The Oort structural equation modeling approach detected a response shift after a COPD self-management program not detected by the Schmitt technique.
J Clin Epidemiol
; 62(11): 1165-72, 2009 Nov.
Article
in En
| MEDLINE
| ID: mdl-19664904
ABSTRACT
OBJECTIVE:
If individuals experience a response shift, scores on measures before and after a self-management intervention may not be comparable. This study evaluated whether persons with chronic obstructive pulmonary disease (COPD) experience a response shift after participating in a self-management program. The second objective was to compare the Oort and Schmitt structural equation modeling (SEM) approaches.METHODS:
Secondary analyses from a randomized controlled trial comparing a home- and hospital-based pulmonary rehabilitation program were used to assess response shift on a physical and mental health-measurement model measured using the Chronic Respiratory Questionnaire (CRQ) and the St. George's Respiratory Questionnaire (SGRQ) over a 1-year period.RESULTS:
The Oort approach showed significant changes between the no response shift model and models removing invariance constraints for the residual of the CRQ dyspnea (chi(2)(SBdiff)=7, df=1) (uniform recalibration) and intercepts of the SGRQ activity (chi(2)(SBdiff)=14, df=1) and impact (chi(2)(SBdiff)=10, df=1) subscales (nonuniform recalibration). Change in factor means showed changes in the physical health factor, which was slightly lower in unadjusted (0.32) as compared with the response shift-adjusted model (0.40). The Schmitt procedure was not supportive of any response shift effect and showed a marginal change in random error over time.CONCLUSIONS:
This study showed that COPD patients experienced a response shift after participating in a self-management program, which resulted in an underestimation of change in physical health. These results suggest that the Oort procedure is more sensitive in detecting a response shift, and that a measurement of response shift is needed before results can be interpreted. Future comparisons with other methods and a control group are needed.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Quality of Life
/
Self Care
/
Adaptation, Psychological
/
Pulmonary Disease, Chronic Obstructive
Type of study:
Clinical_trials
/
Prognostic_studies
/
Qualitative_research
Aspects:
Patient_preference
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Clin Epidemiol
Journal subject:
EPIDEMIOLOGIA
Year:
2009
Document type:
Article
Affiliation country: