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April 12, 2000

Assessing Patients' Views of Clinical Changes—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(14):1824-1825. doi:10.1001/jama.283.14.1821

In Reply: We agree with Dr Bausell that a patient's perception of retrospective change will influence the patient's level of satisfaction and that this could have an acquiescent component, but what the only alternative is not to ask the patient at all. Also, the patients' personal physician did not ask these questions; patients were surveyed by mailed questionnaire sent from the study center.

We understand that change scores may be more or less variable than baseline or follow-up scores individually. However, if we cannot use retrospective judgment because of faulty memory or an acquiescent response, and we cannot use serial change scores because they are more "unreliable," what do we do? At this point, the criticism appears to depart from reality. At least the retrospective judgments have only 1 source of variance, and our results showed that the retrospective variances were much smaller than the variances for change scores, thus giving a much better sensitivity.

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