Search Results (331)

Background: Fatigue is a multidimensional and subjective experience, and it is one of the most common symptoms of multiple sclerosis (MS), affecting up to 80% of patients and acting as a major driver of work disability. Despite its clinical significance, existing assessment tools often lack conceptual clarity or remain too lengthy for routine clinical use. Objective: To develop and evaluate a new patient-reported outcome instrument designed to assess multidimensional fatigue domains in patients with multiple sclerosis (MS) for use in clinical practice. Methods: This study was carried out in three research stages. Stage 1 (Concept Elicitation) involved qualitative interviews (n = 19) to identify core fatigue domains based on patient experience. Stage 2 (Cognitive Interviews) consisted of interviews with 50 patients to ensure the relevance and clarity of the items. Stage 3 (Exploratory Factor Analysis) and internal consistency testing (Cronbach’s alpha) were performed on the same sample of 50 patients to examine the preliminary factor structure and reliability. Results: Concept elicitation identified lack of energy and persistent exhaustion as core symptoms. The resulting 14-item instrument covers three subdomains: Psychosocial, Physical, and Cognitive. Exploratory factor analysis supported a three-factor solution explaining 75% of the total variance (Factor 1: 28%; Factor 2: 27%; Factor 3: 20%). Internal consistency was high across all factors: Psychosocial (α = 0.923), Physical (α = 0.895), and Cognitive (α = 0.844). Conclusions: This new instrument is a conceptually robust tool that captures the interconnected nature of fatigue in multiple sclerosis (MS). These initial findings support its internal structure and conceptual foundation, providing a practical tool for symptom monitoring in neurological consultations. Full article

Musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis affect millions worldwide and are projected to rise sharply by 2050, highlighting the importance of scalable telerehabilitation. This paper introduces Rehabi, a mobile, user-friendly tele-rehabilitation platform that centrally integrates markerless motion for biomechanical assessment and monitoring. Rehabi development followed a user-centered methodology, combining questionnaires, interviews, and natural language processing to elicit requirements from patients and clinicians. The system architecture was implemented in accordance with Clean Architecture principles to ensure modularity and scalability. In a pilot clinical validation of the markerless motion algorithm integrated into Rehabi, 14 post-arthroplasty patients showed moderate agreement for hip flexion (ICC = 0.686) and good agreement for knee flexion (ICC = 0.801). Although the sample was small, the results show a promising trend suggesting that mobile markerless motion capture may be a viable option for remote assessment and monitoring. Full article

Despite substantial investment in teacher preparation, low levels of teacher assessment literacy persist, particularly with respect to the sociocultural and ethical dimensions of assessment. This study reports on interviews with 12 Chilean elementary teacher candidates (TCs). During interviews, TCs reviewed a set of assessment challenges and reported how they would address each challenge. Challenges were designed to elicit assessment as, for, and of learning in response to assessment challenges involving language and culture. Chile presents an interesting context due to its strong policy emphasis on formative assessment and a changing, increasingly diverse student population. TCs’ proposed assessment moves were highly context-dependent and tended to favor formative practices. Culturally responsive assessment approaches were also mentioned, but were primarily oriented toward valuing students as individuals rather than toward sustaining and expanding cultural and linguistic identities. Responses also reflected dominant group-oriented perspectives, characterized by deficit views or the absence of sociocultural considerations. Together, these results highlight the challenge of moving beyond technical assessment skills toward developing the dispositions and skills necessary for justice-oriented classroom assessment practices. Full article

Immersive virtual reality (VR) offers promising opportunities for skill acquisition in complex motor domains, yet its specific potential for martial arts training remains underexplored. This pilot study examined how visual and auditory feedback are associated with subjective immersion and motor performance during the execution of a standardized martial arts sidekick in VR. Ten technically experienced participants completed four training conditions, while full-body kinematics were captured using a synchronized VR-MoCap setup. Subjective ratings of immersion and presence were collected after each condition, and three expert interviews provided complementary qualitative perspectives. Exploratory analyses indicated that high-fidelity visual feedback elicited higher immersion and more stable chamber-phase posture, while voice feedback was associated with smoother timing and improved kick alignment. Experts highlighted multisensory coherence as a key design principle and pointed to concrete opportunities for VR-supported technique refinement. These convergent findings suggest that immersive VR can support technically relevant performance cues in martial arts training while also highlighting design considerations for future high-precision VR coaching systems. As a pilot study, the results provide methodological groundwork and signal directions for larger, confirmatory investigations. Full article

