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Autologous chondrocyte implantation (ACI) is a cell based therapy for the treatment of articular cartilage defects. Numerous studies have reported outcomes following ACI using a variety of patient reported outcomes (PROs), but no clear recommendations exist regarding which PRO is the most responsive to changes following ACI. Few studies have documented changes in performance based assessments (PBAs) following ACI. Response shift theory proposes that residual changes in self-report measures occur over time. Failing to account for response shift may result in over or under reporting of outcomes from which clinical decisions are made. The purposes of this dissertation were 1) review the literature concerning ACI outcomes to determine the responsiveness of PROs to changes in self-reported function following ACI, 2) evaluate the reliability of PBAs among ACI patients, 3) develop a descriptive timeline for the return of function 1 year following ACI using both PROs and PBAs, and 4) utilize PROs and PBAs to evaluate patients undergoing ACI for evidence of response shift. All PRO and PBA measures were collected preoperatively and 3, 6, and 12 months postoperatively. A retrospective then-test PRO evaluation of function prior to surgery was completed at 6 and 12 months. Response shift was calculated by subtracting the original pre-test score from the then-test score. A systematic review and meta-analyses of existing ACI outcome studies resulted in the recommendation of the International Knee Documentation Committee Subjective Knee Form (IKDC) and Lysholm Knee Scale as highly responsive PROs among ACI patients of varying activity levels. Despite significant increases in PRO scores as early as 6 months following ACI, improvement in PBAs at 12 months following ACI were limited to stride length, walking speed, and step-up force. Finally, no evidence of a group level effect for response shift was observed. These results support the validity of traditional pre-test/post-test research designs with no need to account for response shift when evaluating treatment effects of ACI on the group level. However, the Western Ontario and McMasters University Osteoarthritis Index (WOMAC) did show evidence of a measurable response shift on a patient by patient basis.

Introduction: Despite Colombia having adopted a health system based on an insurance market, Bogota in 2004, as part of a left-wing government (elected for first time in the city), decided to implement a Primary Health Care (PHC) strategy to improve quality of life, level of population health and reduce health inequities. The PHC strategy has been implemented through the HomeHealth program by three consecutive governments over the last eight years in the context of continuous political tension stemming from differences between national and district health policies. This thesis is an attempt to provide a better understanding of the overall experience of implementing a PHC strategy in the context of a market-oriented health care system. The research aimed to evaluate results of the PHC strategy through the intervention of the Home Health program and to identify factors that have enabled or limited the on-going PHC implementation process in Bogota. Methods: This study used a combination of quantitative and qualitative methods. A descriptive analysis was performed to assess direct results of the PHC strategy in terms of progress in the Home Health program coverage and increases in health personnel ratios reaching out to poor and vulnerable groups in Bogota. A cross sectional analysis was carried out to evaluate qualities of the delivery of PHC services through the attainment of PHC essential dimensions in the network of first-level public health care facilities. An ecological analysis was performed to estimate the contribution of the PHC strategy, through the Home Health program, to improve child health outcomes and to reduce health inequalities. A qualitative multiple case study was conducted to identify contextual factors that have enabled or limited the on-going PHC implementation process in Bogota. Results: The descriptive analysis showed a notable initial increase and rapid expansion in the development of the PHC strategy between 2004 and 2007, followed by a period of slower growth and stagnation between 2007 and 2010. The cross-sectional analysis suggested that the Home Health program could be helping to improve the performance of first-level public health care facilities. Ratings assigned to PHC dimensions by different participants pointed out the need to strengthen family focus, community orientation, financial resources distribution, and accessibility. The ecological analysis showed that localities with high PHC coverage had a lower risk of under-five mortality, infant mortality and acute malnutrition as well as a higher probability of being vaccinated than low PHC coverage localities. The belonging to a high-coverage locality was significantly associated with risk reductions of under-five mortality (13.8%) and infant mortality by pneumonia (37.5%) as well as increases in the probability of being vaccinated for DPT (4.9%). Concentration curves and concentration indices indicated inequality reductions in all child indicators betwen 2003 and 2007. In 2007 (period after implementation), the PHC strategy was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-five