Your quotation seems to focus on UP.
This seems to look like the same problem posed by measuring
outcome when you have a PRE score. That is, your UP seems to
delegated as the more important, the relevant outcome.
Talking about 'robust' or 'efficient' is not important if you are
measuring the wrong thing. UP versus DOWN is like POST versus PRE.
There is a lot of discussion of 'change' scores for outcome – When
are they appropriate? The three main choices are (a) raw outcome,
(b) simple change score, and (c) regressed change score. Your source
is concerned that raw outcome (UP) contains too much irrelevant
contribution per individual, and 'normalizes' by taking the ratio.
Ratios are involved when the natural relation is multiplicative. That
is, would you normally want to describe UP as "twice DOWN" or do
points of score seem appropriate? Least-square models want you
to use additive, not multiplicative terms, so taking the log is ordinary
and converts the model to additive.
The regressed change can be computed by simple regression on PRE or
by models that include other variables. The goal is to find the outcome
that is sensitive/robust/efficient IN RELATION TO the intervention or
condition that is being studied.
When the 'coefficient of variation' is small, then you get very similar
results whether you take the ratio or the subtract, to see how much
more UP is than DOWN. Since what you quote specifically says 'ratio',
they seem to assume that the simple differences would be misleading
because of the scaling and unequal variation for the extremes.
The use of regressed-change is potentially more 'efficient' – in terms of
smaller variance for the outcome – than either the outcome alone or the
change score: that is, than either UP or the ratio. That might be
used in an analysis by taking log(UP) as the criterion, with log(DOWN)
as the covariate.
Rich Ulrich