Applied Research in Quality of Life

, Volume 6, Issue 1, pp 81–90 | Cite as

Coronary Intervention Improves Disease Specific Health-Related Quality of Life but Not Individualised Quality of Life: A Potential Response Shift Effect?

  • Stefan Höfer
  • Nicole Pfaffenberger
  • Daniela Renn
  • Marion Platter
  • Lena Ring


To explore potential response shift effects with different quality of life (QoL) instruments in cardiac patients undergoing coronary intervention. Study Design and Setting: Recalibration was assessed with the disease specific health-related quality of life (HRQL) instrument MacNew in combination with a then-test approach. Reconceptualisation and reprioritisation were assessed with the individualised QoL instrument SEIQoL-DW. Significant treatment effects were seen on the MacNew (global Δ: 0.6 ± 1.1, p = 0.004) but not on the SEIQoL-DW (Δ: 3.3 ± 16, p = 0.37) 6 months after coronary intervention. No recalibration effect was found on the MacNew then-test, while with the SEIQOL-DW potential response shift effects of reconceptualisation and reprioritisation were seen. For the first time response shift effects were explored in cardiac patients undergoing coronary intervention. This study confirmed that there is a clinically significant improvement in disease specific HRQL over time following successful coronary interventions. However, no treatment effect was seen for individualised QoL with the SEIQoL-DW. This might be due to reconceptualisation and reprioritisation response effects. Future studies need to focus on exploring response shift effects, and the interrelationship between its different components, captured by different patient reported outcome instruments in larger patient groups undergoing coronary interventions.


Schedule for the evaluation of individualised quality of life – Direct weighting (SEIQoL-DW) MacNew Heart disease Angina Coronary intervention Response shift Then-test 