mortality (24%), infant mortality rate (19%), acute malnutrition (7%) and DPT vaccination coverage (20%). The main facilitators of the results achieved so far by the PHC strategy were all related to the commitment and good will of actors at different levels. Longterm political commitment, support by local mayors and hospital managers, organized communities historically active in the process of social participation, as well as extramural work carried out by community health workers and health care teams were highly valued. Barriers to the implementation included the structure of the national health system itself, lack of a stable funding source, unsatisfactory working conditions, lack of competencies among health workers regarding family focus and community orientation, and limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. Conclusion: Despite adverse contextual conditions and limitations imposed by the Colombian health system itself, Bogota’s initiative of a PHC strategy has helped to improve the performance of first-level public health care facilities in the essential dimensions of PHC and has also contributed to improvement of child health outcomes and reduction of health inequalities associated with socioeconomic and living conditions. Significant efforts are required to overcome the market approach of the national health system. Structural changes to social policies at the national and district level are needed if the PHC strategy is expected to achieve its full potential. Specific interventions must be designed to have well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.

Scholarship on the uses of program evaluation in general is extensive, but little specific empirical research has addressed the uses made of teacher program reviews. The purpose of this study was to investigate empirically the factors affecting uses of teacher program review processes and findings in each of four cases, selected from a prior state-wide population survey to include both higher and lower use exemplars. Results indicated that uses of program reviews included both process uses and findings uses and that a number of personal, contextual and other factors influenced the types of use, the recognition of uses that actually occurred, and the amount of use. Sometimes internal formative improvements were reported as taking place and were recognized as benefits but not identified originally as uses of the review processes and findings. This discrepancy occurred because the program staff and higher education administrators focused primarily on accreditation and viewed the successful accreditation outcome as the only use of the review, even when significant program improvements had resulted from the process. Relying primarily on interviews and documentation, the study described in detail three types of process use and three types of findings use. Process use was the most often reported types of use. Human, contextual and procedural factors were important influences on all types of use. Human factors influenced how the review was conducted and used. Context factors determined how the review was completed and how use occurred, either for accreditation or accreditation and program improvement. Procedural factors affected stakeholder involvement and how the administration related to and valued the program review processes and findings.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Objectives: The purpose of this study was to evaluate clinical outcomes based on the American Board of Orthodontics Objective Grading System (ABO-OGS) in a 30-month postgraduate orthodontic residency and to determine what factors affected these treatment outcomes. Methods: Consecutively debonded cases from July 1, 2010 to June 30, 2011 treated by residents in the Orthodontics Department at Nova Southeastern University were graded using the ABO-OGS. The age and sex of the patient, the treatment time, the missed appointments and the number of providers were documented. Discrepancy indices were calculated for each patient. These variables were assessed and their associations with the obtained treatment outcome scores were evaluated. Results: The average OGS score of the debonded cases was 33.87. There was no significant correlation between total OGS score and the demographic or explanatory variables. There were significant correlations found between the discrepancy index (DI) and the treatment time, the number of providers, but not the OGS. Significant correlations were also identified between treatment time and the number of failed appointments and the number of providers. Extraction cases were shown to have a significantly longer treatment time. Out of the eight objective measurements of the OGS, occlusal contacts, marginal ridges, buccolingual inclination and alignment/rotations scored the highest points in our evaluation with an average of 7.81, 6.37, 5.04, and 5.01 respectively. Conclusions: This study indicated the Nova Southeastern University Orthodontic Department average OGS score is about 6 points higher than the ABO clinical exam passing score. The initial complexity of a case was not a pre-determined factor for the final treatment results. This study identified several aspects of treatment outcomes that need improvement including, occlusal contacts, marginal ridges, correcting buccolingual inclination and improving the alignment.

