Physiotherapy in Parkinson's disease. towards evidence- based practice. Keus, S.H.J.

based practice.

Keus, S.H.J.

Citation

Keus, S. H. J. (2010, April 29). Physiotherapy in Parkinson's disease. towards evidence-based practice. Retrieved from https://hdl.handle.net/1887/15341

Version: Corrected Publisher’s Version

License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden

Downloaded from: https://hdl.handle.net/1887/15341

Note: To cite this publication please use the final published version (if applicable).



&OLQLPHWULFDQDO\VHVRIWKH0RGLÀHG3DUNLQVRQ$FWLYLW\6FDOH

&OLQLPHWULFDQDO\VHVRIWKH

0RGLÀHG3DUNLQVRQ$FWLYLW\6FDOH



0XQQHNH03DUNLQVRQLVP5HODW'LVRUG

6XPPDU\

7KH3DUNLQVRQ$FWLYLW\6FDOH3$6LVGHVLJQHGIRUIXQFWLRQDODVVHVVPHQWLQ3DUNLQVRQ·V

GLVHDVH3'EXWWKHVFDOHKDV²LQLWVFXUUHQWIRUP²VHYHUDOGUDZEDFNV7KHREMHFWLYHV

RI WKHSUHVHQWVWXG\DUHDWRLQWURGXFHD0RGLÀHG3$6ZLWKXQDPELJXRXVVFRULQJ

RSWLRQVDQGZLWKRXWFHLOLQJHIIHFWEWRHYDOXDWHWKHLQWHUUDWHUDJUHHPHQWXVLQJSK\VL

RWKHUDSLVWVZLWKDQGZLWKRXW3'VSHFLÀFH[SHUWLVHDQGFWRH[DPLQHWKHFRQFXUUHQW

YDOLGLW\ZLWKWKH9$6*OREDO)XQFWLRQLQJDQGWKH83'56,,,

)LUVWWKH0RGLÀHG3$6ZDVGHYHORSHGEDVHGRQWKHUHVXOWVRIDUHFHQWSLORWIHDVLELOLW\

VWXG\&KDSWHU7RHYDOXDWHLQWHUUDWHUDJUHHPHQWWKH0RGLÀHG3$6ZDVVFRUHGE\D

ODUJHQXPEHURI UDWHUV1 LQSDWLHQWV+RHKQ <DKUVWDJHWRWKXV\LHO

GLQJDKLJKQXPEHURI REVHUYDWLRQV1 DQGFUHDWLQJDGHTXDWHSRZHU7RDVFHUWDLQ

EURDGDSSOLFDELOLW\RI WKHUHVXOWVERWKSK\VLRWKHUDSLVWVZLWKDQGZLWKRXW3'VSHFLÀF

H[SHUWLVHSDUWLFLSDWHG

7KHÀQGLQJVVKRZHGDQLQWHUTXDUWLOHUDQJHRIWKH0RGLÀHG3$6WRWDOVFRUHVRI WR

$VWKLVLVZLWKLQDSRVVLEOHUDQJHRIRSWLPDOSHUIRUPDQFHWRZRUVWSHUIRUPDQFH

WKLVVXJJHVWVDODFNRI FHLOLQJHIIHFW7KHSUHFLVLRQRI WKHVHVFRUHVZDVSRLQWVZLWK

DQLQWHUUDWHUHUURURI DQGDSDWLHQWLQGXFHGHUURURI 7KHUHZHUHQRGLIIHUHQFHV

EHWZHHQH[SHUWVDQGQRQH[SHUWV&RUUHODWLRQWR*OREDO)XQFWLRQLQJDQG83'56

,,,ZDVJRRG

,QFRQFOXVLRQWKH0RGLÀHG3$6VKRZHGQRFHLOLQJHIIHFWJRRGFRQFXUUHQWYDOLGLW\

JRRGLQWHUUDWHUDJUHHPHQWDQGQRGLIIHUHQFHVEHWZHHQH[SHUWVDQGQRQH[SHUWV







,QWURGXFWLRQ

7KHUHLVLQFUHDVLQJHYLGHQFHWRVXJJHVWWKDWSK\VLRWKHUDS\FDQLPSURYHPRELOLW\GHÀFLWV

LQSDWLHQWVZLWK3DUNLQVRQ·VGLVHDVH3'LQFOXGLQJGLIÀFXOWLHVZLWKWUDQVIHUVHJULVLQJ

IURPDFKDLUEDODQFHDQGJDLW^%RWKWRLGHQWLI\OLPLWDWLRQVLQHYHU\GD\DFWLYLWLHVIRU

ZKLFKSK\VLRWKHUDS\FRXOGEHSUHVFULEHGDQGWRHYDOXDWHFKDQJHVIROORZLQJSK\VLRWKH

UDS\WKHXVHRIDGHTXDWHHYDOXDWLRQWRROVLVDGYLVHG^)RUWKLVSXUSRVHWKH3DUNLQVRQ

$FWLYLW\6FDOH3$6ZDVGHYHORSHG^7KLVVFDOHFRQVLVWVRILWHPVGHVFULELQJDFWLYLWLHV

UHODWHGWRPRELOLW\$QREVHUYHUHJDSK\VLRWKHUDSLVWVFRUHVWKHTXDOLW\RIPRYHPHQWV

ZKLOHWKHSDWLHQWSHUIRUPVWKHVHDFWLYLWLHV

7KH3$6SURYHGFDSDEOHRIGHPRQVWUDWLQJFOLQLFDOO\UHOHYDQWLPSURYHPHQWVDIWHUD

KRPHEDVHGSK\VLRWKHUDS\SURJUDPLQZKLFKWKHSDWLHQWVZHUHDVVHVVHGDWKRPH^7KH

LQWHUUDWHUUHOLDELOLW\RIWKH3$6ZKHQDGPLQLVWHUHGWR3'SDWLHQWVLQ+RHKQ <DKU

VWDJHVDQGDQGZKHQVFRUHGIURPYLGHRUHFRUGLQJVE\3'H[SHUWSK\VLRWKHUDSLVWV

LVJRRG^+RZHYHUQRLQIRUPDWLRQLVDYDLODEOHRQDJUHHPHQWOHYHOVZKHQSDWLHQWVDUH

