<p>The general aim of the thesis is to answer questions on general and differential aspects of perceived exertion and on the measurement of its intensity variation. Overall perceived exertion is commonly treated as a unidemensional construct. This thesis also explores its multidimensional character. Four empirical studies are summarized (Study I-IV). Psychophysical power functions of perceived exertion obtained with the new improved Borg CR100 (centiMax) scale were found to be consistent with results obtained with absolute magnitude estimation, and with the classical Borg CR10 and RPE scales. Women gave significantly higher perceived exertion scale values than men for the same levels of workload on a bicycle ergometer. This agrees with the fact that they were physically less strong than men. With regard to the measurement of “absolute” levels of intensity, RPE- and CR-scale values were validated by physiological measurements of heart rate and blood lactate. Predicted values of maximal individual performance obtained from psychophysical functions agreed well with actual maximal performance on the bicycle ergometer. This confirms the validity of the RPE and CR scales for measuring perceptual intensity and their value for interindividual comparisons. To study the multidimensional character of perceived exertion, 18 symptoms were measured with a CR scale: in a questionnaire, and in bicycle ergometer work tests. Five factors were extracted for the questionnaire: (1) Muscles and joints; (2) Perceived exertion; (3) Annoyance/lack of motivation; (4) Head/stomach symptoms; and (5) Cardiopulmonary symptoms. Four factors were extracted for the bicycle max test: (1) Physical distress; (2) Central perceived exertion; (3) Annoyance/lack of motivation; (4) Local perceived exertion. The questionnaire is suggested for clinical use to let patients express a variety of symptoms. The thesis also resulted in improvements of the Borg CR100 scale. An extended use of the scale is recommended.</p>

The general aim of the thesis is to answer questions on general and differential aspects of perceived exertion and on the measurement of its intensity variation. Overall perceived exertion is commonly treated as a unidemensional construct. This thesis also explores its multidimensional character. Four empirical studies are summarized (Study I-IV). Psychophysical power functions of perceived exertion obtained with the new improved Borg CR100 (centiMax) scale were found to be consistent with results obtained with absolute magnitude estimation, and with the classical Borg CR10 and RPE scales. Women gave significantly higher perceived exertion scale values than men for the same levels of workload on a bicycle ergometer. This agrees with the fact that they were physically less strong than men. With regard to the measurement of “absolute” levels of intensity, RPE- and CR-scale values were validated by physiological measurements of heart rate and blood lactate. Predicted values of maximal individual performance obtained from psychophysical functions agreed well with actual maximal performance on the bicycle ergometer. This confirms the validity of the RPE and CR scales for measuring perceptual intensity and their value for interindividual comparisons. To study the multidimensional character of perceived exertion, 18 symptoms were measured with a CR scale: in a questionnaire, and in bicycle ergometer work tests. Five factors were extracted for the questionnaire: (1) Muscles and joints; (2) Perceived exertion; (3) Annoyance/lack of motivation; (4) Head/stomach symptoms; and (5) Cardiopulmonary symptoms. Four factors were extracted for the bicycle max test: (1) Physical distress; (2) Central perceived exertion; (3) Annoyance/lack of motivation; (4) Local perceived exertion. The questionnaire is suggested for clinical use to let patients express a variety of symptoms. The thesis also resulted in improvements of the Borg CR100 scale. An extended use of the scale is recommended.

