Syftet med studien var att utifrån specifika frågeställningar systematiskt granska vetenskapliga studier av audiologisk grupprehabilitering. I studien undersöktes själva definitionen av audiologisk grupprehabilitering, hur olika variabler påverkar resultatet, hur utvärderingen bör ske samt hur den förhåller sig till de uppställda målen.     Den metod som tillämpats är litteraturstudie. För litteratursökningen till denna studie användes databaserna PubMed och Cinahl. Vissa artiklar söktes även från vetenskapliga studiers referenslistor samt tips från handledare.       Resultaten från de olika studierna visar att nytta med rehabilitering varierar då många aspekter spelar in och påverkar utgången av rehabiliteringsinsatsen. Rehabiliteringen bör ses som en patientcentrerad problemlösande process för att nå alla individers önskemål. När patienten själv är mer aktiv i utvärderingen ökar möjligheten att uppnå målen gällande grupprehabilitering. Hänsyn måste tas till varje enskild individs sociala bakgrund för att skapa ett audiologiskt rehabiliteringsprogram som möter deras krav vid lyssnande och kommunikation. Individens livsstil, kommunikationsvanor, krav och egenheter interagerar med fysiska begrepp såsom graden och formen på hörselnedsättningen.    Audiologisk grupprehabilitering är en åtgärd för att förbättra eller lindra problem vid hörselnedsättning och de olika studierna visar på varierande resultat. Grupprehabiliteringens mål skall möta patientens behov. För att nå dit behövs utvärderingsmetoder som är personcentrerade och problemlösande. Användandet av öppna frågeformulär är ett sätt att nå det kriteriet. / The purpose with this study was to systematically examine scientific studies of audiologic group rehabilitation. The definition of audiological rehabilitation was explored, different variables that influence the result and how the outcome measures should be done and its relationship with the goals of audiologic rehabilitation.    The method used was a literature study. Pubmed and Cinahl were used for the search of literature. Some articles were searched from scientific studies reference lists and also advice from the supervisor.   The result from the different studies shows that the effect of rehabilitation varies as there are many aspects that have an affect on the outcome measure. Rehabilitation should be seen as a patient centered problem solving process in order to reach the goals of all the individuals. When the patient is more active in the outcome measure procedure the goals also comply with the group rehabilitation. Consideration must be taken to social background of each and every individual in order to create an audiological rehabilitation program that meets their hearing and communication requirements.  The lifestyle, communication habits and singularity of the individual interact with physical conceptions as well as the grade and shape of the hearing impairment.   Audiological group rehabilitation is a mean to improve or relieve problems due to hearing impairment and the different studies show that the result varies. The goals of group rehabilitation should meet the need of the patient. In doing so there is a need of outcome measures that are person centered and problem solving. Using open questionnaires is a method to reach that criterion. / <p>Examensarbete inom audionomprogrammet, Göteborgs universitet. </p>

No / Objective To assess the learning effect, test–retest reliability and measurement error associated with the SEBT. Design Repeated-measures study. Setting Controlled university laboratory environment. Participants Twenty-two healthy recreational athletes (11 male age 22.3 ± 3.7 years, 11 female age 22.8 ± 3.1 years). Main Outcome Measures Repeated-measures ANOVA assessed learning affects. Intraclass correlations coefficients, standard error of measurement and smallest detectable difference values were calculated to assess reliability and measurement error. Results Results showed that excursion distances stabilised after four trials, therefore trials five to seven were analysed for reliability. Test–retest reliability for all reach directions was high, with intraclass correlation coefficients ranging from 0.84 to 0.92. 95% confidence intervals, standard error of measurement and smallest detectable difference ranged from 77.84 to 94.00, 2.21–2.94% and 6.13–8.15%, respectively. Conclusion These statistics will allow clinicians to evaluate whether changes in SEBT scores are due to change in an individual’s performance or random error. The findings of this study show that the SEBT is a reliable measure of lower limb function in healthy recreational athletes. Changes in normalised scores of at least 6–8% are needed to feel confident that a real change in SEBT performance has occurred.

