Response shift recalibration and reprioritization in health-related quality of life was identified prospectively in older men with and without stroke

• Published in: Journal of clinical epidemiology 2014-05, Vol.67 (5), p.500-507
• Main Authors: Barclay, Ruth, Tate, Robert B
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Aged; Aged, 80 and over; Aging; Analysis. Health state; Biological and medical sciences; Canada; Chronic illnesses; Community-dwelling older adults; Confidence intervals; Epidemiology; General aspects; Health care; Health Status; Health-related quality of life; Humans; Internal Medicine; Male; Mean square errors; Medical sciences; Men; Mens health; Mental health; Older people; Pain; Prospective Studies; Prospective study; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of life; Quality of Life - psychology; Response shift; Stroke; Stroke - psychology; Studies; Survivors - psychology; Survivors - statistics & numerical data
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2013.12.003

Abstract Objectives To prospectively consider evidence for response shift (RS) in health-related quality of life (HRQL) in older men who experienced stroke or remained stroke free. RS is a change in the meaning of self-evaluation; this includes recalibration, reprioritization, and reconceptualization. Study Design A cohort of 3,983 male World War II Royal Canadian Air Force recruits has been followed since 1948. There were three prospectively determined groups: stroke survivors ( n  = 168; mean age, 80.1 years); older stroke-free group ( n  = 254; mean age, 82.8 years); and younger stroke-free group ( n  = 323; mean age, 74.7 years). The Short Form-36 (SF-36) was used to evaluate HRQL. Longitudinal structural equation models were developed using SF-36 subscales and three latent variables. Measurement invariance over two time points for each of the three groups was evaluated to identify RS. Results All RS models had reasonable fit: stroke [root mean square error of approximation (RMSEA), 0.069; 90% confidence interval (CI): 0.052, 0.086], older (RMSEA, 0.055; 90% CI: 0.041, 0.068), and younger (RMSEA, 0.062; 90% CI: 0.051, 0.074). Recalibration of physical function occurred in all three groups. Reprioritization of role limitations due to physical health happened in both stroke-free groups. Conclusion This study is unique in our ability to prospectively identify RS recalibration and reprioritization in HRQL in aging men with stroke and remaining free of stroke. Changes in the meaning of self-evaluation of HRQL occur not only with stroke but also in men who remain free of stroke.