Aki Rintala | LAB University of Applied Sciences (original) (raw)
Papers by Aki Rintala
The development of mobile technology and internet mobile offers new possibilities in both rehabil... more The development of mobile technology and internet mobile offers new possibilities in both rehabilitation and for patients’ assessment in a longitudinal and MS management perspective. However, because the mobile health applications (mHealth) have only been developed recently, the level of evidence supporting the use of mHealth in patients with multiple sclerosis (pwMS) is currently unclear. Therefore, this study aims to list and describe the different mHealth available for rehabilitation and self-assessment of pwMS and to define the level of evidence supporting these interventions for functioning problems categorized within the International Classification of Functioning, Disability and Health (ICF). 36 studies, performed with 22 different mHealth, were included in this review, 30 about rehabilitation and 6 for self-assessment, representing 3,091 patients. For rehabilitation, most of the studies were focusing on cognitive function and fatigue. Concerning the efficacy we found a small...
Brain Sciences
The development of mobile technology and mobile Internet offers new possibilities in rehabilitati... more The development of mobile technology and mobile Internet offers new possibilities in rehabilitation and clinical assessment in a longitudinal perspective for multiple sclerosis management. However, because the mobile health applications (mHealth) have only been developed recently, the level of evidence supporting the use of mHealth in people with multiple sclerosis (pwMS) is currently unclear. Therefore, this review aims to list and describe the different mHealth available for rehabilitation and self-assessment of pwMS and to define the level of evidence supporting these interventions for functioning problems categorized within the International Classification of Functioning, Disability and Health (ICF). In total, 36 studies, performed with 22 different mHealth, were included in this review, 30 about rehabilitation and six for self-assessment, representing 3091 patients. For rehabilitation, most of the studies were focusing on cognitive function and fatigue. Concerning the efficacy,...
Journal of Medical Internet Research
Background In the absence of a vaccine or effective treatment for COVID-19, countries have adopte... more Background In the absence of a vaccine or effective treatment for COVID-19, countries have adopted nonpharmaceutical interventions (NPIs) such as social distancing and full lockdown. An objective and quantitative means of passively monitoring the impact and response of these interventions at a local level is needed. Objective We aim to explore the utility of the recently developed open-source mobile health platform Remote Assessment of Disease and Relapse (RADAR)–base as a toolbox to rapidly test the effect and response to NPIs intended to limit the spread of COVID-19. Methods We analyzed data extracted from smartphone and wearable devices, and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the United Kingdom, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, the maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, ave...
BACKGROUND In recent years, a growing body of literature has highlighted the role of wearable and... more BACKGROUND In recent years, a growing body of literature has highlighted the role of wearable and mobile remote measurement technology (RMT) applied to seizure detection in hospital settings, whereas more limited evidence has been produced in the community setting. In clinical practice, seizure assessment typically relies on self-report, which is known to be highly unreliable. Moreover, most people with epilepsy self-identify factors that lead to increased seizure likelihood, including mood, behavior, sleep pattern, and cognitive alterations, all of which are amenable to measurement via multiparametric RMT. OBJECTIVE The primary aim of this multicenter prospective cohort study is to assess the usability, feasibility, and acceptability of RMT in the community setting. In addition, this study aims to determine whether multiparametric RMT collected in populations with epilepsy can prospectively estimate variations in seizure occurrence and other outcomes, including seizure frequency, q...
JMIR mHealth and uHealth
Background Sleep problems tend to vary according to the course of the disorder in individuals wit... more Background Sleep problems tend to vary according to the course of the disorder in individuals with mental health problems. Research in mental health has associated sleep pathologies with depression. However, the gold standard for sleep assessment, polysomnography (PSG), is not suitable for long-term, continuous monitoring of daily sleep, and methods such as sleep diaries rely on subjective recall, which is qualitative and inaccurate. Wearable devices, on the other hand, provide a low-cost and convenient means to monitor sleep in home settings. Objective The main aim of this study was to devise and extract sleep features from data collected using a wearable device and analyze their associations with depressive symptom severity and sleep quality as measured by the self-assessed Patient Health Questionnaire 8-item (PHQ-8). Methods Daily sleep data were collected passively by Fitbit wristband devices, and depressive symptom severity was self-reported every 2 weeks by the PHQ-8. The data...
