J Vasc Surg. Länk till annan webbplats. 2014 Mar;59(3):700-7. doi: 10.1016/j.jvs.2013.08.099. Epub 2013 Dec 15.
Nordanstig J Länk till annan webbplats.1, Wann-Hansson C Länk till annan webbplats.2, Karlsson J Länk till annan webbplats.3, Lundström M Länk till annan webbplats.4, Pettersson M Länk till annan webbplats.5, Morgan MB Länk till annan webbplats.6.
Author information Länk till annan webbplats.
Most commonly used outcome measures in peripheral arterial disease (PAD) provide scarce information about achieved patient benefit. Therefore, patient-reported outcome measures have become increasingly important as complementary outcome measures. The abundance of items in most health-related quality of life instruments makes everyday clinical use difficult. This study aimed to develop a short version of the 25-item Vascular Quality of Life Questionnaire (VascuQoL-25), a PAD-specific health-related quality of life instrument.
The study recruited 129 individuals with intermittent claudication and 71 with critical limb ischemia from two university hospitals. Participants were a mean age of 70 ± 9 years, and 57% were men. All patients completed the original VascuQoL when evaluated for treatment, and 127 also completed the questionnaire 6 months after a vascular procedure. The VascuQoL-25 was reduced based on cognitive interviews and psychometric testing. The short instrument, the VascuQoL-6, was tested using item-response theory, exploring structure, precision, item fit, and targeting. A subgroup of 21 individuals with intermittent claudication was also tested correlating the results of VascuQoL-6 to the actual walking capacity, as measured using global positioning system technology.
On the basis of structured psychometric testing, the six most informative items were selected (VascuQoL-6) and tested vs the original VascuQoL-25. The correlation between VascuQoL-25 and VascuQoL-6 was r = 0.88 before intervention, r = 0.96 after intervention, and the difference was r = 0.91 (P < .001). The Cronbach α for the VascuQoL-6 was .85 before and .94 after intervention. Cognitive interviews indicated that the responders considered all six items to be relevant and comprehensible. Rasch analysis was used to reduce response options from seven (VascuQoL-25) to four (VascuQoL-6). VascuQol-6 was shown to have high precision and discriminative properties. Item fit was excellent, with both "infit" and "outfit" between 0.7 and 1.3 for all six items. The standardized response mean after intervention was 1.15, indicating good responsiveness to clinical change. VascuQoL-6 results correlated strongly (r = 0.72; P < .001) with the actual measured walking ability (n = 21).
VascuQoL-6 is a valid and responsive instrument for the assessment of health-related quality of life in PAD. The main advantage is the compact format that offers a possibility for routine use in busy clinical settings.
J Cardiovasc Nurs. 2012 May 10. [Epub ahead of print]
Pettersson M, Bergbom I.
Monica Pettersson, PhD, MScN, RN Senior Lecturer, Department of Vascular Surgery, Sahlgrenska University Hospital, and Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Göteborg, Sweden. Ingegerd Bergbom, PhD, RNT, BScN, RN Professor, Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Göteborg, Sweden.
Abdominal aortic aneurysm can be treated using 3 different methods: open repair, endovascular aortic repair, or conservative treatment with regular monitoring and postponement of surgery until the aneurysm is greater than 55 mm. Conservative treatment entails living with the knowledge that an aneurysm is present while undergoing annual outpatient follow-up.
This study describes patients' experiences of living with the knowledge that they have an aneurysm for which they are receiving conservative treatment.
A qualitative, phenomenological-hermeneutic approach was used. Interviews were conducted between April 2007 and December 2008 with 10 patients diagnosed with abdominal aortic aneurysm less than 55 mm. The interpretation and analysis process involved 3 steps: (1) naive reading and understanding, (2) structural analysis, and (3) comprehensive understanding.
Five themes based on subthemes were identified: (a) sudden knowledge of a hitherto undetected condition, (b) putting your life in someone else's hands, (c) waiting in limbo-feeling secure despite concerns, (d) life is at stake, and (e) feeling obliged not to cause worry.
