This thesis starts with a literature review on the observation of aggression, then describes the development and implementation of an Observation Checklist in 2 Dutch Juvenile Justice Institutions ... Show moreThis thesis starts with a literature review on the observation of aggression, then describes the development and implementation of an Observation Checklist in 2 Dutch Juvenile Justice Institutions (JJI) and concludes with two papers researching the added value of data harvested with this tool, both for risk assessment and cultural sensitive assessment. Show less
De eetbuistoornis is de meest voorkomende eetstoornis en komt in vergelijking met anorexia en boulima veel meer onder alle lagen van de bevolking voor. Wereldwijd is er een gebrek aan kennis over... Show moreDe eetbuistoornis is de meest voorkomende eetstoornis en komt in vergelijking met anorexia en boulima veel meer onder alle lagen van de bevolking voor. Wereldwijd is er een gebrek aan kennis over de eetbuistoornis. Door gebrekkige (h)erkenning krijgen individuen met een eetbuistoornis vaak verkeerde zorg, waardoor de eetbuien juist toenemen. Daarnaast zijn er lange wachttijden voor specialistische behandeling en heeft niet iedereen toegang tot behandeling. Deze these is tweeledig: er wordt onderzoek gedaan naar risicofactoren van de eetbuistoornis in Arabische landen en twee diagnostische vragenlijsten worden gevalideerd. In Nederland wordt de werkzaamheid van een traditionele en een digitale begeleide zelfhulp behandeling onderzocht. In Arabische landen bleken een hoog BMI en lichaamsontevredenheid geassocieerd te zijn met eetstoornispathologie. De eating disorder examination questionnaire meet accuraat eetstoornisklachten en de body shape questionnaire lichaamsontevredenheid. In Nederland blijkt cognitive behavioral therapy een werkzame behandeling voor de eetbuistoornis, zowel op de traditionale manier, als digitaal aangeboden. De digitale variant vergroot de toegang tot specialistische zorg en kan mogelijk de lange wachttijden voor behandeling verkorten. Show less
De mogelijke vernieuwingen bij de vreemde talen kunnen resulteren in meer aandacht voor inhoud op het gebied van taal en cultuur. Hoe kun je deze onderdelen geïntegreerd toetsen met taalvaardigheid... Show moreDe mogelijke vernieuwingen bij de vreemde talen kunnen resulteren in meer aandacht voor inhoud op het gebied van taal en cultuur. Hoe kun je deze onderdelen geïntegreerd toetsen met taalvaardigheid? Nivja de Jong, Janine Berns en Tessa Mearns maken in ‘Toetsing als vertrekpunt voor vernieuwing’ creatief gebruik van de bekende driehoek van Biggs (1996) met leerdoelen, toetsing en feedback en leeractiviteiten. Eigenlijk staan de leerdoelen bovenaan, maar als je begint bij de toetsing heb je een veel concreter uitgangspunt. En als het goed is zijn de toetsen valide operationaliseringen van de leerdoelen. De Jong, Berns en Mearns anticiperen op de nieuwe examenprogramma’s voor de moderne vreemde talen en schetsen de voordelen als de leesteksten niet meer over alle mogelijke vakvreemde onderwerpen gaan waar de docenten geen verstand van hebben en die er in feite niet toe doen, maar over taal en cultuur, het vakgebied van de vreemdetaaldocent. De inhoud wordt dan net zo belangrijk als de taal, zoals bij tweetalig onderwijs (CLIL). Daar moet het leerproces, dus ook de feedback en de beoordeling door de docent, zich richten op inhoud én op de taal. Van de CLIL-ervaringen kunnen de vernieuwde talenvakken leren. Show less
Background In medical residency, performance observations are considered an important strategy to monitor competence development, provide feedback and warrant patient safety. The aim of this study... Show moreBackground In medical residency, performance observations are considered an important strategy to monitor competence development, provide feedback and warrant patient safety. The aim of this study was to gain insight into whether and how supervisor-resident dyads build a working repertoire regarding the use of observations, and how they discuss and align goals and approaches to observation in particular. Methods We used a qualitative, social constructivist approach to explore if and how supervisory dyads work towards alignment of goals and preferred approaches to performance observations. We conducted semi-structured interviews with supervisor-resident dyads, performing a template analysis of the data thus obtained. Results The supervisory dyads did not frequently communicate about the use of observations, except at the start of training and unless they were triggered by internal or external factors. Their working repertoire regarding the use of observations seemed to be primarily driven by patient safety goals and institutional assessment requirements rather than by providing developmental feedback. Although intended as formative, the institutional test was perceived as summative by supervisors and residents, and led to teaching to the test rather than educating for purposes of competence development. Conclusions To unlock the full educational potential of performance observations, and to foster the development of an educational alliance, it is essential that supervisory dyads and the training institute communicate clearly about these observations and the role of assessment practices of- and for learning, in order to align their goals and respective approaches. Show less