The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts... more The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. While increases in stress-related symptomatology and other adverse psycho-social outcomes as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. In order to gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (March 22nd to April 19th) in a convenience sample of N=15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the in...
Journal of Medical Internet Research
Background Despite the growing interest in the experience sampling method (ESM) as a data collect... more Background Despite the growing interest in the experience sampling method (ESM) as a data collection tool for mental health research, the absence of methodological guidelines related to its use has resulted in a large heterogeneity of designs. Concomitantly, the potential effects of the design on the response behavior of the participants remain largely unknown. Objective The objective of this meta-analysis was to investigate the associations between various sample and design characteristics and the compliance and retention rates of studies using ESM in mental health research. Methods ESM studies investigating major depressive disorder, bipolar disorder, and psychotic disorder were considered for inclusion. Besides the compliance and retention rates, a number of sample and design characteristics of the selected studies were collected to assess their potential relationships with the compliance and retention rates. Multilevel random/mixed effects models were used for the analyses. Resu...
Archives of Physical Medicine and Rehabilitation
Journal of Sleep Research
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
Systematic reviews, Jan 18, 2018
Due to a number of methodological advantages and theoretical considerations, more and more studie... more Due to a number of methodological advantages and theoretical considerations, more and more studies in clinical psychology research employ the Experience Sampling Method (ESM) as a data collection technique. Despite this growing interest, the absence of methodological guidelines related to the use of ESM has resulted in a large heterogeneity of designs while the potential effects of the design itself on the response behavior of the participants remain unknown. The objectives of this systematic review are to investigate the associations between the design characteristics and the data quality and feasibility of studies relying on ESM in severe psychiatric disorders. We will search for all published studies using ambulatory assessment with patients suffering from major depressive disorder, bipolar disorder, and psychotic disorder or individuals at high risk for these disorders. Electronic database searches will be performed in PubMed and Web of Science with no restriction on the publica...
Journal of rehabilitation medicine, Jan 31, 2017
To determine the effectiveness of technology-based distance interventions for promoting physical ... more To determine the effectiveness of technology-based distance interventions for promoting physical activity, using systematic review and meta-analysis. A literature search of studies published between 2000 and 2015 was conducted in the following databases: CENTRAL, EMBASE, Ovid MEDLINE, CINAHL, PsycINFO, OTseeker, WOS and PEDro. Studies were selected according to the PICOS framework, as follows: P (population): adults; I (intervention): technology-based distance intervention for promoting physical activity; C (comparison) similar distance intervention without technology, O (outcomes) physical activity; S (study design) randomized controlled trial. Physical activity outcomes were extracted and quality was assessed by 2 independent authors. Eight studies were included in the meta-analysis. The mean (standard deviation; range) me thodological quality score of the studies was 6 (1.3; 4-8). Technology-based distance interventions were not more or less effective than conventional treatment ...
European journal of physical and rehabilitation medicine, Jan 2, 2017
Technology has been thought to have strong potential for promoting physical activity, but the evi... more Technology has been thought to have strong potential for promoting physical activity, but the evidence has remained unclear. The aim of this study was to examine whether a technology-based distance intervention promoting physical activity is more effective than a physical activity intervention without the use of technology. This systematic review is registered in Prospero (CRD42016035831). A systematic literature search of studies published between January 2000 to December 2015 was conducted in CENTRAL, EMBASE, Ovid MEDLINE, CINAHL, PsycINFO, OT-Seeker, WOS and PEDro. Studies were selected by two independent authors applying the following PICOS criteria P) adults, I) technology-based distance intervention promoting physical activity, C) distance intervention promoting physical activity without technology, O) physical activity, S) RCT. Quality was assessed following the guidelines of Cochrane Back Review Group. Meta-analysis and meta-regression were performed using R. From 3 031 stud...
