Quality of Life
Quality of life (QOL) is a multidimensional concept that measures a person’s wellbeing. The discussion and use of QOL as a measurable outcome in health has increased in recent decades as healthcare has shifted from a disease-focused biomedical model to a more holistic, well-being focused biopsychosocial model. QOL has also become more important with improvements in medical treatments and disease management leading to longer lives of people in general and particularly those living with chronic diseases.
Research has debated the definition of QOL and no precise definition has yet been agreed upon. This is because QOL means different things to different individuals, groups and cultures. This is the challenge of defining, and measuring, QOL. The individual’s perspective is inherent in QOL yet it is difficult to define for each person and therefore to measure meaningfully in clinical practice.
The term QOL is also not always used consistently or singularly. In literature and practice it is common to hear the terms “health,” “perceived health,” “health status,” “HRQOL,” and “QOL” used interchangeably, adding to the confusion around the concept of QOL.
Four domains common to QOL in health have been defined as: physical health, mental health, social health and functional health.
One common definition used is that of the World Health Organisation (WHO). The WHO has defined QOL as:
“...an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment.”
This definition has merit because it acknowledges the multidimensional aspect of QOL, including the four domains mentioned above, and recognises the specificity of QOL to individuals. The WHO definition also fits alongside the WHO’s International Classification of Functioning and Health (ICF), which provides a framework and definitions that are holistic, individual-specific and focused on well-being rather than disease and deficits.
Upon reviewing QOL up to the early 1990s, Gill and Feldstein argued that QOL should only be measured by measured by recording the opinions of patients because many of the then current measures were not focusing on the correct outcomes. Measures such as the WHOQOL100 are valuable in this regard because they focus on the individual’s perceptions.
There are many QOL related outcome measures. Each has its own strengths and weaknesses. Some more commonly used measures include:
Implications for Physiotherapy
Given that physiotherapists increasingly work with people who live with chronic disease, it is important that QOL is a factor in outcome measurement and treatment planning including goal setting. Using QOL measures can guide clinicians towards patient-centred, meaningful care and rehabilitation.
Because of the lack of consistency in definition, research suggests clinicians be aware of this and therefore choose a measure that is assesses what you want to measure. Clinicians should also use measures that have demonstrated good reliability and validity.
Implications for Research
Research authors should define the concept of QOL they are using and make sure their chosen outcome measures are consistent with the same. Authors should also use more than one outcome measure to insure they cover more than one domain of QOL, including performance and experience.
Research on QOL has been shown to be focused around specific patient groups I.e those with a specific disease and although it is conducted around the world, tends to originate more from Western cultures. To further define the concept and measurement of QOL, research from non-Western cultures would be beneficial.
- Centers for Disease Control and Prevention. HRQOL Concepts. Available from: https://www.cdc.gov/hrqol/concept.htm (accessed 27 February 2020).
- Post MWM. Definitions of Quality of Life: What Has Happened and How to Move On. Top Spinal Cord Inj Rehabil. 2014. 20; 3: 167–180. Accessed 26 February 2020.
- Carr AJ, Thompson PW, Kirwan JR. Quality of life measures. Br J Rheumatol. 1996. 35; 3:275-81. Accessed 27 February 2020.
- Aaronson NK. Quantitative issues in health related quality of life assessment. Health Policy. 1988. 10; 3:217–230.
- World Health Organisation. WHOQOL: Measuring Quality of Life. Available from: https://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/ (accessed 26 February 2020).
- Gill TM, Feinstein AR. A critical appraisal of the quality of quality-of-life measurements. JAMA.1994. 272; 8:619–626.
- Pérez-Ros P, Martínez-Arnau FM. EQ-5D-3L for Assessing Quality of Life in Older Nursing Home Residents with Cognitive Impairment. Life. 2020 Jul;10(7):100.
- Haraldstad, K., Wahl, A., Andenæs, R. et al. A systematic review of quality of life research in medicine and health sciences. Qual Life Res. 2019. 28, 2641–2650.