VFRUHG¶UHDOWLPH·ZKLOHWKH\DFWXDOO\SHUIRUPWKHDFWLYLWLHV$OVRWKHFRQFXUUHQWYDOLGLW\

ZLWKRWKHUIXQFWLRQDOPHDVXUHVLVXQNQRZQ)XUWKHUPRUHIRUSDWLHQWVLQ+RHKQ <DKU

VWDJHDQGWKHUHDSSHDUHGWREHDFHLOLQJHIIHFWIRUDWOHDVWVHYHUDOLWHPV^

2XUREMHFWLYHVZHUHWRDLQWURGXFHD0RGLÀHG3$6ZLWKXQDPELJXRXVVFRULQJDQG

ZLWKRXWFHLOLQJHIIHFWEDVVHVVWKHLQWHUUDWHUDJUHHPHQWZKHQDVVHVVHGLQ¶UHDOWLPH·E\

SK\VLRWKHUDSLVWVZLWKDQGZLWKRXW3'VSHFLÀFH[SHUWLVHDQGFDVVHVVWKHFRQFXUUHQW

YDOLGLW\RI WKH0RGLÀHG3$6ZLWKWKH83'56,,,DQG*OREDO)XQFWLRQLQJ

0HWKRGV

0RGLÀHG3$6

7RLPSURYHWKH3$6WZR3'H[SHUWSK\VLRWKHUDSLVWV6+-. 00LQGHSHQGHQWO\SUR

SRVHGLPSURYHPHQWVEDVHGRQDIHDVLELOLW\VWXG\LQ3'SDWLHQWV&KDSWHU^7KHVH

LPSURYHPHQWVZHUHGLVFXVVHGZLWKWKHGHYHORSHURI WKH3$6$1XQWLOFRQVHQVXVZDV

REWDLQHG

7KH0RGLÀHG3$6FRQVLVWVRILWHPVDUUDQJHGLQWRWKUHHGRPDLQV¶&KDLU7UDQVIHU·

LWHPV¶*DLW$NLQHVLD·LWHPVDQG¶%HG0RELOLW\·LWHPV$SSHQGL[&RPSDUHGZLWK

WKHRULJLQDO3$6PRUHLQIRUPDWLRQZDVSURYLGHGRQHTXLSPHQWQHHGHGWRDGPLQLVWHU

WKHWHVWDQGRQLQVWUXFWLRQVIRUSDWLHQWV$OVRVHYHUDOWHVWVDUHUHQGHUHGPRUHFKDO

OHQJLQJDQGLWHPGHVFULSWLRQVDQGVFRULQJRSWLRQVDUHFODULÀHG)XUWKHUPRUHEDVHGRQ

HDUOLHUZRUN^IRXU¶GXDOWDVN·LWHPVZHUHDGGHGWRWKHGRPDLQ*DLW$NLQHVLDLQRUGHUWR

LQFUHDVHWKHOLNHOLKRRGRI SURYRNLQJIUHH]LQJ^DQGWKHUHE\UHGXFHWKHFHLOLQJHIIHFW



(YDOXDWLRQRI WKH0RGLÀHG3$6

7RHYDOXDWHDSRVVLEOHFHLOLQJHIIHFWWKHGLVWULEXWLRQRIVFRUHVRQWKHWRWDO0RGLÀHG

3$6ZDVDVVHVVHG7RHYDOXDWHLQWHUUDWHUDJUHHPHQWREVHUYDWLRQVRI 0RGLÀHG

3$6VFRUHVUDWHUVRISDWLHQWVZHUHFRPSDUHGWKXVFUHDWLQJDGHTXDWHSRZHU:H

SXUSRVHO\HYDOXDWHGLQWHUUDWHUDJUHHPHQWXVLQJPDQ\UDWHUVUDWKHUWKDQDODUJHUSDWLHQW

JURXSDVWKLVEHWWHUFODULÀHVLQWHUREVHUYHUYDULDWLRQV:HLQFOXGHGSK\VLRWKHUDSLVWV

ERWKZLWKDQGZLWKRXW3'VSHFLÀFH[SHUWLVHWKXVVLPXODWLQJHYHU\GD\SUDFWLFHDQGWR

DVFHUWDLQEURDGDSSOLFDELOLW\RI RXUUHVXOWV)LQDOO\WRHYDOXDWHFRQFXUUHQWYDOLGLW\WKH

VFRUHVRQWKH0RGLÀHG3$6ZHUHFRPSDUHGZLWKWKH83'56,,,PRWRUIXQFWLRQLWHPV

WRWRWDOUDQJHWREHFDXVHWKLVPHDVXUHLVPRVWRIWHQXVHGLQ3'UHVHDUFK

FRQWDLQVLWHPVRQPRVWFRUHDUHDVRISK\VLRWKHUDS\LQ3'LHEDODQFHSRVWXUHDQGJDLW DQGKDVVKRZQHIIHFWVRISK\VLRWKHUDS\LQ3'%HFDXVHWKHV\PSWRPRULHQWHG

83'56GRHVQRWPHDVXUHDFWLYLWLHVWKDWSK\VLRWKHUDS\DLPVWRLPSURYHZHDOVR

FRPSDUHGWKH0RGLÀHG3$6WRWKHH[SHUWSK\VLRWKHUDSLVWV·VFRUHVRQWKH9$6*OREDO

)XQFWLRQLQJDYLVXDODQDORJXHVFDOHZLWKVFRUHVUDQJLQJIURP¶RSWLPDO·WR¶ZRUVW·

WKDWDFFRPPRGDWHVWKHWLPHQHHGHGWRSHUIRUPDFWLYLWLHVDQGWKHSDWLHQW·VJHQHUDOSUH

VHQWDWLRQ

7KHSDWLHQWVJOREDOIXQFWLRQLQJLVPXFKPRUHWKDQWKHTXDOLW\RI WKHSHUIRUPDQFHRI  DFWLYLWLHVLQWKHFRUHDUHDVRISK\VLRWKHUDS\DVPHDVXUHGRQWKH0RGLÀHG3$6,QDGGL

WLRQWRWKHLQIRUPDWLRQSURYLGHGE\WKH0RGLÀHG3$6LQIRUPDWLRQRQWKHSDWLHQWV·

DUULYDOWRDQGGHSDUWXUHIURPWKHWHVWLQJVFHQHDVZHOODVWKHSDWLHQW·VJHQHUDOSUHVHQWD

WLRQFRPPXQLFDWLRQDQGWKHWLPHQHHGHGWRSHUIRUPWKH0RGLÀHG3$6DFWLYLWLHVZLOOEH

XVHGWRHVWLPDWHJOREDOIXQFWLRQLQJ

7KHUDSLVWVDQGSDWLHQWV

7KLUWHHQSK\VLRWKHUDSLVWVSDUWLFLSDWHGLQFOXGLQJVL[3'H[SHUWVZLWKUHJXODULQYROYH

PHQWLQ3'IRUDWOHDVWWZR\HDUVDQGVHYHQQRQH[SHUWVSK\VLRWKHUDS\VWXGHQWVMXVW

SULRUWRJUDGXDWLRQDQGZLWKRXWDQ\H[SHULHQFHLQ3'

