Liv Strand - Academia.edu (original) (raw)
Papers by Liv Strand
Research in Developmental Disabilities, 2009
Evaluating pain in adults with intellectual and developmental disability (IDD) is a challenge. Th... more Evaluating pain in adults with intellectual and developmental disability (IDD) is a challenge. The Non-Communicating Adults Pain Checklist (NCAPC) was recently developed from the Non-Communicating Children's Pain Checklist (NCCPC) and examined in a group of adults with IDD (N = 228) and found to hold satisfactory construct validity, internal consistency and sensitivity to pain. To further explore its basis for clinical use, intra and interrater reliability of the NCAPC was investigated. Data collection was done by videotaping the participants before and during influenza vaccination. Intrarater reliability was evaluated by the first author on a group of 50 randomly selected individuals (mean age 42.5, range 19-72) and was found at 0.94. Interrater reliability was investigated in two stages. In the initial step different groups of health care workers (caregivers, nurses, case managers, and therapists), each including five raters, viewed a sample of 12 adult participants with IDD (3 at each level of IDD mean age was 49 years, range 16-72), that were extracted from the population sample. Interrater reliability of all raters within the groups varied from low to very high (ICC(1,1) = 0.40-0.88). Interrater reliability was very high in caregivers. The Physical-and Occupational therapists are one group were considered potential users of the measure. In the second stage 3 participants from each of the groups showing high interrater reliability (caregivers and therapist) evaluated interrater reliability in a randomly selected group of 40 individuals (mean age 41.2, range 15-72). Interrarter reliability for the therapists and caregivers was found at 0.91 and 0.92 correspondingly. The researchers conclude that that the NCAPC have been found to hold high reliability values.
Research in Developmental Disabilities, 2010
The Journal of Pain, 2009
Despite enhanced interest in manifestations of pain in adults with intellectual and developmental... more Despite enhanced interest in manifestations of pain in adults with intellectual and developmental disabilities (IDD), the characteristics of pain behavior in this group have seldom been examined. The aim of the present study was to provide a sensitive pain behavior scale for adults with IDD. The participants, 228 adults (mean age, 38.7 years) with different levels of IDD, were videotaped before and during an influenza vaccination and scored using the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R). Observed pain behaviors not captured by the NCCPC-R, was also registered. Sensitivity to pain of all 27 items was examined by Signed Rank test, internal consistency by Cronbach's alpha, and sensitivity to change of the total scale by Standardized Response Mean (SRM). Thirteen items were excluded from the original NCCPC-R scale; 4 new items were added, making a modified scale of 18 items. This scale, named the Non-Communicating Adults Pain Checklist-Revised (NCAPC), was rescored and examined for psychometric properties in a random sample (N = 89). Sensitivity to pain of all items (P < .05) and high internal consistency (alpha = 0.773) were demonstrated. Large sensitivity to pain at all levels of IDD was shown (SRM, 1.20 to 2.07). Better psychometric properties were demonstrated for NCAPC than NCCPC-R in the target population. This article presents initial psychometric properties of a new measure, the NCAPC, evaluating pain behavior in adults with IDD. This measure could help clinicians to better capture pain expressions in this population and contribute to better pain management for this group of patients.
BMC Pulmonary Medicine, 2015
Activities of daily living in patients with chronic obstructive pulmonary disease (COPD) are limi... more Activities of daily living in patients with chronic obstructive pulmonary disease (COPD) are limited by exertional dyspnea and reduced exercise capacity. The aims of the study were to examine longitudinal changes in peak oxygen uptake (V̇O2peak), peak minute ventilation (V̇Epeak) and breathing pattern over four years in a group of COPD patients, and to examine potential explanatory variables of change. This longitudinal study included 63 COPD patients, aged 44-75 years, with a mean forced expiratory volume in one second (FEV1) at baseline of 51 % of predicted (SD = 14). The patients performed two cardiopulmonary exercise tests (CPETs) on treadmill 4.5 years apart. The relationship between changes in V̇O2peak and V̇Epeak and possible explanatory variables, including dynamic lung volumes and inspiratory capacity (IC), were analysed by multivariate linear regression analysis. The breathing pattern in terms of the relationship between minute ventilation (V̇E) and tidal volume (VT) was described by a quadratic equation, VT = a + b∙V̇E + c∙V̇E (2), for each test. The VTmax was calculated from the individual quadratic relationships, and was the point where the first derivative of the quadratic equation was zero. The mean changes in the curve parameters (CPET2 minus CPET1) and VTmax were analysed by bivariate and multivariate linear regression analyses with age, sex, height, changes in weight, lung function, IC and inspiratory reserve volume as possible explanatory variables. Significant reductions in V̇O2peak (p < 0.001) and V̇Epeak (p < 0.001) were related to a decrease in resting IC and in FEV1. Persistent smoking contributed to the reduction in V̇O2peak. The breathing pattern changed towards a lower VT at a given V̇E and was related to the reduction in FEV1. Increasing static hyperinflation and increasing airway obstruction were related to a reduction in exercise capacity. The breathing pattern changed towards more shallow breathing, and was related to increasing airway obstruction.
