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Karlsson, J., Hammarström, E., Fogelkvist, M. & Lundqvist, L.-O. (2024). Psychometric characteristics of the Hospital Anxiety and Depression Scale in stroke survivors of working age before and after inpatient rehabilitation. PLOS ONE, 19(8), Article ID e0306754.
Open this publication in new window or tab >>Psychometric characteristics of the Hospital Anxiety and Depression Scale in stroke survivors of working age before and after inpatient rehabilitation
2024 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 8, article id e0306754Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim was to examine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in cohorts of working age stroke survivors, before and after inpatient rehabilitation.

METHODS: Stroke patients aged 18-66 years registered in the national quality register WebRehab Sweden were included in the study at hospital admission (n = 256), discharge (n = 223), and 1-year follow-up (n = 313). Classical and modern (Rasch) methods were used for psychometric evaluation.

RESULTS: The two-factor HADS model measuring anxiety and depression showed better fit than a single factor measuring emotional distress. The instrument's psychometric stability before and after rehabilitation was satisfactory. The anxiety scale showed good psychometric properties, except for item 7, which is not anxiety-specific. Some concerns were observed for the depression items showing weaker discriminant validity, and item 8 performing poorly as a measure of depression. Cronbach's alpha and McDonald's omega coefficients showed satisfactory internal consistency reliability, whereas Rasch person reliability coefficients indicated weaker reliability, especially for the depression scale. Effect size of change between hospital admission and discharge showed a reduction in anxiety and depression symptoms.

CONCLUSIONS: HADS showed a stable two-factor structure over the rehabilitation period. Patients' perception of items was not affected by the recovery, allowing relevant comparison of HADS scores between different phases of the rehabilitation process. Measures of responsiveness suggest that HADS is sensitive to capturing improvements in emotional distress following rehabilitation interventions. Overall, despite minor psychometric weaknesses, HADS is a suitable instrument for assessing anxiety and depresssion symptoms in stroke patients aged 18-66 years.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2024
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-115638 (URN)10.1371/journal.pone.0306754 (DOI)001304516700083 ()39186737 (PubMedID)2-s2.0-85202031745 (Scopus ID)
Available from: 2024-08-27 Created: 2024-08-27 Last updated: 2024-10-02Bibliographically approved
Ohlsson-Nevo, E., Fogelkvist, M., Lundqvist, L.-O., Ahlgren, J. & Karlsson, J. (2024). Validation of the Assessment of Rehabilitation Needs Checklist in a Swedish cancer population. Journal of Patient-Reported Outcomes, 8(1), Article ID 142.
Open this publication in new window or tab >>Validation of the Assessment of Rehabilitation Needs Checklist in a Swedish cancer population
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2024 (English)In: Journal of Patient-Reported Outcomes, E-ISSN 2509-8020, Vol. 8, no 1, article id 142Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Assessment of Rehabilitation Needs Checklist (ARNC), has been developed to assess rehabilitation need in cancer patients and is recommended by the Confederation of Regional Cancer Centres in Sweden, known as Hälsoskattningen. The aim of the study was to test the reliability and validity of the ARNC, mainly by comparing it with the Distress thermometer and EORTC QLQ-C30.

METHODOLOGY: A sample of 993 persons identified in the Swedish cancer register. The study participants were diagnosed with cancer in 2021 in the Mid Sweden region. The psychometric methods tested reliability and validity including factor analysis.

RESULTS: The response rate was 38%. The test-retest analysis showed that ICC was 0.80 or higher for 12 of the ARNC items. A strong or modarete correlation between ARNC and the other instruments was found in all functional scales and for most items. CFA of the 13-item two-factor model showed a RMSEA value of 0.04, CFI and TLI values of 0.97 and 0.96, and a SRMR value of 0.05, indicating a satisfactory model fit.

CONCLUSION: The evaluation of the ARNC suggests that it is an acceptable and reliable screening instrument for detecting symptoms and signs indicating a possible need of rehabilitation. The medium to strong correlations between ARNC items and the EORTC QLQ- C30 items and scales suggest that ARNC could be an alternative also for research purposes when a shorter and less comprehensive instrument is needed. The simple design could be an advantage as it lowers the burden on cancer patients.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
Cancer rehabilitation, Checklist, Hälsoskattning, Survey, Validation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-117649 (URN)10.1186/s41687-024-00818-5 (DOI)001370649500001 ()39638928 (PubMedID)2-s2.0-85211121290 (Scopus ID)
Funder
Örebro UniversityRegion Örebro County
Available from: 2024-12-09 Created: 2024-12-09 Last updated: 2024-12-18Bibliographically approved
Selvin, M., Almqvist, K., Fogelkvist, M., Lundqvist, L.-O. & Schröder, A. (2023). Patient Participation in Forensic Psychiatric Care: The Initial Development and Content Validity of a New Instrument. Journal of Forensic Nursing, 19(3), 204-213
Open this publication in new window or tab >>Patient Participation in Forensic Psychiatric Care: The Initial Development and Content Validity of a New Instrument
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2023 (English)In: Journal of Forensic Nursing, ISSN 1939-3938, E-ISSN 1556-3693, Vol. 19, no 3, p. 204-213Article in journal (Refereed) Published
Abstract [en]

