, Volume 17, Issue 1, pp 13–35 | Cite as

A Comparative Review of Generic Quality-of-Life Instruments

  • Stephen Joel Coons
  • Sumati Rao
  • Dorothy L. Keininger
  • Ron D. Hays
Review Article


The assessment of health-related quality of life (HR-QOL) is an essential element of healthcare evaluation. Hundreds of generic and specific HR-QOL instruments have been developed. Generic HR-QOL instruments are designed to be applicable across a wide range of populations and interventions. Specific HR-QOL measures are designed to be relevant to particular interventions or in certain subpopulations (e.g. individuals with rheumatoid arthritis).

This review examines 7 generic HR-QOL instruments: (i) the Medical Outcomes Study 36-Item Short Form (SF-36) health survey; (ii) the Nottingham Health Profile (NHP); (iii) the Sickness Impact Profile (SIP); (iv) the Dartmouth Primary care Cooperative Information Project (COOP) Charts; (v) the Quality of Well-Being (QWB) Scale; (vi) the Health Utilities Index (HUI); and (vii) the EuroQol Instrument (EQ-5D). These instruments were selected because they are commonly used and/or cited in the English language literature. The 6 characteristics of an instrument addressed by this review are: (i) conceptual and measurement model; (ii) reliability; (iii) validity; (iv) respondent and administrative burden; (v) alternative forms; and (vi) cultural and language adaptations.

Of the instruments reviewed, the SF-36 health survey is the most commonly used HR-QOL measure. It was developed as a short-form measure of functioning and well-being in the Medical Outcomes Study. The Dartmouth COOP Charts were designed to be used in everyday clinical practice to provide immediate feedback to clinicians about the health status of their patients. The NHP was developed to reflect lay rather than professional perceptions of health. The SIP was constructed as a measure of sickness in relation to impact on behaviour. The QWB, HUI and EQ-5D are preference-based measures designed to summarise HR-QOL in a single number ranging from 0 to 1.

We found that there are no uniformly ‘worst’or ‘best’ performing instruments. The decision to use one over another, to use a combination of 2 or more, to use a profile and/or a preference-based measure or to use a generic measure along with a targeted measure will be driven by the purpose of the measurment. In addition, the choice will depend on a variety of factors including the characteristics of the population (e.g. age, health status, language/culture) and the environment in which the measurement is undertaken (e.g. clinical trial, routine physician visit). We provide our summary of the level of evidence in the literature regarding each instrument’s characteristics based on the review criteria. The potential user of these instruments should base their instrument selection decision on the characteristics that are most relevant to their particular HR-QOL measurment needs.


Medical Outcome Study Nottingham Health Profile Health Utility Index Sickness Impact Profile Administrative Burden 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr Rao’s work on this manuscript was supported by the Pharmacoeconomic Clinical Grants Program, Amgen Inc., Thousand Oaks, California, USA. The comments and recommendations provided by reviewers of earlier drafts of this manuscript are greatly appreciated.


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Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Stephen Joel Coons
    • 1
    • 2
  • Sumati Rao
    • 1
  • Dorothy L. Keininger
    • 3
  • Ron D. Hays
    • 4
    • 5
  1. 1.Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, College of PharmacyThe University of ArizonaTucsonUSA
  2. 2.Division of Social and Administrative Sciences, College of PharmacyThe University of ArizonaTucsonUSA
  3. 3.Research and Education DepartmentMAPI Research InstituteLyonFrance
  4. 4.School of Medicine, Division of General Internal Medicine and Health Services ResearchUniversity of California Los AngelesLos AngelesUSA
  5. 5.Health Program, RANDSanta MonicaUSA

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