Translation and cross-cultural adaptation of Nepali versions of the patient-reported outcomes measurement information system (PROMIS®) pain intensity, pain interference, pain behavior, depression, and sleep disturbance short forms in chronic musculoskeletal pain

Purpose: The Patient-Reported Outcomes Meaurement Information System (PROMIS®) measures have been translated into many languages and have been shown to have strong measurement properties across a wide range of clinical conditions. However, Nepali translations of the PROMIS short forms are not yet available. The aim of this study was to translate and cross-culturally adapt the PROMIS Pain Intensity, Pain Interference, Pain Behavior, Depression, and Sleep Disturbance short forms into Nepali. Methods: We used the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology, which incorporated two forward translations, synthesis of the translations, a back-translation, and three independent reviews, harmonization, cognitive debriefing, revisions, and proof reading. The translation and review teams were fluent in Nepali and English and represented five different countries and four continents. We evaluated the short forms for comprehensibility and relevance (two key aspects of the content validity of an instrument), conducting cognitive debriefing with six adults with chronic musculoskeletal pain, in compliance with recommendations by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The final version was proofread by two native Nepali speakers before and three new proofreaders after cognitive debriefing. Results: All five short forms were successfully translated and cross-culturally adapted into Nepali while maintaining equivalence to the source. Conclusions: The translation and review team, along with a sample from the target population with chronic musculoskeletal pain and the proofreaders considered all five PROMIS short forms relevant and comprehensible. An important next step is to evaluate the measurement properties of these instruments

Customer Satisfaction and Customer Loyalty : Case Trivsel Städtjänster (Trivsel siivouspalvelut)

The report emphasized the role and the importance of customer satisfaction and loyalty. Customers are the link to a business success. A business organization should focus on a huge number of customer, for this customer satisfaction and loyalty should be incorporated along the long-term goals. This thesis was implemented to an analyzing the relationship between customer satisfaction and customer relationship. The objective of this research is to study the concept of customer satisfaction, customer loyalty and its relationship. Moreover, this thesis studies the factors that influence customer satisfaction and loyalty. The thesis project examines customer satisfaction provided by Trivsel and customer loyalty received by Trivsel from its customers. The commissioner of this thesis was Karolina Lassfolk (Operational Director, Trivsel). This thesis also analyzes the factors that have impact on customer satisfaction and result in customer loyalty. Recommendations on improving the service quality and getting customer retention are ultimately proposed. In this thesis, the theoretical background chapter reviews studies on customer satisfaction and customer loyalty and the relationship between these two terms. Various methods that have been widely used to measure customer satisfaction and the outcome results of having loyal customers are presented. The thesis presents best practices and the relevant recommendation on how to improve Trivsel customer satisfaction level. This result was accomplished using a quantitative and qualitative research method by means of a questionnaire. The questionnaire was distributed into three different parts, multiple choice questions, open questions and customer’s opinions in the end. The questionnaire was distributed to the customers of Trivsel over a period of one month. In conclusion, the research reveals that the current service level of Trivsel can be marked as positive and customers are very satisfied with the service. However, improvement on certain things should be done in order to increase the level of customer satisfaction. It is recommended that the company should improve its service regarding feedback system, implement staff training as well as conduct regular advertising campaign to attract new customers and also to inform existing customers about upcoming events

Cortical excitability and multifidus activation responses to transcranial direct current stimulation in patients with chronic low back pain during remission

Abstract Evidence indicates that patients with chronic low back pain (CLBP) have lumbar multifidus muscle (LM) activation deficit which might be caused by changes in cortical excitability. Anodal transcranial direct current stimulation (a-tDCS) can be used to restore cortical excitability. This study aimed to (1) determine the immediate effects of a-tDCS on the cortical excitability and LM activation and (2) explore the relationship between cortical excitability and LM activation. Thirteen participants with CLBP during remission and 11 healthy participants were recruited. Cortical excitability (peak-to-peak motor evoked potential amplitude; P2P and cortical silent period; CSP) and LM activation were measured at pre- and post-intervention. We found significant difference (P  0.05) in P2P, CSP and LM activation were found between pre- and post-intervention in CLBP. The CLBP group demonstrated significant correlation (P = 0.05) between P2P and LM activation. Although our finding demonstrates change in P2P in the CLBP group, one-session of a-tDCS cannot induce changes in cortical excitability and LM activation. However, moderate to strong correlation between P2P and LM activation suggests the involvement of cortical level in LM activation deficit. Therefore, non-significant changes could have been due to inadequate dose of a-tDCS

The role of an active muscular subsystem in prone instability test during rest and leg raise conditions