O objetivo desta tese foi identificar, analisar e sintetizar evidências científicas quanto à eficácia do Tratamento Convencional (TC) e do Tratamento Restaurador Atraumático (ART) em molares decíduos considerando os parâmetros de longevidade, custo, aceitabilidade e desfechos reportados pelo paciente. Este volume apresenta um compilado de uma revisão sistemática e dois ensaios clínicos randomizados orientados pelas recomendações PRISMA, CONSORT-PRO e CHEERS. Realizamos uma revisão sistemática, cuja pesquisa bibliográfica buscou por desfechos reportados pelo paciente (PROs) em relação a tratamentos restauradores na dentição decídua em estudos prospectivos indexados no PubMed, Scopus e OpenGrey até fevereiro de 2018. Meta-análise de Comparação de Tratamento Misto foi realizada considerando os resultados dos estudos revisados. Devido à incompatibilidade de dados, apenas dor, ansiedade e a qualidade de vida relacionada à saúde bucal (QVRSB) foram analisados estatisticamente. Adicionalmente, delineamos um ensaio clínico de não inferioridade randomizado por cluster cujo desfecho primário foi a longevidade do TC e do ART em cavidadades oclusais e oclusoproximais de molares decíduos após 24 meses de acompanhamento. Como desfechos secundários, foram avaliados a aceitabilidade, representada pelo desconforto auto relatado e cooperação dos participantes, e a custo-eficácia. Crianças entre 3 e 6 anos apresentando pelo menos uma cavidade oclusal ou oclusoproximal em molares decíduos foram randomizadas entre os grupos convencional (TC) com resina composta sob isolamento absoluto após anestesia local ou o ART. Em ambos os grupos foi realizada remoção parcial de tecido cariado. O estudo foi desenvolvido em um trailer odontológico localizado no interior de uma escola municipal de Barueri/SP. Imediatamente após cada sessão restauradora, foi mensurado o desconforto auto relatado pelo participante e o comportamento pelo operador através da Escala Facial de Wong-Baker e escala de 5 pontos, respectivamente. As restaurações oclusais e oclusoproximais foram avaliadas após 6, 12, 18 e 24 meses segundo o critério de Frencken et al. 1998 e de Roeleveld et al. 2006. Os custos profissional e do procedimento, subdividido em custos variável e do material de consumo, foram considerados para estimar o custo incremental dos tratamentos. Regressão de Poisson em análise de multinível, Regressão de Cox com fragilidade compartilhada e regressão de Bootstrap foram utilizadas para testar o desconforto e cooperação, a sobrevida e o custo entre os tratamentos e outras variáveis independentes. O nível de significância foi ajustado em 5%. Tratamentos restauradores que utilizam agentes quimicomecânicos ou apenas instrumentos manuais para remoção de tecido cariado, como o ART, resultaram em menores índices de ansiedade e menor tendência em provocar dor em crianças do que tratamentos que utilizam instrumentos rotatórios e/ou anestesia. A QVRSB não foi influenciada pelos tratamentos restauradores nem diferiu entre os grupos. Por outro lado, o TC e o ART apresentaram baixa taxa de desconforto e alto índice de cooperação sem diferença estatisticamente significante entre eles. Ambos os tratamentos apresentaram sobrevida semelhante nas cavidades oclusais após 24 meses de acompanhamento, porém o custo do ART foi menor, demonstrando ser a opção mais custo-eficaz. Em relação às restaurações oclusoproximais, apesar do desempenho do TC ser superior ao ART, ele apresentou maior custo. Pode-se concluir que ansiedade e dor estão diretamente relacionados com tratamentos restauradores mais invasivos. Por outro lado, o TC e o ART apresentaram desconforto, cooperação e custo-eficácia