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MSc Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2009 / The cervical spine is subjected to wear and tear as well as trauma. This increases the occurrence of degeneration of intervertebral discs and facet joints. Degeneration will result in loss of disc height and the formation of osteophytes on adjacent vertebrae. Nerve roots can be irritated or compressed by this pathology and patients can possibly develop neurological signs and symptoms as well as pain. An anterior neck fusion is a surgical procedure that is frequently used to manage cervical pathologies such as degeneration, spinal stenosis, disc herniation, or trauma. Cervical pathologies can become severe and neural compression may develop. Compression of neural components can present with symptoms such as muscle weakness, numbness, tingling or radicular pain. The main aim of the surgery is to decompress the neural structures, permanently stabilize the vertebrae, to maintain a cervical lordosis and to hold an anatomical disc space. Chronic spinal disorders, including cervical and lumbar conditions, are considered the most expensive benign condition to manage. Previous research demonstrated poor functional outcomes especially in the lumbar area. Little evidence is available regarding the functional outcomes of patients after anterior neck fusion surgery. The aim of this study was to investigate the levels of pain and the quality of life experienced by patients who had an anterior neck fusion one year ago. Methods A cross – sectional survey was conducted. Neurosurgeons in the Johannesburg region were contacted telephonically to establish whether they performed anterior neck fusion surgery. Potential subjects were then identified and contacted to establish whether they suited the inclusion criteria for the study. Pain was assessed using the Visual Analogue Scale. The Neck Disability Index, Fear Avoidance Beliefs and Short Form-36 questionnaires were completed to determine the levels of dysfunction, anxiety and depression as well as health related quality of life in subjects who had an anterior neck fusion one year ago. The quality of life of these subjects was then compared to that of a healthy baseline group. Results and Discussion Forty-two (n = 42) subjects were telephonically identified from the neurosurgeons’ records. Thirty-five (n = 35) subjects met the inclusion criteria and participated in the study. Twenty-six subjects were female (n = 26) with an average age of 54 years and nine (n = 9) were male with an average age of 53 years. The demographic questionnaire demonstrated a high prevalence v for the use of pain- and anti-inflammatory medication (81.3%). According to the demographic questionnaire, the subjects received on average six physiotherapy treatments postoperatively. Most of the subjects (n = 22) demonstrated pain over the upper shoulder area as well as posterior regions of the neck on the body chart. At the time of assessment, the subjects indicated their level of pain using a VAS scale and had an average score of 35.48mm (SD ± 24.11) which indicated a low level of pain. Results obtained from the NDI questionnaire indicated that the subjects had moderate disability one year postoperatively. The mean score on the NDI for subjects was 31.10 (SD ± 11.96). Subjects did not demonstrate high scores on the FABQ and had a mean score of 54.09 (SD ± 0.99). There were no significant differences between the male and female groups for the FABQ. On the SF-36, the subjects had a moderate reduction in mental health components of QoL [MCS = 42.19 (SD ± 13.31)] as well as the physical health components of QoL [PCS = 46.78 (9.44)]. QoL of these subjects was compared to a baseline group. Results showed a statistically significant difference between the groups for all eight domains (p- values ranged between 0.0001 and 0.012). The mental health component score (MCS) was not significantly different between the groups but subjects with anterior neck fusion had a significantly lower score on the physical health component (PCS) than the baseline group (p = 0.001). Conclusion This paper concluded that subjects who had an anterior neck fusion 12 months ago still suffered from low levels of pain and moderate dysfunction. They reported low levels of QoL related to physical health one year postoperatively.

Quality of life (QOL) studies are abundant within the research and popular literature. Rankings are produced on national, state/province, city and municipal levels. Yet, there is not a widely supported simple index that is applicable to the city level. Using lessons derived from the Human Development Index and a review of the recent QOL literature, an index is developed for city-level comparisons and applied to 30 cities across Canada and the New England states. The QOL index is composed of the dimensions of Economy, Safety, Social Environment, and Education and uses the indicators of average income, crime rate, divorce rate, and educational attainment. Two alternate indices are developed and applied to measure the sensitivity of the index formulation based on the addition of the dimensions of Health (QOL2) and Housing (QOL3). The study indicates that city rankings are not dependent upon population size and that high-ranking cities consistently rank within the top levels of each of the developed indices. Statistical analysis (p<0.001) indicates that there is significant rank correlation between the two additional enlarged indices, QOL2 and QOL3, and the original more simple QOL index suggested in this study, thereby supporting the implementation of a simple, transparent and well-supported index.

