Free 2- The General Aim Of The Dissertation: Thesis Proposal Sample

Protocol for a systematic review of assesses the Quality of Tools used to Measures Adult Oral Health-Related Quality of Life (OHQOL).

1-Background:

3-Methodology-Design
3-1: Over view
 3-2: Inclusion criteria to Selection of Measure Tools:
3-3: Exclusion criteria:
4: Search engines:
5:Pliot study:
6: Timing
7: Variables
8:Data collection
9- Data Analysis:
10-Funding:
11- Reference
1-Background
Introduction:
In 1946, the World Health Organization defined health as “a state of complete physical, mental, and social well-being—not merely the absence of disease, or infirmity” (WHO). This definition reflected a wider concept of health that encompassed social and psychological factors. As a consequence, the dental field also became concerned with factors beyond the patient’s clinical status. Essentially, the aims of dental care were not just about ensuring the absence of dental caries or other diseases, but were extended to cover the patient’s psychological and social comfort as well.
Cohen and Jago (Cohen, 1976), as a consequence of the limited understanding of the psychosocial impact of oral health problems,for the first time recognized the need to develop patients’ treatment based on the measure of oral health condition. Responding to this, Reisine, in 1984, used social indices such as losing a career because of dental condition in order to explain the social impact of oral disease at an individual level(Reisine, 1984).In 1997, Locker constructed a framework that saw a shift from the “biomedical approach (focusing in disease-centered) to biopsychosocial approach (focusing on patient-centered).” Further, he highlighted that health and illness are different paths that are independent. This distinction can be seen clearly from a person’s experience, as he\she will mention either an experience of health or disease. For example, the person could have a disease like diabetes, but assume that his health perfect. Conversely, during an assessment of health, disease could be considered as a factor. Shifting to the relation between health and quality of life, Locker also declared that some points used to measure quality of life (QOL) cannot be distinguished from those used to measure health; but there are other factors, which affect QOL besides health. Locker (1997), following the model of Wilson and Clearly (1995) realized that a person’s character determines his/her QOL as well as the non-medical factors like career, accommodation, community, religiousness, values and social environment.

What is oral health related quality of life (OHRQOL)?

The term oral health related quality of life (OHRQOL) emerged from the new definition of health by representing the relationship between numerous factors such as health status, age, gender and general standard of living. It includes biomedical and biopsychological aspect. The biopsychological approach may be divided into a specific that relates to a particular disease and generic that characterize the whole group of diseases, without referencing to a particular one. The term is also reliant on the perception of the individual because it is not the condition that can be measured direct (McGrath and Bedi, 2002). Conversely, the OHRQOL model is based on the concept of health defined as the state of complete physical, mental, and social well-being and not just the absence of illnesses (WHO, 1948). In this case, complete well-being means that the health status or the clinical variables, functional status of the body, oral-facial appearance, and psychological condition are in line with the quality of life. In this respect, oral health affects different aspects of a person’s social life that may include the self-esteem, social interaction, and performance at different levels of life (Hayes, 1998). Therefore, the OHRQOL model and the concept of health incorporate the biological, social, the psychological and certain cultural factors that affect the overall health status.
The function of the oral cavity, psychology, social, and experience of pain are the main points of OHRQOL; hence, the OHRQOL has been linked directly to the patient himself as a patient-center biopsychosocial (BPS) model.
In 2007, Locker and Allen defined OHQOL as “the impact of oral disorders on aspects of everyday life that are important to patients and persons, with those impacts being of sufficient magnitude, whether in terms of severity, frequency or duration, to affect an individual’s perception of their life overall” (Locker and Allen, 2007).

Types of OHRQOL measures and their uses

A number of measures that have been designed to collate those outcomes and, based on functional and psychosocial factors, assess how it affects quality of life (Locker and Allen, 2007). Equally, the tools that are used to measure the quality of life can be categorized into condition-specific and generic measures. The QOL measures such as Short-Form Health Survey (SF-36) are generic, but in the case of tools, which are used to measure OHQOL, most of them act as organ-specific measures toward oral clinical status. Nonetheless, they are in wide ranges in order to have as much as oral symptoms to achieve their main purpose for a certain population. On the other hand, if the tools measuring OHQOL aim to a specific condition of oral clinical statuses, their goals will switch to report the responsiveness of the treatment by possessing effective evaluative properties (Sischo and Broder, 2011). In addition, the OHRQOL tools also address issues that relate to the age-specificity and the overall oral health such as COHRQOL for children. In short, OHQOL is a specific measure tool to oral cavity by assessing both dimensions during the course of life (Sischo and Broder, 2011).
Slade suggests that, because of the importance of OHRQOL as an outcome when treating oral health conditions, its assessment has to be based on a well-knit logical basis and the assessment tools should also be reliable, rigorous, and valid (Slade, Chapter 4). Slade devised three OHRQOL categories that include social indicators, global self-ratings, and OHRQOL multiple items questionnaires.

