrointestinal transit time and the Patient Assessment of Constipation-Symptoms questionnaire, respectively), treatment guesses to indicate blinding success, and psychological factors. Results There was a strong association between objective and subjective measures of opioid-induced constipation when participants were treated with oxycodone (r=0.676, p=0.006). Furthermore, participants were able to guess that they received active treatment when treated with oxycodone (p<0.001), suggesting that treatment expectations may have influenced the subjective experience of symptoms. Finally, patterns of moderate associations between opioid-induced constipation and other psychological factors emerged, although none reached significance (p>0.05). Conclusions Results indicate that treatment expectations could play an important role in the subjective experience of opioid-induced constipation, and support the importance of assessing blinding success in study trials. Besides expectations, other psychological factors may be associated with opioid-induced constipation.

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First insights on value-based healthcare of elders using ICHOM older person standard set reporting

BMC Geriatrics ◽

10.1186/s12877-020-01734-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Wei-Ju Lee ◽

Li-Ning Peng ◽

Chi-Hung Lin ◽

Shinn-Zong Lin ◽

Ching-Hui Loh ◽

...

Keyword(s):

Decision Making ◽

Cognitive Impairment ◽

Activities Of Daily Living ◽

Outcome Measures ◽

Daily Living ◽

Disease Burden ◽

Place Of Death ◽

Older Person ◽

Standard Set ◽

Prospective Longitudinal

Abstract Background Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset. Methods The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0–10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points. Results Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4%, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease burden (OR 0.40, 95% CI 0.21–0.76, p = 0.005) or cognitive impairment (OR 0.49, 95%CI 0.27–0.87, p = 0.014) were less likely to have high value-based healthcare status. Conclusions The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to whole person-focused goals. This study identified advanced age, chronic disease burden and cognitive impairment as important barriers to achieving high value-based healthcare status.

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The Correlation Between Static Fatigue Testing and the Quantitative Myasthenia Gravis Score and Activities of Daily Living Profile

RRNMF Neuromuscular Journal ◽

10.17161/rrnmf.v2i5.15440 ◽

2021 ◽

Vol 2 (5) ◽

Author(s):

Navdeep Lail ◽

Gil Wolfe ◽

Laura Herbelin ◽

Sharon Nations ◽

Barbara Foster ◽

...

Keyword(s):

Myasthenia Gravis ◽

Activities Of Daily Living ◽

Daily Living ◽

Fatigue Testing ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Static Fatigue ◽

Common Symptom ◽

Subjective Measures ◽

Muscle Groups

Fatigue is a common symptom in myasthenia gravis (MG), but both objective and subjective measures of fatigue are poorly studied in the disease. We conducted a pilot study of static fatigue testing (SFT) in a group of MG patients, using an isometric quantified muscle analysis computer system. Results from sustained isometric contraction of 5 muscle groups in 77 patients were correlated to the Quantitative MG Score (QMG) and the Activities of Daily Living Profile (MG-ADL), two commonly used outcome measures. Pearson correlation coefficients for the SFT were highest (0.33) for hand grip for both the QMG and MG-ADL. Correlations were quite poor for the proximal muscle groups and ankle dorsiflexion. More work is needed to develop objective and subjective measures of fatigue in MG.

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Palliative Care in the Hip Fracture Patient

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459319849801 ◽

2019 ◽

Vol 10 ◽

pp. 215145931984980 ◽

Cited By ~ 2

Author(s):

Nicole M. Sullivan ◽

Lindsay E. Blake ◽

Masil George ◽

Simon C. Mears

Keyword(s):

Decision Making ◽

Palliative Care ◽

Hip Fracture ◽

Activities Of Daily Living ◽

Daily Living ◽

Symptom Relief ◽

Orthopedic Procedures ◽

Surgical Decision ◽

Orthopedic Surgeon ◽

Surgical Decision Making

Introduction: Older patients with hip fracture have a 20% to 30% mortality rate in the year after surgery. Nonoperative care has higher 1-year mortality rates and is generally only pursued in those with an extraordinarily high surgical risk. As the population ages, more patients with hip fracture may fall into this category. The orthopedic surgeon is typically the main consultant responsible for deciding between surgery and conservative management, and the reasoning behind one decision over the other is often poorly understood. We undertook a review to determine decision-making tools for surgery in high-risk patients with hip fracture. Materials and Methods: A review was conducted using PubMed to determine articles published using the terms palliative care, conservative care, nonoperative, hip fracture, orthopedic procedures, fracture fixation, and surgery. Our search resulted in 13 articles to review. These were further screened to determine tools for use in surgical decision-making. Results: Several potential decision-making tools were found in our search. The potential tools to identify patients who would benefit from nonoperative treatment included the Palliative Performance Scale for severe dementia, the Lawton Instrumental Activities of Daily Living and Katz Activities of Daily Living scales for prefracture immobility, a combination of clinical signs and laboratory tests to determine risk of imminent death, and the Charlson Comorbidity Score for additional serious comorbidities. No tools have been prospectively tested in a clinical setting. Discussion: Evaluation of each patient using a variety of decision making tools should help the orthopedic surgeon determine which patients would be better suited to non-operative management. After determining the benefit of non-operative care, they must effectively allow the fracture to heal while ameliorating pain. Palliative care physicians can fulfill this role by providing support and symptom relief. Conclusions: Surgical decision-making for hip fracture repair in the elderly patients is not straight forward. Several tools may be helpful to the surgeon in determining who may be better suited for nonoperative care or a palliative care referral. Prospective data do not exist in these decision-making tools.

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