title: When global rating of change contradicts observed change: Examining appraisal processes underlying paradoxical responses over time.
abstract: Interpreting change scores is challenging when patients' global rating of change (GRC) scores contradict their observed change scores. We examine appraisal processes associated with having GRC-observed change contradictions.
  
  
  
  This secondary analysis of longitudinal multiple sclerosis (MS) registry data examined predictors of GRC scores in the whole sample (n = 858). Logistic modeling then examined predictors of membership in one of two paradoxical subgroups (n = 525): (a) Worsened GRC with unchanged observed Rand-12 Mental Component scores (MCS) (Symptom-Maximizers, n = 171) versus no change GRC among stable MCS subsample; and (b) same GRC with declined observed MCS scores (Symptom-Minimizers, n = 84) versus declining GRC among declining MCS subsample. Independent variables were cognitive appraisal processes from the Quality of Life (QOL) Appraisal Profile.
  
  
  
  GRC scores were more strongly associated with appraisal processes than with change in patient-reported outcomes (PROs) (R2= 11 and 2 %, respectively). Symptom-Maximizers tended to focus on MS-related experiences and emphasize big changes; over time, they decreasingly defined QOL in terms of independence, increasingly focused on their MS, and increasingly compared themselves to doctor's predictions (Pseudo R2= 0.20). In contrast, Symptom-Minimizers tended not to recall recent episodes; over time, they focused increasingly on goals related to living situation and emphasized long-term concerns (Pseudo R2= 0.25).
  
  
  
  Appraisal explains more variance in GRC scores than do changes in PROs. People whose GRC assessment contradicts their observed change can be characterized by distinct cognitive appraisal processes reflecting response shift.
authors.affiliation: DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA. carolyn.schwartz@deltaquest.org.|Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA. carolyn.schwartz@deltaquest.org.
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Schwartz
authors.affiliation: DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA.
authors.forename: Victoria E
authors.initials: VE
authors.lastname: Powell
authors.affiliation: Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Rapkin
mesh_terms: D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D011788:Quality of Life; D012042:Registries; D014481:United States
keywords: Appraisal; Clinical significance; Interpretation of change; Patient-reported outcomes; Response shift