Anners Lerdal

• Buer, Sofie; Hagen, Bjørn Ole Ingulfsvann; Søraas, Arne Vasli Lund; White, Richard Aubrey; Lerdal, Anners & Nygaard, Anders Benteson [Show all 7 contributors for this article] (2026). Subjective and objective working memory deficits in the post-acute phase of COVID-19 in a clinical trial population. Brain, Behavior, and Immunity - Health (BBI - Health). 55. doi: 10.1016/j.bbih.2026.101278. Full text in Research Archive
• Kjeverud, Anita; Andersson, Stein; Lerdal, Anners; Schanke, Anne-Kristine & Østlie, Kristin (2026). Prevalence and biopsychosocial predictors of post-stroke fatigue in patients with minor strokes. Journal of Rehabilitation Medicine. ISSN 1650-1977. 58. doi: 10.2340/jrm.v58.44763. Full text in Research Archive
• Auestad, Nina; Jørgenrud, Benedicte Marie; Bogstrand, Stig Tore; Vallersnes, Odd Martin; Lerdal, Anners & Wüsthoff, Linda Elise Couessurel (2026). Using PEth and AUDIT-4 to Detect Harmful Alcohol Use Among People with Severe Substance Use. Substance Use & Misuse. ISSN 1082-6084. 61(11), p. 1984–1993. doi: 10.1080/10826084.2026.2634253. Full text in Research Archive
• Borge, Christine Råheim; Eik, Hedda; Wahl, Astrid Klopstad; Bragstad, Line Kildal; Sylwander, Charlotte & Hjorthaug, Kristin [Show all 26 contributors for this article] (2026). Health literacy research in primary healthcare services – A scoping review. Patient Education and Counseling. ISSN 0738-3991. 149, p. 109675–109675. doi: 10.1016/j.pec.2026.109675. Full text in Research Archive Show summary

  Objective To systematically map existing evidence on health literacy among people with non-communicable diseases (NCDs) in primary healthcare. Methods An interdisciplinary research group conducted a scoping review following the Arksey and O’Malley framework, refined by Levac and Peters, and reported according to PRISMA-ScR. The review was registered in OSF and applied the Population–Concept–Context framework to define inclusion criteria. Searches were conducted in Medline, APA PsycInfo, Scopus, and Cochrane for studies published between 2000–2025. Peer-reviewed studies were screened in Rayyan, and data were charted and thematically analyzed through team-based consensus. Results The search identified 7952 studies, of which 106 studies met the inclusion criteria. Participants’ mean age was 59 years; 56% were female. Studies originated from 29 countries, mainly the USA, China, and Canada, with an increase after 2013. Three main themes were identified: (1) health literacy, social status, and ethnicity, (2) health literacy, disease, and health outcomes, and (3) health literacy, NCD knowledge, and self-management. Many studies reported associations between health literacy, and self-management, quality of life, and some clinical outcomes, but findings across designs and outcomes were heterogeneous and not consistently positive. Conclusions Improved communication, greater cultural competence, and tailored health literacy interventions are associated with better self-management and disease outcomes in non-communicable diseases, but most evidence is associative rather than causal, intervention effects are mixed, and research on health literacy experiences remains limited. Practice Implications More rigorously designed intervention studies and broader conceptualization and measurement of health literacy with multidimensional instruments are needed to strengthen the evidence and clarify how health literacy relates to social status, disease outcomes, and self-management in primary healthcare. Training healthcare professionals to assess and address health literacy is essential to promote equity and effective patient engagement.

• Kise, Nina Jullum; Eliassen, Siri; Gay, Caryl; Lerdal, Anners; Lindberg, Maren Falch & Nerhus, Tor Kjetil [Show all 9 contributors for this article] (2026). Psychological factors associated with trial participation among patients eligible for total knee arthroplasty with a non-surgical treatment arm: a comparative cross-sectional study. Acta Orthopaedica. ISSN 1745-3674. 97, p. 272–278. doi: 10.2340/17453674.2026.45869. Full text in Research Archive
• Valle, Thea Løver; Søraune, Nashia; Lerdal, Anners & Borge, Christine Råheim (2026). Avansert klinisk allmennsykepleier sin funksjon på medisinske sengeposter: en kvalitativ studie av sykepleie-og legeperspektiv. Nordisk sygeplejeforskning. ISSN 1892-2678. 16(1), p. 1–15. doi: 10.18261/nsf.16.1.4. Full text in Research Archive Show summary

  Bakgrunn: Fremtidens økte behov for helse- og omsorgstjenester vil skjerpe kompetansekravene i spesialisthelsetjenesten, der avansert klinisk allmennsykepleier (AKS) kan inngå. Det foreligger begrenset forskning på AKS-funksjonen ved medisinsk sengepostkontekst. Hensikt: Å utforske sykepleiere og legers refleksjoner om AKS sin mulige funksjon ved medisinske sengeposter i møte med pasienter med komplekse helseplager. Metode: Kvalitativ metode med to fokusgrupper (N=15, leger og sykepleiere ved medisinsk sengepost). Braun & Clarke’s refleksive tematiske analyse ble benyttet. Resultat: Analysen identifiserte fire temaer: 1) Komplekse pasientbehov krever avansert sykepleiekompetanse, 2) AKS med en «på topp funksjon» ved medisinske sengeposter, 3) AKS som ressurs for kompetanse og samarbeid, og 4) AKS-funksjonen krever organisatorisk forankring. Konklusjon: AKS kan bidra til håndtering av komplekse pasientsituasjoner ved medisinske sengeposter, styrke fagmiljøet og fremme økt pasientsikkerhet gjennom kompetansebygging. For å realisere dette kreves en presis funksjonsbeskrivelse.

• Boos, Lukas; Kaufmann, Josefin E; Sauter, Mirjam I; Lyrer, Philippe; Zietz, Annaelle & Trüssel, Simon [Show all 61 contributors for this article] (2026). ESTREL-Fatigue—association of levodopa with post-stroke fatigue. European Stroke Journal. ISSN 2396-9873. 11(4). doi: 10.1093/esj/aakag029. Full text in Research Archive Show summary

  Introduction Post-stroke fatigue (PSF) is common and impacts stroke rehabilitation. Dopaminergic treatment may have beneficial effects on PSF. This study investigated whether levodopa, compared with placebo, was associated with a lower frequency or severity of PSF during in-hospital rehabilitation. Patients and methods Enhancement of Stroke Rehabilitation with Levodopa (ESTREL)-Fatigue was an exploratory analysis of secondary outcome data obtained in the multicentre, randomised, placebo-controlled ESTREL trial. Participants with acute stroke received levodopa 100 mg/carbidopa 25 mg or placebo 3 times daily for 39 days to enhance motor recovery. Participants who (i) reported fatigue at 5 weeks and who (ii) took at least 80% of the study medication were included in ESTREL-Fatigue. No adjustments for confounding were made. The primary endpoint was the presence of PSF at 5 weeks, defined as a T-score of ≥ 55 on the Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue-Short-form-4a. As secondary endpoints, T-score cutoffs of ≥ 60 (moderate fatigue) and ≥ 70 (severe fatigue) were used. Binary logistic regression was used to compare PSF at 5 weeks between treatment groups. Results are presented as odds ratios (ORs) with 95% CI. Results A total of 456 of 505 (90.3%) participants were included (levodopa/placebo 235/221, median age 73 years, 41% female). Post-stroke fatigue at 5 weeks was present in 63/235 (26.8%) levodopa-treated participants and in 65/221 (29.4%) placebo-treated participants (OR: 0.88; 95% CI, 0.58–1.32; risk ratio 0.91; risk difference − 2.6%). For cutoffs of ≥ 60 and ≥ 70, ORs were 0.78 (95% CI, 0.43–1.41) and 0.8 (95% CI, 0.25–2.44), respectively. A sensitivity analysis as per intention-to-treat with all 610 randomised ESTREL participants also showed no significant difference in fatigue presence between levodopa and placebo groups (OR: 0.95; 95% CI, 0.65–1.39) and a sensitivity analysis using a mixed-effects logistic regression showed no evidence of centre-related clustering. Conclusion In ESTREL-Fatigue, levodopa, compared to placebo, was not associated with less PSF during in-hospital rehabilitation.

• Nordmo, Ingrid Kismul; Lerdal, Anners; Gay, Caryl; Bergvad, Ingvild Buset & Lindberg, Maren Falch (2026). Digital health literacy and sociodemographic characteristics of patients undergoing total hip or knee arthroplasty—a cross-sectional study. Frontiers in Digital Health. 8, p. 1–10. doi: https:/www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2026.1724191/full. Full text in Research Archive
• Stavdal, Malene Nerbøvik; Larsen, Marie Hamilton; Sjetne, Ingeborg Strømseng; Wahl, Astrid Klopstad; Gay, Caryl & Kjetland, Monica Bukkøy [Show all 8 contributors for this article] (2026). A health literacy intervention for registered nurses: Development and feasibility testing. International Journal of Nursing Studies Advances (IJNS Advances). 10, p. 1–14. doi: 10.1016/j.ijnsa.2026.100503. Full text in Research Archive Show summary

  Background: Health literacy is essential for improving long-term health outcomes, enhancing quality of care, and ensuring patient safety in healthcare systems. Thus, supporting registered nurses in applying health literacy in practice is essential. While health literacy research is expanding, limited attention has been paid to how healthcare personnel develop health literacy sensitivity (i.e., knowledge, skills, and attitudes healthcare personnel require to effectively meet patients’ health literacy needs). Objective (1) Develop and assess the feasibility of a health literacy intervention for registered nurses working in a general hospital setting. (2) Explore potential changes in health literacy sensitivity, work-related factors, and mental well-being for registered nurses, following the intervention. (3) Evaluate registered nurses’ experiences with implementing the intervention. Design: Pre-post feasibility study employing qualitative and quantitative approaches. Setting: Medical ward, general hospital. Participants: N=32 registered nurses. Methods: An advisory panel, Magnet4Europe’s gap-analysis tool, and prior research were used to design the intervention. Health literacy sensitivity was measured using the Instrument of Health Literacy Competencies. Work-related factors and mental well-being were measured using four validated surveys. Quantitative data were analyzed using descriptive, non-parametric statistics. Registered nurses’ experiences with implementing the intervention were assessed through individual and group interviews and analyzed using thematic analysis. Results: The final intervention included a dedicated health literacy nurse trained to motivate and guide colleagues in improving patients’ health literacy. During a 6-month intervention period, registered nurses participated in internal health literacy education, project groups, morning briefings, and reflection groups. The intervention targeted all registered nurses (N = 32) working on a medical ward (i.e., cardiovascular, stroke, and geriatric conditions). The pre-post study showed statistically-significant improvements in 7 of the 9 domains measuring registered nurses’ health literacy sensitivity (pre n = 29, post n = 20). Additionally, teamwork scores between registered nurses and physicians showed a statistically-significant improvement. Qualitative (n = 9) analyses of registered nurses’ experiences of the intervention revealed three main themes: (1) “Strengthening health literacy through increased resources, embedded routines, and interdisciplinary collaboration,” (2) “Between support and strain: health literacy sensitivity as a professional challenge,” and (3) “Registered nurses’ increased awareness and understanding of health literacy sensitivity”. Conclusion: Post-intervention measures demonstrated a significant increase in registered nurses’ health literacy sensitivity through structured routines, interdisciplinary collaboration, access to resources, and support from a designated health literacy nurse. However, health literacy sensitivity remained a balance between rewarding engagement and burdensome responsibility.

• Simpson, Dawn B.; Gay, Caryl L.; Berg, Søren; English, Coralie; Ihle-Hansen, Hege Beate & Helland, Gisle Berg [Show all 11 contributors for this article] (2026). Sleep quality, not sleep apnoea, is associated with post-stroke fatigue in acute ischemic stroke: a cross-sectional Norwegian study (NORFAST). Disability and Rehabilitation. ISSN 0963-8288. p. 11–11. doi: 10.1080/09638288.2026.2620503. Full text in Research Archive Show summary

  Purpose Post-stroke fatigue affects rehabilitation, daily activities, and quality of life. Its relationship with sleep remains unclear. We aimed in the acute stroke phase to (a) describe fatigue and sleep using self-reported and objective sleep measures, (b) describe sleep apnoea and (c) explore the associations between sleep measures and post-stroke fatigue. Material and methods This cross-sectional study examined Norwegian adults within 14 days of first ischaemic stroke. Fatigue was assessed with the Fatigue Severity Scale. Self-reported sleep factors (Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale) and objective WatchPAT measures (apnoea-hypopnea, sleep time, efficiency, REM/deep sleep) served as exposure variables. Multivariable regression models, adjusted for age, sex, mRS, and depression or anxiety symptoms, were used to examine associations between sleep and fatigue. Results Participants (n = 107, mean age 65 (SD14) years, n = 65(61%) male) had a mean NIHSS score of 2.5 [SD3.3], Fatigue Severity Scale score of 3.11 [SD1.82], and n = 71 (66%) scored as having disturbed sleep (PSQI). Mean total sleep time (n = 81) was 7.04 [SD1.46] hours and 54 (71%) had sleep apnoea. In the final multivariable model, only poor sleep quality (b = 0.45, p = 0.010) was associated with post-stroke fatigue. Conclusions Addressing sleep quality in the acute stroke phase may benefit post-stroke fatigue.

• Kise, Nina Jullum; Eliassen, Siri Marie M; Furnes, Ove Nord; Gay, Caryl; Heir, Stig & Lerdal, Anners [Show all 10 contributors for this article] (2025). Fear avoidance and catastrophizing are associated with both knee awareness and quality of life in knee osteoarthritis patients: a secondary report of a cross-sectional study | Acta Orthopaedica. Acta Orthopaedica. ISSN 1745-3674. 96, p. 920–926. doi: 10.2340/17453674.2025.45070. Full text in Research Archive Show summary

  Background and purpose: In patients with knee osteoarthritis (OA), psychological factors (anxiety, depression, and pain-related catastrophizing) are associated with more pain and worse physical function. Low knee awareness and high knee-related quality of life (QoL) are key indicators of a well-functioning knee. The objective of our study was to evaluate associations between psychological factors and knee awareness and knee-related QoL in patients with knee OA. Methods: In this Norwegian cross-sectional study of 653 patients with knee OA, 4 psychological factors were assessed: anxiety, depression, pain-related catastrophizing, and fear avoidance of physical activity. Associations between these factors and knee awareness and knee-related QoL were examined in unadjusted and adjusted regression models, controlling for age, sex, BMI, pain, and whether patients accepted or declined inclusion in a randomized controlled trial (ClinicalTrials.gov: NCT03771430). Regression coefficients with values below zero indicate negative associations between the independent and dependent factors and values above zero indicate positive associations. Results: Worse scores on all 4 psychological measures were associated with higher knee awareness and poorer knee-related QoL in unadjusted analyses. Standardized estimates (βs) ranged from –0.38 (95% confidence intervals [CI] –0.45 to –0.31) to –0.16 (CI –0.23 to –0.08). In adjusted analyses, pain catastrophizing (β –0.07, CI –0.14 to –0.01) and fear-avoidance (β –0.11, CI –0.18 to –0.05) remained associated with higher knee awareness, whereas poorer knee-related QoL remained associated with more anxiety (β –0.10, CI –0.16 to –0.03) and depression (β –0.14, CI –0.20 to –0.08), as well as more pain catastrophizing (β –0.19, CI –0.26 to –0.12) and fear-avoidance (β –0.19, CI –0.25 to –0.13). Conclusion: Higher fear avoidance of physical activity and more pain catastrophizing had the strongest associations with higher knee awareness and poorer knee-related QoL.