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This dissertation deals with the theoretical basis of both the concept of quality of life, its development and different dimensions of meaning, as well as with the possibilities of its operationalization and quantification (of quality of life) using sets of indicators. On the basis of comparison and compilation of existing scientific geographical, sociological and socio-economic literature, then presents the major findings in this area. The methodological and practical part of the dissertation outlines the regional differentiation of the objective quality of life in the Czech Republic at the regional level. Particular attention is paid to a case study of Prague and its subjective quality of life, through the use of sociological data obtained by field survey carried out between 2004- 2006. Based on these data, the work then focuses on evaluating potential correlations between subjectively perceived quality of life of Prague citizens, their preferences and other characteristics. Conclusion of the dissertation represents a synthesis of findings based on theoretical, methodological and practical part of the work and rating of significance of each set of input hypotheses.

Research on health related Quality of Life (QoL) is valuable in developing health policy, assessing medical treatment outcomes and social sciences. Different QoL measurement instruments reflect different facets, and some QoL assessment tools are culturally insensitive. This study examines the existing WHOQOL-BREF (World Health Organisation Quality of Life) 26-item instrument for its suitability for use in New Zealand studies. It focuses on seeking facets of QoL of particular importance to New Zealand culture upon which New Zealand national items may be constructed and included when using the WHOQOL-BREF in studies in New Zealand. In order to achieve this goal, the project involved four sub-studies: verifying the existing WHOQOL response scale descriptors; conducting focus groups to elicit new areas or facets of QoL peculiar and particular to New Zealanders; examining the stability of the WHOQOL-BREF importance scale test-retest reliability; and conducting a national survey to assess what facets of QoL are most important to New Zealanders upon which national items may be developed and the national importance survey. The verification of response scale showed good correspondence with the standard English WHOQOL version. A total of 46 candidate importance items were generated from 12 focus groups’ discussions. Test/retest reliability revealed that the existing WHOQOL-Importance questionnaire items were more stable over a three week period, better than several of the new candidate importance items. Two thousand questionnaires asking what is important to New Zealand were sent out to the NZ general population and 585 returned. Results revealed that what is important varies across age, gender and health states. Twenty-four national items were developed from the national importance data. The study confirmed that what is considered as important facets of QoL varies within New Zealand and that there are facets that are important to New Zealanders not in the existing WHOQOL-BREF.

Numerous satisfaction studies have been conducted in both tourism and marketing which have examined various aspects of travelers and/or consumers. Quality of life satisfaction studies look beyond the types of satisfaction experiences that endure for only a short time to those that "spill over" into individuals' life domains thus enhancing their overall life satisfaction. Many research studies in the discipline of marketing have revealed that the overall quality of life of consumers may be affected by the marketing efforts of organizations for all of the marketing mix elements. Although it logically follows that the marketing endeavors of tourism organizations would likely have the same impact on their consumers (i.e., travelers), little research has been done to date to determine the validity of this premise. The purpose of this study is to examine the effects of leisure tourism on the traveler's quality of life. A model and measurement instrument which help to explain the role of satisfaction with leisure tourism services and experiences in satisfaction with leisure life and overall life were designed for use in this study. The model was based on the hierarchy of life satisfaction model and speculated that overall life satisfaction is derived from satisfaction with the major life domains (e.g., leisure life). Lasting satisfaction or dissatisfaction experienced within the leisure life domain spills up vertically to the most superordinate domain (life in general), thus affecting the overall life satisfaction or dissatisfaction of the traveler. Both the model and the measurement instrument were validated, refined, and extended in this study. A survey of 815 consumers of travel/tourism services who reside in Southwest Virginia was conducted. Structural Equation Modeling (i.e., LISREL) analysis was performed to test the goodness of fit of the model. The results indicated a good model fit. That is, no revisions to the hypothesized model were needed, thus confirming the belief leisure travel does contribute to travelers' overall quality of life satisfaction. Additional analyses were conducted to test the moderating effects of personality type, length of stay, and type of trip on select relationships in the model. Differences of effects for some of the relationships in the model were identified for length of stay and type of trip, but not for the traveler's personality type. Among the key findings of this work are the establishment of those factors which contribute to the overall life satisfaction of travelers, the validation of a measurement instrument which could be used periodically by industry experts to gauge the "health" of the industry in its contribution to the overall life satisfaction of tourism consumers, and the revelation that the length of stay moderates several of the relationships in the model, thus suggesting differences in the way the various identified components influence the overall life satisfaction of short-term versus long-term visitors. / Ph. D.

