HEALTH-STATUS AND QUALITY-OF-LIFE - WHICH MATTERS TO THE PATIENT

The effect of treatment on the health status of patients suffering fro m claudication of the lower limbs has seldom been studied, and their q uality of life (QOL) not at all. These terms are distinguished and def ined. Studies of both are important, but it is believed that QOL is of more interest to the patient, as representing the individual's apprec iation of and reaction to factors of personal importance. The many met hods employed can be classified according to (a) their emphasis on the individual as against the group and (b) their attention to internal a s against external variables. Problems met in creating new methods for the study of QOL are discussed. These include eliciting features of t heir condition that are of specific importance to patients, and establ ishing the different degrees of importance that individuals attach to these. The new instrument must be phrased in an acceptable, reliable, and valid form for subsequent use. Its validity is most convincingly d emonstrated by the ability to discriminate between patients with diffe rent degrees of disease severity or those who have been differently tr eated, as in a clinical trial. Comparative advantages of general and s pecific methods of inquiry, results expressed as profiles or single in dicators, and the influence of contextual factors (bias due to timing, the effect of the investigator-subject relationship, etc.) are also d iscussed.