Department of Community Health Sciences & Institute of Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Clinical Research Unit, University of Calgary, Calgary, Alberta, Canada.
Epilepsia. 2014 Sep;55(9):1331-8. doi: 10.1111/epi.12697. Epub 2014 Jun 25.
Health-related quality of life (HRQOL) is an important indicator of well-being in patients with epilepsy. When assessing changes in HRQOL over time, some of the changes observed may be due to the patients' change in the internal standards, value, or meaning that they attribute to the HRQOL domain being measured, rather than actual change, a phenomenon known as response shift. Response shifts are increasingly recognized as an important explanation for the seemingly paradoxical or counterintuitive HRQOL results often observed in chronic conditions. We investigated the presence of changing values (reprioritization response shift) in data from a surgical randomized controlled trial of patients with temporal lobe epilepsy (TLE).
Eighty patients with TLE, who were randomized to surgical and medical treatment, provided data on the epilepsy-specific 31-item Quality of life in Epilepsy (QOLIE-31) questionnaire at baseline and 1 year after randomization. Reprioritization response shift among the seven QOLIE-31 domains was assessed using changes in the relative importance weights derived from logistic regression and discriminant analysis.
The relative importance analysis showed a statistically significant increase over time in the importance of social function, but a significant decrease in the relative importance of seizure worry. There were no significant changes in the relative importance of the remaining five domains in distinguishing between surgical and medical group over time.
Patients that receive surgical treatment are more likely to experience a decrease in the valuation of seizure worry and an increase in the value of social function as compared to patients who are medically treated. Changes in expectation about seizure freedom and social function may confound the assessment of longitudinal change on these outcomes, and highlight the importance of assessing response shift and the limitations of assessing HRQOL at a single point in time or without a control group. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
健康相关生活质量（HRQOL）是癫痫患者幸福感的重要指标。在评估 HRQOL 随时间的变化时，观察到的一些变化可能是由于患者对所测量的 HRQOL 领域的内在标准、价值观或意义的改变，而不是实际变化，这种现象称为反应转移。反应转移越来越被认为是慢性疾病中经常观察到的看似矛盾或违反直觉的 HRQOL 结果的一个重要解释。我们调查了颞叶癫痫（TLE）手术随机对照试验数据中变化价值观（重新优先排序反应转移）的存在。
80 名 TLE 患者随机分为手术和药物治疗组，在随机分组后 1 年提供了癫痫特异性 31 项生活质量（QOLIE-31）问卷的数据。使用逻辑回归和判别分析得出的相对重要性权重的变化，评估七个 QOLIE-31 领域中的重新优先排序反应转移。
相对重要性分析显示，随着时间的推移，社会功能的重要性呈统计学显著增加，但对癫痫担忧的相对重要性显著下降。在区分手术和药物治疗组时，其余五个领域的相对重要性在随时间变化方面没有显著变化。
与接受药物治疗的患者相比，接受手术治疗的患者更有可能经历对癫痫担忧的估值降低和对社会功能的价值增加。对无癫痫发作的期望和社会功能的变化可能会混淆对这些结果的纵向变化的评估，并强调评估反应转移和在单个时间点或没有对照组的情况下评估 HRQOL 的局限性的重要性。本文的幻灯片摘要可在支持信息部分下载。
