Understanding the concept of Quality of Life

 Written by Dr Swati Sapna and  Upasna Gaba

WHO defines Quality of Life as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.”(1) Quality of life (QOL) is a broad multidimensional concept that typically involves both positive and negative aspects of life being subjectively assessed.

Measures of  QOL

Quality of life measures includes generic, disease-specific, and individualized measures. Generic measures are designed to evaluate health-related quality of life in any group of patients (indeed, in any population sample); Disease-specific measures, such as those intended to determine the quality of life associated with health in specific disease categories; and Individualized measures incorporate aspects of life that are important to individual patients.(2)

Health-Related Quality Of Life

Health-related quality of life (HRQL) focuses on the impact of health on a person’s ability to live a fulfilling life. HRQL represents a broad concept of physical, psychological, social functioning, and well-being, including both positive and negative aspects. CDC has defined HRQOL as “an individual’s or group’s perceived physical and mental health over time.” Since the 1980s, the concept of HRQOL and its determinants have progressed to include components of the overall quality of life that can influence physical or mental health. it encompasses physical and psychological health perceptions at the individual level (e.g., energy level, mood) and their correlates, including health risks and conditions, functional status, socioeconomic status, and social support. At the community level, HRQOL involves community-level resources, policies, and practices that influence the health perceptions and functional status of a population.(3)

Why is it important to track HRQOL?

As an outcome, focusing on HRQOL can bridge boundaries between disciplines and between social, mental, and medical services. Several recent federal policy reforms underscore the need to measure HRQOL to complement the traditional morbidity and mortality indicators in public health. The HRQOL assessment will help recognize the burden of preventable diseases, injuries, and disabilities. It can provide insights into the relationships between HRQOL and risk factors and help track progress towards the country’s health goals. HRQOL surveillance data analysis will identify subgroups with relatively poor perceived health and support direct measures to improve their conditions and avert more extreme ramifications. Interpretation and disclosure of these data will help define health policy and legislation needs, help allocate resources based on unmet needs, direct strategic strategies to be created, and track large community initiatives’ efficacy.(3)

Tools to assess QOL

 Sickness Impact Profile (SIP)

The SIP is a generic health-related functional status measure designed to be widely applicable across disease types and severities and over diverse demographic and cultural groups. The SIP was initially published in 1977 and is intended for health surveys, program planning, policy formation, and patient progress monitoring. The scale aims to give a descriptive profile of changes in a person’s behavior due to sickness. This SIP136 has 12 domains dealing with the health impact on a range of day-to-day actions, and the SIP68 has 68 items related to essential bodily functions and communication across six disciplines.(4)

Medical outcomes study Short Form 6D (SF‐6D)

The SF-6D aims to provide health-related quality of life (HRQOL) ratings of an individual across all health conditions. The SF‐6D utility score is derived from items within the widely used SF‐36 and SF‐12. The HRQOL ratings are also referred to as “utilities” or preferences for health states used in health economic assessment and derive quality-adjusted life-years (QALYs) for cost-utility analysis.(4)

Health Utilities Index Mark 3 (HUI3)

The HUI is a family of generic preference-based (utility) indicators developed to assess the quality of life associated with health (HRQOL). Describing treatment processes and outcomes in clinical studies, economic assessments of health care services, and evaluating and tracking population health are the HUI’s intended uses. The HUI3 analyses eight fields of HRQOL. It includes vision, hearing, speech, mobility/ambulation, pain, dexterity, emotion, and cognition. HUI2 assesses the seven domains of sensation, mobility, emotion, cognition, self-care, pain, and fertility.(4)

Quality of Well‐Being scale (QWB)

In the general population, the QWB scale determines the quality of life associated with health (HRQOL). The QWB is a preference-based measure that combines functioning and symptoms to produce a 0 (death) to 1 (full, symptom-free functioning) well-being index. The QWB can also be used to determine quality-adjusted life years, combining life expectancy with HRQOL to obtain a summary estimate of the quality and quantity of life lived. A wide variety of physical and mental symptoms that people can experience in everyday life are included in the QWB-SA.(4)

Assessment of Quality Of Life (AQOL)

Multi-attribute utility scales of health-related quality of life are the AQoL tools (HRQOL). Constructed for use throughout health conditions to enable economic assessment studies of health. The AQoL-4D covers four domains of independent living, mental health, relationships, and senses. There are two additional coping and pain domains in the AQoL-6D.(4)

Applications

For quality-of-life statistics, a broad range of uses has been recommended, but the most common applications are evaluating treatment regimes in clinical trials and health surveys. Population and patient surveillance, screening, and enhancement of doctor-patient interactions are other applications. However, one of the most psychological applications of such evidence is in health care economic assessment, with specific measures explicitly designed to be used in cost-utility reviews, i.e., analyses intended to assess the benefits of an intervention in terms of both the length of life achieved and the QoL. The EuroQol 5D (EQ-5D), which addresses five dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, is perhaps the most widely used of these measures.

The five dimensions are divided into sub-levels of patient-perceived problems from which a health state (or health profile) can be generated (e.g., “no problems,” “severe problems”). The values attached to health states are based on answers from general population surveys and are therefore intended to reflect societal views on each condition’s severity.

For the calculation of quality-adjusted life-years (QALYs), the EQ-5D can produce the quality-of-life component in which quality of life is combined with years of life gained due to an intervention. Treatment costs can be linked to the number of QALYs obtained to provide a per-QALY cost.(2)

Dr. Swati Sapna is a dental surgeon and currently a postgraduate student pursuing Masters of Public Health (Epidemiology) at Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.

Upasna Gaba is a pharmacist and currently a postgraduate student pursuing Masters of Public Health (Health Policy) at Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.

References:

  1. WHOQOL – Measuring Quality of Life| The World Health Organization [Internet]. [cited 2021 Feb 22]. Available from: https://www.who.int/tools/whoqol
  2. Definition, Measures, Applications, & Facts | Britannica [Internet]. [cited 2021 Feb 22]. Available from: https://www.britannica.com/topic/quality-of-life
  3. HRQOL Concepts | CDC [Internet]. 2018 [cited 2021 Feb 22]. Available from: https://www.cdc.gov/hrqol/concept.htm
  4. Adult measures of general health and health‐related quality of life: Medical Outcomes Study Short Form 36‐Item (SF‐36) and Short Form 12‐Item (SF‐12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF‐6D), Health Utilities Index Mark 3 (HUI3), Quality of Well‐Being Scale (QWB), and Assessment of Quality of Life (AQOL) – Busija – 2011 – Arthritis Care & Research – Wiley Online Library [Internet]. [cited 2021 Feb 22]. Available from: https://onlinelibrary.wiley.com/doi/10.1002/acr.20541

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