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The psychometric properties of the Fatigue Severity Scale (FSS) have not been tested in people with stroke, despite its being the most frequently used instrument measuring fatigue in this population. The objective of our study was to... more
The psychometric properties of the Fatigue Severity Scale (FSS) have not been tested in people with stroke, despite its being the most frequently used instrument measuring fatigue in this population. The objective of our study was to assess the psychometric properties of the FSS using both traditional and modern test theory approaches in people with stroke. A total of 119 patients admitted to two hospitals in Norway with their first stroke were recruited to a longitudinal study of poststroke fatigue. Data on socio-demographics, fatigue and other clinical variables were collected by face-to-face interviews using standardized questionnaires or by mailed questionnaires at four time points six months apart. A total of 428 responses on the FSS were analysed. The internal scale validity, person response validity, unidimensionality, and uniform differential item functioning were assessed by applications of a Rasch model and by Cronbach's alpha. Additionally, concurrent validity was assessed using bivariate correlation analysis. Items #1 and #2 in the original FSS demonstrated unacceptable high mean-square values. When these two items were removed, the psychometric properties in FSS-7 demonstrated better evidence of validity. No systematic differential item functioning of the items in FSS-7 was found in relation to any of the analysed variables. In patients with stroke, the FSS-7 showed better psychometric properties and had better potential to detect changes in fatigue over time than the FSS-9 version, suggesting satisfactory grounds for removal of items #1 and #2 for its application.
Background Approximately 20% of patients report pain 12 months after TKA. No studies have investigated patients’ experiences of living with persistent postsurgical pain 5 to 7 years after TKA by combining a qualitative and quantitative... more
Background Approximately 20% of patients report pain 12 months after TKA. No studies have investigated patients’ experiences of living with persistent postsurgical pain 5 to 7 years after TKA by combining a qualitative and quantitative methodology. Question/purpose In a mixed-methods study, we explored patients’ experiences of living with persistent pain up to 7 years after primary TKA. We asked: In a subgroup analysis of patients who reported persistent pain 1 year after TKA surgery, how do patients live with persistent pain at the 5- to 7-year postoperative timepoint? Methods This follow-up study was part of a longitudinal study of pain, symptoms, and health-related quality of life in patients who underwent TKA for osteoarthritis. The present study targeted a subgroup of patients (22% [45 of 202]) identified in the longitudinal study who reported no improvement in pain interference with walking at 12 months after surgery. Inclusion criteria were: all 31 patients in this subgroup who attended their 5-year follow-up at the hospital and lived within a 2-hour drive from the hospital. Eight patients declined or were unable to participate due to illness or death. Hence, the final sample consisted of 23 patients (13 women and 10 men). The participants’ mean age at surgery was 66 ± 10 years. There were no differences in sociodemographic baseline data between the 23 included and the 22 excluded participants. A mixed-methods approach was employed, in which the quantitative data were followed up and investigated with qualitative interviews. Instruments used were the Brief Pain Inventory preoperatively, 12 months, and 5 years after surgery, as well as a semistructured interview guide. The individual interviews were conducted at one timepoint 5 to 7 years postsurgery to capture how pain was experienced at that timepoint. The interviews were audiorecorded, transcribed, and analyzed using qualitative content analysis. Meaning units were identified, condensed, and sorted into subthemes that were interpreted and abstracted into themes, guided by the research question. With a small sample, the quantitative analysis focused on descriptive statistics and nonparametric statistics when comparing demographics of included and nonincluded patients. In addition, two multivariate mixed models for repeated measures were employed to estimate within‐patient and between‐patient variations as well as to assess the effect of time on the pain outcomes. Results Pain with walking decreased from 12 months to 5 years postoperatively (estimated mean score 7 versus 4, difference of means -3 [95% CI -5 to -2]; p < 0.001). Pain with daily activity decreased from 12 months to 5 years postoperatively (estimated mean score 6 versus 3, difference of means -3 [95% CI -4 to -1]; p < 0.001). Pain intensity (average pain) decreased from 12 months to 5 years postoperatively (estimated mean score 5 versus 4, difference of means -1 [95% CI -3 to 0]; p = 0.03). The results are presented as point estimates rounded up to whole numbers. The qualitative data analysis yielded three themes: persistent limitations after TKA, regained wellness over time, and complexity in physical challenges. Intermittent pain with certain movements resulted in limitations with some activities in everyday life and seemed to persist beyond 5 years. Multiple painful body sites and presence of comorbidities seemed to interfere with regained wellness over time. Conclusion In this subgroup of patients experiencing postsurgical persistent pain 12 months after primary TKA, persistent postsurgical pain still limited certain activities for the participants, although pain seemed to be less influential in their everyday lives after 5 years to 7 years. Clinicians may use these findings to inform and guide patients with delayed improvements in pain into more realistic expectations for recovery, rehabilitation, and strategies for coping with pain and impaired function. However, it is imperative to rule out other reasons for pain in patients reporting pain 12 months and longer after surgery and to be attentive of possible changes in pain over time. Level of Evidence Level III, therapeutic study.