Maladaptive family interaction is one of the mechanisms through which trauma is transmitted across generations. The current intervention approach for trauma-affected families focuses on traumatized parents and child–parent dyads during childhood. This leaves a gap in how adult children, who might no longer live with their parents, can overcome the negative impacts of maladaptive childhood interactions with parents as a legacy of parental trauma history. This study focuses on the children of Vietnamese boat refugees in their 30s and 40s in two cities in Norway, applying narrative interviews to elicit long narratives about their lifespan experiences. A hybrid analytic approach utilizes Thematic Network Analysis, informed by a conceptual framework integrating salutogenesis theory and Bowen family systems theory. The findings reveal that maladaptive parent–child interactions in Vietnamese boat refugee families include parents’ high expectations, harsh parenting, children’s obligation to please parents, and adultification, which are trauma-shaped and mediated by Vietnamese culture. Developing a strong sense of coherence (SOC), characterized by enhancing one’s understanding of the self in relation to family, making meaning regarding the past, and playing an active role in reframing relationships with one’s parents, serves as a pathway to outgrow the impacts of maladaptive patterns in one’s family of origin. Overall, this paper contributes a salutogenic, lifespan-oriented framework for understanding recovery beyond childhood impacts of intergenerational trauma. Full article

Background/Objectives: Inflammatory Bowel Disease (IBD) often occurs during early adulthood and substantially affects physical, psychological, and relational well-being. Although sexual health is a fundamental component of quality of life, it is rarely addressed in clinical practice and remains insufficiently explored in research. This study aimed to explore the lived experiences of individuals with IBD regarding sexuality and intimate relationships. Methods: Qualitative phenomenological design was adopted. Nineteen adults with a confirmed diagnosis of Crohn’s disease or Ulcerative Colitis were purposively recruited from a gastroenterology and endoscopy unit of a university hospital in Southern Italy. Data were collected through in-depth, audio-recorded interviews conducted in Italian, transcribed verbatim, and analyzed using Cohen’s phenomenological method. Lincoln and Guba’s criteria were applied to ensure methodological rigor. Results: Five main themes and two subthemes emerged. Participants reported that IBD profoundly affected their sexual lives, not only through physical symptoms but also by eliciting emotional distress and avoidance behaviors. Stigmatization of symptoms such as incontinence and bloating frequently led to withdrawal from physical intimacy. Changes in body image, including weight fluctuations, scarring, and fear of a possible stoma, were associated with feelings of shame and self-alienation. Sexuality was often described as mechanical and emotionally detached, although some participants reported processes of relational reconnection. Concerns about relationship stability and uncertainty about the future were common, alongside a persistent lack of communication with healthcare professionals regarding sexual health. Conclusions: Sexual health in people with IBD is essential yet frequently overlooked. A holistic and empathetic approach that integrates sexual health into routine IBD care may enhance emotional well-being, improve partner communication, and strengthen the overall quality of care. Full article

Teacher education systems globally experience a gap in implementation between policy aspirations and everyday enactment, with implications for initial teacher education (ITE), the quality of practicums, professional identity, and teacher recruitment and retention. Situated in Malta’s superdiverse context and informed by international debates on professional capital, care ethics, inclusion, and ecological conceptions of agency, this article introduces the Responsive Teacher Formation Framework (RTFF). This original, theoretically integrated, and empirically grounded framework foregrounds four interdependent pillars of professional formation: belonging, wellbeing, autonomy and agency. Drawing on a two-year, multi-strand national inquiry synthesising perspectives from children, families, newly qualified teachers, learning support educators, and school leaders, we integrated artefact-elicitation, focus groups, interviews, and questionnaires using reflexive thematic analysis and cross-strand configurational synthesis. Through a meta-synthesis convergence of the different strands of the study, recurrent tensions surface, including procedural versus lived belonging; attention versus neglect of wellbeing; nominal autonomy versus fragile system supports and policy endorsement versus constrained agency. The findings demonstrate how these complexities are experienced across the ITE–school interface. We argue that the RTFF offers a coherent and tractable syntax for ITE programme (re)design that is both theoretically robust and practically adaptable, diagnostically sensitive to local context, and implementable at scale. The model contributes to international discourse by linking fragmented debates on these four pillars into a responsive framework of, and for, teacher formation. Beyond the Maltese case, the RTFF offers an adaptable orientation for superdiverse settings seeking to transition from compliance-driven quality assurance to formation-centred professional excellence. The article concludes by outlining how the RTFF can anchor more integrated and sustainable policy, as well as nurture professional learning communities, thereby advancing the transformation of teacher education for academic excellence. Full article

