In order to investigate the etiology of and evaluate interventions for work-related back injuries, researchers need efficient, accurate occupational exposure assessment methods suitable for large samples. The chapters in this thesis examine critical decisions using electromyography (EMG): How should exposure be measured? For what duration? Who should be measured, and how many times? Low-back EMG, or muscle activity data, was collected during 138 full-shift field measurements over 30 different job titles at 50 different worksites in 5 heavy industries: forestry, transportation, wood products, construction, and warehousing. Observations and self-reports of posture, manual materials handling (MMH), and driving exposures were collected concurrently. 1) Variability of EMG calibration measurements was investigated on right/left sides, multiple trials, 4 positions, and pre/post-shift. Position accounts for the majority of explained variability; there is little to gain by measuring multiple trials or pre- and post-shift, but measuring both sides and multiple positions is worthwhile. 2) Observation and self-report data were easier to collect and cheaper than the EMG direct measure. Costs and successful field performance need to be weighed against the added data detail when making choices about exposure assessment techniques for epidemiological studies. 3) Observed and self-reported exposures were used to predict EMG exposure metrics using mixed multiple linear regression models. Regression models using observed variables predicted 43-50% of the variability in the EMG metrics, while self-reported variables predicted 21%-36%. The observation exposure model provides a low-cost alternative to direct measurement. The self-reported exposure model should be considered with more caution. 4) Full-shift EMG data was resampled for 4, 2, and 1 hour, and for 10 and 2 minute durations to determine the optimal sampling duration. Bias was consistently low, but shorter durations had higher absolute error, percentage error, and limits of agreement. Durations of 4 and 2 hours may be acceptable but those less than 1 hour had large errors. 5) Components of EMG variance were calculated between- and within-subject, and between- industry, company, job, and post hoc grouping. Resolution, contrast, and exposure-response relationship attenuation were calculated for each grouping scheme. The post hoc scheme had the highest contrast and lowest resolution.

Cette thèse s’intéresse à la mesure des pratiques éducatives et à leur capacité à rendre compte de ces pratiques. Notamment, la sensibilité des instruments à rendre compte des changements dans les pratiques éducatives suite à un programme d’entraînement aux habiletés parentales est abordée tout en tenant compte des facteurs déterminants de ces pratiques. Le corps de cette thèse est composé de deux articles. L’objectif de la première étude consiste à comparer deux instruments de mesure fréquemment utilisés pour mesurer les pratiques éducatives. Les deux instruments, comparés sur la base de données empiriques, sont le Parenting Practices Interview (PPI), un instrument développé afin de mesurer les changements suite au programme d’entraînement aux habiletés parentales Ces Années Incroyables, et l’Alabama Parenting Questionnaire (APQ). Le premier s’adresse aux parents d’enfants de 3 à 8 ans alors que le second cible les parents d’enfants d’âge scolaire. Cent vingt parents ont complété le PPI et l’APQ. Des analyses corrélationnelles, une analyse en composante principale et des corrélations canoniques ont été utilisées afin de comparer les différentes pratiques mesurées par ces deux instruments. Les résultats indiquent que ces deux instruments mesurent sensiblement les mêmes pratiques parentales. Quelques sous-échelles du PPI ne sont pas mesurées par l’APQ et représentent des pratiques éducatives additionnelles. Puisque ces deux instruments mesurent sensiblement les mêmes pratiques, le choix du questionnaire devrait être fait en fonction de l’objectif de l’étude (p.ex. évaluer l’efficacité du programme Ces Années Incroyables ou non), de la facilité d’utilisation de l’instrument et de l’âge des enfants. Le deuxième article a pour objectif d’évaluer les changements dans les pratiques éducatives suite à la participation des parents à un programme d’entraînement aux habiletés parentales (PEHP) à l’aide d’une grille d’observation spécifiquement développée dans le cadre de ce projet. De plus, cette étude vise à identifier les facteurs modérateurs du changement dans les pratiques éducatives telles certaines caractéristiques de l’enfant et des parents. Soixante-dix-sept familles ayant un enfant de 6 à 9 ans avec un trouble du déficit d’attention/hyperactivité (TDA/H) ont été retenues pour cette étude. Les familles ont participé soit au PEHP, soit elles ont reçu du