Response shift in quality of life assessment in patients with chronic back pain and chronic ischaemic heart disease

Abstract

Purpose: To examine the extent and type of influence of response shift (RS) (reconceptualization, reprioritization, recalibration) on the assessment of changes in health-related quality of life (HRQoL) after the inpatient rehabilitation of patients with chronic back pain and chronic ischaemic heart disease. Methods: RS was assessed using the then-test and structural equation modelling (SEM) approaches. HRQoL was recorded in a questionnaire study at the start and end of rehabilitation using disease-specific instruments. Global items were also developed to collect data on HRQoL at the start and end of rehabilitation, as well as for the retrospective evaluation of HRQoL at the beginning of rehabilitation via the then-test. Results: There are small recalibration effects in the then-test in both diseases in nearly every item which may underestimate the actual effects of change. Using the SEM approach, uniform and non-uniform recalibration effects appear in a few of the scales that cause true change scores to be under- and over-estimated. Conclusion: RS reflects a phenomenon that should be included when assessing HRQoL to allow a more valid interpretation of treatment effects. The results of SEM approach, however, suggest that RS does not lead to fundamentally different results in rehabilitation effects.

Implications for Rehabilitation

• The predominant method for evaluating rehabilitation effects is to assess the patients’ subjectively perceived health status before and after treatment.

• RS characterizes changes in the respondent’s internal evaluation standards and therefore threatens the validity of change scores deriving from pre- test–post-test data.

• Small RS effects also occur in a rehabilitation setting of patients with chronic back pain and chronic ischaemic heart disease leading to an under- or overestimation of true treatment effects.

• RS should be included in the assessment to enable a more valid evaluation of rehabilitation effects.

Keywords::

• Back pain
• ischaemic heart disease
• quality of life

Acknowledgements

We thank the participating rehabilitation centres and their staff: Breisgau-Klinik, Bad Krozingen; Drei-Burgen-Klinik, Bad Münster am Stein-Ebernburg; Fachklinik und Moorbad, Bad Freienwalde; Fachklinik Wolletzsee, Wolletz; Habichtswald-Klinik, Kassel-Wilhelmshöhe; Kerckhoff-Rehabilitations-Zentrum, Bad Nauheim; Kirnitzschtal Klinik, Bad Schandau; Klinik am Südpark Pfitzer GmbH & Co. KG, Abt. Kardiologie, Bad Nauheim; Klinik Bad Wörishofen, Bad Wörishofen; Klinik Graal-Müritz GmbH, Ostseeheilbad Graal-Müritz; Klinikum Salze Klinik Fachklinik für Orthopädie AHB, Bad Salzdetfurth; Median Klinikum für Rehabilitation, Bad Salzuflen; Reha-Klinik Aukammtal, Wiesbaden; Rehaklinik Bad Boll, Bad Boll; Reha-Zentrum Todtmoos – Klinik Wehrawald, Todtmoos; Rheingau-Taunus-Klinik, Bad Schwalbach; Rosentrittklinik, Bad Rappenau; Sachsenklinik, Naunhof; Vesalius-Klinik, Bad Rappenau.

Declaration of interest: The study was conducted in the project “Patientenorientierte Veränderungsmessung: Gesundheitsbewertungen und die Beurteilung der Teilhabe-Relevanz von Behandlungseffekten durch chronisch Kranke” [“Patient-oriented outcome measurement: Health valuations and the assessment of the participation relevance of treatment effects by chronically ill patients”] (POEM) funded by the German Federal Ministry of Education and Research, funding priority “Chronic Illnesses and Patient Orientation.”