Contextualizing the lived experience of quality of life for persons with spinal cord injury: A mixed-methods application of the response shift model

J Spinal Cord Med. 2019 Jul;42(4):469-477. doi: 10.1080/10790268.2018.1517471. Epub 2018 Sep 6.


Objective: The objective of this study was to gain greater insight into individuals' quality of life (QOL) definitions, appraisals, and adaptations following spinal cord injury (SCI). Design: A mixed-methods design, applying the Schwartz and Sprangers response shift (RS) model. RS is a cognitive process wherein, in response to a change in health status, individuals change internal standards, values, or conceptualization of QOL Setting: Community-dwelling participants who receive medical treatment at a major Midwestern medical system and nearby Veterans' Affairs hospital. Participants: A purposive sample of participants with SCI (N = 40) completed semi-structured interviews and accompanying quantitative measures. Interventions: Not applicable. Outcome Measures: Qualitative data were analyzed using content analysis to identify themes. Analysis of variance were performed to detect differences based on themes and QOL, well-being, and demographic and injury characteristics. Results: Four RS themes were identified, capturing the range of participant perceptions of QOL. The themes ranged from complete RS, indicating active engagement in maintaining QOL, to awareness and comparisons redefining QOL, to a relative lack of RS. Average QOL ratings differed as a function of response shift themes. PROMIS Global Health, Anxiety, and Depression also differed as a function of RS themes. Conclusion: The RS model contextualizes differences in QOL definitions, appraisals, and adaptations in a way standardized QOL measures alone do not.

Keywords: Mixed methods research; Neurogenic bladder and bowel; Patient experiences; Qualitative research; Quality of life; Response shift; Spinal cord injury.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Psychological*
  • Motivation / physiology*
  • Quality of Life / psychology*
  • Spinal Cord Injuries / diagnosis
  • Spinal Cord Injuries / physiopathology
  • Spinal Cord Injuries / psychology*

Grant support

This work was supported by the Department of the Army USAMRAA, U.S. Department of Defense (CDMRP) under grant number #SCI110228; the National Institute on Disability and Rehabilitation Research (NIDILRR) under grant number #90AR5020–0200; and the University of Michigan Advanced Rehabilitation Research Training Program (ARRT).