Background In Ethiopia, little is known about postoperative pain trajectories and possible predictive factors associated with them in patients undergoing surgery following traumatic fractures. Methods This multi-center prospective... more
Background In Ethiopia, little is known about postoperative pain trajectories and possible predictive factors associated with them in patients undergoing surgery following traumatic fractures. Methods This multi-center prospective observational cohort study included surgical candidates for traumatic fractures (n = 218). Worst pain intensity was measured with an 11-point numeric rating scale on the first 4 postoperative days and day of hospital discharge. Growth mixture modeling was used to identify subgroups of patients based on their pain trajectories, and logistic regression models to quantify associations between pain trajectories and demographic, clinical, psychological, and life style factors. Results Two postoperative pain trajectory subgroups were identified: rapid pain relief (48% of included individuals) and consistently high pain (52% of included individuals). Sub-analysis stratified by cause of injury demonstrated that higher preoperative pain was an independent risk fact...
Background Harmful use of alcohol is a major public health problem. While harm is often researched in the context of heavy drinking episodes, high-frequency drinking, even when drinking moderate quantities, constitutes a health risk in a... more
Background Harmful use of alcohol is a major public health problem. While harm is often researched in the context of heavy drinking episodes, high-frequency drinking, even when drinking moderate quantities, constitutes a health risk in a longer perspective. The aim of this study was to examine the prevalence of daily use of alcohol in the Norwegian general population, and to assess sociodemographic, mental health-related and personal resource variables associated with daily use of alcohol.Methods A cross-sectional survey concerned with health, illness and serious life events was distributed to 5,500 persons in the general population in Norway (response rate 36%). Sociodemographic variables, personal resource variables (general self-efficacy, optimism, and extraversion) and psychological distress (current anxiety and/or depression) were assessed with regards to their associations with daily drinking in unadjusted and adjusted regression models.ResultsDaily use of alcohol was reported...
Background: It has been hypothesized that post-stroke fatigue (PSF) is associated with reduced physical activity (PA) and impaired physical fitness (fitness). Understanding associations between PSF and PA, and/or fitness could help guide... more
Background: It has been hypothesized that post-stroke fatigue (PSF) is associated with reduced physical activity (PA) and impaired physical fitness (fitness). Understanding associations between PSF and PA, and/or fitness could help guide the development of targeted exercise interventions to treat PSF. Aims: Our systematic review and meta-analysis aimed to investigate PSF’s associations with PA and fitness. Summary of review: Following a registered protocol, we included studies with cross-sectional or prospective observational designs, published in English or a Scandinavian language, which reported an association of PSF with PA and/or fitness in adult stroke survivors. We searched MEDLINE, Embase, AMED, CINAHL, PsycINFO, ClinicalTrials.gov, and World Health Organization’s International Clinical Trials Registry Platform from inception to November 30, 2022. Risk of bias was assessed using Quality in Prognosis Studies. Thirty-two unique studies (total n = 4721 participants, 55% male), a...
