Response Shift in Outcome Assessment in Patients Undergoing Total Knee Arthroplasty
Bibliographic record
Abstract
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 replacement surgery. 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 quality-of-life measures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".