| 1. |
- Hedström, Johanna, et al.
(author)
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Quality of care in dysphagia patients: adaptation and validation of the Swedish SWAL-CARE questionnaire
- 2020
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In: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525. ; 18:1
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Journal article (peer-reviewed)abstract
- Background The aim of this study was to adapt the instrument and evaluate the psychometric properties of the Swedish version of the Swallowing Quality of Care questionnaire (S-SWAL-CARE) in patients with oropharyngeal dysphagia. Methods Translation and adaptation of the original SWAL-CARE into Swedish was performed according to established international guidelines. Field testing was performed using 100 patients with oropharyngeal dysphagia due to multiple reasons such as head and neck cancer and neurologic/neuromuscular disease, who had undergone swallowing evaluation within 6 months prior to the study. The patients answered the S-SWAL-CARE, the Quality from the Patient's Perspective (QPP) and the Swallowing Quality of Life (SWAL-QOL). Test-retest was performed in 20% of the participants. The reliability and validity of the S-SWAL-CARE were assessed by Pearson correlation coefficient and Cronbach's alpha as well as convergent and discriminative validity, respectively. Results The field testing of the S-SWAL-CARE resulted in sufficient reliability, with Cronbach's alpha values exceeding 0.90 for all domains. All items correlated strongly to their own domain, with weaker correlations to the other domains, indicating proper scale structure. Results also indicate sufficient convergent and discriminant validity when tested for association to the QPP domains and the SWAL-QOL Total score. The test-retest reliability of the S-SWAL-CARE demonstrated sufficient intraclass correlation coefficient (ICC) for the General advice domain (0.73) and Clinical advice domain (0.82). The ICC for the Patient satisfaction domain was lower (0.44). Conclusion The S-SWAL-CARE can be considered a reliable and valid tool to assess the dysphagia-related quality of care in a mixed Swedish dysphagia patient population.
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| 2. |
- Johansson, Mia, 1977, et al.
(author)
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Cost-effectiveness analysis of voice rehabilitation for patients with laryngeal cancer: a randomized controlled study
- 2020
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In: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 28, s. 5203-5211
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Journal article (peer-reviewed)abstract
- Introduction Voice problems are common following radiotherapy for laryngeal cancer. Few studies exist covering the effect of voice rehabilitation, and no previous studies exist regarding the cost of said rehabilitation. This randomized controlled study aimed to analyze the cost-effectiveness of voice rehabilitation after radiotherapy for patients with laryngeal cancer. Material and methods A total of 66 patients with laryngeal cancer with follow-up data 12 months post-radiotherapy were included. Patients were randomized into receiving either voice rehabilitation (n = 32) or no voice rehabilitation (n = 34). The patient outcome was measured as quality-adjusted life years (QALYs). The index range between 0 and 1, where 0 equals death and 1 represents perfect health. The QALYs were assessed with the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30 mapped to EuroQoL 5 Dimension values. The cost of rehabilitation and other healthcare visits was derived from hospital systems. The patients reported the total amount of sick leave days during the first 12 months following radiotherapy. The cost-effectiveness of the voice rehabilitation was compared with no rehabilitation intervention based on the incremental cost-effectiveness ratio. Results The cost per gained QALY with voice rehabilitation compared to no rehabilitation from a societal perspective was - 27,594 euro (SEK - 250,852) which indicates that the voice rehabilitation is a cost-saving alternative compared to no rehabilitation due to lower costs and a slightly better health outcome. From a healthcare perspective, the voice rehabilitation indicates a cost 60,800 euro (SEK 552,725) per gained QALY. Conclusion From a societal perspective, i.e., including the costs of production loss, voice rehabilitation compared to no voice rehabilitation following radiotherapy for laryngeal cancer seems to be cost-saving. When analyzing only the healthcare costs in relation to health outcomes, voice rehabilitation indicates an incremental cost of 60,800 euro per gained QALY, which is just above the threshold of the maximum willingness to pay level.
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| 3. |
- Johansson, Mia, 1977, et al.