A Visual Analogue Scale (VAS) e a escala Category-Ratio (CR10) foram aplicadas para mensurar a dor em pacientes com Disfunções Temporomandibulares (DTMs) em dois estudos. No primeiro estudo, em 35 pacientes (Grupo I) foram aplicadas uma versão modificada da escala CR10 em português e a VAS para mensurar a dor espontânea, durante função orofacial e durante palpação antes e após tratamento odontológico. A modificação na CR10 consistiu em um desmembramento das categorias verbais e da escala numérica apresentadas cada uma delas em única coluna em mesma folha. Os coeficientes de correlação de Pearson entre as pontuações da VAS e da CR10 foram 0,85 antes do tratamento odontológico e 0,9 após o tratamento, indicando alta validade de critério. A associação entre os valores numéricos e as categorias verbais da Escala CR10 Modificada mostrou diferenças em relação ao que é proposto na escala original. As categorias: “Moderado", “Forte" e “Muito Forte" foram associadas a valores superiores aos originais. O segundo estudo foi planejado para investigar se essas discrepâncias nas associações das categorias com os seus valores numéricos eram replicáveis e verificar se não dependiam da forma de apresentação da escala CR10 modificada. Para isso, as escalas foram aplicadas para medir dor em duas novas amostras de pacientes com DTMs antes do tratamento odontológico. A CR10 com nova modificação e a VAS foram aplicadas à primeira amostra (Grupo II , n=23 pacientes). A modificação na CR10 consistiu na apresentação primeiro da escala numérica em uma coluna seguida pela apresentação das categorias verbais em três colunas. A CR10 original e a VAS foram aplicadas à segunda amostra (Grupo III, n=17 pacientes). Os coeficientes de correlação de Pearson foram 0,9 para o Grupo II e 0,8 para o Grupo III, indicando também alta validade de critério. Assim como no primeiro estudo, na escala CR10, as categorias verbais: “Moderado", “Forte" e “Muito Forte" foram associadas na escala numérica a valores superiores aos propostos na escala original Em ambos estudos, a escala CR10 foi a mais bem avaliada pelos pacientes, segundo a facilidade de compreensão das instruções e a adequação para o registro da dor. Evidencia-se a necessidade de mais estudos para validar a escala CR10 para a língua portuguesa para determinar com precisão a associação das categorias verbais aos valores numéricos. / Visual Analogue Scale (VAS) and Category-Ratio Scale (CR10) were applied to measure pain in patients with Temporomandibular Disorders (TMDs). In the first study, a modified version of CR10 translated to Portuguese and VAS were applied to measure spontaneous pain, functional pain and pain by touch after and before dentistry treatment in 35 patients (Group I). The CR10 modification consisted of presenting the verbal categories and the numerical scale in separated columns in a sheet. Coefficients of Pearson’s correlation between VAS and CR10 scores were .85 and .90 respectively before and after treatment, indicating a high criterion validation. The association of numerical values and verbal categories of Modified CR10 scale were different from the original CR10. The verbal expressions “moderate", “strong" and “very strong" were attached to higher values. In the second study we investigated if these discrepancies in attaching the verbal categories to the numerical scale were replicable and if they were not an artifact of the way of presenting the modified CR10 scale. To check these topics, the scales were applied to measure pain in two new samples of patients with TMD before dentistry treatment. A new modified version of the CR10 scale and the VAS were applied to the first sample (Group II, n=23 patients). This modification in CR10 scale consisted of presenting first the numerical scale in separate column, and then the verbal categories distributed in three columns. The original CR10 and VAS were applied to the second sample (Group III, n=17 patients). Coefficients of Pearsons correlation between CR10 and VAS were .9 for Group II and .8 for Group III, indicating also high criterion validation. As indicated in the first study, some verbal categories were attached to the numerical scale at higher values than those ones in the original scale. In both studies,, most patients judged the CR10 easier to be understood and more adequate to measure pain than VAS. There is evidence of the necessity of more studies to validate CR10 to Portuguese to determine with precision the association of the verbal categories to the numeric values.

A Visual Analogue Scale (VAS) e a escala Category-Ratio (CR10) foram aplicadas para mensurar a dor em pacientes com Disfunções Temporomandibulares (DTMs) em dois estudos. No primeiro estudo, em 35 pacientes (Grupo I) foram aplicadas uma versão modificada da escala CR10 em português e a VAS para mensurar a dor espontânea, durante função orofacial e durante palpação antes e após tratamento odontológico. A modificação na CR10 consistiu em um desmembramento das categorias verbais e da escala numérica apresentadas cada uma delas em única coluna em mesma folha. Os coeficientes de correlação de Pearson entre as pontuações da VAS e da CR10 foram 0,85 antes do tratamento odontológico e 0,9 após o tratamento, indicando alta validade de critério. A associação entre os valores numéricos e as categorias verbais da Escala CR10 Modificada mostrou diferenças em relação ao que é proposto na escala original. As categorias: “Moderado”, “Forte” e “Muito Forte” foram associadas a valores superiores aos originais. O segundo estudo foi planejado para investigar se essas discrepâncias nas associações das categorias com os seus valores numéricos eram replicáveis e verificar se não dependiam da forma de apresentação da escala CR10 modificada. Para isso, as escalas foram aplicadas para medir dor em duas novas amostras de pacientes com