Response Shift Theory: Important Implications for Measuring Quality of Life in People With Disability

Baylor College of Medicine, Houston, Texas, United States
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.44). 04/2007; 88(4):529-36. DOI: 10.1016/j.apmr.2006.12.032
Source: PubMed

ABSTRACT Measurement of health-related quality of life (HRQOL) in people with disability can be problematic. Ambiguous or paradoxical findings can occur because of differences among people or changes within people regarding internal standards, values, or conceptualization of HRQOL. These "response shifts" can affect standard psychometric indices, such as reliability and validity. Attending to appraisal processes and response shift theory can inform development of HRQOL measures for people with disability that do not confound function and health and that consider important causal indicators such as environment. By design, most HRQOL measures equate function with health, necessarily leading to a lower measured HRQOL in people with functional impairments regardless of their level of self-perceived health. In this article, we present theoretical and conceptual distinctions building on response shift theory and other current developments in HRQOL research. We then submit a set of suggested directions for future measurement development in populations with disabilities that consider these distinctions and extend their use in future measurement developments.

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    • "This finding could reflect a response shift among women who had a RRM prior to testing. Response shift refers to a recalibration, reprioritization or reconceptualization of quality of life over time following an impactful event [36]. Perhaps women who had an RRM prior to testing have had more time living with the impact of their surgery and as a result are more likely to exhibit response shift. "
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    ABSTRACT: As BRCA1/2 testing becomes more routine, questions remain about long-term satisfaction and quality of life following testing. Previously, we described long term distress and risk management outcomes among women with BRCA1/2 mutations. This study addresses positive psychological outcomes in BRCA1/2 carriers, describing decision satisfaction and quality of life in the years following testing METHODS: We evaluated satisfaction with testing and management decisions among 144 BRCA1/2 carriers. Prior to genetic testing, we assessed family history, sociodemographics and distress. At a mean of 5.3 years post-testing, we assessed management decisions, satisfaction with decisions and, among women with cancer, quality of life. Overall, satisfaction with decision making was high. Women who had risk reducing mastectomy or oophorectomy were more satisfied with management decisions. Participants who obtained a risk reducing oophorectomy were more satisfied with their genetic testing decision. Among affected carriers, high pretest anxiety was associated with poorer quality of life and having had risk reducing mastectomy prior to testing was associated with better quality of life. The negative impact of pre-test anxiety was diminished among women who had mastectomies before testing. BRCA1/2 carriers are satisfied with their testing and risk management decisions and report good quality of life years after testing. Having risk reducing surgery predicts increased satisfaction and improved quality of life.
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    • "Investigating aspects of response shift among patients with a disability might seem questionable. One might assume that patients with a disability find a certain balance after going through rehabilitation [48]. However, we examined the aspects of response shift in the subinitial phase after injury. "
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    • "Such evidence solidifies the connection between occupation and health and well-being and supports the premise that mastery in occupational performance is associated with improved well-being (CAOT 2002; Kielhofner 2007; Townsend and Polatajko 2007). Schwartz et al. (2007) concluded that a person with a disability who had the ability to cope with everyday tasks, difficulties, and duties related had a better QOL regardless of the severity of the disability. Therefore, while impairments can limit functioning and participation in social life, they do not automatically relate to a lower QOL (Agarwal and Lim 2003). "
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