Cited by 3,027Health Systems, Economic Evaluations, Quality of LifeCancer survivorship and careMusculoskeletal pain and rehabilitation

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Linking Clinical Variables With Health-Related Quality of Life: A Conceptual Model of Patient Outcomes

Wilson, Ira B.·1995·JAMA

DOI 10.1001/jama.1995.03520250075037

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Abstract

HEALTH-related quality of life (HRQL) is increasingly used as an outcome in clinical trials, effectiveness research, and research on quality of care. Factors that have facilitated this increased usage include the accumulating evidence that measures of HRQL are valid and "reliable,"1the publication of several large clinical trials showing that these outcome measures are responsive to important clinical changes,2-5and the successful development and testing of shorter instruments that are easier to understand and administer.6-13Because these measures describe or characterize what the patient has experienced as the result of medical care, they are useful and important supplements to traditional physiological or biological measures of health status. Given this improved ability to assess patients' health status, how can physicians and health care systems intervene to improve HRQL? Implicit in the use of measures of HRQL in clinical trials and in effectiveness research is the concept that clinical

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“For the purposes of this review, we conceptualize HrQoL according to the Wilson and Cleary model, which emphasizes the importance of symptom status, general health perceptions, and functional status on overall HrQoL [24].”
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“The measurement of health-related quality of life (HRQoL) in patients during an illness experience is an important means to evaluate the quality and outcomes of health care (Bradlyn et al., 1996; Hinds, 1990; Moons, Budts, & De Geest, 2006; Wilson & Cleary, 1995).”
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Method
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“The Wilson–Cleary (W–C) model of HRQL [24]”
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Background
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Background
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“None of the seven instruments include items related to the Wilson and Cleary outcome level labelled as ‘biological and physiological variables’.”
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“Currently there is broad consensus about the importance of measuring health-related quality of life (HRQOL) for persons receiving care in a variety of delivery settings and conditions [1].”
Background
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Background
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“Health-related quality of life HRQL refers to the aspects of quality of life that specially relate to a person’s health and can be defined as self-perceived multidimensional health status [12, 13].”
Background
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“At least, it is not expected that older adults with more severe depressive baseline symptoms accept their health difficulties, lower their expectations, and adjust their internal standards to level out the discrepancy between the possible and the actual situation to a greater degree (“response-shift”) [52] than those…”
Background
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“Essentially, the Wilson-Cleary model conceptualized a continuum linking levels of health outcomesdfrom fundamental physiologic and clinical factors at one end of the continuum to symptoms, to function, to psychological impact, and ultimately to overall QoL at the other end of the continuum, in that order.(12) Also inc…”
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“In agreement with the original Wilson and Cleary model [11] and the version revised by Ferrans et al.”
BackgroundResult
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“Overall health-related QoL is defined as a multidimensional model integrating biological and psychological aspects [24,25], and patient's perception of their own condition is an important independent contributor to QoL in angina [26], and generally in chronic diseases [27].”
Background
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Loneliness as a mediator of social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany
Belau, M. H., Becher, H., & Kraemer, A. (2021) · BMC Public Health · doi:10.1186/s12889-021-12303-5 · Cited by 32
“A theoretical model by Wilson and Cleary [22] considers and describes the influence of the individual and the environment on various dimensions of HRQoL.”
Background
Relevance of community structures and neighbourhood characteristics for participation of older adults: a qualitative study
Strobl, R., Maier, W., Ludyga, A., et al. (2015) · Quality of Life Research · doi:10.1007/s11136-015-1049-9 · Cited by 32
DAILY HEMODIALYSIS—SELECTED TOPICS: Quality of Life and Daily Hemodialysis
Kutner, N. G. (2004) · Seminars in Dialysis · doi:10.1111/j.0894-0959.2004.17203.x · Cited by 32
“Moreover, these relationships are potentially bidirectional (14).”
BackgroundInfluential
