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Saetra, P., Fossum, M., Svensson, E. & Cohen, M. Z. (2016). Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic. Journal of Clinical Nursing, 25(5-6), 799-810
Open this publication in new window or tab >>Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 5-6, p. 799-810Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To evaluate the test-retest stability in assessments of perceived symptom intensity on the Edmonton Symptom Assessment System-revised and the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. The possible interchangeability between the instruments and the patients' experiences of completing the instruments were also studied.

Background: The two instruments assess the same symptoms, but the symptom intensity is assessed on 11-point numerical scales on the Edmonton Symptom Assessment System-revised and on four-point verbal descriptive scales on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. Both instruments are commonly used; however, uncertainty exists about which instrument should be recommended and about the interchangeability of the instruments.

Design: This study used a test-retest design with inter-scale comparisons.

Methods: Data from 54 patients with cancer who were receiving palliative care in an oncology outpatient clinic were self-reported by the patients in the clinic, at home and when patients returned to the clinic.

Results: The assessments on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative verbal rating scales showed a higher level of test-retest stability than the assessments on the Edmonton Symptom Assessment System-revised numerical scoring scales, indicating higher reliability. The correspondence between the verbal categories and the numerical scores of symptom intensity were low because different verbal categories were used by patients who assessed the same numerical score.

Comclusions: The test-retest stability in the assessments was higher on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative and the results show that assessments on the two instruments could not be used interchangeably. Therefore, the symptom instrument chosen must be specified and unchanged within a patient to improve efficacy in clinical practice.

Relevance to clinical practice: The Edmonton Symptom Assessment System-revised or the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative can be used for initial assessments of patients, but should not be compared or used interchangeably. It is vitally important to have individual follow-up for all patients who score an instrument.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
Hospital, Norway, nursing, outpatient clinics, palliative care, rating scales, reliability, symptom assessment, test-retest stability
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-49210 (URN)10.1111/jocn.13100 (DOI)000370627000025 ()26813779 (PubMedID)2-s2.0-84958213466 (Scopus ID)
Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2018-07-10Bibliographically approved
Norrefalk, J.-R. & Svensson, E. (2014). The functional barometer: a self-report questionnaire in accordance with the international classification of functioning, disability and health for pain related problems; validity and patient-observer comparisons. BMC Health Services Research, 14, 187
Open this publication in new window or tab >>The functional barometer: a self-report questionnaire in accordance with the international classification of functioning, disability and health for pain related problems; validity and patient-observer comparisons
2014 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, p. 187-Article in journal (Refereed) Published
Abstract [en]

Background: The International Classification of Functioning, Disability and Health, (ICF) provides a unified, international standardized framework for describing and classifying health and health-related functioning and disability. Based on an ICF core sets the Functional Barometer, (FB), was developed for assessments of perceived pain-related problems with functions, activity and quality-of-life by patients suffering from long-term pain. The aim was to evaluate the construct validity, and to compare the assessments of a patient's problems from the perspectives of the patient and of the examining professional when using the validated FB and corresponding ICF-classification form, respectively.

Methods: Patients with long-term pain for more than 3 months that visited one of four pain clinics during specified time periods of data collections were eligible. The self-report Balanced Inventory for Spinal disorders was used for validation of the FB. Correspondingly to the validated FB an ICF-classification form for professional's assessment was developed. The data sets for these inter-scale and the patient-professional comparisons were collected adjacent to the clinical examination. By the statistical method used for evaluation of the pairs of ordinal data presence of systematic disagreement was identified and measured separately from additional individual variations.

Results: The validation process resulted in a revised FB(2.0) that meets the requirements of good construct and content validity. The professionals' ICF-classifications of the patients' problems disagreed with the patients' assessments on the FB(2.0); the percentage agreements ranged from 18% to 51%. The main reason was that the practitioners systematically underestimated the patients' levels of problems but the different professionals contributed also to a large individual variability (noise) in assessment.

Conclusions: This study presents an ICF-based validated self-report questionnaire, The FB, to be used for identifying and describing pain-related problems with current functioning, activities and quality-of-life as perceived by patients suffering from long-term pain. The strong evidences of underestimation of the patients' problems and the variability in the professionals' ICF-classifications demonstrated the importance of describing the patient's problems both from the patient's and the professional's perspective beneficial for the patient's rehabilitation.

