Lotti Orwelius

Burn injury can be a life-threatening and traumatic event. Despite considerable risk for psychological morbidity, few outcome measures have been evaluated. The aim of this study was to examine the psychometric properties of a Swedish version of the Impact of Event Scale-Revised (IES-R) in patients 1 year after burn injury (N = 147). A principal component analysis was performed, and the results supported the three-factor structure of the IES-R. High internal consistency and intelligible associations with concurrent psychological symptoms and known risk factors for distress after trauma indicate satisfactory psychometric properties. Thus, the study supports the use of the IES-R as a screening tool for measuring traumatic distress after burn.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Swedish research Council for Medicine and health - VR Swedish Research Council for health, working life and welfare - FORTE Background Health-related quality of life (HRQoL) is one and possibly the most important follow-up measure that is used to assess outcomes after long term and critical illness, such as heart failure. There is today an abundance of available generic measures relevant for all types of diseases and health states, and therefore suitable in heterogenous patient cohorts. Globally, two of the most common generic measures of HRQoL in use today are the EuroQol-5D (EQ-5D) and the RAND-36/36-item short-form SF-36. Another commonly used instrument is Cantril’s ladder of life. With the purpose to create a valid but not burdensome survey before and after an intervention in a cohort of former critically ill patients after a period of cardiac care, the question was raised what instrument to choose, and if the instruments correlates. If so, not all items have to be used if they measure the same outcome. Purpose To examine the relationship between different generic instruments for HRQoL in patients with heart failure. Methods For EQ-5D the separate five separate dimensions, the index from the combined dimensions, and a visual analog scale (VAS) can be used. For RAND-36 the eight dimensions created from 35 of the 36 questions, and the extern item as a single item called "Health Transition" can be used. Finally, for the Ladder of life the three questions can be used as separate items. The items chosen and measured in a cohort of former critically ill cardiac patients (n=246) were EQ-5D VAS, EQ-index, RAND-36 health transition question, and ladder of life question 1 and 3. Higher scores indicates higher perceived HRQoL on the scales except for RAND-36. The patients had a mean age of 66 years (SD 11.8), 67.3% (n=165) were men. The most common diagnoses in the sample were heart failure 68% (n=148), diabetes 22% (n=31), cancer (17% (n=36), and pulmonary disease 14% (n=31). The Spearman´s rank correlation was used to analyze the strength of association in the nonparametric data. Results Up to moderately strong correlation was seen between the items (see table). The strongest correlation was found between the EQ-5D VAS and RAND-36 Health Transition item (-0,629 (p=0.01)), followed by both RAND-36 and EQ-5D VAS and the ladder of life question "Where on the ladder do you feel you personally stand right now" (0,615 (p=0.01)) and (0.606 (p=0.01)) respectively. The two ladder of life questions correlated moderately (0.689, (p=0.01)). Conclusions Albeit the same focus area, the chosen general instruments, and items for measuring HRQoL was not strongly correlated indicated that they do not measure the exact same concepts and dimension. This is of importance when chosen instruments for HRQoL follow-up. There might be a need to combine more than one generic instrument considering the balance between the burden for the patient and the purpose and depth of the investigation. Further conceptual consideration regarding to these different generic instruments are warranted.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish research council Expectations of tele-yoga in persons with long-term illness Background Rehabilitation for people with long-term illness, such as various cardiac disease including heart failure or patients with an Internal Cardioverter Defibrillator (ICD), can be a challenge due to the severity of the illness and the ability to participate in group training. Yoga is a mind-body exercise that is feasible and safe, and can lead to long-term positive effects on both physical and mental well-being. Tele-yoga is a new approach of rehabilitation for this group who may have difficulty leaving their home, where participants practice group yoga with a live-streamed yoga-instructor digitally via a tablet from home. Purpose The aim of the study was to explore the expectations of tele-yoga in people with long-term illness before starting a remotely group yoga intervention at...

IntroductionThe aim of the present multicentre study is to assess health‐related quality of life in patients with community‐acquired sepsis, severe sepsis, or septic shock (CAS) 6 months after discharge from the intensive care unit (ICU) and to compare the health‐related quality of life of the ICU survivors with CAS with ICU survivors with other ICU diagnoses.MethodsProspective, multicentre study in nine combined medical and surgical ICUs in Portugal. Health‐related quality of life was assessed 6 months after ICU stay, using EuroQol‐5D (EQ‐5D) mailed to patients. ICU‐related factors were obtained from the local ICU database and the local database for the SACiUCI follow‐up study.ResultsA total of 313 (52%) surviving patients answered the questionnaire, and of these 91 (29%) were admitted for CAS. There were no significant differences in health‐related quality of life between the two study groups.ConclusionPatients admitted to ICU for CAS did not perceived different health‐related quality of life compared with ICU patients admitted for other diagnoses.

Health-related quality of life (HRQoL) is known to be significantly affected in former trauma patients. However, the underlying factors that lead to this outcome are largely unknown. In former intensive care unit (ICU) patients, it has been recognized that preexisting disease is the most important factor for the long-term HRQoL. The aim of this study was to investigate HRQoL up to2 years after trauma and to examine the contribution of the trauma-specific, ICU-related, sociodemographic factors together with the effects of preexisting disease, and further to make a comparison with a large general population. A prospective 2-year multicenter study in Sweden of 108 injured patients. By mailed questionnaires, HRQoL was assessed at 6 months,12 months, and 24 months after the stay in ICU by Short Form (SF)-36, and information of preexisting disease was collected from the national hospital database. ICU-related factors were obtained from the local ICU database. Comorbidity and HRQoL (SF-36)...