O leiomioma uterino é o tumor ginecológico mais comum na mulher, causando principalmente sangramento uterino anormal e dor pélvica. Existe apenas um questionário que avalia a qualidade de vida de mulheres com esta doença, o Uterine Fibroid Symptom and Quality of Life (UFS-QOL), porém somente na língua inglesa. Dessa forma, objetivamos traduzir e validar culturalmente o questionário UFS-QOL para mulheres brasileiras. Realizamos um estudo transversal no Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Cento e treze pacientes portadoras de leiomioma uterino (grupo caso) e 55 pacientes-controle foram entrevistadas com o questionário UFS-QOL, após tradução e adaptação cultural. O questionário Short Form-36 foi utilizado para controle. Variáveis demográficas e psicométricas dos questionários (consistência interna, validade de construto, teste-reteste e responsividade) foram analisadas. As mulheres com leiomioma uterino apresentaram maior média de idade, IMC, peso, paridade e comorbidades do que no grupo controle (p<0.05). O sangramento uterino anormal foi a queixa mais prevalente (93,8%), seguida de dor pélvica (36,3%) e compressão extrínseca (10,6%), sendo que tais queixas apresentaram adequada validade de construto com a severidade do UFS-QOL (p<0.05). O UFS-QOL apresentou adequada consistência interna com a severidade dos sintomas e com os domínios relacionados à qualidade de vida (ICC=0.82/0.88). A validade estrutural mostrou coeficientes de correlação variando de 0,59 até 0,91. O teste-reteste não diferiu entre as subescalas do UFS-QOL. O teste-reteste não diferiu entre as subescalas do UFS-QOL. Depois do tratamento, as mulheres com leiomioma apresentaram melhora em todas as subescalas do UFS-QOL. Portanto, o questionário UFS-QOL para a língua portuguesa apresentou adequada tradução, boa consistência interna, validade de constructo, discriminatória,estrutural e responsividade, assim como adequado teste-reteste / Uterine fibroids (UF) is the most prevalent gynecological tumor, and common symptoms are abnormal uterine bleeding and pelvic pain. The Uterine Fibroids Symptoms and Quality of Life (UFS-QOL) is the only specific questionnaire that assesses the intensity of symptoms and quality-of-life issues for women with symptomatic UF; however, we do not have its translation in another language than English. Thus, we aimed to translate and culturally validate the UFS-QOL questionnaire for Brazilian Portuguese language. We performed a transversal study at the Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo. One hundred and thirteen patients with UF and 55 patients without UF (control group) were interviewed with the UFS-QOL questionnaire after translation and cultural adaptation; the Short-Form 36 questionnaire (SF36) was used as a control questionnaire. Demographic and psychometric variables (internal consistency, construct validity, test-retest and responsiveness) were analyzed. Women with UF presented a higher mean of age, body mass index, weight, parity and comorbidities than the control group (p<0.05). The most prevalent symptoms were abnormal uterine bleeding (93.8%), pelvic pain (36.3%) and extrinsic compression (10.6%) and they presented adequate construct validity with the UFS-QOL severity index (p<0.05). The UFS-QOL presented good internal consistency in severity symptoms and HRQL scores (ICC=0.82/0.88). Test-retest did not differ among all domains of the UFS-QOL questionnaire (p>.05). After treatment, women with UF presented an improvement in all UFS-QOL domains. Therefore, the UFS-QOL presented an adequate translation and cultural validation to the Brazilian Portuguese language, with good internal consistency, discriminant validity, construct validity, structural validity, test-retest and responsiveness.

O auto-relato de qualidade de vida de pacientes com câncer de cabeça e pescoço é registrado por questionários que dimensionam impactos da doença e do tratamento sobre diferentes domínios de ordem fisiológica, psicológica e social. O presente estudo objetivou estimar valores de referência para os diferentes domínios de qualidade de vida incluídos no Questionário da Universidade de Washington sobre Qualidade de Vida (UW-QOL, 4ª edição) para pessoas sem câncer e comparar estes valores com aqueles obtidos para os pacientes com câncer de boca e orofaringe em estágio pré-cirúrgico. Para estimar os valores de referência foram entrevistados 141 pacientes atendidos nos ambulatórios do Hospital Heliópolis, pareados por sexo e idade com 47 pacientes com câncer de boca e orofaringe em estágio pré-cirúrgico, atendidos no mesmo hospital. A média global e os escores específicos dos domínios de qualidade de vida podem variar de 0 a 100, com valores mais elevados indicando melhor condição funcional. A pontuação média de QV para pacientes sem câncer foi 91,1. Essa medida foi significantemente (p<0,01) mais elevada que para os pacientes com câncer, cuja pontuação global foi 80,6. Para os pacientes sem câncer, os escores de ombros, recreação ansiedade e mastigação foram modificados por sexo, estado conjugal, renda, grau de instrução e presença de problemas na boca. A pequena redução dos valores de referência, em relação aos parâmetros máximos passíveis de aferição (100%) indica favoravelmente a especificidade do questionário. No entanto, nem toda redução de QV dos pacientes com câncer de boca e orofaringe pode ser atribuída à doença ou ao tratamento, pois uma redução do escore médio global de cerca de 9% pode ser decorrente de perdas naturais sofridas pelos indivíduos ao longo da vida. Os domínios dor, aparência, deglutição, fala, paladar e ansiedade apresentaram escores significantemente mais reduzidos nos pacientes com câncer de boca e orofaringe que nos pacientes não afetados pela doença. / The self report of quality of life, for patients with head and neck cancer is documented by questionnaires assessing the impact of the disease and its treatment on several physiological, psychological and social domains. This study aimed at assessing reference values for quality of life domains comprised by the University of Washington Quality of Life Questionnaire (UW-QOL, 4th edition) for persons without cancer, and comparing their answers with results obtained for patients with oral and oropharyngeal cancer previoulsly to the primary surgery of tumor resection. A total of 141 patients attended at outpatients units of the Heliópolis Hospital were interviewed to assess reference values for the UW-QOL questionnaire, paired by sex and age with 47 patients hospitalized for surgery of oral and oropharyngeal cancer in the same hospital. Overall and domain specific ratings for QOL can vary from 0 to 100, with higher figures for improved functional status. The overall rating of QOL for patients without cancer was 91.1. This rating was significantly (p<0.01) higher than the corresponding figure for patients affected by cancer, whose global score was 80.6. For patients without cancer, ratings for shoulders, recreation, anxiety and chewing were modified by sex, conjugal status, income, instruction and the self-report of problems in the mouth. The small reduction of reference values, in relation to the maximum parameters that may be assessed (100%) suggests that the questionnaire is specific for head and neck cancer. However, the reduction of QOL for patients with oral and oropharyngeal cancer should not be entirely attributed to the disease and its treatment, because nearly 9% of reduction in QOL ratings may be due to other causes associated with the aging process. Pain, appearance, swallowing, speech, taste and anxiety were the QOL domains with ratings significantly lower for patients with oral and oropharyngeal cancer, in the comparison with those not affected by the disease.

