Response Shift Phenomenon Research Articles

The Effect of the Response Shift Phenomenon on the Results of an Integrative Medicine Workshop Series.

The Effect of the Response Shift Phenomenon on the Results of an Integrative Medicine Workshop Series.

Response-shift effects in childhood cancer survivors: Aprospective study.

Treatment-related late effects can worsen over time among cancer survivors. Such worsening health states may trigger changes in internal standards, values, or conceptualization of quality-of-life (QOL). This "response-shift" phenomenon can jeopardize the validity of QOL assessment, and misrepresent QOL comparisons over time. This study tested response-shift effects in reporting future-health concerns among childhood cancer survivors who experienced progression in chronic health conditions (CHCs). 2310 adult survivors of childhood cancer from St. Jude Lifetime Cohort Study completed a survey and clinical assessment at two or more timepoints. Based on 190 individual CHCs graded for adverse-event severity, global CHC burden was classified as "progression" or "non-progression". QOL was assessed using the SF-36TM eight domains and physical- and mental-component summary scores (PCS, MCS). A single global item measured concerns about future health. Random-effects models comparing survivors with and without progressive global CHC burden (progressors vs. non-progressors) evaluated response-shift effects (recalibration, reprioritization, reconceptualization) in reporting future-health concerns. Compared with non-progressors, progressors were more likely to de-emphasize (or downplay) overall physical and mental health in evaluating future-health concerns (p-values<0.05), indicating recalibration response-shift, and more likely to de-emphasize physical health earlier rather than later in follow-up (p-value<0.05), indicating reprioritization response-shift. There was evidence for a reconceptualization response-shift with progressor classification associated with worse-than-expected future-health concerns and physical health, and better-than-expected pain and role-emotional functioning (p-values<0.05). We identified three types of response-shift phenomena in reporting concerns about future health among childhood cancer survivors. Survivorship care or research should consider response-shift effects when interpreting changes in QOL over time.

Factors associated with long-term functional and psychosocial outcomes in patients with non-Hodgkin lymphoma.

To assess the long-term functional, psychosocial and participation outcomes in an Australian cohort of non-Hodgkin lymphoma (NHL) survivors. A cross-sectional sample of adult NHL survivors at the Peter MacCallum Cancer Centre (between 2015 and 2020), participated by completing validated questionnaires. A series of analyses described their current level of function, psychosocial well-being, and participation. Of 129 participants (mean (M) ± standard deviation (SD) age: 62.5 ± 8.8 years), the majority (58%) had aggressive NHL and grade III-IV (72%), with time since diagnosis of 4.6 ± 1.2 years. Participants reported ongoing issues after completion of treatment: fatigue (63%), bladder dysfunction (61%), cognitive impairment (53%), and NHL-related pain (46%). Most made good functional recovery (M ± SD) (Functional Independent Measure-Motor: 79.5 ± 8.2), reported minimal change in their negative emotional states, and NHL-specific quality of life (QoL) (Functional Assessment of Cancer Therapy-Lymphoma: 133.5 ± 22.1). Participants were "well" adjusted to community living (Community Integration Measure: 42.2 ± 7.4) and satisfied with their current life (Satisfaction with Life Scale: 26.3 ± 6.0). Factors significantly associated with the poorer current level of function were: age at diagnosis < 60 years, time since NHL diagnosis > 4.5 years, and aggressive NHL type. Despite good functional recovery and adjustment in the community, NHL survivors report the presence of ongoing residual impairments and cognitive issues, which requires long-term rehabilitation-inclusive management.

