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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“Moreover, some authors have found correlations between personal and environmental characteristics and self-assessments of oral health in children and adolescents (Agou et al, 2008, 2011), which are consistent with models of disease and its outcomes (Wilson and Cleary, 1995).”
BackgroundResult
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“[41,45] To avoid the conceptual confusion, the authors of the proposed models urged researchers to clearly define their study outcomes; however, the terms QOL and HRQOL were used interchangeably in the studies reviewed here, none of which explicitly provided a definition of QOL.”
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“Content and scale structure were derived from a literature search [8] and from expert and patient interviews [10] and the development was conducted within a classical health-related quality of life theoretical framework [22-25].”
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“relationship between oral diseases and their functional, social, and psychological outcomes [14,15].”
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“Wilson and Cleary [37] stated that the choice, design and implementation of interventions to improve patient outcome require an overall model that integrates different models of health and health outcome.”
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“Self-rated health is widely used as a measure of health status because of its simplicity and strong relation with outcomes, such as the use of general medical services, mortality and survival (Wilson & Cleary 1995, Van den Brink et al. 2005, Perlman 2006).”
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“Specifically, the application of these findings can be considered in four phases: (1) pretransplant, (2) during transplant (through day 100), (3) immediate recovery (3 months-1 year), and (4) long-term recovery (beyond 1 year).”
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“Wilson and Cleary [ 3 ] defined functional status as the ability of the patient to perform certain tasks and functions.”
Influential
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“Though an HS conceptual model will evolve with deeper understanding of the disease, distinguishing the present work from previous descriptions of the disease (7,9,32–36) are several specific characteristics that can be synthesized in a manner consistent with Wilson and Cleary’s classification scheme, which diagrams a…”
Result
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Background
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“This issue, in turn, becomes more relevant when one notices that currently available conceptual models (Wilson and Cleary, 1995; Diamond and Becker, 1999; Post et al., 1999) provide no specificity in understanding the QOL of depressed subjects (AyWoan et al.”
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“But the problem is that this measure is imprecise as fractures are a specific state in themselves which are associated with further burdensome consequences like losses of functioning and fear [15].”
Background
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Background
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“Adding to the complexity, these factors can be influenced by varying personal values, preferences, and motivation, as well as available psychological and social support.(5) In clinical trials, these endpoints measure outcomes important to patients not otherwise captured by traditional clinical or process outcomes.”
Self-Reported Functional Status: An Important Predictor of Health Outcomes Among End-Stage Renal Disease Patents
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“Quality of Life and Associated Factors There is consensus in medical health care that quality of life (QOL) should reflect the subjective perception of a patient’s well-being and functioning, pertaining to physical, emotional, and social aspects as well as everyday life activities (Wilson and Cleary, 1995).”
Background
Testing the applicability of a conceptual model of oral health in housebound edentulous older people
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“Cleary (1) and others (15), it is likely that a range of contextual factors impact on both the reporting and”
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“They contrast the medical model used by clinicians, with its emphasis on ‘‘etiological agents, pathological processes, and biological, physiological, and clinical outcomes’’ and its ‘‘principal goal . . . to understand causation in order to guide diagnosis and treatment’’ ( Wilson & Cleary, 1995 ), with the social sci…”
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“One of the most referenced theoretical frameworks to measure HRQoL in the literature is the Wilson and Cleary model [3,6–8], which presents a conceptual model, a taxonomy of patient outcomes that categorizes patient outcomes according to the underlying health concepts they represent; it proposes specific causal relati…”
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“PROMs that were considered to measure physical functioning based on the Wilson and Cleary model 31 in the first review 25 were included in the current study when the following criteria were met: 1.”
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“be very useful indicators of health and health inequalities [2, 3].”
Background
Calidad de vida relacionada con la salud en una cohorte nacional de pacientes con hipertensión arterial pulmonar o hipertensión pulmonar tromboembólica crónica
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“048 (898) p = ,0,74 PCS inicial (DE) 37 (8,4) 38,8 (10,2) p = ,0,28 PCS tras seguimiento 6 meses (DE) 38,2 (7,9) 41,7 (10,2) p = ,0,048 MCS inicial (DE) 45,4 (8,5) 46 (9,7) p = ,0,32 MCS tras seguimiento 6 meses (DE) 46,5 (10,1) 47,7 (8,6) p = ,0,84 EQ-5D EVA inicial 0,63 (0,19) 0,67 (0,23) p = ,0,19 EQ-5D EVA tras se…”
BackgroundInfluential
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“, 2013), for subjective well-being may not adequately be captured within the medical model framework (Wilson and Cleary, 1995; Vaillant, 2003).”
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Influential
A hair growth questionnaire for use in the evaluation of therapeutic effects in men
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“Also, those reporting poor HRQoL might not differ appreciably from their higher HRQoL counterparts in terms of objective health status (Wilson & Cleary, 1995).”
Background
Predictors of changes in physical, psychosocial, sexual quality of life, and comfort with food after obesity surgery: a 12-month follow-up study
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“L -Q oL (E ng lis h, E st on ia n) U ni te d K in gd om P tie nt in te rv ie w s 0– 25 In te rn al co ns is te nc y Y N ot gi ve n [1 0]”
Background
Development of a Conceptual Model of Adherence to Oral Anticoagulants to Reduce Risk of Stroke in Patients with Atrial Fibrillation
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“Specifically, a conceptual model diagram shows relationships among a set of concepts such as disease symptoms, treatment, outcomes, and patient perceptions [26,27].”
Background
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Wandera, M., KAYONDO, J., Engebretsen, I. M. S., Okullo, I., & Åstrøm, A. N. (2009) · International Journal of Paediatric Dentistry · doi:10.1111/j.1365-263x.2009.00969.x · Cited by 44
Do oncologists have an increasing interest in the quality of life of their patients? A literature review of the last 15 years
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Mental well-being of the general population: direct and indirect effects of socioeconomic, relational and health factors
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“HRQOL is a multidimensional construct that includes global health perspectives, functional status, biological and physical variables, individual and environmental characteristics and general perceptions [4].”
Background
Health status in COPD cannot be measured by the St George's Respiratory Questionnaire alone: an evaluation of the underlying concepts of this questionnaire
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“Similarly, others [5,6] define health status as an overall concept covering physiological functioning, symptoms, functional impairment, quality of life, and social functioning as important main domains.”
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Patient-Reported Outcome Measures in Inflammatory Bowel Disease
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The burden of disease for pituitary patients.
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Labor Force Participation and Health-Related Quality of Life in HIV-Positive Men Who Have Sex with Men: The Multicenter AIDS Cohort Study
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“The following variables were considered as possible predictors of health-related quality of life, based on available data and conceptual models previously used by the MACS:[22, 23] Individual characteristics (sociodemographic and individual risk behaviors), clinical indicators (biological markers, HIV-related medicati…”
Subjective health measures and acute treatment outcomes in geriatric depression
Lenze, E. J., Miller, M. D., Dew, M. A., Martire, L. M., Mulsant, B. H., Begley, A. E., Schulz, R., Frank, E., & Reynolds, C. F. (2001) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.503 · Cited by 41
Health-Related Quality of Life in Asymptomatic Patients with HIV
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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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