Disability and rehabilitation, Jan 15, 2016
To determine the effectiveness of technology-based distance physical rehabilitation interventions... more To determine the effectiveness of technology-based distance physical rehabilitation interventions in multiple sclerosis (MS) on physical activity and walking. A systematic literature search was conducted in seven databases from January 2000 to September 2016. Randomized controlled trials of technology-based distance physical rehabilitation interventions on physical activity and walking outcome measures were included. Methodological quality of the studies was determined and a meta-analysis was performed. In addition, a subanalysis of technologies and an additional analysis comparing to no treatment were conducted. The meta-analysis consisted of 11 studies. The methodological quality was good (8/13). The Internet, telephone, exergaming, and pedometers were the technologies enabling distance physical rehabilitation. Technology-based distance physical rehabilitation had a large effect on physical activity (standard mean difference (SMD) 0.59; 95% confidence interval (95% CI) 0.38 to 0.7...
Quality of Life Research, 2016
The aim of this 10-year follow-up study was to determine changes in health-related quality of lif... more The aim of this 10-year follow-up study was to determine changes in health-related quality of life (HRQoL) over time among ambulatory persons with MS (PwMS) at the baseline using generic and disease-specific instruments. Methods: Of 109 independently walking PwMS included in a population-based study in 2002, 77 (70.6%) were reassessed in 2012. HRQoL was captured using the 36-Item Short Form Survey Instrument (RAND-36), 15D-instrument (15D) and the Multiple Sclerosis Quality of Life-54 (MSQOL-54). Repeated measures ANOVA and effect size (ES) calculations (Cohen's d) were used in the statistical analysis. Results: The RAND-36 physical health composite score (PHC) (p=.003, ES=0.26) and 15D total score (p=.012, ES=0.25) declined from the baseline levels. In particular, lower scores were observed on the RAND-36 scales of physical functioning (p=.001, ES=0.27), pain (p=.020, ES=0.25), and general health perceptions (p=.002, ES=0.36), on the MSQOL-54 scales of physical functioning (p=.001, ES=0.27), pain (p=.040, ES=0.21), sexual functioning (p=.003, ES=0.43), and satisfaction with sexual functioning (p=.012, ES=0.38), and in the 15D dimensions of mobility (p=.004, ES=0.31) and sexual functioning (p=<.001, ES=0.59). Improvement was observed on the RAND-36 scale of social functioning (p=.049, ES=0.25). The other composite scores, scales, and dimensions remained unchanged. Conclusions: The results of this study suggest that ambulatory PwMS at baseline reported reduced HRQoL in physical functioning after a 10-year follow-up period while emotional well-being was maintained and social functioning improved. The scores in the other HRQoL dimensions and scales remained unchanged. More long-term population-based studies are needed to precisely determine the development of HRQoL among PwMS.
Development discussions are confidential discussions between a manager and an employee where the ... more Development discussions are confidential discussions between a manager and an employee where the main topic is the employee's competence and work performance. Development discussions are a good work instrument for managers in knowledge management and for the development of the whole organization or unit. Development discussions are a way to express the strategy of the organization to the employees. The purpose of this development project was to improve the development discussion structure in the remit of the special health care in the Federation of Municipalities for Hospital and Social Services (Carea) in Kymenlaakso. The aim of this development project was to clarify the present state of the development discussions and create a model for the development discussions for the managers in the remit of the special health care. The managers answered a survey, the purpose of which was to establish the present state of the development discussions and the views of the managers on their own competence in holding the development discussions. The development discussion phases vary in different research studies. In this development project, the phases are divided into three parts: preparations, development discussion situations and follow-ups. The result of the survey showed that the managers held development discussions more frequently with their employees' than with their own managers. The discussions were seen as a useful instrument to improve employees' competence and work performance. The information gathered from the development discussions also helped to improve employee training and developed the unit or department. The managers were prepared for the development discussions, but their competence in preparing the employees was lacking. Previous goals were not included in the development discussions and the managers found it challenging to combine the organization goals and strategy to the goals of the employee. Further, the issues agreed on in the development discussions were not followed-up by all the managers. The model for the development discussions was created with the help of the theory part of the development project, the results of the survey and the meetings held with the leading matron. The purpose of the model is to improve the readiness of the managers to hold development discussions.