soutien téléphonique (ST), ou elles ont continué à recevoir les services dans la communauté. Les pratiques éducatives ont été évaluées avant et après l’intervention à l’aide d’une mesure observationnelle. Les résultats indiquent que seuls les parents ayant participé au PEHP utilisent davantage de pratiques positives et ont diminué les pratiques sévères et négatives suite à l’intervention. De plus, le sous-type de TDA/H, la présence ou non de comorbidité chez l’enfant et le cumul de risque à l’intérieur d’une famille, calculé à partir de caractéristiques des parents, ne modèrent pas le changement suite à l’intervention. Cette étude démontre donc la capacité de la mesure observationnelle à détecter des changements suite à l’intervention de même que l’efficacité du PEHP auprès des familles d’enfants d’âge scolaire ayant un TDA/H. / The purpose of this thesis was to examine various measures of parenting practices and their ability to account for these practices. The instrument’s sensitivity to changes following a parent training program is also examined while taking into account potential moderators of treatment response. Two studies constitute the body of this thesis. The first study compared two parenting practices questionnaire on the basis of empirical data. The Parenting Practices Interview (PPI) is a self-report questionnaire for 3 to 8-year old children used to evaluate changes in parenting practices following a parent training program (PTP). The Alabama Parenting Questionnaire (APQ) is a self-report questionnaire for school-age children that has been used for multiple research purposes. One hundred and twenty parents completed both the PPI and APQ. Correlation analyses, principal component analysis and canonical correlations were performed, with results indicating that the PPI and APQ measure similar parenting practices. Only a few scales from the PPI were not measured by the APQ and represented additional content. Because both measures cover the same parenting practices aspects equally well, choice of questionnaire should be based on purpose of study, practicality and age of children. The second study examined changes in parenting practices following a parent training program for families of school-age children diagnosed with attention-deficit/hyperactivity disorder (ADHD). Changes were examined with an observational measure specifically created for this project. Seventy-seven families were assigned to either the Incredible Years parent training program (PTP), a support phone call group (SPC), or to a community services (C) control group. Parenting practices were assessed before and after the intervention through direct observations. Results showed that parents in the PTP group reduced the percentage of harsh/negative parenting practices and increased the percentage of positive parenting practices used following the intervention while parents from the other two groups did not change. In addition, ADHD subtypes, comorbidity and cumulative risks based on parent’s characteristics did not moderate treatment response. Findings from this study show that the new observational measure is sensitive enough to detect changes following a PTP and also indicate that a parent training program is a valuable intervention for families of school-age children diagnosed with ADHD.

The aim of this thesis was to investigate if the outcome of rehabilitation efforts is depending on what view health care has in relation to what need of care people have and if the outcome for different groups of patients with low-back complaints (specific versus non-specific complaints) is various successful. The outcome is measured in length of sick leave, number of spells and granted sickness and disability pensions. This thesis combines a theoretical analysis of different theories of health with studies of two empirical materials. One material comprises a group of individuals with low-back complaints (specific versus non-specific complaints) from a nation-wide survey of Living Conditions conducted by Statistics Sweden in 1981. The other material comprises a sample of individuals on sick leave either due to low-back complaints or other kinds of complaints than low-back complaints. The outcome of these studies are measured as to what extent people with low-back complaints are granted a disability pension (Paper III) and which the characteristics are of those on sick leave due to low-back complaints compared to those with other kinds of complaints (Paper IV). The results from Paper III revealed a difference concerning socio-economic group and granted disability pension between those with specific, non-specific and frequent low-back complaints. Those with non-specific and frequent low-back complaints were to higher extent manual workers and disability pensioners. The results of Paper IV reveals also a socio-economic difference besides that those with low-back complaints had longer sick leave periods and more spells.  