Measuring What Counts in Life: The Development and Initial Validation of the Fulfilled Life Scale (FLS)

In a recent work, we introduced a theoretical model for fulfillment in life that covers cognitive and affective components and distinguishes different time frames. The present study evaluates this model and describes the construction of the Fulfilled Life Scale (FLS) to assess fulfillment regarding the whole lived life retrospectively. We investigated the scale in two samples (Sample 1: N = 282 adults aged 50–93 years; Sample 2: N = 406 adults aged 40–85 years). The model of the cognitive component combines three sources of fulfillment (self, life, impact/legacy) with three criteria (wholeness, fit, value), yielding nine facets. Employing hierarchical factor analysis, we inspected all solutions between one and nine. We identified three optimal factors, which we labeled unfolded self and life, the worthwhile life, and positive impact and legacy. Next, we selected marker items and replicated the factor structure in Sample 2. The three scales were positively intercorrelated and showed good internal consistency in both samples. For the affective component, exploratory and confirmatory factor analyses established a one-factor structure in both samples, and high internal consistency was obtained. Across a range of related constructs, we demonstrated construct and criterion validity. Notably, cognitive and affective fulfillment incrementally predicted a global rating of a fulfilled life and mental well-being, even after controlling for subjective and eudaimonic well-being. Overall, the study proves that the FLS is necessary to capture people’s experience of a fulfilled life, which could not be assessed sufficiently with previous well-being measures. Both cognitive and affective fulfillment were able to predict additional variance in mental well-being. Moreover, the study reveals psychometric support for the FLS and presents the first evidence on its validity. Lastly, applications in research and practice are discussed, especially in the context of living and aging well in the second half of life.

Communication in the face of death and dying - how does the encounter with death influence the patient management competence of medical students? An outcome-evaluation

Background information As part of an elective course, the Interdisciplinary Centre for Palliative Medicine at Duesseldorf University Hospital offers medical students the opportunity to personally meet and talk to a seriously ill patient on one or more occasions. The future physicians are provided with an opportunity to broaden their professional competence, i.e. their knowledge and skills in patient-centred communication at the end of life, and enhance their personal competence, for example in how to professionally handle their own emotions. A topical e-learning module helps the students to prepare for the meetings, and writing a reflection paper forms the basis for the concluding reflection seminar. Objectives The study’s objective is a global and outcome-based evaluation of the elective blended-learning course that provides real-world patient interaction. The outcome-based evaluation or outcome assessment aims to objectively evaluate changes identified in knowledge, skills and attitude among the participants of the elective-course. Furthermore, the evaluation aims to answer the question of whether changes especially in attitude (social skills and self-competence) should be expected after the students have met with severely ill or dying patients. Method On two questionnaires specifically developed for this survey the students were able to provide a global rating of the elective course and describe their learning gains in palliative care. The students’ learning gains were measured by means of 14 items reflecting the specific educational objectives of the offered elective course. Using the German school grading system as a rating scale, the students assessed their learning progress by retrospectively evaluating their skills before and after completion of the elective course (Comparative Self-Assessment, CSA). Results In the time from April 2018 till March 2020, 62 students participated in the evaluation. Overall, learning progress among students could be observed across all areas of competence, and in 50% of all retrospective self-assessment items the learning gains were ≥ 50%. The highest learning gain (63.6%) was observed in the students’ ability to meet a severely ill patient without fear. The lowest learning gain was observed when students had to confront and accept their own mortality. Conclusions The offered elective course supports students in achieving social and self-competence development goals. According to the obtained results, contact with real-world patients helps mould the students’ attitude.

The Use of Global Rating Scales and Checklists in Clinical Simulation-Based Assessments: A Protocol for a Scoping Review