(author)
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Further validation of the Gothenburg Trismus Questionnaire (GTQ).
- 2020
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In: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 15:12
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Journal article (peer-reviewed)abstract
- This study aimed to update and, if necessary, revise the Gothenburg Trismus Questionnaire (GTQ), the only existing trismus-specific questionnaire, and retest its psychometric properties. Semi-structured interviews were performed with 10 trismus patients of which 5 had head and neck cancer (HNC) and 5 suffered from benign temporomandibular disorders. Trismus was defined as a maximal incisal opening of ≤ 35mm. An expert panel discussed and revised the GTQ based on interview information, expertise knowledge and the original questionnaire. The revised questionnaire was then tested in a study sample consisting of benign jaw-related conditions (n = 26), patients treated for HNC (n = 90) and an age- and gender-matched control group with no trismus (n = 116). The revised version of the GTQ (GTQ 2) was well accepted by patients. The original three domains continued to show high internal consistency (Cronbach's alpha 0.74-0.94) and construct validity. Two dually posed single items were split into four questions and the wording was altered in another three items. Moreover, a new domain (Facial pain) was identified, which had excellent internal consistency (α = 0.96) and good construct validity. The revision of the original Gothenburg Trismus Questionnaire (GTQ 1) with inclusion of patient-input, resulted in splitting of ambiguous items, identifying a fourth domain named Facial pain and the recall time shortened for some items. Additionally, the remaining domains and items were re-confirmed as strong in the psychometric analysis. Henceforth, the new version, GTQ 2 should be used.
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| 4. |
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| 5. |
- Johansson, Mia, 1977, et al.
(author)
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Self evaluation of communication experiences after laryngeal cancer - a longitudinal questionnaire study in patients with laryngeal cancer.
- 2008
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In: BMC cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 8
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Journal article (peer-reviewed)abstract
- BACKGROUND: Aim of this longitudinal study was to investigate the sensitivity to change of the Swedish Self Evaluation of Communication Experiences after Laryngeal Cancer questionnaire (the S-SECEL), addressing communication dysfunction in patients treated for laryngeal cancer. Previous studies have highlighted the need for more specific questionnaires for this purpose. METHODS: 100 patients with Tis-T4 laryngeal cancer were included prior to treatment onset. Patients answered four questionnaires at six occasions during one year; the S-SECEL, the European Organisation for Research and Treatment of Cancer (EORTC) Core Quality of Life Core Questionnaire (QLQ-C30) supplemented by the Head and Neck cancer module (QLQ-H&N35) and the Hospital Anxiety and Depression (HAD) scale. In addition, performance status was assessed. Differences within groups were tested with the Wilcoxon paired signed ranks test and between-group analyses were carried out using the Mann-Whitney U test. Magnitude of group differences was analyzed by means of effect sizes. RESULTS: The S-SECEL was well accepted with a response rate of 76%. Communication dysfunction increased at 1 month, followed by a continuous decrease throughout the year. Changes were statistically significant at most measurement, demonstrating the sensitivity of the S-SECEL to changes in communication over time. The S-SECEL and the EORTC QLQ-C30 with the QLQ-H&N35 demonstrated similar results; however the S-SECEL was more sensitive regarding communication dysfunction. The largest changes were found in the most diagnose specific items concerning voice and speech. CONCLUSION: The S-SECEL was investigated in the largest Scandinavian longitudinal study concerning health-related quality of life (HRQL) in laryngeal cancer patients. The questionnaire was responsive to change and showed convergent results when compared to established HRQL questionnaires. Our findings also indicate that the S-SECEL could be a more suitable instrument than the EORTC QLQ-C30 with QLQ-H&N35 when measuring communication experiences in patients with laryngeal cancer; it is more sensitive, shorter and can be used on an individual basis. As a routine screening instrument the S-SECEL could be a valuable tool for identifying patients at risk for psychosocial problems and to help plan rehabilitation. It is therefore recommended for clinical use in evaluation of communication dysfunction for all patients with laryngeal cancer irrespective of treatment.
