Exercise Prescription for Patients with Non-specific Chronic Low Back Pain: a Qualitative Exploration of Decision Making in Physiotherapy Practice

Background: Providing an effective exercise prescription process for patients with non-specific chronic low back pain (NSCLBP) is a challenging task. Emerging research has indicated that partnership in care and shared decision making are important for people with NSCLBP and calls for further investigation into the approaches used to prescribe exercise. Objective: To explore how shared decision making and patient partnership are addressed by physiotherapists in the process of exercise prescription for patients with NSCLBP. Design: A qualitative study using a philosophical hermeneutic approach. Methods: Eight physiotherapists were each observed on three occasions undertaking their usual clinical activities (total n=24 observations). They conducted brief interviews after each observation and a later in depth semi-structured interview. Iterative hermeneutic strategies were used to interpret the texts and identify the characteristics and processes of exercise prescription for patients with NSCLBP. Findings: The findings revealed how physiotherapy practice often resulted in unequal possibilities for patient participation which were in turn linked to the physiotherapists? assumptions about the patients, clinical orientation, cognitive and decision making processes. Three linked themes emerged: (1) I want them to exercise, (2) Which exercise? - the tension between evidence and everyday practice and (3) Compliance-orientated more than concordance based. Conclusions: This research, by focusing on a patient-centred approach, makes an important contribution to the body of evidence relating to the management of NSCLBP. It challenges physiotherapists to critically appraise their approaches to the prescription of exercise therapy in order to improve outcomes for these patients.

Importance of decision-making in a purchasing context – DPS Case Study

This work project has the objective of exploring the importance of making good decisions on supplier selection, so that the purchasing department can contribute to the success of a company. For that it is presented a short bibliography review of the latest insights that were found relevant, on the subjects of purchasing, technology, outsourcing, supplier selection and decision-making techniques. For a better understating on how to deal with a decision-making situation, a case study is also presented: Digital Printing Solutions (DPS) is a Portuguese company that provides complete and integrated printing solutions and has been planning to contract a software supplier. DPS has no formal supplier-selection model and it has to choose between 2 suppliers. The case study was solved using the M-MACBETH software. I have found that complex decisions-making situations can be easily overcome by using the M-MACBETH decision model. Moreover, the usage of a model, instead of decision that follows no formal procedure, provides the decision maker with insights that can be useful to negotiate with the supplier.

The psychophysics of decision making in a two-direction random dot motion target selection task

La tâche de kinématogramme de points aléatoires est utilisée avec le paradigme de choix forcé entre deux alternatives pour étudier les prises de décisions perceptuelles. Les modèles décisionnels supposent que les indices de mouvement pour les deux alternatives sont encodés dans le cerveau. Ainsi, la différence entre ces deux signaux est accumulée jusqu’à un seuil décisionnel. Cependant, aucune étude à ce jour n’a testé cette hypothèse avec des stimuli contenant des mouvements opposés. Ce mémoire présente les résultats de deux expériences utilisant deux nouveaux stimuli avec des indices de mouvement concurrentiels. Parmi une variété de combinaisons d’indices concurrentiels, la performance des sujets dépend de la différence nette entre les deux signaux opposés. De plus, les sujets obtiennent une performance similaire avec les deux types de stimuli. Ces résultats supportent un modèle décisionnel basé sur l’accumulation des indices de mouvement net et suggèrent que le processus décisionnel peut intégrer les signaux de mouvement à partir d’une grande gamme de directions pour obtenir un percept global de mouvement.

A theoretical and experimental dissociation of two models of decision‐making

La prise de décision est un processus computationnel fondamental dans de nombreux aspects du comportement animal. Le modèle le plus souvent rencontré dans les études portant sur la prise de décision est appelé modèle de diffusion. Depuis longtemps, il explique une grande variété de données comportementales et neurophysiologiques dans ce domaine. Cependant, un autre modèle, le modèle d’urgence, explique tout aussi bien ces mêmes données et ce de façon parcimonieuse et davantage encrée sur la théorie. Dans ce travail, nous aborderons tout d’abord les origines et le développement du modèle de diffusion et nous verrons comment il a été établi en tant que cadre de travail pour l’interprétation de la plupart des données expérimentales liées à la prise de décision. Ce faisant, nous relèveront ses points forts afin de le comparer ensuite de manière objective et rigoureuse à des modèles alternatifs. Nous réexaminerons un nombre d’assomptions implicites et explicites faites par ce modèle et nous mettrons alors l’accent sur certains de ses défauts. Cette analyse servira de cadre à notre introduction et notre discussion du modèle d’urgence. Enfin, nous présenterons une expérience dont la méthodologie permet de dissocier les deux modèles, et dont les résultats illustrent les limites empiriques et théoriques du modèle de diffusion et démontrent en revanche clairement la validité du modèle d'urgence. Nous terminerons en discutant l'apport potentiel du modèle d'urgence pour l'étude de certaines pathologies cérébrales, en mettant l'accent sur de nouvelles perspectives de recherche.

Mathematical modelling of decision making processes in construction projects

Many different individuals, who have their own expertise and criteria for decision making, are involved in making decisions on construction projects. Decision-making processes are thus significantly affected by communication, in which a dynamic performance of human intentions leads to unpredictable outcomes. In order to theorise the decision making processes including communication, it is argued here that the decision making processes resemble evolutionary dynamics in terms of both selection and mutation, which can be expressed by the replicator-mutator equation. To support this argument, a mathematical model of decision making has been made from an analogy with evolutionary dynamics, in which there are three variables: initial support rate, business hierarchy, and power of persuasion. On the other hand, a survey of patterns in decision making in construction projects has also been performed through self-administered mail questionnaire to construction practitioners. Consequently, comparison between the numerical analysis of mathematical model and the statistical analysis of empirical data has shown a significant potential of the replicator-mutator equation as a tool to study dynamic properties of intentions in communication.

