Department of Physical Therapy, School of Medical Rehabilitation, University of Manitoba, R106-771 McDermot Ave, Winnipeg, Manitoba, Canada R3E 0T6.
Department of Community Health Sciences, University of Manitoba, T148-770 Bannatyne Ave, Winnipeg, Manitoba, Canada R3E 0W3.
J Clin Epidemiol. 2014 May;67(5):500-7. doi: 10.1016/j.jclinepi.2013.12.003. Epub 2014 Mar 5.
To prospectively consider evidence for response shift (RS) in health-related quality of life (HRQL) in older men who experienced stroke or remained stroke free. RS is a change in the meaning of self-evaluation; this includes recalibration, reprioritization, and reconceptualization.
A cohort of 3,983 male World War II Royal Canadian Air Force recruits has been followed since 1948. There were three prospectively determined groups: stroke survivors (n = 168; mean age, 80.1 years); older stroke-free group (n = 254; mean age, 82.8 years); and younger stroke-free group (n = 323; mean age, 74.7 years). The Short Form-36 (SF-36) was used to evaluate HRQL. Longitudinal structural equation models were developed using SF-36 subscales and three latent variables. Measurement invariance over two time points for each of the three groups was evaluated to identify RS.
All RS models had reasonable fit: stroke [root mean square error of approximation (RMSEA), 0.069; 90% confidence interval (CI): 0.052, 0.086], older (RMSEA, 0.055; 90% CI: 0.041, 0.068), and younger (RMSEA, 0.062; 90% CI: 0.051, 0.074). Recalibration of physical function occurred in all three groups. Reprioritization of role limitations due to physical health happened in both stroke-free groups.
This study is unique in our ability to prospectively identify RS recalibration and reprioritization in HRQL in aging men with stroke and remaining free of stroke. Changes in the meaning of self-evaluation of HRQL occur not only with stroke but also in men who remain free of stroke.
前瞻性地研究经历过中风或未中风的老年男性健康相关生活质量（HRQL）中反应转移（RS）的证据。RS 是自我评估意义的变化；这包括重新校准、重新排序和重新概念化。
自 1948 年以来，一直对 3983 名二战期间的加拿大皇家空军男性新兵进行了队列研究。有三个前瞻性确定的组：中风幸存者（n=168；平均年龄 80.1 岁）；年龄较大的无中风组（n=254；平均年龄 82.8 岁）；和年龄较小的无中风组（n=323；平均年龄 74.7 岁）。使用简短形式 36 项（SF-36）评估 HRQL。使用 SF-36 子量表和三个潜在变量开发了纵向结构方程模型。评估了三个组在两个时间点的测量不变性，以确定 RS。
所有 RS 模型都具有合理的拟合度：中风[近似均方根误差（RMSEA），0.069；90%置信区间（CI）：0.052，0.086]、年龄较大（RMSEA，0.055；90%CI：0.041，0.068）和年龄较小（RMSEA，0.062；90%CI：0.051，0.074）。所有三组的身体功能都进行了重新校准。两个无中风组的身体健康导致角色限制的重新排序。
本研究的独特之处在于，我们能够前瞻性地识别中风和未中风的老年男性 HRQL 中 RS 重新校准和重新排序。HRQL 自我评估意义的变化不仅发生在中风患者中，也发生在未中风的男性中。
