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PubMed2003

Feedback in hypothesis testing: an ERP study.

We used event-related potentials (ERPs) to probe the effects of feedback in a hypothesis testing (HT) paradigm. Thirteen college students serially tested hypotheses concerning a hidden rule by judging its presence or absence in triplets of digits and revised them on the basis of an exogenous performance feedback. ERPs time-locked to performance feedback were then examined. The results showed differences between responses to positive and negative feedback at all cortical sites. Negative feedback, indicating incorrect performance, was associated to a negative deflection preceding a P300-like wave. Spatiotemporal principal component analysis (PCA) showed the interplay between early frontal components and later central and posterior ones. Lateralization of activity was selectively detectable at frontal sites, with a left frontal dominance for both positive and negative feedback. These results are discussed in terms of a proposed computational model of trial-to-trial feedback in HT in which the cognitive and emotive aspects of feedback are explicitly linked to putative mediating brain mechanisms. The properties of different feedback types and feedback-related deficits in depression are also discussed.

Adult↗
PubMed2006

Performance feedback drives caudate activation in a phonological learning task.

Adults have difficulty discriminating nonnative phonetic contrasts, but under certain circumstances training can lead to improvement in this ability. Despite the ubiquitous use of performance feedback in training paradigms in this and many other domains, the mechanisms by which feedback affects learning are not well understood. In this event-related functional magnetic resonance imaging study, we examined how performance feedback is processed during perceptual learning. Thirteen Japanese speakers for whom the English phonemes [r] and [l] were nondistinct performed an identification task of the words "road" and "load" that has been shown to be effective in inducing learning only when performance feedback is present. Each subject performed alternating runs of training with and without feedback, followed by performance of a card-guessing task with monetary reward and punishment outcomes. We found that the caudate nucleus was more robustly activated bilaterally when performing the perceptual identification task with feedback than without feedback, and the right caudate nucleus also showed a differential response to positive and negative feedback. Moreover, using a within-subjects design, we found that the caudate nucleus also showed a similar activation pattern to monetary reward and punishment outcomes in the card-guessing task. These results demonstrate that the caudate responds to positive and negative feedback during learning in a manner analogous to its processing of extrinsic affective reinforcers and indicate that this region may be a critical moderator of the influence of feedback on learning. These findings impact our broader understanding of the mechanisms underlying nondeclarative learning and language acquisition.

Adult↗
PubMed1995

Subject-controlled performance feedback and learning of a closed motor skill.

Research on knowledge of results and knowledge of performance has been directed toward identification of the optimal schedule for administering feedback. The purpose of this investigation was to assess whether a schedule based on performance feedback controlled by the learner would be a more effective means of delivering feedback than any predetermined or random schedule. Participants were randomly assigned to one of five conditions: (a) control group receiving no performance feedback, (b) 50% relative performance feedback, (c) summary performance feedback, (d) subject-controlled performance feedback, and (e) yoked control group. Data were collected during an acquisition phase (four blocks of 10 trials) and a retention phase (two block of 10 trials) in which subjects performed an underhand ball toss. Repeated-measures analyses indicated significant main effects for the absolute error (AE). Participants in the subject-controlled performance feedback condition performed significantly better on both retention trials than the other groups. Analysis suggests that a feedback schedule which is controlled by the learner may be a more effective means of delivering augmented feedback than other schedules which have been examined.

Adult↗
PubMed2005

What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review.

BACKGROUND: Improving the quality of health care requires a range of evidence-based activities. Audit and feedback is commonly used as a quality improvement tool in the UK National Health Service [NHS]. We set out to assess whether current guidance and systematic review evidence can sufficiently inform practical decisions about how to use audit and feedback to improve quality of care. METHODS: We selected an important chronic disease encountered in primary care: diabetes mellitus. We identified recommendations from National Institute for Clinical Excellence (NICE) guidance on conducting audit and generated questions which would be relevant to any attempt to operationalise audit and feedback in a healthcare service setting. We explored the extent to which a systematic review of audit and feedback could provide practical guidance about whether audit and feedback should be used to improve quality of diabetes care and, if so, how audit and feedback could be optimised. RESULTS: National guidance suggests the importance of securing the right organisational conditions and processes. Review evidence suggests that audit and feedback can be effective in changing healthcare professional practice. However, the available evidence says relatively little about the detail of how to use audit and feedback most efficiently. CONCLUSION: Audit and feedback will continue to be an unreliable approach to quality improvement until we learn how and when it works best. Conceptualising audit and feedback within a theoretical framework offers a way forward.

Humans↗
PubMed1998

The ontogeny of glucocorticoid negative feedback: influence of maternal deprivation.