Patient participation is central in modern health care. However, it is a complex phenomenon that lacks a clear definition, and what constitutes participation varies depending on the context and theoretical perspective. It is known that patient participation in forensic psychiatric care is often rated as low by both patients and professionals, and it can be assumed that interventions to increase it are beneficial. In this process, management and staff could benefit from assessing perceived patient participation, and reliable and valid measurement instruments are essential. The aim of this study was to develop an instrument that could be used to measure experiences of participation in forensic psychiatric care from a patient perspective and test it for content validity. A definition of patient participation in forensic psychiatric care was formulated and operationalized in an instrument that an expert group, consisting of patients with ongoing care, evaluated for content validity. In total, 50 items were sorted into five different dimensions: to have good communication, to be involved, to have mutual trust, to trust the care, and to take responsibility. After psychometric testing, the instrument has the potential to become a tool to use in research, clinical work, and development work in the field of forensic psychiatric care. In addition to being used as a measure, the Patient Participation in Forensic Psychiatric Care can also be used to encourage a dialogue about their care and to make both patients and staff more aware of patient participation.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023
Keywords
Forensic psychiatric care, instrument development, patient participation
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing
Identifiers
urn:nbn:se:oru:diva-101204 (URN)10.1097/JFN.0000000000000409 (DOI)001050274000012 ()36094459 (PubMedID)2-s2.0-85168273284 (Scopus ID)
Available from: 2022-09-13 Created: 2022-09-13 Last updated: 2023-09-08Bibliographically approved
Fogelkvist, M., Gustafsson, S. A., Kjellin, L. & Parling, T. (2022). Predictors of outcome following a body image treatment based on acceptance and commitment therapy for patients with an eating disorder. Journal of Eating Disorders, 10(1), Article ID 90.
Open this publication in new window or tab >>Predictors of outcome following a body image treatment based on acceptance and commitment therapy for patients with an eating disorder
2022 (English)In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 10, no 1, article id 90Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It is important to target body image in individuals with an eating disorder (ED). Acceptance and commitment therapy (ACT) has been trialed in a few studies for individuals with an ED. Although ACT outcomes in ED patients hold promise, studies of predictors are scarce. The aim of the present study was to explore differences in ED symptom outcome at two-year follow-up in subgroups of participants attending either treatment as usual (TAU), or a group intervention based on ACT targeting body image. Additionally, we aimed to compare subjective recovery experiences between groups.

METHODS: The study took place at a specialized ED outpatient clinic, and included patients diagnosed with an ED that had received prior treatment and achieved a somewhat regular eating pattern. Study participants were randomly assigned to continue TAU or to participate in a group intervention based on ACT for body image issues. Only participants that completed the assigned intervention and had completed follow up assessment by two-years were included. The total sample consisted of 77 women.

RESULTS: In general, ACT participants showed more favorable outcomes compared to TAU, and results were more pronounced in younger participants with shorter prior treatment duration and lower baseline depression ratings. Participants with restrictive ED psychopathology had three times higher ED symptom score change if participating in ACT in comparison to TAU.

CONCLUSIONS: An ACT group intervention targeting body image after initial ED treatment may further enhance treatment effects. There is a need for further investigation of patient characteristics that might predict response to body image treatment, particularly regarding ED subtypes and depression ratings.

Place, publisher, year, edition, pages
BioMed Central, 2022
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-99929 (URN)10.1186/s40337-022-00615-9 (DOI)000819782600001 ()35778769 (PubMedID)2-s2.0-85133380597 (Scopus ID)
Funder
Örebro University
Note

Funding agencies:

Uppsala-Örebro Region Research Council RFR71381 RFR213931 RFR138611

ALF funding Region Örebro County

Available from: 2022-07-04 Created: 2022-07-04 Last updated: 2022-07-27Bibliographically approved
Fogelkvist, M. (2021). Body image in patients with residual eating disorder symptoms: treatment effects of acceptance and commitment therapy and participants' reflections. (Doctoral dissertation). Örebro: Örebro University
Open this publication in new window or tab >>Body image in patients with residual eating disorder symptoms: treatment effects of acceptance and commitment therapy and participants' reflections
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to evaluate an acceptance and commitment (ACT) group intervention targeting body image in patients with residual eating disorder (ED) symptoms, including treatment effects and participants’ reflections on body image and the intervention. Studies I, II and III are based on a randomized controlled trial including 99 patients that were randomized to the ACT intervention or to continue treatment as usual (TAU). Different self-assessment questionnaires were administered before and after the intervention and at follow up by one and two years. Study IV is based on interviews with patients that had completed the intervention, and did not participate in the trial. 

