Outcome from total hip replacement : From standardised measures to patient-focused narrative-based assessment.

The dynamic construct of quality of life (QoL) and evidence of the response shift phenomenon in longitudinal studies can lead to biased and incomplete evaluation of change over time. This study examines the current approach to measurement of QoL, particularly the validity of measures routinely used in health care, using three different types of standardised measurements in association with narrative interviews of patients following total hip replacement: To explore the outcome from patients' perspectives by obtaining highly individualised data and encouraging them to identify domains of concern in their lives. To compare patients' expectations of outcome with their measured functional ability on the standardised measures. To establish whether there is a relationship between patients' expectations and characteristics and perceived QoL prior to surgery. To determine how well standardised generic measures fulfil patients' particular needs by comparing data obtained using them with individualised data.Narrative interviews were conducted with 25 participants, nine of whom participated in follow-up interviews. Different aspects of their lives, such as values, feelings, job, attitudes and relationships, were explored and analysed using content analysis and narrative analysis. The findings from content analysis were categorised into two major components, themes related to life dimensions and coping-related themes. Core concepts related to life dimensions were collated to develop an instrument representing participants' perspective of hip condition. Performance analysis of narrative showed that understanding of an experience relies on the structure of narrative rather than the content. Participants used different coping strategies not to get rid of pain and physical limitations but to alleviate the damaging effects of hip-related problems, supporting the notion of re-interpretation of life experiences through employing psychological mechanisms.The main recommendations are that (a) health outcomes should be evaluated through models of communication and (b) individualised, qualitative methods be used to generate further understanding of the impact of response shift on self-report measures.