The Quality of Life Scale (QOLS), created originally by American psychologist John Flanagan in the 1970's, has been adapted for use in chronic illness groups. This paper reviews the development and psychometric testing of the QOLS. A descriptive review of the published literature was undertaken and findings summarized in the frequently asked questions format. Reliability, content and construct validity testing has been performed on the QOLS and a number of translations have been made. The QOLS has low to moderate correlations with physical health status and disease measures. However, content validity analysis indicates that the instrument measures domains that diverse patient groups with chronic illness define as quality of life. The QOLS is a valid instrument for measuring quality of life across patient groups and cultures and is conceptually distinct from health status or other causal indicators of quality of life. Why assess Quality of Life in chronic illness?Quality of life (QOL) measures have become a vital and often required part of health outcomes appraisal. For populations with chronic disease, measurement of QOL provides a meaningful way to determine the impact of health care when cure is not possible. Over the past 20 years, hundreds of instruments have been developed that purport to measure QOL [1]. With few exceptions, these instruments measure what Fayers and colleagues [2,3] have called causal indicators of QOL rather than QOL itself. Health care professionals need to be clear about the conceptual definition of QOL and not to confound it with functional status, symptoms, disease processes, or treatment side-effects [4][5][6][7]. Although the definition of QOL is still evolving, Revicki and colleagues define QOL as "a broad range of human experiences related to one's overall well-being. It implies value based on subjective functioning in comparison with personal expectations and is defined by subjective experiences, states and perceptions. Quality of life, by its very natures, is idiosyncratic to the individual, but intuitively meaningful and understandable to most people [[8], p. 888]." This definition denotes a meaning for QOL that transcends health.

Reliability and validity of the Flanagan Quality of Life Scale (QOLS) were tested in four chronic illness groups. Open-ended questions and four instruments, the QOLS, Duke-UNC Health Profile (DUHP), Life Satisfaction Index (LSI-Z), and either the Arthritis Impact Measurement Scales (AIMS) or the Ostomy Adjustment Scale (OAS) were administered by telephone interview and mailed questionnaires to 227 adults three times over 6 weeks. Subjects generated verbal responses that substantiated the content validity of the QOLS. Stability reliability estimates for all instruments ranged from .53 to .90. Cronbach's alpha coefficients averaged .87 for the QOLS. Appropriate validity coefficients indicated both convergent and discriminant construct validity.

If health care providers are to be able to document effective outcomes resulting from their interventions, they must first develop clear conceptual definitions for the outcomes, and then select measures that represent these concepts. No consensus exists in the health care disciplines about what quality of life is or how it should be measured. This paper presents historical and conceptual arguments in favour of a particular definition of quality of life, and distinguishes between quality of life and concepts often confused with it in the literature: symptoms, mood, functional status, and general health status. Whether quality of life is actually amenable to change as a result of health care interventions, and whether we ought to be trying to influence clients' quality of life is also discussed. We conclude that quality of life is an important outcome of health care intervention. However, traditional approaches to influencing quality of life may be misdirected, and the relative importance of our interventions to clients--whose opinions matter the most--ought to be put into perspective.

A short-form of the McGill Pain Questionnaire (SF-MPQ) has been translated into Swedish. One hundred women with either fibromyalgia (FS) or rheumatoid arthritis (RA) filled out the SF-MPQ three times--the RA patients monthly while receiving their routine care, and the FS patients over 6 months while participating in an experimental treatment. Results indicated that the MPQ 15-item descriptor section was internally consistent (Cronbach's alphas .73 to .89), but lacked content validity in the RA sample. Test-retest reliabilities ranged from .45 to .73. Convergent construct validity was demonstrated by significant correlations between the SF-MPQ and other pain measurements. A principal components analysis showed that the 15-item descriptor section has three distinct factors: acute sensory, chronic sensory, and affective. We conclude that the SF-MPQ is reliable and valid for use with FS patients.

MCGILL PAIN QUESTIONNAIRE (MPQ) General DescriptionPurpose. To measure the different qualities of the subjective pain experience (1). Content.Three classes of words (total of 78) that describe the sensory, affective and evaluative aspects of pain, and a 5-point pain intensity scale (present pain intensity [PPI]).Developer/contact information. Ronald Melzack, PhD, Department of Psychology, Stewart Biology Building, McGill University, Montreal, Quebec, Canada H3A 2K6. E-mail: rmelzack@ego.psych. mcgill.ca.Versions. English, French, German, Swedish, Norwegian, Danish, Arabic, Italian, and Japanese. Number of items in scale.There are 20 subclasses, each containing 2-6 words, and 1 pain intensity scale consisting of 1 item.Subscales. Pain Rating Index (PRI) contains 4 subscales (sensory, affective, evaluative, and a miscellaneous category).Populations. Developmental/target. Developed for use in adult populations with a variety of chronic pain problems.Other uses. None. WHO ICF Components. Body function. AdministrationMethod. The respondent is given the questionnaire with the words grouped into 20 subclasses. An interviewer then instructs respondents to choose 1 word from each subclass if a word within that class fits their present pain. If no word fits, then no word should be chosen from that subclass. The interviewer defines any words that the respondent does not understand.Training. The interviewer must be able to define each word.Time to administer/complete. 5-15 minutes. Equipment needed. Pencil and paper.Cost/availability. The MPQ is available at no cost from the author. Also available on line at http://www.qolid.org by paying a membership fee. ScoringResponses. Scale. Each word within the PRI has an assigned value based on its placement within the subclass. The PPI is a 5-point scale.Score range. Scores on the PRI can range from 0 to 20 words chosen (number of words chosen [NWC]), 0 -78 for the total score based on rank value. Scores on the PPI can range from 0 to 5. Interpretation of scores.The PRI is interpreted both in terms of quantity of pain as evidenced by the number of words used and the rank values of the words, as well as the quality of pain as evidenced by the particular words that are Method of scoring. The MPQ is scored by hand by first counting the number of words used to obtain a total word score (number of words chosen). Then the rank values of the words chosen are summed to give a total PRI score and scores on each of the 4 subscales. The PPI is scored by noting the number-word combination chosen by the respondent.Time to score. 1-2 minutes.Training to score. None. Training to interpret. None.Norms available. None. Psychometric InformationReliability. Retest over 3 to 7 days showed that respondents tended to choose the same words in the PRI and report the same PPI level. Validity.Content. Validity is indicated by respondents' tendency to use all 20 subclasses of pain words. Work by Burckhardt (3) found that arthritis patients used similar sets of words to describe their pain and that a substant...

