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Meaningful Change (meaningful + change)
Selected AbstractsMeaningful Change and Responsiveness in Common Physical Performance Measures in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2006Subashan Perera PhD OBJECTIVES: To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness. DESIGN: Secondary data analyses using distribution- and anchor-based methods to determine meaningful change. SETTING: Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors. PARTICIPANTS: Older adults with mobility disabilities in a strength training trial (n=100), subacute stroke survivors in an intervention trial (n=100), and a prospective cohort of community-dwelling older people (n=492). MEASUREMENTS: Gait speed, Short Physical Performance Battery (SPPB), 6-minute-walk distance (6MWD), and self-reported mobility. RESULTS: Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed, 0.27 to 0.55 points for SPPB, and 19 to 22 m for 6MWD. Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed, 0.99 to 1.34 points for SPPB, and 47 to 49 m for 6MWD. Based on responsiveness indices, per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change. CONCLUSION: Best initial estimates of small meaningful change are near 0.05 m/s for gait speed, 0.5 points for SPPB, and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed, 1.0 point for SPPB, and 50 m for 6MWD. For clinical use, substantial change in these measures and small change in gait speed and 6MWD, but not SPPB, are detectable. For research use, these measures yield feasible sample sizes for detecting meaningful change. [source] A survival analysis of clinically significant change in outpatient psychotherapyJOURNAL OF CLINICAL PSYCHOLOGY, Issue 7 2001Edward M. Anderson The number of sessions required to produce meaningful change has not been assessed adequately, in spite of its relevance to current clinical practice. Seventy-five clients attending outpatient therapy at a university-affiliated clinic were tracked on a weekly basis using the Outcome Questionnaire (Lambert et al., 1996) in order to determine the number of sessions required to attain clinically significant change (CS). Survival analysis indicated that the median time required to attain CS was 11 sessions. When current data were combined with those from an earlier investigation (Kadera, Lambert, and Andrews, 1996), it was found that clients with higher levels of distress took 8 more sessions to reach a 50% CS recovery level than clients entering with lower levels of distress. At a six-month follow-up, CS gains appeared to have been maintained. Other indices of change also were examined (reliable change, average change per session). The implications of these results for allocating mental-health benefits, such as the number of sessions provided through insurance, are discussed. © 2001 John Wiley & Sons, Inc. J Clin Psychol 57: 875,888, 2001. [source] How Design Experiments Can Inform Teaching and Learning: Teacher-Researchers as Collaborators in Educational ResearchLEARNING DISABILITIES RESEARCH & PRACTICE, Issue 4 2005Asha K. Jitendra In this commentary, I summarize my own research with colleagues to affirm Dr. Gersten's call for considering design experiments prior to conducting intervention research. I describe how design experiments not only can inform teaching and the learning of innovative approaches, but also hold the promise of effectively bridging the research-to-practice gap to produce meaningful change in practice when innovative practices are fine-tuned and validated by partnerships with teacher-researchers. [source] The Politics of Obesity: A Current Assessment and Look AheadTHE MILBANK QUARTERLY, Issue 1 2009ROGAN KERSH Context: The continuing rise in obesity rates across the United States has proved impervious to clinical treatment or public health exhortation, necessitating policy responses. Nearly a decade's worth of political debates may be hardening into an obesity issue regime, comprising established sets of cognitive frames, stakeholders, and policy options. Methods: This article is a survey of reports on recently published studies. Findings: Much of the political discussion regarding obesity is centered on two "frames," personal-responsibility and environmental, yielding very different sets of policy responses. While policy efforts at the federal level have resulted in little action to date, state and/or local solutions such as calorie menu labeling and the expansion of regulations to reduce unhealthy foods at school may have more impact. Conclusions: Obesity politics is evolving toward a relatively stable state of equilibrium, which could make comprehensive reforms to limit rising obesity rates less feasible. Therefore, to achieve meaningful change, rapid-response research identifying a set of promising reforms, combined with concerted lobbying action, will be necessary. [source] Longitudinal