Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
Institute of Educational Sciences, University of Wuppertal, Wuppertal, Germany.
Qual Life Res. 2019 Sep;28(9):2609-2620. doi: 10.1007/s11136-019-02195-9. Epub 2019 May 8.
The effect of intervention programs on health-related quality of life (HRQoL) can be underestimated due to response shift effects. This study aims to compare HRQoL between cardiac patients taking part in a rehabilitation program and the general population and to investigate changes in HRQoL in terms of response shift with two approaches.
A sample of 282 cardiac rehabilitation inpatients (response rate: 58.9%) responded to the self-report quality of life questionnaire EORTC QLQ-C30 at baseline (during rehabilitation) and three months later (actual and retrospective judgment). Their HRQoL was compared to that of the general population. Response shift evaluation complemented the thentest with the structural equation modeling approach.
Compared to the general population, patients showed impaired quality of life on all scales (Hedges' g between 0.31 and 1.57). The complementation of the thentest with the structural equation modeling approach revealed response shift effects in physical, emotional, cognitive, and social functioning. No effects were found in role functioning.
The combination of both the thentest and the structural equation modeling approaches proved to be essential for obtaining comprehensive statistical evidence that response shift can distort measurements of change. Our results suggest that studies that use the thentest to evaluate the effectiveness of interventions should complement their analyses with the structural equation modeling approach to avoid biased effects.
由于反应转移效应的存在，干预计划对健康相关生活质量（HRQoL）的影响可能被低估。本研究旨在比较参加康复计划的心脏病患者与一般人群的 HRQoL，并通过两种方法研究 HRQoL 的反应转移变化。
本研究采用自我报告生活质量问卷 EORTC QLQ-C30，对 282 名心脏康复住院患者（应答率：58.9%）进行了基线（康复期间）和三个月后的（实际和回顾性判断）调查。将他们的 HRQoL 与一般人群进行比较。反应转移评估通过结构方程建模方法对传统测试进行补充。
与一般人群相比，患者在所有量表上的生活质量都较差（Hedges'g 在 0.31 到 1.57 之间）。通过结构方程建模方法对传统测试的补充显示，在身体、情感、认知和社会功能方面存在反应转移效应。在角色功能方面未发现任何影响。
传统测试和结构方程建模方法的结合对于获得反应转移可能会扭曲变化测量的全面统计证据是至关重要的。我们的结果表明，使用传统测试来评估干预效果的研究应该用结构方程建模方法来补充其分析，以避免有偏的影响。
