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Hagell, P., Alvariza, A., Westergren, A. & Kristofer, Å. (2017). Assessment of burden among family caregivers of people with Parkinson’s disease using the Zarit Burden Interview. Journal of Pain and Symptom Management, 53(2), 272-278
Open this publication in new window or tab >>Assessment of burden among family caregivers of people with Parkinson’s disease using the Zarit Burden Interview
2017 (English)In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 53, no 2, p. 272-278Article in journal (Refereed) Published
Abstract [en]

Context: Previous studies have supported the psychometric properties of the 22-item Zarit Burden Interview (ZBI-22) scale among family caregivers of people with various disorders, including Parkinson´s disease (PD). However, its short-forms have not been psychometrically tested among PD family caregivers, and available psychometric analyses have not accounted for the ordinal nature of item-level data.

Objectives: To assess the psychometric properties of the ZBI-22 and its short forms among family caregivers of people with PD, while taking account for the ordinal nature of data.

Methods: Cross-sectional postal survey ZBI-22 data from 66 family caregiver members (59% women; mean age, 69.6 years) of a local Swedish PD society branch were analysed according to classical test theory methods based on polychoric/polyserial correlations.

Results: Missing item responses were ≤5%. Corrected item-total correlations were ≥0.42 and floor-/ceiling effects were <20%, besides for the briefest (4- and 1-item) short-forms (20% and 40% floor effects, respectively). Reliability was good for all scales (ordinal alpha, 0.89-0.95).  External construct validity was in general accordance with a priori expectations. Short-forms demonstrated good criterion-related validity (rs 0.87-0.99) and discriminative ability (AUC, 0.91-0.98) relative to the full ZBI-22.

Conclusion: This study provides support for the reliability and validity of the ZBI-22 and its various short forms for use among PD family caregivers. In studies where caregiver burden is a central outcome, either ZBI-22 or -12 is suggested for use; other short-forms can be used when caregiver burden is of less central focus or for clinical screening.

Keywords
Burden, family caregivers, Parkinson disease, psychometrics, validation
National Category
Health Sciences
Identifiers
urn:nbn:se:hkr:diva-15972 (URN)10.1016/j.jpainsymman.2016.09.007 (DOI)000397118300018 ()27810571 (PubMedID)
Funder
Swedish Research Council
Available from: 2016-09-14 Created: 2016-09-14 Last updated: 2017-08-11Bibliographically approved
Rosqvist, K., Hagell, P., Odin, P., Ekström, H., Iwarsson, S. & Nilsson, M. H. (2017). Factors associated with life satisfaction in Parkinson's disease. Acta Neurologica Scandinavica, 136(1), 64-71
Open this publication in new window or tab >>Factors associated with life satisfaction in Parkinson's disease
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2017 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 136, no 1, p. 64-71Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To identify factors associated with life satisfaction (LS) in people with Parkinson's disease (PD), including a specific focus on those with late-stage PD.

MATERIAL AND METHODS: The study included 251 persons with PD (median age 70 years; PD duration 8 years). Analyses involved the total sample and a subsample with late-stage PD, that is Hoehn and Yahr stages IV and V (n=62). LS was assessed with item 1 of the Life Satisfaction Questionnaire (LiSat-11). Simple logistic regression analyses were performed for both the total sample and for the subsample with late-stage PD. For the total sample, a multivariable logistic regression analysis was also performed.

RESULTS: In the total sample, 12 of the 20 independent variables were significantly associated with LS: need of help with ADL; walking difficulties; number of non-motor symptoms (NMS); fatigue; depressive symptoms; general self-efficacy; motor symptoms; pain; PD severity; freezing episodes; gender (woman); and fluctuations. When controlling for age and gender in the multivariable logistic regression model, depressive symptoms were negatively associated with high LS and general self-efficacy was positively associated with high LS. In late-stage PD, simple logistic regression analyses (controlling for age and gender) identified the following factors as associated with LS: number of NMS, general self-efficacy, walking difficulties and fatigue.

CONCLUSIONS: This study provides new knowledge on factors associated with LS in a PD sample, including those with late-stage PD. As the ultimate goal for PD care should be improvement in LS, the results have direct clinical implication.