Glucocorticoid feedback can be viewed as having two modes of operation: proactive and reactive. "Proactive" feedback maintains basal activity of the hypothalamic-pituitary-adrenal axis, whereas the termination of stress-induced hypothalamic-pituitary-adrenal activity is facilitated by "reactive" feedback. In the present study we studied the ontogeny of both feedback modes and tested the hypothesis that the development of feedback depends on mother-pup interaction. On postnatal day 9 or 12, pups were deprived (DEP) of the dam for 24 h; nondeprived pups of the same age served as controls. The pups were adrenalectomized (ADX) at the end of deprivation and given corticosterone (CORT) replacement by either injection or pellet implants using the following two designs: first at the time of adrenalectomy (ADX) to test the role of CORT in the maintenance of basal ACTH levels, and then 3 h after ADX, to investigate CORT suppression of elevated ACTH levels induced by prior ADX. Regarding proactive feedback, the results showed that injection of CORT at the time of ADX was only partially effective in preventing ACTH elevations, whereas CORT pellets maintained basal levels of ACTH in all ADX pups. The reactive mode of negative feedback in nondeprived pups was resistant to CORT injection, whereas the CORT pellet resulted in a return to basal levels within 60 min. Maternal deprivation did not affect proactive feedback, but caused a more sustained increase in ACTH levels and a failure to return to basal levels 3 h after ADX despite significantly higher levels of circulating CORT in these DEP pups. It is concluded that 1) proactive and reactive modes of negative feedback are operative, provided the pups are maintained on chronic replacement with CORT; 2) DEP impairs the reactive, rather than the proactive, mode of feedback inhibition in the neonate.

Adrenalectomy↗
PubMed2003

Closing the loop: feedback to accident and emergency SHOs on their referrals to hospital specialists.

OBJECTIVES: To determine whether A&E SHOs in the Anglia and Oxford region receive regular case-specific feedback on their referrals to hospital specialists. METHODS: A telephone survey of an A&E SHO from each hospital in the region, using a semi-structured questionnaire and written protocol. The main questions asked were: (i) do you receive regular feedback about specific patients you refer to other specialties? If so, which one(s)? and (ii) do you think personal regular case-specific feedback about your referrals would be useful? RESULTS: Overall, 18 A&E SHOs and one staff grade were interviewed, one from each hospital (response rate 100%). Over the whole region, there were 106 hospital specialties to which A&E SHOs could directly refer out-patient cases. However, regular case-specific communication or feedback was received by the referring A&E SHO from only 5 (4.7%). There were 237 hospital specialties to which A&E SHOs could directly refer in-patients. However, regular case-specific feedback was received by the referring A&E SHO from only 3 specialities (1.3%). The A&E doctors at 18 of the 19 hospitals (95%) felt regular case-specific feedback would be useful. Of these, 13 (72%) would prefer written feedback - 5 (38%) would prefer a copy of the discharge summary or GP clinic letter, 6 (46%) a letter written specifically to the A&E SHO, 1 a letter to be sent via the A&E consultant, and 1 wished for 'any written feedback'. All 18 doctors wanted feedback from at least one of the specialties of general medicine, paediatrics, trauma and orthopaedics, and general surgery. CONCLUSIONS: A&E SHOs in the Anglia and Oxford region do not receive regular case-specific feedback on their referrals to hospital specialists. Almost all A&E SHOs in this study would welcome it. The situation could be rectified by routinely sending them copies of clinic letters or discharge summaries.

Ambulatory Care↗
PubMed2006

Real-time contributions of auditory feedback to avian vocal motor control.

Songbirds and humans both rely critically on hearing for learning and maintaining accurate vocalizations. Evidence strongly indicates that auditory feedback contributes in real time to human speech, but similar contributions of feedback to birdsong remain unclear. Here, we assessed real-time influences of auditory feedback on Bengalese finch song using a computerized system to detect targeted syllables as they were being sung and to disrupt feedback transiently at short and precisely controlled latencies. Altered feedback elicited changes within tens of milliseconds to both syllable sequencing and timing in ongoing song. These vocal disruptions were larger when feedback was altered at segments of song with variable sequence transitions than at stereotyped sequences. As in humans, these effects depended on the feedback delay relative to ongoing song, with the most disruptive delays approximating the average syllable duration. These results extend the parallels between speech and birdsong with respect to a moment-by-moment reliance on auditory feedback. Moreover, they demonstrate that song premotor circuitry is sensitive to auditory feedback during singing and suggest that feedback may contribute in real time to the control and calibration of song.

