Skip to main content
Log in

On the generalizability of statistical expressions of health related quality of life instrument responsiveness: a data synthesis

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Responsiveness statistics have been suggested as criteria for selecting health-related quality of life (HRQoL) instruments or for calculating the required sample size. This paper raises questions about the stability of estimates of instrument responsiveness. The questions are examined by use of data synthesis. A literature search identified instances where two HRQoL instruments were used concurrently on two or more occasions. An effect size difference between the instruments was calculated. The distribution of the differences in the effect size between pairs of instruments used conjointly in different applications was used as an indicator of variation in responsiveness. The effect size for all possible published uses of generic and disease-specific HRQoL instruments was also examined. Responsiveness was found to be subject to considerable variation. Disease-specific instruments were found to be consistently more responsive than generic instruments. The authors suggest use of responsiveness data should be restricted to expanding pilot study results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kazis LE. Health outcome assessments in medicine: history, applications, and new directions. Adv Intern Med 1991; 36: 109–130.

    Google Scholar 

  2. Ellwood PM. Shattuck lecture—outcomes management. A technology of patient experience. N Engl J Med 1988; 318: 1549–1556.

    Google Scholar 

  3. Jonsson B. Assessment of quality of life in chronic diseases. Acta Paediatr Scand Suppl 1987; 337: 164–169.

    Google Scholar 

  4. Revicki DA. Health-related quality of life in the evaluation of medical therapy for chronic illness. J Family Pract 1989; 29: 377–380.

    Google Scholar 

  5. Cheatle MD. The effect of chronic orthopedic infection on quality-of-life. Orthop Clin N Am 1991; 22: 539–547.

    Google Scholar 

  6. Spilker B, Molinek FR Jr, Johnston KA, Simpson RL Jr, Tilson HH. Quality of life bibliography and indexes. Med Care 1990; 28: DS1–D77.

    Google Scholar 

  7. Spilker B, White WSA, Simpson RL Jr, Tilson HH. Quality of life bibliography and indexes, 1990 Update J Clin R Pharm 1992 6: 87–156.

    Google Scholar 

  8. Spilker B, Simpson RL Jr, Tilson HH, Quality of life bibliography and indexes, 1991 update, J Clin R Pharmacol 1992; 6: 205–266.

    Google Scholar 

  9. Berzon RA, Simeon GP, Simpson, RL Jr, Donnelly MA, Tilson HH, Quality of life bibliography and indexes: 1993 update, Qual Life Res 1995; 4: 53–73.

    Google Scholar 

  10. Berzon RA, Donnelly MA, Simpson RL Jr, Simeon GP, Tilson HH. Quality of life bibliography and indexes, 1994 update. Qual Life Res 1995; 4: 547–569.

    Google Scholar 

  11. Aaronson NK. Qualify of life assessment in clinical trials: methodologic issues. Control Clin Trials 1989; 10: 195S–208S.

    Google Scholar 

  12. Fletcher AE, Bulpitt CJ. Measurement of qualify of life in clinical trials of therapy. Cardiology 1988; 75Suppl 1: 41–52.

    Google Scholar 

  13. Wiklund I, Karlberg J. Evaluation of quality of life in clinical trials. Selecting quality-of-life measures. Control Clin Trials 1991; 12: 204S–216S.

    Google Scholar 

  14. Bergner M. Quality of life, health status, and clinical research. Med Care 1989; 27: S148.

    Google Scholar 

  15. McHorney CA, Ware JE, Rogers W, Raczek AE, Lu JF. The validity and relative precision of MOS short-and long-form health status scales and Dartmouth COOP charts. Results from the Medical Outcomes Study. Med Care 1992; 30: MS253.

    Google Scholar 

  16. Kirshner B, Guyatt G. A methodological framework for assessing health indices. J Chronic Dis 1985; 38: 27–36.

    Google Scholar 

  17. Guyatt GH, Veldhuyzen Van Zanten SJ, Feeny DH, Patrick DL. Measuring quality of life in clinical trials: a taxonomy and review. Can Med Assoc J 1989; 140: 1441–1448.

    Google Scholar 

  18. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993; 118: 622–629.

    Google Scholar 

  19. Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis 1987; 40: 171–178.

    Google Scholar 

  20. Guyatt GH, Deyo RA, Charlson M, Levine MN, Mitchell A. Responsiveness and validity in health status measurement: a clarification. J Clin Epidemiol 1989; 42: 403–408.