semelhantes no tratamento de molares decíduos. Palavras-chave: Restauração dentária permanente. Dente decíduo. Longevidade. Custos e análises de custo. Medidas de resultados relatados pelo paciente. Ensaio clínico. Revisão. Odontopediatria. / The aim of this thesis was to identify, analyze and synthesize scientific evidences regarding the efficacy of conventional treatment (CT) and Atraumatic Restorative Treatment (ART) in primary molars considering the parameters of longevity, cost, acceptability and patient reported outcomes. This volume presents a compilation of a systematic review and two randomized clinical trials guided by the PRISMA, CONSORT-PRO and CHEERS recommendations. We performed a systematic review whose literature search included outcomes reported by the pediatric patient (PROs) related to restorative treatments in the primary dentition in prospective studies indexed in PubMed, Scopus and OpenGrey until February 2018. Mixed Treatment Comparison analysis was performed considering the results of the reviewed studies. Due to data incompatibility, only pain, anxiety and oral health related to quality of life (OHRQoL) were analyzed statistically. Additionally, we designed a cluster randomized non-inferiority clinical trial whose primary outcome was the longevity of occlusal and occlusoproximal ART and TC restorations in primary molars after 24 months of follow-up. As secondary outcomes, acceptability, represented by self-reported discomfort and participant cooperation, and cost-efficacy were assessed. Children between 3 and 6 years old presenting at least one occlusal or occlusoproximal cavity in primary molars were randomized between the conventional group (TC) with composite resin under rubber dam isolation after local anesthesia or ART. Partial removal of carious tissue was performed in both groups. The study was carried out in a dental trailer located inside a municipal school in Barueri/SP. Immediately after each restorative session, self-reported discomfort and participant cooperation were measure through the Wong-Baker Facial Scale and a 5-point scale, respectively. The occlusal and occlusoproximal restorations were evaluated after 6, 12, 18 and 24 months according to the criteria of Frencken et al. 1998 and Roeleveld et al. 2006. The professional and procedural costs, subdivided into variable and material of consumption\' costs, were considered to estimate treatments\' incremental cost. Poisson regression in multilevel analysis, Cox regression with shared fragility and Bootstrap regression were used to test discomfort and cooperation, survival and cost between treatments and among others independent variables. The level of significance was set at 5%. Restorative treatments using chemomechanical agents or only manual instruments, such as ART, were related to lower anxiety rates and less tendency to provoke pain in children compared to treatments using rotary instruments and/or anesthesia. OHRQoL was not influenced by restorative treatments nor differed between groups. On the other hand, CT and ART presented low rate of discomfort and a high cooperation with no statistically significant difference between them. Both treatments presented similar survival rates in occlusal restorations after 24 months of follow-up, but the ART cost was lower, proving to be the most cost-effective option. Regarding occlusoproximal restorations, although CT performance was superior to ART, it presented a higher cost. It can be concluded that anxiety and pain are directly related to more invasive restorative treatments. Differently, CT and ART have similar discomfort, cooperation and cost-efficacy in the treatment of primary molars.