O presente estudo realizou teste de campo para uma versão em Português do questionário de qualidade de vida da Universidade de Washington (UW-QOL, quarta versão), com o intuito de avaliar a capacidade do questionário em descrever padrões diferenciais de qualidade de vida de pacientes com câncer de boca no contexto brasileiro, e incentivar avaliações dessa natureza em diferentes contextos culturais. Foram entrevistados 143 pacientes com carcinoma epidermóide de boca e orofaringe atendidos no Complexo Hospitalar Heliópolis, usando um questionário especificamente desenvolvido para esta finalidade. Dados colhidos do prontuário do paciente informaram características sócio-demográficas desses pacientes, sua condição clínica e os tratamentos efetuados. A auto-avaliação de qualidade de vida foi estratificada segundo categorias sócio-demográficas e clínicas, como estratégia para apreciar a capacidade do questionário em discriminar os domínios mais afetados em diferentes quadros de qualidade de vida. Os pacientes com tumores maiores, os que tinham tumores localizados na orofaringe ou na porção posterior da boca, os que apresentaram metástases regionais e os que foram submetidos a radioterapia apresentaram indicações significantemente menos elevadas (p < 0,05) de qualidade de vida. Mastigar, ansiedade, engolir e saliva foram os domínios de pior pontuação; dor, engolir, mastigar e saliva foram as queixas mais freqüentes na semana que antecedeu a entrevista. O questionário foi bem aceito e facilmente respondido pelos pacientes, permitindo a identificação de relevantes contrastes e similaridades entre os grupos de respondentes. Seu uso regular em ambiente hospitalar pode contribuir para antecipar intervenções voltadas à redução de impacto das aplicações terapêuticas e à gestão dos tratamentos. / This study performed a field trial of a Portuguese version of the University of Washington quality of life questionnaire (UW-QOL, fourth version), aiming at fostering these studies in cross-cultural contexts, and at appraising the questionnaire’s ability in identifying differential patterns of health-related quality of life of patients with cancer of mouth and oropharynx in the Brazilian context. We interviewed 143 patients undergoing treatment for oral squamous cell carcinoma at a large Brazilian hospital (Complexo Hospitalar Heliópolis), using a questionnaire specifically developed for this purpose. Hospital records informed socio-demographic characteristics of these patients, their clinical status, and treatments already performed. The self-report of quality of life was stratified by categories of socio-demographic and clinical characteristics of patients, as a strategy for assessing the ability of the questionnaire in discriminating the most affected domains for patients presenting different conditions. Patients presenting larger tumours, neoplasm in the oropharynx or in posterior parts of the mouth, those affected by regional metastasis and those already treated with radiotherapy presented significantly (p < 0.05) poorer scores of quality of life. Chewing, anxiety, swallowing and saliva were the poorest rated domain; pain, swallowing, chewing and saliva were the most frequent complaints during the week preceding the interview. The questionnaire was well accepted and easily answered by patients, and allowed the identification of relevant contrasts and similarities among subsets of respondents. Its regular use in hospital settings can contribute for anticipating interventions aimed at reducing the impact of therapeutic applications and at subsequent patient management.