Table 5.
Description of HRQOL and health utility instruments used by studies included in the reviewed literature
| Instrument | Number of studies using | Description |
|---|---|---|
| SF-36 Health Survey (SF-36) | 8 | 36 items measuring 8 health domains (physical functioning, role limitations due to physical health problems, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, mental health). Scores range from 0 to 100 with greater scores indicating better HRQOL |
| General Health Questionnaire 12 (GHQ 12) | 4 | Modified from the General Health Questionnaire 60 and contains 12 items, each ranked on a 4-point Likert scale ranging from 0 = ‘absent’ to 3 = ‘present.’ Higher total scores indicate worse HRQOL |
| Beck Depression Inventory (BDI) | 2 | 21-item in multiple choice format measuring the presence and degree of depression among adolescents and adults. Numerical values of 0, 1, 2, or 3 are assigned to each statement to indicate degree of severity. Items are summed to produce an overall score—a cut-off score of ≥13 indicates depression, with greater scores indicating more severe depression |
| Euro-QoL (EQ 5D) | 2 | 5 domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). Each item is ranked on a 3-point scale ranging from ‘no problems’ to extreme problems’ with higher scores indicating better HRQOL |
| Hospital Anxiety and Depression Scale (HAD) | 2 | 14 items comprising 2 dimensions—anxiety and depression. Scores for each item ranges from 0 to 3, with higher scores indicating worse HRQOL (i.e. more anxiety and depression) |
| Mood Adjective Check List Short Form (MACL) | 2 | 38 items categorized into 3 dimensions (pleasantness, activation, calmness). Scores for each item range from 1 to 4, with higher scores indicating better HRQOL |
| Severe Respiratory Insufficiency Questionnaire (SRI) | 2 | 49 items comprising 7 domains (respiratory complaints, physical functioning, attendant symptoms and sleep, social relationships, anxiety, psychological well-being, social functioning). Items are rated on a 5-point Likert scale from ‘strongly disagree’ to ‘strongly disagree’. Higher scores indicate better HRQOL |
| SF-6D utility score | 2 | 11-item generic preference-based single index measure of health status. Scores range from 0 to 1.0, with higher scores indicating better HRQOL |
| Sickness Impact Profile (SIP) | 2 | 136 items measuring 12 domains (sleep and rest, emotional behavior, body care and movement, home management, mobility, social interaction, ambulation, alertness, behavior, communication, work, recreation and pastimes, eating). Subjects endorse items that describe themselves. Scores are calculated as a percentage of total dysfunction; a cut-off score > 10 indicates severe dysfunction |
| Standard Gamble | 2 | Subject choose between certainty of remaining in a given health state and a hypothetical gamble, between the possible outcomes of perfect health and death. Probability of having perfect health in the gamble is lowered from 100% until the subject is indifferent between the choices. (Administration assisted with the use of a colored probability wheel.) The midpoint of the values between this probability of perfect health and the previous probability is the HRQOL score. Scores range from 0 to 1, with higher scores indicating better HRQOL |
| State-Trait Anxiety Inventory Short Form (STAI-6) | 2 | 6 items are rated on a 4-point scale. (Created from the 40-item Spielberger State-Trait Anxiety Inventory.) Items are scaled using a 4-point Likert scale indicating levels of anxiety with 1 = ‘not at all’ to 4 = ‘very much.’ Total scores range from 20 to 80 with a cut-off total score > 44 demonstrating that the subject is highly anxious. (Higher scores indicate worse HRQOL) |
| Visual Analog Scale (VAS) | 2 | Two methods used: (1) 10-cm scale with 0 cm = ‘death’ and 10 cm = ‘perfect health’ and (2) 100-cm ‘feeling thermometer’ with 0 cm = ‘death’ and 100 cm = ‘perfect health’. Patients are asked to mark on these scales where they rate their own state of health. Higher scores indicate better HRQOL |
| Beck Depression Inventory (BDI Short Form) | 1 | 13 items in multiple choice format measuring the presence and degree of depression among adolescents and adults. Numerical values of 0, 1, 2, or 3 are assigned to each statement to indicate degree of severity. Items are summed to produce an overall score with cut-offs of 0-3 = none or minimal depression, 4–7 = mild depression, 8–15 = moderate depression, and ≥16 = severe depression. (Higher scores indicate worse HRQOL) |
| Brief Disability Questionnaire (BDQ) | 1 | 11 items scored on a scale from 0 = never to 2 = always or severe; higher scores indicate worse HRQOL |
| Center for Epidemiologic Studies Depression Scale (CES-D) | 1 | 15 items each ranked on a 4-point Likert scale ranging from ‘not at all’ to ‘very much’. Total scores range from 0 to 60, with a score cut-off ≥16 suggesting a clinically significant level of depressive symptoms. (Higher scores indicate worse HRQOL) |
| DR-12 | 1 | 12 items comprising 2 domains—symptoms and socio-psychological & exercise adaptation. Each item is ranked on a scale from 1 to 3; higher scores indicate better HRQOL |
| Duke Health Profile (DUKE) | 1 | 63 items comprising 4 dimensions (symptom status, physical function, social function, and emotional function). Scores are generated for each domain is scored on a scale of 0–1; higher scores indicate better HRQOL |
