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Putting Wilson and Cleary to the Test: Analysis of a HRQOL Conceptual Model using Structural Equation Modeling

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Abstract

Wilson and Cleary (1995) proposed a conceptual model of health-related quality of life (HRQOL) that integrates both biological and psychological aspects of health outcomes. There are five different levels in their model, namely, physiological factors, symptom status, functional health, general health perceptions, and overall quality of life. Their model has been widely applied to different populations, including patients living with cancer, Parkinson’s disease, arthritis, and HIV+/AIDS. However, their conceptual model has only been partially examined. That is, the five major concepts have not been examined simultaneously. Using structural equation modeling (SEM), the Wilson and Cleary HRQOL model was validated in patients living with HIV from the AIDS Time-Oriented Health Outcomes Study. The results showed that the HRQOL model fit the data adequately, and the relationships between the constructs were all significant (at p<0.05 level). Based on the modification indexes, an alternative model linking symptom status directly with general health perceptions and overall quality of life was specified. Implication and limitation of the findings are discussed.

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References

  1. IB Wilson PD Cleary (1995) ArticleTitleLinking clinical variables with health-related quality of life: A conceptual model of patient outcomes J Am Med Assoc 273 59–65 Occurrence Handle10.1001/jama.273.1.59 Occurrence Handle1:STN:280:DyaK2M%2FovFWgtA%3D%3D

    Article  CAS  Google Scholar 

  2. GL Engel (1977) ArticleTitleThe need for a new medical model: A challenge for biomedicine Science 196 129–136 Occurrence Handle1:STN:280:DyaE2s7ltVOmsA%3D%3D Occurrence Handle847460

    CAS  PubMed  Google Scholar 

  3. JE Haase CJ Braden (1998) Guidelines for achieving clarity of concepts related to quality of life CR King PS Hinds (Eds) Quality of Life: From Nursing and Patient Perspectives Jones & Bartlett Sudbury, MA

    Google Scholar 

  4. J Fawcett FS Downs (1992) The Relationship of Theory and Research FA Davis Philadelphia

    Google Scholar 

  5. AH Vallerand DM Breckenridge WA Hodgson (1998) Theories and conceptual models to guide quality of life research CR King PS Hinds (Eds) Quality of life: From Nursing and Patient Perspectives Jones & Bartlett Boston 37–51

    Google Scholar 

  6. SJ Bennett SM Perkins KA Lane et al. (2001) ArticleTitleSocial support and health-related quality of life in chronic heart failure patients Qual Life Res 10 IssueID8 671–682 Occurrence Handle10.1023/A:1013815825500 Occurrence Handle1:STN:280:DC%2BD387js12mug%3D%3D Occurrence Handle11871588

    Article  CAS  PubMed  Google Scholar 

  7. EA Chrischilles LM Rubenstein MD Voelker et al. (2002) ArticleTitleLinking clinical variables to health-related quality of life in Parkinson’s disease Parkinsonism Relat Disord 8 IssueID3 199–209 Occurrence Handle10.1016/S1353-8020(01)00044-X Occurrence Handle12039432

    Article  PubMed  Google Scholar 

  8. C Cosby WL Holzemer S Bakken-Henry et al. (2000) ArticleTitleHematological complications and quality of life in hospitalized AIDS patients AIDS Patient Care STD 14 IssueID5 269–279 Occurrence Handle10.1089/108729100317731 Occurrence Handle1:STN:280:DC%2BD3cvisFOruw%3D%3D

    Article  CAS  Google Scholar 

  9. WE Cunningham S Crystal S Bozzette et al. (2005) ArticleTitleThe association of health-related quality of life with survival among persons with HIV infection in the United States J Gen Intern Med 20 IssueID1 21–27 Occurrence Handle10.1111/j.1525-1497.2005.30402.x Occurrence Handle15693923

    Article  PubMed  Google Scholar 

  10. RD Hays WE Cunningham CD Sherbourne et al. (2000) ArticleTitleHealth-related quality of life in patients with human immunodeficiency virus infection in the United States: Results from the HIV cost and services utilization study Am J Med 108 IssueID9 714–722 Occurrence Handle10.1016/S0002-9343(00)00387-9 Occurrence Handle1:STN:280:DC%2BD3cvhs1ektQ%3D%3D Occurrence Handle10924648