,QFOXVLRQFULWHULDIRUSDWLHQWVZHUHLGLRSDWKLF3'DFFRUGLQJWRWKH*HOEFULWHULD^+RHKQ

<DKUVWDJHWRGXULQJRQSHULRGV0LQL0HQWDO6WDWH([DPLQDWLRQ006(VFRUH

•DQGSUREOHPVRQDWOHDVWRQHRIWKHLWHPVRIWKH0RGLÀHG3$6DVDVVHVVHGE\

DPRYHPHQWGLVRUGHUVH[SHUW%5%)LIWHHQHOLJLEOHSDWLHQWVZHUHLQFOXGHG7KHWRWDO

QXPEHURI REVHUYDWLRQVZDV

7UDLQLQJDQGREVHUYDWLRQV

$VVHVVPHQWVZHUHGRQHGXULQJRQHGD\7ZRZHHNVEHIRUHSDUWLFLSDWLQJSK\VLRWKHUDSLVWV

UHFHLYHGWKHDUWLFOHGHVFULELQJWKHRULJLQDO3$6^DQGDVFRUHVKHHWRI WKH0RGLÀHG3$6

2QWKHDVVHVVPHQWGD\EXWEHIRUHWKHDFWXDOREVHUYDWLRQVDYLGHRWUDLQLQJVHVVLRQRI 

PLQZDVJLYHQWRSUDFWLFHWKH0RGLÀHG3$6:HQH[WKHOGDFDOLEUDWLRQVHVVLRQZKHUH



RQHSDWLHQWZDVHYDOXDWHGXVLQJWKH0RGLÀHG3$6E\DOOWKHUDSLVWVVLPXOWDQHRXVO\EXW

LQGHSHQGHQWO\DIWHUZKLFKVFRUHVZHUHFRPSDUHGDQGGLVFXVVHG

3DWLHQWVZHUHWKHQWHVWHG$QLQGHSHQGHQWDVVLVWDQWQRWLQYROYHGLQVFRULQJJDYH

LQVWUXFWLRQVWRWKHSDWLHQWV60Y5$FNQRZOHGJHPHQWV$OOWKHUDSLVWVHYDOXDWHGSDWLHQWV

ZLWKWKH0RGLÀHG3$6VLPXOWDQHRXVO\EXWLQGHSHQGHQWO\(DFKHYDOXDWLRQODVWHGWR

PLQXWHV1H[WWKHH[SHUWSK\VLRWKHUDSLVWVVFRUHGWKHSDWLHQW·V9$6*OREDO)XQFWLRQLQJ

7KHVWXG\ZDVDSSURYHGE\WKH0HGLFDO(WKLFV&RPPLWWHH$OOSDWLHQWVVLJQHGLQIRUPHG

FRQVHQW

$QDO\VHV

)RUHDFKGRPDLQDQGIRUWKHWRWDOVFRUHWKHWRWDOHUURUVWDQGDUGGHYLDWLRQRI PHDVXUH

PHQWZDVHVWLPDWHGXVLQJDQDO\VLVRIYDULDQFHZLWKWKHSDWLHQWDVLQGHSHQGHQWIDFWRU

7KHUHODWLYHLPSRUWDQFHRISDWLHQWDQGWKHUDSLVWLQDGGLQJHUURUWRWKHPHDVXUHPHQWZDV

GHWHUPLQHG

7KHLQWHUUDWHUHUURUZDVFDOFXODWHGE\DGGLQJWKHUDQGRPHIIHFW¶WKHUDSLVW·WRWKHPRGHO

,QDGGLWLRQDJUHHPHQWEHWZHHQH[SHUWDQGQRQH[SHUWSK\VLRWKHUDSLVWVZDVHYDOXDWHGE\

LQFOXGLQJWKHIDFWRU¶H[SHUWQRQH[SHUW·LQWKHPRGHO)URPWKHVHHUURUVWKHVPDOOHVW

GHWHFWDEOHGLIIHUHQFH6''FDQEHFDOFXODWHG7KH6''_GLIILV ¥WLPHVWKHHUURU

:KHQDSDWLHQWLVVFRUHGE\WZRGLIIHUHQWUDWHUVDQGWKHVFRUHVGLIIHUE\PRUHWKDQWKH

6''WKHSDWLHQWLVOLNHO\WRKDYHLPSURYHGRUGHWHULRUDWHG

7RFRPSDUHWKHSUHFLVLRQRI WKH0RGLÀHG3$6DQG9$6*OREDO)XQFWLRQLQJZHDOVR

FDOFXODWHGWKHVWDQGDUGLVHGHUURURI PHDVXUHPHQWZKLFKLVWKHVL]HRI WKHHUURUUHODWLYH

WRWKHYDULDWLRQLQVFRUHV:HFDOFXODWHGWKHPHDQVFRUHVSHUSDWLHQWDQGWKHVWDQGDUG

GHYLDWLRQRI WKHVHPHDQV7KLVLVDQHVWLPDWHRIWKHYDULDWLRQEHWZHHQSDWLHQWV7KH

VWDQGDUGLVHGHUURULVWKHTXRWLHQWRIWKHWRWDOHUURUDQGWKHVWDQGDUGGHYLDWLRQRI WKH

PHDQV)LQDOO\WKH6SHDUPDQFRUUHODWLRQFRHIÀFLHQWVRI0RGLÀHG3$6ZLWK83'56,,,

DQG9$6*OREDO)XQFWLRQLQJZHUHFDOFXODWHG

5HVXOWV

3DWLHQWFKDUDFWHULVWLFV

7KHSDUWLFLSDWLQJSDWLHQWV·PHGLDQDJHZDVLQWHUTXDUWLOHUDQJH>,45@WR

ZLWKDPHGLDQGLVHDVHGXUDWLRQRI\HDUV,45WRDPHGLDQ83'56,,,

VFRUHRI ,45WRDPHGLDQ9$6*OREDO)XQFWLRQLQJVFRUHRI,45WR

0RVWSDWLHQWVZHUHPDOHQ 3DWLHQWVZHUHLQ+RHKQ <DKUVWDJHQ 

Q Q RUQ 0HGLDQWLPHVLQFHLQWDNHRI PHGLFDWLRQZDVKRXUV,45

WR1RQHRI WKHSDWLHQWVKDGVLJQLÀFDQWG\VNLQHVLDVDWWKHWLPHRIH[DPLQDWLRQ



'LVWULEXWLRQRI 0RGLÀHG3$6VFRUHV

7KHPHGLDQWRWDOVFRUHZDV,45WR)LJXUH:LWKLQWKHWRWDOSRVVLEOHUDQJH

RI WRLQGLYLGXDOVFRUHVUDQJHGIURPWR2QO\RILQGLYLGXDOVFRUHVH[FHH

GHGSRLQWV)RUIRXULWHPVRYHURIDOOSDWLHQWVDFKLHYHGDPD[LPXPVFRUHWKH

LWHPVLWWLQJGRZQLWHPDQGWKHWKUHHLWHPVIRUVWDUWDNLQHVLDLWHPVDQGQDPHO\

QRUPDOZLWKFRQFXUUHQWPRWRUWDVNDQGZLWKFRQFXUUHQWFRJQLWLYHWDVN7KLVUHVXOWHGLQ

KLJKGRPDLQVFRUHVIRU&KDLU7UDQVIHUV,45WRPD[LPDOSRVVLEOHUDQJHWRDQG

*DLW$NLQHVLD,45WRPD[LPDOSRVVLEOHUDQJHWR

,QWHUUDWHUDJUHHPHQW

7DEOHVKRZVWKHSUHFLVLRQRIWKHVHVFRUHV7KHWRWDOPHDVXUHPHQWHUURUVWDQGDUGGH

YLDWLRQRI WKHVFRUHVSHUSDWLHQWRQWKH0RGLÀHG3$6ZDV7KLVHUURUFRQVLVWHGRI D

V\VWHPDWLFLQWHUUDWHUHUURURI DQGDUHVLGXDOSDWLHQWLQGXFHGHUURURI 

7KHVWDQGDUGLVHGPHDVXUHPHQWHUURURI WKH0RGLÀHG3$6ZDVZKLOHWKHVWDQGDUG

LVHGHUURURI WKH3'H[SHUWVFRUHIRUJOREDOIXQFWLRQLQJZDV7KHVPDOOHVWGHWHF

WDEOHGLIIHUHQFHZKHQWZRGLIIHUHQWUDWHUVDVVHVVHGDSDWLHQWZDVSRLQWV

7KHPHDQ0RGLÀHG3$6VFRUHVGLGQRWGLIIHUEHWZHHQH[SHUWVDQGQRQH[SHUWVS! )LJXUHDOWKRXJKWKHWRWDOHUURUZDVVOLJKWO\ODUJHUIRUQRQH[SHUWVYV

