I have read with interest the commentary by Bruce Rapkin and Carolyn Schwartz, “Advancing quality-of-life research by deepening our understanding of response shift: A unifying theory of appraisal” [
1]. These authors have identified the teleological assumption that there can be no quality-of-life (QOL) measurement and no patient-reported outcomes without some sort of cognitive appraisal going on. The QOL Appraisal Model by Rapkin and Schwartz [
2] has built on the original foundational model of Sprangers and Schwartz [
3] and enables the researcher to account for a mechanism of response shift at the individual level. The hard work now begins and putting a box around this abstraction with scientific rigor is the achievement I feel this commentary has outlined. I will speak to this from my area of clinical practice as a spine surgeon. …