| Dysfunctional Analysis Questionnaire (DAQ) | 1 | 50 items comprising 5 domains (social, vocational, personal, familial, cognitive). Each item rated on a 5-point Likert scale with 1 = better functioning than that before onset of illness and 5 = severe impairment compared to before illness onset; higher scores indicate worse HRQOL |
| Health Utilities Index 2 (HUI 2) | 1 | 7 items (sensation, mobility, emotion, cognition, self-care, pain, fertility) each with 3 to 5 levels. Utility functions are assigned to each level of each item from which that total health utility is calculated that ranges from 0 (death) to 1 (perfect health) |
| Health Utilities Index 3 (HUI 3) | 1 | 8 items (vision, hearing, speech, ambulation, dexterity, emotion, cognition, pain) each with 5 to 6 levels. Utility functions are assigned to each level of each item from which that total health utility is calculated that ranges from 0 (death) to 1 (perfect health). |
| Kessler 10 | 1 | 10 items each ranked on a 5-point Likert scale ranging from 1 = ‘never’ to 5 = ‘all of the time’. Higher scores indicate better HRQOL |
| Life Satisfaction Index Z | 1 | A short form version of the Life Satisfaction Index A containing 13 items. Subjects are asked to agree or disagree with the statement. Total scores range from 0 to 26, with higher scores indicating greater HRQOL |
| Modified version of SF-36 | 1 | 14 items among 3 domains (physical well-being, mental well-being, and social well-being). Responses are categorized into 1 of 3 categories: “worse,” “same as before,” and “better”. Total scores range from 0 to 100; higher scores indicate better HRQOL |
| Modified version of St. George’s Respiratory Questionnaire (SGRQ) | 1 | A version of the SGRQ suited to the study population, located in the Timika District, Papua Province, Indonesia. For more details refer to the SGRQ below |
| Present State Examination (PSE) | 1 | A combination of the 30-item General Health Questionnaire and a Self-rating Depression Scale. The 30-item General Health Questionnaire is a modified version of the General Health Questionnaire 60 and contains 30 items, each ranked on a 4-point Likert scale ranging from 0 = ‘absent’ to 3 = ‘present.’ Higher total scores indicate worse HRQOL. The Self-rating Depression Scale is designed to assess the level of depression among individuals diagnosed with a depressive disorder. There are 20 items comprising 4 domains (the pervasive effect, the physiological equivalents, other disturbances, and psychomotor activities). Each item is ranked on a scale of 1 = ‘a little of the time’ to 4 = ‘most of the time’. Higher scores indicate worse HRQOL with cut-off scores of 20-49 = normal range, 50–59 = mildly depressed, 60–69 = moderately depressed, ≥70 = severely depressed |
| Rosenberg Self-Esteem Scale (RSE) | 1 | 10 items with each item ranked on a 4-point Likert scale from ‘strongly agree’ to ‘strongly disagree’; higher scores indicate better HRQOL |
| Self-Rating Anxiety Scale (SAS) | 1 | 20 items each ranked on 4-point, Likert scale where 1 = ‘a little of the time’ and 4 = “most of the time. Total scores range from 20–80 with score classifications: 20–44 points = normal range anxiety; 45–59 points = mild to moderate anxiety levels; 60–74 points = marked to severe anxiety levels; 75–80 extreme anxiety levels. Higher scores indicate worse HRQOL |
| Sheehan Disability Scale (SDS) | 1 | 20 items comprising 3 domains: work, family, and social lives. Each item rated by using a 10-point visual analog scale with 0 = ‘unimpaired’ to 10 = ‘highly impaired.’ Total scores range from 0 to 30; higher scores indicate worse HRQOL. Scores ≥5 in any of the 3 domains indicates significant impairment |
| Social Support Rating Scale (SSRS) | 1 | 10 items to assess the perceived helpfulness of different types of individuals to the subject. Each item is assessed using a 3-point, Likert scale ranging from 1 = ‘not at all helpful’ to 3 = ‘a great deal helpful’. Higher scores indicate more social support |
| St. George Respiratory Questionnaire Short Form (SGRQ) | 1 | A disease-specific instrument designed to assess patients with mild to severe airway disease. 50 items comprise 3 domains (symptoms, activity, and impacts). Scores are scaled from 0 to 100, with better scores indicating worse HRQOL |
| Symptoms Check List (SCL-90) | 1 | 90 items comprising 9 domains (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, anger-hostility, phobic anxiety, paranoid ideation, psychoticism). Three global indices (Global Severity Index, Positive Symptom Total, and Positive Symptom Distress Index) can also be calculated. Each item is ranked on a 5-point Likert scale, ranging from 0 = `not at all’ to 4 = `extremely’; higher scores indicating worse HRQOL |
| Voice Handicap Index-10 (VHI-10) | 1 | Assessment specific to voice handicap. 30 items comprising 3 domains (functional, physical, and emotional aspects of voice disorders). Each item is ranked on a 5-point Likert scale with 0 = never to 4 = always; higher scores indicate worse HRQOL |
| World Health Organization’s Quality of Life—BREF (WHOQOL-BREF) | 1 | Based on the WHOQOL-100. 26 items across 5 domains (physical health, psychological health, social relationships, environment) are ranked on a 5-point Likert scale ranging from 1 = ‘not at all’ to 5 = ‘an extreme amount’. Higher scores indicate better HRQOL |
| World Health Organization’s Quality of Life—HIV (WHOQOL-HIV) | 1 | Based on the WHOQOL-100 questionnaire, to be used for patients with HIV/AIDS. 115 items (comprising 30 facets) are each ranked on a 5-point Likert scale ranging from 1 = ‘not at all’ to 5 = ‘an extreme amount’. Higher scores indicate better HRQOL |