Place, publisher, year, edition, pages
London: BioMed Central, 2014
Keywords
Disagreement measures, ICF, Ordinal data, Pain, Patient-professional disagreement, Questionnaire, Rehabilitation, Validity
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-35208 (URN)10.1186/1472-6963-14-187 (DOI)000335553500001 ()
Available from: 2014-06-03 Created: 2014-06-02 Last updated: 2018-06-07Bibliographically approved
Fossum, M., Ehnfors, M., Svensson, E., Hansen, L. M. & Ehrenberg, A. (2013). Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study. International Journal of Medical Informatics, 82(10), 911-921
Open this publication in new window or tab >>Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study
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2013 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, no 10, p. 911-921Article in journal (Refereed) Published
Abstract [en]

Background: Nursing documentation is essential for facilitating the flow of information to guarantee continuity, quality and safety in care. High-quality nursing documentation is frequently lacking; the implementation of computerized decision support systems is expected to improve clinical practice and nursing documentation.

Aim: The present study aimed at investigate the effects of a computerized decision support system and an educational program as intervention strategies for improved nursing documentation practice on pressure ulcers and malnutrition in nursing homes.

Design, setting and participants: An intervention study with two intervention groups and one control group was used. Fifteen nursing homes in southern Norway were included. A convenience sample of electronic healthcare records from 46 units was included. Inclusion criteria were records with presence of pressure ulcers and/or malnutrition. The residents were assessed before and after an intervention of a computerized decision support system in the electronic healthcare records. Data were collected through a review of 150 records before (2007) and 141 records after the intervention (2009).

Methods: The nurses in intervention group 1 were offered educational sessions and were trained to use the computerized decision support system, which they used for eight months in 2008 and 2009. The nurses in intervention group 2 were offered the same educational program but did not use the computerized decision support system. The nurses in the control group were not subject to any intervention. The resident records were examined for the completeness and comprehensiveness of the documentation of pressure ulcers and malnutrition with three data collection forms and the data were analyzed with non-parametric statistics.

Results: The implementation of the computerized decision support system and the educational program resulted in a more complete and comprehensive documentation of pressure ulcer- and malnutrition-related nursing assessments and nursing interventions.

Conclusion: This study provides evidence that the computerized decision support system and an educational program as implementation strategies had a positive influence on nursing documentation practice.

Keywords
Decision support system, Documentation, Intervention studies, Malnutrition, Nursing audit, Pressure ulcer
National Category
Medical and Health Sciences Probability Theory and Statistics
Research subject
Caring sciences; Statistics
Identifiers
urn:nbn:se:oru:diva-31983 (URN)10.1016/j.ijmedinf.2013.05.009 (DOI)000324312000002 ()
Available from: 2013-10-14 Created: 2013-10-14 Last updated: 2020-01-28Bibliographically approved
Svensson, E. (2012). Different ranking approaches defining association and agreement measures of paired ordinal data. Statistics in Medicine, 31(26), 3104-3117
Open this publication in new window or tab >>Different ranking approaches defining association and agreement measures of paired ordinal data
2012 (English)In: Statistics in Medicine, ISSN 0277-6715, E-ISSN 1097-0258, Vol. 31, no 26, p. 3104-3117Article in journal (Refereed) Published
Abstract [en]

Rating scales are common for self-assessments of qualitative variables and also for expert-rating of the severity of disability, outcomes, etc. Scale assessments and other ordered classifications generate ordinal data having rank-invariant properties only. Hence, statistical methods are often based on ranks. The aim is to focus at the differences in ranking approaches between measures of association and of disagreement in paired ordinal data. The Spearman correlation coefficient is a measure of association between two variables, when each data set is transformed to ranks. The augmented ranking approach to evaluate disagreement takes account of the information given by the pairs of data, and provides identification and measures of systematic disagreement, when present, separately from measures of additional individual variability in assessments. The two approaches were applied to empirical data regarding relationship between perceived pain and physical health and reliability in pain assessments made by patients. The art of disagreement between the patients' perceived levels of outcome after treatment and the doctor's criterion-based scoring was also evaluated. The comprehensive evaluation of observed disagreement in terms of systematic and individual disagreement provides valuable interpretable information of their sources. The presence of systematic disagreement can be adjusted for and/or understood. Large individual variability could be a sign of poor quality of a scale or heterogeneity among raters. It was also demonstrated that a measure of association must not be used as a measure of agreement, even though such misuse of correlation coefficients is common.

