The relationship between change in subjective outcome and change in disease: a potential paradox
Identifieur interne : 002E00 ( Ncbi/Curation ); précédent : 002D99; suivant : 002E01The relationship between change in subjective outcome and change in disease: a potential paradox
Auteurs : Wietske Kievit [Pays-Bas] ; Jos Hendrikx [Pays-Bas] ; Peep F. M. Stalmeier [Pays-Bas] ; Mart A. F. J. Van De Laar [Pays-Bas] ; Piet L. C. M. Van Riel [Pays-Bas] ; Eddy M. Adang [Pays-Bas]Source :
- Quality of Life Research [ 0962-9343 ] ; 2010.
Abstract
Response shift theory suggests that improvements in health lead patients to change their internal standards and re-assess former health states as worse than initially rated when using retrospective ratings via the then-test. The predictions of response shift theory can be illustrated using prospect theory, whereby a change in current health causes a change in reference frame. Therefore, if health deteriorates, the former health state will receive a better rating, whereas if it improves, the former health state will receive a worse rating.
To explore the predictions of response shift and prospect theory by relating subjective change to objective change.
Baseline and 3-month follow-up data from a cohort of rheumatoid arthritis patients (
At 3 months, 51 (25.9%) patients had good improvement in health, 83 (42.1%) had moderate improvement, and 63 (32.0%) had no improvement or deteriorated in health. All patients no matter whether they improved, did not improve, or even became worse rated their health as worse retrospectively. The difference between the then-test rating and the baseline value was similarly sized in all groups.
More positive ratings of retrospective health are independent of disease change. This suggests that patients do not necessarily change their standards in line with their disease change, and therefore it is inappropriate to use the then-test to correct for such a change. If a then-test is used to correct for shifts in internal standards, it might lead to the paradoxical result that patients who do not improve or even deteriorate increase significantly on self-reported health and pain. An alternative explanation for differences in retrospective and prospective ratings of health is the implicit theory of change which is more successful in explaining our results than prospect theory.
Url:
DOI: 10.1007/s11136-010-9665-x
PubMed: 20454862
PubMed Central: 2923719
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M." last="Stalmeier">Peep F. M. 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Van Riel</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Rheumatology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen</wicri:regionArea><wicri:noRegion>6500 HB Nijmegen</wicri:noRegion></affiliation></author><author><name sortKey="Adang, Eddy M" sort="Adang, Eddy M" uniqKey="Adang E" first="Eddy M." last="Adang">Eddy M. Adang</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20454862</idno><idno type="pmc">2923719</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923719</idno><idno type="RBID">PMC:2923719</idno><idno type="doi">10.1007/s11136-010-9665-x</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">000D58</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000D58</idno><idno type="wicri:Area/Pmc/Curation">000D58</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000D58</idno><idno type="wicri:Area/Pmc/Checkpoint">002301</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002301</idno><idno type="wicri:Area/Ncbi/Merge">002E00</idno><idno type="wicri:Area/Ncbi/Curation">002E00</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The relationship between change in subjective outcome and change in disease: a potential paradox</title><author><name sortKey="Kievit, Wietske" sort="Kievit, Wietske" uniqKey="Kievit W" first="Wietske" last="Kievit">Wietske Kievit</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Rheumatology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen</wicri:regionArea><wicri:noRegion>6500 HB Nijmegen</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Hendrikx, Jos" sort="Hendrikx, Jos" uniqKey="Hendrikx J" first="Jos" last="Hendrikx">Jos Hendrikx</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Rheumatology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen</wicri:regionArea><wicri:noRegion>6500 HB Nijmegen</wicri:noRegion></affiliation></author><author><name sortKey="Stalmeier, Peep F M" sort="Stalmeier, Peep F M" uniqKey="Stalmeier P" first="Peep F. M." last="Stalmeier">Peep F. M. Stalmeier</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Van De Laar, Mart A F J" sort="Van De Laar, Mart A F J" uniqKey="Van De Laar M" first="Mart A. F. J." last="Van De Laar">Mart A. F. J. Van De Laar</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Rheumatology, Medisch Spectrum Twente & University Twente, Enschede, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Medisch Spectrum Twente & University Twente, Enschede</wicri:regionArea><wicri:noRegion>Enschede</wicri:noRegion></affiliation></author><author><name sortKey="Van Riel, Piet L C M" sort="Van Riel, Piet L C M" uniqKey="Van Riel P" first="Piet L. C. M." last="Van Riel">Piet L. C. M. Van Riel</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Rheumatology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen</wicri:regionArea><wicri:noRegion>6500 HB Nijmegen</wicri:noRegion></affiliation></author><author><name sortKey="Adang, Eddy M" sort="Adang, Eddy M" uniqKey="Adang E" first="Eddy M." last="Adang">Eddy M. Adang</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author></analytic><series><title level="j">Quality of Life Research</title><idno type="ISSN">0962-9343</idno><idno type="eISSN">1573-2649</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Response shift theory suggests that improvements in health lead patients to change their internal standards and re-assess former health states as worse than initially rated when using retrospective ratings via the then-test. The predictions of response shift theory can be illustrated using prospect theory, whereby a change in current health causes a change in reference frame. Therefore, if health deteriorates, the former health state will receive a better rating, whereas if it improves, the former health state will receive a worse rating.</p></sec><sec><title>Objective</title><p>To explore the predictions of response shift and prospect theory by relating subjective change to objective change.</p></sec><sec><title>Methods</title><p>Baseline and 3-month follow-up data from a cohort of rheumatoid arthritis patients (<italic>N</italic> = 197) starting on TNFα-blocking agents were used. Objective disease change was classified according to a disease-specific clinical outcome measure (DAS28). Visual analogue scales (VAS) for general health (GH) and pain were used as self-reported measures. Three months after starting on anti-TNFα, patients used the then-test to re-rate their baseline health with regard to general health and pain. Differences between then-test value and baseline values were calculated and tested between improved, non-improved and deteriorated patients by the Student <italic>t</italic>-test.</p></sec><sec><title>Results</title><p>At 3 months, 51 (25.9%) patients had good improvement in health, 83 (42.1%) had moderate improvement, and 63 (32.0%) had no improvement or deteriorated in health. All patients no matter whether they improved, did not improve, or even became worse rated their health as worse retrospectively. The difference between the then-test rating and the baseline value was similarly sized in all groups.</p></sec><sec><title>Conclusion</title><p>More positive ratings of retrospective health are independent of disease change. This suggests that patients do not necessarily change their standards in line with their disease change, and therefore it is inappropriate to use the then-test to correct for such a change. If a then-test is used to correct for shifts in internal standards, it might lead to the paradoxical result that patients who do not improve or even deteriorate increase significantly on self-reported health and pain. An alternative explanation for differences in retrospective and prospective ratings of health is the implicit theory of change which is more successful in explaining our results than prospect theory.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Badia, X" uniqKey="Badia X">X Badia</name></author><author><name sortKey="Monserrat, S" uniqKey="Monserrat S">S Monserrat</name></author><author><name sortKey="Roset, M" uniqKey="Roset M">M Roset</name></author><author><name sortKey="Herdman, M" uniqKey="Herdman M">M Herdman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dworkin, Rh" uniqKey="Dworkin R">RH Dworkin</name></author><author><name sortKey="Turk, Dc" uniqKey="Turk D">DC Turk</name></author><author><name sortKey="Revicki, Da" uniqKey="Revicki D">DA Revicki</name></author><author><name sortKey="Harding, G" uniqKey="Harding G">G Harding</name></author><author><name sortKey="Coyne, Ks" 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