Quality of Life in Clinical Medicine

  • Kathleen W. Wyrwich
  • Cynthia R. Gross


Defining and measuring quality of life (QOL) is challenging and interdisciplinary, but nearly all can agree on the import role of health. The term health-related quality of life (HRQL) distinguishes the elements of health, function, and well-being that are experienced by people in the context of their health conditions and treatments from general QOL. HRQL measures usually incorporate at least three core domains of physical health, mental/emotional health, and social health in accordance with the 1947 World Health Organizations broadened definition of health. Many theoretical models attempt to describe how health affect QOL, but fall short, especially for describing sleep/wake symptoms or energy/fatigue because these facets of health have both a strong physical and mental health component. Wilson and Cleary’s conceptual model of patient outcomes (1995) proposes a testable dynamic model of causal relationships, bridging the gap between biomedical models and psychosocial models of health. Explicit conceptual frameworks are needed for the use of any HRQL measure, which range from generic measures that can be used across a broad spectrum of the population to disease-specific measures that are tailored to a particular health condition. The family of HRQL measures also include clinimetric measures that rely on expert-driven disease attributes or indicators that “make sense” to the clinician, profile measures that provide an outline of several aspects of HRQL, indexes, and utility measures that represent a preference or value between 0 (death) and 1 (complete health), which can be useful in economic evaluations of health conditions and treatment. Recognizing how patients assess their HRQL when responding to HRQL items by use of the Rapkin–Schwartz Appraisal Model (2004) is useful for understanding HRQL responses, especially in longitudinal studies.


Quality of life health-related quality of life well-being generic measures disease-specific measures clinimetric measures utility measures health status Wilson–Cleary model Rapkin–Schwartz Appraisal Model WHOQOL PROMIS 