  1. Ahmed, S., Mayo, N. E., Wood-Dauphinee, S., Hanley, J. A., & Cohen, S. R. (2005a). The structural equation modeling technique did not show a response shift, contrary to the results of the then test and the individualized approaches. Journal of Clinical Epidemiology, 58(11), 1125–1133.CrossRefGoogle Scholar
  2. Ahmed, S., Mayo, N. E., Wood-Dauphinee, S., Hanley, J. A., & Cohen, S. R. (2005b). Using the Patient Generated Index to evaluate response shift post-stroke. Quality of Life Research, 14(10), 2247–2257.CrossRefGoogle Scholar
  3. Benzer, W., Höfer, S., & Oldridge, N. B. (2003). Change in health-related quality of life following medical or invasive treatment for angina in patients with coronary artery disease. Herz, 28(5), 421–428.CrossRefGoogle Scholar
  4. Bernhard, J., Lowy, A., Maibach, R., & Hurny, C. (2001). Response shift in the perception of health for utility evaluation. an explorative investigation. European Journal of Cancer, 37(14), 1729–1735.CrossRefGoogle Scholar
  5. Dixon, T., Lim, L. L., & Oldridge, N. B. (2002). The MacNew heart disease health-related quality of life instrument: reference data for users. Quality of Life Research, 11(2), 173–183.CrossRefGoogle Scholar
  6. Folland, E. D., Hartigan, P. M., & Parisi, A. F. (1997). Percutaneous transluminal coronary angioplasty versus medical therapy for stable angina pectoris: outcomes for patients with double-vessel versus single-vessel coronary artery disease in a Veterans Affairs Cooperative randomized trial. Veterans Affairs ACME InvestigatorS. Journal of the American College of Cardiology, 29(7), 1505–1511.CrossRefGoogle Scholar
  7. Harris, D., O’Boyle, C. A., Marley, J., Höfer, S., & Heuston, F. (2010). A Comparison of Implant Supported Mandibular Dentures and Conventional Dentures on Quality of Life in Edentulous Patients: A Randomised, Prospective, within Subject Controlled Clinical Trial. in preparation.Google Scholar
  8. Hickey, A. M., Bury, G., O’Boyle, C. A., Bradley, F., O’Kelly, F. D., & Shannon, W. (1996). A new short form individual quality of life measure (SEIQoL-DW): application in a cohort of individuals with HIV/AIDS. BMJ, 313(7048), 29–33.Google Scholar
  9. Höfer, S., Benzer, W., Schüßler, G., von Steinbüchel, N., & Oldridge, N. B. (2003). Health-related quality of life in patients with coronary artery disease treated for angina: validity and reliability of German translations of two specific questionnaires. Quality of Life Research, 12(2), 199–212.CrossRefGoogle Scholar
  10. Höfer, S., Benzer, W., Brandt, D., Laimer, H., Schmidt, P., Bernardo, A., et al. (2004a). MacNew Heart Disease Lebensqualitätsfragebogen nach Herzinfarkt: die deutsche Version. Zeitschrift für Klinische Psychologie und Psychotherapie, 33(4), 270–280.CrossRefGoogle Scholar
  11. Höfer, S., Lim, L. L., Guyatt, G. H., & Oldridge, N. B. (2004b). The MacNew Heart Disease health-related quality of life instrument: a summary. Health and Quality of Life Outcomes, 2(1), 3.CrossRefGoogle Scholar
  12. Höfer, S., Anelli-Monti, M., Berger, T., Hintringer, F., Oldridge, N., & Benzer, W. (2005). Psychometric properties of an established heart disease specific health-related quality of life questionnaire for pacemaker patients. Quality of Life Research, 14(8), 1937–1942.CrossRefGoogle Scholar
  13. Höfer, S., Doering, S., Rumpold, G., Oldridge, N., & Benzer, W. (2006). Determinants of health-related quality of life in patients with coronary artery disease. European Journal of Cardiovascular Prevention and Rehabilitation, 13(3), 398–406.CrossRefGoogle Scholar
  14. Höfer, S., Schmid, J. P., Frick, M., Benzer, W., Laimer, H., Oldridge, N., et al. (2008). Psychometric properties of the MacNew heart disease health-related quality of life instrument in patients with heart failure. J Eval Clin Pract.Google Scholar
  15. Joore, M. A., Potjewijd, J., Timmerman, A. A., & Anteunis, L. J. (2002). Response shift in the measurement of quality of life in hearing impaired adults after hearing aid fitting. Quality of Life Research, 11(4), 299–307.CrossRefGoogle Scholar
  16. Korfage, I. J., de Koning, H. J., & Essink-Bot, M. L. (2007). Response shift due to diagnosis and primary treatment of localized prostate cancer: a then-test and a vignette study. Quality of Life Research, 16(10), 1627–1634.CrossRefGoogle Scholar
  17. Neudert, C., Wasner, M., & Borasio, G. D. (2001). Patients’ assessment of quality of life instruments: a randomised study of SIP, SF-36 and SEIQoL-DW in patients with amyotrophic lateral sclerosis. Journal of the Neurological Sciences, 191(1–2), 103–109.CrossRefGoogle Scholar
  18. Norman, G. (2003). Hi! How are you? Response shift, implicit theories and differing epistemologies. Quality of Life Research, 12(3), 239–249.CrossRefGoogle Scholar
  19. Rapkin, B. D., & Schwartz, C. E. (2004). Toward a theoretical model of quality-of-life appraisal: implications of findings from studies of response shift. Health and Quality of Life Outcomes, 2, 14.CrossRefGoogle Scholar
  20. Razmjou, H., Yee, A., Ford, M., & Finkelstein, J. A. (2006). Response shift in outcome assessment in patients undergoing total knee arthroplasty. The Journal of Bone and Joint Surgery. American Volume, 88(12), 2590–2595.CrossRefGoogle Scholar