Bakgrund: En akut akillesseneruptur (ATR) resulterar i begränsning av funktion som kan kvarstå under lång tid. I litteraturen finns ett flertal reliabla och valida utvärderingsinstrument som används vid funktionsbedömningar efter ATR. Då osäkerhet angående lämpligt val av tester inför återgång i aktivitet/idrott föreligger finns ett behov av tydliga riktlinjer i fråga om kliniskt relevanta utvärderingsinstrument. Syfte: Syftet med studien var att identifiera kliniskt relevanta fysioterapeutiska utvärderingsinstrument för bedömning av funktion hos personer med akillesseneruptur samt kartlägga dessa utifrån ett validitets och reliabilitetperspektiv. Metod: En kartläggande litteraturstudie. Litteratursökningen genomfördes i databaserna PubMed, Cinahl och PEDro mellan 2023-02-07 – 2023-02-15 utifrån inklusionskriterierna: vuxna individer med akut ATR, artiklar publicerade 2013-2023, observations- och randomiserade kontrollerade studier. Av identifierade utvärderingsinstrument valdes 15 ut, baserat på kriterierna: frekvens, klinisk användbarhet samt kategorisering enligt ramverket International Classification of Functioning, Disability and Health (ICF). Valda utvärderingsinstrument kategoriserades enligt ICF samt granskades avseende reliabilitet och validitet om denna data fanns tillgänglig. Resultat: Totalt inkluderades 15 olika utvärderingsinstrument, såväl objektiva som subjektiva, för granskning utifrån reliabilitet och validitet. Fem av dessa visade både god reliabilitet och validitet samt klinisk användbarhet. Inga diagnosspecifika utvärderingsinstrument inom ICF-kategorierna personlighetsfaktorer och omgivningsfaktorer identifierades. Slutsats: Achilles Tendon Resting Angle (ATRA), Achilles Tendon Total Rupture Score (ATRS), Foot and Ankle Outcomes Score (FAOS), Heel-Rise Endurence och Heel-Rise Height är fem tillförlitliga utvärderingsinstrumnet att använda i klinik. Inför återgång till aktivitet/idrott är det nödvändigt att komplettera med idrottsspecifika utvärderingsinstrument samt instrument som utvärderar psykologiska faktorer. / Background: An acute achilles tendon rupture (ATR) results in limitations of function that remains for a long time. There are several reliabel and valid outcome measures used in functional evaluation after ATR presented in the litterature. Due to uncertainties regarding which appropriate outcome measures to use for return to activities/sports there is a need for clinical guidelines. Purpose: The purpose was to identify physiotherapeutic outcome measures for the evaluation of function in people with achilles tendon ruptures and to chart these from a perspecive of reliability and validity. Method: A scoping review. A litterature search were performed in the databases PubMed, Cinahl and PEDro between 2023-02-07 – 2023-02-15 based on the inclusion criteria: adults with acute ATR, articles published between 2013-2023, clinical trials and randomized controlled trials. From identified outcome measures 15 were selected based on the criteria frequency, clinical usability and categorized by the theoretical framework International Classification of Functioning, Disability and Health (ICF). Selected outcome measures were categorized according to ICF and reviewed for republicity of results, if this data was available. Results: 15 outcome measures, both objective and subjective, were included for evaluation regarding reliability and validity. Five of these proved good reliability, validity and clinical usability. In the ICF categories, personal factors and environmental factors, no diagnose specific outcome measures were identified. Conclusion: Achilles Tendon Resting Angle (ATRA), Achilles Tendon Total Rupture Score (ATRS), Foot and Ankle Outcomes Score (FAOS), Heel-Rise Endurence och Heel-Rise Height are five reliable outcome measures to use in clinical practice. Before return to activities/sports it is necessary to add sportspecific outcome measures and evaluation of psychological factors.