    Google Scholar 

  21. Guyatt GH, Kirshner B, Jaeschke R. A methodologic framework for health status measures: clarity or oversimplification? J Clin Epidemiol 1992; 45: 1353–1355.

    Google Scholar 

  22. Guyatt GH, Kirshner B, Jaeschke R. Measuring health status: what are the necessary measurement properties? J Clin Epidemiol 1992; 45: 1341–1345.

    Google Scholar 

  23. Hays RD, Hadorn D. Responsiveness to change: an aspect of validity, not a separate dimension. Qual Life Res 1992; 1: 73–75.

    Google Scholar 

  24. Norman GR. Issues in the use of change scores in randomized trials. J Clin Epidemiol 1989; 42: 1097–1105.

    Google Scholar 

  25. Williams JI, Naylor CD. Procrustean frameworks. J Clin Epidemiol 1993; 46: 111–112.

    Google Scholar 

  26. Williams JI, Naylor CD. How should health status measures be assessed? Cautionary notes on procrustean frameworks. J Clin Epidemiol 1992; 45: 1347–1351.

    Google Scholar 

  27. Deyo RA. Measuring functional outcomes in therapeutic trials for chronic disease. Control Clin Trials 1984; 5: 223–240.

    Google Scholar 

  28. Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care 1989; 27: S178–S189.

    Google Scholar 

  29. Liang MH, Fossel AH, Larson MG. Comparisons of five health status instruments for orthopedic evaluation. Med Care 1990; 28: 632–642.

    Google Scholar 

  30. Katz JN, Larson MG, Phillips CB, Fossel AH, Liang MH. Comparative measurement sensitivity of short and longer health status instruments. Med Care 1992; 30: 917–925.

    Google Scholar 

  31. Henry DA, Wilson A. Meta-analysis Part 1: an assessment of its aims, validity and reliability. Med J Aust 1992; 156: 31–38.

    Google Scholar 

  32. Chouinard MJ, Braun CMJ. A meta-analysis of the relative sensitivity of neuropsychological screening tests. J Clin Exp Neuropsychol 1993; 15: 591–607.

    Google Scholar 

  33. Beto JA, Banal V. Quality of life in treatment of hypertension. A meta-analysis of clinical trials. Am J Hypertonias 1992; 5: 125–133.

    Google Scholar 

  34. Workman PM, Eaton WH. Cumulating quality of life results in controlled clinical trials of coronary artery bypass graft surgery. Control Clin Trials 1985; 6: 289–305.

    Google Scholar 

  35. Veldhuyzen Van Zanten SJ. Quality of life as outcome measures in randomized clinical trials. An overview of three general medical journals. Control Clin Trials 1991; 12: 234S–242S.

    Google Scholar 

  36. Hollandsworth JG, Jr. Evaluating the impact of medical treatment on the quality of life: a 5–year update. Soc Sci Med 1988; 26: 425–434.

    Google Scholar 

  37. Hunter JE, Schmidt FL. Methods of Meta-Analysis. Newbury Park, CA: Sage Publications, 1990.

    Google Scholar 

Appendix

  1. Canadian Erythropoietin Study Group. Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis. BMJ 1990; 300: 573. (Erythropoietin in haemodialysis.)

    Google Scholar 

  2. Andrykowski MA, Henslee PJ, Barnett RL. Longitudinal assessment of psychosocial functioning of adult survivors of allogeneic bone marrow transplantation. Bone Marrow Transplant 1989; 4: 505. (Bone marrow transplant.)

    Google Scholar 

  3. Bombardier C, Raboud J. A comparison of health-related quality-of-life measures for rheumatoid arthritis research. The Auranofin Cooperating Group. Control Clin Trials 1991; 12: 243S. (Auranofin in rheumatoid arthritis.)

    Google Scholar 

  4. Bombardier C, Ware J, Russell IJ. Auranofin therapy and quality of life in patients with rheumatoid arthritis. Am J Med 1986; 81: 565. (Auranofin in rheumatiod arthritis.)

    Google Scholar 

  5. Bombardier C, Ware J, Russell IJ, Larson M, Chalmers A, Read JL. Auranofin therapy and quality of life in patients with rheumatoid arthritis. Results of a multicenter trial. Am J Med 1986; 81: 565. (Auranofin in rheumatoid arthritis.)