3W 3W

 3W

 3W

 3W

 3W

 3W

 3W

 3W

 3W

 3W

 3W

 3W

 3W

 3W

















3DWLHQWV1 DUUDQJHGLQRUGHURIVFRUHIRUPRWRUIXQFWLRQLQJPHDQ83'56,,, 7RWDOVFRUH

0RGLILHG3$6

)LJXUH0RGLÀHG3$6VFRUHVE\H[SHUWɻDQGQRQH[SHUWRSK\VLRWKHUDSLVWV (DFKSRLQWɻRURUHÁHFWVD0RGLÀHG3$6WRWDOVFRUHIRURQHSDWLHQWE\RQHWKHUDSLVW



&RQFXUUHQWYDOLGLW\

7KHFRUUHODWLRQEHWZHHQ0RGLÀHG3$6VFRUHVDQG83'56PRWRUVFRUHVZDVJRRG

7KHFRUUHODWLRQEHWZHHQ0RGLÀHG3$6VFRUHVDQGWKH9$6*OREDO)XQFWLRQLQJ

ZDVHYHQEHWWHU

'LVFXVVLRQ

:HKDYHHYDOXDWHGD0RGLÀHG3$6DVDQLPSURYHGWRROIRUPDQDJHPHQWDQGHYDOXDWLRQ

RI SK\VLRWKHUDS\LQ3'7KHUHVXOWVVKRZWKDWWKH0RGLÀHG3$6KDGQRFHLOLQJHIIHFW

)XUWKHUPRUHLWKDVJRRGDJUHHPHQWZKHQXVHGE\SK\VLRWKHUDSLVWVZKRUHFHLYHGDKU

WUDLQLQJLQXVLQJWKHVFDOHDQGWKDWQRYLFHSK\VLRWKHUDSLVWVZLWKRXW3'VSHFLÀFH[SHUWLVH

ZHUHDEOHWRVFRUHZLWKFRPSDUDEOHHUURUOHYHOVWRH[SHUW3'SK\VLRWKHUDSLVWV)LQDOO\

WKHFRQFXUUHQWYDOLGLW\RI WKH0RGLÀHG3$6ZDVGHPRQVWUDWHGE\WKHJRRGFRUUHODWLRQ

ZLWKWZRH[LVWLQJIXQFWLRQDOPHDVXUHV83'56PRWRUVFRUHDQG9$6*OREDO)XQFWLRQ

LQJ7KHVHHIIHFWVZHUHEDVHGRQDKLJKQXPEHURI REVHUYDWLRQVQ PDGHE\

SK\VLRWKHUDSLVWVZLWKGLIIHUHQWOHYHOVRI3'H[SHUWLVH+HQFHWKHDSSOLFDELOLW\RIWKHVH

UHVXOWVDSSHDUVWREHEURDG

'LVWULEXWLRQRI 0RGLÀHG3$6VFRUHV

0RVWSDWLHQWVZHUHVWDJHG+RHKQ <DKUWRDQGPRGHUDWHO\VHYHUHO\DIIHFWHGDFFRU

GLQJWRWKH83'56,,,PRWRUVLJQV$OWKRXJKWKLVLVFRPSDUDEOHWRWKH+RHKQ <DKU

GLVWULEXWLRQRI SDWLHQWVLQWKHRULJLQDOUHOLDELOLW\VWXG\^DQGLQRXUIHDVLELOLW\VWXG\^WKH

0RGLÀHG3$6QRORQJHUVKRZHGDFHLOLQJHIIHFWLQWKLVSRSXODWLRQ:HEHOLHYHWKDWWKH

 6\VWHPDWLF 5DQGRP 7RWDO 6WDQGDUGLVHG 6''GLII 

 HUURU^ HUURU^ HUURU HUURU

3$6WRWDO

UDQJH     

'RPDLQ&KDLU7UDQVIHU

UDQJH     

'RPDLQ*DLW$NLQHVLD

UDQJH     

'RPDLQ%HG0RELOLW\

UDQJH     

9$6*OREDO)XQFWLRQLQJ

UDQJHWR     

6''VPDOOHVWGHWHFWDEOHGLIIHUHQFHLQWHUUDWHUYDULDELOLW\SDWLHQWLQGXFHGUHVLGXDOYDULDELOLW\6''VPDOOHVWGHWHFWDEOH

GLIIHUHQFHLQSRLQWVRI WKHRULJLQDOVFDOH

7DEOH$JUHHPHQWHUURUDQGVPDOOHVWGHWHFWDEOHGLIIHUHQFHRI WKH0RGLÀHG3$6



0RGLÀHG3$6QRZDOORZVPHDVXULQJERWKLPSURYHPHQWDQGGHWHULRUDWLRQRI DSDWLHQW·V

IXQFWLRQDOPRELOLW\7KLVLVLPSRUWDQWEHFDXVH3'LVDSURJUHVVLYHGLVHDVHZKHUHWKHWKH

UDSLVW·VJRDOFDQEHLPSURYHPHQWEXWDOVRWRVORZGRZQWKHGHWHULRUDWLRQRI SHUIRUPLQJ

DFWLYLWLHV7KHUHODWLYHO\KLJKPHGLDQVFRUHRQWKH0RGLÀHG3$6VFRUHVPD\EHH[SODLQHG

E\WKHIDFWWKDWRIWKHSDUWLFLSDWLQJSDWLHQWVZHUHLQ+RHKQ <DKUVWDJHRU

)XWXUHVWXGLHVXVLQJWKH0RGLÀHG3$6VKRXOGDOVRLQFOXGHPRUHSDWLHQWVLQ+RHKQ 

<DKUVWDJHDVWKHVHSDWLHQWVDUHOLNHO\WREHWDUJHWHGIRUSK\VLRWKHUDS\)XUWKHUPRUH

0RGLÀHG3$6VFRUHVDUHFRQFHLYDEO\ORZHUZKHQDVVHVVHGZLWKLQWKHSDWLHQW·VKRPH

ZKHUHPRVWSUREOHPVDUHW\SLFDOO\H[SHULHQFHG

1HYHUWKHOHVVZHUHFRPPHQGVRPHIXUWKHULPSURYHPHQWVIRUWKHIRXULWHPVWKDWVWLOO

VKRZHGDFHLOLQJHIIHFW&RQFHUQLQJLWHPVLWLQJGRZQZHUHFRPPHQGWKDWZKHQ

WHVWLQJDWKRPHSDWLHQWVXVHWKHFKDLURUFRXFKWKDWFDXVHVJUHDWHVWSUREOHPV$SSHQGL[

$WUHWHVWLQJWKHVDPHFKDLURUDQRWKHUFKDLUZLWKDFRPSDUDEOHVHDWKHLJKWDQGVRIWQHVV

QHHGVWREHXVHG&RQFHUQLQJWKHLWHPVIRUVWDUWDNLQHVLDLWHPVDQGZHUHFRP

PHQGWKDWWKHVFRULQJRSWLRQVDUHDGMXVWHGWRFRLQFLGHZLWKWKHGXUDWLRQRIIUHH]LQJRI  JDLWHSLVRGHVLQWKH1HZ)UHH]LQJRI *DLW4XHVWLRQQDLUH1)2*4^7KLVZRXOGLP

