Open Access Research

Responsiveness: a reinvention of the wheel?

Robert Lindeboom1*, Mirjam A Sprangers2 and Aeilko H Zwinderman1

Author Affiliations

1 Departments of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, the Netherlands

2 Medical Psychology, Academic Medical Center, Amsterdam, the Netherlands

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Health and Quality of Life Outcomes 2005, 3:8  doi:10.1186/1477-7525-3-8

Published: 3 February 2005



Since the mid eighties, responsiveness is considered to be a separate property of health status questionnaires distinct from reliability and validity. The aim of the study was to assess the strength of the relationship between internal consistency reliability, referring to an instrument's sensitivity to differences in health status among subjects at one point in time, and responsiveness referring to sensitivity to health status changes over time.


We used three different datasets comprising the scores of patients on the Barthel, the SIP and the GO-QoL instruments at two points in time. The internal consistency was reduced stepwise by removing the item that contributed most to a scale's reliability. We calculated the responsiveness expressed by the Standardized Response Mean (SRM) on each set of remaining items. The strength of the relationship between the thus obtained internal consistency coefficients and SRMs was quantified by Spearman rank correlation coefficients.


Strong to perfect correlations (0.90 – 1.00) was found between internal consistency coefficients and SRMs for all instruments indicating, that the two can be used interchangeably.


The results contradict the conviction that responsiveness is a separate psychometric property. The internal consistency coefficient adequately reflects an instrument's potential sensitivity to changes over time.

quality of life; questionnaires; effect size; psychometrics; scale evaluation; reliability