Un grand défi des cliniciens dans le domaine des commotions cérébrales est de déterminer le moment où l’athlète est prêt à retourner au jeu. Pour guider cette décision, plusieurs ont recours à l’évaluation cognitive pour accompagner l’évaluation des symptômes de l’athlète. Toutefois, plusieurs études appuient la nécessité de développer des tâches cognitives plus raffinées avec des propriétés psychométriques adéquates. Par ailleurs, une étude récente montre que des déficits cognitifs sont exacerbés par l’exercice physique chez 27,7 % des athlètes ayant reçu l’autorisation médicale de retourner au jeu et montrant des résultats normaux à l’état de repos, suggérant une récupération incomplète. Le but de cette thèse consiste en l’élaboration d’un outil, valide et accessible, pour évaluer la disposition d’un athlète à retourner au jeu à la suite d’une commotion, ainsi que pour évaluer les déficits à long terme (c.-à-d., plus de six mois) associés à la blessure. Cet outil comprend un protocole d’exercice standardisé (20 minutes à 80 % de la fréquence maximale théorique sur vélo) et une tâche cognitive, appelée la tâche d’alternance. Dans l’article I, nous avons examiné les propriétés psychométriques de la tâche cognitive. Les résultats suggèrent que la tâche d’alternance est une mesure valide des fonctions exécutives et montre une bonne fidélité test-retest. Ils indiquent aussi que les coûts d’alternance, traditionnellement calculés pour isoler les différentes composantes des fonctions exécutives, ne montrent pas d’aussi bonnes propriétés psychométriques que les variables primaires (vitesse de réaction, précision des réponses et score d’efficacité inverse). Dans l’article II, nous avons mesuré l’effet de pratique associé à la passation répétée de la tâche à des intervalles de 48 heures, dans le but de répliquer l’administration en série de cette tâche lors du suivi post-commotion. Les résultats indiquent que la performance s’améliore durant les trois premières passations de la tâche et que l’utilisation d’une version alternative ne permet pas d’éliminer l’effet de pratique. Dans l’article III, nous avons déterminé que notre outil détenait la capacité de détecter des déficits cognitifs chez des athlètes ayant réussi le protocole de retour au jeu de Zurich. Spécifiquement, notre outil a permis de créer trois sous-groupes : 80 % des athlètes qui ne montrent aucun déficit ; 20 % des athlètes qui montrent des déficits cognitifs au repos sur la tâche d’alternance ; 10 % des athlètes qui montrent des déficits seulement après l’exercice. Ainsi, lorsqu’utilisés ensemble, la tâche d’alternance et le protocole d’exercice permettent de détecter des déficits chez jusqu’à 30 % des athlètes, qui sont pourtant considérés comme rétablis. Dans l’article IV, nous avons montré que notre outil peut détecter les déficits persistants associés à la commotion. Alors qu’au repos aucun déficit n’est observé, l’évaluation post-exercice révèle des déficits chez 20 % des athlètes avec un historique de commotions. En somme, nos résultats soutiennent l’utilisation de notre outil pour l’évaluation du retour au jeu. Les résultats de cette thèse réaffirment la nécessité de changer la norme pour l’évaluation de la commotion. Sur la base des résultats actuels, l’utilisation de tâches cognitives valides et sensibles aux effets de la commotion au-delà de la phase symptomatique, associée à un protocole d’exercice, devrait devenir l’étalon-or. / Concussion is especially hard to detect because clinicians must rely on self-reported symptoms to diagnose the injury and to determine when an athlete is ready to safely return to play (RTP). To guide the latter decision, many use cognitive testing. However, several studies indicate the need to develop more refined cognitive tasks, with better psychometric properties than those currently used to assess concussion. Another option would be to perform the psychometric validation of experimental tasks frequently used in research settings. Further, a recent study suggests that physical exercise can reveal deficits that were not perceptible at rest in one in four athletes, thus indicating incomplete recovery in a significant minority of the concussed athletes. Accordingly, this dissertation aimed to develop a valid and easily accessible tool to assess the readiness of recently concussed athletes to safely return to play, as well as to assess deficits in the protracted phase of the recovery. The tool includes a standardized exercise