SO\WKDWWKHGXUDWLRQRIWKHVHFRQGVFRULQJRSWLRQSRLQWVLVFKDQJHGWR¶XSWRVHF·

ZKHUHDVWKHGXUDWLRQRIWKHWKLUGVFRULQJRSWLRQSRLQWVLVFKDQJHGWR¶WRVHFRQGV·

$SSHQGL[

,QWHUUDWHUDJUHHPHQW

2XUUHVXOWVDOVRVKRZWKDWWKHDJUHHPHQWRIWKH0RGLÀHG3$6LVJRRGZKHQDVVHVVHGLQ

¶UHDOWLPH·DQGWKDWHUURUVRI PHDVXUHPHQWPDGHE\H[SHUWDVZHOODVQRQH[SHUWSK\

VLRWKHUDSLVWVDUHFRPSDUDEOH7KHLQWHUUDWHUYDULDQFHLVRQO\RI WKHWRWDOYDULDQFH

VRWKH0RGLÀHG3$6LVREMHFWLYHLQWKHVHQVHWKDWWKHLQWHUUDWHUYDULDELOLW\V\VWHPDWLF

HUURULVORZ)XUWKHUPRUHWKH3'VSHFLÀFH[SHUWLVHRI WKHSK\VLRWKHUDSLVWVKDGQR

LPSRUWDQWLPSDFWRQWKHDJUHHPHQWRIWKH0RGLÀHG3$6VFRUHVDOWKRXJKWKHVHÀQGLQJV

PD\WRVRPHH[WHQWEHH[SODLQHGE\WKHKRXUWUDLQLQJVHVVLRQSUHFHGLQJWKHREVHUYD

WLRQV

7KH6''RI WKH0RGLÀHG3$6ZDV7KLVFKDQJHLVVWDWLVWLFDOO\VLJQLÀFDQWLPSO\

LQJDSUREDEOHFKDQJHLQVWDWXVRIWKHSDWLHQWGXHIRUH[DPSOHWRPRWRUÁXFWXDWLRQV

RUDFKDQJHLQWKHXQGHUO\LQJVHYHULW\,QRXUVWXG\ZHFDOFXODWHGDQ6''_GLIIEDVHGRQ

PXOWLSOHUHSHWLWLRQVLQZKLFKHDFKWKHUDSLVWVFRUHGHDFKSDWLHQWRQO\RQFH$QDOWHUQD

WLYHGHÀQLWLRQZRXOGEH6''_VDPHZKLFKFDQEHFDOFXODWHGLIWKHVDPHUDWHUFRQVHFXWLYHO\

VFRUHVWKHVDPHSDWLHQW,QWKLVFDVHLIWKHVFRUHVRIWZRFRQVHFXWLYHHYDOXDWLRQVGLIIHU

PRUHWKDQWKH6''WKHSDWLHQWLVOLNHO\WRKDYHLPSURYHGRUGHWHULRUDWHG7KH6''_VDPH LVVPDOOHUWKDQWKH6''_GLII7KHUHIRUHIXWXUHVWXGLHVVKRXOGIRFXVRQWKHHYDOXDWLRQRI  WKH6''_VDPHDVZHOODVWKHPLQLPDOFOLQLFDOO\LPSRUWDQWGLIIHUHQFHDQGUHVSRQVLYHQHVVRI

WKHVFDOH



&RQFXUUHQWYDOLGLW\

7KH0RGLÀHG3$6VKRZHGJRRGFRUUHODWLRQZLWKERWK83'56,,,PRWRUIXQFWLRQDQG

WKH9$6*OREDO)XQFWLRQLQJ7KHKLJKHUFRUUHODWLRQZLWKWKH9$6*OREDO)XQFWLRQLQJ

ZDVH[SHFWHG7KHLWHPVRIWKH83'56PRWRUVHFWLRQUDWHWUHPRUULJLGLW\EDODQFH

SRVWXUHDQGGLVWDOUHSHWLWLYHPRYHPHQWLQDGGLWLRQWRRQHLWHPRQVLWWRVWDQGDQGRQH

LWHPRQZDONLQJ,WUHÁHFWVV\PSWRPEDVHGGLVHDVHVHYHULW\DQGLVGHVLJQHGWRHYDOXDWH

WKHHIÀFDF\RIGUXJVRUVXUJHU\+RZHYHUWKH0RGLÀHG3$6LVEDVHGRQVFRULQJOLPLWD

WLRQVLQHYHU\GD\DFWLYLWLHVZKLFKDUHRQO\SDUWO\LQÁXHQFHGE\PRWRUVLJQV7KHJRDORI  SK\VLRWKHUDS\LVWRGHFUHDVHWKHVHOLPLWDWLRQVLUUHVSHFWLYHRIDQ\FRQFXUUHQWFKDQJHV

