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  • 1.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Rawal, Narinder
    Örebro University, Department of Clinical Medicine.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Idvall, Ewa
    Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability2009In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 3, p. 411-419Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability.   The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery.

    Method. The study involved four steps. 1) A conceptualisation and item definitions were based on a theoretical framework and a description of patients´ postoperative recovery from the perspective of patients, registered nurses and surgeons. 2) Content validity of items was tested through expert judgements. 3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement. 4) The stability of the questionnaire was evaluated through intra-patient reliability assessment.

    Results. As a result of the operationalisation process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability.

    Conclusion. Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.

  • 2.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Rawal, Narinder
    Örebro University, Department of Clinical Medicine.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Kling, Anna-Maria
    Statistical and Epidemiology Unit, Örebro University Hospital, Örebro, Sweden.
    Idvall, Ewa
    The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles2011In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, no 2, p. 236-243Article in journal (Refereed)
    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.

  • 3.
    Berg, Katarina
    et al.
    Department of Medical and Health Sciences/Division of Nursing Science, Linköping University, Linköping, Sweden.
    Idvall, Ewa
    Department of Medical and Health Sciences/Division of Nursing Science, Linköping University, Linköping, Sweden; Research Section, Västervik Hospital, Kalmar County Council, Västervik, Sweden.
    Nilsson, Ulrica
    Department of Anesthesia and Intensive Care/Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Franzén Årestedt, Kristofer
    Department of Medical and Health Sciences/Division of Nursing Science, Linköping University, Linköping, Sweden; School of Human Sciences, University of Kalmar, Kalmar, Sweden.
    Unosson, Mitra
    Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    Psychometric evaluation of the post-discharge surgical recovery scale2010In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, p. 794-801Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIM AND OBJECTIVES: Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patient's recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness.

    METHODS: Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach's alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearson's correlation coefficient. Patients' ability to work and their self-rated health on postoperative day 14 were used as external indicators of change.

    RESULTS: Six items showed floor or ceiling effects. Cronbach's coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63).

    CONCLUSIONS: The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

  • 4.
    Bramhagen, Ann-Cathrine
    et al.
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Harden, Sue
    CSN, e-Learning/Content Developer, Skåne University Hospital, Malmö, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Self-reported post-operative recovery in children: development of an instrument2016In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, no 2, p. 180-188Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives: According to the United Nations (1989) , hildren have the right to be heard and to have their opinions respected. Since post-operative recovery is an individual and subjective experience and patient-reported outcome measures are considered important, our aim was to develop and test an instrument to measure self-reported quality of recovery in children after surgical procedures.

    Methods: Development of the instrument Postoperative Recovery in Children (PRiC) was influenced by the Quality of Recovery-24, for use in adults. Eighteen children and nine professionals validated the items with respect to content and language. A photo question- naire was developed to determine whether the children’s participation would increase compared with the text questionnaire. The final instrument was distributed consecutively to 390 children, ages 4–12 years, who underwent tonsil surgery at four hospitals in Sweden.

    Results: A total o f238 children with a mean age of 6.5 years participated. According to the parents, 23% circled the answers themselves and 59% participated to a significant degree. However, there was no significant difference in participation between those who received a photo versus a text questionnaire. Psychometric tests of the instrument showed that Cronbach’s alpha for the total instrument was 0.83 and the item-total correlations for 22 of the items were ≥0.20.

    Conclusion: Our results support use of the PRiC instrument to assess and follow-up on children’s self-reported post-operative recovery after tonsil operation, both in clinical praxis as well in research. 

  • 5.
    Carlfjord, Siw
    et al.
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden.
    Nilsing-Strid, Emma
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre.
    Johansson, Kajsa
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden.
    Holmgren, Theresa
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden; Department of Orthopaedics, Region Östergötland, Linköping, Sweden.
    Öberg, Birgitta
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study2018In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS, AND OBJECTIVES: To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence-based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence-based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation.

    METHODS: A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis.

    RESULTS: The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient- and provider-related challenges to the implementation were mentioned.

    CONCLUSIONS: The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.

  • 6.
    Dozet, Alexander
    et al.
    Department of Healthcare Governance, Region Skåne, Malmö, Sweden.
    Ivarsson, Bodil
    Medicine Service University Trust, Department of Cardiothoracic Surgery, Skåne University Hospital, Region Skåne, Lund University, Lund, Sweden.
    Eklund, Karin
    Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.
    Klefsgard, Rosemarie
    Hospital Management, Skåne University Hospital, Malmö, Sweden.
    Geijer, Mats
    Örebro University, School of Medical Sciences. Department of Radiology; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Radiography on wheels arrives to nursing homes - an economic assessment of a new health care technology in southern Sweden2016In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, no 6, p. 994-1001Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives: The process of transferring older, vulnerable adults from an elder care facility to the hospital for medical care can be an emotionally and physically stressful experience. The recent development of modern mobile radiography may help to ease this anxiety by allowing for evaluation in the nursing home itself. Up until this point, no health economic evaluation of the technology has been attempted in a Swedish setting. The objective of this study was to determine whether examinations of patients in elder care facilities with mobile radiography were cost-effective from a societal perspective compared with hospital-based radiological examinations.