Osthoff, A.K.R.; Vlieland, T.P.M.V.; Meichtry, A.; Bodegom-Vos, L. van; Topalidis, B.; Buchi, S.; ... ; Niedermann, K. 2022
Background: The Ankylosing Spondylitis Association of Switzerland (SVMB) aimed to implement physical activity recommendations (PAR) within their exercise groups (EGs). The PAR promote exercise in... Show moreBackground: The Ankylosing Spondylitis Association of Switzerland (SVMB) aimed to implement physical activity recommendations (PAR) within their exercise groups (EGs). The PAR promote exercise in all fitness dimensions at the correct dose. To implement the PAR within EGs, they were translated into a new EG concept with five key activities: (a) training for supervising physiotherapists (PTs), (b) correctly dosed exercises in all fitness dimensions, (c) exercise counselling, (d) bi-annual fitness assessments, and (e) individual exercise training, in addition to EG. All these activities were realized in close coordination with SVMB management.Objectives: To analyse the implementation success by evaluating adherence/fidelity, feasibility, and satisfaction at the patient, PTs, and organisational level.Methods: The five key activities of the new EG concept were developed, executed, and assessed after 6 months. The primary outcomes for implementation success were adherence of patients to the recommended exercise behaviour, self-reported by electronic diary; fidelity of PTs to the new concept, self-reported by diary; SVMB organisational changes. Secondary outcomes were feasibility and satisfaction with the new EG concept at all three levels. The tertiary outcome, to evaluate the effectiveness of PAR, was patient fitness, assessed through fitness assessments.Results: 30 patients with axSpA (ten women, mean age 58 +/- 9 years) and four PTs (three women, mean age 46 +/- 9 years) participated. The patients' self-reporting of adherence to the PAR was insufficient (43%), possibly due to technical problems with the electronic dairy. The PTs' fidelity to the new EG concept was satisfactory. On all levels, the new concept was generally perceived as feasible and useful for supporting personalised exercise.The frequency of exercise counselling and the fitness assessments was found by patients and PTs to be too high and rigid. Patients' cardiorespiratory fitness [ES 1.21 (95%CI 0.59, 1.89)] and core strength [ES 0.61 (95%CI 0.18, 1.06)] improved over the 6 months.Conclusions: The pilot implementation of PAR showed acceptance and satisfaction to be sufficient, thus confirming the need for evidence-based EGs, provided by a patient organisation in order to support active PA behaviour. However, adaptations are necessary to increase its feasibility for nationwide implementation. Show less
Andringa, A.; Meskers, C.; Port, I. van de; Zandvliet, S.; Scholte, L.; Groot, J. de; ... ; Wegen, E. van 2021
Patients with poor upper limb motor recovery after stroke are likely to develop increased resistance to passive wrist extension, i.e., wrist hyper-resistance. Quantification of the underlying... Show morePatients with poor upper limb motor recovery after stroke are likely to develop increased resistance to passive wrist extension, i.e., wrist hyper-resistance. Quantification of the underlying neural and non-neural elastic components is of clinical interest. This cross-sectional study compared two methods: a commercially available device (NeuroFlexor (R)) with an experimental EMG-based device (Wristalyzer) in 43 patients with chronic stroke. Spearman's rank correlation coefficients (r) between components, modified Ashworth scale (MAS) and range of passive wrist extension (PRoM) were calculated with 95% confidence intervals. Neural as well as elastic components assessed by both devices were associated (r = 0.61, 95%CI: 0.38-0.77 and r = 0.53, 95%CI: 0.28-0.72, respectively). The neural component assessed by the NeuroFlexor (R) associated significantly with the elastic components of NeuroFlexor (R) (r = 0.46, 95%CI: 0.18-0.67) and Wristalyzer (r = 0.36, 95%CI: 0.06-0.59). The neural component assessed by the Wristalyzer was not associated with the elastic components of both devices. Neural and elastic components of both devices associated similarly with the MAS (r = 0.58, 95%CI: 0.34-0.75 vs. 0.49, 95%CI: 0.22-0.69 and r = 0.51, 95%CI: 0.25-0.70 vs. 0.30, 95%CI: 0.00-0.55); elastic components associated with PRoM (r = -0.44, 95%CI: -0.65- -0.16 vs. -0.74, 95%CI: -0.85- -0.57 for NeuroFlexor (R) and Wristalyzer respectively). Results demonstrate that both methods perform similarly regarding the quantification of neural and elastic wrist hyper-resistance components and have an added value when compared to clinical assessment with the MAS alone. The added value of EMG in the discrimination between neural and non-neural components requires further investigation. Show less