As pesquisas para padronização de instrumentos de avaliação de resultados terapêuticos têm sido produtivas, uma vez que a aproximação entre a pesquisa e a prática clínica permite ao profissional perceber a importância dessa avaliação de processo e de resultados. Com isto, a necessidade dos psicólogos contarem com instrumentos de avaliação, capazes de auxiliá-los nessa tarefa, tem se mostrado cada vez mais essencial. No entanto, a carência de instrumentos válidos para a realidade brasileira impõe limitações a estes profissionais. O Outcome Questionnaire - OQ-45.2 é um dos instrumentos utilizados para avaliar os ganhos obtidos pelo paciente na psicoterapia, com pesquisas realizadas em vários países. Trata-se de uma escala do tipo Likert de cinco pontos, dividida em três subescalas: desconforto subjetivo (SD), relações interpessoais (IR) e desempenho do papel social (SR). Esta pesquisa teve o objetivo de avaliar as propriedades psicométricas da versão em português do OQ-45.2. A amostra foi composta por 419 participantes adultos, subdivididos em dois grupos, um de pacientes (N = 59) e outro de não pacientes (N = 360), sendo 156 homens e 263 mulheres, com idades variando de 18 a 78 anos. O estudo de precisão do OQ-45.2 foi realizado pelo método de teste-reteste, com intervalo de 7 a 14 dias, e o alfa de Cronbach. Para a escala total a precisão pelo reteste foi de 0,895 e para as subescalas variou de 0,756 a 0,883, indicando estabilidade temporal satisfatória. O alfa de Cronbach para a escala total foi de 0,95, semelhante ao do estudo americano (0,93). Os dados de validade foram obtidos pela correlação entre o resultado global e os das subescalas, por meio da comparação entre grupos contrastantes de pacientes e não pacientes e da validade simultânea com a Escala de Avaliação de Sintomas (EAS-40), o Inventário de Depressão de Beck (BDI II) e o Questionário Geral de Saúde (QSG). As correlações das subescalas com a pontuação total e entre as subescalas foram significantes, mas a subescala SR mostrou correlações menores que as outras. Foram obtidas diferenças estatisticamente significantes (p < 0,001) entre as médias dos dois grupos, o que mostra a sensibilidade da escala para avaliação dos pacientes. O resultado do OQ 45.2 se correlacionou significativamente com os três instrumentos utilizados para o estudo de validade, sendo que as correlações com os escores totais dos instrumentos foram: 0,80 com a EAS-40, 0,83 com o BDI-II e 0,88 com o QSG. Também foram calculadas as correlações entre cada item com o escore total do OQ-45.2, tendo sido encontrados quatro itens com correlações menores do que 0,20. Assim os estudos psicométricos indicaram a adequação da escala para o uso no Brasil, embora ainda seja necessária a confirmação de sua estrutura fatorial e de estudos referentes a mudanças obtidas na psicoterapia / Researches for standardization of therapeutic assessment tools have been productive, since the connection between research and clinical practice allows the professional to realize the importance of the assessment process and results. In this way, the psychologists need of available assessment tools, which can assist them in this task, has become ever more essential. However, the lack of valid instruments to the Brazilian reality imposes limitations to these professionals. The Outcome Questionnaire - OQ-45.2 is one of the instruments used to measure the patients progress in psychotherapy and it was studied in several countries. It is a Likert five points scale, divided into three subscales: Symptom Distress (SD), Interpersonal Relationships (IR) and Social-Role performance (SR). The goal of this research was to assess the psychometric properties of the OQ-45-2 Portuguese version. The sample was composed by 419 adult participants, divided in two groups, one group of patients (N = 59) and the other of non-patients (N = 360), 156 men and 263 women, age ranging from 18 to 78 years. The reliability study of the OQ-45.2 was conducted by the test-retest method, using intervals ranging from 7 to 14 days, and by the Cronbach\'s alpha coefficient. The retest reliability for the total score was 0.895 and for the subscales ranged from 0.756 to 0.883, indicating satisfactory temporal stability. The Cronbach\'s alpha for the total scale was 0.95, similar to the American study (0.93). The validity data were obtained by correlations between the total score and the subscales scores; by comparing contrasting groups of patients and non patients and concurrent validity with the Symptom Assessment Scale (EAS-40) Beck Depression Inventory (BDI II) and the General Health Questionnaire (GHQ). Correlations of the subscales with the total score and subscales scores were significant, but the SR subscale showed lower correlations than others. Differences between the means of two groups were significant statistically (p <0.001), which shows the sensitivity of the scale to assess patients. The results of OQ-45.2 correlated significantly with the three tests used in validity study and correlations between the total scores of the tests were 0.80 with the EAS-40, 0.83 with the BDI-II and 0.88 with the GHQ. Correlations total of total score of OQ-45.2 with each item were also calculated and were found four items correlations lower than 0.20. Therefore, the psychometric studies indicated the appropriateness of the scale for use in Brazil, although it is still necessary the confirmation of its factor structure and studies regarding changes obtained in psychotherapy

Thesis (Ph.D.)--Pardee Rand Graduate School, 2007. / Title from title screen (viewed on June 13, 2008). Includes bibliographical references.

As pesquisas para padronização de instrumentos de avaliação de resultados terapêuticos têm sido produtivas, uma vez que a aproximação entre a pesquisa e a prática clínica permite ao profissional perceber a importância dessa avaliação de processo e de resultados. Com isto, a necessidade dos psicólogos contarem com instrumentos de avaliação, capazes de auxiliá-los nessa tarefa, tem se mostrado cada vez mais essencial. No entanto, a carência de instrumentos válidos para a realidade brasileira impõe limitações a estes profissionais. O Outcome Questionnaire - OQ-45.2 é um dos instrumentos utilizados para avaliar os ganhos obtidos pelo paciente na psicoterapia, com pesquisas realizadas em vários países. Trata-se de uma escala do tipo Likert de cinco pontos, dividida em três subescalas: desconforto subjetivo (SD), relações interpessoais (IR) e desempenho do papel social (SR). Esta pesquisa teve o objetivo de avaliar as propriedades psicométricas da versão em português do OQ-45.2. A amostra foi composta por 419 participantes adultos, subdivididos em dois grupos, um de pacientes (N = 59) e outro de não pacientes (N = 360), sendo 156 homens e 263 mulheres, com idades variando de 18 a 78 anos. O estudo de precisão do OQ-45.2 foi realizado pelo método de teste-reteste, com intervalo de 7 a 14 dias, e o alfa de Cronbach. Para a escala total a precisão pelo reteste foi de 0,895 e para as subescalas variou de 0,756 a 0,883, indicando estabilidade temporal satisfatória. O alfa de Cronbach para a escala total foi de 0,95, semelhante ao do estudo americano (0,93). Os dados de validade foram obtidos pela correlação entre o resultado global e os das subescalas, por meio da comparação entre grupos contrastantes de pacientes e não pacientes e da validade simultânea com a Escala de Avaliação de Sintomas (EAS-40), o Inventário de Depressão de Beck (BDI II) e o Questionário Geral de Saúde (QSG). As correlações das subescalas com a pontuação total e entre as subescalas foram significantes, mas a subescala SR mostrou correlações menores que as outras. Foram obtidas diferenças estatisticamente significantes (p < 0,001) entre as médias dos dois grupos, o que mostra a sensibilidade da escala para avaliação dos pacientes. O resultado do OQ 45.2 se correlacionou significativamente com os três instrumentos utilizados para o estudo de validade, sendo que as correlações com os escores totais dos instrumentos foram: 0,80 com a EAS-40, 0,83 com o BDI-II e 0,88 com o QSG. Também foram calculadas as correlações entre cada item com o escore total do OQ-45.2, tendo sido encontrados quatro itens com correlações menores do que 0,20. Assim os estudos psicométricos indicaram a adequação da escala para o uso no Brasil, embora ainda seja necessária a confirmação de sua estrutura fatorial e de estudos referentes a mudanças obtidas na psicoterapia / Researches for standardization of therapeutic assessment tools have been productive, since the connection between research and clinical practice allows the professional to realize the importance of the assessment process and results. In this way, the psychologists need of available assessment tools, which can assist them in this task, has become ever more essential. However, the lack of valid instruments to the Brazilian reality imposes limitations to these professionals. The Outcome Questionnaire - OQ-45.2 is one of the instruments used to measure the patients progress in psychotherapy and it was studied in several countries. It is a Likert five points scale, divided into three subscales: Symptom Distress (SD), Interpersonal Relationships (IR) and Social-Role performance (SR). The goal of this research was to assess the psychometric properties of the OQ-45-2 Portuguese version. The sample was composed by 419 adult participants, divided in two groups, one group of patients (N = 59) and