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Background: To fulfil the desire for evidence-based practice, there is impetus for occupational therapy (OT) to make research a priority and to encourage research engagement. Purpose: This study’s aim was to explore occupational therapists’ reasons for and for not getting involved in research and to determine potential barriers and enablers to engaging in research. Methods: Three focus groups were conducted with five participants each. Data were thematically analysed. Findings: Occupational therapists’ reasons for expressing interest in getting involved in research were having an interest in the condition and/or the symptoms being studied; promoting client support and service development; and ‘upskilling’. Three themes emerged from the thematic analysis: (1) motivation to get involved in research can be influenced; (2) ‘firefighting’: barriers and organisational culture; and (3) The nature of research needs consideration from an occupational therapist perspective. Implications: Findings suggest that though occupational therapists are able to get involved in research, it remains that there are difficulties in doing so (e.g., organisational culture); and such difficulties may outweigh both reasons and enablers to such involvement. Reasons for expressing interest, enablers, barriers and the relationships among them warrant further investigation and consideration with respect to involving occupational therapists in research.

The current study-within-a-trial explored individuals’ decisions to decline participation in research trialling a chronic illness-focused therapy (i.e. multiple sclerosis). Four themes were identified from seven semi-structured interviews with participation decliners and were confirmed by the host trial’s Patient & Public Involvement (PPI) panel: acknowledgement of the value of research; ‘fit’ of the study; misinterpretation of participant information; and ‘ignorance is bliss’ – discussed in light of theory and research. This study-within-a-trial extends research on trial recruitment and participation decline; while also suggesting that PPI can be utilised in both a practical and impactful manner. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study-within-a-trial was conducted within research funded by the Health Research Board (Ireland) under a Definitive Interventions and Feasibility Award (DIFA-FA-2018-027). peer-reviewed

Reliable remote cognitive testing could provide a safer assessment of cognitive impairment in multiple sclerosis (MS) during the COVID-19 pandemic and thereafter. Here we aimed to investigate the reliability and feasibility of administering Brief International Cognitive Assessment for MS (BICAMS) and the Trail-Making Test (TMT) to people with MS online. Between-group differences on BICAMS and the TMT were examined in a sample of 68 participants. Group 1 (N = 34) was tested in-person pre-pandemic. Group 2 was tested remotely. Within-group differences for in-person and virtual administrations were examined for Group 1. No significant differences between virtual and in-person administrations of the CVLT-II and SDMT were detected. BVMT-R scores were significantly higher for virtual administrations (M = 20.59, SD = 6.65) compared to in-person administrations (M = 16.35, SD = 6.05), possibly indicating inter-rater differences. Strong positive correlations were found for in-person and virtual scores within Group 1 on the CVLT-II (r = .84), SDMT (r = .85), TMT-A (r = .88), TMT-B (r = .76) and BVMT-R (r = .72). No significant differences between in-person and remote administrations of CVLT-II and SDMT in people living with MS were detected. Recommendations for future studies employing the TMT and BVMT-R online are provided. This study-within-a-trial was conducted within a trial funded by the Health Research Board (Ireland) under a Definitive Interventions and Feasibility Award [grant number DIFA-FA-2018-027]. peer-reviewed

BackgroundChronic lower back pain (CLBP) is a major health care burden and often results in workplace absenteeism. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions informed by the flags approach, which integrates cognitive and behavioral approaches via identification of biopsychosocial barriers to recovery, have resulted in reduced pain-related work absences and increased return to work for individuals with CLBP. However, research indicates that physicians’ adherence to biopsychosocial guidelines is low.ObjectiveThe current study examined the effects of a flags approach–based educational intervention on clinical judgments of medical students and general practitioner (GP) trainees regarding the risk of future disability of CLBP patients.DesignRandomized controlled trial (trial registration number: ISRCTN53670726).SettingUniversity classroom.SubjectsMedical students and GP trainees.MethodsUsing 40 fictional CLBP cases, differences in clinical judgment accuracy, weighting, and speed (experimental N = 32) were examined pre- and postintervention, as were flags approach knowledge, pain attitudes and beliefs, and empathy, in comparison with a no-intervention control group (control N = 31).ResultsResults revealed positive effects of the educational intervention on flags approach knowledge, pain-related attitudes and beliefs, and judgment weighting of psychologically based cues; results are discussed in light of existing theory and research.ConclusionsShort flags approach–based educational video interventions on clinical judgment-making regarding the risk of future disability of CLBP patients may provide opportunities to gain biopsychosocial knowledge, overcome associated attitude barriers, and facilitate development of clinical judgment-making more aligned with psychological cues.