Introduction: The aim of this study was to obtain expert consensus on the content of a curriculum for learning chorionic villus sampling (CVS) and amniocentesis (AC) and the items of an assessment... Show moreIntroduction: The aim of this study was to obtain expert consensus on the content of a curriculum for learning chorionic villus sampling (CVS) and amniocentesis (AC) and the items of an assessment tool to evaluate CVS and AC competence. Methods: We used a 3-round iterative Delphi process. A steering committee supervised all processes. Seven international collaborators were identified to expand the breadth of the study internationally. The collaborators invited fetal medicine experts to participate as panelists. In the first round, the panelists suggested content for a CVS/AC curriculum and an assessment tool. The steering committee organized and condensed the suggested items and presented them to the panelists in round 2. In the second round, the panelists rated and commented on the suggested items. The results were processed by the steering committee and presented to the panelists in the third round, where final consensus was obtained. Consensus was defined as support by more than 80% of the panelists for an item. Results: Eighty-six experts agreed to participate in the study. The panelists represented 16 countries across 4 continents. The final list of curricular content included 12 theoretical and practical items. The final assessment tool included 11 items, systematically divided into 5 categories: pre-procedure, procedure, post-procedure, nontechnical skills, and overall performance. These items were provided with behavioral scale anchors to rate performance, and an entrustment scale was used for the final overall assessment. Conclusion: We established consensus among international fetal medicine experts on content to be included in a CVS/AC curriculum and on an assessment tool to evaluate CVS/AC skills. These results are important to help transition current training and assessment methods from a time- and volume-based approach to a competency-based approach which is a key step in improving patient safety and outcomes for the 2 most common invasive procedures in fetal medicine. Show less
Rietmeijer, C.B.T.; Blankenstein, A.H.; Huisman, D.; Horst, H.E. van der; Kramer, A.W.M.; Vries, H. de; ... ; Teunissen, P.W. 2021
IntroductionIn competency-based medical education, direct observation (DO) of residents' skills is scarce, notwithstanding its undisputed importance for credible feedback and assessment. A growing... Show moreIntroductionIn competency-based medical education, direct observation (DO) of residents' skills is scarce, notwithstanding its undisputed importance for credible feedback and assessment. A growing body of research is investigating this discrepancy. Strikingly, in this research, DO as a concrete educational activity tends to remain vague. In this study, we concretised DO of technical skills in postgraduate longitudinal training relationships.MethodsInformed by constructivist grounded theory, we performed a focus group study among general practice residents. We asked residents about their experiences with different manifestations of DO of technical skills. A framework describing different DO patterns with their varied impact on learning and the training relationship was constructed and refined until theoretical sufficiency was reached.ResultsThe dominant DO pattern was ad hoc, one-way DO. Importantly, in this pattern, various unpredictable, and sometimes unwanted, scenarios could occur. Residents hesitated to discuss unwanted scenarios with their supervisors, sometimes instead refraining from future requests for DO or even for help. Planned bi-directional DO sessions, though seldom practiced, contributed much to collaborative learning in a psychologically safe training relationship.Discussion and conclusionPatterns matter in DO. Residents and supervisors should be made aware of this and educated in maintaining an open dialogue on how to use DO for the benefit of learning and the training relationship. Show less
