Smith K W, Avis N E, Assmann S F
New England Research Institutes.
Qual Life Res. 1999 Aug;8(5):447-59. doi: 10.1023/a:1008928518577.
Despite the increasing acceptance of quality of life (QOL) as a critical endpoint in medical research, there is little consensus regarding the definition of this construct or how it differs from perceived health status. The objective of this analysis was to understand how patients make determinations of QOL and whether QOL can be differentiated from health status. We conducted a meta-analysis of the relationships among two constructs (QOL and perceived health status) and three functioning domains (mental, physical, and social functioning) in 12 chronic disease studies. Instruments used in these studies included the RAND-36, MOS SF-20, EORTC QLQ-30, MILQ and MQOL-HIV. A single, synthesized correlation matrix combining the data from all 12 studies was estimated by generalized least squares. The synthesized matrix was then used to estimate structural equation models. The meta-analysis results indicate that, from the perspective of patients, QOL and health status are distinct constructs. When rating QOL, patients give greater emphasis to mental health than to physical functioning. This pattern is reversed for appraisals of health status, for which physical functioning is more important than mental health. Social functioning did not have a major impact on either construct. We conclude that quality of life and health status are distinct constructs, and that the two terms should not be used interchangeably. Many prominent health status instruments, including utility-based questionnaires and health perception indexes, may be inappropriate for measuring QOL. Evaluations of the effectiveness of medical treatment may differ depending on whether QOL or health status is the study outcome.
尽管生活质量（QOL）作为医学研究中的关键终点越来越被认可，但对于这一概念的定义以及它与感知健康状况的差异，几乎没有达成共识。本分析的目的是了解患者如何确定生活质量，以及生活质量是否可以与健康状况区分开来。我们对12项慢性病研究中两个概念（生活质量和感知健康状况）以及三个功能领域（心理、身体和社会功能）之间的关系进行了荟萃分析。这些研究中使用的工具包括兰德36项健康调查、MOS SF - 20、欧洲癌症研究与治疗组织核心量表QLQ - 30、MILQ和MQOL - HIV。通过广义最小二乘法估计了一个综合所有12项研究数据的单一相关矩阵。然后使用该综合矩阵来估计结构方程模型。荟萃分析结果表明，从患者的角度来看，生活质量和健康状况是不同的概念。在对生活质量进行评分时，患者更强调心理健康而非身体功能。在评估健康状况时，这种模式则相反，身体功能比心理健康更重要。社会功能对这两个概念都没有重大影响。我们得出结论，生活质量和健康状况是不同的概念，这两个术语不应互换使用。许多著名的健康状况评估工具，包括基于效用的问卷和健康感知指数，可能不适用于测量生活质量。根据研究结果是生活质量还是健康状况，对医疗治疗效果的评估可能会有所不同。
