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      Longitudinal measurement invariance in prospective oral health-related quality of life assessment

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          Prospective assessments of oral health-related quality of life (OHRQoL) changes are prone to response shift effects when patients reconceptualize, reprioritize, or recalibrate the perceived meanings of OHRQoL test items. If this occurs, OHRQoL measurements are not “invariant” and may reflect changes in problem profiles or perceptions of OHRQoL test items. This suggests that response shift effects must be measured and controlled to achieve valid prospective OHRQoL measurement. The aim of this study was to quantify response shift effects of Oral Health Impact Profile (OHIP) scores in prospective studies of prosthodontic patients.


          Data came from the Dimensions of Oral Health-Related Quality of Life Project. The final sample included 554 patients who completed the OHIP questionnaire on two occasions: pre- and post-treatment. Only items that compose the 14-item OHIP were analyzed. Structural equation models that included pre- and post-treatment latent factors of OHRQoL with different across-occasion constraints for factor loadings, intercepts, and residual variances were fit to the data using confirmatory factor analysis.


          Data fit both the unconstrained model (RMSEA = .038, SRMR = .051, CFI = .92, TLI = .91) and the partially constrained model with freed residual variances (RMSEA = .037, SRMR = .064, CFI = .92, TLI = .92) well, meaning that the data are well approximated by a one-factor model at each occasion, and suggesting strong factorial across-occasion measurement invariance.


          The results provided cogent evidence for the absence of response shift in single factor OHIP models, indicating that longitudinal OHIP assessments of OHRQoL measure similar constructs across occasions.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12955-016-0492-9) contains supplementary material, which is available to authorized users.

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          Most cited references 47

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                Author and article information

                [ ]Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
                [ ]Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN USA
                [ ]Department of Psychology, University of Minnesota, Minneapolis, USA
                [ ]Department of Prosthodontics, Showa University, Tokyo, Japan
                [ ]Department of Prosthodontics, University of Pécs, Pécs, Hungary
                [ ]Department of Prosthodontics, University of Zagreb and Clinical Hospital Centre, Zagreb, Croatia
                Health Qual Life Outcomes
                Health Qual Life Outcomes
                Health and Quality of Life Outcomes
                BioMed Central (London )
                7 June 2016
                7 June 2016
                : 14
                27267885 4897855 492 10.1186/s12955-016-0492-9
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef, National Institute of Dental and Craniofacial Research;
                Award ID: R01DE022331
                Award Recipient :
                Funded by: FundRef, Deutsche Forschungsgemeinschaft;
                Award ID: RE 3289/2-1
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                © The Author(s) 2016


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