Keywords
LiSat-11, Parkinson's disease, associated factors, depressive symptoms, general self-efficacy, late-stage, life satisfaction
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-16218 (URN)10.1111/ane.12695 (DOI)000402646200010 ()27726132 (PubMedID)
Funder
Swedish Research Council, CLaSP/JPND HC-559-002Swedish Research Council, 2012-2809Swedish Research Council, 521-2012-2809Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2016-10-27 Created: 2016-10-27 Last updated: 2017-08-01Bibliographically approved
Persson, C. U., Linder, A. & Hagell, P. (2017). Measurement properties of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) using Rasch analysis. European Journal of Physical and Rehabilitation Medicine, 53(6), 848-855
Open this publication in new window or tab >>Measurement properties of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) using Rasch analysis
2017 (English)In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 53, no 6, p. 848-855Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A previous small-sample (n=150) Rasch analysis of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) suggested problems regarding response categories and redundant items that need confirmation in larger samples with more severe strokes.

AIM: To evaluate the measurement properties of the SwePASS in patients with acute stroke.

DESIGN: A multicentre, cross-sectional study.

SETTING: Two stroke units in Western Sweden.

POPULATION: The study cohort included 250 consecutive inpatients undergoing rehabilitation after acute stroke.

METHODS: The SwePASS assessments were performed once within the first four days after admission to the stroke units. The data were analysed according to the Rasch measurement model regarding targeting, model fit, reliability, response category function, local dependence and differential item functioning.

RESULTS: Postural control of 250 patients (median age, 76.5 years) was assessed with the SwePASS within median of two days after admission to the stroke units. The SwePASS covered a continuum of different levels of postural control, but had suboptimal targeting with insufficient representation of lower and higher levels of postural control. The reliability was high, the item fit statistics were generally acceptable and there was no differential item functioning by sex, age and stroke localization. However, response categories did not function as expected for four of the 12 SwePASS items and five items exhibited local dependency.

CONCLUSIONS: The SwePASS exhibited several promising measurement properties. To improve the scale, poor targeting, illogical response categories and local dependency should be addressed.

CLINICAL REHABILITATION IMPACT: The SwePASS provides valuable clinical information regarding postural control in the acute phase after stroke.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-16788 (URN)10.23736/S1973-9087.17.04607-X (DOI)000419258700004 ()28497929 (PubMedID)
Available from: 2017-05-24 Created: 2017-05-24 Last updated: 2018-01-18Bibliographically approved
Garmy, P., Berg, A., Clausson, E., Hagell, P. & Jakobsson, U. (2017). Psychometric analysis of the Salutogenic Health Indicator Scale (SHIS) in adolescents. Scandinavian Journal of Public Health, 45(3), 253-259
Open this publication in new window or tab >>Psychometric analysis of the Salutogenic Health Indicator Scale (SHIS) in adolescents
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2017 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 3, p. 253-259Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to test the psychometric properties of the Salutogenic Health Indicator Scale (SHIS) in an adolescent population. Methods: The investigation was performed among Swedish students aged 13–15 years (n = 817; 58% girls). The SHIS was assessed for respondent acceptability, and its psychometric properties were evaluated according to classical test theory (regarding unidimensionality, targeting, reliability, and external construct validity). Results: The adolescents found it easy to complete the questionnaire, which was completed in an average of 4 minutes. Exploratory factor analysis, which is based on polychoric correlations, identified one factor, supporting the instrument’s unidimensionality. Floor/ceiling effects were ⩽ 3.3%. Reliability estimates yielded a Cronbach’s alpha value of 0.93; the test–retest reliability (n = 50; 2-week interval) coefficients were 0.89 for the total SHIS score and 0.52–0.79 for item scores. Spearman correlations with other variables were based on a priori expectations (self-rated general health, 0.595; depressive symptoms, −0.773; anxiety, −0.577; and sleep problems, 0.519). Conclusions: Our observations support both the acceptability and the psychometric properties of the SHIS as a brief, unidimensional assessment tool for salutogenic health in adolescents. Further studies using modern test theory are needed to better understand the measurement properties of the SHIS, including the functioning of its response categories and its comparability between adolescents and adults.

Keywords
Psychometric evaluation, adolescents, salutogenic health indicator scale
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-16640 (URN)10.1177/1403494816680801 (DOI)000400160200007 ()27940537 (PubMedID)
Funder
Sven Jerring FoundationMarcus and Amalia Wallenberg FoundationThe Crafoord Foundation
Available from: 2017-04-26 Created: 2017-04-26 Last updated: 2017-11-06Bibliographically approved
Garmy, P., Berg, A., Clausson, E., Hagell, P. & Jakobsson, U. (2017). Salutogent frågeformulär för ungdomar. In: : . Paper presented at Skolsköterskornas kongress, Göteborg.
Open this publication in new window or tab >>Salutogent frågeformulär för ungdomar
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2017 (Swedish)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [sv]

