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Item response theory and factor analysis as a mean to characterize occurrence of response shift in a longitudinal quality of life study in breast cancer patients.

Anota A, Bascoul-Mollevi C, Conroy T, Guillemin F, Velten M, Jolly D, Mercier M, Causeret S, Cuisenier J, Graesslin O, Hamidou Z, Bonnetain F - Health Qual Life Outcomes (2014)

Bottom Line: At six months, the recalibration effect was statistically significant for 11/22 dimensions of the QLQ-C30 and BR23 according to the LLRA model (p ≤ 0.001).Our findings demonstrate the usefulness of these analyses in characterizing the occurrence of RS.PCA is an indirect method in investigating the reprioritization and reconceptualization components of RS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Quality of Life in Oncology Platform, Besançon, France. aanota@chu-besancon.fr.

ABSTRACT

Background: The occurrence of response shift (RS) in longitudinal health-related quality of life (HRQoL) studies, reflecting patient adaptation to disease, has already been demonstrated. Several methods have been developed to detect the three different types of response shift (RS), i.e. recalibration RS, 2) reprioritization RS, and 3) reconceptualization RS. We investigated two complementary methods that characterize the occurrence of RS: factor analysis, comprising Principal Component Analysis (PCA) and Multiple Correspondence Analysis (MCA), and a method of Item Response Theory (IRT).

Methods: Breast cancer patients (n = 381) completed the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires at baseline, immediately following surgery, and three and six months after surgery, according to the "then-test/post-test" design. Recalibration was explored using MCA and a model of IRT, called the Linear Logistic Model with Relaxed Assumptions (LLRA) using the then-test method. Principal Component Analysis (PCA) was used to explore reconceptualization and reprioritization.

Results: MCA highlighted the main profiles of recalibration: patients with high HRQoL level report a slightly worse HRQoL level retrospectively and vice versa. The LLRA model indicated a downward or upward recalibration for each dimension. At six months, the recalibration effect was statistically significant for 11/22 dimensions of the QLQ-C30 and BR23 according to the LLRA model (p ≤ 0.001). Regarding the QLQ-C30, PCA indicated a reprioritization of symptom scales and reconceptualization via an increased correlation between functional scales.

Conclusions: Our findings demonstrate the usefulness of these analyses in characterizing the occurrence of RS. MCA and IRT model had convergent results with then-test method to characterize recalibration component of RS. PCA is an indirect method in investigating the reprioritization and reconceptualization components of RS.

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Related in: MedlinePlus

Graph representing the correlation between QLQ-BR23 scores and the first two principal components of Principal Component Analysis at each prospective measurement time (N = 154): at baseline (Panel A), just after surgery (Panel B), at three months (Panel C) and at six months (Panel D). The QLQ-BR23 measures four functional scales (body image (BI), sexual functioning (SEXF), sexual enjoyment (SE), future perspective (FP)) and four symptom scales (systemic therapy side effects (STSE), breast symptoms (BS), arm symptoms (AS), upset by hair loss (HL)). SE and HL are excluded from these analyses.
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Figure 3: Graph representing the correlation between QLQ-BR23 scores and the first two principal components of Principal Component Analysis at each prospective measurement time (N = 154): at baseline (Panel A), just after surgery (Panel B), at three months (Panel C) and at six months (Panel D). The QLQ-BR23 measures four functional scales (body image (BI), sexual functioning (SEXF), sexual enjoyment (SE), future perspective (FP)) and four symptom scales (systemic therapy side effects (STSE), breast symptoms (BS), arm symptoms (AS), upset by hair loss (HL)). SE and HL are excluded from these analyses.

Mentions: Concerning the QLQ-BR23, STSE affected the patients’ body image since these dimensions remained strongly negatively correlated (Figure 3). These scales were highly correlated with the first principal component (Table 7). Post-surgery, arm symptoms as well as body image and STSE were significantly correlated with the first principal component. Thus, arm symptoms were equally important to body image and STSE regarding patient HRQoL level. At M3 and M6, future perspectives became significantly correlated with the first principal component and thus gained importance, highlighting a major reprioritization. Breast symptoms and sexual functioning were not significantly associated with the two first axes at baseline: they were minor dimensions. After surgery, only sexual functioning was a relevant factor, while at M3 and M6, only breast symptoms were relevant.