Background Assessment in health sciences education remains a hotly debated topic, with measures of competency and how to determine them in simulation-based assessments enjoying much of the focus. Global rating scales (GRS) and checklists enjoy widespread use within simulation-based education but there is a question regarding how the two strategies are used within clinical simulation assessment. The aim of this proposed scoping review is therefore to explore, map and summarise the nature, range and extent of published literature available relating to the use of GRS and checklists in clinical simulation-based assessment. Methods We will follow the methodological frameworks and updates described by Arksey and O’Malley, Levac, Colquhoun and O'Brien, and Peters, Marnie and Tricco et al and will report using the PRISMA extension for Scoping Reviews. We will search PubMed, CINAHL, ERIC, Cochrane Library, Scopus, EBSCO, ScienceDirect, Web of Science, the DOAJ, and several sources of grey literature. We developed a search strategy in collaboration with an experienced research librarian and include an example of a full electronic search in this article. We will screen all titles and abstracts and relevant full-text articles and extract the relevant data using the data extraction form. Quantitative data will be presented as will a narrative account of all included studies. We will import the narrative into Atlas.ti and use thematic analysis to identify themes and map the data. We will be including all identified sources published in English after 1 January 2010 that relate to the use of GRS and/or checklists in clinical simulation-based assessments. Discussion The overview of literature produced will help to identify knowledge gaps and inform future research in the use of GRS and checklists in clinical simulation-based assessments. This information will be valuable and useful for all stakeholders that are interested in clinical simulation-based assessments. Scoping review protocol registration: Open Science Framework (OSF) submitted on 26 November 2021 and available at https://osf.io/7yfbq.

Global and national university rankings: A multivariate analysis

Introduction. In the context of globalisation and internationalisation of higher education, university rankings are becoming an important tool for assessing the quality of education received by students at various higher education institutions around the world. These processes actualise the issues of possibilities for practical use of methodologies for calculation of global and national university rankings.The aim of the study was to develop and apply a methodological approach to multivariate the analysis of Higher Education Institutions (HEIs) classification procedures, to construct and analyse aggregated indicators for global and national rating systems of higher education organisations, and to assess the relationship between them.Methodology and research methods. The current paper presents a system analysis of databases of rating systems and an aggregation of independent evaluations of global and national rankings of HEIs using the methodology of league table analysis based on mathematical apparatus of the voting theory. The dependence of global and national university rankings indicators was investigated using correlation, cluster, factor, regression (linear and polynomial) and dispersion methods of analysis.Results and scientific novelty. A comprehensive comparative analysis of ranking systems and their results was carried out. The authors solved the problem of aggregating multiple heterogeneous studies of global and national ranking systems with their qualitative and quantitative variety of criteria, indicators and methods of assessment. The correlation between the indicators of aggregated global and national rankings was revealed; the regression dependence of the integral national ranking with the results of the leading global rating systems was determined.Practical significance. The developed methodical approach is a convenient and effective mechanism for comprehensive monitoring of the members of educational process.

Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial

Background: Greater trochanteric pain syndrome (GTPS) is a debilitating chronic condition, most prevalent in postmenopausal women. A positive association between high estrogen levels and tendon health may exist, and postmenopausal women have reduced estrogen. Menopausal hormone therapy (MHT) may reduce the incidence of tendon abnormality, particularly when combined with exercise. Purpose: To determine the effect of MHT and exercise on tendon pain and function in postmenopausal women with GTPS. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: Postmenopausal women (N = 132; n = 12, lost to follow-up) with GTPS were randomized into MHT and placebo transdermal cream groups combined with tendon-specific or sham exercise. All groups received education about avoiding gluteal tendon compression and load management throughout 12 weeks of intervention. The primary outcome was the Victorian Institute of Sport Assessment for gluteal tendinopathy (VISA-G), and secondary outcomes were measured at baseline and at 12 and 52 weeks. The Global Rating of Change was assessed at 12 and 52 weeks. A linear mixed-effects model was used to assess differences. Body mass index (BMI) was included as a covariate. Results: All participant groups improved over time (baseline vs 12 weeks, P < .001; baseline vs 52 weeks, P < .001). There was no difference among exercise groups measured by all outcomes (VISA-G: baseline, P = .97, mean difference [MD] = 0.10; 12 weeks, P = .49, MD = 2.15; 52 weeks, P = .32, MD = −3.08). There was a significant interaction effect between cream and BMI; therefore, the population was stratified by BMI levels (<25, <30, ≥30). The MHT groups (with exercise and education) had significantly better VISA-G outcomes (baseline, P = .04, MD = −11.20, 95% CI = −21.70 to −0.70; 12 weeks, P < .001, MD = −20.72, 95% CI = −31.22 to −10.22; 52 weeks, P = .002, MD = −16.71, 95% CI = −27.21 to −6.22) and secondary measure scores as compared with placebo at all time points when BMI was <25. Conclusion: MHT or placebo combined with tendon-specific or sham exercise plus education reduced pain and increased function for this population. For women with a BMI <25, MHT with any exercise plus education was better than placebo. A targeted exercise or sham exercise strategy is effective when prescribed with education about avoiding gluteal tendon compression and load management. Registration: ACTRN12614001157662 (Australian New Zealand Clinical Trials Registry).

