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- Flink, Ida K., 1980-, et al.
(författare)
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Expecting the uncertain : The applicability of the intolerance of uncertainty model on fear of childbirth
- 2023
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Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology. - : Taylor & Francis. - 0167-482X .- 1743-8942. ; 44:1
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Tidskriftsartikel (refereegranskat)abstract
- A considerable number of pregnant women experience fear of childbirth (FOC), characterized by worries and fear of the unpredictable. Despite this, the psychological processes in FOC have received notably little attention. The aim of this study was to advance the understanding by exploring the applicability of the Intolerance of Uncertainty (IU) model on FOC. Anonymous data was collected in a sample of pregnant women (N = 357) with varying levels of FOC. Analyses supported the associations between FOC and all proposed psychological processes: IU, negative problem orientation, positive beliefs about worry and avoidance of inner experiences. The exploration of potential mediators of the relation between IU and FOC revealed that, of the three processes from the model, only positive beliefs about worry were a mediator, and more specifically, a partial mediator between IU and FOC. These findings add to the theoretical understanding of FOC, by indicating that the role of IU may be similar to other conditions inflicted by worry and anxiety, which may inform treatment development. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 4. |
- Grönkvist, Rode, et al.
(författare)
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Measurement error, minimal detectable change, and minimal clinically important difference of the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale, and Pain Numeric Rating Scale in patients with chronic pain
- 2024
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Ingår i: Journal of Pain. - 1526-5900 .- 1528-8447.
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Tidskriftsartikel (refereegranskat)abstract
- In both pain research and clinical practice, patient-reported outcome measures are used to assess dimensions of health. Interpreting these instruments requires understanding their measurement error and what magnitude of change has subjective importance for patients. This study estimated the standard error of measurement (SEM), one-year minimal detectable change, and one-year minimal clinically important difference (MCID) for the Short Form-36 Health Survey physical component summary (SF-36 PCS) and mental (SF36 MCS), the Hospital Anxiety and Depression Scale anxiety symptoms (HADS-A) and depression symptoms (HADS-D) subscales, and the Numeric Rating Scale (NRS) for past-week average pain intensity. MCIDs for these instruments have not previously been estimated in a large sample of chronic pain patients participating in interdisciplinary pain rehabilitation. Data were drawn from the Swedish Quality Registry for Pain Rehabilitation (n=8854 patients). MCID was estimated as average change and change difference, based on three different anchors. MCID estimates were 2.62-4.69 for SF-36 PCS, 4.46-6.79 for SF-36 MCS, 0.895-1.48 for NRS, 1.17-2.13 for HADS-A, and 1.48-2.54 for HADS-D. The common assumption of an identical SEM for pre- and post-treatment measurements was not always applicable. When estimating MCID, researchers should select an estimation method and anchor aligned with the study's context and objectives.PERSPECTIVE: This article presents estimates of minimal clinically important difference and minimal detectable change for several commonly used patient-reported outcome measures among patients with chronic pain. These estimates can help clinicians and researchers to determine when a measured health improvement is subjectively important to the patient and greater than measurement error.DATA AVAILABILITY: Data Availability Statement: The data utilized in this study are not available due to ethical considerations and the need for appropriate ethical approval.
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| 5. |
- Leijon, Anna, et al.
(författare)
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Content validity and feasibility of the BABITT questionnaire : assisted infant toilet training and bowel and bladder function in children
- 2024
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Functional bowel and bladder disorders are prevalent among children. The impact of assisted infant toilet training on the prevalence of childhood bowel and bladder disorders has not previously been investigated. As self-reported bowel and bladder symptoms can be unreliable, robust tools are essential to evaluate interventions. The ROME Foundation offers diagnostic criteria for functional gastrointestinal disorders, while the International Children's Continence Society (ICCS) provides definitions for functional bladder disorders. Our research group has launched the BABITT study, a two-armed intervention study to investigate whether assisted infant toilet training reduces the prevalence of functional bowel and bladder disorders.Aim: To construct a questionnaire, assessing bowel and bladder function in children introduced to infant toilet training and to evaluate content validity as well as feasibility.Methods: In three consecutive steps, a web-based questionnaire was developed. In Step 1, the questionnaire was outlined based on literature review and consensus panel discussions. In Step 2, the questionnaire was validated regarding relevance and simplicity by the content validity index (CVI) method. In Step 3, a pilot phase allowed for assessment of feasibility in the clinical study setting.Results: In Step 1, the Rome criteria and ICCS frameworks were selected for primary outcomes. After the final assessment round in Step 2, the i-CVI ranged from 0.88-1.00 in most items, in all domains, for both relevance and simplicity. Generally lower scores on simplicity emphasized revisions of this aspect of the items. In the pilot phase Step 3, respondent burden was analysed and feasibility assessed. The response rate at the 2-months questionnaire was 95% and acceptability of the intervention was satisfactory.Conclusion: A web- based questionnaire for assessment of parent-reported bladder and bowel function in children who are introduced to infant toilet training was developed. The questionnaire emerged as valid and feasible in its context.
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| 6. |
- Lo Martire, Riccardo, et al.