BACKGROUND: Clinicians commonly used prone instability test (PIT) by assessing the posterior-to-anterior (PA) displacement to identify lumbar instability. Most studies focusing on passive subsystem found greater mobility in lower lumbar (L4-L5) than upper lumbar (L1-L3) spine. However, there is still a lack of evidence to demonstrate the role of active subsystem. Additionally, it is unclear whether sex affects PA displacements. AIM: To determine differences in displacement among five lumbar segments, between two testing positions (rest and leg raise), and between male and female during PIT in individuals with chronic non-specific low back pain (CNLBP). DESIGN: A cross-sectional study design. SETTING: Spine biomechanics laboratory. POPULATION: Individuals with CNLBP. METHODS: An electromagnetic tracking system was used to measure PA displacement with sensors attached at T12, S2 and a hand-held dynamometer. Participants were asked to perform PIT, while a 100N force was applied to each lumbar segment during resting and leg raise positions. RESULTS: Significantly less PA displacement (P0.05) during PIT was found. CONCLUSION: Although previous studies have reported that the lower lumbar spine had greater mobility, the lower amount of displacement during the rest position suggests the role of an active subsystem contributing to lumbar stability regardless of sex. CLINICAL REHABILTATION IMPACT: A reduction in displacement during the leg raise position across L1 to L4 suggesting an interaction of stabilizing subsystems of the spine to provide lumbar stability

Translation and cross-cultural adaptation of Nepali versions of the Patient-Reported Outcomes Measurement Information System (PROMIS®) Pain Intensity, Pain Interference, Pain Behavior, Depression, and Sleep Disturbance short forms in chronic musculoskeletal pain

Purpose: The Patient-Reported Outcomes Meaurement Information System (PROMIS®) measures have been translated into many languages and have been shown to have strong measurement properties across a wide range of clinical conditions. However, Nepali translations of the PROMIS short forms are not yet available. The aim of this study was to translate and cross-culturally adapt the PROMIS Pain Intensity, Pain Interference, Pain Behavior, Depression, and Sleep Disturbance short forms into Nepali. Methods: We used the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology, which incorporated two forward translations, synthesis of the translations, a back-translation, and three independent reviews, harmonization, cognitive debriefing, revisions, and proof reading. The translation and review teams were fluent in Nepali and English and represented five different countries and four continents. We evaluated the short forms for comprehensibility and relevance (two key aspects of the content validity of an instrument), conducting cognitive debriefing with six adults with chronic musculoskeletal pain, in compliance with recommendations by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The final version was proofread by two native Nepali speakers before and three new proofreaders after cognitive debriefing. Results: All five short forms were successfully translated and cross-culturally adapted into Nepali while maintaining equivalence to the source. Conclusions: The translation and review team, along with a sample from the target population with chronic musculoskeletal pain and the proofreaders considered all five PROMIS short forms relevant and comprehensible. An important next step is to evaluate the measurement properties of these instruments

Challenges in Effective Referral of Cardiovascular Diseases in Nepal: A Qualitative Study from Health Workers’ and Patients’ Perspective

Background. Nepal, currently facing a high burden of noncommunicable diseases (NCDs), including cardiovascular diseases (CVDs), which poses the highest mortality rate in the country, does not seem to have a proper referral strategy. This study explored the wide range of factors and challenges that affect the referral system of CVD cases in Nepal. Methods. In this qualitative study, we conducted face-to-face and telephone interviews with purposely selected 57 key participants which included 35 healthcare professionals from tertiary, secondary, and primary levels from Bagmati Province and 22 CVD patients (myocardial infarction and stroke) from Bagmati and Madhesh Provinces. We interviewed them using an interview guide with open-ended questions for in-depth information in a local language and in a private space. The interviews were audio-recorded, transcribed verbatim, coded, and analyzed using the thematic approach. Results. The findings indicated that the referral system for CVD cases from primary- to secondary- to tertiary-level care is inadequate and malfunctioning. The major factors affecting referral of CVD cases are centralization of CVD-specific services in few urban areas, inadequate systematic communication between the centers, self-referential, lack of human resources for CVD care, and obstacles to patient transfer due to geographical and financial reasons. Conclusion. A referral system for CVD patients is absent in the context of Nepal. Understanding and addressing key factors that affect the referral system of CVD patients may help to improve cardiac outcomes and ultimately save lives

Health system gaps in cardiovascular disease prevention and management in Nepal

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal's health systems gaps to prevent and manage CVDs. METHODS: We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts' codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. RESULTS: National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. CONCLUSION: Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.</p