Listening to the elephant in the room: response-shift effects in clinical trials research

BackgroundWhile a substantial body of work postulates that adaptation (response-shift effects) may serve to hide intervention benefits, much of the research was conducted in observational studies, not randomized-controlled trials. This scoping review identified all clinical trials that addressed response shift phenomena, and characterized how response-shift effects impacted trial findings.MethodsA scoping review was done of the medical literature from 1968 to 2021 using as keywords “response shift” and “clinical trial.” Articles were included if they were a clinical trial that explicitly examined response-shift effects; and excluded if they were not a clinical trial, a full report, or if response shift was mentioned only in the discussion. Clinical-trials papers were then reviewed and retained in the scoping review if they focused on randomized participants, showed clear examples of response shift, and used reliable and valid response-shift detection methods. A synthesis of review results further characterized the articles’ design characteristics, samples, interventions, statistical power, and impact of response-shift adjustment on treatment effect.ResultsThe search yielded 2148 unique references, 25 of which were randomized-controlled clinical trials that addressed response-shift effects; 17 of which were retained after applying exclusion criteria; 10 of which were adequately powered; and 7 of which revealed clinically-important response-shift effects that made the intervention look significantly better.ConclusionsThese findings supported the presumption that response shift phenomena obfuscate treatment benefits, and revealed a greater intervention effect after integrating response-shift related changes. The formal consideration of response-shift effects in clinical trials research will thus not only improve estimation of treatment effects, but will also integrate the inherent healing process of treatments.Key pointsThis scoping review supported the presumption that response shift phenomena obfuscate treatment benefits and revealed a greater intervention effect after integrating response-shift related changes.The formal consideration of response-shift effects in clinical trials research will not only improve estimation of treatment effects but will also integrate the inherent healing process of treatments.

If it's information, it's not "bias": a scoping review and proposed nomenclature for future response-shift research.

The growth in response-shift methods has enabled a stronger empirical foundation to investigate response-shift phenomena in quality-of-life (QOL) research; but many of these methods utilize certain language in framing the research question(s) and interpreting results that treats response-shift effects as "bias," "noise," "nuisance," or otherwise warranting removal from the results rather than as information that matters. The present project will describe the various ways in which researchers have framed the questions for investigating response-shift issues and interpreted the findings, and will develop a nomenclature for such that highlights the important information about resilience reflected by response-shift findings. A scoping review was done of the QOL and response-shift literature (n = 1100 articles) from 1963 to 2020. After culling only empirical response-shift articles, raters characterized how investigators framed and interpreted study research questions (n = 164 articles). Of 10 methods used, papers using four of them utilized terms like "bias" and aimed to remove response-shift effects to reveal "true change." Yet, the investigators' reflections on their own conclusions suggested that they do not truly believe that response shift is error to be removed. A structured nomenclature is proposed for discussing response-shift results in a range of research contexts and response-shift detection methods. It is time for a concerted and focused effort to change the nomenclature of those methods that demonstrated this misinterpretation. Only by framing and interpreting response shift as information, not bias, can we improve our understanding and methods to help to distill outcomes with and without response-shift effects.

Using structural equation modeling to investigate change and response shift in patient-reported outcomes: practical considerations and recommendations

BackgroundPatient-reported outcomes (PROs) are of increasing importance for health-care evaluations. However, the interpretation of change in PROs may be obfuscated due to changes in the meaning of the self-evaluation, i.e., response shift. Structural equation modeling (SEM) is the most widely used statistical approach for the investigation of response shift. Yet, non-technical descriptions of SEM for response shift investigation are lacking. Moreover, application of SEM is not straightforward and requires sequential decision-making practices that have not received much attention in the literature.AimsTo stimulate appropriate applications and interpretations of SEM for the investigation of response shift, the current paper aims to (1) provide an accessible description of the SEM operationalizations of change that are relevant for response shift investigation; (2) discuss practical considerations in applying SEM; and (3) provide guidelines and recommendations for researchers who want to use SEM for the investigation and interpretation of change and response shift in PROs.ConclusionAppropriate applications and interpretations of SEM for the detection of response shift will help to improve our understanding of response shift phenomena and thus change in PROs. Better understanding of patients’ perceived health trajectories will ultimately help to adopt more effective treatments and thus enhance patients’ wellbeing.

