Outcomes Instrumentation for Clinician Researchers - Key Concepts

Key Concepts

Health: defined by the World Health Organization as "not merely the absence of disease or infirmity"3but as a concept that incorporates well-being or wellness in all areas of life (physical, mental, emotional, social, spiritual). Health, according to this definition, is a broad concept incorporating disease, illness, and wellness. When considered as a dimension of quality of life, health is best thought to fall under the purview of health care providers in order to provide a health care intervention.

Health Status: an individual's relative level of wellness and illness, taking into account the presence of biological or physiological dysfunction, symptoms, and functional impairment.

Health Perceptions/Perceived Health Status: subjective ratings by the affected individual of his or her health status. Some people perceive themselves as healthy despite suffering from arthritis, while others perceive themselves as ill when no objective evidence of disease can be found.

Quality of life: an individual's satisfaction or happiness with life in domains he or she considers important1. Also known as "life satisfaction" or "subjective well-being," it is now sometimes referred to as "overall quality of life" or "global quality of life" to distinguish it from "health-related quality of life." It is the broadest of all concepts influenced by all of the dimensions of life that contribute to its richness and reward, pleasure and pain. These dimensions include, but are not limited to, health. A person's assessment of satisfaction with life involves two subjective considerations:

  • How important a given domain is for that person
  • How satisfied one is with that domain.

For instance a person can be unsatisfied with a domain that one considers to be of relatively little importance, and report a satisfactory overall quality of life. However, dissatisfaction with a domain of great importance to an individual, would clearly contribute to lower overall life quality.

Numerous taxonomies of life domains have been proposed by social, psychological, gerontological, and health sciences researchers based on studies of general populations of both well and ill people. A typical taxonomy is that of Flanagan2, which categorizes 15 dimensions of life quality into five domains, as shown below in the table.

Table: Flanagan’s Dimensions of Quality of Life

Domain

Quality of Life Dimensions

Physical and material well-being

Material well-being and financial security
Health and personal safety

Relations with other people

Relations with spouse
Having and rearing children
Relations with parents, siblings, or other relatives
Relations with friends

Social, community, civic activities

Helping and encouraging others
Participating in local and governmental affairs

Personal development, fulfillment

Intellectual development
Understanding and planning
Occupational role career
Creativity and personal expression

Recreation

Socializing with others
Passive and observational recreational activities
Participating in active recreation

Functional status: an individual's ability to perform normal daily activities required to meet basic needs, fulfill usual roles, and maintain health and well-being5,6. Functional status includes functional capacity and functional performance. Functional status can be influenced by biological or physiological impairment, symptoms, mood, and other factors.6 It is also likely to be influenced by health perceptions. For example, a person whom most would judge to be well but who views him/herself as ill may have a low level of functional performance in relation to his capacity.5

Functional capacity: represents an individual's capacity to perform daily activities in the physical, psychological, social, and spiritual domains of life. Example - A maximal exercise test measures physical functional capacity.

Functional performance: refers to the activities people actually do during the course of their daily lives.5 Example - A self-report of activities of daily living measures functional performance.

Mood: refers to emotional responses to stressors such as changes in health state. These emotional reactions to life experiences are usually reflected in an individual's affect: the face one presents to the world.

  1. Mood describes a sustained emotional response that, when persistent, can color a person's view of the world.
  2. Depression, anxiety, and anger are emotions that sometimes coexist with physical illness, and may affect the individual's functional performance, symptom and health perceptions, and quality of life.6,12,13 Conversely, decreased functional status may contribute to depressed mood in people with chronic lung disease.12

Symptoms: are patients' perceptions of "an abnormal physical, emotional, or cognitive state"6.

References for Key Concepts Section

  1. Oleson M. subjectively perceived quality of life. Image 1990; 22:187-190.
  2. Flanagan JC. A research approach to improving our quality of life. Am Psychol 1978; 33; 138-147
  3. World Health Organization. Constitution of the World Health Organization: Chronicle of the World Health Organization 1. Geneva: WHO, 1947.
  4. Ware JE. The status of health assessment 1994. A Rev Pub Health 1995; 16:327-354.
  5. Leidy NK. Functional status and the forward progress of merry-go-rounds: Toward a coherent analytical framework. Nurs Res 1994; 43:196-202.
  6. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. JAMA 1995; 1995:59-65.
  7. Kinsman RA, Yaroush RA, Fernandez E, Dirks JF, Schocket M, Fukuhara J. Symptoms and experiences in chronic bronchitis and emphysema. Chest 1983; 83:755-761.
  8. McSweeny AJ. Quality of life in relation to COPD. In McSweeny AJ, Grant I, eds. Chronic Obstructive Pulmonary Disease: A Behavioral Perspective. New York: Marcel Dekker, 1988.
  9. Dudley DL, Glaser EM, Jorgenson BN, Logan DL. Psychosocial concomitants to rehabilitation in chronic obstructive pulmonary disease: Part 1. Psychosocial and psychological considerations. Chest 1980; 77:413-420.
  10. Light RW, Merrill EJ, Despars JA, Gordon GH, Mutalipassi LR. Prevalence of depression and anxiety in patients with COPD: Relationship to functional capacity. Chest 1985; 87:35-38.
  11. Curtis JR. Assessing health-related quality of life in chronic pulmonary disease. In Fishman AP, ed. Pulmonary Rehabilitation. New York: Marcel Dekker, 1996.
  12. Anderson KL. The effect of chronic obstructive pulmonary disease on quality of life. Res Nurs Health 1995; 18:547-556.
  13. Moody L, McCormick K, Williams A. Disease and symptom severity, functional status, and quality of life in chronic bronchitis and emphysema. J Behav Med 1990; 13:297-306.
  14. Torrance G, O'Brien B. An interview on utility measurement. J Rheumatol 1995; 22:1200-1202.
  15. Redelmeier DA, Detsky AS. A clinician's guide to utility measurement. Prim Care 1995; 22:271-280.
  16. Patrick DL, Starks HE, Cain KC, Uhlmann RF, Pearlman RA. Measuring preferences for health states worse than death. Med Decis Making 1994; 14:9-18.
  17. Feeny D, Labelle R, Torrance GW. Integrating economic evaluations and quality of life assessments. In Spilker B, ed. Quality of Life Assessments in Clinical Trials. New York: Raven Press, 1990.
  18. Curtis JR, Martin DP, Martin TM. Patient-Assessed Health Outcomes in Chronic Lung Disease: What Are They, How Do They Help Us, and Where Do We Go From Here? American Journal of Respiratory and Critical Care Medicine 1997; 156:1032-1039.

Previous | Index | Next