protocol (20-min on an ergocycle at 80% theoretical maximum heart rate) and a cognitive task (color-shape switch task). In the first manuscript, we examined the construct validity and the test-retest reliability of the switch task. The results suggest that the switch task is a valid measure of executive functions that shows an adequate test-retest reliability. The results also suggest that the switch costs, which are traditionally computed to isolate the different components of executive functions, do not show as good psychometric properties as primary variables do (i.e., reaction time, accuracy, and inverse efficiency score). In the second manuscript, we measured the practice effect associated with serial administration of the switch task. The results indicate that the performance improves during the first three assessments when the task is completed every 48 hours. Also, they do not support the use of alternative versions of the task in order to eliminate the practice effect as it is still present. In the third manuscript, we determined that our tool has the requisite sensitivity for detecting cognitive deficits in recently concussed athletes who had successfully completed the RTP protocol. Specifically, our tool detected deficits in 20% of athletes when the switch task is completed at rest and in an additional 10% when it is completed post-exercise. Thus, our tool can detect deficits in up to 30% of athletes who had received their medical clearance to RTP. In the 4th manuscript, we showed that our tool can detect persistent deficits stemming from sports concussion. The post-exercise testing showed deficits in 20% of athletes, deficits that were not detected at rest. Thus, the use of an acute bout of aerobic exercise may increase the sensitivity of the cognitive testing. The results herein support the use of the switch task, before and after an acute bout of exercise of moderate intensity. Moreover, they reaffirm the necessity to change the standard for assessing sports concussion. Indeed, based on the current results, the use of valid and reliable cognitive tasks, sensitive to the effects of concussion beyond the symptomatic phase, in combination with an exercise protocol, should become the gold standard.

Made available in DSpace on 2015-03-05T20:04:16Z (GMT). No. of bitstreams: 0 Previous issue date: 19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Objetivos: Estimar a prevalência de capacidade para o trabalho em trabalhadores da indústria metalúrgica e verificar a confiabilidade teste-reteste do Índice de Capacidade para o Tabalho (ICT).Metodos: Foram realizados 2 estudos, um estudo de prevalência e um estudo da confiabilidade teste-reteste. O estudo de prevalência partiu de uma amostra não-probabilística com trabalhadores de 4 empresas do setor metal-mecânico de Caxias do Sul e Vacaria (N=460). Tais trabalhadores responderam um questionário auto-aplicável, padronizado e pré-testado. O estudo da confiabilidade do ICT foi realizado com trabalhadores de 2 empresas (N= 153), os quais responderam o ICT 2 vezes, com intervalo de 4 semanas entre elas. A análise dos dados para o estudo de prevalência utilizou o cálculo das Razões de Prevalência e seus respectivos Intervalos de Confiança (IC95%). A confiabilidade teste-reteste do ICT foi estimada pelo coeficiente de correlação intra-classe (CCI), t-teste pareado e coeficiente Kappa (kpon) ponderado.Resultado / Objectives: To estimate the prevalence of the prevalence of decreased work ability in metallurgy workers and to assess the test-retest reliability of the Work Ability Index (WAI). Methods: Two studies were carried out: a prevalence study with a convenience sample of 441 metallurgy workers of four industries from Southern Brazil; and a 4-week-interval test-retest reliability study with 153 workers. Data analyses included chi-squared tests, prevalence ratios and their confidence intervals for the prevalence study; and the intraclass correlation coefficient (ICC), paired t-test and weighted Kappa coefficient for the test-retest study. Results: The prevalence of decreased work ability was 11,2% (CI95% 8.2-14.2). Decreased work ability was not associated with any of the dependent variables. The test-retest reliability for the WAI as a continuous variable showed na ICC of 0,84 (CI95% 0,78-0,88, p<0,001) and the paired t-test did not show significant difference between the 1st and the 2nd application. The weight