LQPRWRUVLJQV6SHFLÀFDOO\SK\VLRWKHUDS\WHDFKHVWKHSDWLHQWWRFDUU\RXWFRPSOH[DQG

DXWRPDWHGPRYHPHQWVLQDOWHUQDWLYHZD\VE\XVLQJFXHLQJRUFRJQLWLYHPRYHPHQWVWUDWH

JLHV^

7KHJRRGFRUUHODWLRQZLWKWKH9$6*OREDO)XQFWLRQLQJLQFRPELQDWLRQZLWKWKHORZHU

VWDQGDUGLVHGHUURURQWKH0RGLÀHG3$6VFRULQJXQGHUVFRUHVWKHYDOLGLW\RI WKH0RGLÀHG

3$6LQHYDOXDWLQJWKHSDWLHQW·VIXQFWLRQLQJIRUSK\VLRWKHUDS\JRDOV)XWXUHFRQFXUUHQW

YDOLGLW\VWXGLHVRQWKH0RGLÀHG3$6VKRXOGLQFOXGHIDOOULVNDVWKLVLVRQHRIWKHPRVW

GLVDEOLQJDQGH[SHQVLYHSUREOHPVLQ3'DQGDQRWKHULPSRUWDQWWDUJHWRI SK\VLRWKHUDS\

/LPLWDWLRQV

7KHGHVLJQRIWKHSUHVHQWVWXG\DOORZHGWHVWLQJIRULQWHUUDWHUDJUHHPHQWEHWZHHQPDQ\

WKHUDSLVWVDQGGLVWLQJXLVKLQJEHWZHHQWKRVHZLWKDQGZLWKRXW3'H[SHUWLVH7KLVKLJK

OLJKWVWKHUREXVWQHVVDQGEURDGDSSOLFDELOLW\RIWKHFXUUHQWO\REVHUYHGDJUHHPHQWUHVXOWV

+RZHYHURQHFRXOGDUJXHWKDWWKHKRXUWUDLQLQJLQXVLQJWKHVFDOHRQWKHGD\RI GDWD

FROOHFWLRQLVDOLPLWDWLRQEHFDXVHLQUHDOOLIHWKLVWUDLQLQJVHVVLRQLVXQDYDLODEOH,QGHHG

WKHLQWHUUDWHUUHOLDELOLW\PLJKWLQGHHGKDYHEHHQLQÁXHQFHGE\WKHWUDLQLQJVHVVLRQ7KLV

QHHGVWREHHYDOXDWHGLQIXWXUH+RZHYHUDOWKRXJKWKHWUDLQLQJVHVVLRQLPPHGLDWHO\IRUH

JRLQJWKHREVHUYDWLRQVPLJKWWRVRPHH[WHQWKDYHLQÁXHQFHGWKHDJUHHPHQWZHIHHOWKDW

WKHGHWDLOHGLQIRUPDWLRQRI PDWHULDOVQHHGHGWRFDUU\RXWWKHWHVWWKHVSHFLÀFLQVWUXF

WLRQVWRWKHSDWLHQWDQGWKHXQDPELJXRXVVFRULQJSRVVLELOLWLHVUHQGHUWKHKRXUWUDLQLQJ

UHGXQGDQWLQGDLO\OLIH:HWKHUHIRUHH[SHFWWKHLQWHUUDWHUUHOLDELOLW\DVIRXQGLQWKLVVWXG\

EURDGO\DSSOLFDEOHWRSK\VLRWKHUDSLVWVZKRKDYHQRWKDGWKHKRXUWUDLQLQJVHVVLRQ

0RUHRYHUZHIHHOWKDWIRUFRUUHFWXVHRIRXWFRPHPHDVXUHVLQJHQHUDOXVHUVVKRXOG

DOZD\VWUDLQWKHFRUUHFWXVHRIWKHVHPHDVXUHVZLWKWKHLUSHHUV

2XUVWXG\GHVLJQZLWKPDQ\WKHUDSLVWVDVVHVVLQJDUHODWLYHO\VPDOOQXPEHURI SDWLHQWV

KDVDGYDQWDJHVZKHQHYDOXDWLQJDJUHHPHQW+RZHYHUWKHVPDOOQXPEHURI SDWLHQWV

OLPLWVWKHEURDGDSSOLFDELOLW\RIWKHUHVXOWVFRQFHUQLQJWKHDEVHQFHRIDFHLOLQJHIIHFW

7KHUHIRUHWRDVFHUWDLQZLGHVSUHDGDSSOLFDELOLW\RIWKHGLVWULEXWLRQRIVFRUHVDOVRIRUWKH

GLIIHUHQW+RHKQ <DKUVWDJHVODUJHUJURXSVRI 3'SDWLHQWVQHHGWREHHYDOXDWHG



&RQFOXVLRQ

:HUHFRPPHQGXVLQJWKH0RGLÀHG3$6DVDYDOLGWRROWRLGHQWLI\DQGHYDOXDWH

SK\VLRWKHUDS\JRDOVLQ3'7KHVFDOHFDQEHXVHGE\ERWKH[SHUWDQGQRQH[SHUWSK\

VLRWKHUDSLVWVDOLNH

$FNQRZOHGJHPHQWV

7KLVVWXG\ZDVVXSSRUWHGE\D=RQ0ZUHVHDUFKJUDQWQXPEHU'U%5

%ORHPZDVVXSSRUWHGE\D=RQ0Z9,',UHVHDUFKJUDQWQXPEHU

:HWKDQN3URIGU5$&5RRVDQG'U-0DULQXV/80&IRUFULWLFDOO\UHYLVLQJWKHDUWLFOH

:HWKDQNDOOSDUWLFLSDQWVRIWKH3$6GD\IRUWKHLUZRUNGXULQJGDWDFROOHFWLRQ'U0

9LVVHU'U-0DULQXVDQG-7LPPHUPDQV/80&&-7GH*RHGH98PF'U.DP

VPDDQG%'LMNVWUD80&*60YDQ5RRGHQ/6PLWVDQG0YDQ=RQQHYHOG/HLGHQ

8QLYHUVLW\RI$SSOLHG6FLHQFHVDQG-%HXQ5+-YDQ8GHQ15DGPLORYLF&6OHHJDQG

,9HUKHJHQ+$18QLYHUVLW\RI$SSOLHG6FLHQFHV



$5LVHZLWKRXWXVLQJKDQGV

3OHDVHULVHZLWKRXWXVLQJ\RXUDUPVRQWKHNQHHVRUFKDLU

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV †

‡ PLOGGLIÀFXOWLHVWRHVGRUVLÁH[WRPDLQWDLQEDODQFHDUPVVZLQJIRUZDUGWRNHHS

 EDODQFHRUXVHRI ¶FRQVFLRXVO\SHUIRUPHGURFNV·FRPSHQVDWLRQVZLWKWKHWUXQN †

‡ GLIÀFXOWVHYHUDODWWHPSWVQHHGHGRUKHVLWDWLRQVYHU\VORZDQGDOPRVWQRÁH[LRQ

 RI WKHWUXQN †

‡ LPSRVVLEOHGHSHQGHQWRQSK\VLFDODVVLVWDQFHSHUIRUP,% †

$6LWGRZQZLWKRXWXVLQJKDQGV 3OHDVHVLWGRZQDJDLQZLWKRXWXVLQJ\RXUDUPV

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV †

‡ PLOGGLIÀFXOWLHVXQFRQWUROOHGODQGLQJ †

‡ FOHDUDEUXSWODQGLQJRUHQGLQJLQDQXQFRPIRUWDEOHSRVLWLRQ †

‡ LPSRVVLEOHGHSHQGHQWRQSK\VLFDODVVLVWDQFHSHUIRUP,% †

%5LVHZLWKXVLQJKDQGVRQO\VFRUHGLI ULVLQJZLWKRXWXVLQJKDQGVLVLPSRVVLEOH :LOO\RXWU\WRULVHDJDLQ":KHQVWDQGLQJ\RXKDYHWRZDLWDVHFRQGDJDLQ<RXPD\XVH\RXUKDQGVQRZ

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV †

‡ GLIÀFXOWVHYHUDODWWHPSWVQHHGHGRUKHVLWDWLRQVYHU\VORZDQGDOPRVWQRÁH[LRQ

 RI WKHWUXQN †

‡ LPSRVVLEOHGHSHQGHQWRQSK\VLFDODVVLVWDQFH †

%6LWGRZQZLWKXVLQJKDQGVRQO\VFRUHGLI ULVLQJZLWKRXWXVLQJKDQGVLVLPSRVVLEOH 3OHDVHVLWGRZQDJDLQ<RXPD\XVH\RXUKDQGV

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV †

‡ DEUXSWODQGLQJRUHQGLQJXSLQDQXQFRPIRUWDEOHSRVLWLRQ †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFH †

$SSHQGL[0RGLÀHG3DUNLQVRQ$FWLYLW\6FDOH

&KDLUWUDQVIHUV



0DWHULDOV

&KDLUZLWKFPVHDWKHLJKWRUZKHQDWWKHSDWLHQW·VKRPHWKHFKDLUWKDWFDXVHVWKHJUHDWHVW

SUREOHPVWRWKHSDWLHQWDQGLVXVHGIUHTXHQWO\%HZDUHWRXVHWKHVDPHFKDLUDWUHWHVWLQJ

6WDUWLQJSRVLWLRQ

7KHSDWLHQWLVVHDWHGLQWKHFKDLUZLWKKLVKDQGVLQKLVODS

$QDO\VHV

7KHKLJKHVWVFRUHVDUHXVHGIRUULVLQJZLWKRUZLWKRXWXVLQJKDQGVPD[LPXPDQGIRUVLWWLQJ

GRZQZLWKRUZLWKRXWXVLQJKDQGVPD[LPXP

,QVWUXFWLRQ

,QDPRPHQW,ZLOODVN\RXODWHUWRULVHIURPWKHFKDLU<RXPD\OHDQZLWK\RXUKDQGVRQWKHDUPRI WKHFKDLU

RU\RXUNQHHV:KHQVWDQGLQJ\RXZLOOKDYHWRZDLWDVHFRQG



3OHDVHULVHZDONWRWKH8WXUQZLWKLQWKH8DQGUHWXUQWRVLWGRZQLQWKHFKDLU

1RQSUHIHUUHGWXUQLQJVLGH

†/HIW†5LJKWDWLWHPVWRWKHSDWLHQWLVDVNHGWRWXUQWRWKLVVLGH

6WDUWDNLQHVLDZLWKRXWDQH[WUDWDVNSRVVLEO\DVVLVWZLWKULVLQJZKLFKLVQRWVFRUHG

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV †

‡ KHVLWDWLRQRUVKRUWIHVWLQDWLRQODVWLQJXSWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJPRUHWKDQVHFRQGV †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHWRVWDUWZDONLQJDIWHUIUHH]LQJ †