    Article  CAS  PubMed  Google Scholar 

  11. DTF Lee DSF Yu J Woo DR Thompson (2005) ArticleTitleHealth-related quality of life in patients with congestive heart failure Eur J Health Fail 7 IssueID3 419–422 Occurrence Handle10.1016/j.ejheart.2004.08.004

    Article  Google Scholar 

  12. FA Masoudi JS Rumsfeld EP Havranek et al. (2004) ArticleTitleAge, functional capacity, and health-related quality of life in patients with heart failure J Card Fail 10 IssueID5 368–373 Occurrence Handle10.1016/j.cardfail.2004.01.009 Occurrence Handle15470645

    Article  PubMed  Google Scholar 

  13. KH Sousa WL Holzemer SB Henry R Slaughter (1999) ArticleTitleDimensions of health-related quality of life in persons living with HIV disease J Adv Nurs 29 IssueID1 178–187 Occurrence Handle10.1046/j.1365-2648.1999.00877.x Occurrence Handle1:STN:280:DyaK1M7mt1Slsg%3D%3D Occurrence Handle10064297

    Article  CAS  PubMed  Google Scholar 

  14. TK Straits JA Fields SB Wilkinson et al. (2000) ArticleTitleHealth-related quality of life in Parkinson’s disease after pallidotomy and deep brain stimulation Brain Cognition 42 IssueID3 399–416 Occurrence Handle10.1006/brcg.1999.1112

    Article  Google Scholar 

  15. L Wettergren M Bjorkhom U Axdorph A Languis-Eklof (2004) ArticleTitleDeterminants of health-related quality of life in long-term survivors of Hodgkin’s lymphoma Qual Life Res 13 IssueID8 1369–1379 Occurrence Handle10.1023/B:QURE.0000040790.43372.69 Occurrence Handle1:STN:280:DC%2BD2crjtlSntg%3D%3D Occurrence Handle15503832

    Article  CAS  PubMed  Google Scholar 

  16. IB Wilson PD Cleary (1996) ArticleTitleClinical predictors of functioning in persons with acquired immunodeficiency syndrome Med Care 34 IssueID6 610–623 Occurrence Handle10.1097/00005650-199606000-00010 Occurrence Handle1:STN:280:DyaK283lvVelsg%3D%3D Occurrence Handle8656726

    Article  CAS  PubMed  Google Scholar 

  17. IB Wilson PD Cleary (1997) ArticleTitleClinical predictors of declines in physical functioning in persons with AIDS: Results of a longitudinal study J Acq Immun Def Synd 16 IssueID5 343–349 Occurrence Handle1:STN:280:DyaK1c%2FotVGjsw%3D%3D

    CAS  Google Scholar 

  18. M Lipkin (1988) Functional Status Measurement in Primary Care Springer-Verlag New York

    Google Scholar 

  19. J Alonso JM Anto M Gonzalez JA Fiz J Izquierdo J Morera (1992) ArticleTitleMeasurement of general health status of non-oxygen-dependent chronic obstructive pulmonary disease patients Med Care 30 MS125–MS135 Occurrence Handle1:STN:280:DyaK383mtFSksQ%3D%3D Occurrence Handle1583927

    CAS  PubMed  Google Scholar 

  20. C Bombardier J Raboud (1991) ArticleTitleThe Auranofin Cooperating Group. A comparison of health-related quality-of-life measures for rheumatoid arthritis research Control Clin Trials 12 243S–256S Occurrence Handle1:STN:280:DyaK387js1yhtg%3D%3D Occurrence Handle1663860

    CAS  PubMed  Google Scholar 

  21. PD Cleary S Greenfield BJ McNeil (1991) ArticleTitleAssessing quality of life after surgery Control Clin Trials 12 189S–203S Occurrence Handle1:STN:280:DyaK387js1yiuw%3D%3D Occurrence Handle1663855