Background Due to the nature of fatigue, a brief reliable measure of fatigue severity is needed. Thus, the aim of our study was to evaluate a short version of the Lee Fatigue Scale (LFS) in the Norwegian general population. Methods This... more
Background Due to the nature of fatigue, a brief reliable measure of fatigue severity is needed. Thus, the aim of our study was to evaluate a short version of the Lee Fatigue Scale (LFS) in the Norwegian general population. Methods This cross-sectional survey consists of a representative sample from the Norwegian population drawn by The National Population Register in Norway. The study is part of a larger study (NORPOP) aimed at collecting normative data from several questionnaires focused on health in adults living in Norway. Registered citizens between 18 and 94 years of age were randomly selected stratified by age, sex and geographic region. Of the 4971 respondents eligible for the study, 1792 (36%) responded to the survey. In addition to age and sex, we collected responses on a 5-item version of the LFS measuring current fatige severity. The psychometric properties focusing on internal structure and precision of the LFS items were analyzed by a Rasch rating scale model. Results Complete LFS scores for analyses were available for 1767 adults. Women had higher LFS-scores than men, and adults < 55 years old had higher scores than older respondents. Our analysis of the LFS showed that the average category on each item advanced monotonically. Two of the five items demonstrated misfit, while the three other items demonstrated goodness-of-fit to the model and uni-dimensionality. Items #1 and #4 (tired and fatigue respectively) showed differential item functioning (DIF) by sex, but no items showed DIFs in relation to age. The separation index of the LFS 3-item scale showed that the sample could be separated into three different groups according to the respondents' fatigue levels. The LFS-3 raw scores correlated strongly with the Rasch measure from the three items. The core dimensions in these individual items were very similarly expressed in the Norwegian language version and this may be a threat to the cultural-related or language validity of a short version of the LFS using these particular items. Conclusions The study provides validation of a short LFS 3-item version for estimating fatigue in the general population.
Rationale: Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. Methods: We convened an interdisciplinary, international... more
Rationale: Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. Methods: We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. Results: We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool.
Main objective Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis. Methods Based on a peer-reviewed protocol, we searched... more
Main objective Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis. Methods Based on a peer-reviewed protocol, we searched Medline, Embase, CINAHL, Cochrane Library, and PEDro for prospective observational studies (January 2000 to February 2023) investigating factors associated with pain after TKA. The primary outcome was pain twelve months after TKA. Pain at three and six months were secondary outcomes. Multivariate random-effects meta-analyses were used to estimate mean correlation (95% CIs) between factors and pain. Sensitivity analysis was performed for each risk of bias domain and certainty of evidence was assessed. Results Of 13,640 studies, 29 reports of 10,360 patients and 61 factors were analysed. The mean correlation between preoperative factors and more severe pain at twelve months was estimated to be 0.36 (95% CI, 0.24, 0.47; P &lt; .000; moderate-certainty e...
BackgroundModerate/severe pain after total knee arthroplasty (TKA) is a poor surgical outcome. Many studies have identified preoperative risk factors of pain after TKA, but studies of the joint contributions of co‐occurring symptoms are... more
BackgroundModerate/severe pain after total knee arthroplasty (TKA) is a poor surgical outcome. Many studies have identified preoperative risk factors of pain after TKA, but studies of the joint contributions of co‐occurring symptoms are lacking.MethodsPatients undergoing primary TKA (n = 202) were enrolled in a longitudinal cohort study. Preoperatively, patients completed questionnaires measuring demographics and symptoms (pain, fatigue, sleep problems and depression). Pain was re‐assessed 12 months after TKA. Logistic regression analysis was used to compute the probabilities of moderate‐severe pain at 12 months based on preoperative symptom levels, and results were combined into a risk matrix.ResultsMore than one‐third (40%) of patients (n = 187) reported moderate‐severe pain after TKA. Among preoperative risk factors included in the logistic regression analyses were age, sex, pain, fatigue, sleep problems and depression. Adjusting for possible confounders, fatigue (p = 0.02) and p...