• Aiken, Linda H.; Sermeus, Walter; Lasater, Karen B.; Busse, Reinhard; McKee, Martin & Smith, Herbert [Show all 21 contributors for this article] (2025). Magnet4Europe Intervention to Improve Clinician and Patient Well-Being. Medical Care. ISSN 0025-7079. doi: 10.1097/mlr.0000000000002257. Full text in Research Archive Show summary

  Background: Descriptive studies have documented high hospital nurse burnout and turnover but there are few, if any, large-scale evaluations of organizational interventions to improve clinician retention. The Magnet model is an organizational hospital intervention associated with better clinician and patient outcomes but there is insufficient evidence as to whether the Magnet model based on structural empowerment of clinicians results in better outcomes or rewards hospitals with good work environments, and whether the Magnet model can be implemented at scale outside the United States. Objective: To evaluate whether Magnet4Europe—a multiyear organizational intervention of European hospitals—could be implemented and would result in improvements in nurse well-being, care quality, and patient safety. Design: Quasi-experimental longitudinal evaluation of 56 European intervention hospitals in 6 countries. Hospital-level implementation of the intervention measured by changes (from baseline to follow-up) in 77 Magnet model intervention targets. Outcome measures (eg, nurse burnout, intent to leave, quality of care, patient safety) were derived from surveys of nurses (4546 nurses at baseline; 3171 at follow-up). Findings: Hospitals that implemented intervention targets during the study period observed reductions in nurse burnout, nurses’ intentions to leave their jobs, and unfavorable care quality. Each 10-percentage-point increase in intervention target implementation was associated with 2.7%-point reduction in nurses who intend to leave (β −2.66; 95% CI: −4.74, −0.58, P<0.05). Hospitals which implemented more than 25% of intervention targets observed 6.3%-point reduction in nurse burnout, 7.6%-point reduction in intent to leave, 6.4%-point reduction in unfavorable care quality, and 3.7%-point reduction in unfavorable patient safety. Improvements in hospital percentages of nurses reporting staffing adequacy were associated with reductions in burnout, intentions to leave, unfavorable care quality, and patient safety. Conclusion: Successful implementation of Magnet4Europe demonstrates promise for international adoption at scale of Magnet as an organizational intervention for improving clinician well-being, care quality, and patient safety.

• Seferowicz, Maria; Lerdal, Anners; Edvardsen, Hilde Marie Erøy; Skråstad, Ragnhild Bergene; Valeur, Jørgen & Jørgenrud, Benedicte Marie [Show all 8 contributors for this article] (2025). Unveiling stages of change among medical inpatients with an increased-risk alcohol consumption—a cross-sectional study. Alcohol and Alcoholism. ISSN 0735-0414. 61(1). doi: 10.1093/alcalc/agaf067. Full text in Research Archive Show summary

  Abstract Aims Alcohol-related harm occurs at lower levels than previously recognized, warranting a need to identify mediators to reduce alcohol-associated risk in increased-risk drinkers. Stages of change (SOC) have been used to assess motivation for health behaviour alteration. The primary aim was to explore distribution on SOC among medical inpatients when comparing low-risk, increased-risk, and high-risk consumers as defined by Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). Our secondary aim was to assess the distribution of SOC when consumption was stratified with a biomarker of alcohol use—phospatidylethanol 16:0/18:1. Methods Cross-sectional study with three participating hospitals. Recruiting consecutive medical inpatients ≥18 years with regular alcohol consumption as screened by score ≥2 on the first question in AUDIT-C (N = 888). AUDIT-C score and SOC were assessed by questionnaires, and phospatidylethanol concentration in a blood sample. Odds ratios and the 95% confidence intervals were calculated through a univariate logistic regression analysis for each variable, and multivariable logistic regression models were then fit to calculate the adjusted odds ratio and 95% confidence interval. Results Distributions of SOC differed between the three risk-groups. Distribution of SOC was comparable whether assessed by phospatidylethanol or AUDIT-C. Conclusions Increased-risk consumers constitute the majority of those in action—the only stage associated with consecutive reduction in drinking. Potentially, these results can aid in reducing perceived barriers among health care professionals in screening and offering health advice to those with increased-risk consumption and inform further research on mediators in this subgroup.

• Linnestad, Anne-M.; Skogestad, Ingrid Johansen; Gay, Caryl L.; Borge, Christine Råheim; Indredavik, Bent & Stubberud, Jan [Show all 7 contributors for this article] (2025). Exploring digital health literacy clusters in a Norwegian stroke survivor population—A cross-sectional study (NORFAST). Digital Health. 11, p. 1–11. doi: 10.1177/20552076251380049. Full text in Research Archive Show summary

  Background Digital health technologies play a pivotal role in stroke prevention and rehabilitation. However, variations in digital health literacy (DHL) among stroke survivors may impede effective use of these tools. Understanding DHL-profiles and their influencing factors is essential for tailoring interventions. Aim This study aimed to identify DHL-profiles among stroke survivors and possible associations with sociodemographic and clinical characteristics. Methods We conducted a cross-sectional study with 177 first-time stroke patients (2021–2022) from the Norwegian stroke registry. DHL was measured using the eHealth Literacy Questionnaire. Cluster analysis identified DHL profiles, and multinomial regression explored associations with sociodemographic and clinical variables. Results Three distinct DHL-profiles emerged: Novices (26%), Cautious users (57%), and Navigators (17%). Novices exhibited notable DHL limitations, cautious users demonstrated moderate proficiency, and navigators displayed a high level of proficiency. Participants aged ≥67 years were five times more likely to be Novices compared to Cautious users. Lower education and cognitive functioning increased novice likelihood, whereas living alone decreased the chance of being a Navigator. Conclusions Diverse DHL-profiles among stroke survivors highlight the need for personalized digital health services. Tailored interventions, developed through co-design and addressing specific DHL challenges, may improve equitable access and enhance usability, ultimately promoting health equity.

• Stavdal, Malene Nerbøvik; Hermansen, Åsmund; Sjetne, Ingeborg Strømseng; Larsen, Marie Hamilton; Wahl, Astrid Klopstad & Kohnen, Dorothea [Show all 9 contributors for this article] (2025). Associations Between Work-Related Factors, Mental Well-Being, and Health Literacy Sensitivity: A Cross-Sectional Study Among Healthcare Personnel. Journal of Healthcare Leadership. 17, p. 383–394. doi: 10.2147/JHL.S533694. Full text in Research Archive
• Bergvad, Ingvild Buset; Kottorp, Anders; Aamodt, Arild; Lerdal, Anners; Skou, Søren Thorgaard & Lindberg, Maren Falch (2025). Cross-cultural adaptation and validation of a Norwegian version of the Goodman Satisfaction Score (GSS-NO) for patients with total hip and knee arthroplasty. Acta Orthopaedica. ISSN 1745-3674. 96, p. 52–58. doi: 10.2340/17453674.2024.42703. Full text in Research Archive Show summary

  Background and purpose: Measuring patient satisfaction after total hip (THA) and total knee arthroplasty (TKA) is important. We aimed to cross-culturally adapt and examine the psychometric properties of the self-reported Goodman Satisfaction Score (GSS) in a sample of Norwegian patients following primary THA and TKA. Methods: The GSS was translated and adapted into Norwegian (GSS-NO) following standard guidelines. 800 patients from the Norwegian Arthroplasty Register who had undergone surgery 6–11 months prior were invited to complete GSS-NO and questions on sociodemographic factors, pain, and function in a cross-sectional study. We examined validity in relation to internal structure, response processes, and precision using Rasch analysis, relationships between the GSS-NO and pain and function using Pearson’s correlation coefficients, and test–retest reliability using linear weighted kappa statistics. Results: The GSS-NO was adapted with few challenges. 404 patients (49% THA, 51% TKA) returned complete answers. The GSS-NO met all criteria regarding the rating scale functioning. Local independence among items and unidimensionality was supported and there was acceptable goodness-of-fit. The internal consistency was 0.94. We found no systematic differential item functioning by age, sex, work status, education, cohabitation status, or hip or knee surgery. The correlation coefficients between GSS-NO and pain and function outcomes were 0.79 (95% confidence interval [CI] 0.76–0.82) and 0.79 (CI 0.76–0.82), respectively. Test–retest reliability with weighted kappa ranged from 0.43–0.55 for THA and 0.54–0.81 for TKA. Conclusion: The cross-cultural adaptation of GSS-NO proved to be a valid and reliable measure for use in Norwegian-speaking patients following primary THA and TKA.

• Larsson, Petra; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene; Ihle-Hansen, Hege Beate & Hagen, Milada [Show all 7 contributors for this article] (2025). Changes in fatigue after first-ever ischemic stroke and their associations with changes in physical fitness, body composition, and physical activity. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 34(6). doi: 10.1016/j.jstrokecerebrovasdis.2025.108297. Full text in Research Archive Show summary

  Objectives: The objectives of the present study were 1) to describe changes in fatigue from 3 to 12 months poststroke and compare different patterns of fatigue changes with respect to concurrent changes in physical fitness, body composition, and activity levels, and 2) to explore whether changes in fatigue are associated with changes in physical fitness, body composition, and physical activity levels in patients recovering from first-ever ischemic stroke. Materials and methods: In this longitudinal observational study, we assessed 72 patients (mean age 62 years, 36 % females) at 3 and 12 months after first-ever ischemic stroke. Fatigue was measured with the 7-item Fatigue Severity Scale. Physical fitness, body composition and physical activity were assessed using cardiopulmonary exercise testing, physical function tests, Dual-energy X-ray Absorptiometry, and accelerometers. Results: Fatigue levels was stable between 3 and 12 months post-stroke in 44 (61 %) patients, decreased in 14 (19 %), and increased in another 14 (19 %). Patients with increased fatigue levels showed a greater decrease in cardiorespiratory fitness, as measured directly by peak oxygen uptake, compared to those with decreased fatigue. Robust regression analysis, adjusted for age and sex, indicated that each kilogram of lean body mass gained from 3 to 12 months post-stroke was significantly associated with a 0.3-point reduction in fatigue during the same timeframe (B= -0.32; 95 %CI [-0.51, -0.12]). Conclusion: There was considerable individual variation in changes to fatigue, physical fitness, body composition, and physical activity levels between 3 and 12 months following a first-ever ischemic stroke. Increased fatigue was linked to a greater concurrent decline in cardiorespiratory fitness, while lean body mass was associated with decreases in fatigue.

• Gamboa, Danil; Kabashi, Saranda; Jørgenrud, Benedicte Marie; Lerdal, Anners; Nordby, Gudmund & Bogstrand, Stig Tore (2025). Missed opportunities: the detection and management of at-risk drinking and illicit drug use in acutely hospitalized patients. Advances in Drug and Alcohol Research (ADAR). 5. doi: 10.3389/adar.2025.14149. Full text in Research Archive Show summary

  At-risk alcohol and illicit drug use are risk factors for disease and in-hospital complications. This study investigated whether clinicians document substance use in the electronic records of acutely hospitalized internal medicine patients. Alcohol and illicit drug positive patients were identified using prospectively gathered substance use data from a study sample comprising 2,872 patients included from November 2016 to December 2017 at an internal medicine hospital in Oslo, Norway. These data were unknown to hospital staff. Whether physicians recorded quantitative substance use assessments and interventions was examined in patients with study-verified alcohol use in excess of low-risk guidelines (Alcohol Use Disorder Identification Test-4 scores [AUDIT-4] of ≥5 for women and ≥7 for men) and/or illicit drug use (one or more illicit drug detected by liquid chromatography-mass spectrometry [LC-MS] analysis). Among 548 study-verified alcohol-positive patients, physicians documented quantity and frequency (QF) of use in 43.2% (n = 237) and interventions in 22.0% (n = 121). Alcohol interventions were associated with harmful drinking (AUDIT-4 ≥9 points; adjusted odds ratio [AOR] = 4.87; 95% CI: 2.54–9.31; p < 0.001) and QF assessments (AOR = 3.66; 95% CI: 1.13–11.84; p = 0.02). Among 157 illicit-positive patients, drug use was described quantitatively in 34.4% (n = 54) and interventions in 26.0% (n = 40). The rate of quantitative alcohol and illicit drug use assessment by hospital physicians is poor, with a correspondingly low intervention rate. Important opportunities for attenuating or intervening in at-risk alcohol and illicit drug use are missed.

• Enbakom, Mestawet Getachew; Lerdal, Anners; Melaku, Tsegaye & Lindberg, Maren Falch (2025). Pre- and postoperative pain management practices in fracture surgery: A bicentric prospective observational study in Ethiopia. Langenbeck's Archives of Surgery. ISSN 1435-2443. 410. doi: 10.1007/s00423-025-03837-y. Full text in Research Archive Show summary

  Background Acute pain is common following orthopedic trauma and surgery. This study aims to evaluate the adequacy of pre- and postoperative pain management in traumatic fracture patients undergoing orthopedic surgery in Ethiopia. Methods A prospective cohort study was conducted at two Ethiopian trauma centers from January 2019 to October 2021. Preoperatively, data was obtained on sociodemographic factors, substance use, type of injury, pain and psychological factors. Pain was assessed again 24 h following surgery. Pain management adequacy was evaluated using the Pain Management Index (PMI), based on the World Health Organization’s pain treatment framework. The PMI was determined by subtracting the patient’s pain intensity from the strength of the prescribed analgesic scores range from − 3 to + 3. Negative values indicate inadequate pain control. Results Of the 220 patients enrolled, 218 completed the study. Preoperative pain was inadequately managed in 74.8% of patients, improving to 42.2% postoperatively. Most patients reported mild (23.3%), moderate (43.1%), or severe (30.8%) pain preoperatively, yet 56.4% received no analgesics. At 24 h post-surgery, the patients reported mild (5.0%), moderate (53.7%), and severe (41.3%) pain, with 99.1% receiving analgesics. Notably, no patients with severe pain were given strong opioids at any time point. Lower educational level was associated with inadequate preoperative pain management (AOR: 3.18; 95% CI: 1.19–8.54). Alcohol use (AOR: 2.80; 95% CI: 1.30–6.05), higher anxiety (AOR: 1.17; 95% CI: 1.05–1.30), and higher depression scores (AOR: 0.77; 95% CI: 0.68–0.88) were associated with inadequate pain management 24 h post-surgery. Conclusions Most patients with traumatic fractures received inadequate perioperative pain management, especially before surgery. Strong opioids were not used even in cases of severe pain. Socio-demographic and psychological factors were significantly associated with inadequate pain management.