What does these results indicate? Are non-specific and frequent low-back complaints not successfully treated within the health care system? Is this due to how these matters have been identified? Are these individuals truly disabled due to their low-back complaints, if so how are they assessed and treated? I believe that the notions of health and disease as well as the social context in which people act influence the outcome of rehabilitation. If people judge their health as bad (here due to low-back troubles) and in need of health care and the health care system do not recognise their need when not identified as diseased a problem arises. These individuals claim that their ability to work is hampered due to the low-back complaint and the society has an obligation and needs a legitimate solution for those individuals that cannot support themselves due to ill health. This obligation makes a demand on the health care system. If non-specific complaints are assessed as non-medical problems, from a biomedical point of view, health care lacks measures to take care of these people if they ought to be taken care of within the health care system at all. But this outcome (a disability pension) may also indicate that people suffer from a “true” illness although not defined by objective findings. If that is the state one may ask if there is a lack of sufficient diagnostic procedures and measures as well. A rehabilitation approach stemming from a humanistic social perspective might lead to a more favourable outcome for people with low-back complaints, whether or not these complaints have been identified in a biomedical sense, as this perspective take into account both the goals, the resources and the social context of that individual.  This thesis has paid attention to the matter that conceptual notions, which seldom are considered within clinical praxis, are of vital importance for the outcome of rehabilitation. Health care falls short especially when it comes to non-specific and frequent low-back complaints and this may be due to the biomedical model being used too strictly within a domain where other models, here exemplified as Pörn’s Theory of Health, might result in a more favourable rehabilitation outcome for the individual. / digitalisering@umu

In order to investigate the etiology of and evaluate interventions for work-related back injuries, researchers need efficient, accurate occupational exposure assessment methods suitable for large samples. The chapters in this thesis examine critical decisions using electromyography (EMG): How should exposure be measured? For what duration? Who should be measured, and how many times? Low-back EMG, or muscle activity data, was collected during 138 full-shift field measurements over 30 different job titles at 50 different worksites in 5 heavy industries: forestry, transportation, wood products, construction, and warehousing. Observations and self-reports of posture, manual materials handling (MMH), and driving exposures were collected concurrently. 1) Variability of EMG calibration measurements was investigated on right/left sides, multiple trials, 4 positions, and pre/post-shift. Position accounts for the majority of explained variability; there is little to gain by measuring multiple trials or pre- and post-shift, but measuring both sides and multiple positions is worthwhile. 2) Observation and self-report data were easier to collect and cheaper than the EMG direct measure. Costs and successful field performance need to be weighed against the added data detail when making choices about exposure assessment techniques for epidemiological studies. 3) Observed and self-reported exposures were used to predict EMG exposure metrics using mixed multiple linear regression models. Regression models using observed variables predicted 43-50% of the variability in the EMG metrics, while self-reported variables predicted 21%-36%. The observation exposure model provides a low-cost alternative to direct measurement. The self-reported exposure model should be considered with more caution. 4) Full-shift EMG data was resampled for 4, 2, and 1 hour, and for 10 and 2 minute durations to determine the optimal sampling duration. Bias was consistently low, but shorter durations had higher absolute error, percentage error, and limits of agreement. Durations of 4 and 2 hours may be acceptable but those less than 1 hour had large errors. 5) Components of EMG variance were calculated between- and within-subject, and between- industry, company, job, and post hoc grouping. Resolution, contrast, and exposure-response relationship attenuation were calculated for each grouping scheme. The post hoc scheme had the highest contrast and lowest resolution.