    CAS  PubMed  Google Scholar 

  22. PD Cleary FJ Fowler J Weissman et al. (1993) ArticleTitleHealth-related quality of life in persons with acquired immune deficiency syndrome Med Care 13 569–580

    Google Scholar 

  23. RD Gelber WR Lenderking DJ Cotton et al. (1991) ArticleTitleQuality-of-life evaluation in a clinical trial of zidovudine therapy in patients with mildly symptomatic HIV infection Ann Intern Med 116 961–966

    Google Scholar 

  24. A Laupacis C Wong D Churchill (1991) ArticleTitleThe use of generic and specific quality-of-life measures in hemodialysis patients treated with erythropoietin Control Clin Trials 12 168S–179S Occurrence Handle1:STN:280:DyaK387js1yitQ%3D%3D Occurrence Handle1663853

    CAS  PubMed  Google Scholar 

  25. WR Lenderking RD Gelber DJ Cotton et al. (1994) ArticleTitleEvaluation of the quality of life associated with zidovudine treatment in asymptomatic human immunodeficiency virus infection New Engl J Med 330 738–743 Occurrence Handle10.1056/NEJM199403173301102 Occurrence Handle1:STN:280:DyaK2c7ltVGntA%3D%3D Occurrence Handle7906386

    Article  CAS  PubMed  Google Scholar 

  26. DR Nerenz DP Repasky FW Whitehouse DM Kahkonen (1992) ArticleTitleOngoing assessment of health status in patients with diabetes mellitus Med Care 30 MS112–MS124 Occurrence Handle1:STN:280:DyaK383mtFSksA%3D%3D Occurrence Handle1583926

    CAS  PubMed  Google Scholar 

  27. T Wachet J Piette V Mor M Stein J Fleishman C Carpenter (1992) ArticleTitleQuality of life in persons with human immunodeficiency virus infection: Measurement by the Medical Outcomes Study instrument Ann Intern Med 116 129–137

    Google Scholar 

  28. KC Calman (1984) ArticleTitleQuality of life in cancer patients – A hypothesis J Med Ethics 10 124–127 Occurrence Handle1:STN:280:DyaL2M%2FlvVSitA%3D%3D Occurrence Handle6334159 Occurrence Handle10.1136/jme.10.3.124

    Article  CAS  PubMed  Google Scholar 

  29. DP Lubeck JF Fries (1997) ArticleTitleAssessment of quality of life in early stage HIV-infected persons: Data from the AIDS Time-Oriented Health Outcome Study (ATHOS) Qual Life Res 6 494–506 Occurrence Handle10.1023/A:1018404014821 Occurrence Handle1:STN:280:DyaK2svntFKjuw%3D%3D Occurrence Handle9330550

    Article  CAS  PubMed  Google Scholar 

  30. AW Wu HR Rubin WC Mathews et al. (1991) ArticleTitleA health status questionnaire using 30 items from the Medical Outcomes Study: Preliminary validation in persons with early HIV infection Med Care 29 786–798 Occurrence Handle1:STN:280:DyaK3Mzkt1altA%3D%3D Occurrence Handle1875745

    CAS  PubMed  Google Scholar 

  31. AW Wu WC Mathews LT Brysk et al. (1993) ArticleTitleFunctional status and well-being in a placebo-controlled trial of zidovudine in early symptomatic HIV infection J AIDS 6 452–458 Occurrence Handle1:STN:280:DyaK3s3ks12qsg%3D%3D

    CAS  Google Scholar 

  32. DP Lubeck JF Fries (1992) ArticleTitleChanges in quality of life among persons with HIV infection Qual Life Res 1 359–366 Occurrence Handle10.1007/BF00704430 Occurrence Handle1:STN:280:DyaK3s3jtVajtg%3D%3D Occurrence Handle1299468

    Article  CAS  PubMed  Google Scholar 

  33. DP Lubeck JF Fries (1993) ArticleTitleHealth status among persons infected with human immunodeficiency virus Med Care 31 269–276 Occurrence Handle1:STN:280:DyaK3s7ps1anug%3D%3D Occurrence Handle8450683