Critical thinking is a metacognitive process that, through purposeful, self-regulatory reflective judgment; skills of analysis, evaluation and inference; and a disposition towards thinking, increases the chances of producing a logical conclusion to an argument or solution to a problem. Critical thinking is vital for not only educational achievement, but also continuous professional development, as it is necessary in social and interpersonal contexts, where adequate decision-making and problem-solving are necessary on a daily basis—which is of particular relevance to adult distance learners, many of whom return to learning to further their professional development. Though a large body of extant research focuses on traditional BA student’s critical thinking performance, there is a dearth of research conducted on more mature adults’ critical thinking. ADL provides a unique opportunity to explore these abilities and the effects of critical thinking instruction through distance learning on such performance. Given the potential benefits linked with critical thinking and associated with adult distance learning, the aim of the current, retrospective, exploratory case study was to examine the effects of an adult distance learning critical thinking module, taught through a BA Training and Education programme, on critical thinking performance. A series of six paired samples t-tests were conducted in order to assess the performance of 95 ADLs from pre-to-post-testing on overall critical thinking performance and the critical thinking sub-scales of hypothesis-testing; verbal reasoning; argument analysis; judging likelihood an uncertainty; and problem-solving. Correlational analysis was also conducted. Results revealed a significant increase from pre-to-post-intervention on overall critical thinking performance, as well as all critical thinking sub-scale performances. However, there were no effects of active engagement with the module, disposition towards thinking or motivation towards learning on critical thinking performance. Results are discussed in light of theory and research on critical thinking.

In this Open Letter we present reflections from three different perspectives on the integration of public and patient involvement (PPI) in a research trial. We reflect on the experience of having a patient employed as a contract researcher, with no prior research experience, on a feasibility trial of cognitive rehabilitation in multiple sclerosis. This Open Letter is written by the PPI research team member with reflections from a researcher on the trial and the principle investigator. We will discuss some of the changes made and the impacts that have been resulted from of PPI input into the trial. We focus on PPI involvement in participant recruitment, the development of trial material, integration of PPI along the research cycle, and collaboration. We hope that this Open Letter will encourage principle investigators and groups to include PPI members as part of the research team and help patients and members of the public understand what the experience of PPI members is like We would like to thank the wider PPI advisory group to the COB-MS trial and PPI Ignite at NUI Galway for their ongoing support throughout the trial. Thank you also to MS Ireland for their continued support throughout. peer-reviewed

Background Cognitive difficulties experienced by people with multiple sclerosis (MS) impact their quality of life and daily functioning, from childcare and work, to social and self-care activities. Despite the high prevalence of cognitive difficulties seen in MS, there is a lack of developed programmes that target cognition, while also supporting patients by helping them to function well in everyday life. The Cognitive Occupation-Based programme for people with MS (COB-MS) was developed as a holistic, individualised cognitive rehabilitation intervention. It addresses the wide-ranging symptoms and functional difficulties that present in MS, including the ability to maintain employment, social activities, home management and self-care. The aim of the current research is to evaluate the feasibility and preliminary efficacy of COB-MS for people with MS. The focus is on feasibility outcomes as well as functioning associated with cognitive difficulty and secondary outcomes related to cognition, fatigue and quality of life. Methods One hundred and twenty people with MS will be assigned to participate in either the COB-MS programme or a treatment as usual, wait-list control group as part of this single-blind, cluster-randomised controlled feasibility and preliminary efficacy trial of the COB-MS programme. The COB-MS group will participate in an eight-session occupational-based cognitive rehabilitation programme over 9 weeks. The primary outcome measure is the goal attainment scaling at 12 weeks. Participants will be assessed pre-intervention, post-intervention and at 12 weeks post-intervention and 6 months post-intervention. Qualitative evaluations of participants’ perspectives will also be examined as part of the feasibility study. Discussion Results will provide recommendations for a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy. In the event that results indicate efficacy, study findings will suggest that COB-MS requires consideration as a means of enhancing cognitive and daily functioning in people living with MS. Trial registration ISRCTN: ISRCTN11462710. Registered on 9 September 2019.

