Economic evaluation of adult rehabilitation: a systematic review and meta-analysis of randomized controlled trials in a variety of settings

Objectives:
To report if there is a difference in costs from a societal perspective between adults receiving rehabilitation in an inpatient rehabilitation setting versus an alternative setting. If there are cost differences, to report whether opting for the least expensive program setting adversely affects patient outcomes.

Data Sources:
Electronic databases from the earliest possible date until May 2011. All languages were included.

Study Selection
Multiple reviewers identified randomized controlled trials with a full economic evaluation that compared adult inpatient rehabilitation with an alternative. There were 29 included trials with 6746 participants.

Data Extraction
Multiple observers extracted data independently. Trial appraisal included a risk of bias assessment and a checklist to report the strength of the economic evaluation.

Data Synthesis:
Results were synthesized using standardized mean differences (SMDs) and meta-analyses for the primary outcome of cost. The Grading of Recommendations Assessment, Development, and Evaluation was applied to assess for risk of bias across studies for meta-analyses. There was high-quality evidence that cost was significantly reduced for rehabilitation in the home versus inpatient rehabilitation in a meta-analysis of 732 patients poststroke (pooled SMD [δ]=−.28; 95% confidence interval [CI], −.47 to −.09), without compromise to patient outcomes. Results of individual trials in other patient groups (orthopedic, rheumatoid arthritis, and geriatric) receiving rehabilitation in the home or community were generally consistent with the meta-analysis. There was moderate quality evidence that cost was significantly reduced for inpatient rehabilitation (stroke unit) versus general acute care in a meta-analysis of 463 patients poststroke (δ=.31; 95% CI, .15–.48), with improvement to patient outcomes. These results were not replicated in 2 individual trials with a geriatric and a mixed cohort, where costs did not differ between general acute care and inpatient rehabilitation. Three of the 4 individual trials, inclusive of a stroke or orthopedic population, reported less cost for an intensive inpatient rehabilitation program compared with usual inpatient rehabilitation. Sensitivity analysis included a health service perspective and varied inflation rates with no change to the significant findings of the meta-analyses.

Conclusions:
Based on this systematic review and meta-analyses, a single rehabilitation service may not provide health economic benefits for all patient groups and situations. For some patients, inpatient rehabilitation may be the most cost-effective method of providing rehabilitation; yet, for other patients, rehabilitation in the home or community may be the most cost-effective model of care. To achieve cost-effective outcomes, the ideal combination of rehabilitation services and patient inclusion criteria, as well as further data for nonstroke populations, warrants further research.

Evaluation of management scenarios for controlling eutrophication in a shallow tropical urban lake

Urban lakes are typically smaller, shallower, and more exposed to human activities than natural lakes. Although the effects of harmful algal blooms (HABs) associated with eutrophication in urban lakes has become a growing concern for water resources management and environmental protection, studies focussing on this topic in relation to urban lakes are rare and knowledge of the ecological dynamics and effective management strategies for controlling eutrophication in urban lakes is lacking. This study applied an integrated three-dimensional hydrodynamics-ecological model for a small shallow tropical urban lake in Singapore and evaluated various management scenarios to control eutrophication in the lake. It is found that in-lake treatment techniques including artificial destratification, sediment manipulation and algaecide addition are either ineffective or possess environmental concerns; while watershed management strategies including hydraulic flushing and inflow nutrients reduction are more effective and have posed less environmental concerns. In this study, inflow phosphorus reduction was found to be the best strategy after evaluating the advantages and drawbacks of the management strategies studied. Runoff from the watershed exerts significant influence on urban lakes and thus an integrated water resources management at the watershed level is critical for the control of eutrophication

Evaluation of University of Queensland Library Spaces: three case studies at St Lucia Campus