• Auestad, Nina; Bogstrand, Stig Tore; Vallersnes, Odd Martin; Lerdal, Anners & Wüsthoff, Linda Elise Couëssurel (2025). Cognitive Function among People with Severe Substance Use. European Addiction Research. ISSN 1022-6877. 31(2), p. 133–144. doi: 10.1159/000543755. Full text in Research Archive Show summary

  Introduction: Studies report a high variability of cognitive impairment in people who use drugs, ranging from 20% to 80%. Most research focuses on individuals who use drugs who are either admitted to treatment facilities or incarcerated and being abstinent from substances. The present study aimed to assess cognitive function among populations with ongoing, severe, habitual substance use, mimicking a real-world day-to-day situation. Methods: Cross-sectional design with 171 participants (70.2% male) with severe substance use, recruited from two sites in Oslo, Norway. All participants were screened for cognitive function using the Montreal Cognitive Assessment (MoCA). A cutoff of <26 points was used to classify possible cognitive impairment. Participants also provided information on their alcohol and substance use, as well as demographic data. Results: 74.9% of the participants scored below the MoCA cutoff for possible cognitive impairment. We did not find any associations between scoring below the MoCA cutoff <26 and the substance use variables (substance use, number of substances used, history of overdoses, injection drug use, and past substance use treatment). Conclusion: A high proportion of people with severe substance use may experience a functional cognitive impairment. This study provides novel insights into cognitive function within a population actively engaged in habitual substance use, offering a real-world perspective with high external validity. This knowledge is highly relevant for service providers who aim to deliver tailored follow-up services to this population outside of traditional treatment settings.

• Stavdal, Malene Nerbøvik; Larsen, Marie Hamilton; Wahl, Astrid Klopstad; Sjetne, Ingeborg Strømseng; Lerdal, Anners & Gay, Caryl [Show all 7 contributors for this article] (2025). Healthcare Personnel Experiences With Health Literacy Sensitivity in Relation to Work Satisfaction and Stress: A Qualitative Study. Journal of Multidisciplinary Healthcare. 18, p. 1269–1280. doi: 10.2147/JMDH.S493548. Full text in Research Archive
• Sjetne, Ingeborg Strømseng & Lerdal, Anners (2024). Sykepleieres arbeidsbetingelser, pasientsikkerhet og kvalitet – sekundæranalyse av tverrsnittsdata. Sykepleien Forskning. ISSN 1890-2936. 19. doi: 10.4220/Sykepleienf.2024.95607. Full text in Research Archive
• Olsen, Unni Solveig Johansen; Sellevold, Vibeke Bull; Gay, Caryl; Aamodt, Arild; Lerdal, Anners & Småstuen, Milada Cvancarova [Show all 8 contributors for this article] (2024). Factors associated with pain and functional impairment five years after total knee arthroplasty: a prospective observational study. BMC Musculoskeletal Disorders. 25(1). doi: 10.1186/s12891-023-07125-y. Full text in Research Archive Show summary

  Background Few studies have evaluated the associations between preoperative factors and pain and physical function outcomes after total knee arthroplasty (TKA) from a mid-term perspective. Identification of such factors is important for optimizing outcomes following surgery. Thus, we examined the associations between selected preoperative factors and moderate to severe pain and pain-related functional impairment as measured using the Brief Pain Inventory (BPI), five years after TKA in patients with knee osteoarthritis. Methods In this prospective observational study, all patients scheduled for primary unilateral TKA for osteoarthritis were consecutively recruited. Preoperative factors identified from previous meta-analyses were included to assess their associations with pain severity and pain-related functional impairment five years after TKA. Pain severity was the primary outcome, while pain-related functional impairment was the secondary outcome. The BPI was used to evaluate outcomes five years post-TKA. Statistically significant factors from univariate regressions were entered into a multiple logistic regression model to identify those with the strongest associations with pain severity or pain-related functional impairment five years after TKA. Results A total of 136 patients were included, with a mean age of 67.7 years (SD 9.2) and a majority being female (68%). More severe preoperative pain (OR = 1.34, 95% CI [1.03 to 1.74]), more painful sites (OR = 1.28., 95% CI [1.01 to 1.63]), and more severe anxiety symptoms (OR = 1.14., 95% CI [1.01 to 1.28]) were associated with increased likelihood of moderate to severe pain five years after TKA surgery, while more severe osteoarthritis (OR = 0.13, 95% CI [0.03 to 0.61]) was associated with reduced likelihood of moderate to severe pain five years after TKA. More severe anxiety symptoms (OR = 1.25, 95% CI [1.08 to 1.46]) were also associated with increased likelihood of moderate to severe pain- related functional impairment five years after surgery, while male sex (OR = 0.23, 95% CI [0.05 to 0.98]) was associated with reduced likelihood of pain-related functional impairment five years after surgery. Conclusion The identified preoperative factors should be included in larger prognostic studies evaluating the associations between preoperative factors and mid-term pain severity and physical function outcomes after TKA surgery.

• Monsen, Ragnhild Elisabeth; Lerdal, Anners; Nordgarden, Hilde; Gay, Caryl & Herlofson, Bente Brokstad (2024). A comparison of the prevalence of dry mouth and other symptoms using two different versions of the Edmonton Symptom Assessment System on an inpatient palliative care unit. BMC Palliative Care. 23(1). doi: 10.1186/s12904-024-01405-7. Full text in Research Archive Show summary

  Background Symptom assessment is key to effective symptom management and palliative care for patients with advanced cancer. Symptom prevalence and severity estimates vary widely, possibly dependent on the assessment tool used. Are symptoms specifically asked about or must the patients add them as additional symptoms? This study compared the prevalence and severity of patient-reported symptoms in two different versions of a multi-symptom assessment tool. In one version, three symptoms dry mouth, constipation, sleep problems were among those systematically assessed, while in the other, these symptoms had to be added as an “Other problem”. Methods This retrospective cross-sectional study included adult patients with advanced cancer at an inpatient palliative care unit. Data were collected from two versions of the Edmonton Symptom Assessment System (ESAS): modified (ESAS-m) listed 11 symptoms and revised (ESAS-r) listed 9 and allowed patients to add one “Other problem”. Seven similar symptoms were listed in both versions. Results In 2013, 184 patients completed ESAS-m, and in 2017, 156 completed ESAS-r. Prevalence and severity of symptoms listed in both versions did not differ. In ESAS-m, 83% reported dry mouth, 73% constipation, and 71% sleep problems, but on ESAS-r, these symptoms were reported by only 3%, 15% and < 1%, respectively. Although ESAS-r severity scores for these three symptoms were higher than on ESAS-m, differences did not reach statistical significance. Conclusion We identified significant differences in patient symptom reporting based on whether symptoms like dry mouth, obstipation and sleep problems were specifically assessed or had to be added by patients as an “Other problem”.

• Rognsvåg, Turid; Bergvad, Ingvild Buset; Furnes, Ove Nord; Indrekvam, Kari; Lerdal, Anners & Lindberg, Maren Falch [Show all 9 contributors for this article] (2024). Exercise therapy, education, and cognitive behavioral therapy alone, or in combination with total knee arthroplasty, in patients with knee osteoarthritis: a randomized feasibility study. Pilot and Feasibility Studies. 10. doi: 10.1186/s40814-024-01470-y. Full text in Research Archive Show summary

  Background: One in five patients experience chronic pain 1 year after total knee arthroplasty (TKA), highlighting the need for enhanced treatment strategies to improve outcomes. This feasibility trial aimed to optimize the content and delivery of a complex intervention tailored to osteoarthritis (OA) patients at risk of poor outcome after TKA and assess the feasibility of initiating a full-scale multicenter randomized controlled trial (RCT). Methods: Patients scheduled for TKA were included between August 2019 and June 2020 and block-randomized into one of three groups: (a) 12-week exercise therapy and education (ExE) and 10-module internet-delivered cognitive behavioral therapy (iCBT), (b) TKA followed by ExE and iCBT and (c) TKA and standard postoperative care. Outcomes were (i) recruitment and retention rate, (ii) compliance to the intervention and follow-up, (iii) crossover, and (iv) adverse events, reported by descriptive statistics. Results: Fifteen patients were included in the study. Only 1 out of 146 patients screened for eligibility was included during the first 4 months. During the next 3 months, 117 patients were not included since they lived too far from the hospital. To increase the recruitment rate, we made three amendments to the inclusion criteria; (1) at-risk screening of poor TKA outcome was removed as an eligibility criterion, (2) patients across the country could be included in the study and (3) physiotherapists without specific certification were included, receiving thorough information and support. No patients withdrew from the study or crossed over to surgery during the first year. Nine out of 10 patients completed the ExE program and six out of 10 completed the iCBT program. Fourteen out of 15 patients completed the 1-year follow-up. One minor adverse event was registered. Conclusions: Except for recruitment and compliance to iCBT, feasibility was demonstrated. The initial recruitment process was challenging, and necessary changes were made to increase the recruitment rate. The findings informed how a definitive RCT should be undertaken to test the effectiveness of the complex intervention.

• Nyhagen, Ragnhild; Egerod, Ingrid; Rustøen, Tone; Lerdal, Anners & Kirkevold, Marit (2024). Family Members' Engagement in Symptom Communication, Assessment, and Management in the Intensive Care Unit: A Qualitative Study. Dimensions of Critical Care Nursing. ISSN 0730-4625. 43(3), p. 111–122. doi: 10.1097/DCC.0000000000000637. Full text in Research Archive
• Rognsvåg, Turid; Nordmo, Ingrid Kismul; Bergvad, Ingvild Buset; Fenstad, Anne Marie; Furnes, Ove Nord & Lerdal, Anners [Show all 9 contributors for this article] (2024). Digital health literacy in Norwegian patients with hip and knee arthroplasty: normative data from a cross-sectional study. Acta Orthopaedica. ISSN 1745-3674. 95, p. 677–684. doi: 10.2340/17453674.2024.42304. Full text in Research Archive Show summary

  Background and purpose: As digital health services become increasingly important in osteoarthritis treatment, understanding patients’ digital health literacy (eHL) is crucial, including those undergoing total hip and knee arthroplasty (THA/TKA). We primarily aimed to provide eHL norms in a representative group of Norwegian patients, and secondarily to examine the relationships between eHL and health-related quality of life (QoL). Methods: We invited 800 randomly selected THA/TKA patients from the Norwegian Arthroplasty Register to complete a paper-based questionnaire, which included sociodemographic variables. eHL was measured using the eHealth Literacy Questionnaire (eHLQ) with 7 domains: Using technology, Understand, Engage, Control, Motivation, Access, and Needs, scored from 1 (strongly disagree) to 4 (strongly agree). The EuroQol EQ-5D-5L measured health-related QoL. We used multivariable regression to examine relationships between eHL domains and health-related QoL controlling for sociodemographic variables. Results: Respondents’ (N = 383, 48%) mean age was 70 years (SD 9.0) and 246 (64%) were female. Mean eHLQ and the proportion of patients with low eHL (≤ 2.5) were Technology 2.7 (34%), Understanding 3.0 (14%), Engage 2.7 (28%), Control 3.2 (7.7%), Motivation 2.8 (35%), Access 2.8 (33%), and Needs 2.6 (46%). Low eHL correlated with older age and low education, but not with sex or type of surgery. Regression analyses showed that lower scores on the domains Technology, Engage, Control, Access, and Needs were associated with poorer QoL after adjusting for sociodemographic factors. Conclusion: About one-third of THA/TKA patients have low eHL, and low eHL was associated with poor QoL.

• Larsson, Petra; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene; Mack, Ulrich & Lerdal, Anners (2024). Cardiorespiratory fitness, physical activity, and fatigue three months after first-ever ischemic stroke. Topics in Stroke Rehabilitation. ISSN 1074-9357. 31(8), p. 817–827. doi: 10.1080/10749357.2024.2333191. Full text in Research Archive Show summary

  Background: Research on cardiorespiratory fitness (CRF) in relation to physical activity (PA) and fatigue after stroke is limited. Increased knowledge of interrelationships between these factors can help optimize rehabilitation strategies and improve health-outcomes. Objectives: We aimed to: 1) evaluate CRF, PA, and fatigue, 2) characterize patients with impaired versus non-impaired CRF, and 3) examine associations of CRF with PA and fatigue, three months after first-ever ischemic stroke. Methods: In this cross-sectional study CRF was measured as peak oxygen uptake (VO2peak) by cardiopulmonary exercise testing. PA was measured using accelerometers. Fatigue was assessed with the 7-item Fatigue Severity Scale (FSS). Results: The sample (n=74, mean age 64±13 years, 36% women) had a mean VO2peak of 27.0±8.7 (86% of predicted). Fifty-one percent met the World Health Organization’s recommendation of ≥150 min of moderate PA/week. Mean steps-per-day was 9316±4424 (113% of predicted). Thirty-five percent of the sample had moderate-to-high fatigue (FSS≥4), mean FSS score was 3.2±1.8. Patients with impaired CRF (VO2peak＜80% of predicted) had higher body-fat-percent (p＜0.01), less moderate-to-vigorous PA (MVPA) (p＜0.01) and a trend toward higher fatigue (p=0.053) compared to the non-impaired. Backward regression analysis showed that higher CRF was associated with more MVPA (unstandardized beta [95% CI]: 0.38 [0.15, 0.63], p=0.002) and less fatigue (unstandardized beta [95% CI]: -3.9 [-6.4, -1.6], p=0.004). Conclusions: Stroke patients had lower CRF compared to reference values. Impaired CRF was mainly related to overweight. Higher CRF was associated with more MVPA and less fatigue. Exercise after stroke may be especially beneficial for patients with impaired CRF.