(författare)
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Predictors of Sickness Absence in a Clinical Population With Chronic Pain
- 2021
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Ingår i: Journal of Pain. - Philadelphia, PA, United States : Churchill Livingstone. - 1526-5900 .- 1528-8447. ; 22:10, s. 1180-1194
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Tidskriftsartikel (refereegranskat)abstract
- Chronic pain-related sickness absence is an enormous socioeconomic burden globally. Optimized interventions are reliant on a lucid understanding of the distribution of social insurance benefits and their predictors. This register-based observational study analyzed data for a 7-year period from a population-based sample of 44,241 chronic pain patients eligible for interdisciplinary treatment (IDT) at specialist clinics. Sequence analysis was used to describe the sickness absence over the complete period and to separate the patients into subgroups based on their social insurance benefits over the final 2 years. The predictive performance of features from various domains was then explored with machine learning-based modeling in a nested cross-validation procedure. Our results showed that patients on sickness absence increased from 17% 5 years before to 48% at the time of the IDT assessment, and then decreased to 38% at the end of follow-up. Patients were divided into 3 classes characterized by low sickness absence, sick leave, and disability pension, with eight predictors of class membership being identified. Sickness absence history was the strongest predictor of future sickness absence, while other predictors included a 2008 policy, age, confidence in recovery, and geographical location. Information on these features could guide personalized intervention in the specialized healthcare. PERSPECTIVE: This study describes sickness absence in patients who visited a Swedish pain specialist interdisciplinary treatment clinic during the period 2005 to 2016. Predictors of future sickness absence are also identified that should be considered when adapting IDT programs to the patient's needs.
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- Lo Martire, Riccardo, et al.
(författare)
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Psychometric properties of Short Form-36 Health Survey, EuroQol 5-dimensions, and Hospital Anxiety and Depression Scale in patients with chronic pain
- 2020
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Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0304-3959 .- 1872-6623. ; 161:1, s. 83-95
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Tidskriftsartikel (refereegranskat)abstract
- Recent research has highlighted a need for the psychometric evaluation of instruments targeting core domains of the pain experience in chronic pain populations. In this study, the measurement properties of Short Form-36 Health Survey (SF-36),EuroQol 5-dimensions (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) were analyzed within the item response-theory framework based on data from 35,908 patients. To assess the structural validity of these instruments, the empirical representations of several conceptually substantiated latent structures were compared in a cross-validation procedure. The most structurally sound representations were selected from each questionnaire and their internal consistency reliability computed as a summary of their precision. Finally, questionnaire scores were correlated with each other to evaluate their convergent and discriminant validity. Our results supported that SF-36 is an acceptable measure of 2 independent constructs of physical and mental health. By contrast, although the approach to summarize the health-related quality of life construct of EQ-5D as a unidimensional score was valid, its low reliability rendered practical model implementation of doubtful utility. Finally, rather than being separated into 2 subscales of anxiety and depression, HADS was a valid and reliable measure of overall emotional distress. In support of convergent and discriminant validity, correlations between questionnaires showed that theoretically similar traits were highly associated, whereas unrelated traits were not. Our models can be applied to score SF-36 and HADS in chronic pain patients, but we recommend against using the EQ-5D model due to its low reliability. These results are useful for researchers and clinicians involved in chronic pain populations because questionnaires' properties determine their discriminating ability in patient status assessment.
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| 8. |
- LoMartire, Riccardo, et al.
(författare)
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The value of interdisciplinary treatment for sickness absence in chronic pain : A nationwide register-based cohort study
- 2021
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 25:10, s. 2190-2201
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Tidskriftsartikel (refereegranskat)abstract
- Background Interdisciplinary treatment (IDT) is an internationally recommended intervention for chronic pain, despite inconclusive evidence of its effects on sickness absence. Methods With data from 25,613 patients in Swedish specialist healthcare, we compared sickness absence, in the form of both sick leave and disability pensions, over a 5-year period between patients either allocated to an IDT programme or to other/no interventions (controls). To obtain population-average estimates, a Markov multistate model with theory-based inverse probability weights was used to compute both the proportion of patients on sickness absence and the total sickness absence duration. Results IDT patients were more likely than controls to receive sickness absence benefits at any given time (baseline: 49% vs. 46%; 5-year follow-up: 36% vs. 35%), and thereby also had a higher total duration, with a mean (95% CI) of 67 (87, 48) more days than controls over the 5-year period. Intriguingly, sick leave was higher in IDT patients (563 [552, 573] vs. 478 [466, 490] days), whereas disability pension was higher in controls (152 [144, 160] vs. 169 [161, 178] days). Conclusion Although sickness absence decreased over the study period in both IDT patients and controls, we found no support for IDT decreasing sickness absence more than other/no interventions in chronic pain patients. Significance In this large study of chronic pain patients in specialist healthcare, sickness absence is compared over a 5-year period between patients in an interdisciplinary treatment programme and other/no interventions. Sickness absence decreased over the study period in bothgroups; however, there was no support forthat it decreased more with interdisciplinary treatment than alternative interventions.
