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Response shift and disease activity in inflammatory bowel disease



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.


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.


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.


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


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

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Correspondence to Lisa M. Lix.

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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.

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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).

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