Acoustic Stimulation↗
PubMed1992

Increasing nurses' use of feedback to promote infection-control practices in a head-injury treatment center.

This study established regular implementation of a simple feedback procedure by supervisory nurses with their assistants at a head-injury treatment center. Five nurses were trained to distribute brief written comments to their assistants about infection-control practices, including using gloves to avoid contact with body fluids. Following low rates of written feedback, nurses met with the trainer weekly to set goals for using the system, to review feedback rates, and to examine contingent letters of appreciation. Written feedback increased from 0.09 to 0.58 per day. When outcome data on glove use were subsequently added to the feedback provided to nurses, nurses' feedback on glove use increased and overall glove use by assistants increased by 36.7% for 66.7% of assistants who responded to feedback. Assistants rated feedback as highly accurate and indicated some interest in receiving future feedback. However, nurses and assistants expressed a preference for oral over written feedback.

Adult↗
PubMed2003

On the generality of optimal versus objective classifier feedback effects on decision criterion learning in perceptual categorization.

Biased category payoff matrices engender separate reward- and accuracy-maximizing decision criteria Although instructed to maximize reward, observers use suboptimal decision criteria that place greater emphasis on accuracy than is optimal. In this study, objective classifier feedback (the objectively correct response) was compared with optimal classifier feedback (the optimal classifier's response) at two levels of category discriminability when zero or negative costs accompanied incorrect responses for two payoff matrix multiplication factors. Performance was superior for optimal classifier feedback relative to objective classifier feedback for both zero- and negative-cost conditions, especially when category discriminability was low, but the magnitude of the optimal classifier advantage was approximately equal for zero- and negative-cost conditions. The optimal classifier feedback performance advantage did not interact with the payoff matrix multiplication factor. Model-based analyses suggested that the weight placed on accuracy was reduced for optimal classifier feedback relative to objective classifier feedback and for high category discriminability relative to low category discriminability. In addition, the weight placed on accuracy declined with training when feedback was based on the optimal classifier and remained relatively stable when feedback was based on the objective classifier. These results suggest that feedback based on the optimal classifier leads to superior decision criterion learning across a wide range of experimental conditions.

Decision Making↗
PubMed1981

[Electromyographic feedback for cerebral children (adults): on the residual tension of muscle (author's transl)].

In order to investigate the residual tension of muscle in cerebral palsied (CP) children (adults) and the effect of EMG feedback on its relaxation processes, 5 normal children and 15 CP children, including one adult, were asked to flex their elbows gradually, then increase the tension with full flexion, and finally relax as quickly as possible under three conditions: pre-feedback, feedback, and post-feedback. Under the feedback condition, a meter display was provided. Results were as follows: (1) All except one in the CP group showed more residual tension than the normals at the pre-feedback condition. (2) Under the feedback condition, the time to relax was shortened significantly in the CP group. (3) The CPs could be classified into following four types by the influence of EMG feedback. (a) Type A (N = 2) showed no change. (b) Type B (N = 9) improved. (c) Type C (N = 1) improved in the latter half of the feedback condition, though it increased tension in the first half. (d) Type D (N = 2) increased conversely under the feedback condition.

Adolescent↗
PubMed2004

Force platform feedback for standing balance training after stroke.

BACKGROUND: Standing balance deficits are common in individuals after stroke. One way to address these deficits is to provide the individual with feedback from a force platform while balance activities are performed. The feedback can take visual and/or auditory form. OBJECTIVES: To determine if visual or auditory force platform feedback improves the clinical and force platform standing balance outcomes in clients with stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register (last searched December 2003), and the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to May 2003), EMBASE (1974 to May 2003), CINAHL (1982 to May 2003), PEDro (May 2003), CIRRIE (May 2003) and REHABDATA (May 2003). Reference lists of articles were reviewed and manufacturers of equipment were contacted. SELECTION CRITERIA: Randomized controlled trials comparing force platform with visual feedback and/or auditory feedback to other balance treatments. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trials for inclusion, methodological quality, and data extraction. Trials were combined for meta-analysis according to outcome and type of feedback. MAIN RESULTS: We included seven trials (246 participants). Force platform feedback did not improve clinical measures of balance when moving or walking (Berg Balance Scale and Timed Up and Go). Significant improvements in laboratory force platform indicators of stance symmetry were found for regimens using visual feedback (standardised mean difference (SMD) -0.68, 95% confidence interval (CI) -1.31 to -0.04, p = 0.04) and the concurrent visual and auditory feedback (weighted mean difference (WMD) -4.02, 95% CI -5.99 to -2.04, p = 0.00007). There were no significant effects on laboratory postural sway indicators, clinical outcomes or measures of function at follow-up assessment. REVIEWERS' CONCLUSIONS: Force platform feedback (visual or auditory) improved stance symmetry but not sway in standing, clinical balance outcomes or measures of independence.