Objective. Fibromyalgia is a common syndrome of musculoskeletal pain and fatigue. Lacking distinctive tissue or laboratory correlations, it has often been considered a form of "psychogenic rheumatism.'' In the present study, the notion that the stage4 sleep anomaly typically seen in the fibromyalgia syndrome may disrupt growth hormone secretion was tested. Because growth hormone has a very short half-life, serum levels of somatomedin C were measured; somatomedin C is the major mediator of growth hormone's anabolic actions and is a prerequisite for normal muscle homeostasis.Methods. Serum levels of somatomedin C were measured in 70 female fibromyalgia patients and 55 healthy controls, using a peptide-specific radioimmunoassay.Results. Significantly lower levels of somatomedin C were observed in the fibromyalgia patients compared with controls (mean 2 SD 124.7 f 47 ng/ml versus 175.2 2 60 ng/ml; P = 0.OoooOl).

The aim of this study was to evaluate and compare the psychometric properties of two generic health-related quality of life (HRQoL) instruments, the Short Form Health Survey (SF-36) and the Nottingham Health Profile (NHP) in a group of patients with chronic peripheral neuropathic pain (PNP). The sample consisted of 126 adults (56 men and 70 women) with PNP following a lesion of a peripheral nerve, spinal nerve or nerve root or patients with post-herpetic neuralgia. The battery of tests included visual analogue scales (VASs) for pain assessment and global rating of health and verbal rating scales of pain and other symptoms, as well as patient descriptors. The SF-36 had higher internal consistency reliability coefficients (alpha=0.79, range 0.70-0.90) than the NHP (alpha=0.68, range 0.49-0.79). Correlations between comparable dimensions of the two instruments were significant (range from -0.79 for the physical and mental dimensions to -0.29 for the social dimension) indicating a moderate degree of convergent validity. The study population had significantly worse scores on all dimensions of the two instruments when compared with the general population. Subjects with high VAS scores for pain on movement and those with low global health ratings had poorer scores on the both instruments. Overall, the SF-36 performed somewhat better on psychometric testing than did the NHP. However, the NHP contains dimensions such as sleep and more pain items which might be of particular importance in the PNP population. Since the instruments are short, both could be retained for continued testing in outcome studies of this population.

Objective. A subset of fibromyalgia (FM) patients have a dysfunctional hypothalamic-pituitary-insulinlike growth factor 1 (IGF-1) axis, as evidenced by low serum levels of IGF-1 and a reduced growth hormone (GH) response to physiologic stimuli. There is evidence that pyridostigmine (PYD) improves the acute response of GH to exercise in FM patients. The purpose of this study was to evaluate the clinical effectiveness of 6 months of PYD and group exercise on FM symptoms.Methods. FM patients were randomized to 1 of the following 4 groups: PYD plus exercise, PYD plus diet recall but no exercise, placebo plus exercise, and placebo plus diet recall but no exercise. The primary outcome measures were the visual analog scale (VAS) score for pain, tender point count, and total myalgic score. Secondary outcome measures were the total score on the Fibromyalgia Impact Questionnaire (FIQ) and FIQ VAS scores for individual symptoms (fatigue, poor sleep, stiffness, and anxiety), as well as quality of life (QOL) and physical fitness (lower body strength/ endurance, upper and lower body flexibility, balance, and time on the treadmill).Results. A total of 165 FM patients completed baseline measurements; 154 (93.3%) completed the study. The combination of PYD and exercise did not improve pain scores. PYD groups showed a significant improvement in sleep and anxiety in those who completed the study and in QOL in those who complied with the therapeutic regimen as compared with the placebo groups. Compared with the nonexercise groups, the 2 exercise groups demonstrated improvement in fatigue and fitness. PYD was generally well tolerated.Conclusion. Neither the combination of PYD plus supervised exercise nor either treatment alone yielded improvement in most FM symptoms. However, PYD did improve anxiety and sleep, and exercise improved fatigue and fitness. We speculate that PYD may have improved vagal tone, thus benefiting sleep and anxiety; this notion warrants further study.