137 research outputs found
Mindfulness-based and acceptance-based interventions and physical activity in the management of fibromyalgia - evaluation of a multicomponent rehabilitation programme
No full textBackground: Fibromyalgia (FM) is a heterogeneous and complex musculoskeletal pain disorder characterised by multiple symptoms. The often unpredictable remission and recurrence of FM symptoms further impair social and physical function and reduce overall quality of life. No curative treatment is available for FM, and pharmacological treatment is inadequate. In Norway, treatment is usually limited to general practitioner (GP) consultations and physiotherapy. Traditionally, health care services have been based on a biomedical approach focusing on pathogenesis, diagnosis, and treatment of diseases. This approach is less likely to benefit patients with FM who have complex symptoms and no effective treatments to access. This condition calls for a broader perspective on health and more holistic management approaches. For optimal management, the European League Against Rheumatism (EULAR) has developed evidence-based recommendations including prompt diagnosis and patient education as first-line treatment. Furthermore, nonpharmacological treatment, such as physical exercise and psychological interventions, should be initiated with the aim of improving patient quality of life. According to Norwegian health authorities, FM treatment is to be provided at the primary care level. However, the treatment modalities described in the EULAR recommendations are available in Norwegian primary health care only to a limited degree.
Aims: The main aim of this thesis was to evaluate the effects of a multicomponent rehabilitation programme combining two nonpharmacological treatment modalities for patients with newly diagnosed FM delivered in primary health care. The specific objectives were 1) to analyse the health effects of mindfulness- and acceptance-based interventions for patients with FM, with an exploration of the content and delivery components in the interventions; 2) to design and implement a randomised controlled trial and to evaluate health effects of a Norwegian mindfulness- and acceptance-based intervention followed by physical activity; and 3) to identify groups of patients with different symptom severity trajectories and to explore differences in baseline characteristics among these groups.
Materials and methods: This thesis comprises a systematic review with meta-analyses, a randomised controlled trial (RCT), and an observational exploratory study. The systematic review included RCTs investigating the effects of mindfulness- and acceptance-based interventions for patients with FM. Furthermore, the Template for Intervention Description and Replication checklist was used to specifically extract, describe, and explore the reported content and delivery components in each study’s intervention. In the RCT, eligible patients were invited to a 3-hour FM patient education programme before randomisation. A multicomponent programme, including a 10-session mindfulness- and acceptance-based group programme followed by 12 weeks of physical activity, was evaluated in comparison to a control group that received treatment as usual, i.e., no treatment or any other treatment of their choice. We collected data using patient-reported questionnaires, with the Patient Global Impression of Change (PGIC) as the primary outcome measure. Secondary outcomes evaluated at the 12-month follow-up were pain, fatigue, sleep quality, psychological distress, physical activity, health-related quality of life, motivation for and barriers to physical activity, mindfulness, and work ability. In the observational exploratory study, to identify groups of patients with different symptom severity trajectories, we evaluated Polysymptomatic Distress Scale (PDS) scores using latent class growth analysis. The study participants were those included in the RCT. We also explored differences in baseline characteristics between groups with different trajectories.
Results: The systematic review included nine RCTs and 750 patients with FM. The metaanalyses, giving standardised mean differences (SMDs) with 95% confidence intervals (CIs), showed small to moderate effects in favour of mindfulness- and acceptance-based interventions at the end of treatment for pain (SMD -0.46 [95% CI -0.75, -0.17]), depression (SMD -0.49 [95% CI -0.85, -0.12]), anxiety (SMD -0.37 [95% CI -0.71, -0.02]), sleep quality (SMD -0.33 [95% CI -0.70, 0.04]), health-related quality of life (SMD -0.74 [95% CI -2.02, 0.54]), and mindfulness (SMD -0.40 [95% CI -0.69, -0.11]). At follow-up, all effect sizes decreased except for anxiety, for which there was a small increase in effect size. We graded the certainty of evidence as very low to moderate. The included studies reported and assessed adherence and fidelity differently. In the RCT, 170 patients were randomised, 85 to the intervention group and 85 to the control group. Our main analysis was the dichotomised PGIC, and we found no statistically significant differences between the intervention and control groups at the 3- and 12-month follow-ups. Additional analyses of the distribution of PGIC showed statistically significant differences between groups in favour of the intervention group at the 3-month follow-up (p=0.01) but not at the 12-month follow-up (p=0.06). For secondary outcomes, we found no statistically significant differences between the groups at the 12-month follow-up, except for a tendency to be mindful (p=0.016) and perception of the benefits of exercise (p=0.033) in favour of the intervention group. We intended to capture patients with FM at an early stage of their disease, but the included patients reported a median symptom duration of 8 years. In the observational study, we identified two distinct groups of PDS trajectories: one group defined by having no improvement and another defined by having some improvement. The analyses showed no statistically significant differences in baseline characteristics between these two groups.