From written evaluations in study I body image was shown to mean different things for different individuals. This was also shown by different expectations on treatment. Study II showed that the ACT intervention was superior to TAU in reducing ED symptoms and body dissatisfaction, while care consumption was lower. In addition, ratings of dropout was low. In study III, it was shown that symptom improvement from the ACT intervention rather than TAU was more pronounced in participants with restrictive ED psychopathology. Participants who displayed binge eating and/or purging ED psychopathology, showed improvement on ED symptoms regardless of intervention. Participants younger than 25, and with lower ratings at baseline, showed no improvement on ED symptoms if continuing with TAU. From interviews with participants in study IV, the intervention was described as demanding, and participants described the importance of their own efforts. Specific processes of the intervention were helpful and the context of the group and context outside of treatment could facilitate or hinder progress. Perceived changes in body image differed between participants in study I, showing the potential breadth of the intervention.

Conclusions from this thesis was that an intervention based on ACT targeting body image was suitable and helpful for patients with residual EDsymptoms. Though the intervention was demanding, dropout was low, and specific processes were described as helpful.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2021. p. 78
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 234
Keywords
Body image, body dissatisfaction, eating disorders, acceptance and commitment therapy, randomized controlled trial, qualitative research
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-91284 (URN)978-91-7529-382-0 (ISBN)
Public defence
2021-05-21, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 12:30 (Swedish)
Opponent
Supervisors
Available from: 2021-04-20 Created: 2021-04-20 Last updated: 2021-04-29Bibliographically approved
Fogelkvist, M., Parling, T., Kjellin, L. & Gustafsson, S. A. (2021). Live with your body - participants' reflections on an acceptance and commitment therapy group intervention for patients with residual eating disorder symptoms. Journal of Contextual Behavioral Science, 20, 184-193
Open this publication in new window or tab >>Live with your body - participants' reflections on an acceptance and commitment therapy group intervention for patients with residual eating disorder symptoms
2021 (English)In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 20, p. 184-193Article in journal (Refereed) Published
Abstract [en]

Acceptance and commitment therapy (ACT) is a transdiagnostic approach to human suffering that has been trialed in a range of different contexts. This study aimed to examine participants' view of helpful and hindering aspects of an in person ACT group intervention targeting body image in patients with residual eating disorder (ED) symptoms. Thirteen women who completed the intervention were interviewed, and transcripts were analyzed through thematic analysis. Nine themes were identified and sorted into three main themes. The first main theme, "Taking the plunge", pointed to the importance of participants own effort, and included subthemes of self-efficacy, self as description, and self-exploration. The second main theme, "A push towards valued ends", indicated that content of the intervention was helpful, and included subthemes of commitment and behavioral change processes, mindfulness and acceptance processes, and assignments in and between sessions. The third main theme, "The context matters", described the importance of the contexts of the intervention and life outside of treatment, and included subthemes of the group format, the context outside of treatment, and the timing of the intervention. Through the description of specific content, we conclude that ACT seems to help women with residual ED symptoms and body image issues by fostering motivation to engage in avoided situations and behaviors while striving to live a more valued life.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Acceptance and commitment therapy, Eating disorder, Body image, Thematic analysis, Qualitative analysis
National Category
Psychology
Identifiers
urn:nbn:se:oru:diva-92617 (URN)10.1016/j.jcbs.2021.04.006 (DOI)000657478800021 ()2-s2.0-85105284286 (Scopus ID)
Note

Funding Agency:

Uppsala Örebro Region Research Council RFR71381 RFR213931 RFR138611

Available from: 2021-06-24 Created: 2021-06-24 Last updated: 2021-06-24Bibliographically approved
Fogelkvist, M., Gustafsson, S. A., Kjellin, L. & Parling, T. (2020). Acceptance and commitment therapy to reduce eating disorder symptoms and body image problems in patients with residual eating disorder symptoms: A randomized controlled trial. Body image, 32, 155-166
Open this publication in new window or tab >>Acceptance and commitment therapy to reduce eating disorder symptoms and body image problems in patients with residual eating disorder symptoms: A randomized controlled trial
2020 (English)In: Body image, ISSN 1740-1445, E-ISSN 1873-6807, Vol. 32, p. 155-166Article in journal (Refereed) Published
Abstract [en]