Updated Global Rating Scale standards for 2021

The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) are pleased to launch an updated version of the Global Rating Scale standards

A pilot study on the validity and psychometric properties of the electronic EQ-5D-5L in routine clinical practice

Background Electronic measurement of health-related quality of life (HRQOL) may facilitate timely and regular assessments in routine clinical practice. This study evaluated the validity and psychometric properties of an electronic version of the EQ-5D-5L (e-EQ-5D-5L) in Chinese patients with chronic knee and/or back problems. Methods 151 Chinese subjects completed an electronic version of the Chinese (Hong Kong) EQ-5D-5L when they attended a primary care or orthopedics specialist out-patient clinic in Hong Kong. They also completed the Chinese Western Ontario and McMaster University Osteoarthritis Index (WOMAC), a Pain Rating Scale, and a structured questionnaire on socio-demographics, co-morbidities and health service utilization. 32 subjects repeated the e-EQ-5D-5L two weeks after the baseline. 102 subjects completed e-EQ-5D-5L and 99 completed the Global Rating on Change Scale at three-month clinic follow up. Construct validity was assessed by the association of EQ-5D-5L scores with external criterion of WOMAC scores. We tested mean differences of WOMAC scores between adjacent response levels of the EQ-5D-5L dimensions by one-way ANOVA, test–retest reliability by intra-class correlation, sensitivity by known group comparisons and responsiveness by changes in EQ-5D-5L scores over 3 months. Results There was an association between EQ-5D-5L and WOMAC scores. Mean WOMAC scores increased with the increase in adjacent response levels of EQ-5D-5L dimensions. Test–retest intraclass correlation coefficient (ICC) of EQ-5D-5L utility and EQ-VAS scores were 0.76 and 0.83, respectively, indicating good reliability. There were significant differences in the proportions reporting limitations in the EQ-5D-5L dimensions, the utility and VAS scores between the mild and severe pain groups (utility = 0.28, p = 0.001; VAS = 11.46, p < 0.001), and between primary care and specialist out-patient clinic patients (utility = 0.15, p = 0.001; VAS = 10.21, p < 0.001), supporting sensitivity. Among those reporting ‘better’ global health at three-months, their EQ-5D-5L utility and EQ-VAS scores were significantly increased from baseline (utility = 0.18, p < 0.001; VAS = 10.75, p = 0.005). Conclusions The electronic version of the EQ-5D-5L is valid, reliable, sensitive and responsive in the measurement of HRQOL in Chinese patients with chronic knee or back pain in routine clinical practice.

Impact of COVID-19 on mobility and participation of older adults living in Hamilton, Ontario, Canada: a multimethod cohort design protocol

IntroductionThe novel COVID-19 required many countries to impose public health measures that likely impacted the participation and mobility of community-dwelling older adults. This protocol details a multimethod cohort design undertaken to describe short-term and medium-term changes to the mobility and participation of older Canadians living in the community rather than retirement facilities during the COVID-19 pandemic.Methods and analysisA longitudinal telephone (or online)-administered survey is being conducted with a random sample of older adults living within 20 km of McMaster University, Hamilton, Ontario, Canada, identified from census dissemination areas. Baseline data collection of community-dwelling older adults aged 65 years and over began in May 2020 with follow-ups at 3, 6, 9 and 12 months. The Late-Life Function and Disability Instrument and global rating of change anchors are the primary outcomes of interest. A subsample of respondents will participate in open-ended, semistructured interviews conducted over the telephone or through video-conference, to explore participants’ lived experiences with respect to their mobility and participation during the pandemic. Descriptive statistics and quantitative approaches will be used to determine changes in mobility and social and personal participation, and associated personal and environmental factors. For the interviews, qualitative data will be analysed using descriptive phenomenology.Ethics and disseminationApproval was obtained from the Hamilton Integrated Research Ethics Board of McMaster University (2020-10814-GRA). This study may inform the design of programmes that can support community-dwelling older adults during and after the COVID-19 pandemic. Findings will be disseminated through peer-reviewed publications and conferences focused on ageing.