Breast cancer entails profound physical, emotional, and relational changes that persist beyond biomedical treatment and may substantially affect women’s body image, sexuality, and engagement in daily occupations. This descriptive phenomenological qualitative study examined the lived experiences of eight Spanish breast cancer survivors through in-depth semi-structured interviews conducted after completion of oncological treatment. Transcripts were analyzed using discourse analysis with iterative interpretation. Three interrelated findings were identified: (1) bodily changes linked to mastectomy and adjuvant therapies disrupted continuity with the previously known body, eliciting estrangement, vulnerability, and grief for the former bodily self; (2) sexuality emerged as a particularly vulnerable domain, shaped by diminished desire, vaginal dryness and pain, shame, altered self-perception, and the need to renegotiate intimacy within the couple; and (3) coping and meaning-making were strengthened by psychological support, efforts to emotionally protect family members, and, notably, peer support and helping other women as key sources of resilience. These findings highlight the need for integrated, culturally sensitive, person-centered survivorship care that explicitly addresses sexuality, body image, and emotional well-being. Occupational therapy may contribute by supporting embodied identity reconstruction, participation in meaningful occupations, and the reconfiguration of intimacy after breast cancer. Full article

We investigated how adding interaction modules—including a category-themed image, slogan, and narrative text—affects user attention during exploratory browsing within category-based recommender interfaces. Eye-tracking data and post-task interviews revealed that the image module captured users’ attention early in the interaction and elicited a visual pairing behavior, wherein users actively searched the product list for items depicted in the image. These findings indicate that semantically rich visual cues can effectively guide user exploration and influence gaze allocation. The results provide empirical support for the design of recommender system interfaces that enhance user engagement through strategically integrated visual elements. Full article

Inquiry-based learning (IBL) is a rapidly growing pedagogical model that uses a learner-centered educational approach to address the needs of the 21st century. Relating to the sustainability of teaching, this approach addresses the systematic and complementary learning dimensions (e.g., cognitive, epistemic, and affective) relevant to the evolving needs of students, curricula, and technology. This study uses adaptive management as a theoretical model which views teachers as dynamic learning managers to investigate the integration of IBL in sustainable education targeting Sustainable Development Goal 4 (SDG4) (Quality Education). With the participation of 11 physics teachers, this phenomenological study delves into the inquiry-based learning implementation and experiences of physics teachers in building a sustainable learning culture in Türkiye’s public schools. The data were collected through semi-structured interviews to elicit teachers’ perceptions of the sustainability of the inquiry ecosystem, and thematic analysis was utilized to interpret and convey the essence of teaching experiences. The findings reveal that the use of adaptive management mechanisms for IBL reinforces students’ conceptual understanding and the long-term sustainability of teaching practices in physics education. The results also highlight the applicability of adaptive inquiry-based paradigms across disciplinary contexts to offer insights for the integration of new educational technology. This study suggests practical implications for teachers, school leaders, and teacher training programs for sustainable and flexible pedagogies. Full article

Visual Impression in Architectural Space (VIAS) plays a central role in user response to environments, yet designer-controlled spatial variables often produce uncertain perceptual outcomes across cultural contexts. This study develops a multi-modal framework integrating VIAS theory, spatial documentation, and sentiment-aware NLP to evaluate temporary event spaces. Using a monthly market in Matsue, Japan as a case study, we introduce (1) systematic documentation of controlled spatial variables (layout, visibility, advertising strategy, (2) culturally balanced datasets comprising native Japanese and international participants across onsite, video, and virtual interviews, and (3) an adaptive sentiment-weighted keyword extraction algorithm suppressing interviewer bias and verbosity imbalance. Results demonstrate systematic modality effects: onsite participants exhibit festive atmosphere bias (+18% positive sentiment vs. video), while remote modalities elicit balanced critique of signage clarity and missing amenities. Cross-linguistic analysis reveals native participants emphasize holistic atmosphere, whereas international participants identify discrete focal points. The adaptive algorithm reduces verbosity-driven score inflation by 45%, enabling fair cross-participant comparison. By integrating spatial variable documentation with sentiment-weighted linguistic patterns, this framework provides a replicable methodology for validating architectural intent through computational analysis, offering evidence-based guidance for inclusive event space design. Full article

