Recent work has shown that human subjects are able to predict the biomechanical ease of potential reaching movements and use these predictions to influence their choices. Here, we examined how reach decisions are influenced by specific biomechanical factors related to the control of end-point stability, such as aiming accuracy or stopping control. Human subjects made free choices between two potential reaching movements that varied in terms of path distance and biomechanical cost in four separate blocks that additionally varied two constraints: the width of the targets (narrow or wide) and the requirement of stopping in them. When movements were unconstrained (very wide targets and no requirement of stopping), subjects' choices were strongly biased toward directions aligned with the direction of maximal mobility. However, as the movements became progressively constrained, factors related to the control of the end point gained relevance, thus reducing this bias. This demonstrates that, before movement onset, constraints such as stopping and aiming participate in a remarkably adaptive and flexible action selection process that trades off the advantage of moving along directions of maximal mobility for unconstrained movements against exploiting biomechanical anisotropies to facilitate control of end-point stability whenever the movement constraints require it. These results support a view of decision making between motor actions as a highly context-dependent gradual process in which the subjective desirability of potential actions is influenced by their dynamic properties in relation to the intrinsic properties of the motor apparatus.

Background MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams. Objective Assess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics. Methods We conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups. Results One thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments—two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors. Conclusion An interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015.

BACKGROUND We previously developed MyDiabetesPlan, an evidence-based, online, interactive patient decision-aid to facilitate patient-centred, diabetes-specific goal-setting and action-planning, using shared decision making (SDM) with interprofessional (IP) healthcare teams. OBJECTIVE The aim of this study is to assess the feasibility of (1) integrating MyDiabetesPlan into routine workflows in IP primary care clinics, and (2) conducting a cluster randomized controlled trial (RCT). METHODS We conducted a pilot cluster-RCT in 10 IP primary care clinics with patients living with diabetes and 2+ other comorbidities; half of the clinics were assigned to the MyDiabetesPlan intervention and the remainder were assigned to usual care. For Objective 1, we used RCT conduct logs and financial account summaries to assess recruitment, retention metrics, and resource use. For Objective 2, we used RCT conduct logs and website usage logs to assess intervention fidelity and resource usage. We used audiotapes of clinical encounters in the intervention groups to identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team. RESULTS Objective 1: 1597 potentially eligible patients were identified through electronic medical record-based searches, of which 1113 patients met eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n=102; control: n=111), for a recruitment rate of 50.1%. 151 patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. Objective 2: A total of 179 appointments occurred (out of a total of 204 expected appointments - 2 per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%) and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 minutes. From the clinical encounter transcripts, we identified diverse strategies used by health care providers and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport-building and individualization. Barriers to use included MyDiabetesPlan-related factors (e.g. limited selection of potential diabetes management strategies), clinician-related factors (e.g. discomfort with asking certain questions), and patient-related factors (e.g. computer literacy). CONCLUSIONS We evaluated the feasibility of an IPSDM approach using decision aids to help establish treatment priorities in patients with diabetes and found that it would be feasible. A total of 151 (70.9%) patients were retained for 12 months, which required 38 personnel hours and $40.42 CAD per participant who completed the study. Lower than expected numbers of diabetes-specific appointments were observed, and only 39% of patients completed MyDiabetesPlan twice. Addressing facilitators and barriers identified in this study will improve feasibility and promote more complete and seamless integration into clinical care. CLINICALTRIAL Clinicaltrials.gov Identifier: NCT02379078 Date of Registration: February 11, 2015