Changes in Health Status, Psychological Distress, and Quality of Life in COPD Patients after Hospitalization
Andenæs, R., Moum, T., Kalfoss, M. H., & Wahl, A. K. (2006) · Quality of Life Research · doi:10.1007/s11136-005-0890-7 · Cited by 32
“In our model, we treated health status (SGRQ) and psychological distress (HSCL) as predictor variables and QoL (WHOQOL – Bref) as the outcome variable [22].”
Method
Independent contributors to overall quality of life in people with advanced cancer
Rodríguez, A. M., Mayo, N. E., & Gagnon, B. (2013) · British Journal of Cancer · doi:10.1038/bjc.2013.146 · Cited by 32
“Individual and environmental characteristics also influence each of the components of the model (Wilson and Cleary, 1995).”
BackgroundMethod
A predictive model of health-related quality of life in young adult survivors of childhood cancer
Maurice‐Stam, H., Oort, F. J., Last, B. F., & Grootenhuis, M. A. (2009) · European Journal of Cancer Care · doi:10.1111/j.1365-2354.2007.00916.x · Cited by 32
Studying psychosocial adaptation to end-stage renal disease: The proximal–distal model of health-related outcomes as a base model
Chan, R., Brooks, R., Erlich, J., Gallagher, M., Snelling, P. L., Chow, J. S. F., & SURANYI, M. G. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.11.005 · Cited by 34
“'s principles that the impact of clinical factors on QoL is fully mediated by other intervening factors such as physical functioning and psychological states [23–25,27] with their impact, thus diminishing along the continuum [23].”
BackgroundMethodInfluential
A Causal Model of Health‐Related Quality of Life in Thai Patients With Heart‐Failure
Krethong, P., Jirapaet, V., Jitpanya, C., & Sloan, R. S. (2008) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.2008.00235.x · Cited by 32
Symptom Management in Taiwanese Patients with HIV/AIDS
Tsai, Y., Hsiung, P., & Holzemer, W. L. (2002) · Journal of Pain and Symptom Management · doi:10.1016/s0885-3924(01)00413-4 · Cited by 32
Postoperative quality of life of patients treated for asymptomatic unruptured intracranial aneurysms
Yamashiro, S., Nishi, T., Koga, K., et al. (2007) · Journal of neurosurgery · doi:10.3171/jns-07/12/1086 · Cited by 32
Bosentan therapy in patients with pulmonary arterial hypertension: The relationship between improvements in 6 minute walk distance and quality of life
Strange, G. A., KEOGH, A. M., Williams, T. J., et al. (2008) · Respirology · doi:10.1111/j.1440-1843.2008.01326.x · Cited by 32
Physical and psychological health of first and second generation Turkish immigrants in Germany
Kotwal, A. (2010) · American Journal of Human Biology · doi:10.1002/ajhb.21044 · Cited by 32
“In contrast, the more objective chronic illness variable is useful in comparing the primarily medical dimension of health between the subgroups (Miilunpalo et al., 1997; Wilson and Cleary, 1995).”
Background
Association between anemia and physical disability in older patients: role of comorbidity
Maraldi, C., Blè, A., Zuliani, G., Guralnik, J. M., Mussi, C., Fellin, R., & Volpato, S. (2006) · Aging Clinical and Experimental Research · doi:10.1007/bf03324848 · Cited by 33
Quality of life versus prolongation of life in patients treated with chemotherapy in advanced colorectal cancer: A review of randomized controlled clinical trials
de Kort, S. J., Willemse, P. H. B., Habraken, J. M., de Haes, J. C. J. M., Willems, D. L., & Richel, D. J. (2006) · European Journal of Cancer · doi:10.1016/j.ejca.2005.10.026 · Cited by 32
Assessment of Psychological Well-Being in Psychosomatic Medicine
Rafanelli, C., & Ruini, C. (2012) · Advances in Psychosomatic Medicine · doi:10.1159/000330021 · Cited by 31
Quality of Life in Adolescents and Young Adults: The Role of Symptom Burden
Steineck, A., Bradford, M. C., O’Daffer, A., Fladeboe, K., O’Donnell, M. B., Scott, S., Yi‐Frazier, J. P., & Rosenberg, A. R. (2022) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2022.05.017 · Cited by 32
Functional variants identify sex-specific genes and pathways in Alzheimer’s Disease
Bourquard, T., Lee, K. D., Al‐Ramahi, I., Pham, M., Shapiro, D., Lagisetty, Y., Soleimani, S., Mota, S., Wilhelm, K. O., Samieinasab, M., et al. (2023) · Nature Communications · doi:10.1038/s41467-023-38374-z · Cited by 32
Prevalence, treatment and correlates of depression in multiple sclerosis
Young, C. A., Langdon, D. W., Rog, D. J., Chhetri, S. K., Tănăsescu, R., Kalra, S., Webster, G., Nicholas, R. S., Ford, H. L., Woolmore, J., et al. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.105648 · Cited by 32
Validity and reliability of the Oral Impacts on Daily Performance (OIDP) scale in the elderly population of Bosnia and Herzegovina
Erić, J., Stančić, I., Tihaček‐Šojić, L., et al. (2011) · Gerodontology · doi:10.1111/j.1741-2358.2011.00584.x · Cited by 31
Validation and comparison of 15-D and EQ-5D-5L instruments in a Spanish Parkinson’s disease population sample
García-Gordillo, M. Á., Cruz, B. D. P., Adsuar, J. C., Martínez, F. I. S., & Abellán‐Perpiñán, J. (2013) · Quality of Life Research · doi:10.1007/s11136-013-0569-4 · Cited by 34
“Therefore, HRQoL has been recognized increasingly as an important outcome of health care to be incorporated into the decision-making process of clinicians and policy [4].”
Background
