Influence of explanatory and confounding variables on HRQoL after controlling for measurement bias and response shift in measurement

Abstract

The purpose of this study was to examine the influence of explanatory and confounding variables on health-related quality of life after accounting for response shift, measurement bias and response shift in measurement using structural equation modeling. Hypertensive patients with coronary artery disease randomized to anti-hypertensive treatment, completed the ShortForm-36 questionnaire at both baseline and 1 year (n = 788). Three measurement biases were found and all three were considered as response shift in measurement. Older patients reported worse scores for both physical functioning (PF) and role-physical at baseline and 1 year later compared to younger patients; and males reported better PF than females after conditioning on the latent trait of general physical health. Before controlling for response shift, patients’ PF scores were not statistically different over time; however, PF scores significantly improved (p < 0.01) after controlling for recalibration response shift. Assessment of how patients perceive their change in health-related quality of life over time is warranted.

Keywords::

• atenolol-led
• health-related quality of life
• hypertensive coronary artery disease
• measurement bias
• response shift
• SF-36
• verapamil-SR

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Hypertensive medications from different pharmacologic classes sometimes have varying side-effect profiles and impact patients’ health-related quality of life in different ways.

• • Response shift is defined as the change in the meaning of one’s perception of a target construct due to changes in standard, value and conceptualization.

• • Older patients reported worse scores for both physical functioning and role limitations due to physical health problems at baseline and 1 year later than younger patients.

• • Males reported better physical functioning at baseline and 1 year later than females.

• • Our findings suggest that health-related quality of life estimates might have been underestimated if measurement issues are not taken into account.

Notes