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Linking Clinical Variables With Health-Related Quality of Life: A Conceptual Model of Patient Outcomes
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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“Symptoms and side effects are the most proximally and least confounded clinical variables associated with disease and treatment; however, as one moves further away from the direct effects of disease and treatment, towards the broader construct of quality of life, many other confounding patient and environmental factors influence a quality of life score.”
In the citing paper
“The model suggests that to be very precise and valid, distinctly different PROs should be assessed separately to maximize information and decrease overlap between constructs.”
In the citing paper
“Per Wilson and Cleary, HRQOL is a broad, multi-faceted construct affected by many confounding variables [16].”
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Vanier, A., Oort, F. J., McClimans, L. M., Ow, N., Gulek, B. G., Boehnke, J. R., Sprangers, M. A. G., Sebille, V., Mayo, N. E., & the Response Shift - in Sync Working Group (2021) · Quality of Life Research · doi:10.1007/s11136-021-02846-w · Cited by 171
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“This suggests that the HRQoL is affected by influences other than Hb level, which is in agreement with the literature (Wilson & Cleary, 1995).”
ResultSpine Focus Issue Introduction
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“Furthermore, most researchers now recognize that general health perceptions integrate patient symptoms and values and, thus, are a cornerstone to patient reports of health-related quality of life (Cleary and Edgman-Levitan 1997; Patrick and Erickson 1993; Wilson and Cleary 1995).”
Pressler, S. J., Subramanian, U., Perkins, S. M., Gradus-Pizlo, I., Kareken, D., Kim, J., Ding, Y., Sauve, M. J., & Sloan, R. (2011) · American Journal of Critical Care · doi:10.4037/ajcc2010931 · Cited by 147
Ramsenthaler, C., Osborne, T. R., Gao, W., Siegert, R. J., Edmonds, P. M., Schey, S., & Higginson, I. J. (2016) · BMC Cancer · doi:10.1186/s12885-016-2410-2 · Cited by 159
“Our findings from the regression analyses support the hypothesised relationships between symptoms, function, emotional response and quality of life in the Wilson and Cleary model [58].”
ResultDiscriminant properties of commonly used quality of life measures in heart failure
Bennett, S. J., Oldridge, N., Eckert, G. J., Embree, J. L., Browning, S., Hou, N., Deer, M. M., & Murray, M. D. (2002) · Quality of Life Research · doi:10.1023/a:1015547713061 · Cited by 146
“HRQL is a multidimensional concept which includes at least physical, emotional, social, and symptom status [2, 3].”
BackgroundThe impact of third molar symptoms, pain, and swelling on oral health-related quality of life
Slade, G. D., Foy, S. P., Shugars, D. A., et al. (2004) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2003.11.014 · Cited by 144
Heyland, D. K., Groll, D., & Caeser, M. (2005) · Critical Care Medicine · doi:10.1097/01.ccm.0000168609.98847.50 · Cited by 150
“different causal pathways that link the various outcomes to each other (24).”
BackgroundHealth-related quality of life following pediatric critical illness
Aspesberro, F. P., Mangione-Smith, R. M., & Zimmerman, J. J. (2015) · Intensive Care Medicine · doi:10.1007/s00134-015-3780-7 · Cited by 143
“In 1995, Wilson and Cleary published a conceptual model of patient outcomes linking clinical variables with HRQL [18].”
BackgroundSedlar, N., Lainščak, M., Mårtensson, J., Strömberg, A., Jaarsma, T., & Farkaš, J. (2017) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515117691644 · Cited by 145
Oral health, academic performance, and school absenteeism in children and adolescents
Ruff, R. R., Senthi, S., Susser, S. R., & Tsutsui, A. (2018) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2018.09.023 · Cited by 158
“This finding is consistent with theories of psychosocial development in children experiencing dental or other craniofacial differences.(36,37) Each of the studies included in meta-analyses found increased odds of poor academic achievement and absences owing to caries or tooth pain; however, over 44% of between-study v…”
ResultBoers, M., Beaton, D., Shea, B., Maxwell, L. J., Bartlett, S. J., Bingham, C. O., Conaghan, P. G., D’Agostino, M. A., de Wit, M. P. T., Gossec, L., et al. (2019) · The Journal of Rheumatology · doi:10.3899/jrheum.181096 · Cited by 141
Are Americans Feeling Less Healthy? The Puzzle of Trends in Self-rated Health
Salomon, J. A., Nordhagen, S., Oza, S., & Murray, C. (2009) · American Journal of Epidemiology · doi:10.1093/aje/kwp144 · Cited by 146
“Measures of health status are widely used in clinical trials and studies on quality of care ( 1 , 2). There is also increasing interest in using health status measures to track changes in population health and health service needs and to monitor progress toward broad goals for the health of communities and nations (3–…”
MethodCorrelation of Postoperative Pain to Quality of Recovery in the Immediate Postoperative Period
Wu, C. L., Rowlingson, A. J., Partin, A. W., et al. (2005) · Regional Anesthesia & Pain Medicine · doi:10.1097/00115550-200511000-00003 · Cited by 141
Sousa, K. H., & Kwok, O. (2006) · Quality of Life Research · doi:10.1007/s11136-005-3975-4 · Cited by 150
“Wilson and Cleary [1] stated that the absence of arrows between nonadjacent levels does not imply that relationships do not exist.”
BackgroundMethodInfluentialIn situ simulation and its effects on patient outcomes: a systematic review
Goldshtein, D., Krensky, C., Doshi, S., & Perelman, V. S. (2019) · BMJ Simulation & Technology Enhanced Learning · doi:10.1136/bmjstel-2018-000387 · Cited by 143
Kumar, P., Casarett, D., Corcoran, A., Desai, K., Li, Q., Chen, J., Langer, C., & Mao, J. J. (2012) · Journal of Palliative Medicine · doi:10.1089/jpm.2011.0217 · Cited by 141
Resident- and Facility-Level Predictors of Quality of Life in Long-Term Care
Shippee, T. P., Henning‐Smith, C., Kane, R. L., & Lewis, T. (2013) · The Gerontologist · doi:10.1093/geront/gnt148 · Cited by 138
Huang, I., Brinkman, T. M., Kenzik, K. M., Gurney, J. G., Ness, K. K., Lanctot, J. Q., Shenkman, E. A., Robison, L. L., Hudson, M. M., & Krull, K. R. (2013) · Journal of Clinical Oncology · doi:10.1200/jco.2012.47.8867 · Cited by 144
Metadata
- 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
- 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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