Parkinson's disease (PD) is a progressive, degenerative, neurological disease. The progressive disability associated with PD results in substantial burdens for those with the condition, their families and society in terms of increased health resource use, earnings loss of affected individuals and family caregivers, poorer quality of life, caregiver burden, disrupted family relationships, decreased social and leisure activities, and deteriorating emotional well-being. Currently, no cure is available and the efficacy of available treatments, such as medication and surgical interventions, decreases with longer duration of the disease. Whilst the cause of PD is unknown, genetic and environmental factors are believed to contribute to its aetiology. Descriptive and analytical epidemiological studies have been conducted in a number of countries in an effort to elucidate the cause, or causes, of PD. Rural residency, farming, well water consumption, pesticide exposure, metals and solvents have been implicated as potential risk factors for PD in some previous epidemiological studies. However, there is substantial disagreement between the results of existing studies. Therefore, the role of environmental exposures in the aetiology of PD remains unclear. The main component of this thesis consists of a case-control study that assessed the contribution of environmental exposures to the risk of developing PD. An existing, previously unanalysed, dataset from a local case-control study was analysed to inform the design of the new case-control study. The analysis results suggested that regular exposure to pesticides and head injury were important risk factors for PD. However, due to the substantial limitations of this existing study, further confirmation of these results was desirable with a more robustly designed epidemiological study. A new exposure measurement instrument (a structured interviewer-delivered questionnaire) was developed for the new case-control study to obtain data on demographic, lifestyle, environmental and medical factors. Prior to its use in the case-control study, the questionnaire was assessed for test-retest repeatability in a series of 32 PD cases and 29 healthy sex-, age- and residential suburb-matched electoral roll controls. High repeatability was demonstrated for lifestyle exposures, such as smoking and coffee/tea consumption (kappas 0.70-1.00). The majority of environmental exposures, including use of pesticides, solvents and exposure to metal dusts and fumes, also showed high repeatability (kappas &gt0.78). A consecutive series of 163 PD case participants was recruited from a neurology clinic in Brisbane. One hundred and fifty-one (151) control participants were randomly selected from the Australian Commonwealth Electoral Roll and individually matched to the PD cases on age (± 2 years), sex and current residential suburb. Participants ranged in age from 40-89 years (mean age 67 years). Exposure data were collected in face-to-face interviews. Odds ratios and 95% confidence intervals were calculated using conditional logistic regression for matched sets in SAS version 9.1. Consistent with previous studies, ever having been a regular smoker or coffee drinker was inversely associated with PD with dose-response relationships evident for packyears smoked and number of cups of coffee drunk per day. Passive smoking from ever having lived with a smoker or worked in a smoky workplace was also inversely related to PD. Ever having been a regular tea drinker was associated with decreased odds of PD. Hobby gardening was inversely associated with PD. However, use of fungicides in the home garden or occupationally was associated with increased odds of PD. Exposure to welding fumes, cleaning solvents, or thinners occupationally was associated with increased odds of PD. Ever having resided in a rural or remote area was inversely associated with PD. Ever having resided on a farm was only associated with moderately increased odds of PD. Whilst the current study's results suggest that environmental exposures on their own are only modest contributors to overall PD risk, the possibility that interaction with genetic factors may additively or synergistically increase risk should be considered. The results of this research support the theory that PD has a multifactorial aetiology and that environmental exposures are some of a number of factors to contribute to PD risk. There was also evidence of interaction between some factors (eg smoking and welding) to moderate PD risk.