    Methods: This prospective study included two groups of nursing home residents in two different areas in southern Sweden. All residents in the nursing homes were targeted for the study. Seventy-one patients were examined with hospital-based radiography at two hospitals, and 312 patients were examined using mobile radiography in nursing homes. Given that the diagnostic effects are regarded as equivalent, a cost minimization method was applied. Direct costs were estimated using prices from the county council, Region Skane, Sweden.

    Results: From a societal perspective, mobile radiography was shown to have significantly lower costs per examination compared with hospital-based radiography. The difference in health care-related costs was also significant in favour of mobile radiography.

    Conclusion: Mobile radiography can be used to examine patients in nursing homes at a lower cost than hospital-based radiography. Patients benefit from not having to transfer to a hospital for radiography, resulting in reduced anxiety for patients.

  • 7.
    Hälleberg Nyman, Maria
    et al.
    Örebro University, School of Health Sciences. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Forsman, Henrietta
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Wallin, Lars
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ostaszkiewicz, Joan
    Centre for Quality and Patient Safety Research, Barwon Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, Australia.
    Hommel, Ami
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden; Department of Orthopaedics, Skåne University Hospital, Lund, Sweden.
    Eldh, Ann Catrine
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care: A process evaluation of an implementation intervention in the orthopaedic context2018In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS, AND OBJECTIVES: The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery.

    METHODS: A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed.

    RESULTS: Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit.

    CONCLUSION: To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.

  • 8.
    Jaensson, Maria
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Impact of changing positively worded items to negatively worded items in the Swedish web‐version of the Quality of Recovery (SwQoR) questionnaire2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 3, p. 502-507Article in journal (Refereed)
    Abstract [en]

    Rationale, aims, and objectives: The Swedish web-version of the Quality of Recovery questionnaire is used to evaluate a person's postoperative recovery after anesthesia and surgery. An earlier study found an increased risk of answering incorrectly when the questionnaire included both positive and negative items. Therefore, this study investigated the effect of changing positively worded items to negatively worded items.

    Methods: This was a cross-sectional study including 90 second-year nursing students. Seven pairs of positively and negatively worded items were evaluated for differences in response as well as agreement between the items.

    Results: Two pairs of items showed higher mean values if the item was negatively worded. Between-item agreement for positively worded item scores and their corresponding reverse-coded negatively worded item scores was poor-to-moderate (intraclass correlation coefficient: 0.35-0.76). A moderate agreement was found when testing all positively worded items against the recoded negatively worded items (intraclass correlation coefficient: 0.65). Internal consistency was 0.86 for the positively worded items and 0.76 for the negatively worded items.

    Conclusions: Changing from positive to negative wording produced some differences in Swedish web-version of the Quality of Recovery item scores. Internal consistency was acceptable, but 2 items (not having a general feeling of well-being and not speaking normally) need further refinement.

  • 9.
    Overmeer, Thomas
    et al.
    Örebro University, School of Health and Medical Sciences.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Main, Chris J.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Do physical therapists change their beliefs, attitudes,knowledge, skills and behaviour after a biopsychosocially orientated university course?2009In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 4, p. 724-732Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this study is to examine the effects of an 8-day university-based training course, aimed at identifying and addressing psychosocial prognostic factors during physiotherapy treatment, in shifting therapists towards a more biopsychosocial orientation as measured by changes in beliefs/attitudes, knowledge, skills and behaviour.MethodWe combined a randomized controlled trail with a pre-post design. Forty-two physiotherapists applied for a university-accredited training course designed to enhance knowledge and management of psychosocial factors in their practice with patients suffering from musculoskeletal pain. The course participants were randomized either to receiving the course or to a waiting list for training. Attitudes and beliefs towards, and knowledge of psychosocial factors, patient vignettes and a video of an imaginary patient were tested before and after training. The patients of the course participants were asked to fill out a questionnaire with background questions at treatment start. The patients also received a questionnaire about the physical therapists' behaviour and patient satisfaction 6 weeks after treatment start.ResultsThe results show that physical therapists' attitudes and believes became more biopsychosocially and less biomedically orientated, they were less convinced that pain justifies disability and limitation of activities, and their knowledge and skills on psychosocial risk factors increased after a university-accredited training course. Yet despite these changes their patients perceived their practice behaviour before and after the course as similar and were equally satisfied with their treatment and treatment result.ConclusionA course, which enhanced biopsychosocial attitudes and beliefs, as well as increased such knowledge and skills did not change the way patients perceived their physical therapists. A future question is whether it improves patient outcome.

  • 10.
    Shields, Linda
    Örebro University, Department of Nursing and Caring Sciences.
    Using semantic differentials in fieldwork2007In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 13, no 1, p. 116-119Article in journal (Refereed)
    Abstract [en]

    Rationale A large project was undertaken to examine attitudes and opinions of health staff and parents about the care of hospitalized children in four countries. A simple scoring system, which allowed comparisons between results from each country, was needed to examine concepts under investigation. Aims and objectives This paper describes how, after trialling a range of methods, semantic differentials (SD) were found to be easy for the subjects to use. They translated well into other languages and provided scores which were easy to analyse and compare. Results Semantic differentials are based on a series of line scores using adjectives and their antonyms for a set of characteristics. They are a particularly useful method for fieldwork analysis, as they can be done by hand with no computer support. Conclusions Semantic differentials were found to be useful for cross-cultural, quantitative studies of this kind. I discuss SDs, how they work, their trialling, reliability and validity and their usefulness in cross-cultural research.

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