The social indicators

Social indicators are used in assessment of oral conditions in the community and mostly done in a large population to express the dental burden through social indicators such as school absenteeism, work loss, and restricted activities due to oral conditions. These assessments, normally related to unimportant rates, have an effect toward individual, but they return to be needful when they expressed illness burden to population in a selective year. Specially, the oral condition is a wide occurrence, and when it occurs it leads to disabling pain in area of the head and neck. A good example of this is available in a study done by Reisine in 1984, when he analyzed the job loss due to oral condition to produce the societal measureable. However, social indicators are important to policy makers, but theyhave boundaries in evaluating OHRQOL.

Global self-ratings of OHRQOL:

Global self-ratings of OHRQOL pose questions to individuals regarding their entire dental health hence the responses can be in Visual Analog Scale (VAS) or categorical format. As an example, a global question may be asked such as “If you were to rate your oral health, how would you rate it today?” and the answer provided can be categorized as “good” or “bad” while in VAS a scale of 1-10 applies. It have been used in the third National Health and Nutrition Examination and one of the question was “How would you describe the condition of your natural teeth?” the answers were frequency categories in five rang: Excellent, Very good, Good, Fair and Poor (Gift, 1998).

OHRQOL multiple items questionnaires

OHRQOL multiple items questionnaires are used for assessment. OHRQOL tools exist in different broad categories in case of question numbers, and in the presentation method of questions as well as how it responses. In the First international Conference on Measuring Oral Health, Ten OHRQOL tools were completelyexamined to evaluate their psychometric properties, such as reliability, rationality and responsiveness.
Gift and Atchison in 1997 suggested that the importance of OHQOL concept was vital in three areas namely; are the dental clinical practice, research of dental and in the education field of dental of dental health in specific (Gift, 1997).Clinically, clinicians and researchers are compelled to not only examine mouth cavities, but to take into consideration the patient’s whole body (Al Shamrany,2006).By assessment of the OHRQOL outcome, oral health professionals will be able to evaluate the value of treatment procedures from patients’ viewpoints (Wright et al., 2009). OHQOL introduces proxy ratings that are valuable resources for verification or contradiction of the self-reported OHRQOL outcomes (Leao, Sheiham, 1996). Therefore, it guarantees the overall health and well-being of the diverse populations considered. Equally, it has been recognized by oral healthcare researchers and policymakers that oral health programs can be planned; using an assessment of oral health outcomes, which implies that the health recourses will be located by their outcomes (Allen, 2003). Thus, the OHQOL will be a good method in order to communicate with the policymaker (Al Shamrany, 2006).Moreover, this aspect is involved in dental education. OHRQOL ideas can act as very important tools in realising tremendous changes in dental treatments by giving researchers, clinicians, and dental educators wide knowledge on dental education that is crucial in achieving quality public dental health (Ohrn and Jonsson, 2011).
Previously, good health simply meant survival; living as long as possible and avoiding diseases, but now its scope is wider, according to the QOL (Cook, 1994). Health-related quality of life is an essential element to pay attention to when obtaining care. For dentistry, scales and measurement tools, which ascertain OHRQOL, are important in ensuring that reliable criteria are met (Locker and Allen, 2007). The assessment of the quality of the tools is based on the specificity, reliability and the validity of the tools; whereas, assessment involves using multi-trait methods based on criterion, reliability, and validity by utilizing clinical assessments (Leao and Sheiham, 1996). To conclude, the tools used in the assessment of the OHRQOL comprise of common features, which are evaluated in the domains based on functionality, psychological, and social aspects (Cushing, 1986). They also have differences in terms of technical characteristics such as administrative methods, sub-scales, the final scoring, and the answer possibilities. Nonetheless, it is essential to know the quality of an OHQOL measures before it is used.

3-objectives of the dissertation:

Identify and retrieve into the measures.
Evaluate the OHQOL measures against the criteria from the Scientific Advisory Committee (SAC) of the Medical Outcomes Trust (MOT) determined by Locker and Allen (2007).

Reach judgment about the quality of adult measures OHRQOL based on the criteria.

3-Methodology-Design:
3-1: Overview
Systematic reviews comparing the quality of OHQOL measures against specific criteria
3-2: Search inclusion criteria for measures :
During the research the following quality inclusion criterions have to be applied through assuming of this research:
measures of OHQOL
used since 2000
3-3: Exclusion criteria:
The OHQOL measure tools that have to be excluded from this systematic review are, the ones that meet one of the following criteria:
Tools focus in specific oral condition and do not cover other mouth conditions such as (HALT), so they are restricted to symptoms.

Tools that were not published in English.

4: Search keyword:
During the research the terms, which will be used, are: questioners, measures, tools, scales, index, scales, oral health and quality of life.

5: Conduct of the study

Data extraction
The studies retrieved, were exported to the software End Note and then the titles of articles connected with OHQOL in adults were selected by one of the author. During the research the following quality inclusion criterions have to be applied through assuming of this research:
measures of OHQOL
these measures are used since 2000
The OHQOL measure tools that have to be excluded from this systematic review are, the ones that meet one of the following criteria:
restricted to symptoms.