Introduction: The paper reports on an evaluation study of spaces in the Social Sciences and Humanities (SSHL), Biological Sciences (BSL) and Walter Harrison Law (WHLL) Libraries of the University of Queensland (UQ). The study was part of an evaluation of the quality and patterns of use of spaces in UQ libraries, which aimed to propose recommendations for future improvements and decision-making. This paper presents a study of areas of weakness in existing SSHL spaces, and impacts of the refurbishment of spaces at BSL and WHLL on students’ experiences. The findings evidence a link between students’ learning experiences and the quality of library spaces.Methods: An online survey, “Students’ Experiences and Perceptions of Library Physical Spaces”, was designed to collect data from students. The survey questions addressed seven topics: (1) overall satisfaction with spaces in the UQ Libraries; (2) welcoming nature of the library entry; (3) lighting; (4) acoustics; (5) furniture; (6) wayfinding; and (7) preferences for different space types in the library.Results: 1505 students completed the surveys, with 1098 responses recorded to open-ended questions on why students visited the libraries and the physical characteristics of the spaces that influenced their experiences. Quantitative and qualitative analysis of the data elucidated key design challenges and considerations. In particular, the data suggested that the provision of individual quiet study spaces remains an important role of academic libraries, with Studying Alone identified as the most important reason for student visits.Conclusions: The findings highlight the importance of individual study spaces and propose a number of recommendations in relation to physical space design and management.Relevance: Academic libraries face the challenge to keep pace with change in relation to students’ demographics, pedagogy and technology. In doing so, it is important to have an understanding of the evolving patterns of students’ learning behaviours, space uses and preferences through ongoing evaluation of library spaces.

A development and evaluation process for mHealth interventions: examples from New Zealand

The authors established a process for the development and testing of mobile phone-based health interventions that has been implemented in several mHealth interventions developed in New Zealand. This process involves a series of steps: conceptualization, formative research to inform the development, pretesting content, pilot study, pragmatic randomized controlled trial, and further qualitative research to inform improvement or implementation. Several themes underlie the entire process, including the integrity of the underlying behavior change theory, allowing for improvements on the basis of participant feedback, and a focus on implementation from the start. The strengths of this process are the involvement of the target audience in the development stages and the use of rigorous research methods to determine effectiveness. The limitations include the time required and potentially a less formalized and randomized approach than some other processes. This article aims to describe the steps and themes in the mHealth development process, using the examples of a mobile phone video messaging smoking cessation intervention and a mobile phone multimedia messaging depression prevention intervention, to stimulate discussion on these and other potential methods.

Modelling solute transport in structured soils: performance evaluation of the ADR and TRM models

The movement of chemicals through the soil to the groundwater or discharged to surface waters represents a degradation of these resources. In many cases, serious human and stock health implications are associated with this form of pollution. The chemicals of interest include nutrients, pesticides, salts, and industrial wastes. Recent studies have shown that current models and methods do not adequately describe the leaching of nutrients through soil, often underestimating the risk of groundwater contamination by surface-applied chemicals and overestimating the concentration of resident solutes. This inaccuracy results primarily from ignoring soil structure and nonequilibrium between soil constituents, water, and solutes. A multiple sample percolation system (MSPS), consisting of 25 individual collection wells, was constructed to study the effects of localized soil heterogeneities on the transport of nutrients (NO−3, Cl−, PO3−4) in the vadose zone of an agricultural soil predominantly dominated by clay. Very significant variations in drainage patterns across a small spatial scale were observed (one-way ANOVA, p < 0.001 indicating considerable heterogeneity in water flow patterns and nutrient leaching. Using data collected from the multiple sample percolation experiments, this paper compares the performance of two mathematical models for predicting solute transport, the advective-dispersion model with a reaction term (ADR), and a two-region preferential flow model (TRM) suitable for modelling nonequilibrium transport. These results have implications for modelling solute transport and predicting nutrient loading on a larger scale.

An evaluation of the construct of body image

Provides information on two studies which were designed to evaluate the efficacy of a multidimensional model of body image that incorporated the dimensions of perception, effect, cognition and behavior. Methodology used in the study; Results and general discussion.

Psychometric evaluation of the body change inventory: an assessment instrument for adolescent boys and girls

A new instrument, the Body Change Inventory, was developed to provide an assessment of body change strategies that are used by both adolescent girls and boys. The novel aspect of this instrument is that it evaluates strategies to increase body size and increase muscle size, as well strategies to decrease body size. Independent samples of adolescent girls and boys aged between 11 and 17 years (N=1732) participated in four studies. The revised instrument consisted of three body change scales—Strategies to Decrease Body Size, Strategies to Increase Body Size, and Strategies to Increase Muscle Size. The studies demonstrated content validity, construct validity, internal consistency, and concurrent and discriminant validity for the new scales. The new scales provide a valuable addition in the literature for assessing three global body change strategies among adolescent girls and boys. They are needed in order to examine further the normative development of different kinds of body change strategies and how these may lead to behavioural problems such as disordered eating, exercise dependence, and steroid use.

