DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA,
Qual Life Res. 2013 Nov;22(9):2255-64. doi: 10.1007/s11136-013-0377-x. Epub 2013 Mar 22.
When patients experience a substantial health state change, they may undergo changes in the underlying meaning of their self-report to standardized outcome measures. These response shifts can reflect changes in the patient's internal standards, values or conceptualization of quality of life. We investigated the presence of changing values (reprioritization response shift) in a longitudinal cohort of spine surgery patients.
Spinal decompression surgery patients (mean age 52 years; 39 % female, 36 % working) provided visual analogue scale (VAS) back and leg pain items, the Short-Form-36 (SF-36v1), and the Oswestry Disability Index (ODI) data pre- and post-surgery (n pre = 169; n 6weeks = 102; n 3months = 106; n 6months = 68). Improved and No-Effect patient groups were compared using the VAS minimally important difference (±15 points) as a cutoff. Reprioritization response shift detection was based on change in the relative importance of the SF-36 domains for group discrimination pre- and post-surgery.
The Improved group evidenced significant post-surgery differences from the No-Effect group on bodily pain, general health, physical functioning, social functioning, vitality, and the ODI. The relative importance analysis showed a differential effect with bodily pain (p < 0.01) and physical functioning (p < 0.05) becoming more important, and role physical (p < 0.01) becoming less important post-surgery in distinguishing the Improved group as compared to the No-Effect group. The Improved patients also evidenced stronger associations between bodily pain and physical functioning, vitality and general health (p < 0.05). The No-Effect group evidenced increased inter-correlations of bodily pain with social functioning, mental health, and general health (p < 0.05).
Patients who report clinically significant change in leg and back pain post-surgery using VAS pain scores are also distinguished by increased importance of bodily pain and physical functioning, and decreased importance of role physical. Bodily pain is primarily reflective of physical item response post-surgery among Improved patients, but reflects physical, social, and emotional item response among No-Effect patients. These changes in values may reflect a "moving goal post" in outcome assessment that complicates the interpretation of mean differences over time on standard spine outcome measures.
当患者经历重大健康状态变化时，他们可能会对标准化结局测量工具的自我报告产生潜在意义的改变。这些反应转移可能反映了患者内部标准、价值观或生活质量概念的变化。我们在脊柱手术患者的纵向队列中研究了变化的价值观（重新优先化反应转移）的存在。
脊柱减压手术患者（平均年龄 52 岁；39%为女性，36%为在职）在术前和术后提供视觉模拟量表（VAS）背部和腿部疼痛项目、简短形式-36 项健康调查简表（SF-36v1）和 Oswestry 残疾指数（ODI）数据（n 术前=169；n 术后 6 周=102；n 术后 3 个月=106；n 术后 6 个月=68）。使用 VAS 最小重要差异（±15 分）作为截止值，将改善组和无效应组进行比较。重新优先化反应转移的检测是基于术前和术后组间区分 SF-36 领域相对重要性的变化。
与无效应组相比，改善组在术后身体疼痛、一般健康、身体功能、社会功能、活力和 ODI 方面表现出显著差异。相对重要性分析显示，身体疼痛（p<0.01）和身体功能（p<0.05）在术后变得更加重要，角色身体（p<0.01）在术后变得不那么重要，从而区分改善组和无效应组。与无效应组相比，改善组的身体疼痛与身体功能、活力和一般健康之间的关联也更强（p<0.05）。无效应组的身体疼痛与社会功能、心理健康和一般健康之间的相关性增加（p<0.05）。
使用 VAS 疼痛评分报告术后腿部和背部疼痛有临床显著变化的患者，身体疼痛和身体功能的重要性增加，角色身体的重要性降低。在改善组中，身体疼痛主要反映术后身体项目的反应，但在无效应组中反映身体、社会和情感项目的反应。这些价值观的变化可能反映了结局评估中“移动目标”的出现，这使得在标准脊柱结局测量工具上随时间推移的均值差异解释变得复杂。