Neural and psychological maturation of decision-making in adolescence and young adulthood

We examined the maturation of decision-making from early adolescence to mid-adulthood using fMRI of a variant of the Iowa gambling task. We have previously shown that performance in this task relies on sensitivity to accumulating negative outcomes in ventromedial PFC and dorsolateral PFC. Here, we further formalize outcome evaluation (as driven by prediction errors [PE], using a reinforcement learning model) and examine its development. Task performance improved significantly during adolescence, stabilizing in adulthood. Performance relied on greater impact of negative compared with positive PEs, the relative impact of which matured from adolescence into adulthood. Adolescents also showed increased exploratory behavior, expressed as a propensity to shift responding between options independently of outcome quality, whereas adults showed no systematic shifting patterns. The correlation between PE representation and improved performance strengthened with age for activation in ventral and dorsal PFC, ventral striatum, and temporal and parietal cortices. There was a medial-lateral distinction in the prefrontal substrates of effective PE utilization between adults and adolescents: Increased utilization of negative PEs, a hallmark of successful performance in the task, was associated with increased activation in ventromedial PFC in adults, but decreased activation in ventrolateral PFC and striatum in adolescents. These results suggest that adults and adolescents engage qualitatively distinct neural and psychological processes during decision-making, the development of which is not exclusively dependent on reward-processing maturation.

The use of contracting out : a case study of decision-making and organisational learning in local government

One objective of government is to provide services at least cost whilst maintaining or improving service quality. While this may be an important objective, questions are being asked whether services can be provided more efficiently and effectively by the private rather than by the government sector. The shift of service provision from the public to the private sector is known as outsourcing or contracting out. The objective in this study is to critically examine whether the contracting out of services by local government to the private sector is an efficient management practice.

The contracting out of Parks and Grounds Maintenance services for the City of Kingston in the State of Victoria, Australia, is used as an exploratory case study to identify the variables associated with management decision-making in the contracting out process. Factors relevant to the contracting out decision such as the criteria used in selecting a contractor; the evaluation of a contractor’s performance; and any subsequent changes to management practice relating to the contracting out of the services are identified and discussed.

Political forces were found to be an important consideration in the initial contracting out decision, and the selection of a contractor was influenced by the potential to avoid costs. It was also found that under-bidding and associated cost /profit constraints lead to contractors engaging in non-sustainable environmental practices which resulted in the degradation of the local government’s Parks and Gardens assets. A sustainable asset management philosophy as opposed to an avoidable costs approach now underpins the contracting out process to ensure the preservation of such assets. Further, administrative processes have been revised to make tender specifications more prescriptive, critical components of services have been brought back in-house, and management practices have been amended so that a greater degree of control is exercised over contractors’ activities.

Corporate social responsibility in professional team sport organisations : towards a theory of decision-making

Research question: 

Assumptions of decision-making capacity: the role supporter attitudes play in the realisation of Article 12 for people with severe or profound intellectual disability

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) was the first legally binding instrument explicitly focused on how human rights apply to people with disability. Amongst their obligations, consistent with the social model of disability, the Convention requires signatory nations to recognise that “…persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life” and mandates signatory nations to develop “…appropriate measures to provide access by persons with disability to the support they may require in exercising their legal capacity”. The Convention promotes supported decision-making as one such measure. Although Australia ratified the UNCRPD in 2008, it retains an interpretative declaration in relation to Article 12 (2, 3, 4), allowing for the use of substituted decision-making in situations where a person is assessed as having no or limited decision-making capacity. Such an outcome is common for people with severe or profound intellectual disability because the assessments they are subjected to are focused on their cognition and generally fail to take into account the interdependent nature of human decision-making. This paper argues that Australia’s interpretative declaration is not in the spirit of the Convention nor the social model of disability on which it is based. It starts from the premise that the intention of Article 12 is to be inclusive of all signatory nations’ citizens, including those with severe or profound cognitive disability. From this premise, arises a practical need to understand how supported decision-making can be used with this group. Drawing from evidence from an empirical study with five people with severe or profound intellectual disability, this paper provides a rare glimpse on what supported decision-making can look like for people with severe or profound intellectual disability. Additionally, it describes the importance of supporters having positive assumptions of decision-making capacity as a factor affecting supported decision-making. This commentary aims to give a focus for practice and policy efforts for ensuring people with severe or profound cognitive disability receive appropriate support in decision-making, a clear obligation of signatory nations of the UNCRPD. A focus on changing supporter attitudes rather than placing the onus of change on people with disability is consistent with the social model of disability, a key driver of the UNCRPD.

How do sport clubs recruit volunteers? Analyzing and developing a typology of decision-making processes on recruiting volunteers in sport clubs.

Effective strategies for recruiting volunteers who are prepared to make a long-term commitment to formal positions are essential for the survival of voluntary sport clubs. This article examines the decision-making processes in relation to these efforts. Under the assumption of bounded rationality, the garbage can model is used to grasp these decision-making processes theoretically and access them empirically. Based on case study framework an in-depth analysis of recruitment practices was conducted in nine selected sport clubs. Results showed that the decision-making processes are generally characterized by a reactive approach in which dominant actors try to handle personnel problems of recruitment in the administration and sport domains through routine formal committee work and informal networks. In addition, it proved possible to develop a typology that deliver an overview of different decision-making practices in terms of the specific interplay of the relevant components of process control (top-down vs. bottom-up) and problem processing (situational vs. systematic).