MEASUREMENT OF THE QUALITY-OF-LIFE IN RHEUMATIC DISORDERS USING THE EUROQOL

The EuroQol is a validated quality of life (QOL) scale that has been u sed in population and clinical studies, and has been reported in patie nts with rheumatoid arthritis (RA). It is short, simple to complete, a nd might be suitable for surveys of rheumatic disease patients. The pr operties of this instrument were investigated in a postal survey of 13 72 rheumatic disease patients, including 537 with RA, 319 with osteoar thritis (OA) and 516 with fibromyalgia. In addition, simultaneous meas urements of functional disability, pain, psychological status, global severity and demographic characteristics were made. EuroQol scores (0. 57) were significantly lower than VAS health state scores (0.67) and a rthritis-related global severity scores (0.62). QOL was similar in RA and OA, but lower in fibromyalgia, across all instruments. The distrib ution of EuroQol scores had many gaps and was not continuous. EuroQol did not reflect VAS QOL scores at EuroQol levels below 0.5, and the me an score difference between the instruments below that level was 0.43. Many patients with low EuroQol scores (including some with health sta tes that were 'worse than death') had high VAS scores. These differenc es appear to have arisen because disability, pain and depression quest ions ask about mild or moderate problems, but not both, thereby forcin g scale compression in the mid ranges. In addition, the 'severe' value is so extremely abnormal that few patients endorse it. Finally, penal ty scores are applied to those with at least one maximally abnormal sc ore. The scoring properties and distributional aspects of the EuroQol indicate substantial problems in its use in rheumatic disease patients .