Living with a diagnosis of abdominal aortic aneurysm implies awareness of having an invisible, life-threatening disease and a sense of being subjected to suffering. We found that patients searched for answers about how to influence the growth of the aneurysm in their everyday life. They avoided thoughts about the aneurysm and struggled to live life as usual.
J Vasc Nurs. Länk till annan webbplats. 2010 Sep;28(3):97-101.
Berterö C Länk till annan webbplats., Carlsson P Länk till annan webbplats., Lundgren F Länk till annan webbplats..
Department of Medical and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden. firstname.lastname@example.org
The purpose of the present study was to investigate whether screening for abdominal aortic aneurysm (AAA) and the finding of an enlarged aorta cause worries and affect the living situations of men with aneurysms or of their families within a 12-month follow-up period. Men invited to ultrasound screening and having an enlarged aorta (>or=30 mm) were invited for an interview. In total, 10 men were interviewed. The semi-structured interview was conducted by using an interview guide. Data was analyzed by using an interpretative phenomenological method. Three themes were identified: (i) feeling secure being under superintendence; (ii) living as usual, but repressing thoughts; and (iii) feeling disillusionment due to negative outcome. Being given the message that an enlarged aorta was discovered at the screening was manageable; hence, continuing growth of the aorta led to some unpleasant feelings. The men were living as usual; however, they all had some reflections about having an AAA and that something could happen when they least expected it. They reported thoughts about the consequences of the enlarged aorta itself and the surgery. In a one-year retrospective interview, men who have had an aneurysm detected in a screening program for AAA reported feeling secure being under superintendence. The one finding in our study concerning worries and effects on life situation could be interpreted as disillusionment due to negative outcomes. Decisions to introduce screening for AAA in Sweden and other countries with ongoing programs should be considered to include guidelines for how to handle disillusionment.
Int J Nurs Stud. 2008 Apr;45(4):552-61. Epub 2007 Feb 5.
Wann-Hansson C, Rahm Hallberg I, Klevsgård R, Andersson E.
School of Health and Society, Malmö University, SE-205 06 Malmö, Sweden. email@example.com
The long-term experience of living with peripheral arterial disease (PAD) and the durability of improvements after revascularisation are sparsely described in the literature. The primary goals of medical treatment and nursing care for PAD are to provide relief of symptoms, improve quality of life, and prevent the progression of arterial disease and cardiovascular complications. The majority of patients are elderly with a significantly increased risk of myocardial infarction, stroke, and cardiovascular death. Which can limit mobility and functional status even in the absence of ischaemic claudication, rest pain, or ulceration after a successful revascularisation.
To illuminate the long-term experience of living with PAD and the recovery following revascularisation.
Fourteen patients were interviewed 6 months and 212 years after revascularisation. The transcribed texts were analysed using manifest and latent content analysis.
The long-term experience of living with PAD meant gradually becoming aware of having a chronic disease. This was interpreted through the following themes, representing the transition from being in an acute phase of PAD to the recovery after revascularisation and entering a chronic phase of PAD: (I) 'becoming better but not cured'; (II) 'recapturing control over life'; (III) 'reappraising meaning in life'.
Becoming aware of having a chronic disease results in a need to adapt to and accept permanent restrictions in daily life. The findings showed that revascularisations offer several benefits. However, when PAD symptoms were relieved, other ailments became discernable, which reflects the complex course of PAD and atherosclerotic disease. Moreover, several critical points and events such as other concurrent diseases, unrealistic hopes for recovery, and the complex course of PAD and atherosclerotic disease complicated the transition process towards health and well-being.
J Adv Nurs. 2005 Aug;51(3):227-35.
Wann-Hansson C, Hallberg IR, Risberg B, Lundell A, Klevsgard R.
Department of Nursing Science, Lund University, Lund, Sweden. firstname.lastname@example.org
This paper reports a study to measure quality of life, before and after revascularization, in patients with intermittent claudication and critical limb ischaemia from a long-term perspective.