Scandinavian Journal of Caring Sciences
Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed... more Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed and under-treated pain. A nurse-administered assessment tool has been developed to unmask pain during standardised, guided movements, called Mobilisation–Observation–Behaviour–Intensity–Dementia (MOBID) Pain Scale. The aim was to examine intra- and inter-rater reliability of pain behaviour indicators, inferred pain intensity, and the overall MOBID Pain Score. Twenty-six nursing home patients with severe dementia and chronic pain, 11 primary caregivers and three external raters at the Red Cross Nursing Home, Bergen were included. During video uptake the patients were guided by their primary caregivers to standardised movements of different body parts. Pain behaviour indicators (pain noises, facial expression and defence) were registered for each movement with subsequent rating of pain intensity by external raters, who assessed and scored the videos concurrently and independently at day 1...
BMJ open, 2014
To compare the effects on balance and walking of three models of stroke rehabilitation: early sup... more To compare the effects on balance and walking of three models of stroke rehabilitation: early supported discharge with rehabilitation in a day unit or at home, and traditional uncoordinated treatment (control). Group comparison study within a randomised controlled trial. Hospital stroke unit and primary healthcare. a score of 2-26 on National Institutes of Health Stroke Scale, assessed with Postural Assessment Scale for Stroke (PASS), and discharge directly home from the hospital stroke unit. Two intervention groups were given early supported discharge with treatment in either a day unit or the patient's own home. The controls were offered traditional, uncoordinated treatment. Primary: PASS. Secondary: Trunk Impairment Scale-modified Norwegian version; timed Up-and-Go; 5 m timed walk; self-reports on problems with walking, balance, ADL, physical activity, pain and tiredness. The patients were tested before randomisation and 3 months after inclusion. From a total of 306 randomise...
Physical therapy, 2002
Activities that require mobility of the trunk are often limited in patients with back problems. F... more Activities that require mobility of the trunk are often limited in patients with back problems. For this study, 5 tests (Sock Test, Pick-up Test, Roll-up Test, Fingertip-to-Floor Test, and Lift Test), all requiring sagittal-plane mobility, were performed, and the test scores were combined by the authors in a scale called the Back Performance Scale (BPS) to obtain a performance measure of mobility-related activities. The participants were 288 patients with long-lasting musculoskeletal pain. The basis for constructing a sum scale (BPS), discriminative ability, and responsiveness to important change of the BPS were examined in patients with back pain. Bivariate correlations (rs) of scores among tests ranged from.27 to.50, and correlations between separate tests and the BPS ranged from.63 to.73. The Cronbach alpha was.73. The BPS sum scores discriminated between patients with different return to work status and were higher for back pain than for other musculoskeletal pain. Responsivenes...
Physiological Reports, 2014
Ventilatory capacity is reduced in chronic obstructive pulmonary disease (COPD) patients. Tidal v... more Ventilatory capacity is reduced in chronic obstructive pulmonary disease (COPD) patients. Tidal volume (V T ) is lower and breathing frequency higher at a given ventilation (V E ) compared to healthy subjects. We examined whether airflow limitation and dynamic hyperinflation in COPD patients were related to breathing pattern. An incremental treadmill exercise test was performed in 63 COPD patients (35 men), aged 65 years (48-79 years) with a mean forced expiratory volume in 1 sec (FEV 1 ) of 48% of predicted (SD = 15%). Data were averaged over 20-sec intervals. The relationship between V E and V T was described by the quadratic equation V T = a + bV E + cV E 2 for each subject. The relationships between the curve parameters b and c, and spirometric variables and dynamic hyperinflation measured as the difference in inspiratory capacity from start to end of exercise, were analyzed by multivariate linear regression. The relationship between V E and V T could be described by a quadratic model in 59 patients with median R 2 of 0.90 (0.40-0.98). The linear coefficient (b) was negatively (P = 0.001) and the quadratic coefficient (c) positively (P < 0.001) related to FEV 1 . Forced vital capacity, gender, height, weight, age, inspiratory reserve volume, and dynamic hyperinflation were not associated with the curve parameters after adjusting for FEV 1 . We concluded that a quadratic model could satisfactorily describe the relationship between V E and V T in most COPD patients. The curve parameters were related to FEV 1 . With a lower FEV 1 , maximal V T was lower and achieved at a lower V E . Dynamic hyperinflation was not related to breathing pattern when adjusting for FEV 1 .
BMC Neurology, 2014
Background: Novel virtual reality rehabilitation systems provide the potential to increase intens... more Background: Novel virtual reality rehabilitation systems provide the potential to increase intensity and offer challenging and motivating tasks. The efficacy of virtual reality systems to improve arm motor function early after stroke has not been demonstrated yet in sufficiently powered studies. The objective of the study is to investigate whether VR training as an adjunct to conventional therapy is more effective in improving arm motor function in the subacute phase after stroke than dose-matched conventional training, to assess patient and therapist satisfaction when working with novel virtual reality training and to calculate cost-effectiveness in terms of resources required to regain some degree of dexterity. Methods/Design: Randomized controlled observer-blind trial. One hundred and twenty patients up to 12 weeks after stroke will be randomized to either a group receiving VR training or dose-matched and therapist attention-matched conventional arm training in addition to standard rehabilitation. During a period of four weeks the patients will be offered additional 4-5 training sessions a week of 45-60 minutes duration by a physiotherapist or an occupational therapist. Study outcomes: Arm motor function, dexterity and independence in daily life activities will be evaluated at baseline, post treatment and three months follow-up assessments with the Action Research Arm Test, Box and Blocks Test and the Functional Independence Measure, respectively. Patient and therapist satisfaction with the implementation of a VR rehabilitation system will also be assessed with questionnaires and interviews. Discussion: Virtual reality systems are promising tools for rehabilitation of arm motor function after stroke. Their introduction in combination with traditional physical and occupational therapy may enhance recovery after stroke, and at the same time demand little personnel resources to increase training intensity. The VIRTUES trial will provide further evidence of VR-based treatment strategies to clinicians, patients and health economists. Trial registration: ClinicalTrials.gov NCT02079103
Zeitschrift für Neuropsychologie, 2012
Pain is likely to be equally prevalent in people with dementia, however, only a small minority ar... more Pain is likely to be equally prevalent in people with dementia, however, only a small minority are prescribed regular analgesics. This is a key issue since untreated pain leads to reduced quality of life and increases the likelihood of emergence of behavioural and psychological symptoms such as agitation. Better assessment and treatment of pain in this fragile patient group are therefore mandatory. In this context, we reviewed the literature on pain and dementia and summarised the best available evidence regarding the frequency of pain and pain diagnosis. Unfortunately, hardly any randomized, controlled studies of pain treatment efficacy in patients with dementia are available, with the consequence that most pain treatment recommendations are not based on the highest level of evidence.