the other of non-patients (N = 360), 156 men and 263 women, age ranging from 18 to 78 years. The reliability study of the OQ-45.2 was conducted by the test-retest method, using intervals ranging from 7 to 14 days, and by the Cronbach\'s alpha coefficient. The retest reliability for the total score was 0.895 and for the subscales ranged from 0.756 to 0.883, indicating satisfactory temporal stability. The Cronbach\'s alpha for the total scale was 0.95, similar to the American study (0.93). The validity data were obtained by correlations between the total score and the subscales scores; by comparing contrasting groups of patients and non patients and concurrent validity with the Symptom Assessment Scale (EAS-40) Beck Depression Inventory (BDI II) and the General Health Questionnaire (GHQ). Correlations of the subscales with the total score and subscales scores were significant, but the SR subscale showed lower correlations than others. Differences between the means of two groups were significant statistically (p <0.001), which shows the sensitivity of the scale to assess patients. The results of OQ-45.2 correlated significantly with the three tests used in validity study and correlations between the total scores of the tests were 0.80 with the EAS-40, 0.83 with the BDI-II and 0.88 with the GHQ. Correlations total of total score of OQ-45.2 with each item were also calculated and were found four items correlations lower than 0.20. Therefore, the psychometric studies indicated the appropriateness of the scale for use in Brazil, although it is still necessary the confirmation of its factor structure and studies regarding changes obtained in psychotherapy

Abstract Reduced physical function and persistent pain are serious consequences of rheumatoid arthritis (RA). Clinical trials have shown that patients with RA suffer from a poor health-related quality of life (HR-QoL). However, limited information is available on the HR-QoL of patients treated in normal clinical practice. The purpose of the present study was to obtain information of how RA can influence on the patients´ HR-QoL and functional ability in a clinical setting and to investigate the impact of disease-related and demographic factors on the HR-QoL. The theoretical framework of the study was the biopsychosocial concept of health, i.e. the ICF model (International Classification of Functioning, Disability and Health) endorsed by WHO. HR-QoL was measured by the Nottingham Health Profile (NHP) questionnaire and functional ability by the Health Assessment Questionnaire (HAQ). The contents of these instruments and the NHP results were evaluated also within the ICF categories. The study consisted of a cross-sectional series and a longitudinal cohort carried out in two central hospitals in Finland in the late 1990s. The cross-sectional group of 122 consecutive out-patients had a mean disease duration of 11 years. The HR-QoL values of the patients were compared with those of an age and gender matched ”healthy” control group living in the same area. The HR-QoL values of the patients were examined also at different functional ability levels. The longitudinal group of 62 consecutive patients had symptom duration ≤ 24 months and no prior use of antirheumatic drugs or glucocorticosteroids at inclusion. First, the impact of the treatment response assessed by the EULAR (DAS28) criteria on HR-QoL was examined at six months from disease onset. Secondly, the HR-QoL changes and their associations with age and gender and with the changes in disease activity, radiographic assessments of hands and feet and functional ability were examined for ten years after the onset of RA. RA patients had poorer scores than the controls in the NHP in the dimensions measuring mobility, pain and energy. These dimensions, along with sleep, displayed also a significant