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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.
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Kling, Anna-Maria
    Statistical and Epidemiology Unit, Örebro University Hospital, Örebro, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Malmö and Skåne University Hospital, Malmö University, Malmö, Sweden.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    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-centeredness2012In: The International Journal of Person Centered Medicine, ISSN 2043-7730, E-ISSN 2043-7749, Vol. 2, no 3, p. 368-376Article in journal (Refereed)
    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.

  • 3.
    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.

  • 4.
    Ewertzon, Mats
    et al.
    Örebro University, School of Health and Medical Sciences.
    Andershed, Birgitta
    Örebro University, School of Health and Medical Sciences.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Lützén, Kim
    Karolinska Institutet, Stockholm, Sweden.
    Family member's expectation of the psychiatric healthcare professionals' approach towards them2011In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 18, no 2, p. 146-157Article in journal (Refereed)
    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.

  • 5.
    Ewertzon, Mats
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lützén, Kim
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Andershed, Birgitta
    Örebro University, School of Health and Medical Sciences.
    Developing the concept of family involvement and the alienation questionnaire in the context of psychiatric care2008In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 17, no 6, p. 439-449Article in journal (Refereed)
    Abstract [en]

    Research shows that family members of persons with a mental illness often experience a lack of involvement in the psychiatric care of their relative. An interpretation of the findings of these studies raises the question whether the family members’ experience of not being involved can be conceptualised in terms of alienation towards mental health services from their encounter with psychiatric care. 

    In order to explore this possibility, the Family Involvement and Alienation Questionnaire (FIAQ) was constructed, guided by relevant theoretical frameworks and empirical research. The content validity of the questionnaire was evaluated by two groups of experienced researchers who had sound knowledge of the theoretical frameworks used. Validity based on the response process was evaluated by parents of persons with mental illness. The reliability of the questionnaire was evaluated by a test-retest design, in a group of 15 family members. The data were analysed by a non-parametric statistical method.

     

    The results of the validity and reliability evaluations show that of the 46 original items 28 items in the questionnaire would be useful in exploring the concept of family involvement and alienation in the context of psychiatric care. Further, minor modification may make the FIAQ useful in exploring these concepts in other settings.

  • 6.
    Ewertzon, Mats
    et al.
    Örebro University, School of Health and Medical Sciences. Sch Hlth Care & Social Sci, Hogskolan Dalarna, Falun, Sweden.
    Lützén, Kim
    Sch Hlth Care & Social Sci, Hogskolan Dalarna, Falun, Sweden.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Andershed, Birgitta
    Örebro University, School of Health and Medical Sciences. Dept Palliat Care Res, Ersta Skondal Univ Coll, Stockholm, Sweden.
    Family members' involvement in psychiatric care: experiences of the healthcare professionals' approach and feeling of alienation2010In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 17, no 5, p. 422-432Article in journal (Refereed)
    Abstract [en]

    The involvement of family members in psychiatric care is important for the recovery of persons with psychotic disorders and subsequently reduces the burden on the family. Earlier qualitative studies suggest that the participation of family members can be limited by how they experience the professionals’ approach, which suggests a connection to the concept of alienation. Thus, the aim of this study was in a national sample investigate family members’ experiences of the psychiatric health-care professionals’ approach. Data were collected by the Family Involvement and Alienation Questionnaire (FIAQ). The median level and quartiles were used to describe the distributions and data were analysed with non-parametric statistical methods. Seventy family members of persons receiving psychiatric care participated in the study.  

    The results indicate that a majority of the participants respond that they have experiencing a negative approach from the professionals, indicating lack of confirmation and cooperation. The results also indicate that a majority of the participants felt powerlessness and social isolation in the care being provided, indicating feelings of alienation. A significant but weak association was found between the family members´ experiences of the professionals´ approach and their feelings of alienation.

  • 7.
    Fossum, Mariann
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Svensson, Elisabeth
    Örebro University, Örebro University School of Business.
    Hansen, Linda M.
    University of Agder, Grimstad, Norway.
    Ehrenberg, Anna
    Dalarna universty, Falun, Sweden.
    Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homesManuscript (preprint) (Other academic)
  • 8.
    Fossum, Mariann
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Svensson, Elisabeth
    Örebro University, Örebro University School of Business.
    Hansen, Linda M.
    Ehrenberg, Anna
    Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study2013In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, no 10, p. 911-921Article in journal (Refereed)
    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.