Objectif : Comparer les dispositifs de délivrance automatisée d’insuline open-source (DDAI-OS) et les DDAI commerciaux hybrides sur le contrôle glycémique, la qualité de vie rapportée, et la sécurité chez des adultes avec diabète de type 1 (DT1). Méthodes : Étude prospective, observationnelle, de non-infériorité, comparative et en vie réelle, incluant 78 adultes canadiens avec un DT1 et utilisant un DDAI ≥ 3 mois. Quatre semaines de mesure continue du glucose ont permis d’évaluer le % temps passé dans la cible de glucose (%TIR, 3,9-10,0 mmol/L). Les indicateurs de qualité de vie ont été évalués par des échelles de mesure validées. Les mesures de sécurité sont le temps passé en hypoglycémie, la survenue d’hypoglycémie sévère ou d’acido-cétose et les problèmes techniques. Résultats : Les participants du groupe DDAI-OS étaient non inférieurs au groupe DDAI commercial sur le %TIR (78,3% [SD 11,0] vs. 71,2% [SD 10,9], différence moyenne 7,2% [95% CI 1,9% à 12,5%], p<0.001), même après ajustement sur plusieurs facteurs confondants. Le groupe DDAI-OS a passé plus de temps en hypoglycémie (<3,9 mmol/L) (3,9% [SD 3,1] vs. 1,8% [SD 1,3], p<0.001) et a rapporté moins de peur de l’hypoglycémie. Aucun épisode d’hypoglycémie sévère ou d’acido-cétose n’a été rapporté, avec un nombre de problèmes techniques similaires entre les deux groupes. Conclusion : Les DDAI-OS hybrides sont sécuritaires et non inférieurs aux DDAI commerciaux hybrides en termes de %TIR chez des adultes vivant avec un DT1 dans des conditions de vie réelle. Nos résultats soutiennent que les DDAI-OS peuvent être considérés pour la gestion du DT1. / Background: Comparison between unregulated open-source (OS) automated insulin delivery (AID) systems and commercial AID (C-AID) systems remains scarce. Objective: Compare both AID systems regarding glucose management, patient-reported outcomes (PROs), and safety among adults with type 1 diabetes (T1D) in real-life conditions. Design: Prospective, observational, non-inferiority, comparative, real-world study. Setting: On-site (a diabetes clinic in Montreal) and online (a T1D registry and social media platforms) across Canada. Participants: 78 adults with T1D, having used an AID system for ≥ 3 months, and living in Canada (26 OS-AID and 52 C-AID users). Measurements: 4-week’s data from a blinded continuous glucose monitor were used to assess effectiveness (primary outcome: 24h time in range % [TIR%], with a non-inferiority margin of 5%). Other outcomes included PRO measures using validated scales. Safety outcomes included time spent in hypoglycemia, severe hypoglycemia, diabetic ketoacidosis (DKA), and technical issues. Results: OS-AIDs were non-inferior to C-AIDs regarding 24h TIR% (78.3% [SD 11.0] vs. 71.2% [SD 10.9], mean difference 7.2% [95% CI 1.9% to 12.5%], p<0.001), even after adjusting for various confounding factors. OS-AIDs spent more time in hypoglycemia (<3.9 mmol/L) than C-AIDs (3.9% [SD 3.1] vs. 1.8% [SD 1.3], p<0.001) and reported less fear of hypoglycemia. No severe hypoglycemia or DKA was reported in either group, with a similar occurrence rate of technical issues between groups. Conclusion: OS-AIDs are safe and non-inferior to C-AIDs for TIR% among adults with T1D in real-world settings. Our findings support that both OS-AID and C-AID systems can be considered for T1D management.

No description available.

Bakgrund Femoroacetabulär impingement (FAI) syndrom är en allt vanligare rörelserelaterad funktionsnedsättning i höften, relaterat till en prematur kontakt mellan proximalafemur och acetabulum. Fysioterapi har visat god effekt vid behandlingen av FAI men aktuell forskning är begränsad och konsensus kring bästa behandlingsmetod saknas. Syfte Identifiera och kategorisera vilka fysioterapeutiska interventioner som används vid behandlingen av femoroacetabulär impingement (FAI), hur interventionerna utvärderas och presentera effekten av dessa interventioner. Metod Kartläggande litteraturöversikt. I februari 2022 genomfördes en elektronisk sökning efter vetenskapliga originalstudier från 2012, i databaserna PubMed, CINAHL och PEDRO. Totalt 1672 studier granskades varav 23 inkluderades. Huvudtyper av interventioner identifieras och kategoriserades med stöd av ICF-ramverket utifrån avsett syfte. Resultat Ur 23 inkluderade studier identifierades 36 huvudtyper av interventioner. Av dessaka tegoriseras 25 interventioner under ICF komponenten kroppsfunktioner. Hälften av interventionerna kategoriseras under neuromuskuloskeletala och rörelserelaterade funktioner. Av totalt 33 olika patientrapporterade utfallsmått (PROM) utgjorde iHOT-33, mHHS och NAHS de tre vanligast förekommande. Minst ett av de rekommenderade utfallsmåtten iHOT-12/-33, HAGOS och HOS användes i 70% av studierna. Alla inkluderade randomiserade kontrollerade studier visar signifikanta förbättringar vid användandet av fysioterapeutiska interventioner för FAI avseende PROM vid uppföljning jämfört baslinjen. Slutsats Utformningen av fysioterapeutiska interventioner