Background: This protocol describes a double-blind, randomised non-inferiority study-within-a-trial (SWAT), comparing the effects of a patient-designed-and-informed participant information sheet with a standard, researcher-designed participant information sheet on recruitment, retention, decision certainty, participant information sheet understanding and likeability. The SWAT is part of a larger trial that aims to evaluate the feasibility and preliminary efficacy of a cognitive occupation-based programme for people with MS (COB-MS) on cognitive and daily functioning for people with multiple sclerosis. Methods: During the study, 120 people with multiple sclerosis will be randomly allocated to one of the two groups, where they will either receive a standard participant information sheet or a patient-designed participant information sheet. Recruitment and retention will be analysed, as well as decision certainty, likability and understanding. Discussion: Results will provide recommendations for recruitment, consent and retention for future trials, as well as shed some light on the factors influencing the understanding and likeability of a trial’s participant information sheet. Recommendations will also be made regarding patient and public involvement in developing and/or aiding the development of participant information sheets. Registration: SWAT: Northern Ireland Hub for Trials Methodology Research SWAT Repository Store (SWAT105). COB-MS trial: ISRCTN11462710.

This review examines Psychology and the Study of Education: Critical Perspectives on Developing Theories, a collection of academic articles edited by Cathal O Siochru. The collection comprehensivel...

Background The prevalence of hypertension is a major public health challenge. Despite it being highly preventable, hypertension is responsible for a significant proportion of global morbidity and mortality. Common methods for controlling hypertension include prescribing anti-hypertensive medication, a pharmacological approach, and increasing physical activity, a behavioural approach. In general, little is known about the comparative effectiveness of pharmacological and behavioural approaches for reducing blood pressure in hypertension. A previous network meta-analysis suggested that physical activity interventions may be just as effective as many anti-hypertensive medications in preventing mortality; however, this analysis did not provide the comparative effectiveness of these disparate modes of intervention on blood pressure reduction. The primary objective of this study is to use network meta-analysis to compare the relative effectiveness, for blood pressure reduction, of different approaches to increasing physical activity and different first-line anti-hypertensive therapies in people with hypertension. Methods A systematic review will be conducted to identify studies involving randomised controlled trials which compare different types of physical activity interventions and first-line anti-hypertensive therapy interventions to each other or to other comparators (e.g. placebo, usual care) where blood pressure reduction is the primary outcome. We will search the Cochrane Library, MEDLINE and PsycInfo. For studies which meet our inclusion criteria, two reviewers will extract data independently and assess the quality of the literature using the Cochrane Risk of Bias Tool. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of reduction of both systolic and diastolic blood pressure. Discussion This study will provide evidence regarding the comparability of two common first-line treatment options for people with hypertension. It will also describe the extent to which there is direct evidence regarding the comparative effectiveness of increasing physical activity and initiating anti-hypertensive therapy. Systematic review registration PROSPERO CRD42017070579 Electronic supplementary material The online version of this article (10.1186/s13643-018-0791-9) contains supplementary material, which is available to authorized users.

Background: Though there is wide support for the application of biopsychosocial perspectives in clinical judgement of chronic pain cases, such perspectives are often overlooked due to either inadequate training or attitudes favoring a biomedical approach. Recent research has indicated that despite such explanations, both established general practitioners (GP) and medical students account for some psychosocial factors when making clinical judgements regarding chronic pain cases, but report not being likely to apply these in real-world, clinical settings due to numerous factors, including available time with patients. Thus, it is evident that a greater understanding of clinical judgement-making processes and the factors that affect application of these processes is required, particularly regarding chronic pain. Objectives: The aims of the current study were to investigate medical students’ conceptualizations of the factors that influence application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain using interactive management (IM), model the relationships among these factors, and make recommendations to chronic pain treatment policy in light of the findings. Study Design: The current study used IM to identify and model factors that influence the application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain, based on medical students’ conceptualizations of these factors. Setting: Two university classrooms. Methods: IM is a systems thinking and action mapping strategy used to aid groups in developing outcomes regarding complex issues, through integrating contributions from individuals with diverse views, backgrounds, and perspectives. IM commonly utilizes the nominal group technique and interpretive structural modeling, which in this context were employed to help medical students identify, clarify, and model influences on the application of biopsychosocial perspectives in treating chronic pain patients. Results: Results of IM group work revealed 7 core biopsychosocial approach application categories: GP attitudes, cost, GP knowledge, time, patient-doctor relationship, biomedical factors. and patient perception. GP attitudes was the most critical driver of all other competencies in the system, with cost and GP knowledge revealed as secondary drivers. Limitations: Potential differences in level of prior biopsychosocial perspective knowledge across participants and a potentially small sample size (though consistent with past research and appropriate for an exploratory study of this nature – for purposes of achieving the depth and richness of the deliberation and qualitative insights revealed by participants using the IM methodology). Conclusions: Results from this study may be used to both recommend further research on the identified factors influencing application of biopsychosocial perspectives in treatment of chronic pain and support amendment to extant health care policy, particularly with respect to cost, GP attitudes, and knowledge. Though this research claims neither that the influences identified are the only influences on biopsychosocial application, nor the order of their importance, the research does contribute to an ongoing effort to better understand the factors that influence doctors in their treatment of chronic pain.