[pt] O equilíbrio corporal é uma importante habilidade física e um aspecto fundamental para a saúde dos idosos, sendo as quedas a principal causa de lesões não intencionais que levam a perda de autonomia e ao óbito neste grupo. Com o envelhecimento da população mundial e sendo os déficits de equilíbrio uma das maiores causas de atendimentos fisioterapêuticos, o uso de instrumentos portáveis de baixo custo e confiáveis para avaliação do equilíbrio são de extrema relevância. Diversos estudos avaliaram a validade concorrente e/ou confiabilidade do Microsoft Kinect (Kinect) e do Nintendo Wii Balance Board (WBB) durante testes de equilíbrio. Estes estudos foram favoráveis ao uso destes equipamentos nestas avaliações em posições semi-estáticas. Este estudo examinou a confiabilidade teste-reteste com o uso concorrente do Kinect e do WBB durante um teste de equilíbrio em três posições semi-estáticas, analisando variáveis do centro de pressão (CoP) e do centro de gravidade (CoG) em manequins e em 70 indivíduos saudáveis. Cada participante executou dois testes na mesma sessão. Os equipamentos demonstraram sensibilidade para identificar diferentes padrões de oscilação corporal. As variáveis mais confiáveis foram a velocidade média e o percurso total em todas as direções e tarefas. A confiabilidade foi considerada de fraca a boa nos testes com pessoas e nos testes com manequins, excelente. Porém, os resultados com as variáveis das pessoas baseadas em dados consolidados das três tarefas alcançaram confiabilidade excelente. Propriedades do CoP demonstraram ser mais confiáveis do que as do CoG, sugerindo que o WBB seja superior ao Kinect nesta tarefa. O presente trabalho corrobora estudos anteriores, podendo, estes dispositivos, prover informações quantitativas confiáveis, aprimorando avaliações qualitativas do equilíbrio. / [en] Body balance is an important physical skill and it is fundamental for elderly´s health, considering that falls are a major cause of unintentional injuries leading to the loss of autonomy and death in this group. Growth of aging in world population and being balance impairment one of the major causes of physiotherapeutic attendance, simple, affordable, portable, and reliable devices for evaluating body balance are of great relevance. Several studies have been examining concurrent validity and reliability of Microsoft Kinect (Kinect) and Nintendo Wii Balance Board (WBB) during balance tests. The majority of these studies suggested that those devices could be used as reliable and valid tools for assessing balance in semi-static positions. Based on that, this study investigated test-retest reliability using Kinect and WBB, concurrently, in three standing positions, and analyzed variables related to center of pressure (CoP) and center of gravity (CoG), in static manikins and in 70 healthy subjects. Each participant performed the set of tests twice in the same day. Our solution demonstrated sensibility to identify different body sway patterns. Tests showed that the most reliable variables were average speed and total path length in all directions and tasks. Despite tests with static manikin signalized excellent reliability, tests with individuals were considered poor to good. However, variables of consolidated data based on different tasks achieved excellent scores. CoP properties outperformed those related to CoG, suggesting that WBB was superior when compared to Kinect in providing more reliable body sway information. This study reinforced that these devices may provide reliable quantitative information that enhances qualitative body balance assessments.

Aim: To investigate the reliability of the COntext Assessment for Community Health (COACH) tool on mobile phone versus pen-paper in Nairobi, Kenya. Background: One of the barriers to the progress of the MDGs has been the failure of health systems in many LMICs to effectively implement evidence-based interventions As a result of the “know-do” gap, patients do not benefit from advances in healthcare and are exposed to unnecessary risks. Better mapping of context improves implementation by allowing tailoring of strategies and interpretation of knowledge translation. COACH investigates healthcare contexts for LMICs and has only been used on pen-paper. With 5 billion mobile phone users globally, mobile technologies is being recognized as able to play a formal role in health services. Methods: Comparative study with 140 nurses/midwives and doctors in four hospitals in Nairobi. 70 were randomly assigned to mobile phone and pen-paper each. The tool was administered twice with a two week interval and test-retest reliability, internal consistency and interrater reliability were assessed. Findings: Excellent test-retest reliability for both pen-paper and mobile phone (ICC &gt;0.81). 45% (pen-paper) and 34% (mobile phone) moderate agreement between individual questions in round 1 and 2. Acceptable average Cronbach’s alpha (&gt;0.70). Conclusion: Both mobile phone and pen-paper were reliable and feasible for data collection. The findings are a good first step towards using COACH in Kenya. Additional research is needed for individual settings. Using mobile phones could increase healthcare facilities’ accessibility in implementation research, helping to close the “know-do” gap and reach the SDGs.