Measure tools that were not published in English

One of the author used piloted forms in order to take out material from the full-text version, which were then scanned by the other author for compliance with the requirements. If the disagreement occurred the consensus was reached through discussion between authors.

5:Pilot study:

The pilot study is directed to assess tow questioners tools that aimed to measure children OHQOLby criteria. The criteria areconstructed from Scientific Advisory Committee (SAC) of the Medical Outcomes Trust (MOT) firm by Terwee, Locker and Allen. The selected tow tools are:

1- CPQ6-7(Child Perceptions Questionnaire for child aged 6to7 years old).

2- CPQ8-10(Child Perceptions Questionnaire for child aged 8to10 years old).
The tow tools will be assessed by applying the questioners of each toolto 8 quality criteria, which are listed below:
“Content validity, Internal consistency, criterion validity, construct validity, reproducibility (agreement and reliability), responsiveness, floor and ceiling effects and interpretability”. (Fouchard A et al., 2013) Each assessment of questioner will be done individual and done twice, one by me and another time by my collogueHaya. After finishing evaluation the tow tools twice and individual, a judgment based in my judgment and Haya will occur if they meet the quality criteria.
6: Timing
The complete framework draft of this project report should be submitted in September 2015. Before that time a number of measures tools will be collected from several of source that had meet the inclusive criteria of this research.

· 5th of December: the start of project.

·2ed of February: the protocol of this research will be submitted.
·From the 9th until 20th February: Pilot study will be conducted in that period time.
. April 2015: produce a systematic search of all the available literatures.

·June 2015: Evaluation of tools used to measure OHQOL and reach a judgment with project partner “Haya” about it.

. August 2015: The first draft will be write-up.

· End of August 2015: review the final draft for submission to Professor: Peter Robinson.

7: Variables

The variables are the criteria from MOT.

8:Data collection:
The data will be collect from number of different journals articles. This should be reached using online source such as electronic search engines like Google and online libraries.
9- Data Analysis:

The analysis of the data (tools used to measure OHQOL) collated for this project should involve three stages.

The first stage: the OHQOL tools that had been collected should meet the inclusive criteria.
The second stage: begin evaluate the tools by applying the tools against the chosen criteria.
The third stage: reach a judgment with “Haya” if questioners of OHQOL tool meet the selected criteria.
10-Funding:

No funding is required for research.

11-Refrences:
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Cushing, A., Sheiham, A., &Maisels, J. (1986). Developing socio-dental indicators-the social impact of dental disease. Community Dental Health, 3:3-17.
Cohen LK, Jago JD (1976): Toward formulation of socio-dental indicators.

International Journal of Health Services, 6:681-698

Finbarr, A. P. (2003). Assessment of oral health related quality of life. Health and Quality of Life Outcomes, 1: 40; doi:10.1186/1477-7525-1-40
Guyatt GD, Cook DJ (1994). Health status, quality of life and the individual. JAMA;272:630–1.
GeryD.Slade (2002). Assessment of Oral Health-Related Quality of Life, Oral Health-Related Quality of Life chapter 4
Fouchard A, Bréchat PH, Castiel D, Pascal J, Sass C, Lebas J, Chauvin P(2013) Qualitative and quantitative comparisons of three individual deprivation scores for outpatients attending a free hospital care clinic in Paris, Revue d'Épidémiologie et de Santé Publique , 62 (4): 237–247
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Locker, D.and Miller, Y. (1994).Evaluation of subjective oral health status indicators. J Public Health Dent, 54: 167-176.
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Leao, A., &Sheiham, A. (1996). The development of a socio-dental measure of Dental Impacts on Daily Living.Community Dental Health, 13:22-26.
McGrath C, Bedi R (2001): An evaluation of a new measure of oral health related quality of life–OHQoL-UK(W).

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Reisine, S.t. (1984): "Dental Disease and Work Loss." Journal of Dental Research :1158-161.
Sischo, L. and Broder, H. L. (2011). Oral Health-related Quality of Life. J Dent Res. 90(11): 1264–1270.
Inglehart.M and Bagramian.R (2002): Oral Health-Related Quality of Life;USA
Öhrn, K., and Jönsson, B. (2011). A comparison of two questionnaires measuring oral health related quality of life before and after dental hygiene treatment in patients with periodontal disease. International Journal Of Dental Hygiene, 10(1), 9-14
Robinson PG, Gibson B, Khan FA, Birnbaum W (2003). Validity of two oral health-related quality of life measures.Community Dent Oral Epidemiol ;
Slade GD ,ed (1997) .Measuring Oral Health and Quality of life. Chapel Hill: University of North Carolina, Dental Ecology.
Wilson and Cleary (1995): Linking Clinical Variables With Health-Related Quality of Life A Conceptual Model of Patient Outcomes; JAMA;273(1):59-65
World Health Organization (WHO) (1948): World Health Organization Constitution. Geneva, Switzerland: World Health Organization.
Yolanda Alonso (2004), The biopsychosocial model in medical research: the evolution of the health concept over the last two decades, Pages 239–244.