• Tjelta, Thomas; Bogstrand, Stig Tore; Lerdal, Anners; Wüsthoff, Linda Elise Couëssurel; Edvardsen, Hilde Marie Erøy & Johannessen, Aud (2024). Screening and Following Up Harmful Alcohol Use “… is Not Necessarily Your Primary Focus”: A Qualitative Study Exploring Health Professionals’ Experiences Addressing Harmful Alcohol Use in a Norwegian Hospital. Journal of Multidisciplinary Healthcare. 17, p. 5189–5198. doi: 10.2147/JMDH.S475750. Full text in Research Archive Show summary

  Introduction: Alcohol use remains a leading cause of excess mortality and morbidity worldwide, and identifying and following up harmful alcohol use represents a key component of alcohol harm reduction policies. This article explores health professionals’ experiences implementing these policies in a Norwegian hospital. Aim: To explore health professionals’ views and experiences of systematic screening and tailored follow-up of harmful and hazardous alcohol use in a Norwegian hospital. Methods: We conducted semi-structured interviews with 13 specialty registrars and nurses working in the emergency department and observation ward of a hospital in Oslo, Norway. Interviews were carried out between May and December 2022, coded using NVivo v.14 and analyzed thematically. Results: We identified three themes: (i) standardized and clinical assessment, referring to tensions between standardized and clinical alcohol risk assessment; (ii) formal and informal treatment guidelines, encompassing the informal patient care practices enacted in the emergency department and on the wards, and; (iii) training delivery and barriers to implementation, referring to the training penetration rate and identified need for “clear and simple” alcohol treatment guidelines. Conclusion: This study highlights tensions between alcohol-related harm and alcohol-related norms as these pertain to screening and following up harmful and hazardous alcohol use in a Norwegian hospital. Results suggest training should focus on zero alcohol recommendations, the use of assessment tools, the acceptability of screening to patients and “clear and simple” patient follow-up procedures

• Buer, Sofie; Hagen, Bjørn Ole Ingulfsvann; Søraas, Arne Vasli Lund; White, Richard Aubrey; Bø, Ragnhild & Ellingjord-Dale, Merete [Show all 12 contributors for this article] (2024). Executive deficits after SARS-CoV-2 infection: A cross-sectional population study. Brain, Behavior, and Immunity - Health (BBI - Health). 41, p. 1–8. doi: 10.1016/j.bbih.2024.100857. Full text in Research Archive Show summary

  Importance Despite the major implications of executive deficits in day-to-day functioning, few studies have investigated this in post-acute sequelae of SARS-CoV-2 infection using standardized measures that differentiate between aspects of executive function. Objective Examine whether SARS-CoV-2 infection is associated with deficits in executive functions and if so, investigate the duration of this association. Design, Setting, and Participants The present research has a cross-sectional design and uses data from the Norwegian Covid-19 Cohort study. The current cohort (n = 8102) completed the Behavior Rating Inventory of Executive Function- Adult Version (BRIEF-A) electronically between April 2021 and September 2021. During the assessment, 4183 of the included participants had a prior positive polymerase chain reaction test (PCR) for SARS-CoV-2 and 3919 were untested or had a confirmed negative PCR test. Exposure Laboratory-confirmed SARS-CoV-2 infection. Main outcomes and measures Executive functions were measured using the BRIEF-A, a self-report questionnaire comprising 75 items within nine theoretically and empirically distinct clinical scales. All participants self-reported on demographical variables and comorbidity. Information on sex and age was derived from the personal identification number, and vaccination status was obtained from the Norwegian Immunization Registry (SYSVAK). Results Participants with a positive SARS-CoV-2 status reported executive deficits in everyday life above the clinical threshold (T-score ≥65) more often than non-infected controls (383 vs. 225). Specifically, the SARS-CoV-2 positive status group indicated significantly more deficits related to metacognition, with the greatest difference demonstrated for working memory. This difference remained when adjusting for various demographic factors and comorbidities, with significantly greater odds of reporting above the clinical threshold following SARS-CoV-2 infection, as observed on the global executive composite score 6–12 months after infection (OR 1.97; 95% CI 1.51 to 2.55). Conclusions Our study confirms more perceived executive deficits following SARS-CoV-2 infection compared to non-infected controls, with metacognitive aspects being the most affected. These findings shed light on the potential functional difficulties that individuals may encounter during the post-acute phase of SARS-CoV-2 infection and may guide further development of targeted interventions addressing metacognitive domains of executive functioning.

• Gamboa, Danil; Kabashi, Saranda; Jørgenrud, Benedicte Marie; Lerdal, Anners; Nordby, Gudmund & Bogstrand, Stig Tore (2024). Is alcohol and psychoactive medication use associated with excess hospital length-of-stay and admission frequency? A cross-sectional, observational study. BMC Emergency Medicine. 24(1). doi: 10.1186/s12873-024-00979-y. Full text in Research Archive Show summary

  Background Hospital length-of-stay and admission frequency are commonly used indicators of disease burden and health resource expenditures. However, the impact of psychoactive prescription medication use and harmful alcohol consumption on both the duration and frequency of hospital admissions is under-explored. Methods We conducted an analysis of data gathered from 2872 patients admitted to the Emergency Department at Lovisenberg Diaconal Hospital in Oslo, Norway. Psychoactive medicines (benzodiazepines, opioids, and z-hypnotics) were detected via liquid chromatography-mass spectrometry analysis of whole blood, while alcohol consumption was self-reported through the Alcohol Use Disorder Identification Test-4 (AUDIT-4). Using logistic regression, we examined associations with our primary outcomes, which were excess length-of-stay and admission frequency, defined as exceeding the sample median of 3.0 days and 0.2 admissions per year, respectively. Results Compared to the absence of psychoactive medication, and after adjusting for age, gender, malignant disease, pre-existing substance use disorder and admission due to intoxication, the detection of two or more psychoactive medicines was associated with both excess length-of-stay (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.20 to 2.14) and yearly hospitalization rate (OR, 3.72; 95% CI, 2.64 to 5.23). This association persisted when increasing the definition for excess length-of-stay to 4 and 5 days and to 1.0 and 1.5 admissions per year for admission frequency. Harmful alcohol consumption (AUDIT-4 scores of 9 to 16) was not associated with excess length-of-stay, but with excess admission frequency when defined as more than 1.0 admission per year when compared to scores of 4 to 6 (OR, 2.68; 95% CI, 1.58 to 4.57). Conclusions Psychoactive medication use is associated with both excess length-of-stay and increased antecedent admission frequency, while harmful alcohol consumption may be associated with the latter. The utility of our findings as a causal factor should be explored through intervention-based study designs.

• Larsson, Petra; Torre, Maria Julia Bidonde; Olsen, Unni Solveig Johansen; Gay, Caryl; Lerdal, Anners & Ursin, Marie Helene [Show all 8 contributors for this article] (2023). Association of post-stroke fatigue with physical activity and physical fitness: A systematic review and meta-analysis. International Journal of Stroke. ISSN 1747-4930. 18(9), p. 1063–1070. doi: 10.1177/17474930231152132. Full text in Research Archive Show summary

  Background: It has been hypothesized that post-stroke fatigue (PSF) is associated with reduced physical activity (PA) and impaired physical fitness (fitness). Understanding associations between PSF and PA, and/or fitness could help guide the development of targeted exercise interventions to treat PSF. Aims: Our systematic review and meta-analysis aimed to investigate PSF’s associations with PA and fitness. Summary of review: Following a registered protocol, we included studies with cross-sectional or prospective observational designs, published in English or a Scandinavian language, which reported an association of PSF with PA and/or fitness in adult stroke survivors. We searched MEDLINE, Embase, AMED, CINAHL, PsycINFO, ClinicalTrials.gov, and World Health Organization’s International Clinical Trials Registry Platform from inception to November 30, 2022. Risk of bias was assessed using Quality in Prognosis Studies. Thirty-two unique studies (total n = 4721 participants, 55% male), and three study protocols were included. We used random-effects meta-analysis to pool data for PA and fitness outcomes, and vote-counting of direction of association to synthesize data that could not be meta-analyzed. We found moderate-certainty evidence of a weak association between higher PSF and impaired fitness (meta r = –0.24; 95% confidence interval (CI) = –0.33, –0.15; n = 905, 7 studies), and very low-certainty evidence of no association between PSF and PA (meta r = –0.09; 95% CI = –0.34, 0.161; n = 430, 3 studies). Vote-counting showed a higher proportion of studies with associations between higher PSF and impaired fitness (pˆ = 0.83; 95% CI = 0.44, 0.97; p = 0.22, n = 298, 6 studies), and with associations between higher PSF and lower PA (pˆ = 0.75; 95% CI = 0.51, 0.90; p = 0.08, n = 2566, 16 studies). Very low- to moderate-certainty evidence reflects small study sample sizes, high risk of bias, and inconsistent results. Conclusions: The meta-analysis showed moderate-certainty evidence of an association between higher PSF and impaired fitness. These results indicate that fitness might protect against PSF. Larger prospective studies and randomized controlled trials evaluating the effect of exercise on PSF are needed to confirm these findings.

• English, Coralie; Simpson, Dawn B; Billinger, Sandra A.; Churilov, Leonid; Coupland, Kirsten G. & Drummond, Avril [Show all 17 contributors for this article] (2023). A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. International Journal of Stroke. ISSN 1747-4930. doi: 10.1177/17474930231189135. Full text in Research Archive Show summary

  Rationale: Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. Methods: We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. Results: We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. Conclusions: By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.

• Nyhagen, Ragnhild; Egerod, Ingrid; Rustøen, Tone; Lerdal, Anners & Kirkevold, Marit (2023). Three patterns of symptom communication between patients and clinicians in the intensive care unit: A fieldwork study. Journal of Advanced Nursing. ISSN 0309-2402. doi: 10.1111/jan.16007. Full text in Research Archive Show summary

  Aim: To describe different patterns of communication aimed at preventing, identify- ing and managing symptoms between mechanically ventilated patients and clinicians in the intensive care unit. Design: We conducted a fieldwork study with triangulation of participant observation and individual interviews. Methods: Participant observation of nine patients and 50 clinicians: nurses, physiother- apists and physicians. Subsequent individual face-to-face interviews with nine of the cli- nicians, and six of the patients after they had regained their ability to speak and breathe spontaneously, were fully alert and felt well enough to sit through the interview. Findings: Symptom communication was found to be an integral part of patient care. We identified three communication patterns: (1) proactive symptom communication, (2) reactive symptom communication and (3) lack of symptom communication. The three patterns co-existed in the cases and the first two complemented each other. The third pattern represents inadequate management of symptom distress. Conclusion: Recognition of symptoms in non-speaking intensive care patients is an important skill for clinicians. Our study uncovered three patterns of symptom commu- nication, two of which promoted symptom management. The third pattern suggested that clinicians did not always acknowledge the symptom distress. Implications for Patient Care: Proactive and reactive symptom assessment of non- speaking patients require patient verification when possible. Improved symptom prevention, identification and management require a combination of sound clinical judgement and attentiveness towards symptoms, implementation and use of relevant assessment tools, and implementation and skill building in augmentative and alterna - tive communication. Impact: This study addressed the challenges of symptom communication between mechanically ventilated patients and clinicians in the intensive care unit. Our findings may have an impact on patients and clinicians concerned with symptom management in intensive care units. Reporting Method: We used the consolidated criteria for reporting qualitative research.

• Monsen, Ragnhild Elisabeth; Kristoffersen, Anne Karin; Gay, Caryl; Herlofson, Bente Brokstad; Fjeld, Katrine Gahre & Hove, Lene Hystad [Show all 10 contributors for this article] (2023). Identification and susceptibility testing of oral candidiasis in advanced cancer patients. BMC Oral Health. 23(1). doi: 10.1186/s12903-023-02950-y. Full text in Research Archive Show summary

  Background Patients with advanced cancer are prone to develop different opportunistic oral infection due to anti-cancer treatment or the malignancies themselves. Studies of oral fungal samples show an increased prevalence of non-Candida albicans species in mixed oral infections with Candida albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azoles, which may have implications for treatment. This study aimed to assess the diversity and antifungal susceptibility of Candida species detected in the oral cavity. Methods An observational study with microbiological analysis was conducted. Clinical fungal isolates were collected from patients in a hospice unit in 2014–2016. Isolates were re-grown on chromID® Candida plates in 2020. Single colony of each species was re-cultivated and prepared for biochemical identification with a VITEK2® system and verified by gene sequencing. Etest was performed on RPMI agar, and the antifungals fluconazole, amphotericin B, anidulafungin and nystatin were applied. Results Fifty-six isolates from 45 patients were identified. Seven different Candida species and one Saccharomyces species were detected. The results of biochemical identification were confirmed with sequencing analysis. Thirty-six patients had mono infection, and nine out of 45 patients had 2–3 different species detected. Of C. albicans strains, 39 out of 40 were susceptible to fluconazole. Two non-C. albicans species were resistant to fluconazole, one to amphotericin B and three to anidulafungin. Conclusion C. albicans was the predominant species, with a high susceptibility to antifungal agents. Different Candida species occur in both mono and mixed infections. Identification and susceptibility testing may therefore lead to more effective treatment and may prevent the development of resistance among patients with advanced cancer. Trail registration The study Oral Health in Advanced Cancer was registered at ClinicalTrials.gov (#NCT02067572) in 20/02/2014.

• Enbakom, Mestawet Getachew; Lerdal, Anners; Småstuen, Milada Cvancarova; Eshete, Million Tesfaye; Desta, Tilahun & Lindberg, Maren Falch (2023). Modifiable factors associated with a consistently high acute pain trajectory after surgical treatment of traumatic fractures in Ethiopia: a multi-center prospective cohort study. Journal of Orthopaedic Surgery and Research. 18(1). doi: 10.1186/s13018-023-03770-0. Full text in Research Archive Show summary

  Background In Ethiopia, little is known about postoperative pain trajectories and possible predictive factors associated with them in patients undergoing surgery following traumatic fractures. Methods This multi-center prospective observational cohort study included surgical candidates for traumatic fractures (n = 218). Worst pain intensity was measured with an 11-point numeric rating scale on the first 4 postoperative days and day of hospital discharge. Growth mixture modeling was used to identify subgroups of patients based on their pain trajectories, and logistic regression models to quantify associations between pain trajectories and demographic, clinical, psychological, and life style factors. Results Two postoperative pain trajectory subgroups were identified: rapid pain relief (48% of included individuals) and consistently high pain (52% of included individuals). Sub-analysis stratified by cause of injury demonstrated that higher preoperative pain was an independent risk factor for consistently high postoperative pain regardless of the patient’s injury type: traffic accident (OR = 1.48, 95% CI 1.23–1.79), machine/tool injury or conflict (OR = 1.58, 95% CI 1.11–2.26), or fall (OR = 1.47, 95% CI 1.08–1.99). Moreover, longer surgical time was a risk factor for consistently high postoperative pain among patients who had a fall-related injury (OR = 1.02, 95% CI 1.00–1.03). In contrast, among patients with a traffic-related injury, receiving a nerve block was a protective factor (OR = 0.19, 95% CI 0.04–0.87) compared with general anesthesia. Conclusion Higher preoperative pain and longer surgical time were associated with a consistently high acute postoperative pain trajectory. Clinicians may use these potentially modifiable factors to identify patients at risk for consistently high pain during the early postoperative period.

• Olsen, Unni; Lindberg, Maren Falch; Rose, Christopher James; Denison, Eva Marie-Louise; Gay, Caryl & Aamodt, Arild [Show all 11 contributors for this article] (2023). Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis. PLOS ONE. 18(3). doi: 10.1371/journal.pone.0283446. Full text in Research Archive Show summary

  Main objective: Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis. Methods: Based on a peer-reviewed protocol, we searched Medline, Embase, CINAHL, Cochrane Library, and PEDro for prospective observational studies (January 2000 to February 2023) investigating factors associated with pain after TKA. The primary outcome was pain twelve months after TKA. Pain at three and six months were secondary outcomes. Multivariate random-effects meta-analyses were used to estimate mean correlation (95% CIs) between factors and pain. Sensitivity analysis was performed for each risk of bias domain and certainty of evidence was assessed. Results: Of 13,640 studies, 29 reports of 10,360 patients and 61 factors were analysed. The mean correlation between preoperative factors and more severe pain at twelve months was estimated to be 0.36 (95% CI, 0.24, 0.47; P < .000; moderate-certainty evidence) for more catastrophizing, 0.15 (95% CI; 0.08, 0.23; P < .001; moderate-certainty evidence) for more symptomatic joints, 0.13 (95% CI, 0.06, 0.19; P < .001; very low-certainty evidence) for more preoperative pain. Mean correlation between more severe radiographic osteoarthritis and less pain was -0.15 (95% CI; -0.23, -0.08; P < .001; low-certainty evidence). In sensitivity analysis, the estimated correlation coefficient for pain catastrophizing factor increased to 0.38 (95% CI 0.04, 0.64). At six and three months, more severe preoperative pain was associated with more pain. Better preoperative mental health was associated with less pain at six months. Conclusion and relevance: More pain catastrophizing, more symptomatic joints and more pain preoperatively were correlated with more pain, while more severe osteoarthritis was correlated with less pain one year after TKA. More preoperative pain was correlated with more pain, and better mental health with less pain at six and three months. These findings should be further tested in predictive models to gain knowledge which may improve TKA outcomes.