    Google Scholar 

  6. Borgquist L, Nilsson LT, Lindelow G, Wiklund I, Thorngren KG. Perceived health in hip-fracture patients: a prospective follow-up of 100 patients. Age Ageing 1992; 21: 109. (Recovery from hip fracture.)

    Google Scholar 

  7. Calfas KJ, Kaplan RM, Ingram RE. One-year evaluation of cognitive-behavioral intervention in osteoarthritis. Arthritis Care Res 1992; 5: 202. (Counseling in osteoarthritis.)

    Google Scholar 

  8. Cunningham AJ, Lockwood GA, Cunningham JA. A relationship between perceived self-efficacy and quality of life in cancer patients. Patient Educat Counsel 1991; 17: 71. (Teaching coping skills.)

    Google Scholar 

  9. Cunningham AJ, Lockwood GA, Edmonds CV. Which cancer patients benefit most from a brief, group, coping skills program? Int J Psychiatr Med 1993; 23: 383. (Teaching coping skills.)

    Google Scholar 

  10. Evans RW, Rader B, Manninen DL. The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. Cooperative Multicenter EPO Clinical Trial Group. JAMA 1990; 263: 825. (Erythropoietin in haemodialysis.)

    Google Scholar 

  11. Fitzpatrick R, Newman S, Lamb R, Shipley M. A comparison of measures of health status in rheumatoid arthritis. Br J Rheumatol 1989; 28: 201. (Progression of rheumatoid arthritis.)

    Google Scholar 

  12. Fitzpatrick R, Ziebland S, Jenkinson C, Mowat A. The social dimension of health status measures in rheumatoid arthritis. Int Disability Studies 1991; 13: 34. (Progression of rheumatoid arthritis.)

    Google Scholar 

  13. Fitzpatrick R, Ziebland S, Jenkinson C, Mowat A. A comparison of the sensitivity to change of several health status instruments in rheumatoid arthritis. J Rheumatol 1993; 20: 429. (Progression of rheumatoid arthritis.)

    Google Scholar 

  14. Fries JF, Spitz PW, Young DY. The dimensions of health outcomes: The Health Assessment Questionnaire, Disability and Pain Scales. J Rheumatol 1982; 9(5): 789. (Progression of rheumatoid arthritis.)

    Google Scholar 

  15. Hassan SJ, Weymuller EAJ. Assessment of quality of life in head and neck cancer patients. Head Neck 1993; 15: 485. (Progression of tumour.)

    Google Scholar 

  16. Hawley DJ, Wolfe F. Sensitivity to change of the Health Assessment Questionnaire (HAQ) and other clinical and health status measures in rheumatoid arthritis: results of short-term clinical trials and observational studies versus long-term observational studies. Arthritis Care Res 1992; 5: 130. (Progression versus multiple treatment for rheumatoid arthritis.)

    Google Scholar 

  17. Hidding A, van der Linden S, Boers M et al. Is group physical therapy superior to individualized therapy in ankylosing spondylitis? A randomized controlled trial. Arthritis Care Res 1993; 6: 117. (Group versus individual physical therapy.)

    Google Scholar 

  18. Hoffman LA, Wesmiller SW, Sciurba FC et al. Nasal cannula and transtracheal oxygen delivery. A comparison of patient response after 6 months of each technique. Am Rev Respirat Dis 1992; 145: 827. (Alternative oxygen delivery systems.)

    Google Scholar 

  19. Jenkinson C, Ziebland S, Fitzpatrick R, Mowat A. Sensitivity to change of weighted and un-weighted versions of two health status measures. Int J Health Sci 1991; 2: 189. (Observational study.)

    Google Scholar 

  20. Jones PW. Quality of life, symptoms and pulmonary function in asthma: long-term treatment with nedocromil sodium examined in a controlled multicentre trial. Nedocromil Sodium Quality of Life Study Group. Eur Respirat J 1994; 7: 55. (Nedocromil in asthma.)

    Google Scholar 

  21. Kaplan RM, Anderson JP, Wu AW, Mathews WC, Kozin F, Orenstein D. The Quality of Well-being Scale. Applications in AIDS, cystic fibrosis, and arthritis. Med Care 1989; 27: S27. (AZT in acquired immune deficiency syndrome (AIDS) and non-steroidal anti-inflammatory drugs (NSAIDS) in rheumatoid arthritis.)

    Google Scholar 

  22. Katz JN, Larson MG, Phillips CB, Fossel AH, Liang MH. Comparative measurement sensitivity of short and longer health status instruments. Med Care 1992; 30: 917. (Hip replacement.)