Physical Activity, Tinnitus Severity, and Improved Quality of Life
Carpenter-Thompson, J. R., McAuley, E., & Husain, F. T. (2015) · Ear and Hearing · doi:10.1097/aud.0000000000000169 · Cited by 31
Improving public health through student-led interprofessional extracurricular education and collaboration: a conceptual framework
Vanderbilt, A. A., Wright, M. S., Isringhausen, K. T., et al. (2014) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s52019 · Cited by 31
“Health is a multidimensional concept that encompasses biological, social, and psychologic dimensions,(1) which are causally associated and ultimately impact quality of life.(2) However, many individuals, clinicians included, have a tendency to see patients as dichotomously healthy or unhealthy,(3) resulting in insuffi…”
Background
Functional status, physical activity level, and exercise regularity in patients with fibromyalgia after Multidisciplinary treatment: retrospective analysis of a randomized controlled trial
Salvat, I., de Zaldívar, P. S., Monterde, S., Montull, S., Rull, I. M., & Castel, A. (2016) · Rheumatology International · doi:10.1007/s00296-016-3597-x · Cited by 36
The effects of family physician-contracted service on health-related quality of life and equity in health in China
Lai, S., Lu, L., Zhou, Z., et al. (2021) · International Journal for Equity in Health · doi:10.1186/s12939-020-01348-4 · Cited by 31
Health-Related Quality of Life and Associated Factors Among Adult Patients with Heart Failure in Wolaita Zone Governmental Hospitals, Southern Ethiopia
Molla, S., Yitayal, M., & Amare, G. (2021) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s288326 · Cited by 31
The minimal perceived change: a formal model of the responder definition according to the patient’s meaning of change for patient-reported outcome data analysis and interpretation
Vanier, A., Sebille, V., Blanchin, M., & Hardouin, J.-B. (2021) · BMC Medical Research Methodology · doi:10.1186/s12874-021-01307-9 · Cited by 32
Health-related quality of life among older adults who experienced the Pohang earthquake in South Korea: A cross-sectional survey
Kim, E., Kim, G. S., Kim, H., et al. (2022) · Health and Quality of Life Outcomes · doi:10.1186/s12955-022-01944-8 · Cited by 31
“Conclusions This study verified the path between associated factors and HRQOL among older adults who experienced the Pohang earthquake in South Korea by constructing a hypothetical model based on the HRQOL model developed by Wilson and Cleary [23] and revised by Zubritsky et al.”
MethodInfluential
Development of a standard set of PROs and generic PROMs for Dutch medical specialist care
Voshaar, M. A. H. O., Terwee, C. B., Haverman, L., et al. (2023) · Quality of Life Research · doi:10.1007/s11136-022-03328-3 · Cited by 31
Health-Related Quality of Life in Advanced Prostate Cancer and Its Treatments: Biochemical Failure and Metastatic Disease Populations
Sartor, O. A., Flood, E. M., Beusterien, K. M., et al. (2014) · Clinical Genitourinary Cancer · doi:10.1016/j.clgc.2014.08.001 · Cited by 31
Construct validation of the Amblyopia and Strabismus Questionnaire (A&SQ) by factor analysis
van de Graaf, E. S., Felius, J., Saar, H. V. K.-D., et al. (2009) · Graefe s Archive for Clinical and Experimental Ophthalmology · doi:10.1007/s00417-009-1112-8 · Cited by 31
Advances in Measuring Quality-of-Life Outcomes in Cancer Care
Ferrans, C. E. (2010) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2009.11.002 · Cited by 32
Qualidade de vida em doenças pulmonares crônicas: aspectos conceituais e metodológicos
Ramos‐Cerqueira, A. T. D. A., & Crepaldi, A. (2000) · Jornal de Pneumologia · doi:10.1590/s0102-35862000000400008 · Cited by 31
Validity and responsiveness of the work functioning impairment scale (WFun) in workers with pain due to musculoskeletal disorders
Makishima, M., Fujino, Y., Kubo, T., Izumi, H., Uehara, M., Oyama, I., & Matsuda, S. (2017) · Journal of Occupational Health · doi:10.1539/joh.17-0166-oa · Cited by 31
The disease process and utilization of health services in rheumatoid arthritis: The relative contributions of various markers of disease severity in explaining consumption patterns
Waltz, M. (2000) · Arthritis & Rheumatism · doi:10.1002/1529-0131(200004)13:2 · Cited by 31

Authors: Wilson, I. B.
Corresponding author: Wilson, Ira B.
ORCID: Wilson, Ira B.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 1995-01-04
Volume: 273
Issue: 1
Pages: 59
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.1995.03520250075037
OpenAlex: W4292024189
Cited by: 3,027
References: 0
Citations by year: 2026: 151 · 2025: 168 · 2024: 134 · 2023: 141 · 2022: 176 · 2021: 183 · 2020: 197 · 2019: 137 · 2018: 138 · 2017: 130 · 2016: 145 · 2015: 131 · 2014: 128 · 2013: 123 · 2012: 106
FWCI: 96.54
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
Funders: Agency for Healthcare Research and Quality (1-R01-HS06239)
Topics: Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Keywords: health-related quality of life, clinical factors, patient-reported outcomes, outcome measures, quality of care, effectiveness research, health assessment

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Linking Clinical Variables With Health-Related Quality of Life: A Conceptual Model of Patient Outcomes

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