When global rating of change contradicts observed change: Examining appraisal processes underlying paradoxical responses over time.

Abstract

Interpreting change scores is challenging when patients' global rating of change (GRC) scores contradict their observed change scores. We examine appraisal processes associated with having GRC-observed change contradictions. This secondary analysis of longitudinal multiple sclerosis (MS) registry data examined predictors of GRC scores in the whole sample (n=858). Logistic modeling then examined predictors of membership in one of two paradoxical subgroups (n=525): (a) Worsened GRC with unchanged observed Rand-12 Mental Component scores (MCS) (Symptom-Maximizers, n=171) versus no change GRC among stable MCS subsample; and (b) same GRC with declined observed MCS scores (Symptom-Minimizers, n=84) versus declining GRC among declining MCS subsample. Independent variables were cognitive appraisal processes from the Quality of Life (QOL) Appraisal Profile. GRC scores were more strongly associated with appraisal processes than with change in patient-reported outcomes (PROs) (R 2=11 and 2%, respectively). Symptom-Maximizers tended to focus on MS-related experiences and emphasize big changes; over time, they decreasingly defined QOL in terms of independence, increasingly focused on their MS, and increasingly compared themselves to doctor's predictions (Pseudo R 2=0.20). In contrast, Symptom-Minimizers tended not to recall recent episodes; over time, they focused increasingly on goals related to living situation and emphasized long-term concerns (Pseudo R 2=0.25). Appraisal explains more variance in GRC scores than do changes in PROs. People whose GRC assessment contradicts their observed change can be characterized by distinct cognitive appraisal processes reflecting response shift.