Individual Goals Research Articles

The Current State-or Lack Thereof-of Screening and Prevention for Gynecologic Malignancies for Patients With Lynch Syndrome.

Lynch syndrome (LS) is an autosomal dominant genetic disorder that results in an increased risk of ovarian and endometrial cancers. The aim of this paper was to explore the management of this risk through screening and prevention. Published materials and evidence were explored and summarized. This paper demonstrated that while there has been increased awareness and advances in the identification and diagnosis of patients with LS, recommendations for screening and prevention remain less evidence-based. In decisions of management of patients with LS, a shared decision-making model should be used considering individual patient goals.

The role of the child-adult community in the development of adolescents’ meaning of life

Importance. The search for the meaning of life is a relevant issue during adolescence. A childadult community plays an important role in the development of meaning of teenagers’ lives by providing support, participation in social events, role models, and opportunities for selfrealization. Interacting with adult members of the community contributes to the development of value orientations among adolescents, the establishment of individual personal and professional goals, and provides support in the search for meaning of life. The purpose of the study is to identify the specific role of the child-adult community in the development of adolescents’ meaning of life.Materials and Methods. Analysis of Russian and foreign literature, conducting a survey among adolescents, conducting interviews and observations, as well as statistical processing of the results are used.Results and Discussion. It has been established that in developing the meaning of life, child-adult communities play the role of creating a supportive and emotionally favourable environment, mentoring and role models, and so forth. However, not all of the roles are fulfilled by the community equally. To increase the effectiveness of the child-adult community in matters of meaningful selfdetermination of adolescents, a programme of activities aimed at compensating for the lack of community work is developed.Conclusion. The study will help educational and social institutions to develop effective strategies and programmes of pedagogical support for adolescents, which may become an object of future research.

Write here write now. What can we learn from the writing goals of people with aphasia?

ABSTRACT Background People with aphasia commonly have difficulties with producing written language (dysgraphia). Greater understanding of people with aphasia’s rehabilitation goals for writing can inform development of evidence-based assessment and management tools. Aims This qualitative study aimed to explore the nature of writing goals of people with aphasia who attended an intensive speech and language therapy (SLT) centre. Methods and Procedures Qualitative data was obtained from five years-worth of client SLT reports from an intensive aphasia centre. Using qualitative content analysis, a deductive coding framework was used to identify any description of writing goals; coding incorporated iterative refinement and agreement among authors. Themes were then constructed to reflect clients’ goals to inform writing assessment and therapies. Outcomes and Results Qualitative analysis focused on content describing 66 goals on writing from 87 reports. There were two dominant interrelated themes: Supporting Communication (33 goals) and Technology (25 goals). Technology included subthemes on Emailing, Texting, Social Media, and Assistive Technology. Two smaller themes were Impairment Focused (4 goals), where goals did not have a clear functional direction, and Other (4 goals), where goals targeted specific writing activities, e.g. crosswords. Conclusions These thematic findings demonstrate the varied real-life goals for writing among attendees at an aphasia centre. They highlight the nature of relatively early-stage rehabilitation goals for individuals with aphasia, focusing on supporting communication and returning to valued activities. The results provide a context within which we can scrutinise the adequacy of current clinical tools to support goal setting, assess functional writing and design interventions for acquired writing difficulties. Further guidance is needed on assessment of writing as a supportive communication strategy and therapy towards improving this skill. There are also gaps in supporting the personal goals of people with aphasia who wish to produce written language via technology or in online environments. Future research should recognise these priorities and work together with people with aphasia, clinicians, and technology specialists to address an area of clinical need.

Sustainable Personalized E-Learning through Integrated Cross-Course Learning Path Planning

This study addresses the growing need for sustainable and personalized learning solutions in online education by optimizing cross-course learning paths. With the increasing volume of e-learning resources, students often struggle to select appropriate courses and learning paths that align with their individual abilities and goals. A novel cross-course learning path planning model is proposed, which integrates resources from multiple courses using modified matching functions based on Item Response Theory (IRT) and a knowledge graph. This model effectively matches learner attributes, such as abilities, learning styles, and goals, with material attributes like difficulty, types, and prerequisites. An innovative variable-length continuous representation (VLCR) and an improved differential evolution algorithm are employed to optimize the multi-attribute matching (MAM) model, enhancing learning personalization. Results from numerical experiments indicate that cross-course learning paths significantly enhance learning outcomes for a wide range of learners, with over 45% benefiting from improved matches compared to single-course paths. Additionally, 70% of learners experienced similar or better results with cross-course learning. This approach not only promotes efficient learning but also supports sustainable educational practices, preparing educators and learners to meet the challenges of a rapidly changing world.