Item response theory and factor analysis as a mean to characterize occurrence of response shift in a longitudinal quality of life study in breast cancer patients.

Anota A, Bascoul-Mollevi C, Conroy T, Guillemin F, Velten M, Jolly D, Mercier M, Causeret S, Cuisenier J, Graesslin O, Hamidou Z, Bonnetain F - Health Qual Life Outcomes (2014)

Graph representing the correlation between QLQ-BR23 scores and the first two principal components of Principal Component Analysis at each prospective measurement time (N = 154): at baseline (Panel A), just after surgery (Panel B), at three months (Panel C) and at six months (Panel D). The QLQ-BR23 measures four functional scales (body image (BI), sexual functioning (SEXF), sexual enjoyment (SE), future perspective (FP)) and four symptom scales (systemic therapy side effects (STSE), breast symptoms (BS), arm symptoms (AS), upset by hair loss (HL)). SE and HL are excluded from these analyses.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4016038&req=5

Figure 3: Graph representing the correlation between QLQ-BR23 scores and the first two principal components of Principal Component Analysis at each prospective measurement time (N = 154): at baseline (Panel A), just after surgery (Panel B), at three months (Panel C) and at six months (Panel D). The QLQ-BR23 measures four functional scales (body image (BI), sexual functioning (SEXF), sexual enjoyment (SE), future perspective (FP)) and four symptom scales (systemic therapy side effects (STSE), breast symptoms (BS), arm symptoms (AS), upset by hair loss (HL)). SE and HL are excluded from these analyses.
Mentions: Concerning the QLQ-BR23, STSE affected the patients’ body image since these dimensions remained strongly negatively correlated (Figure 3). These scales were highly correlated with the first principal component (Table 7). Post-surgery, arm symptoms as well as body image and STSE were significantly correlated with the first principal component. Thus, arm symptoms were equally important to body image and STSE regarding patient HRQoL level. At M3 and M6, future perspectives became significantly correlated with the first principal component and thus gained importance, highlighting a major reprioritization. Breast symptoms and sexual functioning were not significantly associated with the two first axes at baseline: they were minor dimensions. After surgery, only sexual functioning was a relevant factor, while at M3 and M6, only breast symptoms were relevant.

Bottom Line: At six months, the recalibration effect was statistically significant for 11/22 dimensions of the QLQ-C30 and BR23 according to the LLRA model (p ≤ 0.001).Our findings demonstrate the usefulness of these analyses in characterizing the occurrence of RS.PCA is an indirect method in investigating the reprioritization and reconceptualization components of RS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Quality of Life in Oncology Platform, Besançon, France. aanota@chu-besancon.fr.

ABSTRACT

Background: The occurrence of response shift (RS) in longitudinal health-related quality of life (HRQoL) studies, reflecting patient adaptation to disease, has already been demonstrated. Several methods have been developed to detect the three different types of response shift (RS), i.e. recalibration RS, 2) reprioritization RS, and 3) reconceptualization RS. We investigated two complementary methods that characterize the occurrence of RS: factor analysis, comprising Principal Component Analysis (PCA) and Multiple Correspondence Analysis (MCA), and a method of Item Response Theory (IRT).

Methods: Breast cancer patients (n = 381) completed the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires at baseline, immediately following surgery, and three and six months after surgery, according to the "then-test/post-test" design. Recalibration was explored using MCA and a model of IRT, called the Linear Logistic Model with Relaxed Assumptions (LLRA) using the then-test method. Principal Component Analysis (PCA) was used to explore reconceptualization and reprioritization.

Results: MCA highlighted the main profiles of recalibration: patients with high HRQoL level report a slightly worse HRQoL level retrospectively and vice versa. The LLRA model indicated a downward or upward recalibration for each dimension. At six months, the recalibration effect was statistically significant for 11/22 dimensions of the QLQ-C30 and BR23 according to the LLRA model (p ≤ 0.001). Regarding the QLQ-C30, PCA indicated a reprioritization of symptom scales and reconceptualization via an increased correlation between functional scales.

Conclusions: Our findings demonstrate the usefulness of these analyses in characterizing the occurrence of RS. MCA and IRT model had convergent results with then-test method to characterize recalibration component of RS. PCA is an indirect method in investigating the reprioritization and reconceptualization components of RS.

Show MeSH
Related in: MedlinePlus