Impact of reconceptualization response shift on rating of quality of life over time among people with advanced cancer.

People with cancer may experience change in what constitutes quality of life (QOL) over time as a result of the cancer progression (true change) or adaptation to the experience, considered as a response shift phenomenon. As individualized measures are ideally suited to explore response shift, this study aimed to estimate the extent to which reconceptualization response shift occurred over time in a cancer population and the impact of this response shift on estimates of change on QOL measures. Ninety-seven people with advanced cancer completed the study measures including the Patient-Generated Index (PGI) at diagnosis (T0) and 1year later (T1). The response shift indicator was the change in the number of areas nominated (range - 4 to + 3). Multivariate linear regression was used to estimate the effect of changing areas on change in the PGI score, single indicators of global QOL, and the EQ-5Dindex adjusted for age and sex. Approximately 72% of people in this sample either added or dropped areas over time. People who dropped more than two areas had higher PGI scores at T1 than T0 while people who added areas showed low PGI score. The results are consistent with the PGI framework as areas nominated tend to focus on negative aspects of QOL.

Long-term Quality of Life of Patients With Permanent End Ileostomy: Results of a Nationwide Cross-Sectional Survey.

Patients with permanent end ileostomy are at high risk for detrimental stomal effects on their quality of life. However, little is known about the long-term quality of life of these patients. The purpose of this study was to assess long-term quality of life in patients with permanent end ileostomy. Registration at the German self-help organization ILCO was used for this study. Selection included a cross-sectional survey of 1434 patients with permanent end ileostomy. Quality of life was assessed using the Medical Outcomes Study Short Form 36, including physical and mental component summary scores, the Gastrointestinal Quality of Life Index, and the Cleveland Global Quality of Life Index. Multivariate risk factor analysis was performed. A total of 783 responders were included. Indications for ileostomy included ulcerative colitis (44%), Crohn's disease (38%), and colorectal cancer (7%). Adverse effects on daily life because of stoma were reported by 72% of participants. Quality of life was significantly impaired compared with the general population on all of the summary scores and several subscales (physical component summary: 44.6 ± 10.4 (mean ± SD) vs 50.2 ± 10.2, p < 0.001; mental component summary: 47.5 ± 10.7 vs 51.5 ± 10.2, p < 0.001; Gastrointestinal Quality of Life Index: 94.4 ± 16.4 vs 126.0, p < 0.001). Stoma care problems affecting quality of life were reported by 63% of respondents. These included parastomal hernia (p < 0.001), stenosis (p = 0.003), and prolapse (p = 0.008). Vitamin B12, iron, and zinc deficiencies were also associated with diminished quality of life; in particular, vitamin B12 deficiency was associated with reduced mental and emotional quality of life. Not all patients undergoing ileostomy in Germany are registered at ILCO, and there were many nonresponders. In addition, the inherent limitations of cross-sectional studies should be considered, including the response-shift phenomenon. Quality of life was markedly impaired in patients with permanent end ileostomy as compared with the general population. The main reasons were stoma-associated morbidity and nutritional deficiency syndromes. These findings highlight the importance of prevention, screening, and adequate treatment.

An Exploratory Study Identifying a Possible Response Shift Phenomena of the Glasgow Hearing Aid Benefit Profile.

A then-test technique was used to investigate the possibility of a response shift in the Glasgow hearing aid benefit profile (GHABP).Following completion of part 1 of the GHABP, 16 adults were invited for hearing-aid follow up appointments. In accordance with then-test technique, participants were asked to think back to before they had their hearing-aids fitted and the GHABP part 1 was completed again to re-establish the disability and handicap scores. These scores were then compared with the initial GHABP part I scores. Paired T testing and Wilcoxon Rank tests were carried out to investigate the statistical significance of the response shift effect.Statistically significant differences were seen between initial and retrospective GHABP (disability) scores using t test. No significant differences could be seen between the initial and retrospective handicap scores. Results suggest participants may have demonstrated a possible response shift phenomenon with the disability construct of the GHABP questionnaire, related to a possible re-calibration effect or a denial of disability effect.This exploratory study suggests that the GHABP questionnaire may be subject to a response shift phenomena. We suggest that further more robust studies are completed to verify this and recommend that this could have psychological impact on participants when explaining the results of the outcome measure and may affect hearing aid use. There is also potential for this phenomenon to affect global GHABP scores specifically when demonstrating to stakeholders the overall success of an audiology service.