Aims This analysis aims to estimate the comparative efficacy of anti-hypertensive medications and exercise interventions on systolic and diastolic blood pressure reduction in people with hypertension. Methods A systematic review was conducted focusing on randomised controlled trials (RCTs) of exercise interventions and first-line anti-hypertensives where blood pressure reduction was the primary outcome in those with hypertension. Network meta-analyses were conducted to generate estimates of comparative efficacy. Results We identified 93 RCTs ( N = 32,404, mean age in RCTs: 39–70 years) which compared placebo or usual care with first-line antihypertensives including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers and thiazide-like diuretics and exercise interventions including aerobic training and dynamic resistance training. Of these, there were 81 (87%) trials related to medications ( n = 31,347, 97%) and 12 (13%) trials related to exercise ( n = 1057, 3%). The point estimates suggested that antihypertensive medications were more effective than exercise but there was insufficient evidence to suggest that first-line medications significantly reduced blood pressure to a greater extent than did the exercise interventions. Of the first-line treatments, angiotensin receptor blockers and calcium channel blockers had the highest treatment ranking, while exercise had the second lowest treatment ranking, followed by control conditions. Conclusion The current evidence base with a bias towards medication research may partly explain the circumspection around the efficacy of exercise in guidelines and practice. Clinicians may justifiably consider exercise for low risk hypertension patients who confirm a preference for such an approach.

IntroductionMultimorbidity refers to the presence of two or more chronic health conditions within one person, where no one condition is primary. Research suggests that multimorbidity is highly correlated with chronic pain, which is pain lasting longer than 3 months. Psychotherapeutic interventions for people living with chronic illness have resulted in reduced symptom reporting and improved psychological well-being. There is a dearth of research, however, using online psychotherapy for people living with multimorbidity where chronic pain is a central condition. This study will compare the effectiveness of an online acceptance and commitment therapy (ACT) intervention with a waiting list control condition in terms of improving health-related quality of life (HRQoL) and reducing levels of pain interference in people with chronic pain and at least one other condition.Methods and analysis192 adult participants with non-malignant pain that persists for at least 3 months and at least one other medically diagnosed condition will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. A waiting list group will be offered the ACT intervention after the 3-month follow-up period. HRQoL and pain interference will act as the primary outcomes. Data will be analysed using a linear mixed model and adjusted to account for demographic and clinical variables as necessary. A Study Within a Trial will be incorporated to examine the effect on recruitment and retention of showing participants an animated educational video.Ethics and disseminationEthical approval has been granted by the Research Ethics Committee of the National University of Ireland, Galway. Dissemination of results will be via peer reviewed journal articles and conference presentations.Trial registration numberISRCTN22343024.

Critical thinking (CT) is a metacognitive process, consisting of a number of sub-skills and dispositions that, when used appropriately, increases the chances of producing a logical conclusion to an argument or solution to a problem. Though the CT literature argues that dispositions are as important to CT as is the ability to perform CT skills, the majority of research in the area has focused on CT skills. In addition, though most CT interventions are designed based on academic or expert definitions of CT, students are rarely, if ever, asked to guide their instruction by describing their perspectives on what constitutes CT. Thus, the current study used interactive management to examine similarities and differences in the way students and educators conceptualise CT dispositions. Interactive management (IM) is a computer-assisted process that allows a group to build a consensus-based structural model describing relations between elements in a system. Consistent with previous research, it is suggested that addressing how students conceptualise CT may provide a starting point to negotiate and innovative the CT curriculum and learning process. Furthermore, evaluating similarities and differences in the way students and educators understand CT dispositions may facilitate the building of complementary and integrative models of CT dispositions that reflect the full range of perspectives in University teaching environments. Results of the current study suggest that while students’ conceptualisation of CT dispositions was largely consistent with both the educators’ conceptualisation and dispositions highlighted in the extant literature, students’ descriptions were broader, less abstract and more concrete accounts of CT dispositions; and were also primarily focused on utility or function rather than ideal principles of action. Results are discussed in light of research and theory on CT and best practice for CT instruction.