Background It has been suggested that countries with more resources and better healthcare have populations with a higher risk of post-traumatic stress disorder (PTSD). Norway is a high-income country with good public healthcare. Aims To... more
Background It has been suggested that countries with more resources and better healthcare have populations with a higher risk of post-traumatic stress disorder (PTSD). Norway is a high-income country with good public healthcare. Aims To examine lifetime trauma exposure and the point prevalence of PTSD in the general Norwegian population. Method A survey was administered to a national probability sample of 5500 adults (aged ≥18 years). Of 4961 eligible individuals, 1792 responded (36%). Responders and non-responders did not differ significantly in age, gender or urban versus rural residence. Trauma exposure was measured using the Life Events Checklist for the DSM-5. PTSD was measured with the PTSD Checklist for the DSM-5. We used the DSM-5 diagnostic guidelines to categorise participants as fulfilling the PTSD symptom criteria or not. Results At least one serious lifetime event was reported by 85% of men and 86% of women. The most common event categories were transportation accident ...
To explore experiences of nurses implementing and using the Modified Early Warning Score (MEWS) and a Mobile Intensive Care Nurse (MICN) providing 24-hour on-call nursing support. To secure patient safety in hospital wards, nurses may... more
To explore experiences of nurses implementing and using the Modified Early Warning Score (MEWS) and a Mobile Intensive Care Nurse (MICN) providing 24-hour on-call nursing support. To secure patient safety in hospital wards, nurses may increase the quality of care using a tool to detect the failure of vital functions. Possibilities for support can be provided through on-call supervision from a qualified team or nurse. This exploratory qualitative investigation used focus group interviews with nurses from two wards of a university hospital in Norway. A purposive sample of seven registered nurses was interviewed in focus groups. A semi-structured guide and an inductive thematic analysis were used to identify interview themes. Three themes emerged: (1) experiences with the early recognition of deterioration using the MEWS, (2) supportive collaboration and knowledge transfer between nurses and (3) a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;new&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; precise language using the score for communicating with physicians. The use of scores and support were perceived as improving care for deteriorating patients and for supporting the collaboration of nurses with other professionals. In our study, nurses described increased confidence in the recognition of deteriorating patients and in the management of such situations. The non-critical attitude, supportive communication and interactive learning according to the MICN were essential elements for success.
Aims Valid measures to identify harmful alcohol use are important. Alcohol Use Disorders Identification Test (AUDIT) is a validated questionnaire used to self-report harmful drinking in several cultures and settings. Phosphatidylethanol... more
Aims Valid measures to identify harmful alcohol use are important. Alcohol Use Disorders Identification Test (AUDIT) is a validated questionnaire used to self-report harmful drinking in several cultures and settings. Phosphatidylethanol 16:0/18:1 (PEth) is a direct alcohol biomarker measuring alcohol consumption levels. The aim of this study was to investigate how PEth levels correlate with AUDIT-QF and weekly grams of alcohol consumed among patients in two urban hospitals. In addition, we wanted to investigate the predictive value of PEth in identifying harmful alcohol use as defined by AUDIT-QF and weekly grams of alcohol cutoffs. Methods A cross-sectional study comprising acute medically ill patients with measurable PEth levels (≥0.030 μM) admitted to two urban hospitals in Oslo, Norway (N = 931) and Moscow, Russia (N = 953) was conducted using PEth concentrations in whole blood, sociodemographic data and AUDIT-QF questionnaires. Results PEth levels from patients with measurable ...
