title: Response shift and disease activity in inflammatory bowel disease.
abstract: Response shift (RS) may mask true change in health-related quality of life in longitudinal studies. People with chronic conditions may experience RS as they adapt to their disease, but it is unknown whether fluctuations in disease activity will influence the presence of RS. The study purpose was to test for RS in individuals with inflammatory bowel disease (IBD), a condition characterized by periods of symptom flares and remission.
  
  
  
  Data were from the Manitoba IBD Cohort Study (N = 388). Multi-group confirmatory factor analysis (MG-CFA) and a RS detection method based on structural equation modeling were used to test for reconceptualization, reprioritization, and recalibration RS in participants with consistent active, consistent inactive, and inconsistent disease activity over a 6-month period on the SF-36.
  
  
  
  The MG-CFA revealed that a weak invariance model with equal factor loadings across groups was the best fit to the baseline SF-36 data. Reconceptualization, uniform recalibration, and non-uniform recalibration RS was detected in the consistent active group, but effect sizes were small. For the consistent inactive group, recalibration RS was observed and effect sizes were small to moderate. For the inconsistent disease activity group, small-to-moderate recalibration RS effects were observed. There was no evidence of reprioritization.
  
  
  
  Individuals with a chronic disease may exhibit RS even if they are not actively experiencing symptoms on a consistent basis. Heterogeneity in the type and magnitude of RS effects may be observed in chronic disease patients who experience changes in disease symptoms.
authors.affiliation: Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada. Lisa.Lix@umanitoba.ca.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lix
authors.affiliation: Measurement, Evaluation, and Research Methodology (MERM) Program, University of British Columbia, Vancouver, Canada.|School of Nursing, Trinity Western University, Langley, Canada.
authors.forename: Eric K H
authors.initials: EK
authors.lastname: Chan
authors.affiliation: School of Nursing, Trinity Western University, Langley, Canada.|Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Sawatzky
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Canada.|O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.
authors.forename: Tolulope T
authors.initials: TT
authors.lastname: Sajobi
authors.affiliation: Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Juxin
authors.initials: J
authors.lastname: Liu
authors.affiliation: Queen's University, Kingston, Canada.
authors.forename: Wilma
authors.initials: W
authors.lastname: Hopman
authors.affiliation: McGill University Health Centre, Montreal, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Mayo
mesh_terms: D002908:Chronic Disease / Q000523:psychology*; D015331:Cohort Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006304:Health Status; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000473:pathology* / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D008962:Models, Theoretical; D011788:Quality of Life / Q000523:psychology*
keywords: Disease activity; Group comparisons; Health-related quality of life; Longitudinal; Measurement invariance; Structural equation modeling