Våra observationer stöder både acceptansen och de psykometriska egenskaperna för SHIS som ett kort, en-dimensionellt frågeformulär för att mäta salutogen hälsa hos ungdomar.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-17440 (URN)
Conference
Skolsköterskornas kongress, Göteborg
Available from: 2017-10-12 Created: 2017-10-12 Last updated: 2017-10-17Bibliographically approved
Timpka, J., Svensson, J., Nilsson, M. H., Pålhagen, S., Hagell, P. & Odin, P. (2017). Workforce unavailability in Parkinson's disease. Acta Neurologica Scandinavica, 135(3), 332-338
Open this publication in new window or tab >>Workforce unavailability in Parkinson's disease
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2017 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 135, no 3, p. 332-338Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Individuals with Parkinson's disease (PD) become unavailable in the workforce earlier than comparable members of the general population. This may result in significant social insurance expenses, but as workforce participation can be a source for social interaction and a vital part of the personal identity, there are likely to be personal implications extending far beyond the economic aspects. This study aimed to identify aspects that may contribute to workforce unavailability in people with PD.

MATERIALS & METHODS: This was a cross-sectional registry study using data from the Swedish national quality registry for PD and included persons with PD in Skåne County, Sweden who were younger than 65 years. Variables were selected from the registry based on earlier studies and clinical experience and were tested for association with unavailability in the workforce: first in a series of simple regression analyses and then in a multiple logistic regression analysis.

RESULTS: A total of 99 persons with PD-of whom 59 were available and 40 were unavailable in the workforce-were included in the study. Age (OR per year: 1.47, 95% CI: 1.18-1.85; P < 0.01) and anxiety (OR: 6.81, 95% CI: 1.20-38.67; P = 0.03) were significant contributing factors for unavailability in the workforce.

CONCLUSIONS: Based on the findings in this exploratory study, anxiety-a potentially modifiable factor-and age may be contributing factors for workforce unavailability in PD. However, prospective studies are warranted to confirm the findings and the causation of the association between anxiety and workforce unavailability needs to be clarified.

Keywords
Anxiety, employment, Parkinson’s disease, registries, retirement, sick leave
National Category
Health Sciences
Identifiers
urn:nbn:se:hkr:diva-15399 (URN)10.1111/ane.12602 (DOI)000397285600009 ()27072284 (PubMedID)
Available from: 2016-04-15 Created: 2016-04-15 Last updated: 2017-11-13Bibliographically approved
Westergren, A., Hagell, P., Wendin, K. & Sjödahl Hammarlund, C. (2016). Conceptual relationships between the ICF and experiences of mealtimes and related tasks among persons with Parkinson’s disease. Nordic journal of nursing research, 36(4), 201-208
Open this publication in new window or tab >>Conceptual relationships between the ICF and experiences of mealtimes and related tasks among persons with Parkinson’s disease
2016 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 36, no 4, p. 201-208Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate experiences of mealtimes and related tasks among people with Parkinson’s disease (PD) and to link these conceptually to the International Classification of Functioning, Disability and Health (ICF). Data were collected by use of semi-structured interviews of 19 people with PD. Inductive content analysis resulted in five categories: 1) Managing mealtime preparations and related tasks, 2) Compromised physical control, 3) Difficulties enjoying meals, 4) Difficulties eating together with others, and 5) Strategies to maintain conventional norms and independence. Deductive content analysis linked the categories to the ICF categories: body functions (mental, sensory, neuromusculoskeletal and movement-related functions); activities (self-determination and chores); participation (interpersonal interactions and relationships); and environmental factors (conventional norms, attitudes of friends and strangers). Emotional and involuntary movement functions were represented in all five inductively derived categories. Eating difficulties may have negative consequences on participation and the emotional wellbeing of people with Parkinson’s disease.

Keywords
content analysis, cooking, eating difficulties, ICF, mealtime, Parkinson’s disease
National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-15373 (URN)10.1177/2057158516642386 (DOI)
Funder
Swedish Research CouncilVårdal Foundation
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2017-11-30Bibliographically approved
Lindholm, B., Nilsson, M., Hansson, O. & Hagell, P. (2016). External validation of a 3-step falls prediction model in mild Parkinson’s disease. Journal of Neurology, 263(12), 2462-2469
Open this publication in new window or tab >>External validation of a 3-step falls prediction model in mild Parkinson’s disease
2016 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 263, no 12, p. 2462-2469Article in journal (Refereed) Published
Abstract [en]

