Response shift results of quantitative research using patient-reported outcome measures: a descriptive systematic review

, Richard Sawatzky (Lead / Corresponding author), Tolulope T. Sajobi, Lara Russell, Oluwagbohunmi A Awosoga, Ayoola Ademola, Jan R. Böhnke, Oluwaseyi Lawal, Anita Brobbey, Lisa M. Lix, Amelie Anota, Véronique Sebille, Mirjam A. G. Sprangers, Mathilde G. E. Verdam

Research output: Contribution to journalReview articlepeer-review


Purpose: The objective of this systematic review was to describe the prevalence and magnitude of response shift effects, for different response shift methods, populations, study designs, and patient-reported outcome measures (PROM)s.

Methods: A literature search was performed in MEDLINE, PSYCINFO, CINAHL, EMBASE, Social Science Citation Index, and Dissertations & Theses Global to identify longitudinal quantitative studies that examined response shift using PROMs, published before 2021. The magnitude of each response shift effect (effect sizes, R-squared or percentage of respondents with response shift) was ascertained based on reported statistical information or as stated in the manuscript. Prevalence and magnitudes of response shift effects were summarized at two levels of analysis (study and effect levels), for recalibration and reprioritization/reconceptualization separately, and for different response shift methods, and population, study design, and PROM characteristics. Analyses were conducted twice: (a) including all studies and samples, and (b) including only unrelated studies and independent samples.

Results: Of the 150 included studies, 130 (86.7%) detected response shift effects. Of the 4868 effects investigated, 793 (16.3%) revealed response shift. Effect sizes could be determined for 105 (70.0%) of the studies for a total of 1130 effects, of which 537 (47.5%) resulted in detection of response shift. Whereas effect sizes varied widely, most median recalibration effect sizes (Cohen's d) were between 0.20 and 0.30 and median reprioritization/reconceptualization effect sizes rarely exceeded 0.15, across the characteristics. Similar results were obtained from unrelated studies.

Conclusion: The results draw attention to the need to focus on understanding variability in response shift results: Who experience response shifts, to what extent, and under which circumstances?

Original languageEnglish
Number of pages23
JournalQuality of Life Research
Early online date13 Sept 2023
Publication statusE-pub ahead of print - 13 Sept 2023


  • Response shift
  • Patient-reported outcomes
  • Systematic review
  • Prevalence
  • Effect sizes


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