Background: Pain is common in people with dementia, yet identification is challenging. A number o... more Background: Pain is common in people with dementia, yet identification is challenging. A number of pain assessment tools exist, utilizing observation of pain-related behaviours, vocalizations and facial expressions. Whilst they have been developed robustly, these often lack sufficient evidence of psychometric properties, like reliability, face and construct validity, responsiveness and usability, and are not internationally implemented. The EU-COST initiative ? Pain in impaired cognition, especially dementia? aims to combine the expertise of clinicians and researchers to address this important issue by building on previous research in the area, identifying existing pain assessment tools for dementia, and developing consensus for items for a new universal meta-tool for use in research and clinical settings. This paper reports on the initial phase of this collaboration task.
Spine, 2004
A single group design to examine reliability and validity of the Back Performance Scale.
Spine, 2001
A randomized, controlled trial. To examine the impact of physical function and pain on work statu... more A randomized, controlled trial. To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain. Sickness benefit is granted to a person who is incapable of working because of reduced functioning. Improved physical function and decrease of pain may be important in considering return to work. Physical performance (five activities), disability, and pain (self-reported questionnaires) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients randomized to an intervention group (n = 81) and a control group (n = 36). At the 1-year follow-up evaluation, 50% had returned to work. Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work: in the intervention group on all tests and in the control group on all except two performance tests. Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test. In the intervention group, odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain; in the control group, this appeared in high pain. Return to work was related to physical function and pain. More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work.
Spine, 2010
Cross-sectional and longitudinal designs within a prospective cohort study. Translation of Hannov... more Cross-sectional and longitudinal designs within a prospective cohort study. Translation of Hannover Functional Ability Questionnaire (FFbH-R) into Norwegian and examination of its factor structure, internal consistency, reproducibility, construct validity, and responsiveness in patients with long-lasting back pain. Several condition-specific instruments have been developed to evaluate functional status in low back pain, but FFbH-R was the only instrument found to solely measure perceived capability of performing daily activities. Recommended guidelines for translation of questionnaires and quality criteria for validation were followed. A total of 111 patients (aged 18-65 years) with long-lasting back pain were consecutively recruited from an outpatient spine clinic. Two additional samples of patients with long-lasting back pain were added into the exploratory factor analysis, giving a total number of 224 patients. Predefined hypotheses regarding construct and longitudinal validity (responsiveness) were examined. Factor analysis indicated that 2 items should be removed, resulting in a 3-factor solution as the best fit. The factors were related to flexibility, dynamic strength, and posture endurance. Satisfactory internal consistency and reproducibility were demonstrated for the total and subscales of the Norwegian version of FFbH-R. Most of the predefined hypothesis regarding construct and longitudinal validity were confirmed, and discriminate ability was shown. Minor floor and ceiling effects were demonstrated. Psychometric properties of the Norwegian version of FFbH-R were satisfactory in patients with long-lasting back pain, but the dynamic strength and posture endurance subscales might be complemented with additional items.
Scandinavian Journal of Caring Sciences, 2009
Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID... more Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed and under-treated pain. A nurse-administered assessment tool has been developed to unmask pain during standardised, guided movements, called Mobilisation-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale. The aim was to examine intra-and inter-rater reliability of pain behaviour indicators, inferred pain intensity, and the overall MOBID Pain Score. Twenty-six nursing home patients with severe dementia and chronic pain, 11 primary caregivers and three external raters at the Red Cross Nursing Home, Bergen were included. During video uptake the patients were guided by their primary caregivers to standardised movements of different body parts. Pain behaviour indicators (pain noises, facial expression and defence) were registered for each movement with subsequent rating of pain intensity by external raters, who assessed and scored the videos concurrently and independently at day 1, 4 and 8. Facial expression was most commonly observed, followed by pain noises and defence. Repeated assessments increased the number of observed pain behaviours, but did not improve reliability. Inter-rater reliability was highest for noises, followed by defence and facial expression (j = 0.44-0.92, j = 0.10-0.76 and j = 0.05-0.76 respectively, at day 8). Mobilisation of arms and legs were rated most painful. Intra-and inter-rater reliability of overall pain were very good [intraclass correlation coefficient (1,1) ranging 0.92-0.97 and 0.94-0.96 respectively, at day 8]. Reliability of pain intensity scores tended to increase by repeated assessment. Using video uptake, MOBID Pain Scale was shown to be sufficiently reliable to assess pain in older persons with severe dementia.
