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© Borgis - New Medicine 3/2004, s. 74-76
Anna Chmielik, Jan Ciszecki
Assessment of health-related quality of life
Paediatric Rehabilitation Clinic, Child Health Memorial Hospital, Warsaw, Poland
Head: Prof. Jan Ciszecki MD, PhD
Summary
The growing population of chronically ill and disabled patients requires a new approach to the assessment of their health status. The patient survival is no longer an endpoint in medical care efficiency; quality of life is also important. Although this view is widely accepted, there is still no consensus regarding the definition of health-related quality of life (HRQL), and how the quality of life should be measured. The authors present a brief description of the main concepts of HRQL and methods of measurement with regard to paediatric care.
Advances in medical sciences have brought a significant improvement in medical care, which has resulted in a decreased infant mortality rate, eradication of many infectious diseases as well as an effective prevention and treatment of potentially fatal diseases. Consequently, this has contributed to lifespan extension, but also to an increasingly growing population of disabled and chronically ill patients (1). For example, an improved neonatal care resulted in an increased survival rate of premature infants; however, at the same time it was accompanied by an increased prevalence of neurological problems or vision and hearing disorders. The efficiency of medical care is no longer assessed merely by survival. The quality of life, not only its span, is equally important (2).
Due to their chronic course or dysfunction of social interactions they provoke, certain ENT diseases, may lead to a decreased quality of life, e.g., chronic otitis media, severe hearing loss, chronic speech disorders, upper respiratory infections, tracheostomy. Therefore, while choosing an appropriate treatment, ENT specialists should consider the above-mentioned problem, as well as carry out its assessment.
Despite a significant interest in the subject among researchers, the definition and assessment measures of quality of life are still under debate. There is no one generally accepted definition of quality of life, although there is a consensus that quality of life is a broad, multidimensional concept. It is usually characterized as an overall assessment of physical and mental wellbeing across different, broad domains, including socioeconomic status, characteristics of community and environment as well as other factors (3, 4).
Since the description of quality of life is so broad and imprecise, the term "health-related quality of life” (HRQL) is used in medical sciences. HRQL includes areas of an overall quality of life, which are directly related to an individual´s health, excluding such aspects as income, freedom, air or water quality (3, 4). The concept of quality of life as a component of health is not new. It was highlighted in 1948 by the World Health Organization in the definition of health. Health was described as the presence of physical, mental and social wellbeing, and not only absence of illness (5). Dividing health into physical and mental domains helps understand the influence of health status on HRQL. HRQL can be described as a four-domain structure including both objective and subjective assessment of the patient´s health (6).
Objective physical functioning involves measuring the physical ability to work and perform everyday tasks. Assessment of objective mental functioning is related to the psychological ability to do simple everyday activities, as well as carrying out complex professional and social duties. This part of HRQL is very similar to the assessment of physical and mental disabilities. The subjective assessment provides information about the patient´s feelings. Physical wellbeing reflects general satisfaction from physical health, including information about the sense of discomfort or pain, as mental wellbeing is related to an individual´s psychological comfort, emotional state and social interaction. A traditionally measured health status is only a part of the HRQL assessment, so it is different than the assessment of HRQL (7, 8).
Moreover, there is no simple association between the individual´s health status and wellbeing. Patients with severe disease symptoms do not always describe their quality of life as poor (8), which might result from the mode of assessment. People assess their health-related quality of life by comparing their experience of health with their expectations of it (9). Therefore patients with different expectations will report different quality of life even if their health status is the same. Moreover, patients whose health has changed, may assess their quality of life at the same level. Perception of quality of life varies between people and changes with time (10).
Fig. 1. A classification scheme of quality of life measures. Muldonn 1998.
The purpose of HRQL measurements
HRQL measurements may be used in clinical practice, as well as in establishing health standards and economic analysis.

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Piśmiennictwo
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New Medicine 3/2004
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