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Quality of Life Research

, Volume 23, Issue 9, pp 2421–2430 | Cite as

Minimal evidence of response shift in the absence of a catalyst

  • Sara Ahmed
  • Richard Sawatzky
  • Jean-Frédéric Levesque
  • Deborah Ehrmann-Feldman
  • Carolyn E. Schwartz
Article

Abstract

Background

Individuals with chronic conditions experience fluctuations in health status and thus may experience response shift. We sought to test the hypothesis that response shift effects would be non-significant among individuals with chronic disease who experienced relatively small changes in their health status over a 1-year period.

Methods

This secondary analysis utilized longitudinal cohort data on a community-based sample (n = 776) representing four chronic diseases (arthritis, heart failure, diabetes, or chronic obstructive pulmonary disease). Information on health-care utilization was obtained from the provincial health insurance database. Participants completed the SF-36 twice annually. Parameter invariance over 1 year in a second-order SF-36 factor structure was evaluated by adapting Oort’s approach by fitting a second-order measurement structure with first-order factors for the SF-36 subscales and second-order factors for physical and mental health status while accommodating ordinal data.

Results

Over 80 % of participants had no hospitalizations or emergency room visits over follow-up. The model had an acceptable fit when all measurement model parameters were constrained at both time points (RMSEA = .035, CFI = .97). There was no substantial difference in fit when measurement model parameters (item thresholds, first-order factor intercepts, and factor loadings) were allowed to vary over time.

Conclusion

Among chronically ill individuals with stable health, substantial response shift effects were not detected. These results support the theoretical proposition that response shift is not expected to occur in patients with relatively stable conditions.

Keywords

Structural equation modeling Chronic disease Response shift Health-related quality of life 

Notes

Acknowledgments

This work was funded in part by a Catalyst grant award from the Canadian Institute of Health Research (Grant #103630), and a Career Award (Grant #13870) from the Fond de Recherche en Sante du Quebec to Dr. Ahmed. We thank Brian Quaranto, B.Sc., for assistance with data management and manuscript preparation.

Supplementary material

11136_2014_699_MOESM1_ESM.docx (158 kb)
Figure 2 (online repository): Distributions of the SF-36 items at baseline and one-year follow-up* * The numbers of each item and their response categories correspond with those of the Qualimetric SF-36® instrument (Version 1). The response categories of items GH_1, GH_11B, GH_11D, BP_7, BP_8, VI_9a, VI_9e, SF_6, MH_9d and MH_9h have been reversed so the greater category numbers indicate higher functioning (DOCX 157 kb)
11136_2014_699_MOESM2_ESM.docx (27 kb)
Supplementary material 2 (DOCX 26 kb)

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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Sara Ahmed
    • 1
    • 2
    • 3
  • Richard Sawatzky
    • 4
    • 6
  • Jean-Frédéric Levesque
    • 5
    • 7
    • 8
  • Deborah Ehrmann-Feldman
    • 7
    • 9
  • Carolyn E. Schwartz
    • 10
    • 11
  1. 1.Faculty of Medicine, School of Physical and Occupational TherapyMcGill UniversityMontrealCanada
  2. 2.Clinical EpidemiologyMcGill University Health CenterMontrealCanada
  3. 3.Centre de recherche interdisciplinaire en réadaptation (CRIR)MontrealCanada
  4. 4.Trinity Western University School of NursingLangleyCanada
  5. 5.Centre de Recherche du Centre Hospitalier de l’Université de MontréalMontrealCanada
  6. 6.Centre for Health Evaluation and Outcome SciencesVancouverCanada
  7. 7.Université de MontréalMontrealCanada
  8. 8.Institut National de Santé Publique du QuébecMontrealCanada
  9. 9.Direction de Santé Publique de l’ASSS de MontréalMontrealCanada
  10. 10.DeltaQuest Foundation, Inc.ConcordUSA
  11. 11.Departments of Medicine and Orthopaedic SurgeryTufts University Medical SchoolBostonUSA

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