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  1. 1.
    WHOQOL Group (1995) The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Social Science and Medicine, 41, 1403–1409.Google Scholar
  2. 2.
    Quality of Life (2006) Glossary. Available at http://www. Accessed on December 1, 2006.Google Scholar
  3. 3.
    Quality of Life (2006) In Wikipedia, The Free Encyclopedia. Available at of Life. Accessed on December 1, 2006.Google Scholar
  4. 4.
    International Society for Quality of Life Studies (ISQOLS) homepage (2006) Accessed on December 1, 2006.Google Scholar
  5. 5.
    Andrè P, Bitondo D (2001) Development of a Conceptual and Methodological Framework for the Integrated Assessment of the Impacts of Linear Infrastructure Projects on Quality of Life. Prepared for the Research and Development Monograph Series. Available at Accessed on November 3, 2007.Google Scholar
  6. 6.
    Shackman G, Liu YL, Wang X (2005) Brief Review of World Quality of Life. Available at Accessed on December 1, 2006.Google Scholar
  7. 7.
    Estes RJ (1997) Social development trends in Europe, 1970–1994: development prospects for the new Europe. Social Indicators Research 42, 1–19.CrossRefGoogle Scholar
  8. 8.
    Prescott-Allen R (2001) The Well Being of Nations. Covelo, CA: IDRC/Island Press. Available at the World Conservation Union, doc. Accessed on November 3, 2007.Google Scholar
  9. 9.
    Sharpe A, Smith J (2005) Measuring the Impact of Research on Well-Being. Report number 2005–02. Centre for the Study of Living Standards. Available at http://www. Accessed on June 20, 2005.Google Scholar
  10. 10.
    United Nations Development Programme (2004) Human Development Report (Statistical feature 1 The state of human development). Available at Scholar
  11. 11.
    Veenhoven R (2006) World Database of Happiness. AVAILABLE AT Acces- sed on December 1, 2006.Google Scholar
  12. 12.
    Gill TM, Feinstein AR (1994) A critical appraisal of the quality-of-life measurements. Journal of American Medical Association, 272(8), 619–626.CrossRefGoogle Scholar
  13. 13.
    Farquhar M (1995) Definitions of quality of life: a taxonomy. Journal of Advanced Nursing, 22, 502–508.PubMedCrossRefGoogle Scholar
  14. 14.
    Campbell A, Converse PE, Rodgers WL (1976) The Quality of American Life. New York: Russell Sage Foundation.Google Scholar
  15. 15.
    Diener E (2000) Subjective well-being. The science of happiness and a proposal for a national index. American Psychologist, 55(1), 34–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Joyce CRB, O’Boyle CA, McGee H (eds.) (1999) Individual Quality of Life – Approaches to Conceptualization and Assessment. Amsterdam: Harwood Academic Publishers.Google Scholar
  17. 17.
    Food and Drug Administration (2006) Guidance for Industry Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims. Available at Accessed on Dec. 1, 2006.Google Scholar
  18. 18.
    Koch T (2000) Life quality vs the ‘quality of life’: assumptions underlying the prospective quality of life instruments in health care planning. Social Science and Medicine, 51, 419–427.PubMedCrossRefGoogle Scholar
  19. 19.
    Guyatt GH, Feeny DH, Patrick DL (1993) Measuring health-related quality of life. Annals of Internal Medicine, 118(8), 622–629.PubMedGoogle Scholar
  20. 20.
    Gelber RD, Lenderking WR, Cotton DJ, Cole BF, Fischl MA, Goldhirsch A, et al. (1992) Quality-of-life evaluation in a clinical trial of zidovudine therapy in patients with mildly symptomatic HIV infection. Annals of Internal Medicine, 116, 961–966.PubMedGoogle Scholar
  21. 21.
    Kaplan RM, Bush JW (1982) Health-related quality of life measurement for evaluation research and policy analysis. Health Psychology, 1, 61–80.CrossRefGoogle Scholar
  22. 22.
    Schipper H, Clinch JJ, Olweny CLM (1996) Quality of life studies: definitions and conceptual issues. In B. Spilker (ed.), Quality of Life and Pharmacoeconomics (2nd ed., pp. 11–23). Philadelphia, PA: Lippincott-Raven Publishers.Google Scholar
  23. 23.
    World Health Organization (1947) Constitution of the World Health Organization. Chronicle of the World Health Organization, 1, 1–29.Google Scholar
  24. 24.
    PROMIS (2006) Available at Accessed on December 1, 2006.Google Scholar
  25. 25.
    Wilson IB, Cleary PD (1995) Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes. Journal of American Medical Association, 273(1), 59–65.CrossRefGoogle Scholar
  26. 26.
    Ware JE (1993) SF-36 Health Survey: Manual and Interpretation Guide. Boston, MA: The Health Institute, New England Medical Center.Google Scholar
  27. 27.
    Varni JW, Seid M, Rode CA (1999) The PedsQoL: measurement model for the Pediatric Quality of Life Inventory. Medical Care, 37, 126–139.PubMedCrossRefGoogle Scholar
  28. 28.
    Cella DF, Tulsky DS, Gray G, Sarafian B, Lin EBA (1993) The functional assessment of cancer therapy: development and validation of the general measure. Journal of Clinical Oncology, 11, 570–579.PubMedGoogle Scholar
  29. 29.
    Ware JE, Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.PubMedCrossRefGoogle Scholar
  30. 30.
    Bergner M, Bobbitt RA, Carter WB, Gilson BS (1981) The sickness impact profile: development and final revision of a health status measure. Medical Care, 19, 787–805.PubMedCrossRefGoogle Scholar
  31. 31.
    Nunnally JC, Bernstein IH (1994) Psychometric Theory (3rd ed.). New York: McGraw-Hill.Google Scholar
  32. 32.
    Streiner DL. & Norman GR (2003) Health Measurement Scales: A Practical Guide to Their Use and Development. Oxford: Oxford Medical Publishing.Google Scholar
  33. 33.
    Feinstein AR (1987) Clinimetrics. New Haven, CT: Yale University Press.Google Scholar
  34. 34.
    Fayers PM, Machin D (2000) Quality of Life: Assessment, Analysis and Interpretation. New York: John Wiley & Sons.Google Scholar
  35. 35.
    American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Arlington, VA: American Psychiatric Association.Google Scholar
  36. 36.
    Gold M, Siegel JE, Russell LB, Weinstein MC (1996) Cost-Effectiveness in Health and Medicine. New York: Oxford University Press.Google Scholar
  37. 37.
    Brazier J, Usherwood T, Harper R, Thomas K (1998) Deriving a preference-based single index from the UK SF-36 health survey. Journal of Clinical Epidemiology, 51(11), 1115–1128.PubMedCrossRefGoogle Scholar
  38. 38.
    Fryback DG, Lawrence WF, Martin PA, Klein R, Klein BEK (1997) Predicting quality of well-being scores from the SF-36: results from the Beaver Dam Health Outcomes Study. Medical Decision Making, 17, 1–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Lobo FS, Gross CR, Matthees BJ (2004) Estimation and comparison of derived preference scores from the SF-36 in lung transplant patients. Quality of Life Research, 13, 377–388.PubMedCrossRefGoogle Scholar
  40. 40.
    EQ-5D (2006) Available at Accessed on December 1, 2006.Google Scholar
  41. 41.
    Spranger AG, Schwartz CE (1999) Integrating response shift into health-related quality of life research: a theoretical model. Social Science Medicine 48, 1507–1515.CrossRefGoogle Scholar
  42. 42.
    Rapkin BD, Schwartz CE (2004) Toward a theoretical model of quality-of-life appraisal: implications of findings from studies of response shift. Health and Quality of Life Outcomes, 2, 14.PubMedCrossRefGoogle Scholar
  43. 43.
    Wyrwich KW, Tardino V (2006) Understanding global transition assessments. Quality of Life Research. 15(6), 995–1004.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press, Totowa, NJ 2008

Authors and Affiliations

  • Kathleen W. Wyrwich
  • Cynthia R. Gross

There are no affiliations available

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