Lisa M Lix1, Eric K H Chan2,3, Richard Sawatzky3,4, Tolulope T Sajobi5,6, Juxin Liu7, Wilma Hopman8, Nancy Mayo9. 1. Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada. Lisa.Lix@umanitoba.ca. 2. Measurement, Evaluation, and Research Methodology (MERM) Program, University of British Columbia, Vancouver, Canada. 3. School of Nursing, Trinity Western University, Langley, Canada. 4. Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, Canada. 5. Department of Community Health Sciences, University of Calgary, Calgary, Canada. 6. O'Brien Institute for Public Health, University of Calgary, Calgary, Canada. 7. Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, Canada. 8. Queen's University, Kingston, Canada. 9. McGill University Health Centre, Montreal, Canada.
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.
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 diseasepatients who experience changes in disease symptoms.
Entities:
Keywords:
Disease activity; Group comparisons; Health-related quality of life; Longitudinal; Measurement invariance; Structural equation modeling
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