Quality of Life Research

, Volume 25, Issue 6, pp 1385–1393 | Cite as

The Guttman errors as a tool for response shift detection at subgroup and item levels

  • Myriam Blanchin
  • Véronique Sébille
  • Alice Guilleux
  • Jean-Benoit Hardouin
Special Section: Response Shift Effects at Item Level (by invitation only)



Statistical methods for identifying response shift (RS) at the individual level could be of great practical value in interpreting change in PRO data. Guttman errors (GE) may help to identify discrepancies in respondent’s answers to items compared to an expected response pattern and to identify subgroups of patients that are more likely to present response shift. This study explores the benefits of using a GE-based method for RS detection at the subgroup and item levels.


The analysis was performed on the SatisQoL study. The number of GE was determined for each individual at each time of measurement (at baseline T0 and 6 months after discharge M6). Individuals showing discrepancies (with many GE) were suspected to interpret the items differently from the majority of the sample. Patients having a large number of GE at M6 only and not at T0 were assumed to present RS. Patients having a small number of GE at T0 and M6 were assumed to present no RS. The RespOnse Shift ALgorithm in Item response theory (ROSALI) was then applied on the whole sample and on both groups.


Different types of RS (non-uniform recalibration, reprioritization) were more prevalent in the group composed of patients assumed to present RS based on GE. On the opposite, no RS was detected on patients having few GE.


Guttman errors and item response theory models seem to be relevant tools to discriminate individuals affected by RS from the others at the item level.


Response shift Guttman errors Item response theory Item level Individual level 



The authors gratefully acknowledge Frans J. Oort, Mirjam A. G. Sprangers and Mathilde G. E. Verdam for their comments on the manuscript. This study was supported by the Institut National du Cancer, under reference “INCA_6931.” The SatisQoL cohort project (Investigators: P Auquier, F Guillemin (PI), M Mercier) was supported by an IRESP (Institut de recherche en santé publique) grant from Inserm, and a PHRC (Programme Hospitalier de Recherche Clinique) national grant from French Ministry of Health, France.

Compliance with ethical standards

Authors declare that they have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The SatisQoL study was approved by the national Institutional Review Board and the national committee for data protection (CCTIRS 07.212 and CNIL 1248560).


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.EA 4275, Biostatistics, Pharmacoepidemiology and Subjective Measures in Health SciencesUniversity of NantesNantesFrance

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