The development of mobile technology and internet mobile offers new possibilities in both rehabil... more The development of mobile technology and internet mobile offers new possibilities in both rehabilitation and for patients’ assessment in a longitudinal and MS management perspective. However, because the mobile health applications (mHealth) have only been developed recently, the level of evidence supporting the use of mHealth in patients with multiple sclerosis (pwMS) is currently unclear. Therefore, this study aims to list and describe the different mHealth available for rehabilitation and self-assessment of pwMS and to define the level of evidence supporting these interventions for functioning problems categorized within the International Classification of Functioning, Disability and Health (ICF). 36 studies, performed with 22 different mHealth, were included in this review, 30 about rehabilitation and 6 for self-assessment, representing 3,091 patients. For rehabilitation, most of the studies were focusing on cognitive function and fatigue. Concerning the efficacy we found a small...
Brain Sciences
The development of mobile technology and mobile Internet offers new possibilities in rehabilitati... more The development of mobile technology and mobile Internet offers new possibilities in rehabilitation and clinical assessment in a longitudinal perspective for multiple sclerosis management. However, because the mobile health applications (mHealth) have only been developed recently, the level of evidence supporting the use of mHealth in people with multiple sclerosis (pwMS) is currently unclear. Therefore, this review aims to list and describe the different mHealth available for rehabilitation and self-assessment of pwMS and to define the level of evidence supporting these interventions for functioning problems categorized within the International Classification of Functioning, Disability and Health (ICF). In total, 36 studies, performed with 22 different mHealth, were included in this review, 30 about rehabilitation and six for self-assessment, representing 3091 patients. For rehabilitation, most of the studies were focusing on cognitive function and fatigue. Concerning the efficacy,...
Journal of Medical Internet Research
Background In the absence of a vaccine or effective treatment for COVID-19, countries have adopte... more Background In the absence of a vaccine or effective treatment for COVID-19, countries have adopted nonpharmaceutical interventions (NPIs) such as social distancing and full lockdown. An objective and quantitative means of passively monitoring the impact and response of these interventions at a local level is needed. Objective We aim to explore the utility of the recently developed open-source mobile health platform Remote Assessment of Disease and Relapse (RADAR)–base as a toolbox to rapidly test the effect and response to NPIs intended to limit the spread of COVID-19. Methods We analyzed data extracted from smartphone and wearable devices, and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the United Kingdom, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, the maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, ave...
BACKGROUND In recent years, a growing body of literature has highlighted the role of wearable and... more BACKGROUND In recent years, a growing body of literature has highlighted the role of wearable and mobile remote measurement technology (RMT) applied to seizure detection in hospital settings, whereas more limited evidence has been produced in the community setting. In clinical practice, seizure assessment typically relies on self-report, which is known to be highly unreliable. Moreover, most people with epilepsy self-identify factors that lead to increased seizure likelihood, including mood, behavior, sleep pattern, and cognitive alterations, all of which are amenable to measurement via multiparametric RMT. OBJECTIVE The primary aim of this multicenter prospective cohort study is to assess the usability, feasibility, and acceptability of RMT in the community setting. In addition, this study aims to determine whether multiparametric RMT collected in populations with epilepsy can prospectively estimate variations in seizure occurrence and other outcomes, including seizure frequency, q...
JMIR mHealth and uHealth
Background Sleep problems tend to vary according to the course of the disorder in individuals wit... more Background Sleep problems tend to vary according to the course of the disorder in individuals with mental health problems. Research in mental health has associated sleep pathologies with depression. However, the gold standard for sleep assessment, polysomnography (PSG), is not suitable for long-term, continuous monitoring of daily sleep, and methods such as sleep diaries rely on subjective recall, which is qualitative and inaccurate. Wearable devices, on the other hand, provide a low-cost and convenient means to monitor sleep in home settings. Objective The main aim of this study was to devise and extract sleep features from data collected using a wearable device and analyze their associations with depressive symptom severity and sleep quality as measured by the self-assessed Patient Health Questionnaire 8-item (PHQ-8). Methods Daily sleep data were collected passively by Fitbit wristband devices, and depressive symptom severity was self-reported every 2 weeks by the PHQ-8. The data...
