Assessment of response shift using two structural equation modeling techniques

Abstract

Objective: To identify response shift using two structural equation modeling (SEM) techniques.

Study design and setting: Hypertensive patients (n = 909) with coronary artery disease (CAD) completed SF-36 surveys at both baseline and 1-year follow-up. Response shift was identified using Oort and Schmitt SEM techniques. The type of response shift linked to changes in various parameters of the SEM measurement model is defined differently for both SEM approaches. Effect sizes were calculated for the impact of response shift on the change of SF-36 domain scores when using the Oort approach.

Results: Both Oort and Schmitt SEM approaches identified response shift only in the SF-36 physical functioning (PF) scale. The effect size of recalibration on the change of PF domain scores when using the Oort approach was -0.12.

Conclusion: This study showed that hypertensive patients with CAD experienced a response shift over a 1-year period. Both the SEM approaches identified response shift (uniform recalibration using the Oort approach and recalibration using the Schmitt approach); however, both approaches use different parameters to define and test response shift. We found that either the variation in analytic methods or the sample used may influence the identification and type of response shift.

Figure 1

The measurement model used in response shift detection Notes: Circles represent latent variables (common and residual factors) and squares represent observed variables (SF-36 scales). Abbreviations: PF – physical functioning; RP – role physical; BP – bodily pain; GH – general health; VT – vitality; SF – social functioning; RE – role-emotional; MH – mental health.