Biofeedback, Psychology↗
PubMed1994

The self-comparison process and self-discrepant feedback: consequences of learning you are what you thought you were not.

In 4 experiments, college students received bogus personality-test feedback that they possessed an actual-self, ideal-self (desired but unpossessed), or rejected-self (unwanted and unpossessed) trait. When the test had low credibility, rejected-self feedback produced positive mood (PM), whereas ideal-self feedback produced negative mood (NM). Self-comparison of the feedback with self-representations apparently revealed the falsity of the feedback, making salient Ss' virtues or shortcomings. The pattern reversed when test credibility was high: Rejected-self feedback led to NM and ideal-self feedback to PM. These effects were not evident, however, when the feedback trait had high personal importance or when Ss generated counterexamples before feedback about an unimportant trait. This suggests that reactions to self-discrepant feedback depend on whether convincing counterexamples are readily accessed during self-comparison.

Affect↗
PubMed1992

Augmented Kinematic Feedback for Motor Learning.

Although the study of feedback about goal achievement (knowledge of results, KR) has been important for the development principles of augmented information feedback in simple skills, there is reason to question the generalizability of these findings to many common learning situations. A more appropriate type of information for skill learning appears to be augmented kinematic (or kinetic) feedback regarding the movement pattern. The experiments presented here extend recent findings about KR to a paradigm involving kinematic feedback. In Experiment 1, we examined how several kinds of temporal and spatial kinematic information supplement KR in learning. Spatial kinematic variables were more effective than temporal variables, as indicated by performance in a retention test without kinematic feedback. In Experiment 2, we manipulated the schedule of augmented kinematic feedback in a method that paralleled previous KR work. We contrasted averaged schedules of augmented feedback, in which information was given either after every trial or as averaged information after every set of five trials. On retention tests without kinematic feedback given 1 day and 1 week after acquisition, averaged schedules led to enhanced performance over an every-trial format. Together, these results begin to define the variables important in kinematic feedback, and suggest that this feedback may influence learning in ways parallel to KR.

Journal Article↗
PubMed1996

Use of effective feedback to facilitate adult learning.

Effective feedback plays a critical role in helping adult learners achieve their educational goals and reach their maximum potential. It should be an integral part of every adult education program. Both formal and informal feedback should be provided by teachers, based on the underpinnings of effective feedback techniques. The feedback source, message, and recipient exert influences on the process and must be considered in this context. For maximum impact, the source of feedback must be considered credible and trustworthy by the recipient. The message should provide clear information about performance standards and the performance of the student, in order to elucidate any differences. Positive information should be shared before negative information, and the feedback should be specific, objective, consistent, and timely. The environment in which feedback is provided must be supportive, and should encourage an open dialog between the teacher and the student. Both parties should discuss various items in a spirit of collaboration, and clearly define the goals that need to be achieved. A plan for follow-up and ongoing reinforcement must be developed and implemented. In addition to oral and written feedback, other modes of providing feedback, such as computers, audiotapes, and videotapes, should be considered, and used as appropriate. Skills of faculty members in providing effective feedback may be enhanced through faculty-development programs, such as workshops and self-study modules.

Adult↗
PubMed2002

Antithrombotic prescribing in atrial fibrillation: application of a prescribing indicator and multidisciplinary feedback to improve prescribing.

BACKGROUND: Atrial fibrillation is common in older people, and is associated with an increased risk of ischaemic stroke. Antithrombotic therapy reduces stroke-risk, but is known to be under-prescribed. OBJECTIVES: To use an evidence-based indicator to audit antithrombotic prescribing for older hospital inpatients with atrial fibrillation, and to assess whether feedback of audit results to hospital staff increases antithrombotic use. DESIGN: Cross-sectional notes-based audits, before and after feedback. SETTING: Six Aged Care and three General Medicine units at nine Australian public teaching hospitals between September 1998 and May 1999. SUBJECTS: 1416 hospital inpatients aged 65 years and over (median age 81). METHODS: Medication charts were reviewed to identify patients prescribed digoxin or amiodarone. Presence of atrial fibrillation was confirmed by review of the patients' medical notes. To be considered appropriate, patients with atrial fibrillation had to be receiving either warfarin or aspirin (or both), or have documented contraindications to both agents. Feedback of audit results was provided to medical, pharmacy and nursing staff at multidisciplinary meetings. Changes in antithrombotic prescribing 4-8 weeks and 6 months after feedback were assessed. Prescribing 8 weeks prior to feedback was assessed retrospectively. RESULTS: Appropriateness of the decision to prescribe (or not prescribe) antithrombotic therapy increased from 81/112 (72%) immediately prior to feedback to 97/105 (92%) 4-8 weeks later (P<0.0001). Six months after feedback, appropriateness of prescribing declined slightly, to 85% (p=0.36). Over the 8 weeks prior to feedback, appropriateness of prescribing did not change (74% versus 77%, p=0.80). Increased aspirin prescribing accounted for most of the improvement in antithrombotic use after feedback, while warfarin continued to be under-used. CONCLUSIONS: Antithrombotics were under-prescribed for older patients with atrial fibrillation. Audit and multidisciplinary feedback resulted in increased antithrombotic prescribing. The intervention had a greater impact on aspirin prescribing compared with warfarin.