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| 6. |
- Johansson, Mia, 1977, et al.
(author)
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"Setting boundaries" - Mental adjustment to cancer in laryngeal cancer patients: An interview study.
- 2012
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In: European journal of oncology nursing. - : Elsevier BV. - 1532-2122 .- 1462-3889. ; 16:4, s. 419-425
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Journal article (peer-reviewed)abstract
- PURPOSE: To increase the understanding of mental adjustment responses in laryngeal cancer patients, as well as the outcome of these responses. Further, to evaluate the content validity of the Swedish version of the Mini-MAC (Mental Adjustment to Cancer) Scale with regard to findings from the patient interviews. METHOD: Data was collected with semi-structured interviews and analyzed using a constant comparison technique consistent with Grounded Theory. Eighteen participants were selected according to the idea of theoretical sampling. RESULTS: The core category arising was "Setting boundaries". This seemed to be a prerequisite for mental adjustment to diagnosis and treatment without major negative impact on mental health or health-related quality of life (HRQL). Five descriptive categories also emerged: Fighting Spirit; Avoidance; Comparisons; Anxious Preoccupation; and Social Interactions. When comparing these results with the domains of the Mini-MAC Scale, the Fighting Spirit, Cognitive Avoidance and Anxious Preoccupation domains were clearly represented. Concerning the Fatalism and the Hopeless-Helpless domains the support was somewhat weaker. CONCLUSION: Central theme of mental adjustment responses in laryngeal cancer patients was "Setting Boundaries", concerning above all patients' attitude to information and thoughts about the cancer. This response seems to be the dividing line between good and poor adjustment. The results emphasize the importance of adapting the information given and rehabilitation options to each individual patient. The findings largely support the Swedish version of the Mini-MAC, but some deviations were found which should be considered when interpreting results from the Mini-MAC in laryngeal cancer patients.
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| 7. |
- Johnson, Joakim, et al.
(author)
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Development and validation of the Gothenburg Trismus Questionnaire (GTQ).
- 2012
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In: Oral oncology. - : Elsevier BV. - 1368-8375. ; 48:8, s. 730-736
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To develop and validate a comprehensive, self-administered questionnaire for patients with limited ability to open the mouth, trismus. MATERIALS AND METHODS: We derived the Gothenburg Trismus Questionnaire (GTQ) from empirical evidence in the medical literature and interviews with medical experts as well as patients. The draft version was tested in a pilot study (n=18). Patients with a maximal incisal opening (MIO) of ⩽35mm were included. The study comprised patients with benign jaw-related conditions (n=51), patients treated for head and neck (H&N) cancer (n=78) and an age- and gender-matched control group without trismus (n=129). RESULTS: The GTQ instrument was well accepted by the patients, with satisfactory compliance and low rates of missing items. After item reduction, due to items not being conceptually relevant and/or low factor loadings, the GTQ demonstrated high internal consistency (Cronbach's alpha 0.72-0.90), good construct validity and known-group validity. CONCLUSION: We developed a trismus-specific self-administered questionnaire, the GTQ, that showed good psychometric properties. We suggest this questionnaire, that has clear clinical relevance, to be adopted and used in clinical practice and in research, acting as a screening tool as well as an endpoint in intervention and jaw physiotherapy/rehabilitation studies.
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| 8. |
- Johnson, Joakim, et al.
(author)
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The impact of trismus on health-related quality of life and mental health.