Introdução: A melhora na sobrevida de pacientes com AIDS está associada ao aumento da disponibilidade de terapia antirretroviral cada vez mais eficaz. A eficácia do tratamento exige que a adesão aos antirretrovirais seja igual ou superior a 95% das doses prescritas. Objetivo: Comparar a adesão dos pacientes durante sua participação em ensaio clínico e após esse período. Método: Estudo de coorte. Incluíram-se pacientes já inseridos em um ensaio clínico randomizado. A adesão foi aferida durante a participação no ensaio clínico, através de auto-relato. Após o encerramento do ensaio clínico, a adesão foi aferida pelo registro da retirada dos medicamentos no SICLOM. Considerou-se aderente pacientes que obtiveram escore de 95% ou mais. Resultados: Foram incluídos 310 pacientes. Maioria homens (63,2%) com idade média de 40 (±9,8) anos. O regime terapêutico mais utilizado por 52,9% dos pacientes foi associação de zidovudina + lamivudina com efavirenz. A taxa de adesão foi de 60,8% durante a participação no ensaio clínico e de 35,2% no segundo momento (P<0,001). O escore médio considerando a adesão média do período aferida por auto-relato foi maior (M=88,9% DP 19,2) que a obtida a partir do registro das retiradas dos antirretrovirais no SICLOM (M=78,1% ±DP 28,5; P=0,02). Conclusão: A adesão dos pacientes durante a participação no ensaio clínico foi melhor do que no período após o término deste. A adesão não foi satisfatória em ambos os períodos alertando para necessidade de intervenções continuadas para melhorar a adesão à terapia antirretroviral. / Background: The improvement in survival of AIDS patients is associated with increased availability of antiretroviral therapy more effective. The effective treatment requires regimen adherence at least of 95% of the prescribed doses. Objective: To compare the adherence of patients during their participation in clinical trial and thereafter. Method: Cohort study. It included patients already entered into a clinical trial. Adherence was measured during participation in the trial through self-report. After the end of the Clinical trial, the adherence was measured by recording the pharmacy refill of medication in SICLOM. It was considered adherent patients achieving a score of 95% or more. Results: We included 310 patients. Most men (63.2%) aged average 40 (± 9.8) years. The most widely used regimen for 52.9% of patients was the association of zidovudine + lamivudine with efavirenz. The rate of compliance was 60.8% during participation in the trial and 35.2% in second time (P <0.001). The average score given the accession mean period measured by self-report was higher (M = 88.9% SD 19.2) that obtained From the record of withdrawals of antiretroviral drugs in SICLOM (M ± SD = 78.1% 28.5, P = 0.02). Conclusion: The patient compliance during participation in clinical trial was better than in the period after the end of it. The membership does not was satisfactory in both periods need for warning continued interventions to improve adherence to antiretroviral therapy.

Introdução: A melhora na sobrevida de pacientes com AIDS está associada ao aumento da disponibilidade de terapia antirretroviral cada vez mais eficaz. A eficácia do tratamento exige que a adesão aos antirretrovirais seja igual ou superior a 95% das doses prescritas. Objetivo: Comparar a adesão dos pacientes durante sua participação em ensaio clínico e após esse período. Método: Estudo de coorte. Incluíram-se pacientes já inseridos em um ensaio clínico randomizado. A adesão foi aferida durante a participação no ensaio clínico, através de auto-relato. Após o encerramento do ensaio clínico, a adesão foi aferida pelo registro da retirada dos medicamentos no SICLOM. Considerou-se aderente pacientes que obtiveram escore de 95% ou mais. Resultados: Foram incluídos 310 pacientes. Maioria homens (63,2%) com idade média de 40 (±9,8) anos. O regime terapêutico mais utilizado por 52,9% dos pacientes foi associação de zidovudina + lamivudina com efavirenz. A taxa de adesão foi de 60,8% durante a participação no ensaio clínico e de 35,2% no segundo momento (P<0,001). O escore médio considerando a adesão média do período aferida por auto-relato foi maior (M=88,9% DP 19,2) que a obtida a partir do registro das retiradas dos antirretrovirais no SICLOM (M=78,1% ±DP 28,5; P=0,02). Conclusão: A adesão dos pacientes durante a participação no ensaio clínico foi melhor do que no período após o término deste. A adesão não foi satisfatória em ambos os períodos alertando para necessidade de intervenções continuadas para melhorar a adesão à terapia antirretroviral. / Background: The improvement in survival of AIDS patients is associated with increased availability of antiretroviral therapy more effective. The effective treatment requires regimen adherence at least of 95% of the prescribed doses. Objective: To compare the adherence of patients during their participation in clinical trial and thereafter. Method: Cohort study. It included patients already entered into a clinical trial. Adherence was measured during participation in the trial through self-report. After the end of the Clinical trial, the adherence was measured by recording the pharmacy refill of medication in SICLOM. It was considered adherent patients achieving a score of 95% or more. Results: We included 310 patients. Most men (63.2%) aged average 40 (± 9.8) years. The most widely used regimen for 52.9% of patients was the association of zidovudine + lamivudine with efavirenz. The rate of compliance was 60.8% during participation in the trial and 35.2% in second time (P <0.001). The average score given the accession mean period measured by self-report was higher (M = 88.9% SD 19.2) that obtained From the record of withdrawals of antiretroviral drugs in SICLOM (M ± SD = 78.1% 28.5, P = 0.02). Conclusion: The patient compliance during participation in clinical trial was better than in the period after the end of it. The membership does not was satisfactory in both periods need for warning continued interventions to improve adherence to antiretroviral therapy.

