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.

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).

Effect of positioning on the accuracy of decision making of association football top-class referees and assistant referees during competitive matches

The aim of this study was to examine the effect of positioning on the correctness of decision making of top-class referees and assistant referees during international games. Match analyses were carried out during the Fe´de´ration Internationale de Football Association (FIFA) Confederations Cup 2009 and 380 foul play incidents and 165 offside situations were examined. The error percentage for the referees when indicating the incidents averaged 14%. The lowest error percentage occurred in the central area of the field, where the collaboration of the assistant referee is limited, and was achieved when indicating the incidents from a distance of 11–15 m, whereas this percentage peaked (23%) in the last 15-min match period. The error rate for the assistant referees was 13%. Distance of the assistant referee to the offside line did not have an impact on the quality of the offside decision. The risk of making incorrect decisions was reduced when the assistant referees viewed the offside situations from an angle between 46 and 608. Incorrect offside decisions occurred twice as often in the second as in the first half of the games. Perceptual-cognitive training sessions specific to the requirements of the game should be implemented in the weekly schedule of football officials to reduce the overall error rate.

Self perception of decision making competence in spanish football players

Background: It is known that competence to make decisions is a fundamental aspect of sport competition. Objective: This study has analyzed the decision profile of a sample of Spanish football players of different levels of expertise. Methods: 690 Spanish football players of national and international level completed the decision making questionnaire, which cover three dimensions ? perceived decision competence, decision anxiety and commitment with decision learning. MANCOVA and ANOVA analysis were carried out to analyse the differences in each dimension based on the level of expertise. Results: Results showed that perception of decision making competence increased and the anxiety decreased with the level of expertise. Conclusions: This study confirmed the usefulness of this questionnaire in the process of training for coaches and sport psychologists.

Self-perceptions of decision making competence in Spanish football players

Background: It is known that competence to make decisions is a fundamental aspect of sport competition. Objective: This study has analyzed the decision profile of a sample of Spanish football players of different levels of expertise. Methods: 690 Spanish football players of national and international level completed the decision mak- ing questionnaire, which cover three dimensions ? perceived decision competence, decision anxiety and commit- ment with decision learning. MANCOVA and ANOVA analysis were carried out to analyse the differences in each dimension based on the level of expertise. Results: Results showed that perception of decision making competence increased and the anxiety decreased with the level of expertise. Conclusions: This study confirmed the usefulness of this questionnaire in the process of training for coaches and sport psychologists.

The Optimality of Decision Making During Motor Learning

In our daily lives, we often must predict how well we are going to perform in the future based on an evaluation of our current performance and an assessment of how much we will improve with practice. Such predictions can be used to decide whether to invest our time and energy in learning and, if we opt to invest, what rewards we may gain. This thesis investigated whether people are capable of tracking their own learning (i.e. current and future motor ability) and exploiting that information to make decisions related to task reward. In experiment one, participants performed a target aiming task under a visuomotor rotation such that they initially missed the target but gradually improved. After briefly practicing the task, they were asked to select rewards for hits and misses applied to subsequent performance in the task, where selecting a higher reward for hits came at a cost of receiving a lower reward for misses. We found that participants made decisions that were in the direction of optimal and therefore demonstrated knowledge of future task performance. In experiment two, participants learned a novel target aiming task in which they were rewarded for target hits. Every five trials, they could choose a target size which varied inversely with reward value. Although participants’ decisions deviated from optimal, a model suggested that they took into account both past performance, and predicted future performance, when making their decisions. Together, these experiments suggest that people are capable of tracking their own learning and using that information to make sensible decisions related to reward maximization.