<p><strong>Objectives: </strong>To assess the reliability and validity of the Patient Specific Functional Scale when administered to people living with Parkinson’s Disease.<strong></strong></p> <p><strong>Methods and Materials: </strong>Twenty six people living with Parkinson’s Disease from Hamilton and Burlington were interviewed four times within a four month period. The participants answered the Movement Disorders Sponsored Unified Disease Rating Scale part II, the Parkinson’s Disease Questionnaire 39, and the Patient Specific Functional Scale. Reliability assessment addressed test-retest reliability and reliability of the change scores using Intraclass Correlation Coefficients. Validity assessment focused on convergent construct validity and longitudinal validity by correlating the Patient Specific Functional Scale with the other measures administered.</p> <p><strong>Results: </strong>The<strong> </strong>test retest reliability of the scores yielded by the PSFS was ICCpre= 0.72 (95%CI=0.47-0.86); ICCpost=0.83 (95%CI=0.66-0.92). The reliability of change scores was 0.50. In relation to the validity, no significant correlations were found between the Patient Specific Functional Scale and the other measures. <strong></strong></p> <p><strong>Conclusions: </strong>The PSFS yields reliable scores when it is administered to people living with PD. The Patient Specific Functional Scale does not target the same outcomes as the MDS-UPDRS part II and the PDQ-39. The PSFS does not detect change in functioning in people living with PD within a four month period.</p> / Master of Science (MSc)

Objective: The primary aim of the study was to examine the automated linguistic analysis of the open-ended problem (PQ) and life-effects (LEQ) questionnaires to understand the psychological effects of tinnitus. Design: The study used a cross-sectional design. Participants completed online questionnaires which included demographic questions, several standardised patient-reported outcome measures (PROMs), and two open-ended questions focussing on PQ and LEQ related to tinnitus. The response to open-ended questions was analysed using the Linguistic Inquiry Word Count (LIWC) software to identify the frequency of text on various linguistic dimensions relevant to tinnitus. Study sample: 336 individuals with tinnitus. Results: The study results point to two broad findings. First, although PQ and LEQ have some similarities with PROMs (e.g. the linguistic dimension negative emotions having a weak positive correlation with anxiety and depression), no correlation with the number of dimensions suggests that the open-ended questions identify additional elements that are not captured in PROMs. Second, more linguistic dimensions from the PQ correlate with PROMs compared to LEQ suggesting that the current PROMs are problem-oriented. Conclusions: The study results support the idea that the use of open-ended questions in addition to PROMs may help optimise the efforts in examining the effects of chronic conditions such as tinnitus.

This thesis explored symptom clusters in patients with lung cancer before, during and after oncological treatment. A literature review and an interview study was used to explore the symptom cluster experience from the patients’ perspective. A large diversity of symptom cluster constellations were identified, in which fatigue was the most commonly occurring symptom, followed by dyspnea, pain, depression, cough and nutritional impact symptoms. Many symptom assessment instruments were identified, measuring mostly the intensity-dimension alone or in combination with timing. The results also stress that living with symptom clusters during treatment is more about survival than actually living. Patients’ symptom management strategies were shaped by impacting conditions such as knowledge and earlier experience of symptoms. Symptoms were often regarded as unavoidable by the patients and something to accept. How symptoms were recognized by health care professionals further added to the normalization of symptom clusters. Subsequently, patients would not always ask for support, and their quality of life was negatively affected. Holistic person-centered care including multi-dimensional symptom assessment is considered essential to ensure adequate symptom cluster management for patients with lung cancer.

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.

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.

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.