Assessment of Tug of War pullers competition intensity and physiological response at the 2019 European Championship

Tug of war (TOW) involves 2 teams of eight people, pulling against each other on a rope. The main goal of TOW is to pull the opposing team towards a centre line over a distance of 4 m. The measurement of physiological parameters is key to understanding the demands of an activity and to identifying its limiting performance factors. The main aim of this study was to evaluate the intensity and effort demands of TOW pullers during competition, as follows: Data were collected from 7 male pullers (Height: 175.14±4.85; Body Mass: 77.39±3.92; Age: 39.86±11.68; %Fat: 17.56±5.21; VO2max: 44.24±8.38) in the 560 kg category. The blood lactate concentrations (LAC) were assessed before and at the end of each pull, and the global rating of perceived exertion (RPE) at the end of the pulls. The following week, pullers performed a graded exercise test (GXT). Heart rate, LAC and RPE were assessed before, during and at the end of the GXT to calculate the individual anaerobic threshold. The mean blood lactate concentrations recorded at the end of the pulls (6±1.9 mmol/l) were 32% higher than the mean values recorded for the individual anaerobic threshold intensity (4.1±0.5 mmol/l). For their part, the mean RPE values of athletes after the pulls (6±1.5 mmol/l) were 21% lower than those obtained for intensity of the individual anaerobic threshold (7.6±0.8 mmol/l). The intensity and effort response are greater and kept above the anaerobic threshold during the competition in TOW pullers. Resumen. Tug of war (TOW) involucra a 2 equipos de ocho personas, tirando una contra la otra con una cuerda. El objetivo principal es llevar al equipo contrario hacia una línea central a una distancia de 4 m. La medición de parámetros fisiológicos es clave para comprender las demandas de una actividad y para identificar sus factores limitantes de rendimiento. El objetivo principal de este estudio fue evaluar la intensidad y las demandas de esfuerzo de los tiradores de TOW durante la competición. 7 tiradores masculinos (altura: 175,14 ± 4,85; masa corporal: 77,39 ± 3,92; edad: 39,86 ± 11,68; % de grasa: 17,56 ± 5,21; VO2max: 44,24 ± 8,38) en la categoría de 560 kg. Se evaluaron concentraciones de lactato (LAC) antes y después de cada tirada, y el esfuerzo percibido (RPE) al final. La siguiente semana, los tiradores realizaron una prueba de esfuerzo (GXT). La FC, LAC y RPE se evaluaron antes, durante y después del GXT para calcular el umbral anaeróbico individual. Las concentraciones de LAC registradas medios registrados para la intensidad del umbral anaeróbico individual (VT2) (4,1 ± 0,5 mmol/l). Los valores medios de RPE de los deportistas en competición (6 ± 1,5 mmol/l) fueron un 21% inferiores a los obtenidos para la intensidad del VT2 (7,6 ± 0,8 mmol/l). La intensidad y la respuesta al esfuerzo son mayores y se mantienen por encima del VT2 durante la competición en tiradores TOW al final de los tirones (6 ± 1,9 mmol/l) fueron un 32% más altas que los valores.

Translation, Reliability Assessment, and Validation of the Persian Version of MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (20-Item MRPS)

Introduction: This study aimed to evaluate the reliability and validity of the Persian version of the 20-item version of the MedRisk. Materials and Methods: In our study, we used a cross-sectional and prospective validation study design. This research was a test development study involving 297 outpatients with musculoskeletal disorders from the physiotherapy centers in Kerman City, Iran, in 2017. All patients completed the MedRisk instrument for measuring patient satisfaction with physical therapy care. Participants also answered a demographic questionnaire, visual analog score, and global rating of change. Internal consistency and reproducibility were investigated, too. To determine test-retest reliability, 40 randomly selected patients completed the MedRisk instrument again 5-7 days after their treatment. Factor analysis, divergent validity, convergent validity, and the floor and ceiling effects were tested, too. The Ethics Committee of the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, reviewed and approved this research project. The SPSS software-24 was used for statistical analysis. Results: Dimension of MedRisk demonstrated a high internal consistency (the Cronbach alpha=0.82). Reproducibility was also satisfactory (intraclass correlation coefficient=0.76). The standard error of measurement, minimal detectable changes, and coefficients of variation indices were respectively 0.63, 1.76, and 0.13 for the total score. In factor analysis, the 4-factor solution has emerged. The external validity testing revealed that the MedRisk instrument score correlated negatively with the visual analog scale (r=-0.18, P=0.002) and global rating of change (r=-0.19, P=0.001). Eighteen individual items of MedRisk were positively correlated with global satisfaction. The results showed that items 5 and 7 had a floor effect, and all other items except items 4, 5, and 7 had a ceiling effect. Conclusion: The Persian version of the MedRisk instrument is a valid and reliable instrument for measuring patient satisfaction with physical therapy and can be used in a clinical setting.