Body image problems are central aspects of eating disorders (ED), and risk factors both for the development of and relapse into an ED. Acceptance and commitment therapy (ACT) aims at helping patients accept uncomfortable internal experiences while committing to behaviors in accordance with life values. The aim of the present study was to compare the effectiveness of a group intervention, consisting of 12 sessions, based on ACT to treatment as usual (TAU) for patients with residual ED symptoms and body image problems. The study was a randomized controlled superiority trial. Patients with residual ED symptoms and body image problems were recruited from a specialized ED clinic in Sweden. The final sample consisted of 99 women, randomized to ACT or TAU. At the two-year follow-up, patients who received ACT showed a significant greater reduction in ED symptoms and body image problems and received less specialized ED care than patients in TAU. In conclusion, ACT was superior in reducing ED symptoms and body image problems.

Place, publisher, year, edition, pages
Saunders Elsevier, 2020
Keywords
Acceptance and commitment therapy, Body dissatisfaction, Body image, Eating disorder, Psychotherapy, Randomized controlled trial
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-79954 (URN)10.1016/j.bodyim.2020.01.002 (DOI)000527989100018 ()32000093 (PubMedID)2-s2.0-85078121718 (Scopus ID)
Note

Funding Agency:

Uppsala-Örebro Regional Research Council  RFR71381 RFR213931 RFR138611

Available from: 2020-02-19 Created: 2020-02-19 Last updated: 2021-05-17Bibliographically approved
Fogelkvist, M., Parling, T., Kjellin, L. & Gustafsson, S. A. (2016). A qualitative analysis of participants' reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy. Journal of Eating Disorders, 4, Article ID 29.
Open this publication in new window or tab >>A qualitative analysis of participants' reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy
2016 (English)In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 4, article id 29Article in journal (Refereed) Published
Abstract [en]

Background: Negative body image is a risk factor for development and relapse in eating disorders (ED). Many patients continue to be dissatisfied with their body shape or weight after treatment. This study presents a qualitative analysis of written reflections on body image from patients with an ED and a negative body image before and after an Acceptance and Commitment Therapy group treatment at a specialized ED-unit.

Method: Before and after the treatment participants (n = 47) answered a questionnaire with open ended questions on their thoughts on body image. Data were analyzed through conventional content analysis.

Results: Body image meant different things for different participants. For some it had to do with how you evaluate your body, whereas others focused on whether their body image was realistic or not. Some emphasized their relationship with their body, while some described body image as strongly related to global self-esteem. These different views on the concept of body image affected the participants' descriptions of their own body image, and how they wanted it to change. Body image was considered a state that fluctuated from day to day. After treatment the participants described changes in their body image, for instance perceiving oneself as less judgmental towards one's body, and a shift in focus to the important things in life.

Conclusions: The participants had different views on body image and how they wished it to change. Thus treatment interventions targeting negative body image needs to address various aspects of this complex construct.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Acceptance and commitment therapy, Body dissatisfaction, Body image, Content analysis, Eating disorders, Qualitative research
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:oru:diva-57168 (URN)10.1186/s40337-016-0120-4 (DOI)000395714600001 ()27999670 (PubMedID)2-s2.0-85003441548 (Scopus ID)
Note

Funding Agency:

Uppsala-Örebro Regional Research Council  RFR71381  RFR213931  RFR138611

Available from: 2017-04-24 Created: 2017-04-24 Last updated: 2025-02-11Bibliographically approved
Fogelkvist, M., Kjellin, L., Gustafsson, S. A. & Parling, T. (2015). Live with your body: Acceptance and commitment therapy to increase body acceptance in patients with eating disorders. In: ECED 2015: Abstracts. Paper presented at European Council on Eating Disorders (ECED) 2015, Heidelberg, Germany, 20-22 November, 2015 (pp. 31-31). , Article ID P9.
Open this publication in new window or tab >>Live with your body: Acceptance and commitment therapy to increase body acceptance in patients with eating disorders
2015 (English)In: ECED 2015: Abstracts, 2015, p. 31-31, article id P9Conference paper, Oral presentation with published abstract (Other academic)
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-101840 (URN)
Conference
European Council on Eating Disorders (ECED) 2015, Heidelberg, Germany, 20-22 November, 2015
Available from: 2022-10-19 Created: 2022-10-19 Last updated: 2022-12-08Bibliographically approved
Fogelkvist, M., Parling, T., Kjellin, L. & Gustafsson, S. A.Live with your body – participants reflections on an Acceptance and commitment therapy group intervention for patients with residual eating disorder symptoms.
Open this publication in new window or tab >>Live with your body – participants reflections on an Acceptance and commitment therapy group intervention for patients with residual eating disorder symptoms
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-91493 (URN)
Available from: 2021-04-28 Created: 2021-04-28 Last updated: 2021-05-19Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2655-3573

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