linear association with poorer HAQ levels (p&#160;&#60;&#160;0.001). A better treatment response during the first six months was linearly associated with better HR-QoL with respect to the pain, energy and mobility dimensions (p&#160;&#60;&#160;0.001). Those patients exhibiting no response to treatment had already at baseline the poorest HR-QoL in the dimension for pain and emotional reaction compared with those in the moderate and good responders. During the ten years´ follow-up, all NHP dimensions except social isolation displayed significant improvements, these being most marked during the first six months. Changes in disease activity correlated with changes in pain, energy and emotional reaction (p&#160;&#60;&#160;0.001). The mean level of the HAQ was well preserved over the ten years of this study and its changes were correlated with changes in pain, mobility and energy (p&#160;&#60;&#160;0.001). Women had somewhat poorer NHP improvements in the dimensions assessing energy, emotional reaction and social isolation than males. Disease duration associated strongly with poorer mobility and pain dimensions (p&#160;&#60;&#160;0.01). Within the ICF framework, pain, mobility, energy and sleep were identified as being the most important categories from the patient's perspective. The results of the present study demonstrate that RA has a major influence on the patients´ HR-QoL but early and active treatment can improve the situation. In the ICF framework, the NHP covers a broader spectrum of the ICF categories than can be assessed by the HAQ. / Tiivistelmä Alentunut fyysinen toimintakyky ja jatkuva kipu ovat nivelreumaan liittyviä vakavia seurannaisvaikutuksia. Kliiniset tutkimukset ovat osoittaneet, että nivelreumaa sairastavat potilaat kärsivät huonontuneesta terveyteen liittyvästä elämänlaadusta. Normaalista kliinisestä käytännöstä saatava tieto potilaiden terveyteen liittyvästä elämänlaadusta on kuitenkin niukkaa. Tämän tutkimuksen tarkoituksena oli saada tietoa nivelreuman vaikutuksista potilaiden terveyteen liittyvään elämänlaatuun ja toimintakykyyn kliinisessä asetelmassa ja tutkia sekä tautiin liittyvien että demografisten tekijöiden vaikutusta terveyteen liittyvään elämänlaatuun. Tutkimuksen teoreettisena viitekehyksenä käytettiin WHO:n hyväksymää toimintakyvyn, toimintarajoitteiden ja terveyden kansainvälistä luokitusta (ICF-malli). Terveyteen liittyvää elämänlaatua arvioitiin mittarilla Nottingham Health Profile (NHP) ja toimintakykyä mittarilla Health Assessment Questionnaire (HAQ). Kyseisten mittareiden sisältö samoin kuin NHP- tuloksia arvioitiin käyttämällä myös ICF- luokitusta. Tutkimus käsitti poikkileikkaus- ja pitkittäistutkimuksen, jotka toteutettiin 1990-luvun lopulla kahdessa suomalaisessa keskussairaalassa. Poikkileikkaustutkimukseen osallistui 122 perättäistä polikliinistä potilasta, joilla taudin kesto oli ollut keskimäärin 11 vuotta. Potilaiden terveyteen liittyvää elämänlaatua verrattiin samalla seudulla elävään iän ja sukupuolen suhteen kaltaistettuun verrokkiryhmään. Potilaiden terveyteen liittyvää elämänlaatua arvioitiin myös eri toimintakykytasoilla. Pitkittäistutkimus käsitti 62 perättäistä potilasta, joilla oireet olivat kestäneet ≤&#160;24 kuukautta ja jotka tutkimuksen alkaessa eivät olleet käyttäneet edeltävästi antireumaatteja tai kortikosteroideja. Näillä potilailla hoitovasteen vaikutusta terveyteen liittyvään elämänlaatuun arvioitiin EULAR DAS28- kriteerein kuuden kuukauden kohdalla taudin alusta. Lisäksi tutkittiin terveyteen liittyvän elämänlaadun muutoksia kymmenen vuoden ajalta nivelreuman alusta ja näiden muutosten yhteyttä ikään ja sukupuoleen, taudin aktiviteetissa ja käsissä ja jalkaterissä todettuihin röntgenmuutoksiin samoin kuin toimintakyvyn muutoksiin. Hoitovasteetta jääneillä potilailla oli jo lähtötilanteessa huonoin terveyteen