    Google Scholar 

  23. Kazis LE, Callahan LF, Meenan RF, Pincus T. Health status reports in the care of patients with rheumatoid arthritis. J Clin Epidemiol 1990; 43: 1243. (NSAIDS in rheumatoid arthritis.)

    Google Scholar 

  24. Larson JL, Kim MJ, Sharp JT, Larson DA. Inspiratory muscle training with a pressure threshold breathing device in patients with chronic obstructive pulmonary disease. Am Rev Respirat Dis 1988; 138: 689. (Breathing exercise in chronic obstructive pulmonary disease (COPD).)

    Google Scholar 

  25. Laupacis A, Bourne R, Rorabeck C et al. The effect of elective total hip replacement on health-related quality of life. J Bone Joint Surg Am 1993; 75: 1619. (Hip replacement.)

    Google Scholar 

  26. Laupacis A, Muirhead N, Keown P, Wong C. A disease-specific questionnaire for assessing quality of life in patients on hemodialysis. Nephron 1992; 60: 302. (Disease progression during haemodialysis.)

    Google Scholar 

  27. Laupacis A, Pus N, Muirhead N, Wong C, Ferguson B, Keown P. Disease-specific questionnaire for patients with a renal transplant. Nephron 1993; 64: 226. (Renal transplant.)

    Google Scholar 

  28. Laupacis A, Wong C, Churchill D. The use of generic and specific quality-of-life measures in hemodialysis patients treated with erythropoietin. The Canadian Erythropoietin Study Group. Control Clin Trials 1991; 12: 168S. (Erythropoietin in haemodialysis.)

    Google Scholar 

  29. Levenstein J. Quality of Life, symptoms and pulmonary function in asthma. A year-long multicentre double-blind trial of nedocromil sodium versus placebo. Family Pract 1991; 8: 402. (Nedocromil in asthma.)

    Google Scholar 

  30. McGauley GA, Cuneo RC, Salomon F, Sonksen PH. Psychological well-being before and after growth hormone treatment in adults with growth hormone deficiency. Hormone Res 1990; 33Suppl 4: 52. (Growth hormone treatment.)

    Google Scholar 

  31. Ringsberg KC, Wiklund I, Wilhelmsen L. Education of adult patients at an asthma school—effects on quality-of-life, knowledge and need for nursing. Eur Respirat J 1990; V3(n1): 33. (Cognitive therapy in asthma.)

    Google Scholar 

  32. Rorabeck CH, Bourne RB, Laupacis A et al. A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life. Clin Orthopaed 1994; 298: 156. (Hip replacement.)

    Google Scholar 

  33. Stevens P, Hodkin JE, Hopewell PC. Intermittent positive pressure breathing therapy of chronic obstructive pulmonary disease. Ann Intern Med 1983; 99: 612. (Breathing exercise in COPD.)

    Google Scholar 

  34. Weinberger M, Samsa GP, Tierney WM, Belyea MJ, Hiner SL. Generic versus disease specific health status measures: comparing the sickness impact profile and the arthritis impact measurement scales. J Rheumatol 1992; 19: 543. (Progression of hip or knee osteoarthritis.)

    Google Scholar 

  35. Wiklund I, Berg G, Hammar M, Karlberg J, Lindgren R, Sandin K. Long-term effect of transdermal hormonal therapy on aspects of quality of life in postmenopausal women. Maturitas 1992; 14: 225. (Oestrogen replacement.)

    Google Scholar 

  36. Wiklund I, Holst J, Karlberg J et al. A new methodological approach to the evaluation of QoL in postmenopausal women. Maturitas 1992; 14: 211. (Oestrogen replacement.)

    Google Scholar 

  37. Wiklund I, Karlberg J. Evaluation of quality of life in clinical trials. Selecting quality-of-life measures. Control Clin Trials 1991; 12: 204S. (Oestrogen replacement.)

    Google Scholar 

  38. Wiklund I, Karlberg J, Mattsson L. Quality of life of postmenopausal women on a regimen of transdermal estradiol therapy: a double blind placebo-controlled study. Am J Obstet Gynecol 1993; 168: 824. (Oestrogen replacement.)

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Murawski, M.M., Miederhoff, P.A. On the generalizability of statistical expressions of health related quality of life instrument responsiveness: a data synthesis. Qual Life Res 7, 11–22 (1997). https://doi.org/10.1023/A:1008828720272

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1008828720272

Navigation