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Response shift and disease activity in inflammatory bowel disease

Quality of Life Research volume 25, pages 1751–1760 (2016)Cite this article

Abstract

Purpose

Response shift (RS) may mask true change in health-related quality of life in longitudinal studies. People with chronic conditions may experience RS as they adapt to their disease, but it is unknown whether fluctuations in disease activity will influence the presence of RS. The study purpose was to test for RS in individuals with inflammatory bowel disease (IBD), a condition characterized by periods of symptom flares and remission.

Methods

Data were from the Manitoba IBD Cohort Study (N = 388). Multi-group confirmatory factor analysis (MG-CFA) and a RS detection method based on structural equation modeling were used to test for reconceptualization, reprioritization, and recalibration RS in participants with consistent active, consistent inactive, and inconsistent disease activity over a 6-month period on the SF-36.

Results

The MG-CFA revealed that a weak invariance model with equal factor loadings across groups was the best fit to the baseline SF-36 data. Reconceptualization, uniform recalibration, and non-uniform recalibration RS was detected in the consistent active group, but effect sizes were small. For the consistent inactive group, recalibration RS was observed and effect sizes were small to moderate. For the inconsistent disease activity group, small-to-moderate recalibration RS effects were observed. There was no evidence of reprioritization.

Conclusions

Individuals with a chronic disease may exhibit RS even if they are not actively experiencing symptoms on a consistent basis. Heterogeneity in the type and magnitude of RS effects may be observed in chronic disease patients who experience changes in disease symptoms.

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Acknowledgments

LML is supported by a Manitoba Health Research Chair. RS is supported by a Canada Research Chair.

Funding

This study was funded by the Canadian Institutes of Health Research (Funding Reference #122110) and Research Manitoba.

Author information

Authors and Affiliations

  1. Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada

    Lisa M. Lix

  2. Measurement, Evaluation, and Research Methodology (MERM) Program, University of British Columbia, Vancouver, Canada

    Eric K. H. Chan

  3. School of Nursing, Trinity Western University, Langley, Canada

    Eric K. H. Chan & Richard Sawatzky

  4. Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, Canada

    Richard Sawatzky

  5. Department of Community Health Sciences, University of Calgary, Calgary, Canada

    Tolulope T. Sajobi

  6. O’Brien Institute for Public Health, University of Calgary, Calgary, Canada

    Tolulope T. Sajobi

  7. Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, Canada

    Juxin Liu

  8. Queen’s University, Kingston, Canada

    Wilma Hopman

  9. McGill University Health Centre, Montreal, Canada

    Nancy Mayo

Authors
  1. Lisa M. Lix
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  2. Eric K. H. Chan
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Correspondence to Lisa M. Lix.

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Conflict of interest

None of the authors has a conflict of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Manitoba Health Research Ethics Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the Manitoba Inflammatory Bowel Disease Cohort Study.

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Lix, L.M., Chan, E.K.H., Sawatzky, R. et al. Response shift and disease activity in inflammatory bowel disease. Qual Life Res 25, 1751–1760 (2016). https://doi.org/10.1007/s11136-015-1188-z

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Keywords

  • Disease activity
  • Group comparisons
  • Health-related quality of life
  • Longitudinal
  • Measurement invariance
  • Structural equation modeling