Scandinavian Journal of Caring Sciences, 2007
Scandinavian Journal of Caring Sciences, 2010
Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observati... more Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting Background: To assess pain in older persons with severe dementia is a challenge due to reduced self-report capacity. Recently, the development and psychometric property testing of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale was described using video-recording. The purpose of this article was to present the further development of this instrument. In MOBID-2 Pain Scale, the assessment of inferred pain intensity is based on patient's pain behaviours in connection with standardized, guided movements of different body parts (Part 1). In addition, MOBID-2 includes the observation of pain behaviours related to internal organs, head and skin registered on pain drawings and monitored over time (Part 2). Objective: The aim of this study was to examine psychometric properties of the MOBID-2 Pain Scale, like interrater and test-retest reliability, internal consistency, as well as face-, construct-and concurrent validity. Subjects and Setting: Patients with severe dementia (n = 77) were examined by 28 primary caregivers in clinical practice, who concurrently and independently completed the MOBID-2 Pain Scale. Characteristics of the patients' pain were also investigated by their physicians (n = 4). Results: Prevalence of any pain was 81%, with predominance to the musculoskeletal system, highly associated with the MOBID-2 overall pain score (rho = 0.82). Most frequent and painful were mobilizing legs. Pain in pelvis and/or genital organs was frequently observed. Moderate to excellent agreement was demonstrated for behaviours and pain drawings (j = 0.41-0.90 and j = 0.46-0.93).
Scandinavian Journal of Caring Sciences, 2007
Relationships between demographic, clinical and pain variables and health-related quality of life... more Relationships between demographic, clinical and pain variables and health-related quality of life in patients with chronic low back pain treated with instrumented fusion The purpose of this cross-sectional study was to assess the relationships between demographic, clinical and pain variables and health-related quality of life (HRQOL) in patients who had undergone instrumented spinal fusion because of chronic low back pain (CLBP). The sample comprises 101 patients (70% women, mean age 46 years) who had received surgery between 1993 and 2000. The SF-36 Health Survey was used to assess HRQOL. Pain was assessed by sensory, affective and evaluative subgroups of the Norwegian Pain Questionnaire (modified McGill Pain Questionnaire). Age, work status, number of years after surgery, physical training, other chronic conditions and affective and evaluative pain (all p < 0.05) were the most prominent factors affecting HRQOL. The highest adjusted R 2 to explain the variance was physical function (52%) and the lowest was emotional role limitations (15%). Pain, particularly affective and evaluative pain, contributed more to the explained variance of HRQOL than demographic and clinical variables.
Respiratory Medicine, 2014
Background: The 6-min walk distance (6MWD) is widely used to evaluate functional capacity in pati... more Background: The 6-min walk distance (6MWD) is widely used to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD). Aim: To examine predictors for longitudinal change in 6MWD including self-reported physical activity, smoking habits, body composition, exacerbations, comorbidity and lung function. Methods: The cohort included 389 patients aged 44e75 years, with clinically stable COPD in GOLD stages IIeIV. The follow-up time was 3 years. Measurements included 6MWD, spirometry, fat and fat free mass index (FMI and FFMI), and assessment of physical activity, smoking habits, comorbidities and exacerbations by questionnaires. Generalized estimating equations (GEE) regression analyses were used to analyze predictors for the change in 6MWD. Results: There was a reduction in 6MWD from baseline to 3 years for patients in GOLD stages III and IV (B Z À36 m, 95% CI Z À51 to À7, p Z 0.009 and B Z À79 m, CI Z À125 to À20, p Z 0.007). The unadjusted GEE analysis demonstrated that baseline self-reported physical activity level, forced expiratory volume in one second (FEV 1 ), forced vital capacity, FFMI, GOLD stages and age predicted change in 6MWD, but in the adjusted GEE analysis only self-reported physical activity level (p Z 0.001) and FEV 1 (p Z 0.019) predicted change over time.
