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Schwartz CE, Rapkin BD, Borowiec K, Finkelstein JA. Cognitive Processes during Recovery: Moving toward Personalized Spine Surgery Outcomes. J Pers Med 2022; 12:jpm12101545. [PMID: 36294682 PMCID: PMC9605664 DOI: 10.3390/jpm12101545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022] Open
Abstract
This paper focuses on a novel application of personalized medicine: the ways one thinks about health (i.e., appraisal processes) as relevant predictors of spine-surgery response. This prospective longitudinal cohort study (n = 235) investigated how appraisal processes relate to outcomes of spinal decompression and/or fusion surgery, from pre-surgery through one-year post-surgery. Patient-reported outcomes assessed spine-specific disability (Oswestry Disability Index (ODI)), mental health functioning (Rand-36 Mental Component Score (MCS)), and cognitive appraisal processes (how people recall past experiences and to whom they compare themselves). Analysis of Variance examined the appraisal-outcomes association in separate models at pre-surgery, 3 months, and 12 months. We found that appraisal processes explained less variance at pre-surgery than later and were differentially relevant to health outcomes at different times in the spine-surgery recovery trajectory. For the ODI, recall of the seriousness of their condition was most prominent early in recovery, and comparing themselves to positive standards was most prominent later. For the MCS, not focusing on the negative aspects of their condition and/or on how others see them was associated with steady improvement and higher scores at 12 months. Appraisal processes are relevant to both spine-specific disability and mental-health functioning. Such processes are modifiable objects of attention for personalizing spine-surgery outcomes.
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Affiliation(s)
- Carolyn E. Schwartz
- DeltaQuest Foundation, Inc., Concord, MA 02111, USA
- Departments of Medicine and Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA 02111, USA
- Correspondence: ; Tel.: +1-978-318-7914
| | - Bruce D. Rapkin
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Katrina Borowiec
- DeltaQuest Foundation, Inc., Concord, MA 02111, USA
- Department of Measurement, Evaluation, Statistics & Assessment, Boston College Lynch School of Education and Human Development, Chestnut Hill, MA 02467, USA
| | - Joel A. Finkelstein
- Department of Surgery, University of Toronto, Toronto, ON M4N 3M5, Canada
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Spine Surgery, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
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Vanier A, Oort FJ, McClimans L, Ow N, Gulek BG, Böhnke JR, Sprangers M, Sébille V, Mayo N. Response shift in patient-reported outcomes: definition, theory, and a revised model. Qual Life Res 2021; 30:3309-3322. [PMID: 33909187 PMCID: PMC8602159 DOI: 10.1007/s11136-021-02846-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/24/2022]
Abstract
Purpose The extant response shift definitions and theoretical response shift models, while helpful, also introduce predicaments and theoretical debates continue. To address these predicaments and stimulate empirical research, we propose a more specific formal definition of response shift and a revised theoretical model. Methods This work is an international collaborative effort and involved a critical assessment of the literature. Results Three main predicaments were identified. First, the formal definitions of response shift need further specification and clarification. Second, previous models were focused on explaining change in the construct intended to be measured rather than explaining the construct at multiple time points and neglected the importance of using at least two time points to investigate response shift. Third, extant models do not explicitly distinguish the measure from the construct. Here we define response shift as an effect occurring whenever observed change (e.g., change in patient-reported outcome measures (PROM) scores) is not fully explained by target change (i.e., change in the construct intended to be measured). The revised model distinguishes the measure (e.g., PROM) from the underlying target construct (e.g., quality of life) at two time points. The major plausible paths are delineated, and the underlying assumptions of this model are explicated. Conclusion It is our hope that this refined definition and model are useful in the further development of response shift theory. The model with its explicit list of assumptions and hypothesized relationships lends itself for critical, empirical examination. Future studies are needed to empirically test the assumptions and hypothesized relationships. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02846-w.
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Affiliation(s)
- Antoine Vanier
- Inserm - University of Nantes - University of Tours, UMR 1246 Sphere "Methods in Patient-Centered Outcomes and Health Research", Nantes, France. .,University Hospital of Tours - Inserm, CIC 1415, Unit of Methodology Biostatistics and Data-Management, Tours, France. .,Inserm U1246 Sphere, Institut de Recherche en Santé 2 - Université de Nantes, 22, Boulevard Bénoni-Goullin, 44200, Nantes, France.
| | - Frans J Oort
- University of Amsterdam, Research Institute of Child Development and Education, Amsterdam, The Netherlands
| | - Leah McClimans
- Department of Philosophy, University of South Carolina, Columbia, SC, USA
| | - Nikki Ow
- Center for Outcomes Research and Evaluation, McGill University, Montreal, Canada
| | - Bernice G Gulek
- Harborview Medical Center, University of Washington, Seattle, WA, USA.,College of Nursing, Washington State University, Spokane, WA, USA
| | - Jan R Böhnke
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Mirjam Sprangers
- Department of Medical Psychology, Location AMC, Research Institute Amsterdam Public Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Véronique Sébille
- Inserm - University of Nantes - University of Tours, UMR 1246 Sphere "Methods in Patient-Centered Outcomes and Health Research", Nantes, France.,Unit of Methodology in Clinical Research and Biostatistics, University Hospital of Nantes, Nantes, France
| | - Nancy Mayo
- Center for Outcomes Research and Evaluation, McGill University, Montreal, Canada.,Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre Research Institute, Montreal, Canada
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Boehnke JR, Skolasky RL, Rutherford C. Introduction to "Advancing quality‑of‑life research by deepening our understanding of response shift". Qual Life Res 2019; 28:2621-2622. [PMID: 31515748 DOI: 10.1007/s11136-019-02294-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jan R Boehnke
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK.
| | - Richard L Skolasky
- Departments of Orthopaedic Surgery and Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, Quality of Life Office, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), The University of Sydney, Sydney, Australia
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