Objectives To adapt the core strength endurance test battery (aCSE), previously used for testing athletes, to a target group of patients with axial spondylarthritis (axSpA), to evaluate its intra... Show moreObjectives To adapt the core strength endurance test battery (aCSE), previously used for testing athletes, to a target group of patients with axial spondylarthritis (axSpA), to evaluate its intra-tester reliability and its associations with disease-specific factors. Methods A cross-sectional study was conducted at axSpA exercise therapy groups, including both axSpA patients and the physiotherapist group leaders (PTs). The aCSE was used to measure the isometric strength endurance of the ventral, lateral, and dorsal core muscle chains (measured in seconds), as well as to assess the disease-specific factors of functional status, self-reported pain, and perceived strength performance. The aCSE was repeated after 7-14 days to measure intra-tester reliability for the same rater (PT group leader). Reliability was calculated as an intra-class correlation coefficient (ICC) using a nested design. The associations between ventral, lateral, and dorsal strength endurance and the disease-specific factors were calculated using Pearson correlation coefficients. Results Study participants were 13 PT group leaders and 62 axSpA patients. The latter were all capable of performing the aCSE, with the exception of one individual. A moderate to substantial intra-rater reliability (ICCs (95%CI)) was found for the ventral (0.54 (0.35, 0.74)), lateral (0.52 (0.33, 0.70)), and dorsal (0.71 (0.58, 0.86)) core muscle chains. None of the aCSE measures correlated with the disease-specific factors. Conclusion The aCSE was found to be a reliable test battery for assessing core strength endurance in axSpA patients. Interestingly, aCSE performance was not associated with any disease-specific factors. Show less
Pergolotti, M.; Battisti, N.M.L.; Padgett, L.; Sleight, A.G.; Abdallah, M.; Newman, R.; ... ; Ahles, T.A. 2020
Cancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make... Show moreCancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make decisions, treatment adherence, overall quality of life, and ultimately survival. In honor of Dr. Hurria's work we explore and examine multiple types of screening, assessment and non-pharmacologic treatments for CRCD. We then suggest future research and clinical practice questions to holistically appreciate the complexity of older adults with cancer's experiences and fully integrate the team-based approach to best serve this population. (C) 2019 Elsevier Ltd. All rights reserved. Show less
Objective: In the past decade, several authors have advocated that formative assessment programmes have an impact on teachers’ knowledge. Consequently, various requirements have been proposed in... Show moreObjective: In the past decade, several authors have advocated that formative assessment programmes have an impact on teachers’ knowledge. Consequently, various requirements have been proposed in the literature for the design of these programmes. Only few studies, however, have focused on a direct comparison between programmes with respect to differences observed in their effect on teachers’ knowledge. Therefore in this study we explored the impact of three formative assessment programmes on teachers’ knowledge about supporting students’ reflection. Methods: Our study was carried out in the domain of vocational nursing education. Teachers were assigned to an expertise-based assessment programme, a self-assessment combined with collegial feedback programme, or a negotiated assessment programme. We scored the verbal transcriptions of teachers’ responses to video vignette interviews in order to measure their knowledge in a pre- and post-test. Multilevel regression analyses were performed to investigate differences in teachers’ knowledge between the three programmes on the post-test; potential moderating effects of pre-test scores, contextual and individual factors were controlled for. Findings: The knowledge of teachers participating in the expertise-based assessment programme was significantly higher than that of teachers participating in the self-assessment combined with collegial feedback programme. Furthermore, the findings indicate that for professional learning, not only the approach to formative assessment is an important variable, but also the extent to which (a) teachers are intrinsically motivated and (b) they experience a high degree of collegiality at their school. Show less
Eidhof, M.B.; Heide, F.J.J. ter; Aa, N. van der; Schreckenbach, M.; Schmidt, U.; Brand, B.L.; ... ; Vermetten, E. 2019
The inclusion of the dissociative subtype of post-traumatic stress disorder (PTSD-DS) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reflects the... Show moreThe inclusion of the dissociative subtype of post-traumatic stress disorder (PTSD-DS) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reflects the importance of assessing PTSD-DS. We developed the Dissociative Subtype of PTSD Interview (DSP-I). This clinician-administered instrument assesses the presence and severity of PTSD-DS (i.e., symptoms of depersonalization or derealization) and contains a supplementary checklist that enables assessment and differentiation of other trauma-related dissociative symptoms (i.e., blanking out, emotional numbing, alterations in sensory perception, amnesia, and identity confusion). The psychometric properties were tested in 131 treatment-seeking individuals with PTSD and histories of multiple trauma, 17.6 % of whom met criteria for