Although many conceptualisations of critical thinking (CT) exist, the vast majority acknowledge the importance of both skill-based and disposition-based components. There is, however, a notable lack of agreement regarding what constitutes CT dispositions and how best to approach the measurement of CT dispositions. The current study reports on the development and validation of a new Student-Educator Negotiated CT Dispositions scale (SENCTDS). Using collective intelligence methods for scale item generation and both exploratory and confirmatory factor analysis across two independent samples for factor structure identification, a six-factor CT disposition scale was developed. Convergent and predictive validity tests indicated relationships between CT dispositions and other constructs and outcomes, including Need for Cognition (NCS), Motivated Strategies for Learning (MSLQ), Real World Outcomes of Critical Thinking (RWO), and both conspiracy and paranormal beliefs. Given the limited availability of measures of CT dispositions, the development of the SENCTDS is a valuable contribution to the field, which may prove useful in future research that seeks to examine predictors and outcomes of both skill-based and disposition-based aspects of CT.

BACKGROUND Electronic health (eHealth) is the use of information and communication technology in the context of health care and health research. Recently, there has been a rise in the number of eHealth modalities and the frequency with which they are used to deliver technology-assisted self-management interventions for people living with chronic pain. However, there has been little or no research directly comparing these eHealth modalities. OBJECTIVE The aim of this systematic review with a network meta-analysis (NMA) is to compare the effectiveness of eHealth modalities in the context of chronic pain. METHODS Randomized controlled trials (N>20 per arm) that investigated interventions for adults with chronic pain, delivered via an eHealth modality, were included. Included studies were categorized into their primary node of delivery. Data were extracted on the primary outcome, pain interference, and secondary outcomes, pain severity, psychological distress, and health-related quality of life. Pairwise meta-analyses were undertaken where possible, and an NMA was conducted to generate indirect comparisons and rankings of modalities for reducing pain interference. RESULTS The search returned 18,470 studies with 18,349 being excluded (duplicates=2310; title and abstract=16,039). Of the remaining papers, 30 studies with 5394 randomized participants were included in the review. Rankings tentatively indicated that modern eHealth modalities are the most effective, with a 43% chance that mobile apps delivered the most effective interventions, followed by a 34% chance that interventions delivered via virtual reality were the most effective. CONCLUSIONS This systematic review with an NMA generated comparisons between eHealth modalities previously not compared to determine which delivered the most effective interventions for the reduction of pain interference in chronic pain patients. There are limitations with this review, in particular, the underrepresented nature of some eHealth modalities included in the analysis. However, in the event that the review is regularly updated, a clear ranking of eHealth modalities for the reduction of pain interference will emerge.

Chronic low back pain is a major healthcare burden that has wide ranging effects on the individual, their family, society and the workplace. However, appropriate management and treatment is often difficult, as a majority of cases are non-specific in terms of underlying pathology. As a result, there are extensive differences in both individual patient preferences for treatment and treatment decisions amongst general practitioners. The current study examined the clinical judgements of GPs in Ireland, regarding fictional patients’ case severity and future risk of disability, through judgement analysis. Judgement analysis (JA) is an idiographic regression modelling technique that has been utilised in extant healthcare research for the purpose of allocating weighting to judgement criteria, or cues, observed by professionals in their clinical decision-making. The primary aim of the study was to model two critical information utilisation tasks performed by GPs with regard to CLBP–in combining information cues to form a judgement about current case severity and a judgement about the same patient’s risk of future disability. It was hypothesised that the judgement weighting would differ across the two judgements and that judgements regarding future risk of disability would be less consistent among GPs than judgements about case severity. Results from the regression-based judgement analysis and subsequent follow-up statistical analysis provided support for both study hypotheses. Study findings are discussed in light of theory and research on judgement, clinical decision-making and chronic low back pain.

The current study compared the immediate (post-intervention) and long-term (6-months later) effects on reflective judgement (RJ) of an argument mapping-infused Critical Thinking (CT) training course versus CT training using hierarchical outlines (HO) and a no-CT training control condition in students scoring high and low on baseline CT dispositions. While previous studies have demonstrated effects of argument mapping (AM) training on CT outcomes, no AM study to date has focused on RJ outcomes and no study has examined if CT dispositions moderate the effect of AM training on RJ outcomes. AM is a method of diagrammatically representing arguments, designed to simplify the assimilation of an argument structure and facilitate analysis and evaluation of propositions and relations. Eighty-one undergraduate students scoring high and low on CT dispositions were randomly allocated to either an AM-infused CT training group, a HO CT training group or a no-CT training control group and were tested on RJ ability using the Lectical Reflective Judgement Assessment before, immediately after and 6-months after a 6-week intervention period. Results revealed a main effect of CT disposition, with higher CT disposition associated with higher RJ scores at all testing times. Students scoring low on CT dispositions, trained through AM, showed a significant increase in RJ performance from pre-to-post-testing. Conversely, students scoring high on CT dispositions, trained through AM, showed a decrease in RJ performance from pre-to-post-testing; whereas both the HO and control groups showed a significant increase in RJ performance from pre-to-post-testing. Findings are discussed in light of research and theory on RJ development and the best practices for CT instruction through AM.