validity and responsiveness of the Food Allergy Quality of Life Questionnaire , Parent Form in children 0,12 years following positive and negative food challengesCLINICAL & EXPERIMENTAL ALLERGY, Issue 3 2010A. DunnGalvin Summary Background There are no published studies of longitudinal health-related quality of life (HRQL) assessments of food-allergic children using a disease-specific measure. Objective This study assessed the longitudinal measurement properties of the Food Allergy Quality of Life Questionnaire , Parent Form (FAQLQ-PF) in a sample of children undergoing food challenge. Methods Parents of children 0,12 years completed the FAQLQ-PF and the Food Allergy Independent Measure (FAIM) pre-challenge and at 2 and 6 months post food challenge. In order to evaluate longitudinal validity, differences between Group A (positive challenge) and Group B (negative challenge) were expected over time. We computed correlation coefficients between change scores in the FAQLQ-PF and change scores in the FAIM. To determine the minimally important difference (MID), we used distributional criterion and effect size approaches. A logistic regression model profiled those children falling below this point. Results Eighty-two children underwent a challenge (42 positive; 40 negative). Domains and total score improved significantly at pos-challenge time-points for both groups (all P<0.05). Sensitivity was demonstrated by significant differences between positive and negative groups at 6 months [F(2, 59)=6.221, P<0.003] and by differing improvement on relevant subscales (P<0.05). MID was 0.45 on a seven-point response scale. Poorer quality of life at baseline increased the odds by over 2.0 of no improvement in HRQL scores 6-month time-point. General maternal health (OR 1.252), number of foods avoided (OR 1.369) and children >9 years (OR 1.173) were also predictors. The model correctly identified 84% of cases below MID. Conclusion The FAQLQ-PF is sensitive to change, and has excellent longitudinal reliability and validity in a food-allergic patient population. The standard error of measurement value of 0.5 points as a threshold for meaningful change in HRQL questionnaires was confirmed. The FAQLQ-PF may be used to identify problems in children, to assess the effectiveness of clinical trials or interventions, and to guide the development of regulatory policies. Cite this as: A. DunnGalvin, C. Cullinane, D. A. Daly, B. M. J. Flokstra-de Blok, A. E. J. Dubois and J. O'B. Hourihane, Clinical & Experimental Allergy, 2010 (40) 476,485. [source] Long-Term Tolerability of Sumatriptan Nasal Spray in Adolescent Patients With MigraineHEADACHE, Issue 10 2004Shankar Natarajan MD Objective.,This 1-year, open-label, multicenter study was designed to assess the long-term tolerability and efficacy of sumatriptan nasal spray 20 mg in adolescent patients with migraine. Methods.,A prospective, multicenter, open-label study was conducted in patients aged 12 to 17 years who were allowed to treat an unlimited number of migraines at severe, moderate, or mild pain intensity with sumatriptan nasal spray for up to 1 year. All patients started the study at the 20-mg dose of sumatriptan nasal spray. Dose could be adjusted downward to 5 mg at the discretion of the investigator to optimize therapy. Results.,A total of 484 adolescent migraineurs treated 4676 migraines with sumatriptan nasal spray 20 mg (3593 during the first 6 months and 1083 during the second 6 months). A total of 3940 migraines and 699 migraines were treated with one and two 20-mg doses of sumatriptan nasal spray, respectively. Only 10 patients (treating 42 migraines) took the 5-mg dose of sumatriptan nasal spray. The overall percentage of migraines treated with either one 20-mg dose or one, two, or three 20-mg doses with at least 1 drug-related adverse event was 19%. The most common specific drug-related adverse event was unpleasant taste, reported in 17% of migraines. No other single drug-related adverse event was reported in more than 1% of migraines over the 1-year treatment period. When unpleasant taste was excluded from the adverse-event tabulations, the percentages of migraines with at least 1 drug-related adverse event after one or one, two, or three 20-mg doses declined to 4% and 3%, respectively. No patient experienced any drug-related changes in 12-lead ECGs, vital signs, or nasal assessments; and no clinically meaningful changes in clinical laboratory values were observed. Across all migraines with evaluable efficacy data (n = 4334), headache relief was reported in 43% of migraines at 1 hour and in 59% at 2 hours after dosing with sumatriptan nasal spray 20 mg. Of the 2561 migraines with headache relief 2 hours postdose, headache recurrence was reported within 24 hours of initial dosing in 7% of migraines. None of the efficacy or tolerability results varied as a function of time in the study (ie, first 6 months