Impact evaluation of a five-day short course in health promotion: workforce development in action

Issue addressed: This paper reports on impact evaluation of a series of five-day Short Courses in Health Promotion that have been delivered to more than 2,000 people since 2002 as part of a statewide workforce development strategy.

Methods: A triangulated mixed methods research design was selected for the evaluation. Data were collected through a mail survey, key informant interviews, focus groups and organisational case studies. Stakeholder and participant involvement were central to the evaluation.

Results: Organisational change emerged as a key theme. Impacts of the short course were felt in relation to health promotion practice and on organisational capacity to conduct health promotion, while the development of confidence and skills of participants to engage in collaborative opportunities was a not unexpected, but important, benefit of the course.

Conclusions: A short course is effective if attention is given to quality delivery, adult learning methods, participant involvement, appropriate targeting, good planning, and adequate funding. However, respondents commonly report the need for organisational change in order for health promotion practice to be embedded into organisations and for practitioners to be supported in their efforts to re-orient services towards health promotion.

A bioeconomic evaluation of a commercial scale recirculating finfish growout system - an Australian perspective

This study, based on 3 years of commercial data, presents the results of an economic analysis of a 20-tonne per annum (TPA) commercial recirculating aquaculture system (RAS) facility located in Warrnambool, Victoria, Australia. Based on the assumptions of the analysis, results highlight the non-viability of the facility, with a 10-year projected negative cumulative cash flow of − $648,038, and negative net present value (NPV) of − $707,546. Economies of scale were assessed by the development of economic models for hypothetical 50-TPA and 100-TPA facilities, based on the actual figures obtained from the 20-TPA case study. These analyses highlighted marginal viability for the 50-TPA facility (with a ten-year projected cumulative cash flow of $1,030,300; negative NPV of − $167,651 and internal rate of return (IRR) of 11.75%), and an economically viable 100-TPA facility (with a ten-year projected cumulative cash flow of $3,176,750; NPV of $522,200 and IRR of 21.03%). Sensitivity analysis highlighted that the greatest gains to be realised in improving profitability were those associated with increasing the productive capacity of the facility, increasing the sale price of the product, and decreasing the capital costs of RAS facilities. Contradictions between the results from the present study to similar studies clearly highlight a need for further economic analyses of commercial RAS facilities, using commercial data sets and standard economic analysis procedures.

Understanding the management of doctoral studies in Australia as risk management

This paper discusses and analyses theoretical explanations of risk and risk management in terms of the management of doctoral studies. It deals with the ways in which Government policy, together with contemporary approaches to the bureaucratisation of risk management and the development and imposition of rationalities of risk, are shaping the practices of universities concerning the selection, supervision, support and assessment of doctoral candidates. In particular, the impact of the Research Training Scheme on doctoral studies is discussed as a particular context in which the institutionalisation of risk management occurs.

Automatic refinement of user requirements : a case study in software tool evaluation

This paper presents an assessment of system effectiveness in automatic requirements refinement by comparing results obtained from experts and novices with those achieved by the system. As the investigated system was a combination of a tightly inter-connected methods and a tool, the evaluation framework melded together a number of distinct methodological approaches structured into three empirical studies, which aimed at the construction of a case problem domain, calibrating the system using this defined domain elements and finally using the calibrated system to assess its effectiveness. In consequence, it was concluded that the evaluated methods and tools were effective in supporting requirements refinement.

Mentoring volunteer festival managers : evaluation of a pilot scheme in regional Australia

Festival managers in regional locations often have limited access to didactic experiences in their field. As such, developing strategies that enhance the skills of festival management in regional locations can be challenging. This paper, set within the context of the Australian regional arts festival sector, evaluates a pilot mentoring scheme developed by Regional Arts Victoria and Arts Victoria to assist volunteer festival managers to enhance the management, and focus the artistic direction, of their festivals. The results of the evaluation, based on six case studies, indicate that mentoring is highly suited to this scenario. Recommendations are made with regard to the future application of mentoring within this context, particularly in relation to communication and formalisation.