    CAS  PubMed  Google Scholar 

  34. DP Lubeck JF Fries (1994) ArticleTitleChanges in health status after one year for persons at risk for and with HIV infection Psychol Health 9 79–92

    Google Scholar 

  35. DP Lubeck H Shi DA Bloch JF Fries (1995) ArticleTitleClinical correlates of quality of life among males with HIV infection Qual Life Res 4 IssueID5 456–457

    Google Scholar 

  36. MW O’Dell DP Lubeck S Matsuno (1995) ArticleTitleValidity of the Karnofsky performance status in an HIV-infected sample J AIDS 10 350–357 Occurrence Handle1:STN:280:BymD38jotVc%3D

    CAS  Google Scholar 

  37. MW O’Dell HB Hubert DP Lubeck P O’Driscoll (1996) ArticleTitlePhysical disability in a cohort of persons with AIDS AIDS 10 667–673 Occurrence Handle1:STN:280:BymA2svlvFE%3D Occurrence Handle8780822 Occurrence Handle10.1097/00002030-199606000-00013

    Article  CAS  PubMed  Google Scholar 

  38. SA Strathdee MV O’Shaughnessy JSG Montaner MT Schechter (1996) ArticleTitleA decade of research in the natural history of HIV infection: Part 1. Markers Clin Invest Med 19 111–120 Occurrence Handle1:CAS:528:DyaK28XislKisrs%3D Occurrence Handle8697670

    CAS  PubMed  Google Scholar 

  39. WL Holzemer SB Henry KM Nokes et al. (1999) ArticleTitleValidation of the signs and symptom check-list for persons with HIV disease (SSC-HIV) J Adv Nurs 30 1041–1049 Occurrence Handle10.1046/j.1365-2648.1999.01204.x Occurrence Handle1:STN:280:DC%2BD3c%2Fjt1aqtw%3D%3D Occurrence Handle10564402

    Article  CAS  PubMed  Google Scholar 

  40. G Singh JF Fries CA Williams E Zattarain P Spitz DA Bolch (1991) ArticleTitleToxicity profiles of disease modifying antirheumatic drugs in rheumatoid arthritis J Rheumatol 18 188–194 Occurrence Handle1:STN:280:DyaK3M3hvVWjsA%3D%3D Occurrence Handle1673721

    CAS  PubMed  Google Scholar 

  41. SE Milligan DL Hom SP Ballou LJ Persse GM Svilar CJ Boulton (1993) ArticleTitleAn assessment of the Health Assessment Questionnaire functional ability index among women with systemic lupus erythematosus J Rheumatol 20 972–976 Occurrence Handle1:STN:280:DyaK3szltlCqtQ%3D%3D Occurrence Handle8350333

    CAS  PubMed  Google Scholar 

  42. DR Ramey JF Fries G Singh (1996) The health assessment questionnaire 1995 – Status and review B. Spiker (Eds) Quality of Life and Pharmacoeconomics in Clinical Trials EditionNumber2 Lippincott-Raven Philadelphia 227–237

    Google Scholar 

  43. F Wolfe SM Kleinheksel MA Cathey DJ Hawley PW Spitz JF Fries (1988) ArticleTitleThe clinical value of the Stanford Health Assessment Questionnaire functional disability index in patients with rheumatoid arthritis J Rheumatol 15 1480–1488 Occurrence Handle1:STN:280:DyaL1M%2FotFamsQ%3D%3D Occurrence Handle3204597

    CAS  PubMed  Google Scholar 

  44. RD Hays AL Stewart (1990) ArticleTitleThe structure of self-report health in chronic disease patients Psychol Assessment. J Consult Clin Psychol 2 22–30

    Google Scholar 

  45. CA McHorney JE Ware AE Raczek (1993) ArticleTitleThe MOS 36-item short-form health survey (SF-36): II Psychometric and clinical tests of validity in measuring physical and mental health constructs Med Care 31 247–263 Occurrence Handle1:STN:280:DyaK3s7ps1antA%3D%3D Occurrence Handle8450681