- 2015
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In: Head & neck. - : Wiley. - 1097-0347 .- 1043-3074. ; 37:11, s. 1672-1679
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Journal article (peer-reviewed)abstract
- Background: Trismus is a common symptom often related to the treatment of head and neck (H&N) cancer and to temporomandibular disorders (TMD). The aim of the present study was to measure the impact of trismus on health related quality of life (HRQL) and mental health in patients with H&N cancer and TMD. Materials and Methods: We used the criteria for trismus of maximum interincisal opening (MIO) ≤35 mm and the study subjects responded to the following instruments; The Gothenburg Trismus Questionnaire (GTQ), the Short-Form 36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). The study also comprised an age- and gender-matched control group without trismus. Results: Trismus patients reported significantly more dysfunction in all GTQ domains and more facial pain compared to the control group. The patients with H&N cancer and trismus scored significantly lower on all SF-36 domains except General Health compared to the control group, and the TMD patients with trismus scored significantly lower in three of the eight domains in SF-36. According to the HADS, a greater proportion of H&N cancer patients with trismus displayed more depression compared to the control group. Conclusion: The results showed that trismus is associated with a significant impact on HRQL and that patients with trismus should be approached in a holistic way with respect for the underlying cause, treating not only the physical aspects of trismus but also addressing the patients' mental health. Head Neck, 2014.
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| 9. |
- Karlsson, Therese, et al.
(author)
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Effects of voice rehabilitation after radiotherapy for laryngeal cancer: a longitudinal study.
- 2017
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In: Logopedics, phoniatrics, vocology. - : Informa UK Limited. - 1651-2022 .- 1401-5439. ; 42:4, s. 167-177
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Journal article (peer-reviewed)abstract
- The study aimed to investigate the effects of voice rehabilitation on health-related quality of life (HRQL) and voice function in patients treated for laryngeal cancer six months post-rehabilitation completion. A secondary aim was to identify factors that predict significant communication improvement.Longitudinal follow-up of randomised controlled trial.In total, 33 patients received voice rehabilitation post-radiotherapy and 32 patients constituted the control group. Outcome measures included patient-reported HRQL, communication and voice function (acoustic measures and perceptual analysis). Outcome measures were analysed one (baseline), six and 12 months post-radiotherapy, where voice rehabilitation was conducted between the first two time-points.Patients improved after voice rehabilitation with regard to communication function and HRQL and remained unchanged after 12 months post-radiotherapy. A significant roughness deterioration in the control group occurred between six and 12 months post-radiotherapy, yet remained unchanged in the intervention group. A factors increasing odds of significant communication improvement 12 months post-radiotherapy was voice rehabilitation. Smoking affected communication negatively.Voice rehabilitation appears to have positive effect on voice function and HRQL, which persist up to 12 months of follow-up and appears to prevent deterioration of perceived roughness. Patients who experience voice and communication problems at baseline are most likely to benefit from voice rehabilitation.
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| 10. |
- Karlsson, Therese, et al.
(author)
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Effects of voice rehabilitation on health-related quality of life, communication and voice in laryngeal cancer patients treated with radiotherapy: A randomised controlled trial.
- 2015
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In: Acta oncologica (Stockholm, Sweden). - 1651-226X. ; 54:7, s. 1017-1024
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Journal article (peer-reviewed)abstract
- Objective. This study aims to assess the effect of voice rehabilitation on health-related quality of life (HRQL) and communication experience for laryngeal cancer patients treated with radiotherapy. Method. This prospective randomised controlled trial included 74 patients with Tis-T4 laryngeal cancer treated curatively by radiotherapy, of which 37 constituted the intervention group receiving voice rehabilitation and 37 patients as a control group. Patients were followed at one and six months post-radiotherapy, with voice rehabilitation conducted between these time-points. Endpoints included patient reported outcomes, including HRQL as measured by European Organisation for Research and Treatment of Cancer (EORTC) Core30 (C30) and Head & Neck35 (H&N35) as well as communication function as measured by Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer (S-SECEL). Results. The intervention group reported statistically significant improvements in communication experience as measured by S-SECEL environmental, attitudinal and total score domains compared to the control group. Similar improvements were seen in EORTC H&N35 Speech domain and the EORTC C30 domain Global quality of life. Moderate correlations were noted (r = 0.51-0.59) between three of four S-SECEL domains and the EORTC domains Speech and Global quality of life. Conclusion. Laryngeal cancer patients treated with radiotherapy who receive voice rehabilitation appear to experience beneficial effects on communication function and selected HRQL domains. Voice rehabilitation following radiotherapy is recommended but further research investigating potential target groups and long-term effects is required.
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