Research in Developmental Disabilities, 2009
Evaluating pain in adults with intellectual and developmental disability (IDD) is a challenge. Th... more Evaluating pain in adults with intellectual and developmental disability (IDD) is a challenge. The Non-Communicating Adults Pain Checklist (NCAPC) was recently developed from the Non-Communicating Children's Pain Checklist (NCCPC) and examined in a group of adults with IDD (N = 228) and found to hold satisfactory construct validity, internal consistency and sensitivity to pain. To further explore its basis for clinical use, intra and interrater reliability of the NCAPC was investigated. Data collection was done by videotaping the participants before and during influenza vaccination. Intrarater reliability was evaluated by the first author on a group of 50 randomly selected individuals (mean age 42.5, range 19-72) and was found at 0.94. Interrater reliability was investigated in two stages. In the initial step different groups of health care workers (caregivers, nurses, case managers, and therapists), each including five raters, viewed a sample of 12 adult participants with IDD (3 at each level of IDD mean age was 49 years, range 16-72), that were extracted from the population sample. Interrater reliability of all raters within the groups varied from low to very high (ICC(1,1) = 0.40-0.88). Interrater reliability was very high in caregivers. The Physical -and Occupational therapists are one group were considered potential users of the measure. In the second stage 3 participants from each of the groups showing high interrater reliability (caregivers and therapist) evaluated interrater reliability in a randomly selected group of 40 individuals (mean age 41.2, range 15-72). Interrarter reliability for the therapists and caregivers was found at 0.91 and 0.92 correspondingly. The researchers conclude that that the NCAPC have been found to hold high reliability values. ß
Research in Developmental Disabilities, 2009
Evaluating pain in adults with intellectual and developmental disability (IDD) is a challenge. Th... more Evaluating pain in adults with intellectual and developmental disability (IDD) is a challenge. The Non-Communicating Adults Pain Checklist (NCAPC) was recently developed from the Non-Communicating Children's Pain Checklist (NCCPC) and examined in a group of adults with IDD (N = 228) and found to hold satisfactory construct validity, internal consistency and sensitivity to pain. To further explore its basis for clinical use, intra and interrater reliability of the NCAPC was investigated. Data collection was done by videotaping the participants before and during influenza vaccination. Intrarater reliability was evaluated by the first author on a group of 50 randomly selected individuals (mean age 42.5, range 19-72) and was found at 0.94. Interrater reliability was investigated in two stages. In the initial step different groups of health care workers (caregivers, nurses, case managers, and therapists), each including five raters, viewed a sample of 12 adult participants with IDD (3 at each level of IDD mean age was 49 years, range 16-72), that were extracted from the population sample. Interrater reliability of all raters within the groups varied from low to very high (ICC(1,1) = 0.40-0.88). Interrater reliability was very high in caregivers. The Physical-and Occupational therapists are one group were considered potential users of the measure. In the second stage 3 participants from each of the groups showing high interrater reliability (caregivers and therapist) evaluated interrater reliability in a randomly selected group of 40 individuals (mean age 41.2, range 15-72). Interrarter reliability for the therapists and caregivers was found at 0.91 and 0.92 correspondingly. The researchers conclude that that the NCAPC have been found to hold high reliability values.
Research in Developmental Disabilities, 2010
The Journal of Pain, 2009
Despite enhanced interest in manifestations of pain in adults with intellectual and developmental... more Despite enhanced interest in manifestations of pain in adults with intellectual and developmental disabilities (IDD), the characteristics of pain behavior in this group have seldom been examined. The aim of the present study was to provide a sensitive pain behavior scale for adults with IDD. The participants, 228 adults (mean age, 38.7 years) with different levels of IDD, were videotaped before and during an influenza vaccination and scored using the Non-Communicating Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Pain Checklist-Revised (NCCPC-R). Observed pain behaviors not captured by the NCCPC-R, was also registered. Sensitivity to pain of all 27 items was examined by Signed Rank test, internal consistency by Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha, and sensitivity to change of the total scale by Standardized Response Mean (SRM). Thirteen items were excluded from the original NCCPC-R scale; 4 new items were added, making a modified scale of 18 items. This scale, named the Non-Communicating Adults Pain Checklist-Revised (NCAPC), was rescored and examined for psychometric properties in a random sample (N = 89). Sensitivity to pain of all items (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05) and high internal consistency (alpha = 0.773) were demonstrated. Large sensitivity to pain at all levels of IDD was shown (SRM, 1.20 to 2.07). Better psychometric properties were demonstrated for NCAPC than NCCPC-R in the target population. This article presents initial psychometric properties of a new measure, the NCAPC, evaluating pain behavior in adults with IDD. This measure could help clinicians to better capture pain expressions in this population and contribute to better pain management for this group of patients.
BMC Pulmonary Medicine, 2015
Activities of daily living in patients with chronic obstructive pulmonary disease (COPD) are limi... more Activities of daily living in patients with chronic obstructive pulmonary disease (COPD) are limited by exertional dyspnea and reduced exercise capacity. The aims of the study were to examine longitudinal changes in peak oxygen uptake (V̇O2peak), peak minute ventilation (V̇Epeak) and breathing pattern over four years in a group of COPD patients, and to examine potential explanatory variables of change. This longitudinal study included 63 COPD patients, aged 44-75 years, with a mean forced expiratory volume in one second (FEV1) at baseline of 51 % of predicted (SD = 14). The patients performed two cardiopulmonary exercise tests (CPETs) on treadmill 4.5 years apart. The relationship between changes in V̇O2peak and V̇Epeak and possible explanatory variables, including dynamic lung volumes and inspiratory capacity (IC), were analysed by multivariate linear regression analysis. The breathing pattern in terms of the relationship between minute ventilation (V̇E) and tidal volume (VT) was described by a quadratic equation, VT = a + b∙V̇E + c∙V̇E (2), for each test. The VTmax was calculated from the individual quadratic relationships, and was the point where the first derivative of the quadratic equation was zero. The mean changes in the curve parameters (CPET2 minus CPET1) and VTmax were analysed by bivariate and multivariate linear regression analyses with age, sex, height, changes in weight, lung function, IC and inspiratory reserve volume as possible explanatory variables. Significant reductions in V̇O2peak (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and V̇Epeak (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) were related to a decrease in resting IC and in FEV1. Persistent smoking contributed to the reduction in V̇O2peak. The breathing pattern changed towards a lower VT at a given V̇E and was related to the reduction in FEV1. Increasing static hyperinflation and increasing airway obstruction were related to a reduction in exercise capacity. The breathing pattern changed towards more shallow breathing, and was related to increasing airway obstruction.