Introdução: A melhora na sobrevida de pacientes com AIDS está associada ao aumento da disponibilidade de terapia antirretroviral cada vez mais eficaz. A eficácia do tratamento exige que a adesão aos antirretrovirais seja igual ou superior a 95% das doses prescritas. Objetivo: Comparar a adesão dos pacientes durante sua participação em ensaio clínico e após esse período. Método: Estudo de coorte. Incluíram-se pacientes já inseridos em um ensaio clínico randomizado. A adesão foi aferida durante a participação no ensaio clínico, através de auto-relato. Após o encerramento do ensaio clínico, a adesão foi aferida pelo registro da retirada dos medicamentos no SICLOM. Considerou-se aderente pacientes que obtiveram escore de 95% ou mais. Resultados: Foram incluídos 310 pacientes. Maioria homens (63,2%) com idade média de 40 (±9,8) anos. O regime terapêutico mais utilizado por 52,9% dos pacientes foi associação de zidovudina + lamivudina com efavirenz. A taxa de adesão foi de 60,8% durante a participação no ensaio clínico e de 35,2% no segundo momento (P<0,001). O escore médio considerando a adesão média do período aferida por auto-relato foi maior (M=88,9% DP 19,2) que a obtida a partir do registro das retiradas dos antirretrovirais no SICLOM (M=78,1% ±DP 28,5; P=0,02). Conclusão: A adesão dos pacientes durante a participação no ensaio clínico foi melhor do que no período após o término deste. A adesão não foi satisfatória em ambos os períodos alertando para necessidade de intervenções continuadas para melhorar a adesão à terapia antirretroviral. / Background: The improvement in survival of AIDS patients is associated with increased availability of antiretroviral therapy more effective. The effective treatment requires regimen adherence at least of 95% of the prescribed doses. Objective: To compare the adherence of patients during their participation in clinical trial and thereafter. Method: Cohort study. It included patients already entered into a clinical trial. Adherence was measured during participation in the trial through self-report. After the end of the Clinical trial, the adherence was measured by recording the pharmacy refill of medication in SICLOM. It was considered adherent patients achieving a score of 95% or more. Results: We included 310 patients. Most men (63.2%) aged average 40 (± 9.8) years. The most widely used regimen for 52.9% of patients was the association of zidovudine + lamivudine with efavirenz. The rate of compliance was 60.8% during participation in the trial and 35.2% in second time (P <0.001). The average score given the accession mean period measured by self-report was higher (M = 88.9% SD 19.2) that obtained From the record of withdrawals of antiretroviral drugs in SICLOM (M ± SD = 78.1% 28.5, P = 0.02). Conclusion: The patient compliance during participation in clinical trial was better than in the period after the end of it. The membership does not was satisfactory in both periods need for warning continued interventions to improve adherence to antiretroviral therapy.

