Minimal important differences and response shift in health-related quality of life: a longitudinal study in patients with multiple myeloma

Ann K Kvam (Corresponding Author), Finn Wisloff, Peter M Fayers

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BACKGROUND: We previously reported that changes of 6-17 percent in the EORTC QLQ-C30 scores are considered important by patients with multiple myeloma and thus may be considered as Minimal Important Differences (MIDs). However, patients' internal standard of measurement may have changed over time (response shift, RS). In the present work, we evaluated whether myeloma patients experience RS and if this could affect the MID-estimates. METHODS: Between 2006 and 2008, 239 patients with multiple myeloma completed the EORTC QLQ-C30 at inclusion (T1) and after three months (T2). At T2, patients were asked if they had noticed any change in the domains pain, fatigue, physical function and global quality of life. They were also asked to give a retrospective judgment of their health-related quality of life at T1 for the four domains. RESULTS: We found clear evidence of RS in myeloma patients. However, there were differences in both magnitude and direction between patients who stated that they improved and those who deteriorated. Deteriorating patients retrospectively reported better health-related quality of life at T1 for the domains pain, fatigue and physical function. In these patients, MIDs adjusted for RS were observed to increase up to 12 percentage points. In contrast, for patients stating that they improved, we only found evidence of statistically significant RS in global quality of life. CONCLUSIONS: MIDs estimated from pre-test/post-test data appeared to be robust against RS in patients reporting improvement over 3-months. This could indicate that RS has a minimal impact on the results in patients who respond to treatment, and that RS may not have an important impact on interpretation of changes reported in clinical trials where an improvement occurs. Although the effect sizes of the RSs were small, RS in deteriorating patients may have an important impact on the interpretation of changes reported in clinical trials. Trial registration: The study is registered at, identifier NCT00290095.
Original languageEnglish
Article number79
Number of pages8
JournalHealth and Quality of Life Outcomes
Issue number1
Early online date3 Aug 2010
Publication statusPublished - 3 Aug 2010


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