7XUQLQJƒZLWKRXWDQH[WUDWDVN

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV †

‡ KHVLWDWLRQRUVKRUWIHVWLQDWLRQODVWLQJXSWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJPRUHWKDQVHFRQGV †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHWRVWDUWZDONLQJDIWHUIUHH]LQJ †

*DLWDNLQHVLD



0DWHULDOV

‡ &KDLUVHH¶&KDLU7UDQVIHUV·

‡ 3ODVWLFFXSõIXOOZLWKZDWHU

‡ $8VKDSHWDSHGRQWKHÁRRU7KHPLGGOHRIWKH8VKDSHLVVLWXDWHGWKUHHPHWHUV

 LQIURQWRI WKHPLGGOHRIWKHFKDLU7KHOHQJWKVRIWKHVLGHVRIWKH8DUHPHWHU

6WDUWLQJSRVLWLRQ

7KHSDWLHQWLVVHDWHGLQWKHFKDLUZLWKKLVKDQGVLQKLVODS)LUVWWKHSUHIHUUHGVLGHZLWKUHJDUGWR

WXUQLQJLVGHWHUPLQHGE\DVNLQJWKHSDWLHQWWRZDONWXUQDQGUHWXUQ

7KHSDWLHQWKDVWREHDEOHWRZDONZLWKRXWWKHKHOSRIRWKHUV

,QVWUXFWLRQ

'R\RXVHHWKHWDSHLQ8VKDSH",QDPRPHQW,ZLOODVN\RXWRULVH<RXPD\LI \RXZDQWWRXVH\RXUKDQGV

7KHQ\RXZDONWRWKH8DQGWXUQLQVLGHWKH8,WLVXSWR\RXKRZ\RXGRWKLV7KHQ\RXUHWXUQWRWKHFKDLUDQG

VLWGRZQ,WLVQRWDERXWGRLQJLWDVIDVWDV\RXFDQ,WLVDERXWGRLQJLWVDIHO\,VWKDWFOHDU"



1RZDELWPRUHGLIÀFXOWZKLOHFDUU\LQJDSODVWLFFXSZLWKZDWHU3OHDVHULVHZDONWRWKH8WXUQZLWKLQWKH8DQG

UHWXUQWRVLWGRZQLQWKHFKDLU

6WDUWDNLQHVLDZLWKDPRWRUGXDOWDVNSRVVLEO\DVVLVWZLWKULVLQJZKLFKLVQRWVFRUHG

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV †

‡ KHVLWDWLRQRUVKRUWIHVWLQDWLRQODVWLQJXSWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJPRUHWKDQVHFRQGV †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHWRVWDUWZDONLQJDIWHUIUHH]LQJ †

7XUQLQJƒZLWKDPRWRUGXDOWDVN

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV †

‡ KHVLWDWLRQRUVKRUWIHVWLQDWLRQODVWLQJXSWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJPRUHWKDQVHFRQGV †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHWRVWDUWZDONLQJDIWHUIUHH]LQJ †

1RZHYHQPRUHGLIÀFXOWZKLOHFRXQWLQJEDFNZDUGVLQWKUHHVVWDUWLQJZLWK3OHDVHULVHZDONWRWKH8WXUQ

ZLWKLQWKH8DQGUHWXUQWRVLWGRZQLQWKHFKDLU

LIUHTXLUHGDQH[DPSOHRI FRXQWLQJEDFNZDUGVLVJLYHQVWDUWLQJDW

6WDUWDNLQHVLDZLWKDFRJQLWLYHGXDOWDVNSRVVLEO\DVVLVWZLWKULVLQJZKLFKLVQRWVFRUHG

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV †

‡ KHVLWDWLRQRUVKRUWIHVWLQDWLRQODVWLQJXSWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJPRUHWKDQVHFRQGV †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHWRVWDUWZDONLQJDIWHUIUHH]LQJ †

7XUQLQJƒZLWKDFRJQLWLYHGXDOWDVN

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV †

‡ KHVLWDWLRQRUVKRUWIHVWLQDWLRQODVWLQJXSWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJWRVHFRQGV †

‡ XQZDQWHGDUUHVWRIPRYHPHQWZLWKRUZLWKRXWIHVWLQDWLRQODVWLQJPRUHWKDQVHFRQGV †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHWRVWDUWZDONLQJDIWHUIUHH]LQJ †



/\LQJGRZQZLWKRXWDFRYHU

3OHDVHOLHGRZQRQ\RXUEDFNRQWKHFRYHUMXVWOLNH\RXZRXOGGRDWKRPH%HVXUHWKDW\RXHQG

XSLQDFRPIRUWDEOHSRVLWLRQ

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV QRUPDO †

‡ ZLWKGLIÀFXOW\

 R GLIÀFXOW\ZLWKOLIWLQJOHJV GLIÀFXOW\ †

 R GLIÀFXOW\ZLWKPRYLQJWUXQN GLIÀFXOWLHV †

 R GLIÀFXOW\ZLWKUHDFKLQJDGHTXDWHHQGSRVLWLRQ GLIÀFXOWLHV †

  IXQFWLRQDOO\OLPLWLQJRUXQFRPIRUWDEOH 

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHSDWLHQWDVNVFOHDUO\

 IRUKHOSRUGRHVQRWUHDFKDQDFFHSWDEOHHQGSRVLWLRQ GHSHQGHQW †

5ROOLQJRYHUZLWKRXWDFRYHU

$3OHDVHUROORYHURQWR\RXUVLGH7RWKHOHIW%HVXUHWKDW\RXHQGXSLQDFRPIRUWDEOHSRVLWLRQ

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV QRUPDO †

‡ ZLWKGLIÀFXOW\

 R GLIÀFXOW\ZLWKWXUQLQJWUXQNSHOYLV GLIÀFXOW\ †

 R GLIÀFXOW\ZLWKPRYLQJWUXQNSHOYLV GLIÀFXOWLHV †

 R GLIÀFXOW\ZLWKUHDFKLQJDGHTXDWHHQGSRVLWLRQ GLIÀFXOWLHV †

  IXQFWLRQDOO\OLPLWLQJRUXQFRPIRUWDEOH 

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHSDWLHQWDVNVFOHDUO\ GHSHQGHQW †

 IRUKHOSRUGRHVQRWUHDFKDQDFFHSWDEOHHQGSRVLWLRQ

%HGPRELOLW\

0DWHULDOV

‡ %HG

‡ 3LOORZVKHHWVDQGEODQNHWRUGXYHW

$QDO\VHV

)RUWKHLWHPVFRQFHUQLQJUROOLQJRYHUDEDQGDEWKHPHDQRIWKH¶D·DQG¶E¶VFRUHVLV

XVHG

6WDUWLQJSRVLWLRQ

7KHSDWLHQWLVVWDQGLQJLQIURQWRIWKHEHGRQWKHSUHIHUUHGVLGH%HIRUHUROOLQJRYHURQWRWKH

VLGHWKHSDWLHQWLVLIUHTXLUHGDVVLVWHGWROLHFRPIRUWDEO\RQKLVEDFN

,QIRUPDWLRQ

,I \RXDUHVWDQGLQJLQIURQWRI \RXUEHGDWKRPHDWZKLFKVLGHLV\RXUSLOORZ"