Abstract Study samples in medical research are selected according to the objectives of the studies. Researchers seek to collect data as extensively and reliably as possible. In practice, however, data are often missing or may be incorrect. This thesis covers some of the problems concerning missing data and data collection in psychiatric research. Methods for adjusting for missing data and for evaluating the reliability of data are presented. The data originate from the Northern Finland 1966 Birth Cohort (N = 12058). This study explored how participation in an epidemiologic study that includes questionnaires and a clinical examination is affected by mental health (N = 11540), and whether non-participants experience more severe clinical symptoms than participants in a psychiatric field study (N = 145) among subjects with a psychosis. Inverse probability weighting (IPW) was used to adjust for non-participation in comparisons of brain volumes between schizophrenia and control groups. The precision of self-reported medication use was also explored (N = 7625). In an epidemiologic study of all cohort members, subjects with a psychiatric disorder participated less actively than those without one. In the psychiatric field study, non participants were more often patients with schizophrenia than other psychoses. The psychiatric symptoms of non-participants were more severe and they needed more hospital care than participants. The use of IPW led to higher estimates of cerebrospinal fluid volume and lower estimates of grey and white matter volumes in schizophrenia patients, and increased the statistical significance of the differences in brain volume estimates between the schizophrenia and control groups. The precision of self-reported data on psychoactive medication use was substantial. Due to non-participation, the true prevalence of psychiatric disorders is probably higher than the prevalence estimates from field studies that are based on data provided by participants only. In order to reflect the true differences in the target population, weighting methods can be used to improve estimates affected by non-participation. Regarding psychoactive medication use, data collected by postal questionnaire can be assumed accurate enough for study purposes. However, it may underestimate the prevalence of medication use due to non-participation. / Abstract Tutkimusaineisto valitaan tutkimuksen tavoitteiden perusteella. Tavoitteena on kerätä kattava ja virheetön aineisto. Käytännössä kuitenkin osa tiedoista voi puuttua tai olla virheellistä. Tässä väitöskirjassa esitellään yleisesti menetelmiä huomioida puuttuva tieto analyyseissä ja arvioida aineistojen luotettavuutta psykiatrisessa tutkimuksessa. Aineisto perustuu Pohjois-Suomen vuoden 1966 syntymäkohorttiin (N = 12058). Väitöskirjassa tutkittiin, miten psykiatrinen sairastavuus vaikuttaa osallistumiseen epidemiologisessa tutkimuksessa, joka sisälsi kyselyitä ja terveystutkimuksen (N = 11540), sekä erosiko psykiatriseen kenttätutkimukseen osallistuneiden ja osallistumattomien psykoosipotilaiden kliininen taudinkuva toisistaan (N = 145). Käänteisen todennäköisyyden painotusmenetelmää käytettiin korjaamaan puuttuvan tiedon aiheuttamaa virhettä aivovolyymien estimaateissa skitsofreniapotilailla. Lisäksi arvioitiin itse ilmoitetun lääkekäyttötiedon luotettavuutta (N = 7625). Epidemiologisessa tutkimuksessa ne kohortin jäsenet, joilla oli jokin psykiatrinen sairaus, osallistuivat passiivisemmin kuin ne, joilla ei ollut psykiatrista sairautta. Psykoosipotilaat, jotka eivät osallistuneet psykiatriseen kenttätutkimukseen, sairastivat tutkimukseen osallistuneita useammin skitsofreniaa kuin muita psykooseja ja heidän taudinkuvansa oli vakavampi. Painottaminen kasvatti aivonesteen ja alensi harmaan ja valkean aineen tilavuuksien estimaatteja skitsofreniapotilailla, ja lisäsi aivovolyymien erojen tilastollista merkitsevyyttä skitsofreniapotilaiden ja vertailuhenkilöiden välillä. Itse ilmoitetun psykoaktiivisten lääkkeiden käyttötiedon luotettavuus oli merkittävä. Kadosta johtuen psykiatristen sairauksien todellinen vallitsevuus on todennäköisesti korkeampi kuin vallitsevuuden estimaatit, jotka on laskettu tutkimukseen osallistuneiden tiedoista. Painotusmenetelmiä voidaan käyttää parantamaan puuttuvan tiedon vääristämiä estimaatteja, koska painottamalla huomioidaan todellisia eroja kohdeväestössä. Tutkittaessa lääkekäyttötietoa postikyselyillä kerätyn aineiston voidaan olettaa olevan laadultaan riittävä tutkimustarpeisiin.