Scandinavian Journal of Caring Sciences
Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed... more Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed and under-treated pain. A nurse-administered assessment tool has been developed to unmask pain during standardised, guided movements, called Mobilisation–Observation–Behaviour–Intensity–Dementia (MOBID) Pain Scale. The aim was to examine intra- and inter-rater reliability of pain behaviour indicators, inferred pain intensity, and the overall MOBID Pain Score. Twenty-six nursing home patients with severe dementia and chronic pain, 11 primary caregivers and three external raters at the Red Cross Nursing Home, Bergen were included. During video uptake the patients were guided by their primary caregivers to standardised movements of different body parts. Pain behaviour indicators (pain noises, facial expression and defence) were registered for each movement with subsequent rating of pain intensity by external raters, who assessed and scored the videos concurrently and independently at day 1...
BMJ open, 2014
To compare the effects on balance and walking of three models of stroke rehabilitation: early sup... more To compare the effects on balance and walking of three models of stroke rehabilitation: early supported discharge with rehabilitation in a day unit or at home, and traditional uncoordinated treatment (control). Group comparison study within a randomised controlled trial. Hospital stroke unit and primary healthcare. a score of 2-26 on National Institutes of Health Stroke Scale, assessed with Postural Assessment Scale for Stroke (PASS), and discharge directly home from the hospital stroke unit. Two intervention groups were given early supported discharge with treatment in either a day unit or the patient's own home. The controls were offered traditional, uncoordinated treatment. Primary: PASS. Secondary: Trunk Impairment Scale-modified Norwegian version; timed Up-and-Go; 5 m timed walk; self-reports on problems with walking, balance, ADL, physical activity, pain and tiredness. The patients were tested before randomisation and 3 months after inclusion. From a total of 306 randomise...
Physical therapy, 2002
Activities that require mobility of the trunk are often limited in patients with back problems. F... more Activities that require mobility of the trunk are often limited in patients with back problems. For this study, 5 tests (Sock Test, Pick-up Test, Roll-up Test, Fingertip-to-Floor Test, and Lift Test), all requiring sagittal-plane mobility, were performed, and the test scores were combined by the authors in a scale called the Back Performance Scale (BPS) to obtain a performance measure of mobility-related activities. The participants were 288 patients with long-lasting musculoskeletal pain. The basis for constructing a sum scale (BPS), discriminative ability, and responsiveness to important change of the BPS were examined in patients with back pain. Bivariate correlations (rs) of scores among tests ranged from.27 to.50, and correlations between separate tests and the BPS ranged from.63 to.73. The Cronbach alpha was.73. The BPS sum scores discriminated between patients with different return to work status and were higher for back pain than for other musculoskeletal pain. Responsivenes...
Physiological Reports, 2014
Ventilatory capacity is reduced in chronic obstructive pulmonary disease (COPD) patients. Tidal v... more Ventilatory capacity is reduced in chronic obstructive pulmonary disease (COPD) patients. Tidal volume (V T ) is lower and breathing frequency higher at a given ventilation (V E ) compared to healthy subjects. We examined whether airflow limitation and dynamic hyperinflation in COPD patients were related to breathing pattern. An incremental treadmill exercise test was performed in 63 COPD patients (35 men), aged 65 years (48-79 years) with a mean forced expiratory volume in 1 sec (FEV 1 ) of 48% of predicted (SD = 15%). Data were averaged over 20-sec intervals. The relationship between V E and V T was described by the quadratic equation V T = a + bV E + cV E 2 for each subject. The relationships between the curve parameters b and c, and spirometric variables and dynamic hyperinflation measured as the difference in inspiratory capacity from start to end of exercise, were analyzed by multivariate linear regression. The relationship between V E and V T could be described by a quadratic model in 59 patients with median R 2 of 0.90 (0.40-0.98). The linear coefficient (b) was negatively (P = 0.001) and the quadratic coefficient (c) positively (P < 0.001) related to FEV 1 . Forced vital capacity, gender, height, weight, age, inspiratory reserve volume, and dynamic hyperinflation were not associated with the curve parameters after adjusting for FEV 1 . We concluded that a quadratic model could satisfactorily describe the relationship between V E and V T in most COPD patients. The curve parameters were related to FEV 1 . With a lower FEV 1 , maximal V T was lower and achieved at a lower V E . Dynamic hyperinflation was not related to breathing pattern when adjusting for FEV 1 .
BMC Neurology, 2014
Background: Novel virtual reality rehabilitation systems provide the potential to increase intens... more Background: Novel virtual reality rehabilitation systems provide the potential to increase intensity and offer challenging and motivating tasks. The efficacy of virtual reality systems to improve arm motor function early after stroke has not been demonstrated yet in sufficiently powered studies. The objective of the study is to investigate whether VR training as an adjunct to conventional therapy is more effective in improving arm motor function in the subacute phase after stroke than dose-matched conventional training, to assess patient and therapist satisfaction when working with novel virtual reality training and to calculate cost-effectiveness in terms of resources required to regain some degree of dexterity. Methods/Design: Randomized controlled observer-blind trial. One hundred and twenty patients up to 12 weeks after stroke will be randomized to either a group receiving VR training or dose-matched and therapist attention-matched conventional arm training in addition to standard rehabilitation. During a period of four weeks the patients will be offered additional 4-5 training sessions a week of 45-60 minutes duration by a physiotherapist or an occupational therapist. Study outcomes: Arm motor function, dexterity and independence in daily life activities will be evaluated at baseline, post treatment and three months follow-up assessments with the Action Research Arm Test, Box and Blocks Test and the Functional Independence Measure, respectively. Patient and therapist satisfaction with the implementation of a VR rehabilitation system will also be assessed with questionnaires and interviews. Discussion: Virtual reality systems are promising tools for rehabilitation of arm motor function after stroke. Their introduction in combination with traditional physical and occupational therapy may enhance recovery after stroke, and at the same time demand little personnel resources to increase training intensity. The VIRTUES trial will provide further evidence of VR-based treatment strategies to clinicians, patients and health economists. Trial registration: ClinicalTrials.gov NCT02079103
Zeitschrift für Neuropsychologie, 2012
Pain is likely to be equally prevalent in people with dementia, however, only a small minority ar... more Pain is likely to be equally prevalent in people with dementia, however, only a small minority are prescribed regular analgesics. This is a key issue since untreated pain leads to reduced quality of life and increases the likelihood of emergence of behavioural and psychological symptoms such as agitation. Better assessment and treatment of pain in this fragile patient group are therefore mandatory. In this context, we reviewed the literature on pain and dementia and summarised the best available evidence regarding the frequency of pain and pain diagnosis. Unfortunately, hardly any randomized, controlled studies of pain treatment efficacy in patients with dementia are available, with the consequence that most pain treatment recommendations are not based on the highest level of evidence.