Using structural equation modeling to detect response shifts and true change in discrete variables: an application to the items of the SF-36.

PurposeThe structural equation modeling (SEM) approach for detection of response shift (Oort in Qual Life Res 14:587–598, 2005. doi:10.1007/s11136-004-0830-y) is especially suited for continuous data, e.g., questionnaire scales. The present objective is to explain how the SEM approach can be applied to discrete data and to illustrate response shift detection in items measuring health-related quality of life (HRQL) of cancer patients.MethodsThe SEM approach for discrete data includes two stages: (1) establishing a model of underlying continuous variables that represent the observed discrete variables, (2) using these underlying continuous variables to establish a common factor model for the detection of response shift and to assess true change. The proposed SEM approach was illustrated with data of 485 cancer patients whose HRQL was measured with the SF-36, before and after start of antineoplastic treatment.ResultsResponse shift effects were detected in items of the subscales mental health, physical functioning, role limitations due to physical health, and bodily pain. Recalibration response shifts indicated that patients experienced relatively fewer limitations with “bathing or dressing yourself” (effect size d = 0.51) and less “nervousness” (d = 0.30), but more “pain” (d = −0.23) and less “happiness” (d = −0.16) after antineoplastic treatment as compared to the other symptoms of the same subscale. Overall, patients’ mental health improved, while their physical health, vitality, and social functioning deteriorated. No change was found for the other subscales of the SF-36.ConclusionThe proposed SEM approach to discrete data enables response shift detection at the item level. This will lead to a better understanding of the response shift phenomena at the item level and therefore enhances interpretation of change in the area of HRQL.Electronic supplementary materialThe online version of this article (doi:10.1007/s11136-015-1195-0) contains supplementary material, which is available to authorized users.

Exploring the Response Shift Phenomenon in Childhood Patients With Cancer and Its Effect on Health-Related Quality of Life

To explore the response shift phenomenon in pediatric patients with cancer and to determine its effects on ratings of health-related quality of life (HRQOL). Retrospective pre- and post-test design. Pediatric oncology department in the northern part of the Netherlands. 37 children newly diagnosed with cancer and 80 parents. The then-test method was used to determine response shift. HRQOL was assessed within two weeks postdiagnosis (pretest) and three months later (post-test) using both child and parent reports of PedsQL and Cantril's ladder. The post-test and then-test were administered concurrently. Overall and multidimensional HRQOL. Scores on Cantril's then-test were lower than the pretest in both child and parent reports, indicating response shift in the assessment of overall HRQOL. Children experienced a greater response shift than parents. No differences were found between the PedsQL then- and pretests. Both child- and parent-report ratings of overall HRQOL were affected by response shift, resulting in an underestimation of the improvement in overall HRQOL between diagnosis and three months postdiagnosis. No response shift was demonstrated in the more specific domains of HRQOL (PedsQL). Knowledge of the response shift phenomenon helps nurses to better interpret the outcomes of HRQOL. The use of the PedsQL instrument is recommended in future studies that aim to demonstrate changes in HRQOL.

