Measurement of the quality of life in rheumatic disorders using the EuroQol

The EuroQol is a validated quality of life (QOL) scale that

has been used in population and clinical studies, and has been

reported in patients with rheumatoid arthritis (RA). It is

short, simple to complete, and might be suitable for surveys

of rheumatic disease patients. The properties of this

instrument were investigated in a postal survey of 1372

rheumatic disease patients, including 537 with RA, 319 with

osteoarthritis (OA) and 516 with fibromyalgia. In addition,

simultaneous measurements of functional disability, pain,

psychological status, global severity and demographic

characteristics were made.

EuroQol scores (0.57) were

significantly lower than VAS health state scores (0.67) and

arthritis-related global severity scores (0.62). QOL was

similar in RA and OA, but lower in fibromyalgia, across all

instruments. The distribution of EuroQol scores had many gaps

and was not continuous. EuroQol did not reflect VAS QOL scores

at EuroQol levels below 0.5, and the mean score difference

between the instruments below that level was 0.43. Many

patients with low EuroQol scores (including some with health

states that were ‘worse than death’) had high VAS scores.

These differences appear to have arisen because disability,

pain and depression questions ask about mild or moderate

problems, but not both, thereby forcing scale compression in

the mid ranges. In addition, the ‘severe’ value is so

extremely abnormal that few patients endorse it. Finally,

penalty scores are applied to those with at least one

maximally abnormal score. The scoring properties and

distributional aspects of the EuroQol indicate substantial

problems in its use in rheumatic disease patients.

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