    CAS  PubMed  Google Scholar 

  46. AL Stewart JE Ware (1992) Measuring Functioning and Well-being: The Medical Outcomes Study Approach Duke University Durham, NC

    Google Scholar 

  47. JE Ware A Davies-Avery RH Brook (1980) Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol. 6. Analysis of Relationships among Health Status Measures RAND Santa Monica, CA

    Google Scholar 

  48. KH Sousa FF Chen (2001) ArticleTitleA theoretical approach to measuring quality of life J Nurs Measure 10 47–58 Occurrence Handle10.1891/jnum.10.1.47.52545

    Article  Google Scholar 

  49. JF Fries P Spitz RG Kraines HR Holman (1980) ArticleTitleMeasurement of patient outcome in arthritis Arthritis Rheumatism 23 137–145 Occurrence Handle1:STN:280:DyaL3c7ltlGlsQ%3D%3D Occurrence Handle7362664

    CAS  PubMed  Google Scholar 

  50. AL Stewart RD Hays JE Ware (1992) Methods of constructing health measures AL Stewart JE Ware (Eds) Measuring Functioning and Well-being: The Medical Outcomes Study Approach Duke University Durham NC 67–85

    Google Scholar 

  51. LK Muthen BO Muthen (1998) Mplus User’s Guide Muthen & Muthen Los Angeles

    Google Scholar 

  52. D Kaplan (2000) Structural Equation Modeling: Foundations and Extensions Sage Thousand Oaks, CA

    Google Scholar 

  53. Muthen BO, du Toit SHC, Spisic D. Robust inference using weighted least squares and quadratic estimating equations in latent variable modeling with categorical outcomes. Psychometrika (in press).

  54. PM Bentler (1990) ArticleTitleComparative fit indices in structural equation models Psychol Bull 107 238–246 Occurrence Handle10.1037/0033-2909.107.2.238 Occurrence Handle1:STN:280:DyaK3c3gslGlsg%3D%3D Occurrence Handle2320703

    Article  CAS  PubMed  Google Scholar 

  55. MW Browne R Cudeck (1993) Alternative ways of assessing model fit KA Bollen JS Long (Eds) Testing Structural Equation Models Sage Newbury Park, CA 136–162

    Google Scholar 

  56. LT Hu PM Bentler (1998) ArticleTitleFit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification Psychol Methods 3 IssueID4 424–453 Occurrence Handle10.1037/1082-989X.3.4.424

    Article  Google Scholar 

  57. PM Bentler C Chou (1987) ArticleTitlePractical issues in structural modeling Sociol Method Res 16 78–187

    Google Scholar 

  58. KG Joreskog (1993) Testing structural equation models KA Bollen JS Long (Eds) Testing Structural Equation Models Sage Newbury Park, CA 294–316

    Google Scholar 

  59. J Pearl (2000) Causality: Models, Reasoning, and Inference Cambridge University Press Cambridge 133–171

    Google Scholar 

  60. CWJ Granger (1986) ArticleTitleDevelopments in the study of cointegrated economic variables Oxford Bull Econ Stat 48 213–228 Occurrence Handle10.1111/j.1468-0084.1986.mp48003002.x

    Article  Google Scholar 

  61. CWJ Granger P Newbold (1986) Forecasting Economic Time Series Academic Press Orlando, FL

    Google Scholar 

  62. PJ Curran KA Bollen (2002) The best of both worlds: Combining autoregressive and latent curve models LM Collins AG Sayer (Eds) New Methods for the Analysis of Change American Psychological Association Washington, DC 107–135

    Google Scholar 

  63. S Greenfield EC Nelson (1992) ArticleTitleRecent developments and future issues in the use of health status assessment measures in clinical settings Med Care 30 MS23–MS41 Occurrence Handle1:STN:280:DyaK383mtFSrsw%3D%3D Occurrence Handle1583935

    CAS  PubMed  Google Scholar 

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Sousa, K.H., Kwok, OM. Putting Wilson and Cleary to the Test: Analysis of a HRQOL Conceptual Model using Structural Equation Modeling. Qual Life Res 15, 725–737 (2006). https://doi.org/10.1007/s11136-005-3975-4

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