Aged↗
PubMed1991

The acceptability of behavioral and emotional feedback depending upon valence and structure in personal growth groups.

Forty-eight students participated in a one-time personal growth group. Subjects were assigned to one of eight groups. Exercises were conducted to promote interpersonal contact, followed by feedback sessions. Four groups generated and exchanged feedback among group members. Statement lists were used as feedback in remaining groups. Within each set, one group delivered positive-behavioral; one, positive-emotional; one, negative-behavioral; and one, negative-emotional feedback. Positive feedback was more credible, desirable, and influential for recipients and donors; positive-behavioral feedback in particular was more credible. Donors rated unstructured feedback as more credible than structured feedback, with negative-structured feedback the least credible with donors and recipients. Findings are discussed in terms of research and application.

Adult↗
PubMed2005

Visual feedback schedules influence visuomotor resistance to the Müller-Lyer figures.

We examined whether blocked or random visual feedback schedules influence visuomotor resistance to the Müller-Lyer (ML) illusion. Participants completed closed-loop (CL) and open-loop (OL) grasping movements to an object embedded within fins-in and fins-out ML configurations. In the blocked feedback schedule, CL and OL trials were completed in separate blocks of trials, whereas visual conditions were randomly interleaved in the random feedback schedule. The results of the blocked feedback schedule showed that OL, but not CL, trials were influenced in a direction consistent with the perceptual effects of the ML illusion. For the random feedback schedule, however, both CL and OL trials were influenced by the illusion. We have interpreted these results to reflect the fact that participants evoked distinct control strategies based on the predicted availability of visual feedback. Specifically, the refractory nature of CL trials in the blocked feedback schedule suggests that advance knowledge that visual feedback would be available during a response encouraged an online control strategy wherein metrical visual information supported grasping. When visual feedback was unavailable (i.e., blocked OL trials), or could not be predicted in advance of a response (i.e., random CL and OL trials), it is proposed that movements were structured offline via perception-based visual information that was "tricked" by the cognitive properties of the ML illusion.

Feedback↗
PubMed2004

Feedback of workplace data to individual workers, workgroups or supervisors as a way to stimulate working environment activity: a cluster randomized controlled study.

OBJECTIVE: To test whether feedback and discussion of ergonomic and psychosocial working-environment data during one short session with individual, groups or supervisors of white-collar computer workers had an effect on activity to modify workplace design, working technique and psychosocial aspects of work. METHODS: A total of 36 workgroups from nine organizations representing different trades was randomized (stratified for organization) to three feedback conditions or control with no feedback. Data were collected 1 month before and 6 months after feedback sessions. The effects studied were: (1) change in the proportion of workgroup members who reported any modification regarding workplace design or working technique; (2) change in the proportion of workgroup members who reported any modification regarding psychosocial aspects; (3) average number of modification types regarding workplace design or working technique per individual in a workgroup; (4) average number of modification types regarding psychosocial aspects per individual in a workgroup. RESULTS: All feedback conditions differed positively from controls regarding change in the proportion of workgroup members who reported any modification in workplace design or working technique. No such effect was found for psychosocial aspects. For change in average number of psychosocial modification types per individual in a workgroup an effect was observed for feedback to supervisors. No intervention effect was observed for the average number of modifications in workplace design or working technique per individual in a workgroup. CONCLUSION: Feedback and discussion of ergonomic and psychosocial working-environment data during one short session with individual, groups or supervisors of white-collar computer workers may have a positive effect on how many people in a workgroup modify (or have modifications done regarding) workplace design and working technique. Feedback to supervisors may have an effect on the average number of psychosocial modification types per individual in a workgroup. Feedback to group supervisors appeared to be the most cost-effective variant.

Adult↗