• Lerdal, Anners; Gay, Caryl; Bonsaksen, Tore; Ekeberg, Øivind; Grimholt, Tine Kristin & Heir, Trond [Show all 10 contributors for this article] (2023). Validation of a short version of the Lee fatigue scale in adults living in Norway: a cross-sectional population survey. BMC Public Health. 23(1). doi: 10.1186/s12889-023-17036-1. Full text in Research Archive Show summary

  Background Due to the nature of fatigue, a brief reliable measure of fatigue severity is needed. Thus, the aim of our study was to evaluate a short version of the Lee Fatigue Scale (LFS) in the Norwegian general population. Methods This cross-sectional survey consists of a representative sample from the Norwegian population drawn by The National Population Register in Norway. The study is part of a larger study (NORPOP) aimed at collecting normative data from several questionnaires focused on health in adults living in Norway. Registered citizens between 18 and 94 years of age were randomly selected stratified by age, sex and geographic region. Of the 4971 respondents eligible for the study, 1792 (36%) responded to the survey. In addition to age and sex, we collected responses on a 5-item version of the LFS measuring current fatige severity. The psychometric properties focusing on internal structure and precision of the LFS items were analyzed by a Rasch rating scale model. Results Complete LFS scores for analyses were available for 1767 adults. Women had higher LFS-scores than men, and adults < 55 years old had higher scores than older respondents. Our analysis of the LFS showed that the average category on each item advanced monotonically. Two of the five items demonstrated misfit, while the three other items demonstrated goodness-of-fit to the model and uni-dimensionality. Items #1 and #4 (tired and fatigue respectively) showed differential item functioning (DIF) by sex, but no items showed DIFs in relation to age. The separation index of the LFS 3-item scale showed that the sample could be separated into three different groups according to the respondents’ fatigue levels. The LFS-3 raw scores correlated strongly with the Rasch measure from the three items. The core dimensions in these individual items were very similarly expressed in the Norwegian language version and this may be a threat to the cultural-related or language validity of a short version of the LFS using these particular items. Conclusions The study provides validation of a short LFS 3-item version for estimating fatigue in the general population.

• Skogestad, Ingrid Johansen; Kottorp, Anders; Larsson, Petra; Moen, Marie Therese Kristine Normann; Gay, Caryl & Borge, Christine Råheim [Show all 7 contributors for this article] (2023). Development and evaluation of the Norwegian Fatigue Characteristics and Interference Measure (FCIM) for stroke survivors: cognitive interviews and Rasch analysis. Quality of Life Research. ISSN 0962-9343. doi: 10.1007/s11136-023-03477-z. Full text in Research Archive Show summary

  Purpose There is need for a comprehensive measure of post-stroke fatigue with sound measurement properties. This study aimed to develop the Norwegian Fatigue Characteristics and Interference Measure (FCIM) and assess its content validity, structural validity, and internal consistency. Method This study consisted of three steps: (1) an expert panel developed version 1.0 of the Norwegian FCIM, (2) its content validity was assessed in cognitive interviews with stroke patients (N = 15), (3) a convenience sample of stroke patients (N = 169) completed an online questionnaire with the FCIM, Fatigue Severity Scale, and sociodemographic information; validity and reliability were assessed using Rasch analysis. Results FCIM version 1.0 included a 10-item characteristics subscale, a 20-item interference subscale, and two pre-stroke fatigue items. The cognitive interviews revealed content validity issues, resulting in two interference items being removed and five items being flagged but retained for Rasch analysis (version 2.0). Rasch analysis led to removal of four items from the characteristics subscale and six more from the interference subscale. The final six-item characteristics subscale and 12-item interference subscale (version 3.0) both showed adequate fit to the Rasch model with indications of unidimensionality and local independence. The interference subscale had a high person separation index. No significant differential item function (DIF) was found in relation to gender, but one item demonstrated DIF in relation to age. Conclusion The cognitive interviews and Rasch analysis demonstrated that the Norwegian version of the FCIM has high content validity, structural validity, and internal consistency. Future research should assess its construct validity, reliability, and responsiveness.

• Rehman, Yasser; Korsvold, Ann Magrit; Lerdal, Anners & Aamodt, Arild (2023). No difference in patient-reported outcomes with cruciate-retaining, anterior-stabilized, and posterior-stabilized total knee arthroplasty designs. The Bone & Joint Journal. ISSN 2049-4394. 105-B(12), p. 1271–1278. doi: 10.1302/0301-620X.105B12.BJJ-2023-0064.R3. Full text in Research Archive Show summary

  Aims This study compared patient-reported outcomes of three total knee arthroplasty (TKA) designs from one manufacturer: one cruciate-retaining (CR) design, and two cruciate-sacrificing designs, anterior-stabilized (AS) and posterior-stabilized (PS). Methods Patients scheduled for primary TKA were included in a single-centre, prospective, three-armed, blinded randomized trial (n = 216; 72 per group). After intraoperative confirmation of posterior cruciate ligament (PCL) integrity, patients were randomly allocated to receive a CR, AS, or PS design from the same TKA system. Insertion of an AS or PS design required PCL resection. The primary outcome was the mean score of all five subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) at two-year follow-up. Secondary outcomes included all KOOS subscales, Oxford Knee Score, EuroQol five-dimension health questionnaire, EuroQol visual analogue scale, range of motion (ROM), and willingness to undergo the operation again. Patient satisfaction was also assessed. Results Patients reported similar levels of pain, function, satisfaction, and general health regardless of the prosthetic design they received. Mean maximal flexion (129° (95% confidence interval (CI) 127° to 131°) was greater in the PS group than in the CR (120° (95% CI 121° to 124°)) and AS groups (122° (95% CI 120° to 124°)). Conclusion Despite differences in design and constraint, CR, AS, and PS designs from a single TKA system resulted in no differences in patient-reported outcomes at two-year follow-up. PS patients had statistically better ROM, but the clinical significance of this finding is unclear.

• English, Coralie; Simpson, Dawn B; Billinger, Sandra A; Churilov, Leonid; Coupland, Kirsten G & Drummond, Avril [Show all 17 contributors for this article] (2023). A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabilitation and Neural Repair. ISSN 1545-9683. doi: 10.1177/15459683231209170. Full text in Research Archive Show summary

  Rationale: Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. Methods: We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. Results: We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. Conclusions: By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.

• Sellevold, Vibeke Bull; Olsen, Unni; Lindberg, Maren Falch; Steindal, Simen Alexander; Aamodt, Arild & Lerdal, Anners [Show all 7 contributors for this article] (2023). “I am accustomed to something in my body causing pain”: A qualitative study of knee replacement non-improvers’ stories of previous painful and stressful experiences. BMC Musculoskeletal Disorders. 24(1). doi: 10.1186/s12891-023-06423-9. Full text in Research Archive Show summary

  Background: Approximately 20% of total knee arthroplasty patients experience persistent postsurgical pain one year after surgery. No qualitative studies have explored previous stories of painful or stressful life experiences in patients experiencing persistent postsurgical pain after total knee replacement. This study aimed to explore stories of previous painful or stressful experiences in life in a cohort of patients that reported no improvement in pain one year after total knee arthroplasty. Methods: The study employed an explorative-descriptive qualitative design. Data was collected through semistructured interviews five to seven years after surgery, with patients who reported no improvement in pain-related interference with walking 12 months after total knee replacement. The data was analyzed using qualitative content analysis. Results: The sample consisted of 13 women and 10 men with a median age of 67 years at the time of surgery. Prior to surgery, six reported having at least one chronic illness and 16 reported having two or more painful sites. Two main themes were identified in the data analysis: Painful years - the burden of living with long lasting pain, and the burden of living with psychological distress. Conclusions: The participants had severe longlasting knee pain as well as longlasting pain in other locations, in addition to experiences of psychologically stressful life events before surgery. Health personnel needs to address the experience and perception of pain and psychological struggles, and how it influences patients’ everyday life including sleeping routines, work- and family life as well as to identify possible vulnerability for persistent postsurgical pain. Identifying and assessing the challenges enables personalized care and support, such as advice on pain management, cognitive support, guided rehabilitation, and coping strategies both pre-and post-surgery.

• Hansen, Christin Saltnes; Rustøen, Tone; Beitland, Sigrid; Puntillo, Kathleen; Småstuen, Milada Cvancarova & Lerdal, Anners [Show all 7 contributors for this article] (2023). Self-reported symptoms experienced by intensive care unit patients: a prospective observational multicenter study. Intensive Care Medicine. ISSN 0342-4642. 49(11), p. 1370–1382. doi: 10.1007/s00134-023-07219-0. Full text in Research Archive Show summary

  Purpose: The purpose of this study is to describe the prevalence, intensity and distress of five symptoms in intensive care unit (ICU) patients and to investigate possible predictive factors associated with symptom intensity. Methods: This is a prospective cohort study of ICU patients. A symptom questionnaire (i.e., Patient Symptom Survey) was used to describe the prevalence, intensity and distress of pain, thirst, anxiousness, tiredness, and shortness of breath over seven ICU days. Associations between symptom intensity and possible predictive factors were assessed using the general estimating equation (GEE) model. Results: Out of 603 eligible patients, 353 (Sample 2) were included in the present study. On the first ICU day, 195 patients (Sample 1) reported thirst as the most prevalent symptom (66%), with the highest mean intensity score (6.13, 95% confidence interval (CI) [5.7–6.56]). Thirst was the most prevalent (64%) and most intense (mean score 6.05, 95%CI [5.81–6.3]) symptom during seven days in the ICU. Anxiousness was the most distressful (mean score 5.24, 95%CI [4.32–6.15]) symptom on the first day and during seven days (mean score 5.46, 95%CI [4.95–5.98]). During seven days, analgesic administration and sepsis diagnosis were associated with increased thirst intensity. Older age and being mechanically ventilated were associated with decreased pain intensity, and analgesic administration was associated with increased pain intensity. Family visits and female gender were associated with increased intensity of anxiousness and shortness of breath, respectively. Conclusions: Self‑reporting ICU patients experienced a high and consistent symptom burden across seven days. Certain variables were associated with the degree of symptom intensity, but further research is required to better understand these associations.

• Nyhagen, Ragnhild; Egerod, Ingrid; Rustøen, Tone; Lerdal, Anners & Kirkevold, Marit (2022). Unidentified communication challenges in the intensive care unit: A qualitative study using multiple triangulations. Australian Critical Care. ISSN 1036-7314. p. 1–8. doi: 10.1016/j.aucc.2022.01.006. Full text in Research Archive Show summary

  Background Communication in the intensive care unit is challenged by patients’ inability to speak owing to intubation, treatment, and illness. Research has focused on the use of communication tools or techniques, characteristics of the communication between patients and clinicians, and their experiences of communication challenges. However, few studies have combined the perspectives of patients, family members, and clinicians. We explored communication from different angles and investigated challenges that cannot be explained by ineffective use of aids and communication techniques. Objectives The aim of this study was to explore communication between patients, family members, and nurses and to investigate previously unidentified communication challenges. Methods This study used a case-oriented design with multiple triangulations. It was conducted in two general intensive care units at a Norwegian university hospital. Participant observations were conducted on nine mechanically ventilated patients while communicating with family members and healthcare personnel. Following the observations, individual interviews were conducted with six patients, six family members, and nine healthcare personnel. Findings Communication often seemed uncomplicated at the time of observations, but information from the interviews revealed another picture. We demonstrate what participants emphasised differently when they discussed their experiences, revealing a discrepancy in perceived importance in the situation. Family members had an important role in interpreting signs from the patient, uncovering challenges that would have been unknown to the nurses otherwise. Conclusions This study illustrates how communication challenges in the intensive care unit may not be perceptible to an observer or to all of the participants involved at the time of the communication. Nurses need to be aware of these communication challenges and realise that the patient might face issues that cannot be easily solved without extensive involvement of the patient, family, and nurses, and perhaps not even until a later stage in the patient's recovery process.

• Tollisen, Anita; Selvaag, Anne Marit G; Aasland, Astrid; Ingebrigtsen, Trude Miljeteig; Sagen, Joachim & Lerdal, Anners [Show all 7 contributors for this article] (2022). Personally generated quality of life outcomes in adults with juvenile idiopathic arthritis. Journal of Rheumatology. ISSN 0315-162X. 49(10), p. 1138–1145. doi: 10.3899/jrheum.211245. Full text in Research Archive Show summary

  Objective To explore quality of life (QOL) using the individualized Patient Generated Index (PGI) in young adults who were diagnosed with juvenile idiopathic arthritis ( JIA) in childhood, and to examine associations between PGI ratings and standardized health-related outcome measures. Methods Patients (N = 79, mean age 25.1 [SD 4.2] yrs, 72% female) completed the PGI and the standardized measures: Health Assessment Questionnaire–Disability Index, 12-item Short Form Health Survey (SF-12; physical and mental health-related QOL [HRQOL]), Brief Pain Inventory (pain severity and interference), 5-item Hopkins Symptom Checklist, and visual analog scale for fatigue. Information on morning stiffness, medications, and demographics was also collected. Patients were compared to 79 matched controls. Results The most frequently nominated areas of importance for patients' personally generated QOL (assessed by PGI) were physical activity (n = 38, 48%), work/school (n = 31, 39%), fatigue (n = 29, 37%) and self-image (n = 26, 33%). Nomination of physical activity was associated with older age, morning stiffness, and more pain interference. Nomination of fatigue was associated with current use of disease-modifying antirheumatic drugs, whereas nomination of self-image was associated with polyarticular course JIA and pain interference. Nomination of work/school was not associated with other factors. Higher PGI scores (indicating better QOL) correlated positively with all SF-12 subscales except role emotional, and negatively with disability, pain severity, pain interference, and morning stiffness. Compared to controls, patients had more pain, poorer physical HRQOL, and less participation in full-time work or school. Conclusion Physical activity, work/school, fatigue, and self-image were frequently nominated areas affecting QOL in young adults with JIA. The PGI included aspects of QOL not covered in standardized measures.