vs. second 6 months). Conclusion.,Sumatriptan nasal spray 20 mg is generally well tolerated and may be beneficial during long-term use by adolescent migraineurs ages 12 to 17 years. [source] A Culturally Appropriate School Wellness Initiative: Results of a 2-Year Pilot Intervention in 2 Jewish SchoolsJOURNAL OF SCHOOL HEALTH, Issue 8 2010Maureen R. Benjamins PhD BACKGROUND: Despite the growing number of school-based interventions designed to reduce childhood obesity or otherwise promote health, no models or materials were found for Jewish schools. The current study describes an effort within a Jewish school system in Chicago to create, implement, and evaluate a school-based intervention tailored to the unique characteristics of Jewish religion, culture, and school structures. METHODS: Two schools (with approximately 600 students) were selected for the 2-year pilot study. The schools were required to form a wellness council, write a wellness policy, and implement policy changes or activities in 5 target areas (health education, physical education, school environment, family involvement, and staff wellness). Objectives were measured using pre- and postintervention surveys for students, as well as the School Health Index and other tools. RESULTS: Findings showed several significant increases in student knowledge, as well as an increase in the percentage of older students regularly meeting physical activity guidelines. Few changes in attitudes, other behaviors, or environmental factors were seen. CONCLUSIONS: Due to a strong partnership between researchers, schools, and community organizations, meaningful changes were made within the pilot schools. These changes were reflected in a limited number of improvements in student knowledge and activity levels. Future work is needed to determine how to bring about behavioral changes, how to increase the sustainability of all of the changes, and how to disseminate the model and products of this intervention to other day schools. [source] Non-invasive cryolipolysisÔ for subcutaneous fat reduction does not affect serum lipid levels or liver function tests,LASERS IN SURGERY AND MEDICINE, Issue 10 2009Kenneth B. Klein MD Abstract Background and Objective Cryolipolysis provides a method of non-invasive fat reduction that significantly reduces subcutaneous fat without injury to adjacent tissues. Preliminary animal and human data have suggested that cryolipolysis has no effect on serum lipid profiles or liver tests. This study was intended to more fully document any effect of this procedure on lipid and liver-related blood tests. Study Design/Materials and Methods Forty subjects with fat bulges on their flanks ("love handles") were treated bilaterally with a non-invasive device (Zeltiq Aesthetics, Pleasanton, CA) that precisely cools tissue to achieve a reduction in the fat layer. Serum lipid levels and liver tests were measured prior to treatment, and at 1 day and 1, 4, 8, and 12 weeks post-treatment. Results No meaningful changes in mean values were observed for any blood lipid level or liver test at any point over the 12-week follow-up period. Conclusion Cryolipolysis, when used for reduction of subcutaneous flank fat, is not associated with changes in serum lipids or liver test results. Lasers Surg. Med. 41:785,790, 2009. © 2009 Wiley-Liss, Inc. [source] Changes in Work Motivation During Transition: A Case from SloveniaAPPLIED PSYCHOLOGY, Issue 4 2000Edvard Konrad A longitudinal study of work motivation based on the VIE model was conducted in a Slovenian iron and steel organisation in five-year intervals from 1979 to 1994. During this period we can observe some changes in the importance of values and changes in the perceptions of the work environment. Results were interpreted as context-specific reflections of the macrosocietal changes that have occurred during the transition in Eastern and Central Europe. The results also indicate that meaningful changes in organizational culture and climate occurred long before the actual political and economic change happened. Limitations related to the nature of the research design and to the cross-level nature of transitional changes are discussed. Une e´tude longitudinale de la motivation au travail exploitant le modèle VIE a e´te´ poursuivie dans la side´rurgie slovène sur des intervalles de cinq ans de 1979 à 1994. Certains chagements ont pu être observe´s sur cette pe´riode dans l'importance des valeurs et dans les perceptions de l'environnement de travail. Les re´sultats ont e´te´ intepre´te´s comme des retombe´es des changements globaux qui intervinrent en Europe centrale et de l'Est; ils montrent aussi que des e´volutions majeures dans la culture et le climat organisationnels e´taient apparues bien avant l'avènement de la mutation politique et e´conomique. On souligne enfin les limites dues au plan de recherche et à la nature complexe des changements. [source] | |||||||||||||