DTMs antes do tratamento odontológico. A CR10 com nova modificação e a VAS foram aplicadas à primeira amostra (Grupo II , n=23 pacientes). A modificação na CR10 consistiu na apresentação primeiro da escala numérica em uma coluna seguida pela apresentação das categorias verbais em três colunas. A CR10 original e a VAS foram aplicadas à segunda amostra (Grupo III, n=17 pacientes). Os coeficientes de correlação de Pearson foram 0,9 para o Grupo II e 0,8 para o Grupo III, indicando também alta validade de critério. Assim como no primeiro estudo, na escala CR10, as categorias verbais: “Moderado”, “Forte” e “Muito Forte” foram associadas na escala numérica a valores superiores aos propostos na escala original Em ambos estudos, a escala CR10 foi a mais bem avaliada pelos pacientes, segundo a facilidade de compreensão das instruções e a adequação para o registro da dor. Evidencia-se a necessidade de mais estudos para validar a escala CR10 para a língua portuguesa para determinar com precisão a associação das categorias verbais aos valores numéricos. / Visual Analogue Scale (VAS) and Category-Ratio Scale (CR10) were applied to measure pain in patients with Temporomandibular Disorders (TMDs). In the first study, a modified version of CR10 translated to Portuguese and VAS were applied to measure spontaneous pain, functional pain and pain by touch after and before dentistry treatment in 35 patients (Group I). The CR10 modification consisted of presenting the verbal categories and the numerical scale in separated columns in a sheet. Coefficients of Pearson’s correlation between VAS and CR10 scores were .85 and .90 respectively before and after treatment, indicating a high criterion validation. The association of numerical values and verbal categories of Modified CR10 scale were different from the original CR10. The verbal expressions “moderate”, “strong” and “very strong” were attached to higher values. In the second study we investigated if these discrepancies in attaching the verbal categories to the numerical scale were replicable and if they were not an artifact of the way of presenting the modified CR10 scale. To check these topics, the scales were applied to measure pain in two new samples of patients with TMD before dentistry treatment. A new modified version of the CR10 scale and the VAS were applied to the first sample (Group II, n=23 patients). This modification in CR10 scale consisted of presenting first the numerical scale in separate column, and then the verbal categories distributed in three columns. The original CR10 and VAS were applied to the second sample (Group III, n=17 patients). Coefficients of Pearsons correlation between CR10 and VAS were .9 for Group II and .8 for Group III, indicating also high criterion validation. As indicated in the first study, some verbal categories were attached to the numerical scale at higher values than those ones in the original scale. In both studies,, most patients judged the CR10 easier to be understood and more adequate to measure pain than VAS. There is evidence of the necessity of more studies to validate CR10 to Portuguese to determine with precision the association of the verbal categories to the numeric values.

Sleep is a basic need as important as physical fitness and good nutrition. Without enough sleep, we will create a sleep debt and experience sleepiness. Sleepiness can be defined as the inability to stay awake, a condition that has become a health problem in our 24-hour-7-day-a-week society. Estimates suggest that up to one-third of the population suffers from excessive sleepiness. Among other interactions, sleepiness affects our performance, increasing the risk of being involved in accidents. A considerable portion of work related accidents and injuries are related to sleepiness resulting in large costs for the individuals and society. Professional drivers are one example of workers who are at risk of sleepiness related accidents. Up to 40% of heavy truck accidents could be related to sleepiness. A better knowledge about reliable indicators and predictors of sleepiness is important in preventing sleepiness related accidents. This thesis investigates both objective and subjective indicators of sleepiness, how these relate to each other, and how their pattern changes over time. The indicators investigated were electroencephalography, heart rate variability, simple reaction time, head movement, and subjective ratings of sleepiness (Study I-IV). In Study V, a questionnaire study was conducted with professional drivers in northern Sweden. This study mainly deals with predictors of sleepiness. When subjects were sleep deprived both objective and subjective ratings indicated a rapid increase in sleepiness during the first hour of the test followed by a levelling off. This change in pattern was evident for all the indicators except heart rate and heart rate variability. On the other hand, HRV was correlated with the increase of EEG parameters during the post-test sleep period. The changes in pattern of the indicators included in the thesis are analysed in the perspective of temporal patterns and relationships. Of the tested indicators, a subjective rating of sleepiness with CR-10 was considered to be the most reliable indicator of sleepiness. Of the investigated predictors of sleepiness, prior sleep habits were found to be strongly associated to sleepiness and the sleepiness related symptoms while driving. The influences of driving conditions and individual characteristics on sleepiness while driving were lower. A multidisciplinary approach when investigating and implementing indicators and predictors of sleepiness is important. In addition to their actual relations to the development of sleepiness, factors such as technical and practical limitations, work, and individual and situational needs must be taken into account.