In this thesis report we conducted research study on driver's behavior in T-Intersections using simulated environment. This report describes and discusses correlation analysis of driver's personality traits and style while driving at T-Intersections. The experiments were performed on multi user driving simulator under controlled settings, at Linköping University. A total of forty-eight people participated in the study and were divided into groups of four, all driving in the same simulated world. During the experiments participants were asked to fill a series of well-known self-report questionnaires. We evaluated questionnaires to get the insight in driver's personality traits and driving style. The self-report questionnaires consist of Schwartz's configural model of 10 values types and NEO-five factor inventory. Also driver's behavior was studied with the help of questionnaires based on driver's behavior, style, conflict avoidance, time horizon and tolerance of uncertainty. Then these 10 Schwartz's values are correlated with the other questionnaires to give the detail insight of the driving habits and personality traits of the drivers.

La qualité de vie (QV) liée à la sclérose en plaques (SEP) a été très étudiée lors de ces dernières années et plusieurs échelles d'évaluation ont ainsi été élaborées. Cependant, peu d'échelles de QV liée à la SEP validées sont disponibles en version française, et aucune ne s'attache à évaluer spécifiquement les périodes de poussées ni les perspectives temporelles. C'est l'objet de ce travail. La première étape a permis d'élaborer une première version d'une échelle d'évaluation de la perception de la QV liée à la SEP et à ses poussées (PERSEPP) en se basant sur la réalisation d'entretiens semi-directifs auprès de patients atteints de formes rémittentes de SEP et de soignants. A partir d'une analyse de contenu thématique de l'ensemble des entretiens individuels et de groupes réalisés, des items spécifiques du concept de QV liée à la SEP et à ses poussées ont ainsi été sélectionnés afin d'élaborer l'échelle PERSEPP constituée d'un questionnaire principal et de modules complémentaires. Une étude pilote a ensuite été réalisée afin d'évaluer différents critères d'acceptabilité et de faisabilité de l'échelle PERSEPP auprès de 40 patients. A la suite de cette étape, une étude multicentrique a permis d'inclure des patients atteints de forme rémittente de SEP, en poussée ou hors poussée, et suivis à l'hôpital ou chez des neurologues libéraux. L'analyse des données recueillies auprès de 305 patients a permis de compléter plusieurs étapes nécessaires à la validation d'une échelle de QV liée à la santé et d'obtenir une version définitive de l'échelle PERSEPP. De par sa méthodologie d'élaboration, cette échelle est spécifique de la forme rémittente de SEP. / Quality of life (QoL) related to multiple sclerosis (MS) has been widely studied in recent years and several rating scales have been developed. However, few QoL scales validated in MS are available in French, and none specifically focuses on assessing periods of relapses or time perspective. This is the purpose of this work. The first step consisted in establishing a first version of a rating scale of QoL perceived in MS and its relapses (PERSEPP) based on semi-structured interviews with patients affected by relapsing-remitting forms of MS and with health care providers. From a thematic content analysis of ail individual interviews and focus groups conducted, specific items of the concept of QoL related to MS and its relapses were selected to develop the PERSEPP scale consisting of a main questionnaire and additional modules. A pilot study with 40 patients was then conducted to evaluate various criteria for acceptability and feasibility of the PERSEPP scale. Following this step, a multicenter study included patients with a relapsing-remitting form of MS, in relapse or not in relapse, and followed by hospital or private practice neurologists. Analysis of the data collected from 305 patients has enabled us to complete several steps necessary for the validation of a health­related QoL scale and obtain a final version of the PERSEPP scale. This scale is specific for relapsing­remitting form of MS due to the methodology used.