Conclusion: In the systematic review, we found overall small to moderate uncertain effects of mindfulness- and acceptance-based interventions for patients with FM. The RCT demonstrated no enhanced benefit over treatment as usual with the addition of a multicomponent rehabilitation programme that added a mindfulness- and acceptance-based intervention followed by physical activity to patient education. In the observational exploratory study, analyses identified two groups of FM trajectories, one group that improved slightly and one group that experienced no improvements, but the two groups did not differ in baseline characteristics
Employees’ experience after completing a vitality training program: An acceptance-based cognitive behavioral groupintervention
No full textExploring Player Engagement in Social and Pervasive Learning Games
No full textPervasive gaming is a genre of gaming that integrates with the physical and social aspects of the real world and blends into the player’s everyday life. The context of this thesis is the use of long-lasting pervasive games to facilitate learning. However, for students to achieve the intended learning outcome from pervasive learning games, they need to participate. Hence, player motivation and engagement are critical success factors and the strategies and mechanisms that can be implemented for this purpose is the focus for this thesis.
Extrinsic and intrinsic motivation and player enjoyment is the theoretical foundation for the research presented here. Different methods and techniques to increase player engagement have been explored and evaluated, including features to support “in-game” awareness.
The research presented is conducted on three primary artifacts. One artifact was a commercial web-based smokers’ cessation program designed as a 50-day real-time pervasive learning game. The two other artifacts were Pervasive Learning Games designed and developed as a part of this research project. Both these games were 100% designed, developed and game mastered by the author of this thesis. The game “Nuclear Mayhem” was in addition programmed by the author while the programming of the second game “HiNTHunt” was outsourced and done by a third party. A Design Science research method was applied to investigate how storytelling, real-life locations, real-life events, awareness enhancing, social game play, as well as other types of game play and game design, can be implemented in long lasting learning games to motivate and improve player participation.
Results from this research project have been presented to the research community in six scientific papers, all published in renowned international conferences and journals according to the Norsk Publiseringsindikator (NPI) listing published by the Norwegian Centre for Research Data.
Main contribution presented in these six papers are strategies and solutions demonstrated in the artifacts designed, developed, and instantiated as a part of this research project and expanded knowledge about how to increase player engagement in long-lasting pervasive learning.
We learned that using pervasive learning games could expand the area for learning into the student’s everyday life and enable learning to be anytime and anywhere. Furthermore, we discovered that a dynamic game story that incorporates real life events that unfolds in the duration of the game as a part of the game story, created more awareness about the game and proved to be a valuable technique to create increased player engagement. This resulted in the development of the Dynamic Pervasive Storytelling model.
Different iterations of the artifact HiNT Hunt provided information about the importance of a game story to engage players as early as possible and increase overall player engagement. Iterations of artifact HiNT Hunt also provided learning that led to the development of The-Last-Shall-Be-The-First Dynamic Bonus System, a method to activate passive players to get them more engaged in the game.
Case study of the commercial web-based freeFromNicotine course, which provides a game-based approach to smoking cessation led to the principle of core assignments and individual assignments, a successful method to ensure that all users could participate in the overall competition on equal terms while still have a unique tailored personal course program to follow.