%3OHDVHUROORYHURQWR\RXUEDFN1RZUROORYHURQWR\RXURWKHUVLGH7RWKHULJKW%HVXUHWKDW\RXHQGXSLQD

FRPIRUWDEOHSRVLWLRQ

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV QRUPDO †

‡ ZLWKGLIÀFXOW\

 R GLIÀFXOW\ZLWKWXUQLQJWUXQNSHOYLV GLIÀFXOW\ †

 R GLIÀFXOW\ZLWKPRYLQJWUXQNSHOYLV GLIÀFXOWLHV †

 R GLIÀFXOW\ZLWKUHDFKLQJDGHTXDWHHQGSRVLWLRQ GLIÀFXOWLHV †

  IXQFWLRQDOO\OLPLWLQJRUXQFRPIRUWDEOH 

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHSDWLHQWDVNVFOHDUO\ GHSHQGHQW †

 IRUKHOSRUGRHVQRWUHDFKDQDFFHSWDEOHHQGSRVLWLRQ

*HWWLQJRXWRI EHGZLWKRXWDFRYHU

3OHDVHULVHDQGVLWRQWKHHGJHRI WKHEHGZLWKERWKIHHWRQWKHJURXQG

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV QRUPDO †

‡ ZLWKGLIÀFXOW\

 R GLIÀFXOW\ZLWKWXUQLQJWUXQNSHOYLV GLIÀFXOW\ †

 R GLIÀFXOW\ZLWKPRYLQJOHJV GLIÀFXOWLHV †

 R GLIÀFXOW\ZLWKUHDFKLQJDGHTXDWHHQGSRVLWLRQ GLIÀFXOWLHV †

  DV\PPHWULFXQFRPIRUWDEOH

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHSDWLHQWDVNVFOHDUO\ GHSHQGHQW †

 IRUKHOSRUGRHVQRWUHDFKDQDFFHSWDEOHHQGSRVLWLRQ

/\LQJGRZQZLWKDFRYHU

3OHDVHOLHGRZQRQ\RXUEDFNXQGHUWKHFRYHU%HVXUHWKDW\RXHQGXSLQDFRPIRUWDEOHSRVLWLRQXQGHUWKHFRYHUV

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV QRUPDO †

‡ ZLWKGLIÀFXOW\

 R GLIÀFXOW\ZLWKPRYLQJWUXQNRUOHJ GLIÀFXOW\ †

 R GLIÀFXOW\ZLWKDGMXVWLQJFRYHU RUUHDFKLQJQRDGHTXDWH

  FRYHULQJHJZLWKSDUWRIWKHEDFNXQFRYHUHG GLIÀFXOWLHV †

 R GLIÀFXOW\ZLWKUHDFKLQJDGHTXDWHHQGSRVLWLRQ

  IXQFWLRQDOO\OLPLWLQJRUXQFRPIRUWDEOH  GLIÀFXOWLHV †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHSDWLHQWDVNVFOHDUO\

 IRUKHOSRUGRHVQRWUHDFKDQDFFHSWDEOHHQGSRVLWLRQ GHSHQGHQW †



5ROOLQJRYHUZLWKDFRYHU

$3OHDVHUROORYHURQWR\RXUVLGH7RWKHOHIW%HVXUHWKDW\RXHQGXSLQDFRPIRUWDEOHSRVLWLRQXQGHUWKHFRYHUV

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV QRUPDO †

‡ ZLWKGLIÀFXOW\

 R GLIÀFXOW\ZLWKWXUQLQJWUXQNSHOYLV GLIÀFXOW\ †

 R GLIÀFXOW\ZLWKDGMXVWLQJFRYHU RUUHDFKLQJQRDGHTXDWH

  FRYHULQJHJZLWKSDUWRIWKHEDFNXQFRYHUHG GLIÀFXOWLHV †

 R GLIÀFXOW\ZLWKUHDFKLQJDGHTXDWHHQGSRVLWLRQ

  IXQFWLRQDOO\OLPLWLQJRUXQFRPIRUWDEOH  GLIÀFXOWLHV †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHSDWLHQWDVNVFOHDUO\

 IRUKHOSRUGRHVQRWUHDFKDQDFFHSWDEOHHQGSRVLWLRQ GHSHQGHQW †

%3OHDVHUROORYHURQWR\RXUEDFN1RZUROORYHURQWR\RXURWKHUVLGH7RWKHULJKW%HVXUHWKDW\RXHQGXSLQD

FRPIRUWDEOHSRVLWLRQXQGHUWKHFRYHUV

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV QRUPDO †

‡ ZLWKGLIÀFXOW\

 R GLIÀFXOW\ZLWKWXUQLQJWUXQNSHOYLV GLIÀFXOW\ †

 R GLIÀFXOW\ZLWKDGMXVWLQJFRYHU RUUHDFKLQJQRDGHTXDWH

  FRYHULQJHJZLWKSDUWRIWKHEDFNXQFRYHUHG GLIÀFXOWLHV †

 R GLIÀFXOW\ZLWKUHDFKLQJDGHTXDWHHQGSRVLWLRQ

  IXQFWLRQDOO\OLPLWLQJRUXQFRPIRUWDEOH  GLIÀFXOWLHV †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHSDWLHQWDVNVFOHDUO\

 IRUKHOSRUGRHVQRWUHDFKDQDFFHSWDEOHHQGSRVLWLRQ GHSHQGHQW †

*HWWLQJRXWRI EHGZLWKDFRYHU

3OHDVHULVHDQGVLWRQWKHHGJHRI WKHEHGZLWKERWKIHHWRQWKHJURXQG

‡ QRUPDOZLWKRXWDSSDUHQWGLIÀFXOWLHV QRUPDO †

‡ ZLWKGLIÀFXOW\

 R GLIÀFXOW\ZLWKPRYLQJWUXQNRUOHJ GLIÀFXOW\ †

 R GLIÀFXOW\ZLWKDGMXVWLQJFRYHU  GLIÀFXOWLHV †

 R GLIÀFXOW\ZLWKUHDFKLQJDGHTXDWHHQGSRVLWLRQ

  DV\PPHWULFXQFRPIRUWDEOH GLIÀFXOWLHV †

‡ GHSHQGHQWRQSK\VLFDODVVLVWDQFHSDWLHQWDVNVFOHDUO\

 IRUKHOSRUGRHVQRWUHDFKDQDFFHSWDEOHHQGSRVLWLRQ GHSHQGHQW †



 8QFRPIRUWDEOHHQGSRVLWLRQZKHQO\LQJRQEDFNHJZLWKKHDGXQFRPIRUWDEO\DJDLQVWWKHKHDGRI WKHEHGRUZLWK

OHJVZKLFKDUHQRWUHOD[HGGXHWRWRRPXFKÁH[LRQ 8QFRPIRUWDEOHHQGSRVLWLRQZKHQO\LQJRQVLGHHJXQGHUO\LQJ

VKRXOGHUDQGDUPLQVXIÀFLHQWO\LQSURWUDFWLRQDQGIUHHKHDGXQFRPIRUWDEO\DJDLQVWWKHKHDGRI WKHEHGRUOHVVWKDQ

FPEHWZHHQWUXQNDQGWKHHGJHRI WKHEHG 'LIÀFXOW\ZLWKDGMXVWLQJFRYHUWKUHHRUPRUHDGMXVWPHQWV