Background: Pain is common in people with dementia, yet identification is challenging. A number o... more Background: Pain is common in people with dementia, yet identification is challenging. A number of pain assessment tools exist, utilizing observation of pain-related behaviours, vocalizations and facial expressions. Whilst they have been developed robustly, these often lack sufficient evidence of psychometric properties, like reliability, face and construct validity, responsiveness and usability, and are not internationally implemented. The EU-COST initiative ? Pain in impaired cognition, especially dementia? aims to combine the expertise of clinicians and researchers to address this important issue by building on previous research in the area, identifying existing pain assessment tools for dementia, and developing consensus for items for a new universal meta-tool for use in research and clinical settings. This paper reports on the initial phase of this collaboration task.
Spine, 2004
A single group design to examine reliability and validity of the Back Performance Scale.
Spine, 2001
A randomized, controlled trial. To examine the impact of physical function and pain on work statu... more A randomized, controlled trial. To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain. Sickness benefit is granted to a person who is incapable of working because of reduced functioning. Improved physical function and decrease of pain may be important in considering return to work. Physical performance (five activities), disability, and pain (self-reported questionnaires) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients randomized to an intervention group (n = 81) and a control group (n = 36). At the 1-year follow-up evaluation, 50% had returned to work. Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work: in the intervention group on all tests and in the control group on all except two performance tests. Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test. In the intervention group, odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain; in the control group, this appeared in high pain. Return to work was related to physical function and pain. More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work.
Spine, 2010
Cross-sectional and longitudinal designs within a prospective cohort study. Translation of Hannov... more Cross-sectional and longitudinal designs within a prospective cohort study. Translation of Hannover Functional Ability Questionnaire (FFbH-R) into Norwegian and examination of its factor structure, internal consistency, reproducibility, construct validity, and responsiveness in patients with long-lasting back pain. Several condition-specific instruments have been developed to evaluate functional status in low back pain, but FFbH-R was the only instrument found to solely measure perceived capability of performing daily activities. Recommended guidelines for translation of questionnaires and quality criteria for validation were followed. A total of 111 patients (aged 18-65 years) with long-lasting back pain were consecutively recruited from an outpatient spine clinic. Two additional samples of patients with long-lasting back pain were added into the exploratory factor analysis, giving a total number of 224 patients. Predefined hypotheses regarding construct and longitudinal validity (responsiveness) were examined. Factor analysis indicated that 2 items should be removed, resulting in a 3-factor solution as the best fit. The factors were related to flexibility, dynamic strength, and posture endurance. Satisfactory internal consistency and reproducibility were demonstrated for the total and subscales of the Norwegian version of FFbH-R. Most of the predefined hypothesis regarding construct and longitudinal validity were confirmed, and discriminate ability was shown. Minor floor and ceiling effects were demonstrated. Psychometric properties of the Norwegian version of FFbH-R were satisfactory in patients with long-lasting back pain, but the dynamic strength and posture endurance subscales might be complemented with additional items.
Scandinavian Journal of Caring Sciences, 2009
Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID... more Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed and under-treated pain. A nurse-administered assessment tool has been developed to unmask pain during standardised, guided movements, called Mobilisation-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale. The aim was to examine intra-and inter-rater reliability of pain behaviour indicators, inferred pain intensity, and the overall MOBID Pain Score. Twenty-six nursing home patients with severe dementia and chronic pain, 11 primary caregivers and three external raters at the Red Cross Nursing Home, Bergen were included. During video uptake the patients were guided by their primary caregivers to standardised movements of different body parts. Pain behaviour indicators (pain noises, facial expression and defence) were registered for each movement with subsequent rating of pain intensity by external raters, who assessed and scored the videos concurrently and independently at day 1, 4 and 8. Facial expression was most commonly observed, followed by pain noises and defence. Repeated assessments increased the number of observed pain behaviours, but did not improve reliability. Inter-rater reliability was highest for noises, followed by defence and facial expression (j = 0.44-0.92, j = 0.10-0.76 and j = 0.05-0.76 respectively, at day 8). Mobilisation of arms and legs were rated most painful. Intra-and inter-rater reliability of overall pain were very good [intraclass correlation coefficient (1,1) ranging 0.92-0.97 and 0.94-0.96 respectively, at day 8]. Reliability of pain intensity scores tended to increase by repeated assessment. Using video uptake, MOBID Pain Scale was shown to be sufficiently reliable to assess pain in older persons with severe dementia.
