Ruth Barclay, Kedar K. V. Mate, Brittany Lapin, Nikki Ow, Richard Sawatzky, and Nancy Mayo

Response shift

Response shift occurs when observed change of a person’s score on a questionnaire (patient-reported outcome – PRO) is not completely explained by change in the concept being measured (for example, health related quality of life), because of change in the meaning of subjective evaluation of the concept. Response shift is often considered a potential bias in interpreting change scores in PROs. However, there is another way of looking at response shift.

We are a group of researchers and clinicians in rehabilitation and healthcare, from the ISOQOL Response Shift Special Interest Group. We have observed clinically that rehabilitation professionals may intentionally or unintentionally induce a change in perspective during therapy, interactions, and while developing therapeutic relationships. Very often, as health care professionals, we aim to achieve this change in perspective as it often reflects better management of the client’s health condition. For example, consider Susan who had a stroke one year ago. At the end of rehabilitation, she was asked to rate her perception of recovery and she rated it very poor (2 out of 10), as she was very limited in walking outdoors. She was discouraged by this limitation, as going for long walks had been a main way to socialize with friends and was of primary importance to her well-being. Over time, she became involved with her local community center and started teaching people of all ages how to knit. She discovered a new love of teaching and felt her life was full. At her one-year follow-up assessment, she was asked again to rate her recovery and reported it to be 8 of 10, despite no change in her reported walking capacity. Her change in recovery (+6 / 10) was not fully explained by change in neurological/motor recovery, indicating that she had undergone ‘positive’ response shift by reconceptualizing recovery.

 Our Objective

We need to know more about potential intervention components that may lead to a response shift. The objective of the project was to identify, from the perspectives of experts and clients, intervention components that could potentially be associated with response shift. 

 What we did

We communicated with seven experts in rehabilitation, mental health and nursing; they shared their experiences with clients who had undergone changes in perception of a self-perceived outcome. We reviewed quotes from qualitative studies on the client experience of response shift / change in perspective, which were previously presented together in one paper. We also reviewed a qualitative paper on physical and occupational therapist (PT / OT) experiences with clients undergoing changes in perspective during rehabilitation. The information from all the sources was used to identify potential intervention components, which may be associated with response shift in a rehabilitation or healthcare setting. ‘Intervention components’ refers to parts of treatment strategies.

What we found

The experiences from the experts resulted in 91 comments grouped into 14 categories of intervention components.  The PT / OT experiences consisted of 13 quotes clustered into five categories. These five categories corresponded with the expert experiences. Sixty-one quotes from a client point of view were grouped into eight categories. Seven of the eight categories agreed with the expert communication, and they overlapped with all the categories identified in the OT / PT study. The seven categories include: the appraisal process, coping strategies, goal setting, peer support, self-efficacy training, self-reflection and social comparison.

The data suggested a number of intervention components that could possibly lead to response shift. Noted across data sources was the importance of the timing of interventions and that interventions be uniquely geared to the individual.

What we still need to learn

We have only started to identify potential intervention components associated with response shift. Future work should include in-depth evaluation of the intervention components identified in this project and may develop a program that could be targeted towards people living with chronic health conditions.

Abstract will be presented in the Thursday Morning Poster Presentations: Slot 2 on 20 October, 10:25 am – 10:40 am. 

This newsletter editorial represents the views of the author and does not necessarily reflect the views of ISOQOL. 

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The International Society for Quality of Life Research (ISOQOL) is a global community of researchers, clinicians, health care professionals, industry professionals, consultants, and patient research partners advancing health related quality of life research (HRQL).

Together, we are creating a future in which patient perspective is integral to health research, care and policy.