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| 9. |
- Molin, Beata
(författare)
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Chronic pain related to childbirth : Prevalence, characteristics, women's experiences about its impact and support from healthcare
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pregnancy and labour often entail pain and tissue damage, which may lead to the development of chronic pain. Globally, chronic pain, defined as pain that persists after three months, is a leading cause of lasting suffering and disability. If pain is not timely diagnosed and adequately treated it can become a chronic condition. However, among healthcare professionals, there seems to be a lack of strategies for its prevention and treatment.Aim: The aim of this thesis was to describe the prevalence and characteristics of chronic pain related to childbirth. Further aims were to explore women’s experiences of pain and its consequences as well as information and support from healthcare professionals.Methods: Study I was conducted as a prospective cohort study, Studies II and IV had a qualitative approach, and Study III was a mixed methods study with a sequential explanatory design. In Study I, as well as in the first, quantitative part of Study III, data were obtained through two self-administered questionnaires and the patient record system, Obstetrix. The first questionnaire was distributed on the maternity ward, 24–36 h after labour between April and December 2015. The second questionnaire was sent by post eight months after childbirth. Data from 1,171 women, who answered the second questionnaire, were analysed using descriptive statistics. Studies II and IV as well as the second, qualitative part of Study III, had a qualitative approach and included 20 individual semi-structured interviews. Participants in these studies consisted of the same sample, recruited among women who had reported chronic pain related to pregnancy and/or labour in Study I. The interviews were conducted between June and November 2016, recorded and transcribed verbatim. The data were processed and analysed using inductive content analysis.Results: The results of Study I showed that 17% of the women reported chronic pain related to childbirth. Approximately 80% rated their worst pain as moderate or severe and more than 40% of the women experienced pain constantly or daily. Dyspareunia related to childbirth was reported by 19% of the women, with approximately 60% experiencing their worst pain during intercourse as moderate or severe. Study II revealed that women constantly struggled with the pain and its consequences. Chronic pain had a negative impact on several aspects of women’s lives, including physical and social activities, psychological well-being, self-image, as well as their roles as partners and mothers. The results of Study III revealed that the majority of the women did not receive information about risks of developing chronic pain related to childbirth. They did not have knowledge about when and where to seek help, and half of them did not consult healthcare professionals. The lack of information also led to women feeling unprepared for the pain causing emotional distress. In addition, as Study IV revealed, when women turned to healthcare, they did not receive the attention, recognition, and support they needed. They reported not being listened to, not taken seriously, or believed by healthcare professionals and their pain was not assessed, diagnosed, or treated. The women felt abandoned after childbirth and forced to manage the condition on their own. There was an overall desire for more support and continuity regarding care as well as better knowledge among healthcare professionals.Conclusions: Chronic pain eight months after childbirth was reported by one in six women and one in five experienced dyspareunia. Approximately 80% of the women rated their worst pain as moderate or severe, and more than 40% experienced pain constantly or daily. The pain and its consequences had a negative impact on several aspects of women’s lives. In addition, women did not receive adequate information or support from healthcare. In consequence, they did not seek help or when they did, their pain was not recognised, treated, or resolved. Living with pain as well as the lack of adequate information and support from healthcare may also lead to emotional distress. Together this may contribute to women’s suffering as well as an increased risk of development and maintenance of chronic pain. This thesis indicates a need to review the content and quality of current postpartum maternal care concerning pain assessment and management, as well as to develop standards and guidelines for prevention and treatment of pain persisting after pregnancy or labour.
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| 10. |
- Osman, Fatumo, 1973-, et al.
(författare)
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Impact of a culturally tailored parenting programme on the mental health of Somali parents and children living in Sweden : a longitudinal cohort study
- 2021
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:8
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Tidskriftsartikel (refereegranskat)abstract
- Objectives This study aimed to evaluate the long-term impact (3-year follow-up) of a culturally tailored parenting support programme (Ladnaan) on the mental health of Somali-born parents and their children living in Sweden.Methods In this longitudinal cohort study, Somali-born parents with children aged 11-16 were followed up 3 years after they had participated in the Ladnaan intervention. The Ladnaan intervention comprises two main components: societal information and the Connect parenting programme delivered using a culturally sensitive approach. It consists of 12 weekly group-based sessions each lasting 1-2 hours. The primary outcome was improved mental health in children, as measured by the Child Behaviour Checklist (CBCL). The secondary outcome was improved mental health in parents, as measured by the General Health Questionnaire-12. Data were collected from the parent's perspective.Results Of the 60 parents who were originally offered the intervention, 51 were included in this long-term follow-up. The one-way repeated measures (baseline to the 3-year follow-up) analysis of variance for the CBCL confirmed maintenance of all the treatment gains for children: total problem scores (95% CI 11.49 to 18.00, d=1.57), and externalising problems (95% CI 2.48 to 5.83, d=0.86). Similar results were observed for the parents' mental health (95% CI 0.40 to 3.11, d=0.46).Conclusion Positive changes in the mental health of Somali-born parents and their children were maintained 3 years after they had participated in a parenting support programme that was culturally tailored and specifically designed to address their needs. Our findings highlight the long-term potential benefits of these programmes in tackling mental health issues in immigrant families.
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