Scandinavian Journal of Caring Sciences, 2007
Scandinavian Journal of Caring Sciences, 2010
Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observati... more Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting Background: To assess pain in older persons with severe dementia is a challenge due to reduced self-report capacity. Recently, the development and psychometric property testing of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale was described using video-recording. The purpose of this article was to present the further development of this instrument. In MOBID-2 Pain Scale, the assessment of inferred pain intensity is based on patient's pain behaviours in connection with standardized, guided movements of different body parts (Part 1). In addition, MOBID-2 includes the observation of pain behaviours related to internal organs, head and skin registered on pain drawings and monitored over time (Part 2). Objective: The aim of this study was to examine psychometric properties of the MOBID-2 Pain Scale, like interrater and test-retest reliability, internal consistency, as well as face-, construct-and concurrent validity. Subjects and Setting: Patients with severe dementia (n = 77) were examined by 28 primary caregivers in clinical practice, who concurrently and independently completed the MOBID-2 Pain Scale. Characteristics of the patients' pain were also investigated by their physicians (n = 4). Results: Prevalence of any pain was 81%, with predominance to the musculoskeletal system, highly associated with the MOBID-2 overall pain score (rho = 0.82). Most frequent and painful were mobilizing legs. Pain in pelvis and/or genital organs was frequently observed. Moderate to excellent agreement was demonstrated for behaviours and pain drawings (j = 0.41-0.90 and j = 0.46-0.93).
Scandinavian Journal of Caring Sciences, 2007
Relationships between demographic, clinical and pain variables and health-related quality of life... more Relationships between demographic, clinical and pain variables and health-related quality of life in patients with chronic low back pain treated with instrumented fusion The purpose of this cross-sectional study was to assess the relationships between demographic, clinical and pain variables and health-related quality of life (HRQOL) in patients who had undergone instrumented spinal fusion because of chronic low back pain (CLBP). The sample comprises 101 patients (70% women, mean age 46 years) who had received surgery between 1993 and 2000. The SF-36 Health Survey was used to assess HRQOL. Pain was assessed by sensory, affective and evaluative subgroups of the Norwegian Pain Questionnaire (modified McGill Pain Questionnaire). Age, work status, number of years after surgery, physical training, other chronic conditions and affective and evaluative pain (all p < 0.05) were the most prominent factors affecting HRQOL. The highest adjusted R 2 to explain the variance was physical function (52%) and the lowest was emotional role limitations (15%). Pain, particularly affective and evaluative pain, contributed more to the explained variance of HRQOL than demographic and clinical variables.
Respiratory Medicine, 2014
Background: The 6-min walk distance (6MWD) is widely used to evaluate functional capacity in pati... more Background: The 6-min walk distance (6MWD) is widely used to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD). Aim: To examine predictors for longitudinal change in 6MWD including self-reported physical activity, smoking habits, body composition, exacerbations, comorbidity and lung function. Methods: The cohort included 389 patients aged 44e75 years, with clinically stable COPD in GOLD stages IIeIV. The follow-up time was 3 years. Measurements included 6MWD, spirometry, fat and fat free mass index (FMI and FFMI), and assessment of physical activity, smoking habits, comorbidities and exacerbations by questionnaires. Generalized estimating equations (GEE) regression analyses were used to analyze predictors for the change in 6MWD. Results: There was a reduction in 6MWD from baseline to 3 years for patients in GOLD stages III and IV (B Z À36 m, 95% CI Z À51 to À7, p Z 0.009 and B Z À79 m, CI Z À125 to À20, p Z 0.007). The unadjusted GEE analysis demonstrated that baseline self-reported physical activity level, forced expiratory volume in one second (FEV 1 ), forced vital capacity, FFMI, GOLD stages and age predicted change in 6MWD, but in the adjusted GEE analysis only self-reported physical activity level (p Z 0.001) and FEV 1 (p Z 0.019) predicted change over time.
Research in Developmental Disabilities, 2009
Evaluating pain in adults with intellectual and developmental disability (IDD) is a challenge. Th... more Evaluating pain in adults with intellectual and developmental disability (IDD) is a challenge. The Non-Communicating Adults Pain Checklist (NCAPC) was recently developed from the Non-Communicating Children's Pain Checklist (NCCPC) and examined in a group of adults with IDD (N = 228) and found to hold satisfactory construct validity, internal consistency and sensitivity to pain. To further explore its basis for clinical use, intra and interrater reliability of the NCAPC was investigated. Data collection was done by videotaping the participants before and during influenza vaccination. Intrarater reliability was evaluated by the first author on a group of 50 randomly selected individuals (mean age 42.5, range 19-72) and was found at 0.94. Interrater reliability was investigated in two stages. In the initial step different groups of health care workers (caregivers, nurses, case managers, and therapists), each including five raters, viewed a sample of 12 adult participants with IDD (3 at each level of IDD mean age was 49 years, range 16-72), that were extracted from the population sample. Interrater reliability of all raters within the groups varied from low to very high (ICC(1,1) = 0.40-0.88). Interrater reliability was very high in caregivers. The Physical -and Occupational therapists are one group were considered potential users of the measure. In the second stage 3 participants from each of the groups showing high interrater reliability (caregivers and therapist) evaluated interrater reliability in a randomly selected group of 40 individuals (mean age 41.2, range 15-72). Interrarter reliability for the therapists and caregivers was found at 0.91 and 0.92 correspondingly. The researchers conclude that that the NCAPC have been found to hold high reliability values. ß