Impact of response shift on the assessment of treatment effects using the Oral Health Impact Profile

The assessment of changes in oral health-related quality of life (OHRQoL) is challenging because individuals' concepts and internal standards of OHRQoL may change over time. The aim of this study was to detect response shifts in OHRQoL assessments made using the Oral Health Impact Profile (OHIP). Oral health-related quality of life was assessed in a consecutive sample of 126 patients seeking prosthodontic care. Patients were asked to rate their OHRQoL before treatment started and 1 month after treatment was finished, using the German 49-item version of the OHIP. When rating their OHRQoL after treatment, patients were also asked to rate their pre-treatment OHRQoL without having access to their baseline data. The response shift was calculated as the difference in OHIP summary scores between the initial assessment and the retrospective baseline assessment. The OHIP mean scores decreased from 31.8 at the initial baseline assessment to 24.4 after treatment. The retrospective baseline assessment resulted in an OHIP mean score of 38.1, corresponding to a response shift of 6.3 OHIP points. The effect size (Cohen's d = 0.21) of the response shift was considered small. The response shift phenomenon and its magnitude have important implications for dental practice, where patients and dentists often assess perceived treatment effects retrospectively.

Response shift in oral health‐related quality of life measurement in patients with partial edentulism

The purposes of this study were to determine whether a response shift was observable after partial denture treatment and to identify the predictors that influenced the response shift magnitude and direction. A total of 173 consecutive patients with no more than eight missing teeth who received implant-supported, fixed or removable partial dentures at Okayama University Dental Hospital were asked to complete a full-version Oral Health-Related Quality of Life (OHRQoL) questionnaire before (pre-test) and after treatment (post-test). Additionally, a short form (then-test) consisting of seven questions selected from the full version had its reliability verified and was utilised to retrospectively assess the pre-treatment OHRQoL status. The difference between the summary scores of the then-test and the pre-test determined the response shift magnitude and direction. The then-test mean score (22·9 ± 6·6) was significantly lower (worse OHRQoL) than that of the pre-test (26·4 ± 5·2). The response shift effect size was of moderate magnitude and negative direction (d = -0·78). A multiple regression analysis showed that age (younger patients) (P < 0·01), number of replaced teeth (fewer) (P < 0·01) and pre-test scores (lower) (P < 0·01) were the significant predictors for response shift. In conclusion, a response shift phenomenon with negative and moderate effect size was observed after partial denture treatment. The significant predictor variables were young age, fewer numbers of replaced teeth and lower pre-test scores.

The Impact of Response Shift on Perceived Disability Two Years Following Rotator Cuff Surgery

Understanding how patients appraise their health-related problems is important for an accurate assessment of recovery over time. It has been proposed that the response shift phenomenon has an impact on self-report measures, and this may subsequently affect measurement of true treatment effects. The objective of the present study was to explore the impact of response shift on the subjective perception of disability following rotator cuff surgery. We conducted a repeated-measures study of the outcome following surgical decompression or repair of the rotator cuff. The American Shoulder and Elbow Surgeons (ASES) questionnaire was used in a thentest design to measure recalibration response shift two years following surgery. Disability was measured with a disease-specific measure. Objective findings consisting of the range of motion and strength were recorded preoperatively and postoperatively. Parametric and nonparametric univariate and multivariate analyses were performed. The contribution of recall bias was estimated by assessing agreement between pretest and thentest scores on the basis of the percentage of agreement and the Spearman correlation coefficient. One hundred and seven patients (forty-one women and sixty-six men; mean age, fifty-seven years) participated in the study. Seventy-two patients had decompression surgery and forty-four underwent a rotator cuff repair; nine patients had both procedures. A significant response shift was observed in the pain domain (p < 0.0001) and not in the functional ability domain of the ASES (p = 0.58). Three distinct patterns of response shift were observed. Univariate analyses showed that satisfaction with the result of the surgery, the range of motion, strength, age, and response shift were associated with disability. The final multivariate analysis showed that disability at two years following the surgery was affected by the range of motion (p < 0.0001), satisfaction (p = 0.006), age (p = 0.02), and response shift (p = 0.03). The response shift phenomenon exists in patients who have undergone surgery for rotator cuff disorders and has different patterns related to overrating or underrating of preoperative pain. A recalibration response shift characterized by overrating of preoperative pain was associated with lower levels of residual disability at two years following the surgery.