The 3-Step Falls Prediction Model (3-step model) that include history of falls, history of freezing of gait and comfortable gait speed <1.1m/s was suggested as a clinical fall prediction tool in Parkinson’s disease (PD). We aimed to externally validate this model as well as to explore the value of additional predictors in 138 individuals with relatively mild PD. We found the discriminative ability of the 3–step model in identifying fallers to be comparable to previously studies (area under curve (AUC), 0.74; 95%CI, 0.65-0.84) and to be better than that of single predictors (AUC, 0.61-0.69). Extended analyses generated a new model for prediction of falls and near falls (AUC, 0.82; 95%CI, 0.75-0.89) including history of near falls, retropulsion according to the Nutt Retropulsion Test (NRT) and tandem gait (TG). This study confirms the value of the 3-step model as a clinical falls prediction tool in relatively mild PD and illustrates that it outperforms the use of single predictors. However, to improve future outcomes, further studies are needed to firmly establish a scoring system and risk categories based on this model. The influence of methodological aspects of data collection also needs to be scrutinized. A new model for prediction of falls and near falls, including history of near falls, TG and retropulsion (NRT) may be considered as an alternative to the 3-step model, but needs to be tested in additional samples before being recommended. Taken together, our observations provide important additions to the evidence base for clinical fall prediction in PD. 

Keywords
Parkinson disease, falls, near falls, gait, balance, prediction
National Category
Health Sciences
Identifiers
urn:nbn:se:hkr:diva-15973 (URN)10.1007/s00415-016-8287-9 (DOI)000388625500015 ()27646115 (PubMedID)
Funder
Region Skåne
Available from: 2016-09-14 Created: 2016-09-14 Last updated: 2017-10-20Bibliographically approved
Sjödahl Hammarlund, C., Hagell, P. & Westergren, A. (2016). Fall risk and its associated factors among older adults without home help services in a Swedish municipality. Journal of Community Health Nursing, 33(4), 181-189
Open this publication in new window or tab >>Fall risk and its associated factors among older adults without home help services in a Swedish municipality
2016 (English)In: Journal of Community Health Nursing, ISSN 0737-0016, E-ISSN 1532-7655, Vol. 33, no 4, p. 181-189Article in journal (Refereed) Published
Abstract [en]

During preventive home visits, the purpose of this study was, to identify the prevalence of fall risk and any associated factors. Participants (n=1471) were cognitively sound community-dwelling older adults (≥ 70 years) without home-help service, living in a Swedish municipality. The Downton Fall Risk Index and nine single items were used. Tiredness/fatigue, age ≥ 80, inability to walk one hour, inability to climb stairs and worrying were significantly associated with fall risk. Preventive home visits incorporating fall risk screening proved valuable, providing information for interventions aimed at preventing falls, maintaining independence and facilitating health among community dwelling participants.

Keywords
Community dwelling, cross-sectional, older adults, fall risk, fatigue, prevalence, preventive home visits, worry
National Category
Health Sciences
Identifiers
urn:nbn:se:hkr:diva-15971 (URN)10.1080/07370016.2016.1227211 (DOI)000386584600002 ()27749090 (PubMedID)
Available from: 2016-09-14 Created: 2016-09-14 Last updated: 2017-10-03Bibliographically approved
Hagell, P., Edfors, E., Hedin, G., Westergren, A. & Sjödahl Hammarlund, C. (2016). Group concept mapping for evaluation and development in nursing education. Nurse Education in Practice, 20, 147-153
Open this publication in new window or tab >>Group concept mapping for evaluation and development in nursing education
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2016 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 20, p. 147-153Article in journal (Refereed) Published
Abstract [en]

The value of course evaluations has been debated since they frequently fail to capture the complexity of education and learning. Group Concept Mapping (GCM), a participant-centred mixed-method was explored as a tool for evaluation and development in nursing education and to better understand students' learning experiences, using data from a GCM-based evaluation of a research training assignment integrating clinical practice and research data collection within a Swedish university nursing program. Student nurses (n = 47) participated in a one-day GCM exercise. Focus group brainstorming regarding experiences from the assignment that the students considered important and instructive yielded 98 statements that were individually sorted based on their student-perceived relationships, and rated regarding their importance/instructiveness and need for development. Quantitative analysis of sort data produced a 2-dimensional map representing their conceptual relationships, and eight conceptual areas. Average cluster ratings were plotted relative to each other and provided a decision aid for development and planning by identifying areas (i.e., "Research methodology", "Patients' perspectives", and "Interviewer role") considered highly important/instructive and in high need for development. These experiences illustrate the use and potential of GCM as an interactive participant-centred approach to evaluation, planning and development in nursing and other higher health science educations.

National Category
Health Sciences Educational Sciences
Identifiers
urn:nbn:se:hkr:diva-15974 (URN)10.1016/j.nepr.2016.08.006 (DOI)000385322200021 ()27591400 (PubMedID)
Available from: 2016-09-14 Created: 2016-09-14 Last updated: 2017-08-15Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2174-372X

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