Verdam Mathilde G E, Oort Frans J, Sprangers Mirjam A G
Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands; Department of Child Development and Education, University of Amsterdam, Postbus 15776, 1001 NG, Amsterdam, The Netherlands.
Department of Child Development and Education, University of Amsterdam, Postbus 15776, 1001 NG, Amsterdam, The Netherlands.
J Clin Epidemiol. 2017 May;85:37-44. doi: 10.1016/j.jclinepi.2017.02.012. Epub 2017 Mar 22.
The investigation of response shift in patient-reported outcomes (PROs) is important in both clinical practice and research. Insight into the presence and strength of response shift effects is necessary for a valid interpretation of change.
When response shift is investigated through structural equation modeling (SEM), observed change can be decomposed into change because of recalibration response shift, change because of reprioritization and/or reconceptualization response shift, and change because of change in the construct of interest. Subsequently, calculating effect-size indices of change enables evaluation and interpretation of the clinical significance of these different types of change.
Change was investigated in health-related quality of life data from 170 cancer patients, assessed before surgery and 3 months after surgery. Results indicated that patients deteriorated on general physical health and general fitness and improved on general mental health. The decomposition of change showed that the impact of response shift on the assessment of change was small.
SEM can be used to enable the evaluation and interpretation of the impact of response shift effects on the assessment of change, particularly through calculation of effect-size indices. Insight into the occurrence and clinical significance of possible response shift effects will help to better understand changes in PROs.
在临床实践和研究中，对患者报告结局（PROs）中的反应转移进行调查都很重要。了解反应转移效应的存在及其强度对于有效解释变化是必要的。
当通过结构方程模型（SEM）对反应转移进行调查时，观察到的变化可以分解为因重新校准反应转移导致的变化、因重新排序和/或重新概念化反应转移导致的变化以及因感兴趣的构念变化导致的变化。随后，计算变化的效应量指标能够评估和解释这些不同类型变化的临床意义。
对170名癌症患者术前和术后3个月评估的健康相关生活质量数据中的变化进行了调查。结果表明，患者在总体身体健康和总体健康状况方面恶化，在总体心理健康方面有所改善。变化的分解表明，反应转移对变化评估的影响较小。
SEM可用于评估和解释反应转移效应在变化评估中的影响，特别是通过计算效应量指标。了解可能的反应转移效应的发生情况及其临床意义将有助于更好地理解PROs中的变化。