The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts... more The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. While increases in stress-related symptomatology and other adverse psycho-social outcomes as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. In order to gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (March 22nd to April 19th) in a convenience sample of N=15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the in...
Journal of Medical Internet Research
Background Despite the growing interest in the experience sampling method (ESM) as a data collect... more Background Despite the growing interest in the experience sampling method (ESM) as a data collection tool for mental health research, the absence of methodological guidelines related to its use has resulted in a large heterogeneity of designs. Concomitantly, the potential effects of the design on the response behavior of the participants remain largely unknown. Objective The objective of this meta-analysis was to investigate the associations between various sample and design characteristics and the compliance and retention rates of studies using ESM in mental health research. Methods ESM studies investigating major depressive disorder, bipolar disorder, and psychotic disorder were considered for inclusion. Besides the compliance and retention rates, a number of sample and design characteristics of the selected studies were collected to assess their potential relationships with the compliance and retention rates. Multilevel random/mixed effects models were used for the analyses. Resu...
Archives of Physical Medicine and Rehabilitation
Journal of Sleep Research
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
Systematic reviews, Jan 18, 2018
Due to a number of methodological advantages and theoretical considerations, more and more studie... more Due to a number of methodological advantages and theoretical considerations, more and more studies in clinical psychology research employ the Experience Sampling Method (ESM) as a data collection technique. Despite this growing interest, the absence of methodological guidelines related to the use of ESM has resulted in a large heterogeneity of designs while the potential effects of the design itself on the response behavior of the participants remain unknown. The objectives of this systematic review are to investigate the associations between the design characteristics and the data quality and feasibility of studies relying on ESM in severe psychiatric disorders. We will search for all published studies using ambulatory assessment with patients suffering from major depressive disorder, bipolar disorder, and psychotic disorder or individuals at high risk for these disorders. Electronic database searches will be performed in PubMed and Web of Science with no restriction on the publica...
Journal of rehabilitation medicine, Jan 31, 2017
To determine the effectiveness of technology-based distance interventions for promoting physical ... more To determine the effectiveness of technology-based distance interventions for promoting physical activity, using systematic review and meta-analysis. A literature search of studies published between 2000 and 2015 was conducted in the following databases: CENTRAL, EMBASE, Ovid MEDLINE, CINAHL, PsycINFO, OTseeker, WOS and PEDro. Studies were selected according to the PICOS framework, as follows: P (population): adults; I (intervention): technology-based distance intervention for promoting physical activity; C (comparison) similar distance intervention without technology, O (outcomes) physical activity; S (study design) randomized controlled trial. Physical activity outcomes were extracted and quality was assessed by 2 independent authors. Eight studies were included in the meta-analysis. The mean (standard deviation; range) me thodological quality score of the studies was 6 (1.3; 4-8). Technology-based distance interventions were not more or less effective than conventional treatment ...
European journal of physical and rehabilitation medicine, Jan 2, 2017
Technology has been thought to have strong potential for promoting physical activity, but the evi... more Technology has been thought to have strong potential for promoting physical activity, but the evidence has remained unclear. The aim of this study was to examine whether a technology-based distance intervention promoting physical activity is more effective than a physical activity intervention without the use of technology. This systematic review is registered in Prospero (CRD42016035831). A systematic literature search of studies published between January 2000 to December 2015 was conducted in CENTRAL, EMBASE, Ovid MEDLINE, CINAHL, PsycINFO, OT-Seeker, WOS and PEDro. Studies were selected by two independent authors applying the following PICOS criteria P) adults, I) technology-based distance intervention promoting physical activity, C) distance intervention promoting physical activity without technology, O) physical activity, S) RCT. Quality was assessed following the guidelines of Cochrane Back Review Group. Meta-analysis and meta-regression were performed using R. From 3 031 stud...