Main objective Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis. Methods Based on a peer-reviewed protocol, we searched... more
Main objective Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis. Methods Based on a peer-reviewed protocol, we searched Medline, Embase, CINAHL, Cochrane Library, and PEDro for prospective observational studies (January 2000 to February 2023) investigating factors associated with pain after TKA. The primary outcome was pain twelve months after TKA. Pain at three and six months were secondary outcomes. Multivariate random-effects meta-analyses were used to estimate mean correlation (95% CIs) between factors and pain. Sensitivity analysis was performed for each risk of bias domain and certainty of evidence was assessed.
Aims: The study aimed to describe the participants with regards to their motivation for physical activity, and to examine associations between sociodemographic variables and motivation for physical activity at the beginning of a patient... more
Aims: The study aimed to describe the participants with regards to their motivation for physical activity, and to examine associations between sociodemographic variables and motivation for physical activity at the beginning of a patient education course and at one-year follow-up. Methods: The study had a longitudinal cohort design. Participants with morbid obesity attended a patient education course and comple­ted self-report questionnaires, including the Stages of Change-Exerci­se. The data were analyzed descriptively and with independent t-test, Chi Square test, Fisher&#39;s exact test, and logistic regression analysis. Results: Data from 69 participants were analyzed. Of these, 42 (60.9 percent) reported sustained high or increased motivation for physical activity between the beginning of the patient education course and the one-year follow-up, whereas 27 (39.1 percent) reported continuing low or decreased motivation. Higher education reduced the odds of being physically active at the beginning of the course, whereas employment increased the odds of being physically active at one-year follow-up. Conclusion: A majority of the participants showed a positive change in their motivation for physical activity, while a considerable minority remained physically inactive. Employment appears to be an important resource for promoting motivation for physical activity
Background Prevalence studies are needed to assess the distribution of diseases. However, in a contrasting health promotion perspective, self-rated health is in itself an important field of study. This study investigated self-rated global... more
Background Prevalence studies are needed to assess the distribution of diseases. However, in a contrasting health promotion perspective, self-rated health is in itself an important field of study. This study investigated self-rated global health in the general population in Norway. Methods As part of a national survey, a two-item measure of global health (score range 0–100) was administered to a general population sample, and 1776 of 4961 eligible participants (response rate 36%) responded. Group comparisons were conducted using independent t-tests and one-way analyses of variance, whereas factors associated with global health was investigated with linear regression analysis. Results In the adjusted analyses, better global health was associated with higher age (β = 0.13, p &lt;  0.001), having higher education (β = 0.10, p &lt;  0.001), being employed (β = 0.21, p &lt;  0.001), and living with a spouse or partner (β = 0.05, p &lt;  0.05). Conclusions While global health was similar ...
BackgroundSeveral studies have found that optimism is associated with better health. However, all those studies have investigated the subject in a specific context: gender, age group, diagnosis, situation, or population segment. Given the... more
BackgroundSeveral studies have found that optimism is associated with better health. However, all those studies have investigated the subject in a specific context: gender, age group, diagnosis, situation, or population segment. Given the association found between optimism and physical health, mental health and well-being in previous studies, one would expect optimistic individuals in the general population to report fewer physical and mental health conditions during their lifetimes than pessimists. The aim of the present study was to test this hypothesis.Participants and procedureA random sample of 1792 people participated in a survey on a broad variety of mental and physical health conditions. In addition they filled out the Life Orientation Test–Revised (LOT-R). Optimism was defined as a score of ≥ 17 on the LOT-R.ResultsOptimists reported a lower prevalence of a wide range of mental and physical health conditions compared with pessimists. The associations between optimism and be...
Introduction: Interest in researching physical activity in relation to mental health is growing. This exploratory study investigated the relationships between self-reported physical activity, depression, anxiety and quality of life in... more
Introduction: Interest in researching physical activity in relation to mental health is growing. This exploratory study investigated the relationships between self-reported physical activity, depression, anxiety and quality of life in patients with severe mental illness. Method: A cross-sectional, correlational design study was conducted at a psychiatric hospital department in eastern Norway. A convenience sample of 18 inpatients with severe mental illness was used. Physical activity was measured with the International Physical Activity Questionnaire; anxiety and depression were measured with the Hospital Anxiety and Depression Scale; and quality of life was measured with the World Health Organization Quality of Life — BREF. Correlation and multiple regression analyses were employed. Results: Bivariate analyses showed that patients with more depression and anxiety symptoms reported lower quality of life. There was no bivariate relationship between physical activity and quality of li...