  • 9.
    Högberg, Hans
    et al.
    Örebro University, Swedish Business School at Örebro University.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    An overview of methods in the analysis of dependent ordered categorical data: assumptions and implications2008Report (Other academic)
    Abstract [en]

    Subjective assessments of pain, quality of life, ability etc. measured by rating scales and questionnaires are common in clinical research. The resulting responses are categorical with an ordered structure and the statistical methods must take account of this type of data structure. In this paper we give an overview of methods for analysis of dependent ordered categorical data and a comparison of standard models and measures with nonparametric augmented rank measures proposed by Svensson. We focus on assumptions and issues behind model specifications and data as well as implications of the methods. First we summarise some fundamental models for categorical data and two main approaches for repeated ordinal data; marginal and cluster-specific models. We then describe models and measures for application in agreement studies and finally give a summary of the approach of Svensson. The paper concludes with a summary of important aspects.

  • 10.
    Högberg, Hans
    et al.
    Örebro University, Swedish Business School at Örebro University.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Comparison of methods in the analysis of dependent ordered catagorical data2008Report (Other academic)
    Abstract [en]

    Rating scales for outcome variables produce categorical data which are often ordered and measurements from rating scales are not standardized. The purpose of this study is to apply commonly used and novel methods for paired ordered categorical data to two data sets with different properties and to compare the results and the conditions for use of these models.

    The two applications consist of a data set of inter-rater reliability and a data set from a follow-up evaluation of patients. Standard measures of agreement and measures of association are used. Various loglinear models for paired categorical data using properties of quasi-independence and quasi-symmetry as well as logit models with a marginal modelling approach are used. A nonparametric method for ranking and analyzing paired ordered categorical data is also used.

    We show that a deeper insight when it comes to disagreement and change patterns may be reached using the nonparametric method and illustrate some problems with standard measures as well as parametric loglinear and logit models. In addition, the merits of the nonparametric method are illustrated.

  • 11.
    Ledenius, K.
    et al.
    Dept Radiat Phys, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Stalhammar, F.
    Dept Paediat Radiol & Physiol, Queen Silvia Childrens Hosp, Gothenburg, Sweden.
    Wiklund, L-M
    Dept Paediat Radiol & Physiol, Queen Silvia Childrens Hosp, Gothenburg, Sweden.
    Thilander-Klang, A.
    Dept Radiat Phys, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Dept Med Phys & Biomed Engn, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    A method to analyse observer disagreement in visual grading studies: example of assessed image quality in paediatric cerebral multidetector CT images2010In: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 83, no 991, p. 604-611Article in journal (Refereed)
    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.

  • 12.
    Norrefalk, Jan-Rickard
    et al.
    Dept Publ Hlth Sci, Div Rehabil Med, Karolinska Inst, Stockholm, Sweden.
    Svensson, Elisabeth
    Örebro University, Örebro University School of Business.
    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 comparisons2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, p. 187-Article in journal (Refereed)
    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.

  • 13.
    Olovson, B.
    et al.
    Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Rydenhag, B.
    Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Svensson, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Olsson, I.
    Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Parents' perceptions of outcome after epilepsy surgery in children2009In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 50, p. 258-258Article in journal (Other academic)
  • 14.
    Saetra, Pia
    et al.
    Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; Sörlandet Hospital, Arendal, Norway.
    Fossum, Mariann
    Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; Faculty of Health, School of Nursing and Midwifery, Deakin University, Burwood Vic., Australia.
    Svensson, Elisabeth
    Örebro University, Örebro University School of Business.
    Cohen, Marlene Z.
    Center for Nursing Sciences, University of Nebraska Medical Center, Omaha, USA.
    Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 5-6, p. 799-810Article in journal (Refereed)
    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.

  • 15.
    Svensson, Elisabeth
    Örebro University, Örebro University School of Business.
    Different ranking approaches defining association and agreement measures of paired ordinal data2012In: Statistics in Medicine, ISSN 0277-6715, E-ISSN 1097-0258, Vol. 31, no 26, p. 3104-3117Article in journal (Refereed)
    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.

  • 16.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Experiencing the complexity of reality before graduation2009Conference paper (Other academic)
    Abstract [en]

    The curriculum for undergraduate students offers not only basic statistics courses but also optional courses regarding statistical methods for times series, modelling, epidemiology,econometrics and other topics potentially useful in a statistician’s career. This means that the students believe that they will get a comprehensive statistical toolbox for solving a variety of reallife problems after graduation. But can they use the tools in a complex reality? The aim is to present the use of inter-disciplinary statistical problem solving courses for introducing the complexity of reality to statistics students before graduation. Experiences of the discordance between students’ theoretical and practical skills regarding statistical description, analysis and understanding will be given.

  • 17.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Teaching: a way of implementing novel statistical methods for ordinal data to researchers2010In: Data and context in statistical education: Towards an evidence-based society / [ed] Chris Reading, International Association for Statistical Education , 2010Conference paper (Other academic)
    Abstract [en]

    The use of questionnaires, rating scales and other kinds of ordered classifications is unlimited and inter-disciplinary, 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 nonparametric and often rank-based. These limited mathematical properties have been taken into account in my research regarding development of statistical methods for paired ordinal 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.