PTSD-DS in accordance with the DSP-I. The checklist was tested in 275 treatment-seeking individuals. Results showed the DSP-I to have high internal consistency, good convergent validity with PTSD-DS items of the CAPS-5, and good divergent validity with scales of somatization, anxiety and depression. The depersonalization and derealization scales were highly associated. Moreover, the DSP-I accounted for an additional variance in PTSD severity scores of 8% over and above the CAPS-5 and number of traumatic experiences. The dissociative experiences of the checklist were more strongly associated with scales of overall distress, somatization, depression, and anxiety than scales of depersonalization and derealization. In conclusion, the DSP-I appears to be a clinically relevant and psychometrically sound instrument that is valuable for use in clinical and research settings. Show less
The need for data to study the relationship between fatigued healthcare professionals and performance outcomes is evident, however, it is unclear which methodology is most appropriate to provide... Show moreThe need for data to study the relationship between fatigued healthcare professionals and performance outcomes is evident, however, it is unclear which methodology is most appropriate to provide these insights. To address this issue, we performed a systematic review of relevant articles by searching the MEDLINE, EMBASE, Cochrane, Web of Science, and CINAHL databases. The literature search identified 2960 unique references, of which 82 were identified eligible. The impact on performance was studied on clinical outcomes, medical simulation, neurocognitive performance, sleep quantification and subjective assessment. In general results on performance are conflicting; impairment, no effect, and improvement were found. This review outlines the various methods currently available for assessing fatigue-impaired performance. The contrasting outcomes can be attributed to three main factors: differences in the operationalisation of fatigue, incomplete control data, and the wide variety in the methods used. We recommend the implementation of a clinically applicable tool that can provide uniform data. Until these data become available, caution should be used when developing regulations that can have implications for physicians, education, manpower planning, and - ultimately - patient care. (C) 2019 Elsevier Ltd. All rights reserved. Show less
In upper motor neuron diseases, like spinal cord injury, cerebral palsy and stroke, motor areas in the brain and/or spinal cord are damaged or fail to develop normally. Patients suffer from... Show moreIn upper motor neuron diseases, like spinal cord injury, cerebral palsy and stroke, motor areas in the brain and/or spinal cord are damaged or fail to develop normally. Patients suffer from increased joint stiffness, diminished range of motion and flexion deformity. The underlying neural reflexive and non-neural tissue (i.e. muscle slack length and stiffness) contributors of these motor disorders cannot be distinguished by current clinical tests. This distinction of contributors is however important for treatment selection and to understand the mechanism of functional recovery. To quantify the neural and non-neural contributors, an instrumented electromyography driven non-linear neuromuscular modeling approach was developed, validated and applied in patients with stroke and cerebral palsy. The clinical potential of the modeling approach was illustrated by the development over time of neural and non-neural contributors in the sub-acute phase post-stroke and by the effect of botulinum toxin A treatment on these contributors in chronic stroke patients. The results from longitudinal assessments are a step forward in answering “when” to treat a stroke patient. The results also give direction to the question “how” to treat stroke patients, i.e. which treatment option is most effective in each individual patient. Both are a prerequisite for personalized treatment. Show less
Speyer, R.; Kim, J.H.; Doma, K.; Chen, Y.W.; Denman, D.; Phyland, D.; ... ; Cordier, R. 2019
PurposeThe current review was conducted to identify all self-report questionnaires on functional health status (FHS) and/or health-related quality-of-life (HR-QoL) in adult populations with... Show morePurposeThe current review was conducted to identify all self-report questionnaires on functional health status (FHS) and/or health-related quality-of-life (HR-QoL) in adult populations with dysphonia (voice problems), and to evaluate the psychometric properties of the retrieved questionnaires.MethodsA systematic review was performed in the electronic literature databases PubMed and Embase. The psychometric properties of the questionnaires were determined using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) taxonomy and checklist. Responsiveness was outside the scope of this review and as no agreed gold standard' measures are available in the field of FHS and