Keywords
ranks, association, agreement, disagreement, ordinal data
National Category
Probability Theory and Statistics
Research subject
Statistics
Identifiers
urn:nbn:se:oru:diva-26552 (URN)10.1002/sim.5382 (DOI)000309745400003 ()
Available from: 2012-11-30 Created: 2012-11-30 Last updated: 2017-12-07Bibliographically approved
Allvin, R., Kling, A.-M., Idvall, E. & Svensson, E. (2012). Patient Reported Outcome Measures (PROMs) after total hip- and knee replacement surgery evaluated by the Postoperative Recovery Profile questionnaire (PRP): improving clinical quality and person-centeredness. The International Journal of Person Centered Medicine, 2(3), 368-376
Open this publication in new window or tab >>Patient Reported Outcome Measures (PROMs) after total hip- and knee replacement surgery evaluated by the Postoperative Recovery Profile questionnaire (PRP): improving clinical quality and person-centeredness
2012 (English)In: The International Journal of Person Centered Medicine, ISSN 2043-7730, E-ISSN 2043-7749, Vol. 2, no 3, p. 368-376Article in journal (Refereed) Published
Abstract [en]

Rationale and aims: The importance of evaluating postoperative recovery with consideration to the patient’s perspectivehas been emphasized. The aim of this study was to demonstrate how the recovery-specific Postoperative Recovery Profile(PRP) questionnaire can be used to evaluate patient-reported outcome measures (PROMs) after hip- and knee replacementin the enhancement of clinical quality and the person-centeredness of clinical services. Method: Patients undergoing primary total knee- and hip replacement were eligible for this longitudinal follow-up study. The participants completed the PRP questionnaire on repeated occasions. In this paper, data from Day 3 and Month 1 afterdischarge were used. The change in recovery, between the two measurement occasions, on item-, dimensional- and globallevels, both for each patient and for the group, were evaluated. Results: A total number of 75 patients were included. One month after discharge the median PRP score was 13 (partly recovered) out of 19. Recovery changes towards lower levels of problems/difficulties were shown in both item-, dimensional- and global levels of recovery month 1 after discharge, as compared with Day 3. The group of patients washomogenous in change. Conclusions: We demonstrated that the PRP questionnaire can be used to evaluate postoperative recovery after hip- andknee replacement surgery on item-, dimensional- and global levels. Data from each recovery level can be useful for quality development and in informing increases in the person-centeredness of clinical services. The global population scores can beused to evaluate treatment effect on a group of patients. It can also be used to define endpoints in follow-up studies.

Place, publisher, year, edition, pages
Buckingham, United Kingdom: University of Buckingham Press, 2012
Keywords
Arthroplasty, clinical quality, measurement, outcome, person-centeredness, postoperative recovery, questionnaire
National Category
Medical and Health Sciences Orthopaedics
Research subject
Health and Medical Care Research
Identifiers
urn:nbn:se:oru:diva-42105 (URN)
Available from: 2015-01-20 Created: 2015-01-20 Last updated: 2018-05-14Bibliographically approved
Svensson, E., Schillberg, B., Kling, A.-M. & Nyström, B. (2012). Reliability of the balanced inventory for spinal disorders, a questionnaire for evaluation of outcomes in patients with various spinal disorders. Journal of Spinal Disorders & Techniques, 25(4), 196-204
Open this publication in new window or tab >>Reliability of the balanced inventory for spinal disorders, a questionnaire for evaluation of outcomes in patients with various spinal disorders
2012 (English)In: Journal of Spinal Disorders & Techniques, ISSN 1536-0652, E-ISSN 1539-2465, Vol. 25, no 4, p. 196-204Article in journal (Refereed) Published
Abstract [en]

