Background: A response shift is a psychological change in one's
perception of the quality of life following a change in health status. This
phenomenon initially was recognized in patients with terminal diseases who,
despite a worsening of the physical condition, did not necessarily report
deterioration in quality of life. The purpose of the present study was to
examine the role of response shift in patients undergoing total knee
Methods: Consecutive candidates undergoing total knee replacement
for the treatment of degenerative arthritis completed a Western Ontario and
McMaster Universities Osteoarthritis questionnaire preoperatively (Pre-Test).
At six months postoperatively, the patients completed two questionnaires: one
on how they felt currently (Post-Test), and one on how they perceived
themselves to have been prior to surgery (Then-Test). The study cohort
comprised 125 subjects, including ninety-one women and thirty-four men, with a
mean age (and standard deviation) of 68 ± 9.5 years. The impact of
response shift was examined statistically.
Results: With use of the Then-Test methodology, a significant (p
< 0.05) response shift was observed in the domains of pain, physical
function, and total Western Ontario and McMaster Universities Osteoarthritis
score, indicating that patients perceived themselves as having been more
disabled than what they had reported before surgery. In measuring outcome,
this translates into the treatment effect being greater when adjusting for the
presence of a response shift. With the numbers available, age, gender,
comorbidity, and amount of recovery did not have a significant impact on
response shift when adjusted for the preoperative level of disability.
Conclusions: Patients who have undergone total knee replacement
demonstrate a response shift in the measurement of their outcome at six months
postoperatively. Although the response shift effect in the present study did
not affect the interpretation of clinical results, we have highlighted the
different patterns of individuals' psychological adaptation to a change in
health status. This is an essential component of assessing the success or
failure of surgical interventions as quantified with self-administered
Level of Evidence: Prognostic Level I. See Instructions
to Authors for a complete description of levels of evidence.