Applications of Response Shift Theory and Methods to Participation Measurement: A Brief History of a Young Field

Schwartz CE. Applications of response shift theory and methods to participation measurement: a brief history of a young field. Measurement of participation in people with disability can pose psychometric and conceptual challenges. Ambiguous or paradoxical findings can occur because of differences among people or changes within people regarding internal standards, values, or conceptualization of participation. These response shifts can affect standard psychometric indices, such as reliability and validity. We focus herein on the interpretation of patient-reported outcomes and, in particular, on the cognitive appraisal processes known as response shift. We present theoretical and conceptual distinctions building on response shift theory and other current developments in health-related quality of life research to inform participation measurement research. We discuss how response shifts can influence the interpretation of reliability, validity, and responsiveness of participation measures. We then discuss the evidence for the clinical significance of response shift phenomena and describe current design, statistical, and individualized approaches for detecting response shift phenomena.

Response shift phenomenon. Does this apply to spine outcomes research?

COMMENTARY ON: Schwartz CE, Finkelstein JA. Understanding inconsistencies in patient-reported outcomes after spine treatment: response shift phenomenon. Spine J 2009;9:1039–1045 (in this issue) .

Response shift and outcome assessment in orthopedic surgery: is there a difference between complete and partial treatment?

Outcome measurement after surgical treatment for spinal disorders has traditionally relied on pre- and posttreatment assessment, measuring change from baseline to follow-up. These assessments assume that patients have the same perspective of their disease, and the same evaluation for their assessment of quality of life (QOL) throughout the recovery process. If the patient's internal standard of measurement were to change, the postoperative assessment must reflect this shift in addition to the actual changes in the level of functioning. Comparisons of pretest with posttest ratings may be confounded by this distortion of the scale, and consequently, an inaccurate interpretation of the effectiveness of the treatment may be obtained. We have previously shown that “response shift” exists in outcome measures used in orthopedic surgery when using self-report questionnaires [ 1 Razmjou H. Yee A. Ford M. Finkelstein J.A. Response shift in outcome assessment in patients undergoing total knee arthroplasty. J Bone Joint Surg Am. 2006; 88: 2590-2595 Crossref PubMed Scopus (62) Google Scholar , 2 Razmjou H. Schwartz C.E. Yee A. Finkelstein J.A. Traditional assessment of health outcome following total knee arthroplasty was confounded by response shift phenomenon. J Clin Epidemiol. 2009; 62: 91-96 Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar ]. The response shift phenomenon is better studied in the fields of education, nutrition, program evaluation, and in conditions, such as cancer, acquired immunodeficiency syndrome (AIDS), multiple sclerosis, stroke, and others [ 3 Echteld M.A. Deliens L. Ooms M.E. Ribbe M.W. van der Wal G. Quality of life change and response shift in patients admitted to palliative care units: a pilot study. Palliat Med. 2005; 19: 381-388 Crossref PubMed Scopus (25) Google Scholar , 4 Howard G.S. Ralph K.M. Gulanick N.A. Maxwell S.E. Nance D.W. Gerber S.K. Internal invalidity in pretest/posttest self report evaluations and a re-evaluation of retrospective pretests. Appl Psychol Meas. 1979; 3: 1-23 Crossref Scopus (304) Google Scholar , 5 Broberger E. Sprangers M. Tishelman C. Do internal standards of quality of life change in lung cancer patients?. Nurs Res. 2006; 55: 274-282 Crossref PubMed Scopus (15) Google Scholar , 6 Hagedoorn M. Sneeuw K.C. Aaronson N.K. Changes in physical functioning and quality of life in patients with cancer: response shift and relative evaluation of one's condition. J Clin Epidemiol. 2002; 55: 176-183 Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar , 7 Jansen S.J. Stiggelbout A.M. Nooij M.A. Noordijk E.M. Kievit J. Response shift in quality of life measurement in early-stage breast cancer patients undergoing radiotherapy. Qual Life Res. 2000; 9: 603-615 Crossref PubMed Scopus (86) Google Scholar , 8 Osborne R.H. Hawkins M. Sprangers M.A. Change of perspective: a measurable and desired outcome of chronic disease self-management intervention programs that violates the premise of preintervention/postintervention assessment. Arthritis Rheum. 2006; 55: 458-465 Crossref PubMed Scopus (47) Google Scholar , 9 Tierney D.K. Facione N. Padilla G. Dodd M. Response shift: a theoretical exploration of quality of life following hematopoietic cell transplantation. Cancer Nurs. 2007; 30: 125-138 Crossref PubMed Scopus (35) Google Scholar , 10 Schwartz C.E. Sprangers M.A.G. Carey A. Reed G. Exploring response shift in longitudinal data. Psychol Health. 2004; 19: 51-69 Crossref Scopus (69) Google Scholar , 11 Ahmed S. Mayo N.E. Corbiere M. Wood-Dauphinee S. Hanley J. Cohen R. Change in quality of life in people with stroke over time: true change or response shift?. Qual Life Res. 2005; 14: 611-627 Crossref PubMed Scopus (72) Google Scholar ]. In these populations, affecting a response shift may be beneficial to a person's QOL, as it may assist with adapting to their condition.