An intensive eye-tracking intervention in children with dyskinetic cerebral palsy: a multiple case study

This study aimed to explore the effects of a four-week intensive eye-tracking intervention on children with dyskinetic cerebral palsy (DCP), focusing on goal attainment, communication competencies, stress levels, subjective workload, and caregivers’ perception of psychosocial impact. A multiple case study design with non-concurrent, staggered multiple baselines was employed, involving three children aged 7, 12, and 13 years. The study included a randomized baseline period of two or three weeks, an intensive eye-tracking intervention, and a six-month follow-up. Two individual eye-tracking goals were identified and assessed using the Goal Attainment Scale, while communication competencies were evaluated with the Augmentative and Alternative Communication Profile: A Continuum of Learning. Stress levels were monitored through Heart Rate Variability measured by the Bittium Faros 360° ECG Holter during eye-tracking tasks. Subjective workload and psychosocial impact were assessed using pictograms and the Psychosocial Impact of Assistive Devices Scale, respectively. Descriptive statistics were applied for analysis. All participants attained and retained their eye-tracking goals, regardless of their initial functional profiles or prior experience with eye-tracking technology. Post-intervention improvements in communication competencies were maintained at the six-month follow-up. Variations in stress levels, subjective workload, and psychosocial impact were observed among participants across different phases of the study, aiding the interpretation of the results. The study concludes that a structured, tailored, four-week intensive eye-tracking intervention can yield successful results in children with DCP, irrespective of their baseline communication abilities or functional profile. Recommendations for future research, including more robust methodologies and reliable computerized tests, are provided.

Prescribing sustainability: should UN sustainable development goals be part of the medical, pharmacy, and biomedical education?

How to adapt the curriculum of medicine, pharmacy, and biomedical sciences to prepare future health professionals to meet the challenge of maintaining quality care in a period of socio-ecological crisis? Addressing connections between humanity and sustainable environment should include an analysis of the reciprocal influence of various ecosystems, since it is now clear that healthcare systems have an impact on ecosystems and vice versa. Here, we propose that integrating the United Nations Sustainable Development Goals (SDGs) into the curriculum could be a first step in such a transversal education. Members of the faculty of medicine at the University of Namur, Belgium, including teaching staff of the department of medicine, pharmacy, biomedical sciences and psychology, were invited to respond anonymously to a questionnaire about their views on the feasibility of integrating the SDGs into their teaching. A subsequent survey on students' perceptions of such teaching was conducted by student representatives. Seventy-nine percent of surveyed members of the medical faculty believe that it is possible to integrate SDGs into their lectures. However, 44-86% of them did not know how to integrate each individual goal. 94.4% of students would like SDGs to play a greater role in their education; 64.4% of them would integrate them into existing modules; 23.9% would create an optional module, and 11.9% would create a mandatory module. Sustainable Development Goals integration into the curriculum of medicine, pharmacy, and biomedical sciences is perceived as challenging in a dense teaching program. To clarify how SDGs can translate into traditional lectures, we provide for each SDG targeted applications for bachelor's, master's and continuing education.

Embracing a different outlook: Strengths and goals of individuals currently in treatment for anorexia nervosa

PurposeDeveloping personal goals beyond weight and shape, and promoting the agency to pursue those goals, could aid in treatment and recovery from anorexia nervosa (AN). This research explores the strengths, interests and goals of individuals currently receiving treatment for AN and evaluates how treatment services are supporting them to work towards personal goals across all areas of everyday life.MethodA total of 58 community-dwelling adults currently receiving treatment for anorexia nervosa at any stage of recovery completed the Client Assessment of Strengths, Interests and Goals Self-Report (CASIG-SR). Participants reported their goals for accommodation, work and study, interpersonal relationships, recreational activities, spirituality, religion or life purpose, physical health and mental health, and the personal strengths and supports needed to achieve those goals. Concordance scores were calculated between importance of personal goals and level of support from current services regarding these goals.ResultsThemes identified across goals, strengths and supports were Connection, Independence & Confidence, Meaning & Self: The Real Me, and Stability & Balance. Work and study goals and strengths were identified strongly. The key support needed was stability from the current treatment team to provide a stable base for change. Concordance scores indicate support provided for personal goals was less than the importance of the goal to the individual.ConclusionResults suggest goals for everyday living are critical to recovery in anorexia nervosa. Specific clinical considerations to increase motivation and hope are increased access to peer support, a focus on increasing positive affect, supporting safe exercise and promoting outdoor experiences and connection with nature.Level IIIEvidence obtained from well-designed cohort or case–control analytic studies.

Transgender Latinas' Perspectives on HIV PrEP Uptake, Condom Use, and Medically Supervised Gender-Affirming Hormone Therapy: Insights From ChiCAS Qualitative Interviews.

There is a dearth of HIV prevention behavioral interventions for transgender Latinas, despite this population's HIV risk. ChiCAS (Chicas Creando Acceso a la Salud) is an intervention to increase PrEP, condom, and gender-affirming hormone therapy (GAHT) use among transgender Latinas. To inform future work, semistructured interviews were conducted postintervention with 28 ChiCAS participants. Thematic analysis with inductive coding was used. Six themes emerged: (1) health-related priorities include sexual health and avoiding discrimination; (2) safe and collaborative community is of high importance; (3) interactive education with time for sharing stories and discussion was valued; (4) PrEP uptake was facilitated through awareness and health care navigation; (5) accessing GAHT depends on cost, clinic location, and individual goals; (6) ChiCAS could be improved with more PrEP/GAHT details and social connection. Interventions with goals similar to those of ChiCAS should prioritize building community, PrEP and GAHT education tailored to participants' needs, and emphasize health care options available locally.

The rise of the owners and the neo-accumulationist imaginary: Changing perceptions of private wealth in Finnish business media, 1981–2021

The rise of the super-rich has been a defining characteristic of recent decades. This paper analyses the cultural underpinnings of contemporary private wealth accumulation, by exploring the changes in how Finnish business media has approached wealth accumulation at the top. Drawing from cultural political economy and Bourdieu’s theory of the social space, it examines how private wealth and wealthy owners have been represented in Finnish business media between 1981 and 2021. The paper argues that the changes in the representations demonstrate a rise of a new imaginary, in which private wealth accumulation is valued and perceived as a desirable goal both for individuals and the society. Finally, these cultural changes might pave the way for a new economic regime that could be called neo-accumulationist, meaning a regime characterized by specific advantages for those with accumulated economic assets.

Demand-Aware Distributed Pathfinding for Repositioning Vehicles in Shared-use Autonomous Mobility Services

Shared-use autonomous mobility services (SAMS) have the potential to provide accessible and demand-responsive mobility to passengers, while benefitting from autonomous vehicle (AV) technology and bypassing challenges related to supply-side incentives or individual driver goals. SAMS operators typically aim to achieve efficiency and improved service quality in their fleet operations, both of which are further enabled by the use of AVs. Specifically, fleet repositioning decisions in anticipation of future demand can improve service quality, but existing approaches in the literature seldom consider the problem of routing repositioning vehicles in a way that further improves SAMS objectives. This paper presents an approach for demand-aware distributed routing pathfinding for repositioning vehicles, which can supplement existing vehicle repositioning approaches. The problem is formulated with a multi-criteria objective that minimizes the vehicles’ total travel time and maximizes their total demand-serving potential, while distributing that potential equitably among the ride-seeking passengers across the transportation network. We evaluate the proposed approach via numerical experiments using an agent-based simulation of SAMS operations in the network of Manhattan in New York City. The proposed approach is compared to a baseline simple shortest path approach for routing the repositioning vehicles. The results demonstrate that mean passenger waiting times for pick-up can be reduced, while also reducing the total vehicle miles and the empty miles travelled due to repositioning. Thus, the proposed approach can help improve the overall system performance in terms of both service quality and efficiency metrics, relative to the baseline approach.

Self-realization as a Driver of Sustainable Social Development: Balancing Individual Goals and Collective Values

Self-realization is integral to the social aspect of sustainable development, as it enables individuals to boost mental health and personal well-being by achieving and enhancing their potential and life goals. This study explores how self-realization functions as a driver for sustainable social development in the face of adversity. The research, which involved 122 adult Ukrainians, utilized written surveys, statistical analysis, qualitative assessment, and ranking to collect data. Despite the persistent threats and crises, Ukrainians exhibit significant motivation and engagement in self-realization across various domains, including professional endeavors, family interactions, and parenting. The wartime environment has introduced new dimensions to self-realization, such as involvement in volunteering and charitable activities. Key areas of self-realization include professional and family roles, which highlight the effectiveness of personal fulfillment. Nonetheless, respondents encounter common challenges, such as procrastination, laziness, and emotional strain. The majority acknowledge the connection between their self-realization and sustainable social development, particularly its social dimensions. While self-actualization is essential for life fulfillment during the ongoing conflict in Ukraine, it necessitates targeted psychological support to tackle individual-specific challenges. Self-actualization remains a vital process for life fulfillment in wartime Ukraine, yet it requires targeted psychological support to address individual challenges. Keywords: self-realization, personality, development, societal sustainable development, social component of societal sustainable development, adult personality, communication

Promoting Enrichment of Living Conditions: Indispensable Goal of all Individuals

The individuals, belonging to all occupations, communities, categories and socio-economic backgrounds have one of the major goals of individuals of promoting enrichment of living conditions. In order to achieve this goal, they are required to augment information in terms of different types of subjects and concepts. Furthermore, they are required to reinforce the traits of morality, ethics, diligence and conscientiousness. In addition, individuals need to understand that there are some job duties, which are carried out on an individual basis, whereas, there are others, which are implemented through working in co-ordination with other individuals. One of the important aspects that needs to be taken into account is, individuals should not be disheartened due to problems and challenging situations. One needs to ensure, they are aware in terms of different job duties and methodologies. In addition, they need to augment confidence levels and overcome the feelings of apprehensiveness and vulnerability. Furthermore, all types of problems and challenging situations need to be prevented from giving rise to impediments within the course of putting into operation different types of tasks and activities. Therefore, it is understood on a comprehensive basis that promoting enrichment of living conditions is an indispensable goal of all individuals. The main concepts that are taken into account in this research paper are, understanding the meaning and significance of promoting enrichment of living conditions, measures to be put into operation in promoting enrichment of living conditions and advantages of promoting enrichment of living conditions.

Individual and contextual effects of attention in risky choice

AbstractWe investigate the role of visual attention in risky choice in a rich experimental dataset that includes eye-tracking data. We first show that attention is not reducible to individual and contextual variables, which explain only 20% of attentional variation. We then decompose attentional variation into individual average attention and trial-wise deviations of attention to capture different cognitive processes. Individual average attention varies by individual, and can proxy for individual preferences or goals (as in models of “rational inattention” or goal-directed attention). Trial-wise deviations of attention vary within subjects and depend on contextual factors (as in models of “salience” or stimulus-driven attention). We find that both types of attention predict behavior: average individual attention patterns are correlated with individual levels of loss aversion and capture part of this individual heterogeneity. Adding trial-wise deviations of attention further improves model fit. Our results show that a decomposition of attention into individual average attention and trial-wise deviations of attention can capture separable cognitive components of decision making and provides a useful tool for economists and researchers from related fields interested in decision-making and attention.

Performance Management Systems and Employee performance in Selected Ministries in Enugu State, Nigeria

The broad objective of this study is to investigate performance management systems and employee performance in selected ministries in Enugu state, Nigeria. Two hypotheses were formulated in line with the objectives of the study. The study adopted a descriptive research design and survey method for data collection. The population of the study was 637. The study sampled the entire population due to the size of the studied population. The instrument for data collection was a structured questionnaire. Data presentation was on tabulated frequency and statistical Mean Score. Hypotheses were tested using a t-test. The results of the findings revealed that Performance planning has significant positive effects on employee performance levels in selected ministries in Enugu state(this is where the t-value = -796.442, and p-value = 0.00); that performance target setting systems do significantly drive positively employee performance level (where t-value = -295.988, and p-value = 0.00); and that Performance monitoring does significantly propel positively employee performance rate (where t-value = -128.604, and p-value = 0.00). The study, therefore, recommends that the Enugu state government should prioritize PMS through proper planning of work and work-related activities by adopting a friendly work environment and by setting clear, measurable goals, setting achievable goals for individuals and organizations; continuously monitoring the level of goal achievement and providing feedback.

A cluster approach to matching the competences of data specialists with skills in demand on the labour market

This paper addresses the challenge of aligning the competences of data specialists with skills in demand on the labour market in the rapidly evolving field of data science. Using an open dataset of 3,744 IT job postings, the study applies K-means clustering to identify key skill groupings for data specialist positions. The optimal number of clusters is determined using the elbow method, resulting in four distinct clusters: Data Analyst & Engineer, Data Platform Engineer, Data Science & Engineering Specialist, and Cloud Data Engineer. The research methodology employs unsupervised learning techniques, specifically K-means clustering, to analyze the distribution of skills across job postings. The clusters are visualized using t-distributed Stochastic Neighbor Embedding (t-SNE), providing insights into the relationships between different skill sets. The study reveals that job titles do not always unambiguously define the required skills, emphasizing the importance of focusing on specific skill sets rather than job titles alone. To bridge the gap between specific subject competences academic programs and industry requirements, the paper proposes a novel approach for comparing the proportion of skills in job clusters with the proportion of professional competencies in academic programs. This method is demonstrated using the Information Systems and Technologies Master's program at Kherson State University as a case study. The chi-square test is applied to confirm the statistical similarity between the skill structure of the Data Science & Engineering Specialist cluster and the competency structure of the academic program. The findings highlight the importance of continuous adaptation of profile of academic program to meet evolving industry needs. The proposed approach provides a data-driven framework for universities to align their programs with labor market demands, potentially improving graduate employability in the data science field. The study also underscores the need for personalized learning paths that can be tailored to individual career goals and skill gaps. Future research directions include the development of an artificial intelligence system to form individualized educational trajectories based on the skills required for specific job clusters. This could further enhance the alignment between education and industry needs, preparing students more effectively for the dynamic data science job market.

Effectiveness of solution-focused brief therapy: An umbrella review of systematic reviews and meta-analyses

Objective This umbrella review of systematic reviews and meta-analyses evaluates the effectiveness of Solution-Focused Brief Therapy (SFBT) across various populations and settings. Method A total of 25 systematic reviews, including 15 meta-analyses, were analyzed. Reviews were included if they used systematic search methods and quality assessments and focused on the effectiveness of SFBT as a therapeutic approach. Results SFBT demonstrated significant positive outcomes across different issues, settings, and cultural contexts, with no evidence of harm. High confidence in evidence of effectiveness was established for depression, overall mental health, and progress towards individual goals for the adult population. In addition, findings indicated mainly moderate confidence in evidence of SFBT effectiveness for a wide variety of outcomes for all age groups. No difference was found in the confidence in the evidence by world region, though Western and Eastern studies researched some different aspects. Conclusion SFBT is an effective therapeutic approach for various psychological, social, school, medical, couple, or self-related issues. Further research with rigorous methodologies and comprehensive reporting is needed to strengthen the confidence in these findings and provide evidence for the brevity of the intervention.

Future Sensemaking Beyond Own Business Self-Interests: Insights from Offshore Wind Energy Innovation Ecosystems

This research explores how participants in an innovation ecosystem, operating without a focal firm, can collaboratively envision and create societal value beyond their individual business goals. Using participatory action research, the investigation focuses on two cases within the offshore wind energy sector, involving four complementary enterprises and nine enterprises that are both complementary and competitive. The findings suggest that ecosystem participants can collectively pursue opportunities for sustainable value creation that surpass the interests and goals of individual firms. This shift towards a future-oriented, ecosystem-wide perspective was driven by the focus on ecosystem-level value propositions and the dynamic organizing of heterogeneous knowledge, individual behaviors, and organizational behaviors, enabling successful future-oriented sensemaking. The research process highlights practices that led to significant innovation outcomes, such as halving investments, reducing accidents and rework, accelerating operational flow, and fostering long-term investments, like a floating port for installation and maintenance improvements. This study enhances understanding of how future-oriented sensemaking in innovation ecosystems without a focal firm can drive innovation and societal value creation, offering insights for practitioners, academics, and policymakers on governance and collaborative efforts to enable value creation in innovation ecosystems.