Although critical thinking (CT) skills are usually considered as domain general (Gabbenesch, 2006; Halpern, 2003), CT ability may benefit from expertise knowledge and skill. The current study examined both general CT ability and CT ability related to business scenarios for individuals (a) expert in business, (b) novice in business, and (c) with no business experience, as well as the effects of educational background on both general and business-related CT. Results are discussed in light of research and theory on CT and business, and implications for future research are discussed.

Critical thinking (CT) is a metacognitive process, consisting of a number of sub-skills and dispositions, that, when used appropriately, increases the chances of producing a logical solution to a problem or a valid conclusion to an argument. CT has been identified as a fundamental learning objective of third-level education; however, students often report not being given the opportunity to adequately understand and cultivate CT skills. Though most CT interventions are designed based on academic or expert definitions of CT skills, students are rarely, if ever, asked to guide their instruction by describing their perspectives on what constitutes CT. The current case study investigated students’ conceptualisations of what constitutes good CT using a collective intelligence methodology, interactive management. Interactive management (IM) is a computer-assisted process that allows a group to build a structural model describing relations between elements in a system. Though decades of research on group decision-making in educational and social psychology highlight the many limitations associated with group problem solving (e.g. as a result of an over-reliance on heuristics, cognitive biases and ‘groupthink’), a fundamental skill for making decisions and solving problems is the ability to collectively visualise the structure of a shared problem, and use this knowledge to design solutions and strategies for collective action. Results of IM group work from the current case study revealed five core CT skills (clarity of expression, conversational skill, inference, evaluation, and explanation), five CT dispositions (detachment, listening, systematicity, recognising uncertainty, and self-questioning) and fourteen structural relationships among them. The ability to detach, listen and engage in conversation with others, were seen as fundamental drivers of all other competencies in the system. Results are discussed in light of research and theory on CT and best practice for CT instruction.

Critical thinking is a metacognitive process that, through purposeful, reflective judgement, increases the chances of producing a logical conclusion to an argument or solution to a problem. Instruction in critical thinking is becoming exceedingly important because it allows individuals to gain a more complex understanding of information they encounter and promotes good decision-making and problem-solving in real-world applications ( Butler et al., 2012 , Halpern, 2003 , Ku, 2009 ). Due to what can be considered an exponential increase in the creation of new information every year ( Darling-Hammond, 2008 , Jukes and McCain, 2002 ), critical thinking skills are needed more than ever in order to aid individuals in becoming more adaptable, flexible and better able to cope with this rapidly evolving information. This review investigates existing theoretical frameworks of thinking skills and educational objectives, as well as cognitive models situated in empirical research; and aims to develop an integrated framework of learning outcomes based on the integration of these extant frameworks with recent conceptualisations of critical thinking.

Background: Electronic health (eHealth) is the use of information and communication technology in the context of health care and health research. Recently, there has been a rise in the number of eHealth modalities and the frequency with which they are used to deliver technology-assisted self-management interventions for people living with chronic pain. However, there has been little or no research directly comparing these eHealth modalities. Objective: The aim of this systematic review with a network meta-analysis (NMA) is to compare the effectiveness of eHealth modalities in the context of chronic pain. Methods: Randomized controlled trials (N>20 per arm) that investigated interventions for adults with chronic pain, delivered via an eHealth modality, were included. Included studies were categorized into their primary node of delivery. Data were extracted on the primary outcome, pain interference, and secondary outcomes, pain severity, psychological distress, and health-related quality of life. Pairwise meta-analyses were undertaken where possible, and an NMA was conducted to generate indirect comparisons and rankings of modalities for reducing pain interference. Results: The search returned 18,470 studies with 18,349 being excluded (duplicates=2310; title and abstract=16,039). Of the remaining papers, 30 studies with 5394 randomized participants were included in the review. Rankings tentatively indicated that modern eHealth modalities are the most effective, with a 43% chance that mobile apps delivered the most effective interventions, followed by a 34% chance that interventions delivered via virtual reality were the most effective. Conclusions: This systematic review with an NMA generated comparisons between eHealth modalities previously not compared to determine which delivered the most effective interventions for the reduction of pain interference in chronic pain patients. There are limitations with this review, in particular, the underrepresented nature of some eHealth modalities included in the analysis. However, in the event that the review is regularly updated, a clear ranking of eHealth modalities for the reduction of pain interference will emerge.

