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Knee Surg Sports Traumatol Arthrosc. 2014 Sep;22(9):2163-71. doi: 10.1007/s00167-013-2654-1. Epub 2013 Sep 6.

Influence of response shift on early patient-reported outcomes following autologous chondrocyte implantation.

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Department of Rehabilitation Sciences, University of Kentucky, Lexington KY, Wethington Building, Room 206B, 900 South Limestone, Lexington, KY, 40536-0200, USA,

Erratum in

  • Knee Surg Sports Traumatol Arthrosc. 2014 Sep;22(9):2172.



Response shift is the phenomenon by which an individual's standards for evaluation change over time. The purpose of this study was to determine whether patients undergoing autologous chondrocyte implantation (ACI) experience response shift.


Forty-eight patients undergoing ACI participated. The "then-test" method was used to evaluate response shift in commonly used patient-reported outcome measures (PROMs)-the SF-36 Physical Component Scale (SF-36 PCS), WOMAC, IKDC, and Lysholm. Each PROM was completed pre- and 6 and 12 months post-surgery. At 6 and 12 months, an additional "then" version of each form was also completed. The "then" version was identical to the original except that patients were instructed to assess how they were prior to ACI. Traditional change, response shift adjusted change, and response shift magnitude were calculated at 6 and 12 months. T tests (p < 0.05) were used to compare traditional change to response-shift-adjusted change, and response shift magnitude values to previously established minimal detectable change.


There were no differences between traditional change and response-shift-adjusted change for any of the PROMs. The mean response shift magnitude value of the WOMAC at 6 months (15 ± 14, p = 0.047) was greater than the previously established minimal detectable change (10.9). The mean response shift magnitude value for the SF-36 PCS at 12 months (9.4 ± 6.8, p = 0.017) also exceeded the previously established minimal detectable change (6.6).


There was no evidence of a group-level effect for response shift. These results support the validity of pre-test/post-test research designs in evaluating treatment effects. However, there is evidence that response shifts may occur on a patient-by-patient basis, and scores on the WOMAC and SF-36 in particular may be influenced by response shift.



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