Global environmental sustainability trends: A temporal comparison using a new interval-based composite indicator

Assessing progress on the pursuit of the Sustainable Development Goals is crucial for evaluating the sustainability of a Country, although this is not easy, considering the interdependencies or interconnections of individual goals with others, and the fact that there are several indicators for each goal. The aims of this research are: (1) to propose a novel interval-based environmental sustainable composite index (ESI) suitable to monitor the worldwide environmental SDGs' implementation at national scale, (2) to solve the problem of missing data in large databases and the subjectivity in computing a composite index (CI), (3) to group and compare statistically countries according to the ESI, and (4) to represent spatially the results to identify areas of the world more or less environmentally sustainable than others. Clustering and Sankey diagrams have supported the temporal and spatial analysis of ESI trends, showing that Canada, Brazil, New Zealand, and several European countries have been the most sustainable in 2019. The novelty of this indicator is that each country presents an ESI central value, the most probable value of the composite indicator, and a range, which represents the uncertainty given by the lower and upper bounds. In this sense, it is possible to better interpret the results of the composite indicator, while simultaneously obtaining a measure of the uncertainty of the results. The composite indicator can be used to monitor countries’ vulnerability towards the unsustainability risk, as well as countries that are not able to escape from a sort of “unsustainability trap”.

Advancing SDGs and performance management strategies for security personnel in higher education

Orientation: Performance management aligns individual and organisational goals, enhancing employee motivation, sustaining organisational success.Research purpose: The study aimed to investigate challenges experienced by security managers with performance management systems in a tertiary institution in Durban, South Africa.Motivation for the study: Understanding challenges delivers insights to advance organisational effectiveness, support sustainable development, and enhance human resources (HR) practices in the higher education security sector.Research approach/design and method: A qualitative approach was used. Twelve security managers were purposively selected for semi-structured interviews. Data were analysed using thematic analysis and NVivo software.Main findings: The study identified three challenges, namely inadequate training, education, development and communication, technological barriers and low computer literacy, limited resource allocation, inconsistent rewards, and a lack of transparency. These challenges were found to hinder performance management system application, reducing employee engagement and productivity.Practical/managerial implications: The study recommends the institution increase adult basic education and training in technological skills and literacy. Enhancing feedback mechanisms, conducting performance needs assessments, and implementing fair reward strategies may improve sustainable development of performance management practices.Contribution/value-add: The study advocates for practical strategies in response to the challenges faced by security managers to enhance performance aligned with sustainable development goals 4 (quality education), 8 (decent work and economic growth), 10 (reduced inequalities) and 16 (peace, justice and strong institutions), contributing to sustainable HR, embracing contextualised performance management application in developing countries.

Quality indicators for occupational therapy: a scoping review

BackgroundOccupational therapists are increasingly asked to demonstrate the effectiveness, appropriateness, and efficiency of their interventions to funding bodies. However, the extent to which this is practiced and the health policy context within which such a practice is situated differs internationally. The aim of this scoping review was to establish which quality indicators are used internationally for this purpose.MethodsWe conducted a scoping review, limiting our search to Europe and the English-speaking world. To search for suitable literature, we used specialized databases from medicine, health sciences, and related fields, including CINAHL Complete and MEDLINE, as well as free internet search via Google. Furthermore, we contacted national occupational therapy associations from several countries asking for access to documents found within this search that were only accessible to association members.ResultsThe screening process identified 32 studies and documents from six national contexts. We identified and described process-level indicators, functional outcome indicators, one outcome indicator based on individual goal attainment (the Goal Attainment Scale, or GAS), and PRO-Ergo, a patient-reported experience measure (PREM). There was little information on the use of quality indicators to demonstrate the effectiveness, appropriateness, and efficiency of occupational therapy services to funding bodies in Europe and the English-speaking world that was openly available. The identified process indicators were in most cases not specific to occupational therapy interventions. Functional outcome indicators were highly specific to certain client groups or health conditions and partially appropriate for use in occupational therapy. The GAS was found to be a highly customizable measure which allowed an evaluation on body structure and function levels as well as activity and participation levels. PRO-Ergo was focused on the clients’ subjective view and their experience with occupational therapy interventions.ConclusionsAll identified quality indicators have advantages and disadvantages. Process-level indicators specific to occupational therapy could be a chance to foster the use of best practice methods. GAS and PRO-Ergo seem to be the most versatile assessment, allowing an evaluation on the level of activity and participation. Functional outcome indicators that cover a broad area of client problems may be useful additional quality indicators for some areas of practice.