• Larsen, Marie Hamilton; Mengshoel, Anne Marit; Andersen, Marit Helen; Borge, Christine Råheim; Ahlsen, Birgitte & Dahl, Kari Gire [Show all 15 contributors for this article] (2022). “A bit of everything”: Health literacy interventions in chronic conditions – a systematic review. Patient Education and Counseling. ISSN 0738-3991. 105(10), p. 2999–3016. doi: 10.1016/j.pec.2022.05.008. Full text in Research Archive Show summary

  Objective: To systematically evaluate health literacy (HL) interventions in chronic conditions by exploring theoretical perspectives, intervention content and effectiveness. Method: We searched MEDLINE, Cochrane, CINAHL, EMBASE, ERIC, Web of Science and PsycINFO. Standardised systematic review methods were used, and sequences informing our research question were extracted and analysed. The study includes a descriptive summary of the included papers. Results: We included 39 unique interventions, with diabetes and heart disease as the most targeted chronic conditions. Fifty-four percent of papers included a definition of HL, but the studies showed significant heterogeneity of theoretical underpinnings, modes, measures and content. We identified 23 HL measures, mostly assessing functional HL. The HL interventions were often more complex than the measures indicated. A significant change in HL was found in 28 studies. Study quality was generally poor. Conclusions: Interventions optimizing HL appear important to improve health outcomes in chronic conditions. To ensure cumulative knowledge development of this field we need theory-based interventions, consistency in methods and more tailored and comprehensive measures to capture the interventions’ complexity. Practice implications: A more valid understanding of HL interventions and measurements is needed to reach an agreed understanding of their components and intentions.

• Sellevold, Vibeke Bull; Steindal, Simen Alexander; Lindberg, Maren Falch; Småstuen, Milada Cvancarova; Aamodt, Arild & Lerdal, Anners [Show all 7 contributors for this article] (2022). Many Patients with Persistent Pain One Year After TKA Report Improvement by 5-7 years: A Mixed Methods Study. Clinical Orthopaedics and Related Research. ISSN 0009-921X. 480(11), p. 2075–2088. doi: 10.1097/CORR.0000000000002183. Full text in Research Archive Show summary

  Background: Approximately 20% of patients report pain 12 months after TKA. No studies have investigated patients’ experiences of living with persistent postsurgical pain 5 to 7 years after TKA by combining a qualitative and quantitative methodology. Question/purpose: In a mixed-methods study, we explored patients’ experiences of living with persistent pain up to 7 years after primary TKA. We asked: In a subgroup analysis of patients who reported persistent pain 1 year after TKA surgery, how do patients live with persistent pain at the 5- to 7-year postoperative timepoint? Methods: This follow-up study was part of a longitudinal study of pain, symptoms, and health-related quality of life in patients who underwent TKA for osteoarthritis. The present study targeted a subgroup of patients (22% [45 of 202]) identified in the longitudinal study who reported no improvement in pain interference with walking at 12 months after surgery. Inclusion criteria were: all 31 patients in this subgroup who attended their 5-year follow-up at the hospital and lived within a 2-hour drive from the hospital. Eight patients declined or were unable to participate due to illness or death. Hence, the final sample consisted of 23 patients (13 women and 10 men). The participants’ mean age at surgery was 66 6 10 years. There were no differences in sociodemographic baseline data between the 23 included and the 22 excluded participants. A mixed-methods approach was employed, in which the quantitative data were followed up and investigated with qualitative interviews. Instruments used were the Brief Pain Inventory preoperatively, 12 months, and 5 years after surgery, as well as a semistructured interview guide. The individual interviews were conducted at one timepoint 5 to 7 years postsurgery to capture how pain was experienced at that timepoint. The interviews were audiorecorded, transcribed, and analyzed using qualitative content analysis. Meaning units were identified, condensed, and sorted into subthemes that were interpreted and abstracted into themes, guided by the research question. With a small sample, the quantitative analysis focused on descriptive statistics and nonparametric statistics when comparing demographics of included and nonincluded patients. In addition, two multivariate mixed models for repeated measures were employed to estimate within‐patient and between‐patient variations as well as to assess the effect of time on the pain outcomes. Results: Pain with walking decreased from 12 months to 5 years postoperatively (estimated mean score 7 versus 4, difference of means -3 [95% CI -5 to -2]; p < 0.001). Pain with daily activity decreased from 12 months to 5 years postoperatively (estimated mean score 6 versus 3, difference of means -3 [95% CI -4 to -1]; p < 0.001). Pain intensity (average pain) decreased from 12 months to 5 years postoperatively (estimated mean score 5 versus 4, difference of means -1 [95% CI -3 to 0]; p = 0.03). The results are presented as point estimates rounded up to whole numbers. The qualitative data analysis yielded three themes: persistent limitations after TKA, regained wellness over time, and complexity in physical challenges. Intermittent pain with certain movements resulted in limitations with some activities in everyday life and seemed to persist beyond 5 years. Multiple painful body sites and presence of comorbidities seemed to interfere with regained wellness over time. Conclusion: In this subgroup of patients experiencing postsurgical persistent pain 12 months after primary TKA, persistent postsurgical pain still limited certain activities for the participants, although pain seemed to be less influential in their everyday lives after 5 years to 7 years. Clinicians may use these findings to inform and guide patients with delayed improvements in pain into more realistic expectations for recovery, rehabilitation, and strategies for coping with pain and impaired function. However, it is imperative to rule out other reasons for pain in patients reporting pain 12 months and longer after surgery and to be attentive of possible changes in pain over time.

• Getachew, Mestawet; Lerdal, Anners; Småstuen, Milada Cvancarova; Gay, Caryl; Aamodt, Arild & Tesfaye, Million [Show all 7 contributors for this article] (2022). Worst pain intensity and opioid intake during the early postoperative period were not associated with moderate-severe pain 12 months after total knee arthroplasty - a longitudinal study. Scandinavian Journal of Pain. ISSN 1877-8860. doi: 10.1515/sjpain-2022-0007. Full text in Research Archive Show summary

  Objectives: There are several known predictors of pain after total knee arthroplasty (TKA). However, it is unclear whether acute postoperative pain intensity and postoperative opioid intake are associated with pain 12 months after TKA. Thus, the aim of this study was to assess whether worst pain intensity and opioid intake during the early postoperative period are associated with moderate-severe pain 12 months after TKA. Methods: A total of 202 patients undergoing primary TKA between October 2012 and September 2014 were prospectively enrolled. Age, sex, contralateral knee pain, BMI, physical status and opioid intake were collected preoperatively. Ketamine and daily opioid intake were collected on postoperative days (POD) 0–3. Using the Brief Pain Inventory, patients’ “worst pain intensity” was measured pre-operatively, on POD 0–4, and 12 months after TKA. Two logistic regression models evaluated the independent association of early postoperative pain intensity (model 1) and postoperative opioid intake (model 2) with moderate-severe pain 12 months after TKA, adjusting for possible confounders. Results: In total, 187 patients with data at the 12 month postoperative follow-up were included in this analysis. Pain intensity on POD2 and POD3, as well as preoperative pain and BMI, were significantly associated with pain at 12 months in univariate models. However, in multivariable models adjusted for preoperative pain and BMI, neither pain intensity on POD 0–4 (model 1) nor opioid intake on POD 0–3 (model 2) were associated with pain at 12 months. Preoperative pain was still significant in both models, but BMI remained significant only in model 2. Conclusions: Worst pain intensity and opioid intake during the early postoperative period were not associated with moderate-severe pain 12 months after TKA when controlling for potential confounders. More research is needed to confirm these findings.

View all works in NVA

• Heggestad, Anne Kari Tolo; Knutstad, Unni; Lode, Kirsten; Sandbekken, Ida Hellum; Løyland, Borghild & Lohne, Vibeke [Show all 13 contributors for this article] (2025). Sykepleieboken 2 : Sentrale begreper og pasientens opplevelser. Cappelen Damm Akademisk. ISBN 9788202839192. 238 p. Full text in Research Archive Show summary

  Sykepleieboken 2 – Sentrale begreper og pasientens opplevelser retter søkelyset mot en rekke fenomener som kan komme til syne ved sykdom og lidelse. Denne utgaven er betydelig redusert i omfang i forhold til forrige utgave. Alle kapitlene er oppdatert i forhold til nyere forskning og nye retningslinjer. Enkelte kapitler er nyskrevet med nye forfattere. Boken tar for seg begrep og fenomener som verdighet, mestring, livskvalitet, håp og omsorg. Videre omhandler den tretthet og utmattelse, smerter, kvalme og svimmelhet. Boken har også et nytt kapittel som omhandler vektutfordringer i helsefaglig praksis; fra spiseforstyrrelser til overvekt og fedme. Boken er primært skrevet for bachelorstudenter i sykepleie. Den gir et godt grunnlag for å forstå sentrale begreper. Videre tar boken for seg pasientens opplevelser av generelle symptomer, samt sykepleierens oppgaver i forhold til kartlegging og intervensjoner.

View all works in NVA

• Lerdal, Anners (2026). Fatigue etter hjernesykdom. Full text in Research Archive
• Lerdal, Anners (2026). Recomoncations from the International 3rd Stroke Recovery and Rehabilitation Roundtable: A roadmap for research i post-stroke fatigue. doi: https:/www.elasf.org/speakers/professor-anners-lerdal/. Full text in Research Archive
• Lerdal, Anners (2026). Magnetsykehus som organisasjonsmodell - arbeidsmiljø, pasientsikkerhet og bedre beslutninger. Full text in Research Archive Show summary

  Foredraget gir en innføring i Magnetsykehusmodellen, i EU-studien Magnet4Europe - gjennomføring og resultater, oppsummert kunnskap fra internasjonale studier avarbeidsmiljø og parsientresultater i magnetsykehus, og eksempler på forbedringsprosjekter ved Lovisenberg Diakonale Sykehus (LDS) som en del av intenvensjonen i Magnet4Europe. LDS var det eneste norske sykehuset blant 56 sykehus i 6 europeiske land som deltok i Magnet4Europe.

• Linnestad, Anne-Margrethe; Skogestad, Ingrid Johansen; Gay, Caryl; Borge, Christine Råheim; Indredavik, Bent & Stubberud, Jan Egil [Show all 7 contributors for this article] (2025). E-poster #786_17th World Stroke Congress, 22-24 October 2025, Barcelona, Spain. doi: 10.1177/17474930251371440. Full text in Research Archive
• Buer, Sofie; Hagen, Bjørn Ole Ingulfsvann; Søraas, Arne Vasli Lund; White, Richard Aubrey; Lerdal, Anners & Nygaard, Anders Benteson [Show all 7 contributors for this article] (2025). Working Memory Deficits in the post-acute phase of COVID-19 in a Clinical Trial Population. doi: https:/event.trippus.net/Home/Index/AEAKgIPHKxDGXt9WWufkKpiqnCz6wQruet7nzC50zg3_S3hAj-XGe9T9NTp47uSsFlG4xbd_zhBm/AEAKgIPGaNFh8o7gPpdTB6e-8t5U-Cs-bMNPVzKOFUzFTeufxZ-sT9BfzwNmJiybZYKgn43Mnh4S/eng. Full text in Research Archive
• Linnestad, Anne-Margrethe; Skogestad, Ingrid Johansen; Gay, Caryl; Borge, Christine Råheim; Indredavik, Bent & Stubberud, Jan Egil [Show all 7 contributors for this article] (2025). UNDERSTANDING DIGITAL HEALTH LITERACY AMONG STROKE SURVIVORS: A CLUSTER ANALYSIS APPROACH (NORFAST). Full text in Research Archive
• Larsson, Petra; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene; Ihle-Hansen, Hege Beate & Lerdal, Anners (2025). Physical Activity And Its Association With Physical Performance In The First Month Following First-Ever Ischemic Stroke (NORFAST). International Journal of Stroke. ISSN 1747-4930. Full text in Research Archive Show summary

  This study explored association between physical activity and physical performance in the first month following stroke and found that more time spent in moderate-to-vigorous physical activity was associated with male sex. We found no statistically significant associations between moderate-to-vigorous physical activity and physical performance or age, nor between daily step count and physical performance, age or sex. Small sample size may have affected the results.

• Simpson, Dawn; Gay, Caryl; Berg, Søren; English, Coralie; Ihle-Hansen, Hege Beate & Helland, Gisle Berg [Show all 11 contributors for this article] (2025). Self-reported and objective sleep measures: Their role in post-stroke fatigeu among acute stroke patients - (NORFAST). Full text in Research Archive
• Finstad, Therese Aamli; Larsen, Marie Hamilton; Stubberud, Jan Egil; Lerdal, Anners; Gay, Caryl & Lindberg, Maren Falch (2025). Breaking New Ground: Cluster-Based Insights into Digital Health Literacy in KOA Patients. Full text in Research Archive
• Lillegård, Julianne Helene Frøyen; Lindberg, Maren Falch; Bergvad, Ingvild Buset; Gay, Caryl & Lerdal, Anners (2025). No associations between digital health literacy and adherence to internet-delivered cognitive behavioral therapy in OA patients. Full text in Research Archive
• Simpson, Dawn; Gay, Caryl; Berg, Søren; Ihle-Hansen, Hege Beate; Helland, Gisle Berg & Larsson, Petra [Show all 10 contributors for this article] (2025). The relationship between objective and subjective sleep measures and post-stroke fatkgue: Insights from an acute ischaemic stroke cohort (the NORFAST study). Full text in Research Archive
• Sellevold, Vibeke Bull; Olsen, Unni; Lindberg, Maren Falch; Steindal, Simen Alexander; Aamodt, Arild & Lerdal, Anners [Show all 7 contributors for this article] (2025). Pain in Europe XIV – the 14th Congress of the European Pain Federation EFIC, Lyon, France: "I am accustomed to something in my body causing pain" -A qualitative study of knee replacement non-improvers’ stories of previous painful and stressful experience. Full text in Research Archive Show summary

  Background: Long lasting preoperative pain and poorer psychological status are predictors of persistent postsurgical pain (PPP) following total knee arthroplasty (TKA). We aimed to explore stories of previous painful or stressful experiences in life in a cohort of patients that reported no improvement in pain one year after TKA. Methods: An explorative-descriptive qualitative design was employed. Data were collected using semi-structured interviews with 23 patients. Quantitative preoperative data included number of painful sites and chronic illnesses. Data were analyzed using qualitative content analysis. Results: Six patients reported at least one chronic illness and 16 reported two or more painful sites before surgery. Two main themes were identified: 1) Painful years – the burden of living with long lasting pain and 2) The burden of living with psychological distress. The patients shared stories of years with painful conditions prior to surgery in addition to symptomatic knee joints. They emphasized life experiences that included loss of a close relation, long-lasting grief, and difficult family relations. Thus, their stories revealed experiences of psychological distress prior to surgery, unrelated to their painful knee. Conclusion: This study provides insight into non-improving TKA patients as individuals. The double burden of preoperative pain and psychological distress left the patients struggling physically, socially, and psychologically, often for many years before surgery. These patients may benefit from stratified TKA education and prehabilitation and adapted perioperative pain management. Health personnel need to address the experience and perception of pain and psychological struggles preoperatively to identify possible vulnerability for PPP.