liittyvä elämänlaatu kipu- ja tunnereaktiot- ulottuvuuksissa verrattuna kohtalaisen ja hyvän hoitovasteen saaneisiin. Kymmenen vuoden seurannassa kaikki NHP- ulottuvuudet sosiaalista eristyneisyyttä lukuun ottamatta osoittivat merkittävää paranemista. Selvintä se oli ensimmäisen kuuden kuukauden aikana. Taudin aktiviteetin muutokset korreloivat kipu-, tarmokkuus- ja tunnereaktiot- ulottuvuuksien muutoksiin (p&#160;&#60; &#160;0.001). Keskimääräinen HAQ- taso säilyi hyvänä kymmenen vuoden seurannassa ja HAQ- muutokset korreloivat kipu-, liikkuminen- ja tarmokkuus- ulottuvuuksien muutosten kanssa (p&#160;&#60; &#160;0.001). Naisilla oli miehiä jonkin verran huonompi NHP-paraneminen tarmokkuus-, tunnereaktiot- ja sosiaalinen eristyneisyys- ulottuvuuksissa. Taudin kesto oli selvästi yhteydessä huonompiin liikkuminen- ja kipu- ulottuvuuksiin (p&#160;&#60; &#160;0.01). ICF- luokitusta käytettäessä potilaiden näkökulmasta kipu, liikkuminen, tarmokkuus ja uni nousivat tärkeimmiksi kategorioiksi. Tämän tutkimuksen tulokset osoittavat, että nivelreumalla on huomattava vaikutus potilaiden terveyteen liittyvään elämänlaatuun, jota varhainen ja aktiivinen hoito voi kuitenkin parantaa. ICF- viitekehyksessä NHP kattaa laajemman spektrin ICF- luokista kuin HAQ.

The thesis reports on the evaluation of a digital information literacy program (DILP) to determine the program’s effectiveness in enhancing students’ digital information literacy skills. The program was originally designed and developed for the South African student, as member of Generation Y, but was adapted to suit the demographics and characteristics of Generation Z. New learning technologies were incorporated to enhance students’ learning experience. One of the characteristics of information literacy programs that illustrate best practice is the evaluation of the program itself to judge it’s effectiveness and validate the program as a learning tool. A review of the literature confirmed the paucity of the evaluation of such programs using assessment of student learning through outcomes assessment instruments, based on information literacy competency standards, designed with proven validity and reliability. The literature review found no evidence of the evaluation of the effectiveness of such programs through meaningful assessment of student learning using outcomes assessment in South Africa. For these reasons, the evaluation of the DILP was undertaken. To evaluate the effectiveness of the DILP, a non-randomised quasi-experimental research design, focusing on a single-group pre-test/post-test design which incorporated a combined quantitative and qualitative research approach was used. The primary research instrument was a pre- and post-test. A group of students, belonging to Generation Y and Z, completed a pre-test, worked through the DILP and completed a post-test. Telephonic and e-mail interviews were used to collect further data. The statistical analysis is presented by using descriptive statistics (stacked bar charts for the quantitative data and pie charts for the qualitative data). Inferential statistics were used to reach conclusions beyond the immediate data presented in the charts. The final step was to judge the overall effectiveness of the DILP. The difference between the means was statistically significant, indicating that the DILP was effective in enhancing the digital information literacy skills of students. Based on this research, additional research could be the evaluation of a DILP designed specifically for “digital natives”; the development of online outcomes assessment instruments for web-based tutorials with proven validity and reliability and research in the area of integrating emerging learning technologies with such programs, evaluating their effectiveness. / Information Science / D. Litt. et Phil. (Information Science)