Background: Patients on the ICU often spend a great deal of their time either unconscious or heavily sedated. When they return from the zone between life and death they are often in a state of confusion where dreams and delusions are intertwined with reality and it is not always easy to distinguish them apart. These experiences could lead to psychological problems and post-traumatic stress disorder (PTSD). Recovery may be improved by filling in the significant memory gaps and explaining what really happened during the “chaotic” time on the ICU. The provision of a diary describing the patients’ stay in ICU on a day to day basis and a follow-up meeting (together named the ICU-diary concept), may help the whole family to understand. Aim: The principal aim of this thesis was to see if the ICU-diary concept was of help to patients and relatives in the recovery after critical illness. A further aim was to look for precipitants in the ICU of PTSD. Material and Methods: ICU patients in a ha...

BackgroundThe Short Form 36-Item Survey is one of the most commonly used instruments for assessing health-related quality of life. Two identical versions of the original instrument are currently available: the public domain, license free RAND-36 and the commercial SF-36.RAND-36 is not available in Swedish. The purpose of this study was threefold: to translate and culturally adapt the RAND-36 into Swedish; to evaluate its reliability and responsiveness using Svensson’s method for paired ordered categorical data; and to assess the usability of an electronic version of the questionnaire.The translation process included forward and backward translations and reconciliation. Test-retest reliability was examined during a period of two-weeks in 84 patients undergoing dialysis for chronic kidney disease. Responsiveness was examined in 97 patients before and 2 months after a cardiac rehabilitation program. Usability tests and cognitive debriefing of the electronic questionnaire were carried o...

Background: For people with long-term illness, debilitated by severe symptoms, it can be difficult to attend regular yoga classes. We have therefore developed a tele-health format of yoga that can be delivered in the home. The tele-yoga was co-designed with members of a patient-organisation, yoga-instructor, and IT-technician. It includes live-streamed group-yoga sessions twice a week and an app with instructions on how to self-perform yoga. Aim: To describe a study protocol for a randomised controlled trial (RCT) including a process evaluation and report on a pilot study evaluating method- and intervention-related components including feasibility, safety, and efficacy. Methods: Ten participants with heart failure aged between 41–76 years were randomised to tele-yoga (n = 5) or to the control group (n = 5). In the pilot study recruitment, enrolment, randomisation, and data collection of all outcomes including primary, secondary and process evaluation measures were tested according t...

The aim of the present multicentre study is to assess health-related quality of life in patients with community-acquired sepsis, severe sepsis, or septic shock (CAS) 6 months after discharge from the intensive care unit (ICU) and to compare the health-related quality of life of the ICU survivors with CAS with ICU survivors with other ICU diagnoses. Prospective, multicentre study in nine combined medical and surgical ICUs in Portugal. Health-related quality of life was assessed 6 months after ICU stay, using EuroQol-5D (EQ-5D) mailed to patients. ICU-related factors were obtained from the local ICU database and the local database for the SACiUCI follow-up study. A total of 313 (52%) surviving patients answered the questionnaire, and of these 91 (29%) were admitted for CAS. There were no significant differences in health-related quality of life between the two study groups. Patients admitted to ICU for CAS did not perceived different health-related quality of life compared with ICU patients admitted for other diagnoses.

The Short Form 36-Item Survey is one of the most commonly used instruments for assessing health-related quality of life. Two identical versions of the original instrument are currently available: the public domain, license free RAND-36 and the commercial SF-36.RAND-36 is not available in Swedish. The purpose of this study was threefold: to translate and culturally adapt the RAND-36 into Swedish; to evaluate its reliability and responsiveness using Svensson's method for paired ordered categorical data; and to assess the usability of an electronic version of the questionnaire.The translation process included forward and backward translations and reconciliation. Test-retest reliability was examined during a period of two-weeks in 84 patients undergoing dialysis for chronic kidney disease. Responsiveness was examined in 97 patients before and 2 months after a cardiac rehabilitation program. Usability tests and cognitive debriefing of the electronic questionnaire were carried out wit...

To assess the independent associations between ability to cope and hopelessness with measures of health-related quality of life (HRQoL) and their effects on mortality up to 3 years after discharge in patients who have been treated in an intensive care unit (ICU). A prospective, cross-sectional multicenter study of 980 patients. Ability to cope, hopelessness, and HRQoL were evaluated using validated scales. Questionnaires were sent to patients 6, 12, 24, and 36 months after discharge from ICU. After adjustment, low scores for ability to cope and high scores for hopelessness were both related to poorer HRQoL for all subscales (except for coping with bodily pain). Effects were in the same range as coexisting disease for physical subscales, and stronger for social and mental subscales. High scores for hopelessness also predicted mortality up to 3 years after discharge from ICU (p<0.001). The psychological factors ability to cope and hopelessness both strongly affected HRQoL after ICU...