Classification and regression tree uncovered hierarchy of psychosocial determinants underlying quality-of-life response shift in HIV/AIDS

Objectives Rapkin and Schwartz define response shift as otherwise unexplained, discrepant change in health-related quality of life (HRQOL) that is associated with change in cognitive appraisal. In this article, we demonstrate how a recursive partitioning (rpart) regression tree analytic approach may be used to explore cognitive changes to gain additional insight into response-shift phenomena. Study Design and Setting Data are from the “Choices in Care Study,” an evaluation of HIV+ Medicaid recipients' experiences and outcomes in care ( N = 394). Cognitive assessment was based on the QOL appraisal battery. HRQOL was measured by the SF-36 Health Survey, version 2 (SF-36v2). Results We used rpart to examine 6-month change in SF-36v2 mental composite score as a function of changes in appraisal, after controlling for patient characteristics, health changes, and intervening events. Rpart identified nine distinct patterns of cognitive change, including three associated with negative discrepancies, four with positive discrepancies, and two with no discrepancies. Conclusion Rpart classification provides a nuanced treatment of response shift. This methodology has implications for evaluating programs, guiding decisions, and targeting care.

Traditional assessment of health outcome following total knee arthroplasty was confounded by response shift phenomenon

Objectives To examine the existence, direction, and effect of response shift as measured by the total score of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and SF-36 physical and mental component score domains at 6 months and 1 year after primary total knee arthroplasty (TKA). Study Design and Setting Consecutive candidates participated in the study. In line with the Then-test design, two sets of questionnaires were completed at 6 months and 1 year postoperatively. Patients were divided into three groups on the basis of minimal clinically important differences (MCIDs). Parametric and nonparametric statistics and generalized mixed effects models were used. Results Two hundred and thirty-six patients completed the study. The magnitude of response shift increased over time for SF-36 physical and mental component scores. The traditional unadjusted presurgical and 1-year postsurgical assessment failed to reveal any mental health improvement, whereas the adjusted treatment effect demonstrated statistically significant changes. Conclusion Response shift phenomenon increases with time in patients undergoing orthopedic interventions. The traditional pre- and post-assessment of joint replacement surgery may be confounded by a change in perspective and in internal standards of measurement in patients undergoing surgery. Response shift has substantial impact on measuring recovery in this population.

The patient knows best: significant change in the physical component of the Multiple Sclerosis Impact Scale (MSIS-29 physical)

Aim: The aims of this study were to determine the reliability, responsiveness and minimally important change score of the Multiple Sclerosis Impact Scale (MSIS)-29 physical using the Expanded Disability Status...