The work presented in this thesis provides unique insight into strategies and methods for player engagement in pervasive games. This is relevant knowledge when designing and developing pervasive games to increase player engagement and the solutions that have been develop can be reused, as well as provide a good foundation for further research on the topic
Coner: A Collaborative Approach for Long-Tail Named Entity Recognition in Scientific Publications
No full textNamed Entity Recognition (NER) for rare long-tail entities as e.g., often found in domain-specific scientific publications is a challenging task, as typically the extensive training data and test data for fine-tuning NER algorithms is lacking. Recent approaches presented promising solutions relying on training NER algorithms in an iterative weakly-supervised fashion, thus limiting human interaction to only providing a small set of seed terms. Such approaches heavily rely on heuristics in order to cope with the limited training data size. As these heuristics are prone to failure, the overall achievable performance is limited. In this paper, we therefore introduce a collaborative approach which incrementally incorporates human feedback on the relevance of extracted entities into the training cycle of such iterative NER algorithms. This approach, called Coner, allows to still train new domain specific rare long-tail NER extractors with low costs, but with ever increasing performance while the algorithm is actively used in an application.Web Information System
Mindfulness- and acceptance-based interventions for patients with fibromyalgia - A systematic review and meta-analyses.
No full textObjectives To analyze health effects of mindfulness- and acceptance-based interventions, including mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT). Additionally, we aimed to explore content and delivery components in terms of procedure, instructors, mode, length, fidelity and adherence in the included interventions. Methods We performed a systematic literature search in the databases MEDLINE, PsychINFO, CINAHL, EMBASE, Cochrane Central and AMED from 1990 to January 2019. We included randomized and quasi-randomized controlled trials analyzing health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia compared to no intervention, wait-list control, treatment as usual, or active interventions. MBSR combined with other treatments were included. Predefined outcomes were pain, fatigue, sleep quality, psychological distress, depression, anxiety, mindfulness, health-related quality of life and work ability. The Template for Intervention Description and Replication (TIDieR) checklist and guide was used to explore content and delivery components in the interventions. Meta-analyses were performed, and GRADE was used to assess the certainty in the evidence. Results The search identified 4430 records, of which nine original trials were included. The vast majority of the participants were women. The analyses showed small to moderate effects in favor of mindfulness- and acceptance-based interventions compared to controls in pain (SMD -0.46 [95% CI -0.75, -0.17]), depression (SMD -0.49 [95% CI -0.85, -0.12]), anxiety (SMD -0.37 [95% CI -0.71, -0.02]), mindfulness (SMD -0.40 [-0.69, -0.11]), sleep quality (SMD -0.33 [-0.70, 0.04]) and health-related quality of life (SMD -0.74 [95% CI -2.02, 0.54]) at end of treatment. The effects are uncertain due to individual study limitations, inconsistent results and imprecision. Conclusion Health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia are promising but uncertain. Future trials should consider investigating whether strategies to improve adherence and fidelity of mindfulness- and acceptance-based interventions can improve health outcomes
Effects of a mindfulness-based and acceptance-based group programme followed by physical activity for patients with fibromyalgia: a randomised controlled trial
No full textIntroduction: Non-pharmacological approaches are recommended as first-line treatment for patients with fibromyalgia. This randomised controlled trial investigated the effects of a multicomponent rehabilitation programme for patients with recently diagnosed fibromyalgia in primary and secondary healthcare.
Methods: Patients with widespread pain ≥3 months were referred to rheumatologists for diagnostic clarification and assessment of study eligibility. Inclusion criteria were age 20–50 years, engaged in work or studies at present or during the past 2 years, and fibromyalgia diagnosed according to the American College of Rheumatology 2010 criteria. All eligible patients participated in a short patient education programme before inclusion and randomisation. The multicomponent programme, a 10-session mindfulness-based and acceptance-based group programme followed by 12 weeks of physical activity counselling was evaluated in comparison with treatment as usual, that is, no treatment or any other treatment of their choice. The primary outcome was the Patient Global Impression of Change (PGIC). Secondary outcomes were self-reported pain, fatigue, sleep quality, psychological distress, physical activity, health-related quality of life and work ability at 12-month follow-up.