• Bergvad, Ingvild Buset; Gay, Caryl; Aamodt, Arild; Edvardsen, Elisabeth; Furnes, Ove Nord & Kise, Nina Jullum [Show all 9 contributors for this article] (2025). Factors associated with physical activity in men and women with severe knee OA. Full text in Research Archive
• Kise, Nina Jullum; Eliassen, Siri; Furnes, Ove Nord; Gay, Caryl; Heir, Stig & Lerdal, Anners [Show all 10 contributors for this article] (2025). The influence of fear avoidance and pain catastrophizing on knee awareness and quality of life in osteoarthritis patients. Full text in Research Archive
• Lerdal, Anners (2025). Personalized Care and Patient-Centered Interventions. Full text in Research Archive
• Lerdal, Anners & Lindberg, Maren Falch (2025). Forskning på symptomer styrker pasientenes helse og livskvalitet. Tidsskriftet sykepleien. ISSN 0806-7511. doi: 10.4220/Sykepleiens.2025.98112. Full text in Research Archive
• Lerdal, Anners; Gay, Caryl; Rehman, Yasser; Petursson, Gunnar & Lindberg, Maren Falch (2025). Preoperative illness perceptions predict pain interference in patients undergoing total knee arthroplasty. Full text in Research Archive
• Eikrem-Lüthi, Alexander; Lerdal, Anners; Gay, Caryl; Holmen, Heidi; Magnussen, Jon & Aamodt, Arild [Show all 7 contributors for this article] (2025). Streamlining Knee Replacements: Do Efficiency Gains Compromise Patient Quality of Life? A Retrospective Cohort Study. Full text in Research Archive
• Bogstrand, Stig Tore; Auestad, Nina; Vallersnes, Odd Martin; Lerdal, Anners & Wüsthoff, Linda Elise Couëssurel (2024). COGNITIVE FUNCTION IN PEOPLE WITH SEVERE SUBSTANCE USE. Full text in Research Archive
• Buer, Sofie; Hagen, Bjørn Ingulfsvann; Nygaard, Anders Benteson; Bø, Ragnhild; Ellingjord-Dale, Merete & Istre, M.S. [Show all 12 contributors for this article] (2024). Cognitive rehabilitation of executive functions and attention in post-COVID-19 condition: A randomized controlled trial. Full text in Research Archive
• Bergvad, Ingvild Buset; Lerdal, Anners & Lindberg, Maren Falch (2024). Body mass index and physical activity in patients undergoing total knee arthroplasty – a prospective cohort study. Full text in Research Archive
• Buer, Sofie; Hagen, Bjørn Ole Ingulfsvann; Nygaard, Anders; Søraas, Arne Vasli Lund; Landrø, Nils Inge & Bø, Ragnhild [Show all 11 contributors for this article] (2024). Cognitive rehabilitation of executive functions and attention in post-COVID-19 condition: A randomized controlled trial. Full text in Research Archive
• Buer, Sofie; Stubberud, Jan Egil; Hagen, Bjørn Ole Ingulfsvann; Nygaard, Anders Benteson; Søraas, Arne Vasli Lund & Lerdal, Anners [Show all 12 contributors for this article] (2024). Executive functions following COVID-19. Full text in Research Archive Show summary

  A significant proportion of patients recovering from SARS-CoV-2 (COVID-19) exhibit deficits in executive functions. This presentation highlighted preliminary results from a cross-sectional population study examining these executive deficits following SARS-CoV-2 infection. Additionally, it introduced early findings from a randomized controlled trial (RCT) assessing the effectiveness of Goal Management Training in improving executive functions for individuals experiencing Post-COVID-19 conditions.

• Eikrem-Lüthi, Alexander; Lerdal, Anners; Holmen, Heidi; Magnussen, Jon; Aamodt, Arild & Hagen, Milada [Show all 7 contributors for this article] (2024). Effektivisering av pasientforløp ved kneprotesekirurgi – hva betyr det for pasienters livskvalitet? Full text in Research Archive
• Lindberg, Maren Falch; Aamodt, Arild; Badawy, Mona; Bergvad, Ingvild Buset; Furnes, Ove Nord & Gay, Caryl [Show all 13 contributors for this article] (2024). Education, exercise therapy and iCBT for patients with knee osteoarthritis - the MultiKnee trial. Full text in Research Archive
• Rognsvåg, Turid; Nordmo, Ingrid Kismul; Bergvad, Ingvild Buset; Fenstad, Anne Marie; Furnes, Ove Nord & Lerdal, Anners [Show all 9 contributors for this article] (2024). Digital health literacy in patients undergoing hip and knee arthroplasty surgery. Full text in Research Archive
• Nordmo, Ingrid Kismul; Lindberg, Maren Falch; Bergvad, Ingvild Buset; Gay, Caryl & Lerdal, Anners (2024). Digital health literacy and sociodemographic factors in patients with hip and knee OA. Full text in Research Archive
• Olsen, Unni; Lindberg, Maren Falch; Rose, Christopher James; Denison, Eva Marie-Louise; Gay, Caryl & Aamodt, Arild [Show all 11 contributors for this article] (2023). BMI, Physical Function And Osteoarthritis Severity Correlate With Physical Function One Year After Total Knee Arthroplasty: A Systematic Review And Meta-Analysis. Full text in Research Archive
• Lerdal, Anners; Kjetland, Monica & Granheim, Tove Irene (2023). Magnet-sykehus kan bedre trivsel og psykisk helse hos helsepersonell. Tidsskriftet sykepleien. ISSN 0806-7511. 111(92165). doi: 10.4220/Sykepleiens.2023.92165. Full text in Research Archive
• Rehman, Yasser; Aamodt, Arild; Lerdal, Anners & Korsvold, Ann Magrit (2023). Ingen forskjell i pasientrapporterte utfallsmål mellom korsbåndsbevarende og korsbåndsofrende kneprotesedesign. Full text in Research Archive
• Larsson, Petra; Lerdal, Anners; Gay, Caryl; Ursin, Marie Helene; Mack, Ulrich & Edvardsen, Elisabeth (2023). Physical activity and cardiorespiratory fitness three months following stroke. Full text in Research Archive
• Linnestad, Anne-Margrethe; Skogestad, Ingrid Johansen; Stubberud, Jan Egil; Indredavik, Bent; Lerdal, Anners & Gay, Caryl (2023). Using Stroke Patients´ Digital Health Skills to Inform e-Health Intervention Development. Full text in Research Archive Show summary

  Background: e-Health interventions are increasingly important in healthcare services. Describing and assessing the digital health literacy (HL) and competency of stroke survivors may enable healthcare providers to design patient-centered e-Health interventions aligned with their needs. By gaining insights into the digital health skills of the stroke population, healthcare providers can optimize the use of e-Health technologies like for example using tailored technologies as the FatigueACt app to improve stroke patients' health outcomes. Aim: Describe the HL and digital HL of a representative sample of stroke survivors who have been admitted to Norwegian hospitals and identify clusters of stroke patients with distinct digital HL profiles, both strengths and needs. Methods: The study has a cross-sectional design and a sample of 200 stroke survivors is randomly drawn from the Norwegian stroke population registered in the Norwegian Stroke Registry. Data will be collected using a structured telephone interview and questionnaires. Expected results: The description of digital HL profiles of stroke patients and identification of distinct clusters with varying levels of literacy in multiple domains, may provide valuable insights for the development of e-Health interventions. Conclusions: Understanding the digital health skills of the stroke population is crucial for tailoring e-Health interventions. Hence, we will use these findings to inform the design and customization of a phone application (FatigueACt) to address the unique needs of stroke patients with fatigue.

• Bergvad, Ingvild Buset; Kottorp, Anders; Aamodt, Arild; Lerdal, Anners; Skou, Søren Thorgaard & Lindberg, Maren Falch (2023). Translation and validation of the Norwegian version of a brief satisfaction measure for use in patients undergoing total joint arthroplasty. Full text in Research Archive
• Sellevold, Vibeke Bull; Steindal, Simen Alexander; Lindberg, Maren Falch; Småstuen, Milada Cvancarova; Aamodt, Arild & Lerdal, Anners [Show all 7 contributors for this article] (2022). IASP World Congress on Pain, Toronto: Many patients with persistent pain one year after total knee arthroplasty report improvement by 5-7 years. Full text in Research Archive
• Moen, Marie Therese; Skogestad, Ingrid Johansen & Lerdal, Anners (2022). Management of post-stroke fatigue with the FatigueACt application. Full text in Research Archive Show summary

  Background: Fatigue is a common symptom after stroke, with prevalence ranging 25-85%. As there is no treatment for fatigue, guidelines recommend different coping strategies for managing it. These strategies often involve monitoring one’s daily fatigue and energy levels in order to understand how they fluctuate – positively or negatively - based on one’s daily activities or behaviors. Based on this monitoring and personal knowledge, individuals are advised to prioritize activities, plan for periods of rest and use energy-saving strategies. Moen´s experience as a stroke survivor with post- stroke fatigue, and the coping strategies she learned from occupational therapists at Sunnaas Hospital, gave her the idea for an app that facilitates use of these strategies. The app Fatigue & ACtivity energy conservation strategies (FatigueACt) will have 3 components: 1) A calendar for planning activities and rest and for registering energy levels before and after activities and rest; 2) Prediction of one’s future fatigue levels based on data registered in the calendar; 3) Information on updated research-based knowledge about fatigue, energy-saving strategies and the importance of daily planning of activities and rest. Material and Methods: FatigueACt is being developed at Lovisenberg Diaconal Hospital by Moen and researchers in the Norwegian Study of Fatigue after Stroke Research Group (NORFAST), and programmed at the University Center of Information Technology, University of Oslo. Stroke survivors with fatigue have met with interaction designers and researchers to ensure relevance and user-friendliness. We expect to test FatigueACtv1 in Fall 2022. Feedback from users with stroke and health professionals will be used for revision of FatigueACtv2 in 2023. Results: This app will increase stroke survivors’ awareness of their personal fatigue fluctuations in daily life. The app will also give them a framework for planning future activities that is more balanced with regards to spending energy on activities in relation to restoration of energy through rest or energizing activities. The app will also make the person’s fatigue more predictable through its predictive component. Users’ documentation of variations in their fatigue may also be clinically useful in consultations with health professionals, e.g. allowing them to better adjust to the strain of rehabilitation. Development of this app is funded by LHL-Hjerneslag through Stiftelsen DAM and Lovisenberg Diaconal Hospital.

• Rognsvåg, Turid; Lindberg, Maren Falch; Lerdal, Anners; Furnes, Ove Nord; stubberud, jan & Holm, Inger [Show all 11 contributors for this article] (2022). Development of an internet-delivered cognitive behavioral therapy program for use in combination with exercise therapy and education by patients at increased risk of chronic pain following total knee arthroplasty. Full text in Research Archive
• Sellevold, Vibeke Bull; Steindal, Simen Alexander; Lindberg, Maren Falch; Småstuen, Milada Cvancarova; Aamodt, Arild & Lerdal, Anners [Show all 7 contributors for this article] (2022). NSFs faggruppe for sykepleiere i ortopedi, Oslo: "Smerter ett år etter kneprotese? Det kan fremdeles være utsikter til bedring’. Full text in Research Archive
• Moen, Marie Therese Kristine Normann; Skogestad, Ingrid Johansen & Lerdal, Anners (2022). Management of post-stroke fatigue with the FatigueACt application. Full text in Research Archive
• Rognsvåg, Turid; Bergvad, Ingvild Buset; Furnes, Ove Nord; Indrekvam, Kari; Lerdal, Anners & Lindberg, Maren Falch [Show all 9 contributors for this article] (2022). Effekt av trening, undervisning og kognitiv adferdsterapi for artrosepasienter med eller uten totalprotese i kne: En randomisert feasibility studie. Full text in Research Archive
• Lerdal, Anners (2022). How should we measures fatigue? Full text in Research Archive
• Monsen, Ragnhild Elisabeth; Kristoffersen, Anne Karin; Gay, Caryl; Herlofson, Bente Brokstad; Fjeld, Katrine Gahre & Hove, Lene Hystad [Show all 10 contributors for this article] (2022). Orale soppinfeksjoner - mer enn Candida albicans: mikrobiologiske analyser av prøver fra alvorlig syke pasienter med kreft. Full text in Research Archive Show summary

  Bakgrunn Pasienter med alvorlig kreftsykdom er utsatte for orale soppinfeksjoner, grunnet sykdommen, kreftbehandling og/eller svekket immunforsvar. Orale soppinfeksjon påvirker pasienters matlyst, ernæringstilstand og livskvalitet. Candida albicans er en vanlig soppart i munnhulen, men forekomst av non-albicans Candida-arter, og i kombinasjon med C. albicans, er økende. Artene har varierende toleranse for antimykotiske midler, det kan gi behandlingsutfordringer. Hensikten med studien var å identifisere og resistensteste Candida sopparter i munnhulen til alvorlig syke pasienter med kreft. Metode Sopprøver tatt under studien Oral Health in Advanced Cancer i perioden 2014 – 2016, ble analysert høsten 2020. Pasientprøvene ble re-dyrket ved Institutt for oral biologi, Universitetet i Oslo. Soppartene ble identifisert biokjemisk og ved DNA sekvensering, og resistenstestet for antimykotiske legemidler: fluconazole, amphotericin B, anidulafungin og nystatin. Resultat Vi analyserte totalt 56 isolater fra 45 pasienter og identifiserte syv Candida arter og en Saccharomyces. Til sammen hadde 36 pasienter oppvekst av én soppart, og 9 pasienter hadde 2 til 3 ulike sopparter i munnhulen. Av C. albicans artene var 39 av 40 følsomme for fluconazole. To Candida parapsilosis og en Candida tropicalis var resistent mot anidulafungin. En C. tropicalis var resistent mot anidulafungin. En Candida glabrata var resistent mot fluconazole. Konklusjon Studien viste at forskjellige Candida arter forekommer både i monoinfeksjoner og blandingsinfeksjoner. C. albicans var dominerende med høy følsomhet for antimykotiske midler. Blandingsinfeksjoner kan komplisere behandlingen og forårsake gjentagende infeksjoner. Mikrobiologiske prøver og analyser med identifisering og resistenstesting, bør være en del av utredningen hos pasienter med alvorlig og tilbakevendende orale soppinfeksjoner.