Patients with peripheral arterial occlusive disease have a number of problems which affect their quality of life and a successful revascularization results in immediate improvements in quality of life. However, knowledge of the durability of the improvements is sparse. Therefore, research on the outcomes of treatment and nursing care should investigate the long-term effects on quality of life and daily activities.
A quasi-experimental longitudinal follow-up study was conducted with 80 patients with intermittent claudication and 62 with critical ischaemia. Assessment with the Nottingham Health Profile was made before revascularization and 6 months, 12 months and up to 4 years afterwards. The data were collected between 1995 and 2000.
Quality of life was improved 6 and 12 months after revascularization in patients with intermittent claudication in energy, pain, emotional reactions and physical mobility, while those with critical limb ischaemia also had improvements in pain and sleep. The improvement in pain was particularly evident for both groups and remained significantly improved up to 4 years after revascularization. Patients with critical limb ischaemia, however, deteriorated significantly with regard to physical mobility between 12 months and 4 years. Being a woman and belonging to the critical ischaemia group was significantly associated with high total Nottingham Health Profile score. Thus, patients with intermittent claudication had more durable benefits from revascularization than those with critical limb ischaemia. However, both groups had less pain than at baseline after 4 years.
The degree to which quality of life was durable over time seems to depend on the severity of the disease and gender. Patients with critical limb ischaemia were older, had more other diseases and a lower quality of life than patients with intermittent claudication, which confirmed that patients with critical limb ischaemia need more ongoing nursing support to maintain independence in daily life a long time after revascularization.
Authors: Hansson, Anders1; Brodersen, John2; Reventlow, Susanne2; Pettersson, Monica3
Source: Health, Risk & Society, Volume 14, Number 4, 1 June 2012 , pp. 341-359(19)
Abdominal aortic aneurysm (AAA) is a ballooning-out of the aorta that does not normally give any symptoms. Undetected and untreated an aortic aneurysm can rupture, which in most cases is fatal. Mass screening of 65-year old men for the early detection of AAA and, in selected cases, operation seem to reduce mortality due to rupture, although, screening has not reduced the overall mortality in this group. In Västra Götaland, the southwest part of Sweden, screening for AAA amongst 65-year old men started in 2009. There are controversies within the medical community about the benefits and adverse effects of screening. In order to explore men's experiences of being screened and knowing they had an aortic aneurysm, we undertook a qualitative interview study with 15 men who in the screening programme were identified as having an aortic aneurysm and who were to be followed-up with annual ultrasonic examinations for an indeterminate number of years. The interviews were analysed for categories and themes using content analysis. The study found that the men were ambivalent about the knowledge that they had an AAA and about the follow-up monitoring. They appreciated having the knowledge but it was accompanied by worry, feelings of anxiety and existential thoughts about the fragility and finiteness of life. We recommend that before a screening programme is implemented, the psycho-social consequences should be thoroughly investigated. Participants should be given adequate and understandable information about the consequences of screening so that they can make an informed choice whether to participate or not.
Keywords:risk; risk perception; mass screening; abdominal aortic aneurysm; mortality; qualitative research; psycho-social health.
J Vasc Surg. 2009 Sep;50(3):492-9.
Pettersson M, Mattsson E, Bergbom I.
Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. Monica.email@example.com
Surgical intervention in the treatment of abdominal aortic aneurysms (AAA) can affect sexual functions, resulting in a negative impact on the quality of life. The aim of this study was to investigate the preoperative information given about sexual functions and to compare the functional changes after open (OR) and endovascular repair (EVAR) for patients with AAA during one year after treatment.
Seventy-six patients participated in the study (40 OR and 36 EVAR). A questionnaire was used to measure the sexual function preoperatively, and then after one month and one year following surgical interventions. Four aspects related to sexual function were studied: interest in sex, quality of erection, ability to achieve orgasm, and ejaculation. Two questions about the preoperative information covering the sexual function and another two questions about the patients concern for their sexual activities were also added. Fisher's exact test was used to test for significant relative changes within each group of treatment for the variables studied.
