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Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal

Carolyn E Schwartz1234* and Bruce D Rapkin5

Author Affiliations

1 QualityMetric Incorporated, Waltham, MA, USA

2 Health Assessment Lab, Waltham, MA, USA

3 Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

4 DeltaQuest Foundation, Inc., Concord, MA, USA

5 Department of Psychiatry and the Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA

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Health and Quality of Life Outcomes 2004, 2:16  doi:10.1186/1477-7525-2-16

Published: 23 March 2004


The increasing evidence for response shift phenomena in quality of life (QOL) assessment points to the necessity to reconsider both the measurement model and the application of psychometric analyses. The proposed psychometric model posits that the QOL true score is always contingent upon parameters of the appraisal process. This new model calls into question existing methods for establishing the reliability and validity of QOL assessment tools and suggests several new approaches for describing the psychometric properties of these scales. Recommendations for integrating the assessment of appraisal into QOL research and clinical practice are discussed.

psychometric theory; quality-of-life assessment; appraisal; response shift