• Asgeir Store Jakola, Ole Solheim, Sasha Gulati, and Lisa Millgård Sagberg.
• Department of Neurosurgery, Sahlgrenska University Hospital, Blå Stråket 5, vån 3, 413 45, Göteborg, Sweden. legepost@gmail.com.
• Acta Neurochir (Wien). 2017 Feb 1; 159 (2): 377-384.

BackgroundPatients may recalibrate internal standards when faced with a serious diagnosis or neurological deficits. This so-called response shift is important to understand in longitudinal health-related quality of life (HRQoL) data, but this is not quantitatively assessed in glioma patients.MethodsPatients with gliomas were eligible for this HRQoL study. We used EuroQol-5D 3 L to assess generic HRQoL with assessment preoperatively and at 6 months postoperatively. At time of follow-up, patients scored how they considered their baseline HRQoL in retrospect using the same questionnaire ("then-test").ResultsSeventy-three patients were enrolled between January 2013 and September 2015. With the then-test approach, the mean EQ-5D 3 L index was similar compared to baseline (0.77, mean difference 0.01, 95% CI -0.57 to 0.07, p = 0.82). Also, then-test and baseline VAS score were similar (mean difference 0, 95% CI -7 to 7, p = 0.97). However, a 0.10-0.13 difference from baseline was observed in patients that improved or deteriorated in HRQoL at follow-up according to the then-test EQ-5D 3 L index value. The direction of change as observed from the then-test was similar to the direction of clinical change, reducing the impact of any HRQoL change from baseline to follow-up.ConclusionsOn average, we observed no response shift using EQ-5D 3 L in the selection of glioma patients able to participate at 6 months after surgery. However, following change in HRQoL at follow-up, response shift seems to reduce the effects of HRQoL changes by lowering of internal standards in patients that deteriorate and raising the standards in patients that improve.

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