Abstract
The assessment of health related quality of life aims at an evaluation of the patient's perspective with regard to the consequences of a disease or to treatment outcome. Frequently, there is a focus on change over time. The outcome of measurement may reflect real change, but, on the other hand, may also be the consequence of cognitive changes such as changes in the reference system of the patient or in values and concepts about health and disease. Changes that are reflected in repeated measurements and that may not be attributed to real change in quality of life, are defined as response shifts. It is a challenge to separate change due to response shifts from those due to real change. The present article reviews research on this field and provides recommendations for future assessment procedures.
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