  21. Rees, J., Clarke, M. G., Waldron, D., O’Boyle, C., Ewings, P., & MacDonagh, R. P. (2005). The measurement of response shift in patients with advanced prostate cancer and their partners. Health and Quality of Life Outcomes, 3, 21.CrossRefGoogle Scholar
  22. Ring, L., Höfer, S., Heuston, F., Harris, D., & O’Boyle, C. A. (2005). Response shift masks the treatment impact on patient reported outcomes (PROs): the example of individual quality of life in edentulous patients. Health and Quality of Life Outcomes, 3, 55.CrossRefGoogle Scholar
  23. Robling, M. (2006). Measuring change in patient quality of life over time: An evaluation of scale responsiveness and patient response shift. Unpublished Monography. Cardiff: Cardiff University.Google Scholar
  24. Robling, M., & Hood, K. (2002). Response shift, responsiveness or recall bias? The British Journal of General Practice, 52(480), 585.Google Scholar
  25. Rustoen, T., Howie, J., Eidsmo, I., & Moum, T. (2005). Hope in patients hospitalized with heart failure. American Journal of Critical Care, 14(5), 417–425.Google Scholar
  26. Schwartz, C. E., & Sprangers, M. A. (1999). Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Social Science & Medicine, 48(11), 1531–1548.CrossRefGoogle Scholar
  27. Schwartz, C. E., Feinberg, R. G., Jilinskaia, E., & Applegate, J. C. (1999). An evaluation of a psychosocial intervention for survivors of childhood cancer: paradoxical effects of response shift over time. Psychooncology, 8(4), 344–354.CrossRefGoogle Scholar
  28. Schwartz, C. E., & Sprangers, M. A. (2002). An introduction to quality of life assessment in oncology: the value of measuring patient-reported outcomes. The American Journal of Managed Care, 8(18 Suppl), S550–S559.Google Scholar
  29. Schwartz, C. E., Bode, R., Repucci, N., Becker, J., Sprangers, M. A., & Fayers, P. M. (2006). The clinical significance of adaptation to changing health: a meta-analysis of response shift. Quality of Life Research, 15(9), 1533–1550.CrossRefGoogle Scholar
  30. Sharpe, L., Butow, P., Smith, C., McConnell, D., & Clarke, S. (2005). Changes in quality of life in patients with advanced cancer: evidence of response shift and response restriction. Journal of Psychosomatic Research, 58(6), 497–504.CrossRefGoogle Scholar
  31. Solomon, A. J., & Gersh, B. J. (1998). Management of chronic stable angina: medical therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft surgery. Lessons from the randomized trials. Annals of Internal Medicine, 128(3), 216–223.Google Scholar
  32. Sprangers, M. A., & Schwartz, C. E. (1999). Integrating response shift into health-related quality of life research: a theoretical model. Social Science & Medicine, 48(11), 1507–1515.CrossRefGoogle Scholar
  33. Strauss, W. E., Fortin, T., Hartigan, P., Folland, E. D., & Parisi, A. F. (1995). A comparison of quality of life scores in patients with angina pectoris after angioplasty compared with after medical therapy. Outcomes of a randomized clinical trial. Veterans Affairs Study of Angioplasty Compared to Medical Therapy Investigators. Circulation, 92(7), 1710–1719.Google Scholar
  34. Visser, M. R., Oort, F. J., & Sprangers, M. A. (2005). Methods to detect response shift in quality of life data: a convergent validity study. Quality of Life Research, 14(3), 629–639.CrossRefGoogle Scholar
  35. Wagner, J. A. (2005). Response shift and glycemic control in children with diabetes. Health and Quality of Life Outcomes, 3, 38.CrossRefGoogle Scholar
  36. Weintraub, W. S., Spertus, J. A., Kolm, P., Maron, D. J., Zhang, Z., Jurkovitz, C., et al. (2008). Effect of PCI on quality of life in patients with stable coronary disease. The New England Journal of Medicine, 359(7), 677–687.CrossRefGoogle Scholar
  37. Yu, D. S., Thompson, D. R., Yu, C. M., & Oldridge, N. B. (2008). Validation of the Chinese version of the MacNew heart disease health-related quality of life questionnaire. Journal of Evaluation in Clinical Practice, 14, 326–335.CrossRefGoogle Scholar
  38. Zhang, Z., Mahoney, E. M., Stables, R. H., Booth, J., Nugara, F., Spertus, J. A., et al. (2003). Disease-specific health status after stent-assisted percutaneous coronary intervention and coronary artery bypass surgery: one-year results from the Stent or Surgery trial. Circulation, 108(14), 1694–1700.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V./The International Society for Quality-of-Life Studies (ISQOLS) 2010

Authors and Affiliations

  • Stefan Höfer
    • 1
    • 5
  • Nicole Pfaffenberger
    • 2
  • Daniela Renn
    • 1
    • 3
  • Marion Platter
    • 1
  • Lena Ring
    • 4
  1. 1.Department of Medical PsychologyInnsbruck Medical UniversityInnsbruckAustria
  2. 2.Department of General and Social PsychiatryInnsbruck Medical UniversityInnsbruckAustria
  3. 3.www.psypraxis.orgInnsbruckAustria
  4. 4.Department of PharmacyUppsala UniversityUppsalaSweden
  5. 5.Department of Medical PsychologyMedical University InnsbruckInnsbruckAustria

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