Ungefär 20% av befolkningen uppfyller kriterier för läs- och skrivsvårigheter. För att kunna hjälpa elever som uppvisar svårigheter av denna typ behövs reliabla och valida testinstrument. LäSt är ett normerat svenskt lästest som är väl använt på nationell basis i syfte att mäta barns förmåga till ordavkodning. Avkodning innefattar en koppling mellan enskilda bokstäver och ord till deras korrekta språkljud vid uttal, och utgör således en central teknisk del av läsning. Evidens finns för att olika typer av psykologiska test, däribland lästest, uppvisar en igenkänningseffekt varigenom elevers prestation på dessa test ökar till följd av upprepad administrering. Syftet med den aktuella studien är att undersöka huruvida LäSt uppvisar en igenkänningseffekt vid upprepad administrering till ett urval av elever i årskurs 4 och 6.  Sammanlagt deltog 92 elever från 4 skolor i Sverige. De genomförde LäSt vid tre separata tillfällen under ett tidsintervall på 8 veckor. Testning 1 skedde vid vecka 1, testning 2 skedde vid vecka 2, och testning 3 skedde vid vecka 8.  En signifikant igenkänningseffekt hittades som tyder på att elevers resultat på LäSt förbättrades över tid. Det fanns ingen skillnad i igenkänning mellan pojkar och flickor, elever i årskurs 4 och årskurs 6, eller enspråkiga och flerspråkiga elever. En signifikant skillnad i igenkänning fanns mellan de elever som hade allra lägst avkodningsförmåga (poor decoders)och de elever som hade en mycket hög avkodningsförmåga (good decoders). Poor decoders uppvisade en starkare igenkänning på deltestet ord än good decoders. Ingen sådan effekt fanns för deltestet non-ord.  Dessa resultat indikerar att elevers prestation på LäSt kan förbättras över tid till följd av igenkänning av testmaterialet. Detta påverkar hur man bör tolka individers resultatutveckling vid upprepad testning och hur ofta det är lämpligt att använda LäSt på en och samma elev. Dessa resultat och deras implikationer diskuteras i relation till tidigare forskning. / Approximately 20% of the population suffer from a reading- or writing disability. In order to aid students with such disabilities reliable and valid reading tests are warranted. LäSt is a Swedish standardised reading test currently well-used nationally to measure children’s ability to decode words. Decoding encompasses the making of connections between single letters and words and their correct sounds, and therefore constitutes a central technical aspect of reading. There is evidence to show that some common psychological tests, including reading tests, display a retest-effect, whereby individual’s results increase over time as a result of repeated test administration. The aim of the current study is to investigate whether such a retest-effect is pronounced when LäSt is repeatedly administered to a sample of students in year 4 and 6.  In sum, 92 students from 4 different schools in Sweden took part in the study. They completed LäSt at three separate times during a time interval of 8 weeks. Testing 1 was completed in the first week, testing 2 was completed in the second week, and testing 3 was completed in the eight week.  A significant retest-effect was found indicating that students’ results on LäSt increased with each administration. There was no difference in retest-effect between boys and girls, students in year 4 and year 6, or monolingual and multilingual students. A significant difference emerged between students who had a very low word decoding ability (poor decoders) and those who had a very high word decoding ability (good decoders). Poor decoders showcased a stronger retest-effect on the sub-test Words than good decoders. No such effect was found for the sub-test Non-words.  The current results indicate that repeated testing with LäSt yields improved results over time due to familiarity. These findings have implications for how one should interpret students’ test scores over time, as well as how often LäSt should be administered. The findings and their implications are further discussed in relation to previous research.