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Response shift masks the treatment impact on patient reported outcomes (PROs): the example of individual quality of life in edentulous patients

Identifieur interne : 001779 ( Ncbi/Curation ); précédent : 001778; suivant : 001780

Response shift masks the treatment impact on patient reported outcomes (PROs): the example of individual quality of life in edentulous patients

Auteurs : Lena Ring [Irlande (pays), Suède] ; Stefan Höfer [Irlande (pays), Autriche] ; Frank Heuston [Irlande (pays)] ; David Harris [Irlande (pays)] ; Ciaran A. O'Boyle [Irlande (pays)]

Source :

Health and Quality of Life Outcomes [ 1477-7525 ] ; 2005.

RBID : PMC:1236951

Descripteurs français

English descriptors

KwdEn :
- Adaptation, Psychological, Aged, Dental Implantation, Endosseous (psychology), Dental Service, Hospital, Denture, Complete (psychology), Female, Hospitals, Teaching, Humans, Ireland, Male, Middle Aged, Mouth, Edentulous (psychology), Mouth, Edentulous (surgery), Mouth, Edentulous (therapy), Patient Satisfaction, Psychometrics, Quality of Life (psychology), Self Concept, Surveys and Questionnaires, Time Factors, Treatment Outcome.
MESH :
- geographic : Ireland.
- psychology : Dental Implantation, Endosseous, Denture, Complete, Mouth, Edentulous, Quality of Life.
- surgery : Mouth, Edentulous.
- therapy : Mouth, Edentulous.
- Adaptation, Psychological, Aged, Dental Service, Hospital, Female, Hospitals, Teaching, Humans, Male, Middle Aged, Patient Satisfaction, Psychometrics, Self Concept, Surveys and Questionnaires, Time Factors, Treatment Outcome.

Abstract

Background

Quality of life (QoL) is now established as an important outcome for evaluating the impact of disease, and for assessing the efficacy of treatments. However, individuals change with time and the basis on which they make a QoL judgement may also change, a phenomenon increasingly referred to as response shift. Here, the individual may change his or her internal standards, values, and/or conceptualization on the target construct as a result of external factors such as a treatment or a change in health status. This has important implications for assessing the effects of treatments as a change in QoL may reflect a response shift, a treatment effect, or a complex combination of both. In this study, we used an individualised quality of life (IQoL) measure, the SEIQoL, together with a then-test to determine whether response shift would influence the measurement of treatment efficacy in edentulous patients.

Methods

Data are reported here for the first phase of a randomised controlled clinical trial designed to assess the impact, on IQoL, of implant supported dentures compared with high quality conventional dentures. IQoL was measured using the SEIQoL-DW in 117 patients (mean age 64.8; 32% male) at baseline (T₁) and 3 months (T₂) after receiving high quality conventional dentures. The work was carried out in dental teaching hospitals in Dublin and Belfast.

Results

Unadjusted SEIQoL index scores revealed no significant impact of treatment at three months (baseline: 75.0; 3 months: 73.2, p = .33, n.s.). However, the then-test at 3 months revealed that patients retrospectively rated their baseline IQoL as significantly lower (P < .001) than they had rated it at the time (then-test baseline: 69.2). Comparison of the 3 month scores with this readjusted baseline indicated a significant treatment effect (then-test baseline: 69.2; 3 months: 73.2, p = 0.016). 81% of patients nominated at least one different IQoL domain at 3 months.

Conclusion

The positive impact of denture treatment for edentulous patients on IQoL was seen only when response shifts were taken into consideration. The nature of the response shifts was highly complex but the data indicated a degree of re-conceptualisation and reprioritisation. Assessment of the impact of treatments using patient-generated reports must take account of the adaptive nature of patients.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1236951

DOI: 10.1186/1477-7525-3-55
PubMed: 16146573
PubMed Central: 1236951

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Le document en format XML

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<term>Female</term>
<term>Hospitals, Teaching</term>
<term>Humans</term>
<term>Ireland</term>
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<term>Middle Aged</term>
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<term>Concept du soi</term>
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<term>Qualité de vie (psychologie)</term>
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<term>Satisfaction du patient</term>
<term>Service hospitalier d'odontologie</term>
<term>Sujet âgé</term>
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<term>Pose d'implant dentaire endo-osseux</term>
<term>Prothèse dentaire complète</term>
<term>Qualité de vie</term>
</keywords>
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<term>Denture, Complete</term>
<term>Mouth, Edentulous</term>
<term>Quality of Life</term>
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</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Mouth, Edentulous</term>
</keywords>
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<term>Aged</term>
<term>Dental Service, Hospital</term>
<term>Female</term>
<term>Hospitals, Teaching</term>
<term>Humans</term>
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<term>Middle Aged</term>
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<term>Time Factors</term>
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<term>Adulte d'âge moyen</term>
<term>Bouche édentée</term>
<term>Concept du soi</term>
<term>Enquêtes et questionnaires</term>
<term>Facteurs temps</term>
<term>Femelle</term>
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<term>Mâle</term>
<term>Psychométrie</term>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Quality of life (QoL) is now established as an important outcome for evaluating the impact of disease, and for assessing the efficacy of treatments. However, individuals change with time and the basis on which they make a QoL judgement may also change, a phenomenon increasingly referred to as response shift. Here, the individual may change his or her internal standards, values, and/or conceptualization on the target construct as a result of external factors such as a treatment or a change in health status. This has important implications for assessing the effects of treatments as a change in QoL may reflect a response shift, a treatment effect, or a complex combination of both. In this study, we used an individualised quality of life (IQoL) measure, the SEIQoL, together with a then-test to determine whether response shift would influence the measurement of treatment efficacy in edentulous patients.</p>
</sec>
<sec sec-type="methods"><title>Methods</title>
<p>Data are reported here for the first phase of a randomised controlled clinical trial designed to assess the impact, on IQoL, of implant supported dentures compared with high quality conventional dentures. IQoL was measured using the SEIQoL-DW in 117 patients (mean age 64.8; 32% male) at baseline (T<sub>1</sub>
) and 3 months (T<sub>2</sub>
) after receiving high quality conventional dentures. The work was carried out in dental teaching hospitals in Dublin and Belfast.</p>
</sec>
<sec><title>Results</title>
<p>Unadjusted SEIQoL index scores revealed no significant impact of treatment at three months (baseline: 75.0; 3 months: 73.2, p = .33, n.s.). However, the then-test at 3 months revealed that patients retrospectively rated their baseline IQoL as significantly lower (P < .001) than they had rated it at the time (then-test baseline: 69.2). Comparison of the 3 month scores with this readjusted baseline indicated a significant treatment effect (then-test baseline: 69.2; 3 months: 73.2, p = 0.016). 81% of patients nominated at least one different IQoL domain at 3 months.</p>
</sec>
<sec><title>Conclusion</title>
<p>The positive impact of denture treatment for edentulous patients on IQoL was seen only when response shifts were taken into consideration. The nature of the response shifts was highly complex but the data indicated a degree of re-conceptualisation and reprioritisation. Assessment of the impact of treatments using patient-generated reports must take account of the adaptive nature of patients.</p>
</sec>
</div>
</front>
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Response shift masks the treatment impact on patient reported outcomes (PROs): the example of individual quality of life in edentulous patients

Response shift masks the treatment impact on patient reported outcomes (PROs): the example of individual quality of life in edentulous patients

Source :

Descripteurs français

English descriptors

Abstract

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