vid FAI varierar, även om majoriteten syftar till att påverka neuromuskuloskeletala och rörelserelaterade funktioner. Det är möjligt att utifrån interventionens syfte klassificera interventioner vid FAI enligt ICF-ramverket. Rekommenderade diagnosspecifika PROM används i relativt hög utsträckning, till skillnad från de rekommenderade livskvalitetsmåtten. Studien belyser i likhet med tidigare forskning, bristen på konsensus gällande den fysioterapeutiska behandlingen vid FAI. / Background Femoroacetabular impingement (FAI) syndrome is an increasingly prevalent movement related disability in the hip, related to premature contact between the femur and acetabulum. Physiotherapy has shown efficacy in treating FAI, but research is limited and shows a lack of consensus regarding best conservative care. Purpose This study aims to identify and categorize the type of physiotherapeutic interventions used in treating FAI, present the effects of these interventions and to map the use of outcome measures. Methods Scoping review. In February 2022 an electronic search was conducted across the databases PubMed, CINAHL and PEDRO. A total of 1672 studies were identified of which 23 met eligibility. Main types of interventions were identified and classified based on aim using the ICF-framework. Results A total of 36 main types of interventions were identified. Out of these, 25 could be categorized under the ICF-component body functions and 18 under neuromusculoskeletal and movement-related functions. Out of 33 total PROMs, iHOT-33, mHHS and NAHS saw most use. At least one of the recommended PROMs was used in 70% of the studies. Included RCT: s show significant improvement on a variety of outcome scores. Conclusion Interventions treating FAI varies, with most targeting neuromusculoskeletal and movement-related functions. Categorization based on the aim of interventions is possible using the ICF-framework. Recommended hip-specific outcome measures are used to a greater extent compared to the more general quality of life measures. This study, in accordance with earlier research, illustrates the lack of consensus regarding the physiotherapeutic care of FAI.

Syfte: Syftet med uppsatsen är att analysera hur Sveriges landsting och regioner formulerar och visualiserar orsak-verkan-samband mellan perspektiven vid tillämpning av balanserat styrkort. Metod: Uppsatsen använder sig av en kvantitativ innehållsanalys med en dokumentstudie av Sveriges landsting och regioners årsredovisningar och budgetdokument för år 2015. Slutsatser: Av Sveriges landsting och regioner tillämpar 11 av 21 balanserat styrkort som styrmodell. Landstingen och regionernas balanserade styrkort uppnår i relativt hög grad orsak-verkan-samband, dock presenteras orsak-verkan-samband i mycket låg utsträckning för verksamhetens intressenter. Sveriges Landsting och regioner presenterar ingen form av strategikarta som uppfyller rekvisiten som ställs på en strategikarta. Vidare visar författarna att tidsperspektivet mellan perspektiven påverkas av förhållandet mellan utfallsmått och drivande mått i varje perspektiv. En hög andel utfallsmått placerar perspektivet högt upp i det balanserade styrkortet och en hög andel drivande mått placerar perspektivet långt ner i det balanserade styrkortet. / Purpose: The purpose of the thesis is to analyse how Sweden's county councils and regions phrases and visualizes the cause and effect relationship between the perspectives in the implementation of the balanced scorecard. Method: This thesis uses a quantitative content analysis with a document study of Sweden's county councils and regions financial statement and budget documents for the year 2015. Conclusions: 11 of 21 of Sweden's county councils and regions are using balanced scorecard as governance model. The county councils and regions’ balanced scorecards are demonstrating a relatively high degree of cause and effect relationship. However, this is not presented to the organization's stakeholders. Sweden's county councils and regions does not present any form of strategy map that fulfills the demands that is required of a strategy map. The authors also finds that the time dimension between the perspectives is affected by the mixture of outcome measures and performance drivers in each of the perspectives. A high proportion of outcome measures will place the perspective high up in the balances scorecard. A high proportion performance drivers will place the perspective lower in the balanced scorecard.