Purpose Harmful use of alcohol is a major public health problem. While harm is often researched in the context of heavy drinking episodes, high-frequency drinking, even when drinking moderate quantities, constitutes a health risk in a... more
Purpose Harmful use of alcohol is a major public health problem. While harm is often researched in the context of heavy drinking episodes, high-frequency drinking, even when drinking moderate quantities, constitutes a health risk in a longer perspective. The purpose of this paper is to examine the prevalence of daily use of alcohol in the Norwegian general population and to assess sociodemographic, mental health-related and personal resource variables associated with daily use of alcohol. Design/methodology/approach A cross-sectional survey concerned with health, illness and serious life events was distributed to 5,500 persons in the general population in Norway (response rate 36%). Sociodemographic variables, personal resource variables (general self-efficacy, optimism and extraversion) and psychological distress (current anxiety and/or depression) were assessed with regards to their associations with daily drinking in unadjusted and adjusted regression models. Findings Daily use o...

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Klinisk forskning er ifølge Helse- og omsorgsdepartement nødvendig for å sikre at pasientene får god kunnskapsbasert behandling og en viktig forutsetning for utvikling av fremtidens helsetjenester. God tverrfaglig forskning forutsetter at... more
Klinisk forskning er ifølge Helse- og omsorgsdepartement nødvendig for å sikre at pasientene får god kunnskapsbasert behandling og en viktig forutsetning for utvikling av fremtidens helsetjenester. God tverrfaglig forskning forutsetter at alle fag bidrar i forskningen og har personer med høy forskningskompetanse. Muligheter for faglig utvikling på egen arbeidsplass er også motiverende og bidrar til trivsel og stabil arbeidskraft.
Hensikten med denne boken er å tenne og styrke interessen for forskning, og formidle kunnskaps om pasientnær forskning til studenter, helsepersonell, ph.d.-kandidater og forskere.
Boken tar for seg et vidt spekter av tema, og formidler kunnskap og gode råd om blant annet: oppbygging av kunnskapsbasert praksis i de kommunale helse- og omsorgstjenester samt i spesialisthelsetjenesten, planlegging av kliniske studier og valg av forskningsdesign, brukerdeltakelse i forskning, skriving av søknader for å få ekstern finansiering, forskningsetikk og personvern, hvordan skrive CV samt formidling av forskning. Noen kapitler gir også eksempler på karriereløp og forskning fra sykepleiere i kombinerte stillinger som arbeider klinisk og samtidig driver forskning.
Redaktørene har lang erfaring fra forskning i klinikk
Skal du i gang med å skrive en vitenskapelig artikkel? Da er håndboken Hvordan skrive den gode vitenskapelige artikkelen? akkurat noe for deg. Gjennom et lettlest språk og praktiske eksempler følger forfatteren deg trinnvis gjennom den... more
Skal du i gang med å skrive en vitenskapelig artikkel? Da er håndboken Hvordan skrive den gode vitenskapelige artikkelen? akkurat noe for deg. Gjennom et lettlest språk og praktiske eksempler følger forfatteren deg trinnvis gjennom den vitenskapelige artikkelens sjanger og krav til struktur og innhold. Målgruppen for boken er studenter på bachelor-, master-og ph.d.-nivå som skriver artikkelbaserte oppgaver. Spesialisthelsetjenesten er i lovs form pålagt å drive forskning med påfølgende formidling av resultater. Boken er dermed også aktuell for helsepersonell som jobber med manuskripter med mål om vitenskapelig publisering.