Ninety-one percent reported that they did not receive any preoperative information about the risk for any possible negative impact on the sexual function. None of the EVAR patients were given such information. Forty-two percent of all patients felt some anxiety about having sex before the operation, which decreased to 7% after one year. About 22% reported having strong/moderate ability of their erection and 54% reported this as being weak/very weak preoperatively. Patients who preoperatively had reported some form of sexual interest had experienced a significant impairment in sex (P < .039) one year after the interventions. Patients treated with EVAR reported a significant impairment in the quality of erection (P < .033) and their ability to achieve ejaculation (P < .047) one year after the operation. A similar tendency was seen in the OR group, but did not achieve statistical significance.
Few patients were given or understood any preoperative information concerning the risk and possibility of a negative impact on their sexual function following surgical interventions. This was especially reported by patients in the EVAR group. Following the operation, the reported sexual interest and ability was decreased among patients in both groups. When only those patients who had reported some form of interest in sexual activity before the intervention were analyzed, a small significant impairment in quality of erection and achieving ejaculation could be found during the one year follow-up in the EVAR group.
· Regarding "prospective follow-up of sexual function after elective repair of abdominal aortic aneurysms using open and endovascular techniques". [J Vasc Surg. 2010]
Invited commentary. [J Vasc Surg. 2009]
Health Qual Life Outcomes. 2012 Apr 30;10:45.
Nordanstig J, Karlsson J, Pettersson M, Wann-Hansson C.
Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Bruna Stråket 11 B, 413 45, Gothenburg, Sweden. firstname.lastname@example.org.
Traditional outcome measures in peripheral arterial disease (PAD) provide insufficient information regarding patient benefit. It has therefore been suggested to add patient-reported outcome measures. The main aim of this study was to validate the Swedish Vascular Quality of Life questionnaire (VascuQoL) version, a patient-reported PAD-specific health-related quality of life (HRQoL) instrument.
Two-hundred PAD patients were consecutively recruited from two university hospitals. Out of the 200 subjects, 129 had intermittent claudication and 71 had critical limb ischemia. Mean age was 70 ± 9 y and 57% of the participants were male. All patients completed SF-36 and VascuQoL at the vascular outpatient clinic, when evaluated for invasive treatment. Risk factors and physiological parameters were registered. Construct validity was tested by correlation analysis versus SF-36 and was also assessed with multitrait/multi-item scaling analysis (MTMI). Sensitivity analysis regarding disease severity identification was performed. Reliability was assessed with Cronbach's alpha and responsiveness by standardized response mean (SRM) calculations.
Significant correlations were demonstrated between relevant subscales of VascuQoL and SF-36. MTMI showed acceptable construct validity, but some scaling-errors. VascuQoL significantly (p < 0.001) discriminated claudicants from critical limb ischemia patients. Cronbach's alpha was 0.94 and SRM 1.02 (sum score).
The Swedish version of VascuQoL is valid and quantifies central aspects of HRQoL in PAD patients. Sensitivity analysis showed high ability to differentiate between disease severity and SRM illustrated excellent responsiveness. The relative abundance of items however makes use in the everyday clinical setting somewhat difficult.
J Vasc Nurs. 2010 Mar;28(1):2-10.
Pettersson M, Bergbom I.
Department of Vascular surgery, Sahlgrenska University Hospital, and Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Göteborg, Sweden.
The purpose of this study is to describe and interpret what it means for patients to be diagnosed with an abdominal aortic aneurysm (AAA) and how they experience treatment. AAA is usually asymptomatic and often discovered coincidentally in conjunction with a diagnostic workup for other medical problems. Twenty patients who had undergone 2 different surgical procedures were sequentially invited for interviews 1 month following surgery. A hermeneutic approach was used. For all patients three themes emerged: an inability to come to terms with a life-threatening condition, a sense of living on borrowed time, and a sense of being granted a new lease on life. The theme that emerged for patients with open repair was that diagnosis with AAA was an ordeal to endure, while the theme for patients who underwent endovascular treatment was a sense of gratitude, security, and insecurity. Once the aneurysm was discovered patients were convinced that they were both blessed and saved, along with a sense of gratitude. Pre- and postoperative nursing care strategies can be developed based on the findings from this study.