Journal article Argument mapping (AM) is a method of visually diagramming arguments to allow for easy comprehension of core statements and relations. A series of three experiments compared argument map reading and construction with hierarchical outlining, text summarisation, and text reading as learning methods by examining subsequent memory and comprehension performance. Effects of study environment, argument size, learning strategy (active and passive) and recall interval (immediate and delayed) were also examined. Results revealed that argument map reading and construction significantly increased subsequent immediate recall for arguments in both passive and active learning settings. These findings indicate that AM is a useful learning and teaching methodology, particularly in comparison with standard text-based learning. Results are discussed in light of research and theory on learning and memory. -------------------------------------------------------------------------------- Irish Research Council for Humanities and Social Sciences peer-reviewed

Background As eHealth interventions prove both efficacious and practical, and as they arguably overcome certain barriers encountered by traditional face-to-face treatment for chronic pain, their number has increased dramatically in recent times. However, there is a dearth of research that focuses on evaluating and comparing the different types of technology-assisted interventions. This is a protocol for a systematic review that aims to evaluate the eHealth modalities in the context of psychological and non-psychological (other than non-drug) interventions for chronic pain. Methods/design We will search the Cochrane Central Register of Controlled Trials (CENTRAL: The Cochrane Library), MEDLINE, Embase and PsycINFO. Randomised controlled trials (RCTs) with more than 20 participants per trial arm that have evaluated non-drug psychological or non-psychological interventions delivered via an eHealth modality and have pain as an outcome measure will be included. Two review authors will independently extract data and assess the study suitability in accordance with the Cochrane Collaboration Risk of Bias Tool. Studies will be included if they measure at least one outcome variable in accordance with the IMMPACT guidelines (i.e. pain severity, pain interference, physical functioning, symptoms, emotional functioning, global improvement and disposition). Secondary outcomes will be measures of depression and health-related quality of life (HRQoL). A network meta-analysis will be conducted based on direct comparisons to generate indirect comparisons of modalities across treatment trials, which will return rankings for the eHealth modalities in terms of their effectiveness. Discussion Most trials that use an eHealth intervention to manage chronic pain typically use one modality. As a result, little evidence exists to support which modality type is the most effective. The current review will address this gap in the literature and compare the different eHealth modalities used for technology-assisted interventions for chronic pain. With the growing reliance and use of technology as a medium for delivering treatment for chronic conditions more generally, it is imperative that research identify the most efficacious eHealth modalities and systematically identify the most important features of such treatment types, so they may be replicated and used for research and in the provision of care. Trial registration PROSPERO, CRD42016035595 Electronic supplementary material The online version of this article (doi:10.1186/s13643-017-0414-x) contains supplementary material, which is available to authorized users.

Introduction Chronic lower back pain (CLBP) is a major healthcare problem with wide ranging effects. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions that identify biopsychosocial barriers to recovery have been observed to lead to successfully reduced pain-related work absences and increased return to work for individuals with CLBP. Modern conceptualisations of pain adopt a biopsychosocial approach, such as the flags approach. Biopsychosocial perspectives have been applied to judgements about future adjustment, recovery from pain and risk of long-term disability; and provide a helpful model for understanding the importance of contextual interactions between psychosocial and biological variables in the experience of pain. Medical students and general practitioner (GP) trainees are important groups to target with education about biopsychosocial conceptualisations of pain and related clinical implications. Aim The current study will compare the effects of an e-learning intervention that focuses on a biopsychosocial model of pain, on the clinical judgements of medical students and trainees. Methods and analysis Medical student and GP trainee participants will be randomised to 1 of 2 study conditions: (1) a 20 min e-learning intervention focused on the fundamentals of the flags approach to clinical judgement-making regarding risk of future pain-related disability; compared with a (2) wait-list control group on judgement accuracy and weighting (ie, primary outcomes); flags approach knowledge, attitudes and beliefs towards pain, judgement speed and empathy (ie, secondary outcomes). Participants will be assessed at preintervention and postintervention. Ethics and dissemination The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee. The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. Trial registration number ISRCTN53670726; Pre-results.

a b s t r a c t The Halpern Critical Thinking Assessment (HCTA) is a reliable measure of critical thinking that has been validated with numerous qualitatively different samples and measures of academic success (Halpern, 2010a). This paper presents several cross-national applications of the assessment, and recent work to expand the validation of the HCTA with real-world outcomes of critical thinking (e.g., contracting a sexual transmitted infection because you did not wear a condom). The real-world outcomes (RWO) inventory measures behavior in a wide range of domains, such as education, health, finance, and interpersonal relationships. Study 1 examined whether scores on the HCTA predicted real-world outcomes in three qualitatively different samples in the United States. Study 2 used the HCTA to assess the effectiveness of an online critical thinking course, and whether the HCTA predicted real- world outcomes in Ireland. Study 3 describes preliminary research involving the translation quality of the RWO (into Spanish and Portuguese) and explored differences in behaviors in the two countries. Overall, the HCTA is a useful tool for assessing critical thinking and pre- dicts real-world outcomes of critical thinking. Cross-national implications and applications are discussed.

