A comparative review of generic quality-of-life instruments

The assessment of health-related quality of life:(HR-QOL)is an essential el ement of healthcare evaluation. Hundreds of generic and specific HR-QOL ins truments 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 Out-come s Study 36-Item Short Form (SF-36) health survey; (ii) the Nottingham Healt h Profile (NHP), (iii) the Sickness Impact Profile (SIP); (iv) the Dartmout h Primary care Cooperative Information Project (COOP) Charts; (v) the Quali ty of Well-Beings (QWB) Scale; (vi) the Health Utilities Index (HUI); and ( vii) the EuroQol Instrument (EQ-5D). These instruments were selected becaus e they are commonly used and/or cited in the English language literature. T he 6 characteristics of an instrument addressed by this review are: (i) con ceptual and measurement model; (ii) reliability; (iii) validity; (iv) respo ndent and administrative burden; (v) alternative forms; and (vi) cultural a nd language adaptations. Of the instruments reviewed, the SF-36 health survey is the most commonly u sed 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 we re designed to be used in everyday clinical practice to provide immediate f eedback to clinicians about the health status of their patients. The NHP wa s developed to reflect lay rather than professional perceptions of health. The SLP was constructed as a measure of sickness in relation to impact on b ehaviour. The QWB, HUI and EQ-5D art: preference-based measures designed to summarise HR-QOL in a single number ranging from 0 to i. We found that there are no uniformly 'worst' or 'best' performing instrumen ts. 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 me asure along with a targeted measure will be driven by the purpose of the me asurement. Ln addition, the choice will depend on a variety of factors incl uding the characteristics of the population (e.g. age, health status, langu age/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 characteris tics 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 par particular HR-QOL measurement needs.