Study Design: An intrapatient reliability study of the previously validated 18-item questionnaire, the Balanced Inventory for Spinal disorders (BIS), in patients referred for planned spinal surgery. Statistical evaluation of the test-retest assessments was performed by a rank-based method that allows for separate analyses of the systematic and individual components of an observed disagreement. Objective: To evaluate the intrapatient reliability and the art of disagreement, when present, in assessing the extent to which pain affects perceived physical health, social life, mental health, and quality of life according to the BIS. For comparative reasons corresponding items in Short-Form-36 (SF-36) and Oswestry Disability Index (ODI) were also evaluated. Summary of Background Data: The questionnaires were filled in by 101 patients the evening before going to the clinic for planned spinal surgery and the following evening at the clinic. Results: The percentage agreement in test-retest assessments of the items varied from 52% to 84%. The important items of pain, physical activities, social life, overall mental health, and quality of life showed high levels of reliability. An intrapatient disagreement of more than 1 category was seen in 4 items of mental health and in physical health, only. The observed individual variability and the significant systematic decrease on the second occasion could be explained by the fact that the patients were at the hospital on the retest occasion. The variation in percentage agreements found, and the different reasons for disagreement in items speak against that memory alone could have caused the retest assessments. Conclusion: The comprehensive evaluation of test-retest reliability showed that the test-retest assessments on the BIS could be regarded as reliable, and the measures of reliability of the BIS items were on the same levels as for corresponding items of the SF-36 and the ODI questionnaires.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2012
Keywords
agreement, back pain, ordinal data, reliability, spinal disorders
National Category
Probability Theory and Statistics
Research subject
Statistics
Identifiers
urn:nbn:se:oru:diva-23698 (URN)10.1097/BSD.0b013e31821534da (DOI)000304765000008 ()21423051 (PubMedID)2-s2.0-84862235515 (Scopus ID)
Available from: 2012-06-25 Created: 2012-06-25 Last updated: 2017-12-07Bibliographically approved
Svensson, E. (2012). Teaching: A Way of Implementing Statistical Methods for Ordinal Data to Researchers. Journal of Mathematics and System Science, 2, 8-12
Open this publication in new window or tab >>Teaching: A Way of Implementing Statistical Methods for Ordinal Data to Researchers
2012 (English)In: Journal of Mathematics and System Science, ISSN 2159-5291, E-ISSN 2159-5305, Vol. 2, p. 8-12Article in journal (Other academic) Published
Abstract [en]

The use of questionnaires, rating scales and other kinds of ordered classifications is unlimited and interdisciplinary, so it can take long time before novel statistical methods presented in statistical journals reach researchers of applied sciences. Therefore, teaching is an effective way of introducing novel methods to researchers at an early stage. Assessments on scales produce ordinal data having rank-invariant properties only, which means that suitable statistical methods are non-parametric and often rank-based. These limited mathematical properties have been taken into account in the research regarding development of statistical methods for pairedordinal data. The aim is to present a statistical method for paired ordinal data that has been successfully implemented to researchers from various disciplines together with statisticians attending interactive problem solving courses of biostatistics.

Place, publisher, year, edition, pages
David Publishing Company, 2012
Keywords
Ordinal data, rating scales, ranks, reliability.
National Category
Probability Theory and Statistics
Research subject
Statistics
Identifiers
urn:nbn:se:oru:diva-42104 (URN)
Available from: 2015-01-20 Created: 2015-01-20 Last updated: 2017-12-05Bibliographically approved
Ewertzon, M., Andershed, B., Svensson, E. & Lützén, K. (2011). Family member's expectation of the psychiatric healthcare professionals' approach towards them. Journal of Psychiatric and Mental Health Nursing, 18(2), 146-157
Open this publication in new window or tab >>Family member's expectation of the psychiatric healthcare professionals' approach towards them
2011 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 18, no 2, p. 146-157Article in journal (Refereed) Published
Abstract [en]