The current study compared the effects on comprehension and memory of learning via text versus learning via argument map. Argument mapping is a method of diagrammatic representation of arguments designed to simplify the reading of an argument structure and allow for easy assimilation of core propositions and relations. In the current study, 400 undergraduate volunteers were presented with a colour map, black-and-white map, or text version of a large (50 bit) or small (30 bit) argument that centred on the question: can computers think? Argument comprehension and memory was tested immediately after a 10 min study period. Results indicated that participants who studied the argument maps scored higher than those who studied text, on tests of memory, though not comprehension, and that participants had more difficulty assimilating the large (50 bit) argument in the time allotted. Results are discussed in light of research and theory on human learning and memory.

Metacognition, or thinking about thinking [1], refers to the application and regulation of cognitive processes. According to Boekaerts and Simons [2], Brown [3] and Ku and Ho [4], individuals think metacognitively in two ways: first, individuals must be aware of their own cognitive processes (e.g., through self-monitoring or self-regulation); second, individuals must be able to apply available cognitive processes for purposes of learning or devising solutions to problems [e.g., using critical thinking or reflective judgment [5]. Though a topic of research interest for almost 40 years, debate continues as to how best to conceptualise metacognition and cultivate metacognitive ability. However, due to what can be considered an exponential increase in the creation of new information every year [6, 7], higher-order, metacognitive skills are needed more than ever in order to aid individuals and groups in becoming more adaptable, flexible and better able to cope in the context of a rapidly evolving information society. In order to help guide the facilitation of metacognitive understanding in educational and applied settings, this chapter draws upon recent research in the learning sciences to propose a new framework of metacognition. Specifically, we outline a model of metacognition that integrates processes associated with self-other representations, executive function, emotion regulation, mindfulness, motivation, thinking dispositions, critical thinking, reflective judgment and collaborative systems thinking skills, which can be fostered in the context of individual and team-based tool use. Two cases studies are presented, which provide evidence for the value of both argument mapping and collective intelligence tools in facilitating the development of higher-order critical, reflective and collaborative metacognitive thinking skills. The chapter concludes with a number of recommendations for future research on applied systems science and metacognitive skills development.

Journal article The current research examined the effects of a critical thinking (CT) e-learning course taught through argument mapping (AM) on measures of CT ability. Seventy-four undergraduate psychology students were allocated to either an AM-infused CT e-learning course or a no instruction control group and were tested both before and after an 8-week intervention period on CT ability using the Halpern Critical Thinking Assessment. Results revealed that participation in the AM-infused CT course significantly enhanced overall CT ability and all CT sub-scale abilities from pre- to post-testing and that post-test performance was positively correlated with motivation towards learning and dispositional need for cognition. In addition, AM-infused CT course participants exhibited a significantly larger gain in both overall CT and in argument analysis (a CT subscale) than controls. There were no effects of training on either motivation for learning or need for cognition. However, both the latter variables were correlated with CT ability at post-testing. Results are discussed in light of research and theory on the best practices of providing CT instruction through argument mapping and e-learning environments. peer-reviewed

Introduction Multimorbidity (MM) refers to the coexistence of two or more chronic conditions within one person, where no one condition is considered primary. As populations age and healthcare provision improves, MM is becoming increasingly common and poses a challenge to the single morbidity approach to illness management, usually adopted by healthcare systems. Indeed, recent research has shown that 66.2% of the people in primary care in Ireland are living with MM. Healthcare usage and cost is significantly associated with MM, and additional chronic conditions lead to exponential increases in service usage and financial costs, and decreases in physical and mental well-being. Certain conditions, for example, chronic pain, are highly correlated with MM. This study aims to assess the extent, profile, impact and cost of MM among Irish adults with chronic pain. Methods and analysis Using cluster sampling, participants aged 18 years and over will be recruited from Irish pain clinics and provided an information package and questionnaire asking them to participate in our study at three time points, 1 year apart. The questionnaire will include our specially developed checklist to assess the prevalence and impact of MM, along with validated measures of quality of life, pain, depression and anxiety, and illness perception. Economic data will also be collected, including direct and indirect costs. Ethics and dissemination Ethical approval has been granted by the Research Ethics Committee of the National University of Ireland, Galway. Dissemination of results will be via journal articles and conference presentations.