This study examines how the sense of home for people with dementia is shaped not only by physical settings but by dynamic atmospheric compositions emerging through memory, sensation, and everyday practices. Building on a preliminary literature mapping that identified three dimensions of home in later-life care environments—safe space, small world, and connection—we developed a multisensory co-design toolkit combining key-element cards and curated olfactory prompts. The study was conducted in a dementia-friendly residential care facility in Italy. Nine residents with mild–moderate dementia (aged 75–84) participated in two group sessions and six individual sessions, facilitated by two design researchers with care staff present. Data consist of audio-recorded and transcribed interviews, guided olfactory sessions, and researcher fieldnotes. Across sessions, participants articulated “small worlds” as micro-environments composed of meaningful objects, bodily comfort, routines, and sensory cues that supported emotional regulation and identity continuity. Olfactory prompts, administered through a low-intensity and participant-controlled protocol, supported scene-based autobiographical recall for some participants, often eliciting memories of domestic rituals, places, and relationships. Rather than treating home-like design as a fixed architectural style, we interpret home as continuously re-made through situated sensory–temporal patterns and relational practices. We translate these findings into atmospheric design directions for dementia care: designing places of self and refuge, staging accessible material memory devices, embedding gentle olfactory micro-worlds within daily routines, and approaching atmosphere as an ongoing process of co-attunement among residents, staff, and environmental conditions. The study contributes a methodological and conceptual framework for multisensory, narrative-driven approaches to designing home-like environments in long-term care. Full article

Background: Most older adults prefer to age in place. Technology-assisted monitoring can enhance safety while maintaining independence. However, there is limited understanding of older adult end users’ preferences and experiences. Methods: In this interpretive phenomenological study, we interviewed eight older adults, with and without dementia, to understand their lived experiences with monitoring technology and its impact on self-identity, independence, and aging-in-place. Results: We found that older adults use pragmatic strategies to process the meaning of life as “monitored” individuals, reflected in four themes: (1) freedom to age in place, (2) the need for active and integrated intervention, (3) individualized approaches to technology based on temperament, usefulness, and worldview, and (4) a sense of changing situations while remaining unchanged. Adaptive techniques for older adults with dementia successfully elicited complex thoughts and desires when participants were given sufficient time and space. Conclusions: As technology-assisted monitoring becomes more common, it is imperative to understand the perspectives of older adult end users. Focusing on lived experiences offers valuable insights to ensure technology-assisted monitoring interventions are effective and accepted as older adults navigate changes in their capabilities and endeavor to age in place. Full article

With the advancement of digital technology, serious games have become an essential tool for disseminating and educating individuals about cultural heritage. However, systematic empirical research remains limited with respect to how visual elements influence users’ cognitive and emotional engagement through interactive behaviors. Using the “Macau Historic Centre Science Popularization System” as a case study, this mixed-methods study investigates the mechanisms by which visual elements affect user experience and learning outcomes in digital interactive environments. Eye-tracking data, behavioral logs, questionnaires, and semi-structured interviews from 30 participants were collected to examine the impact of visual elements on cognitive resource allocation and emotional engagement. The results indicate that the game intervention significantly enhanced participants’ retention and comprehension of cultural knowledge. Eye-tracking data showed that props, text boxes, historic buildings, and the architectural light and shadow shows (as incentive feedback elements) had the highest total fixation duration (TFD) and fixation count (FC). Active-interaction visual elements showed a stronger association with emotional arousal and were more likely to elicit high-arousal experiences than passive-interaction elements. The FC of architectural light and shadow shows a positive correlation with positive emotions, immersion, and a sense of accomplishment. Interview findings revealed users’ subjective experiences regarding visual design and narrative immersion. This study proposes an integrated analytical framework linking “visual elements–interaction behaviors–cognition–emotion.” By combining eye-tracking and information dynamics analysis, it enables multidimensional measurement of users’ cognitive processes and emotional responses, providing empirical evidence to inform visual design, interaction mechanisms, and incentive strategies in serious games for cultural heritage. Full article

Stroke is a leading cause of long-term disability worldwide, and new technologies such as Fully Immersive Virtual Reality (FIVR) are being explored to promote functional recovery as well as optimize rehabilitation outcomes. The aim of the present study was to explore Greek OTs’ perspectives on the use of FIVR in rehabilitation of the upper limb after stroke. Two focus groups took place with six experienced OTs, who were recruited from diverse clinical settings across Greece. The interviews were facilitated using a semi-structured guide and inductively coded using thematic analysis following Braun and Clarke’s six-stage process. Six theme-rich findings were elicited. Therapists identified FIVR’s potential to enable patient involvement, motivation, and recovery of function through the use of immersion and feedback-based practice. They reported significant barriers, however, in terms of technical challenges, safety issues, and costly equipment. OTs also highlighted the fact that occupation-based, culturally sensitive task design is central to ensuring ecological validity and transfer to naturalistic settings. There is a high potential for FIVR in stroke rehabilitation, but it requires user-centered design, cultural adaptation, adequate training, and systemic support towards long-term implementation. Full article