The importance of involving family members in the care of individuals with schizophrenia or other psychotic illnesses has received increasing attention within psychiatric health-care services. However, several studies suggest that family members often experience a lack of involvement. Furthermore, research indicates that family members’ experience of the professional’s approach has bearing on whether they feel involved or not. Thus, the aims of this study were to investigate the level of importance that the family members of individuals with schizophrenia or other psychotic illnesses ascribe to the professionals’ approach, the level of agreement between their experiences and what they consider as important, and aspects they consider to be important with regards to contact with professionals. Seventy family members from various parts of Sweden participated. Data were collected by the Family Involvement and Alienation Questionnaire and open-ended questions. The median level and quartiles were used to describe the distribution, and percentage agreement was analysed. Open-ended questions were analysed by qualitative content analysis. The results reveal that the majority of the participants consider Openness, Confirmation, and Cooperation as important aspects of a professional’s approach. Continuity emerged as an additional aspect. The results show a low level of agreement between the participants’ experience and what they consider as important.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2011
Keywords
family expectation, family involvement, professional-family relations, professionals´approach, psychiatric healtcare services
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-14645 (URN)10.1111/j.1365-2850.2010.01647.x (DOI)000287096200010 ()21299727 (PubMedID)2-s2.0-79551628836 (Scopus ID)
Available from: 2011-02-16 Created: 2011-02-16 Last updated: 2018-05-02Bibliographically approved
Allvin, R., Svensson, E., Rawal, N., Ehnfors, M., Kling, A.-M. & Idvall, E. (2011). The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles. Journal of Evaluation In Clinical Practice, 17(2), 236-243
Open this publication in new window or tab >>The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles
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2011 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, no 2, p. 236-243Article in journal (Refereed) Published
Abstract [en]

Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated.

Methods. Postoperative recovery was assessed during the period from discharge to 12 months after lower abdominal- and orthopedic surgery. Construct validity was evaluated by comparing the assessments from the PRP-questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering.

Results. A total of 158 patients were included. The result showed that 7.6 % of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge 51 % participants in the abdominal group were fully recovered, as compared with the 73%, in the orthopedic group (95% CI: 6 % to 40 %). The item variable pain appeared as top five at eight measurement occasions of eight possible in both the abdominal and the orthopedic groups. The importance of the items was emphasized.

Conclusions. The PRP questionnaire allows for evaluation of the progress of postoperative recovery, and can be useful to assess patient-reported recovery after surgical treatment. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-8083 (URN)10.1111/j.1365-2753.2010.01422.x (DOI)000288217700005 ()20846316 (PubMedID)2-s2.0-79952668667 (Scopus ID)
Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-12-13
Ledenius, K., Svensson, E., Stalhammar, F., Wiklund, L.-M. & Thilander-Klang, A. (2010). A method to analyse observer disagreement in visual grading studies: example of assessed image quality in paediatric cerebral multidetector CT images. British Journal of Radiology, 83(991), 604-611
Open this publication in new window or tab >>A method to analyse observer disagreement in visual grading studies: example of assessed image quality in paediatric cerebral multidetector CT images
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2010 (English)In: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 83, no 991, p. 604-611Article in journal (Refereed) Published
Abstract [en]

The purpose was to demonstrate a non-parametric statistical method that can identify and explain the components of observer disagreement in terms of systematic disagreement as well as additional individual variability, in visual grading studies. As an example, the method was applied to a study where the effect of reduced tube current on diagnostic image quality in paediatric cerebral multidetector CT (MDCT) images was investigated. Quantum noise, representing dose reductions equivalent to steps of 20 mA, was artificially added to the raw data of 25 retrospectively selected paediatric cerebral MDCT examinations. Three radiologists, blindly and randomly, assessed the resulting images from two different levels of the brain with regard to the reproduction of high- and low-contrast structures and overall image quality. Images from three patients were assessed twice for the analysis of intra-observer disagreement. The intra-observer disagreement in test-retest assessments could mainly be explained by a systematic change towards lower image quality the second time the image was reviewed. The inter-observer comparisons showed that the paediatric radiologist was more critical of the overall image quality, while the neuroradiologists were more critical of the reproduction of the basal ganglia. Differences between the radiologists regarding the extent to which they used the whole classification scale were also found. The statistical method used was able to identify and separately measure a presence of bias apart from additional individual variability within and between the radiologists which is, at the time of writing, not attainable by any other statistical approach suitable for paired, ordinal data.

National Category
Probability Theory and Statistics
Research subject
Statistics
Identifiers
urn:nbn:se:oru:diva-12924 (URN)10.1259/bjr/26723788 (DOI)000279475400009 ()
Available from: 2011-01-04 Created: 2011-01-03 Last updated: 2018-09-14Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-7210-1925

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