HR-QoL in dysphonia, criterion validity was not assessed. Only questionnaires developed and published in English were included.ResultsForty-eight studies reported on the psychometric properties of 15 identified questionnaires. As many psychometric data were missing or resulted from biased study designs or statistical analyses, only preliminary conclusions can be drawn. Based on the current available psychometric evidence in the literature, the Voice Handicap Index seems to be the most promising questionnaire, followed by the Vocal Performance Questionnaire.ConclusionsMore research is needed to complete missing data on psychometric properties of existing questionnaires in FHS and/or HR-QoL. Further, when developing new questionnaires, the use of item response theory is preferred above classical testing theory, as well as international consensus-based psychometric definitions and criteria to avoid bias in outcome data on measurement properties. Show less
This PhD-thesis analyses the relationship between the parties’ choices in the CPB Netherlands Bureau for Economic Policy Analysis’ assessments of the election manifestos and coalition agreements... Show moreThis PhD-thesis analyses the relationship between the parties’ choices in the CPB Netherlands Bureau for Economic Policy Analysis’ assessments of the election manifestos and coalition agreements over the period 1986-2017, and tries to explain this relationship. First, the theoretical framework is set out, in which agenda-setting, political economy and civil service influence have prominent positions, followed by a description of the political rationality and the civil service rationality. Then, multiple reflections are made on the history of the assessments and their (dis)advantages for both the Dutch politicians and the civil service. Second, the empirical analysis of the parties’ choices with regard to government expenditures, tax burdens, purchasing power and macroeconomic outcomes in election manifestos and coalition agreements is carried out. It appears that for the majority of parties’ choices, negotiators in the formation decide in line with their manifestos. But there are also clear deviations. In general; government expenditures turn out higher, except the expenditures on education. Tax burdens end up higher, but foremost for households while companies receive tax reliefs. The purchasing power of high incomes and middle incomes falls behind, in contrast to the purchasing power of social security beneficiaries and low incomes which end up better. Show less
Woldendorp, K.H.; Schipper, A.W. de; Boonstra, A.M.; Sluis, C.K. van der; Arendzen, J.H.; Reneman, M.F. 2018
Study Design: Psychometric study with 2-week interval.Introduction: Musculoskeletal hand complaints are common among manual workers. Mismatch between anthropometric hand features and tasks can... Show moreStudy Design: Psychometric study with 2-week interval.Introduction: Musculoskeletal hand complaints are common among manual workers. Mismatch between anthropometric hand features and tasks can affect the ability to perform hand activities, with an increased risk of complaints. Although screening of these features may improve diagnosis and treatment, no validated screening tool is available. The Practical Hand Evaluation (PHE) screening tool might fill this gap, but its psychometric properties are unknown.Purpose of the Study: To test the reliability of the PHE and to explore the feasibility of item reduction of the PHE.Methods: Right-hand profiles of 117 healthy volunteers (66 women, 51 men; mean age, 22.8 years) were independently assessed 4 times by 6 couples of researchers using the PHE, twice on day 1 and twice 2-3 weeks later. Intrarater and inter-rater reliability (intraclass correlations), standard error of measurement (SEM), potential confounding factors (gender, joint hyperlaxity, and measurement order) affecting the instrument's reliability (limits of agreement), and collinearity between the PHE items were determined (variation inflation factor analysis and hierarchical clustering of correlation coefficients).Results: The intrarater and inter-rater reliabilities of the PHE were good for 12 of 14 items (86%; r = 0.67-0.90). Absolute SEM varied between 2.01 and 9.23 mm. The percentage of shifts of at least 2 classes in a repeated measurement was <15%. Cluster analysis identified 6 clusters of hand items.Discussion: The reliability for nearly all PHE items is good. Measurement errors were substantial relative to variances in the reference population, but not to gender, joint laxity and order of administration. Clustering into 6 seperated clusters of items was possible.Conclusions: The PHE fulfills many of the criteria for screening of anthropometrics of the hand. Its reliability is high. The SEM might be improved with future adaptations toward a digital photographic PHE. Reduction to 6 items seems also possible. (C) 2018 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. Show less