  • 18.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Teaching: A Way of Implementing Statistical Methods for Ordinal Data to Researchers2012In: Journal of Mathematics and System Science, ISSN 2159-5291, E-ISSN 2159-5305, Vol. 2, p. 8-12Article in journal (Other academic)
    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.

  • 19.
    Svensson, Elisabeth
    Örebro University, Department of Business, Economics, Statistics and Informatics.
    Vad är behandlingseffekt om patienten blev bättre, men ingen vet hur mycket bättre?: Statistisk metod för parade ordinaldata2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 8, p. 596-601Article in journal (Refereed)
    Abstract [en]

    Assessments on scales and questionnaires generate ordered categorical data. Characteristic features are the ordered structure with lack of information regarding size and inter-categorical distances. This paper presents a statistical method for analysis of change in paired ordinal data. The combination of marginal based statistical measures and allocation of ranks tied to the pairs of assessments makes it possible to evaluate the systematic change in common for the group separately from additional individual changes. Different examples with calculations and interpretations are presented in the paper.

  • 20.
    Svensson, Elisabeth
    et al.
    Örebro University, Örebro University School of Business.
    Schillberg, Birgitta
    Kling, Anna-Maria
    Nyström, Bo
    Reliability of the balanced inventory for spinal disorders, a questionnaire for evaluation of outcomes in patients with various spinal disorders2012In: Journal of Spinal Disorders & Techniques, ISSN 1536-0652, E-ISSN 1539-2465, Vol. 25, no 4, p. 196-204Article in journal (Refereed)
    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.

  • 21.
    Svensson, Elisabeth
    et al.
    Örebro University, Swedish Business School at Örebro University.
    Schillberg, Birgitta
    Kling, Anna-Maria
    Nyström, Bo
    The balanced inventory for spinal disorders: the validity of a disease specific questionnaire for evaluation of outcomes in patients with various spinal disorders2009In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 34, no 18, p. 1976-1983Article in journal (Refereed)
    Abstract [en]

    Study Design. A prospective validation study. Objective. To validate the Balanced Inventory for Spinal Disorders (BIS), a questionnaire concerning the extent to which pain affects perceived physical health, social life, mental health, and quality of life. The operational definitions of the items and the verbal descriptive scales were compared with corresponding items in the Short-Form 36 (SF-36), European Quality of Life Scale (EQ), and Oswestry Disability Index (ODI). Summary of Background Data. In validation studies, scales that intend to measure the same variable are compared. Methods. The SF-36, EQ, ODI, and the BIS were filled in by 101 patients before surgical treatment. The comparisons were analyzed by statistical methods that take account of the nonmetric properties of ordered categorical data to obtain reliable results. The level of order-consistency between BIS and comparing items, when present, was calculated. The Spearman rank-order correlation coefficient was also calculated. Results. In the paired comparisons between the BIS pain scales and the other pain scales about 80% units more pairs were ordered than disordered, and the disorder was explained by the discriminating ability of the BIS back and leg pain items. The BIS and ODI items of limitation in walking were comparable, and the assessments of social limitations on the questionnaires were consistent; the disordered pairs being explained by different coverage of activities in the items. The assessments of physical and mental health on BIS were disordered, with the responses in SF-36 in favor of the BIS type of scale categories. The few items and response categories in the EQ did not discriminate the assessments. Conclusion. The BIS assessments can be regarded as being a valid disease-specific questionnaire that provides interpretable information regarding the impact of back end leg pain on well-defined physical, social and mental aspects, and on the quality of life.

  • 22.
    Svensson, Elisabeth
    et al.
    Örebro University, Örebro University School of Business.
    Yang, Yishen
    Örebro University, Örebro University School of Business.
    Holm, Sture
    Göteborg University.
    Asymptotic distribution of rank-based measures for paired ordinal data and their use in interval estimationsManuscript (preprint) (Other academic)
  • 23.
    Yang, Yishen
    et al.
    Örebro University, Örebro University School of Business.
    Svensson, Elisabeth
    Örebro University, Örebro University School of Business.
    Analysing inter-rater agreement: Spearman’s rank order correlation coefficient vs. Svensson’s augmented rank order agreement correlationManuscript (preprint) (Other academic)
  • 24.
    Yang, Yishen
    et al.
    Örebro University, Örebro University School of Business.
    Svensson, Elisabeth
    Örebro University, Örebro University School of Business.
    Non-parametric analyses of change within group and between two groups of paired assessments on rating scalesManuscript (preprint) (Other academic)
1 - 24 of 24
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