• Monsen, Ragnhild Elisabeth; Kristoffersen, Anne Karin; Gay, Caryl; Herlofson, Bente Brokstad; Fjeld, Katrine Gahre & Hove, Lene Hystad [Show all 10 contributors for this article] (2022). Identification and susceptibility testing of oral candidiasis in advanced cancer patients – an important diagnostic tool. Full text in Research Archive Show summary

  Background: Candida albicans is the most common fungal species detected in the oral cavity. Studies of oral fungal samples have shown an increased prevalence of non-C. albicans species in mixed infection with C. albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azole. This may have implications for treatment, due to acquired antifungal resistance. Aims: To assess the diversity and susceptibility of detected Candida species in the oral cavity in patients with advanced cancer. Methods: Clinical fungal isolates sampled in 2014-2016 from 45 patients in a hospice unit were analyzed. A total of 56 isolates were grown on chromID Candida plates. After phenotypic identification by colour of the colonies, one single colony of each species was re-cultivated and prepared for identification on a VITEK2® system. Susceptibility testing with E-test was performed on RPMI agar, and the antifungal agents fluconazole, amphotericin B, anidulafungin and nystatin were tested. Results: A total of 56 Candida isolates were identified. The diversity of Candida species was dominated by C. albicans at 89%, followed by C. glabrata 11%, C. parapsilosis 7%, C. tropicalis 4%, C. krusei 2%, C. guilliermondii 2% and C. dubliniesis 2%. Thirty-six patients had monoculture, and nine patients had 2-3 different species detected. Almost all C. albicans strains (97.5%) were susceptible to fluconazole. One C. parapsilosis and one C. tropicalis strain were resistant to anidulafungin. One C. glabrata was resistant to fluconazole and another was just below the threshold for resistance. Conclusion: C. albicans was the most prevalent Candida species in our sample. Variation in susceptibility was observed in patients with both C. albicans and C. glabrata. Combinations of Candida species and the lack of identification and susceptibility testing may lead to inadequate treatment and accelerate the development of resistance.

• Monsen, Ragnhild Elisabeth; Kristoffersen, Anne Karin; Gay, Caryl; Herlofson, Bente Brokstad; Fjeld, Katrine Gahre & Hove, Lene Hystad [Show all 10 contributors for this article] (2022). Oral candidiasis in advanced cancer – identification and susceptibility testing of detected Candida species. Full text in Research Archive Show summary

  Introduction: Candida albicans is the most common fungal species in the oral cavity. Increased prevalence of non-C. albicans are detected, and co-infection with C. albicans may have implications for treatment, due to antifungal resistance. The aim of the study was to assess the diversity and susceptibility of oral yeasts in patients with advanced cancer. Methods: Clinical fungal isolates were sampled in 2014-2016 from 45 patients in a hospice unit. Totally 56 isolates were grown on chromID Candida plates, prepared for biochemical identification, and controlled with DNA sequencing. E-test was performed with the antifungal agents fluconazole, amphotericin B, anidulafungin and nystatin were tested. Results: A total of 56 isolates were identified. Candida species was dominated by C. albicans at 71%, followed by C. glabrata 9%, C. parapsilosis 5%, C. tropicalis 4%, C. krusei 2%, C. guilliermondii 2% and C. dubliniesis 2%. Nine patients had 2-3 different species. C. albicans strains were susceptible to fluconazole in 97.5%. One C. parapsilosis and one C. tropicalis strain were resistant to anidulafungin. One C. glabrata was resistant to fluconazole and another was just below the threshold for resistance. The sequencing confirmed the biochemical identification. Conclusion: C. albicans was the most prevalent species. Variation in susceptibility was observed in patients with mixed colonies. Combinations of Candida species and the lack of identification and susceptibility testing may lead to inadequate treatment.

• Monsen, Ragnhild Elisabeth; Nordgarden, Hilde; Gay, Caryl; Lerdal, Anners & Herlofson, Bente Brokstad (2022). Munntørrhet - et manglende symptom i Edmonton Symptom Assessment System? Full text in Research Archive
• Nyhagen, Ragnhild; Kirkevold, Marit; Rustøen, Tone & Lerdal, Anners (2025). Symptom Communication in the Intensive Care Unit: An Exploration Through Participant Observation and Individual Interviews with Patients, Family Members, and Clinicians. Universitetet i Oslo. ISSN 9788234806049. Full text in Research Archive Show summary

  Symptom distress is a major concern for patients in intensive care units (ICU), and common symptoms include pain, anxiety, dyspnoea, thirst, and tiredness. Symptoms are subjective experiences that cannot be monitored or measured objectively but must somehow be communicated by the patient. Communication in the ICU is challenged due to intubation, treatment, and illness, and challenges to communication cause challenges to symptom assessment and management. The aim of this fieldwork study was to explore symptom communication between patients, family members, and clinicians in the ICU to identify communication challenges, patterns of symptom communication, and forms of family engagement. Mechanically ventilated patients were observed in interaction with family and clinicians. Following participant observation, the same patients, and a sample of family members and clinicians were interviewed individually, providing a combination of perspectives not previously explored in research on symptom communication in the ICU. This thesis shows how clinicians, through vigilance and behaviour, used clinical expertise to foresee possible symptoms, prevent and manage them when necessary, but it also shows when symptom communication failed to be successful. Family members took an active role in symptom communication, and patients described them as extremely important. The serious condition of patients caused communication challenges beyond lack of speech, some of which were not evident until the findings from the participant observation and interviews with patients, family members, and clinicians were combined. Due to the complexity of symptoms, assessment tools and task-oriented communication are insufficient to provide clinicians with the full symptom experience of patients, and patients are left with unrelieved symptoms.

• Olsen, Unni; Lerdal, Anners; Skare, Øystein; Lindberg, Maren Falch & Aamodt, Arild (2024). Advancing the understanding of preoperative factors and patient experiences related to pain and physical function after total knee arthroplasty. Universitetet i Oslo. ISSN 9788234803284. Full text in Research Archive Show summary

  Total Knee Arthroplasty (TKA) is a commonly performed surgical procedure for treating knee osteoarthritis. Despite its prevalence, a significant number of patients continue to suffer from chronic post-surgical pain and impaired function following the surgery. The overarching aim of this thesis was to advance the understanding of preoperative factors and patient experiences related to pain and function after TKA. A meta-analysis of pain outcome one year after TKA identified that higher levels of preoperative pain catastrophizing, more severe pain, and more symptomatic joints were correlated with more severe postoperative pain one year after surgery. At the five-year follow-up with evidence from a prospective observational study, the same factors, with the exception of pain catastrophizing, were correlated with more severe pain. More severe radiographic osteoarthritis was correlated with less pain at both one and five years after the surgery. In a meta-analysis examining function outcomes one year after TKA, a correlation was estimated between higher preoperative body mass index and poorer function post-surgery. More severe radiographic osteoarthritis was correlated with better function. Furthermore, in a prospective observational study, more severe preoperative anxiety was correlated with worse pain-related functional impairment, whereas male sex was correlated with better functional outcome five years after TKA. In a qualitative study, participants without pain improvement one year after TKA, described stories of living with persistent pain or psychosocial stress in years before surgery. The findings from this thesis emphasize the importance of including prognostic factors in future predictive models for TKA outcomes. The study also underscores the need to integrate patient experiences for effective pre-surgical knee osteoarthritis management.

• Monsen, Ragnhild Elisabeth; Lerdal, Anners; Herlofson, Bente Brokstad & Nordgarden, Hilde (2024). Oral Health in Advanced Cancer. Assessment and management of oral symptoms and fungal infection in adult patients with advanced cancer. Universitetet i Oslo. ISSN 9788234804137. Full text in Research Archive Show summary

  Oral symptom and problems are highly prevalent in patient with advanced cancer, and xerostomia is reported in 84% of the cases. Between 30% - 50% of the patients develop oral infections, which most common infection is oral candidiasis. Despite the symptoms negative impact on quality of life, oral symptoms and problems are not systematically assessed or treated in palliative care. The evidence supporting the effectiveness of mouth rinses in alleviating oral discomfort is limited. Additionally, knowledge of oral fungal species and their susceptibility to antifungal agents are spares. The overall aim of this thesis was to investigate oral symptoms and problems in patients with limited life expectancy receiving inpatient palliative care due to advanced cancer. In study 1 we performed an interventions study where we investigated the effect of a mouth rinse based on the herb Salvia Officinalis (SO) compared to standard care using normal saline in 88 patients with advanced cancer. Both groups showed statistically significant improvement in their overall oral symptoms and SO was as effective as standard care. In study 2 we conducted a microbiological analysis of oral swab tests from 45 patients taken during study 1. Seven different Candida species were detected, and nine patients had mixed infection. The susceptibility to antifungal agents was high. In Study 3, we observed the symptom dry mouth in two different versions of a symptom assessment questionnaire. The symptom dry mouth was included in one version, while in a revised version, patients were required to report dry mouth as an “Other problem”. Dry mouth was the third most reported symptom when prompted in a symptom list, whereas the symptom was significantly less reported in the revised version. This thesis highlights the presence of oral symptoms and problems in patients with advanced cancer and has shown that SO mouth rinse was as good as normal saline in an oral care procedure. Furthermore, there is a diversity of Candida species and mixed oral infections occurs. Finally, systematic assessment is crucial to identify the present of different oral symptoms.

• Enbakom, Mestawet Getachew; Lindberg, Maren Falch & Lerdal, Anners (2024). Pain after surgery for knee replacement in Norway and for traumatic injury in Ethiopia: Observational cohort studies. Universitetet i Oslo. ISSN 9788234803321. Full text in Research Archive Show summary

  Pain after orthopedic surgery is a considerable clinical problem. There is a lack of knowledge on acute pain trajectories, as well as how psychological, clinical, surgical, and lifestyle risk factors may be related to severe acute pain in patients undergoing surgery following traumatic fracture in Ethiopia. While several predictors of chronic pain after total knee arthroplasty (TKA) have been identified, further knowledge is needed on the contributions of co‐occurring preoperative symptoms (pain, fatigue, sleep problems, depression), acute pain intensity and opioid intake during the early postoperative period, on chronic pain outcomes after TKA. The doctoral thesis “Pain after surgery for knee replacement in Norway and for traumatic fractures in Ethiopia: Observational cohort studies” aimed to identify the association between pre, intra and postoperative factors, and acute pain trajectories after traumatic fracture surgery and chronic knee pain following TKA. Mestawet Getachew and co-authors found that higher levels of preoperative pain and fatigue were associated with moderate-severe knee pain 12 months after TKA. Furthermore, neither the patients’ trajectories of pain nor opioid intake during the early postoperative period were associated with moderate-severe pain 12 months after TKA. In the Ethiopian sample, two subgroups of patients with distinct pain trajectories following fracture surgery were identified: The rapid pain relief group (48% of the sample) and the consistently high pain group (52% of the sample). Patients who had longer duration of surgery, received general anesthesia and had higher levels of preoperative pain were more likely to be in the consistently high pain group. The findings in this thesis are of importance for clinicians when evaluating orthopedic patients, as this knowledge may help to identify patients at higher risk for poor pain outcome and may help researchers in developing preventive measures for patients at risk for poor pain outcome.

• Kjeverud, Anita; Østlie, Kristin; Schanke, Anne-Kristine; Lerdal, Anners & Andersson, Stein (2024). Post-stroke fatigue: Assessment, trajectories and associated factors. Universitetet i Oslo. Full text in Research Archive Show summary

  Fatigue is a frequent and severe symptom in stroke survivors, associated with poorer physical health, reduced quality of life and even increased mortality. Although post-stroke fatigue (PSF) is common and disabling, there is no consensus on definition, evaluation methods or interventions. Furthermore, the underlying mechanisms of PSF and the significance of different biopsychosocial factors in PSF development are not fully elucidated. The overall aim of this thesis was to increase the knowledge about assessment, trajectories and associated factors of PSF to establish a better knowledge base for developing treatment strategies aiming at ameliorating PSF. The work is based on two longitudinal observational studies. In the first study, displayed in paper I, trajectories of PSF through the first 18 months post-stroke were investigated. The second study yielded the data for paper II and III. In paper II the overlap and differences in prevalence-estimates in fatigue-caseness using the Fatigue Severity Scale, the Fatigue Questionnaire and the Lynch Interview at one time-point in a sample of stroke-patients was explored. In addition, we investigated how PSF measured with these instruments were associated with different predictor-variables. In paper III, the associations of demographic, medical and symptom-related factors with PSF in the acute phase, at three and twelve months post-stroke were explored. The first aim of the thesis was to explore whether subgroups of stroke survivors with distinct trajectories could be identified using Growth Mixture Modeling and secondly whether these subgroups differed on sociodemographic, medical and symptom-related characteristics. Paper I displays three distinct trajectories of PSF from the acute phase to 18 months post stroke, namely courses displaying low, medium and high fatigue. Belonging to the high fatigue-class was associated with pre-stroke fatigue, multiple comorbidities and not working. Belonging to a low fatigue-class was associated with few symptoms of depression and being more independent in personal activities of daily living. Paper II displays a vast variance in prevalence of fatigue-cases in the same sample at the same time-point depending on which of three instruments was used to assess fatigue symptoms and cases. There was also a variance in the associations between being a fatigue-case and the analyzed predictor variables using the different instruments, probably reflecting that they cover slightly different aspects of the PSF-experience. In paper III, the associations of demographic, medical and symptom-related factors with PSF at different time-points were explored. The findings suggest that PSF may be triggered, maintained or worsened by stroke-related impairments, psychological distress and/or maladaptive coping strategies. Furthermore, we found that significant PSF also occur in patients with minor stroke-sequelae. In summary, this thesis gives insights into different trajectories of fatigue post-stroke. It also expands on current knowledge about which factors may serve as protective against PSF-development and which factors may render stroke survivors vulnerable for developing PSF, hereby suggesting possible targets for development of interventions aimed at ameliorating PSF. A special awareness should be on patients with minor stroke-sequale as they may have unmet need for follow-up, increasing the risk of PSF-development. The results in this thesis also demonstrate how different methodology yields a wide variance in identification of fatigue-cases, underscoring the importance of reaching a consensus on how to measure fatigue. Correct identification of fatigue-cases is crucial for understanding fatigue, its causes and for development of empirically based interventions. Further studies are warranted in larger samples, preferably multicenter studies, to allow for necessary increase in the sample size, to achieve consensus on how to measure fatigue. Methods should include a wide array of measurements, reflecting a biopsychosocial understanding of fatigue

• Rehman, Yasser; Aamodt, Arild; Lerdal, Anners; Røhrl, Stephan & Gay, Caryl (2024). The impact of implant design and severity of knee osteoarthritis on clinical outcome after total knee arthroplasty. Universitetet i Oslo. ISSN 9788234803758. Full text in Research Archive
• Skogestad, Ingrid Johansen; Lerdal, Anners; Kirkevold, Marit & Indredavik, Bent (2023). Developing and testing a patient-reported outcome measure for post-stroke fatigue – a mixed-methods approach. Universitetet i Oslo. ISSN 9788234802782. Full text in Research Archive Show summary

  Post-stroke fatigue (PSF) is a highly prevalent condition which negatively impacts the lives of stroke survivors. Currently, there is a lack of evidence-based treatments for PSF, and a major barrier to further progress is the absence of a high-quality instrument to measure and diagnose PSF. The overarching aim of this thesis was to develop and evaluate a new patient-reported outcome measure (PROM) for fatigue in stroke patients. This thesis adhered to PROM development guidelines, combining qualitative and quantitative methods. We found that existing fatigue PROMs used in stroke populations have significant shortcomings and do not comply with the best practice guidelines and high standards set by regulators. As a result, we developed a new PROM specifically targeted for measuring PSF. We explored stroke survivors and health professionals’ experiences with fatigue, which further led to the formulation of a definition and a conceptual framework of PSF. These results guided the creation of items in our new PROM. The measurement properties of the instrument were then tested in additional studies with stroke patients. We found that our new PROM exhibited strong content validity, structural validity, and internal consistency.

View all works in NVA