Results: In total, 170 patients were randomised, 1:1, intervention:control. Overall, the multicomponent rehabilitation programme was not more effective than treatment as usual; 13% in the intervention group and 8% in the control group reported clinically relevant improvement in PGIC (p=0.28). No statistically significant between-group differences were found in any diseaserelated secondary outcomes. There were significant between-group differences in patient’s tendency to be mindful (p=0.016) and perceived benefits of exercise (p=0.033) in favour of the intervention group.
Conclusions: A multicomponent rehabilitation programme combining patient education with a mindfulness-based and acceptance-based group programme followed by physical activity counselling was not more effective than patient education and treatment as usual for patients with recently diagnosed fibromyalgia at 12-month follow-u
A Domain Meta-wrapper Using Seeds for Intelligent Author List Extraction in the Domain of Scholarly Articles
No full textIn this paper we investigate about automated extraction of author lists in the domain of scientific digital libraries. It is given a list of known “seed” authors and we aim to extract complete lists of co-authors from Web pages in arbitrary format. We adopt a methodology embedding domain knowledge in a unique “meta-wrapper”, not requiring training, with negligible maintenance costs and based on the combination of several extraction techniques. Such methods are applied at the structural level, at the character level and at the annotation level. We describe the methodology, illustrate our tool, compare with known approaches and measure the accuracy of our techniques with proper experiments
Archives and Technological Selection
No full textThe archive is not a place for the undifferentiated storage of the past: the political role of the archive is to select what to include as the past and what to discard, in order to regulate the future. These selections are prescribed by laws and regulations, but they are also determined by the archival techniques available for inscription, storage, indexing and access. The author analyses the technological selections of two ages of the archive. The first age is that of the intermedial archive emerging after the end of the text archive monopoly, with the gramophone, photograph and, in particular, film. The gaps and contradictions resulting from this configuration of media are investigated through a discussion of the media set-up of Albert Kahn’s Les archives de la planète (1908-1931). The second age is that of the digital archives, and the digitization of analogue material, again with Les archives de la planète as an example. Instead of understanding these ages of archival technologies as autonomous and separate, the author argues that they should be approached as “superimposed” archival regimes in order to tease out the current interrelations between analogue and digital archives.Une archive n’est pas un endroit où l’on stocke indifféremment les traces du passé. Le rôle politique de l’archive est de sélectionner ce qui doit participer du passé et ce qui doit être mis de côté, de manière à réguler le futur. Ce processus de sélection repose sur des lois et des régulations, mais il est également prescrit par les techniques d’archivage disponibles, tant pour l’inscription, l’entreposage, l’indexation et l’accès. L’auteur de cet article analyse les sélections technologiques à deux époques distinctes de l’archive. La première est celle de l’archive intermédiale, qui émerge après le monopole de l’archive textuelle, avec l’arrivée du gramophone, de la photographie et, surtout, du cinéma. Les lacunes et les contradictions qui résultent de cette nouvelle configuration médiatique sont investiguées à la lumière des propos d’Albert Kahn dans Les archives de la planète (1908-1931). Les archives numériques et la numérisation du matériel analogique constituent la seconde époque analysée, de nouveau avec Les archives de la planète comme exemple. Plutôt que d’essayer de comprendre ces différentes technologies archivistiques comme appartenant à des périodes autonomes et séparées, l’auteur propose de les appréhender comme des régimes archivistiques « superposés », dans le but d’éclairer les relations entre les archives analogiques et numériques
To graver med hest og hesteutstyr fra Tu : maktpolitiske forhold på Sørvestlandet i yngre jernalder
No full textThis article discusses political changes in Southwest Norway in the 8th and 9th centuries. It is suggested that two male graves
from this period, found at Tu in Klepp, Rogaland, and containing horse and horse equipment, are related to political changes. The
author suggests that graves with horses and horse equipment belong to persons and families with significant roles in the political
development of the time
Trajectories of change in symptom severity in patients with fibromyalgia: exploratory analyses of a randomised controlled trial
No full textpublishedVersio
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