© Borgis - New Medicine 3/2006, s. 63-64
Lechosław P. Chmielik1, Anna Chmielik2
The measurement of health-related quality of life for children with ENT diseases
1Department of Paediatric Otorhinolaryngology, Medical University, Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik MD, PhD
2The Clinic of Paediatric Rehabilitation IPCZD Warsaw, Poland
Head of Clinic: Dr Jan Ciszecki MD
The quality of life for patients who are after and before treatment is becoming more and more significant for modern medicine. In order to achieve comparable results we ought to use standardized tools. The presented model has already been used in a considerable number of medical fields.
In everyday clinical practice, patients attach greater and greater significance not only to treatment of organic lesions but also to the comfort of their life after this treatment. Despite the growth of interest in this subject, scientists are still debating the definition of quality of life and how to measure it. Thus, there is no one good working definition of quality of life. Nevertheless, all scientists accept the fact that the definition is very broad and it includes many aspects of life. Most often, quality of life is described as a total evaluation of psychical and emotional well-being, which is characterized by the use of various and widely understood living conditions, such as material status, the social environment in which a subject lives, the quality of the natural environment, and others .
Because of such a wide and inaccurate definition, medicine uses the term "health-related quality of life” [HRQL], which includes those aspects of living that are directly related to the patient´s health, but excludes such issues as, for example, income per family member, restriction or non-restriction of liberty, and quality of the natural environment . The term "quality of life” as an element of health was first introduced by the World Health Organization in 1984. Health was defined not only as lack of disease but also as the presence of psychical, emotional and social well-being . Division of health into physical and emotional helps us to understand better the influence of health state on the quality of life. Each of these areas affects the quality of life, where this quality includes the objective evaluation of functional condition and the subjective evaluation of mental state .
The objective evaluation of functional condition takes into account the physical capability to perform everyday activities as well as the ability to work or study. The objective evaluation of mental state includes the mental ability to deal both with everyday common tasks and with more complex objectives such as playing social roles. These areas may also reflect the estimated state of disability. Finally, the objective functional condition is complemented by the subjective evaluation made by a patient. It involves the evaluation of discomfort felt with disease symptoms – subjective physical state, which displays general satisfaction derived from the state of physical condition, and subjective mental state, which refers to patients´ emotional state and their level of social engagement. The state of physical and mental condition measured in a traditional way is only a part of HRQL and should not be considered equivalent to HRQL measurement 4.
Moreover, there is often no simple relation between the patient´s health and his/her frame of mind. Patients who suffer from severe disorders do not necessarily describe their quality of life as bad . An explanation may be found in the way patients choose to evaluate this quality. People define it through their personal experience and expectations about their health state . Persons with different expectations about their health state do not measure HQRL equally, even if their clinical state is indifferent. Furthermore, patients whose health state has improved may evaluate their quality of life at the same level as they did in the previous test. Thus, the HQRL evaluation varies for particular people and is changeable in time .
THE USE OF HQRL MEASUREMENT IN MEDICINE
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