Disability and rehabilitation, Jan 15, 2016
To determine the effectiveness of technology-based distance physical rehabilitation interventions... more To determine the effectiveness of technology-based distance physical rehabilitation interventions in multiple sclerosis (MS) on physical activity and walking. A systematic literature search was conducted in seven databases from January 2000 to September 2016. Randomized controlled trials of technology-based distance physical rehabilitation interventions on physical activity and walking outcome measures were included. Methodological quality of the studies was determined and a meta-analysis was performed. In addition, a subanalysis of technologies and an additional analysis comparing to no treatment were conducted. The meta-analysis consisted of 11 studies. The methodological quality was good (8/13). The Internet, telephone, exergaming, and pedometers were the technologies enabling distance physical rehabilitation. Technology-based distance physical rehabilitation had a large effect on physical activity (standard mean difference (SMD) 0.59; 95% confidence interval (95% CI) 0.38 to 0.7...
Quality of Life Research, 2016
The aim of this 10-year follow-up study was to determine changes in health-related quality of lif... more The aim of this 10-year follow-up study was to determine changes in health-related quality of life (HRQoL) over time among ambulatory persons with MS (PwMS) at the baseline using generic and disease-specific instruments. Methods: Of 109 independently walking PwMS included in a population-based study in 2002, 77 (70.6%) were reassessed in 2012. HRQoL was captured using the 36-Item Short Form Survey Instrument (RAND-36), 15D-instrument (15D) and the Multiple Sclerosis Quality of Life-54 (MSQOL-54). Repeated measures ANOVA and effect size (ES) calculations (Cohen's d) were used in the statistical analysis. Results: The RAND-36 physical health composite score (PHC) (p=.003, ES=0.26) and 15D total score (p=.012, ES=0.25) declined from the baseline levels. In particular, lower scores were observed on the RAND-36 scales of physical functioning (p=.001, ES=0.27), pain (p=.020, ES=0.25), and general health perceptions (p=.002, ES=0.36), on the MSQOL-54 scales of physical functioning (p=.001, ES=0.27), pain (p=.040, ES=0.21), sexual functioning (p=.003, ES=0.43), and satisfaction with sexual functioning (p=.012, ES=0.38), and in the 15D dimensions of mobility (p=.004, ES=0.31) and sexual functioning (p=<.001, ES=0.59). Improvement was observed on the RAND-36 scale of social functioning (p=.049, ES=0.25). The other composite scores, scales, and dimensions remained unchanged. Conclusions: The results of this study suggest that ambulatory PwMS at baseline reported reduced HRQoL in physical functioning after a 10-year follow-up period while emotional well-being was maintained and social functioning improved. The scores in the other HRQoL dimensions and scales remained unchanged. More long-term population-based studies are needed to precisely determine the development of HRQoL among PwMS.
Development discussions are confidential discussions between a manager and an employee where the ... more Development discussions are confidential discussions between a manager and an employee where the main topic is the employee's competence and work performance. Development discussions are a good work instrument for managers in knowledge management and for the development of the whole organization or unit. Development discussions are a way to express the strategy of the organization to the employees. The purpose of this development project was to improve the development discussion structure in the remit of the special health care in the Federation of Municipalities for Hospital and Social Services (Carea) in Kymenlaakso. The aim of this development project was to clarify the present state of the development discussions and create a model for the development discussions for the managers in the remit of the special health care. The managers answered a survey, the purpose of which was to establish the present state of the development discussions and the views of the managers on their own competence in holding the development discussions. The development discussion phases vary in different research studies. In this development project, the phases are divided into three parts: preparations, development discussion situations and follow-ups. The result of the survey showed that the managers held development discussions more frequently with their employees' than with their own managers. The discussions were seen as a useful instrument to improve employees' competence and work performance. The information gathered from the development discussions also helped to improve employee training and developed the unit or department. The managers were prepared for the development discussions, but their competence in preparing the employees was lacking. Previous goals were not included in the development discussions and the managers found it challenging to combine the organization goals and strategy to the goals of the employee. Further, the issues agreed on in the development discussions were not followed-up by all the managers. The model for the development discussions was created with the help of the theory part of the development project, the results of the survey and the meetings held with the leading matron. The purpose of the model is to improve the readiness of the managers to hold development discussions.