Abstract
Background: To date, many health status instruments exist, but the validity of these instruments is questionable. This is caused by the fact that health status is poorly defined.Purpose: To develop a validated framework that improves conceptual insight into health status and its domains.Methods: Based on theoretical and clinical considerations, we defined the domains of health status into concrete sub-domains by formulating conceptual models. Guided by these conceptual models, for each sub-domain, existing instruments were selected. We validated the conceptual models in the data of 168 COPD patients. Using factor analysis, underlying concepts in the data were identified.Results: The resulting framework included physiological functioning, complaints, functional impairment, and quality of life. These main domains were shown to be subdivided into 15 sub-domains.Conclusions: The present study shows that health status consists of conceptually distinct sub-domains. Integral assessment of health status thus entails measuring all sub-domains. Existing instruments measure only few sub-domains. Integral assessment of health status thus requires the combination of different instruments. The present framework of health status can help in composing such a battery of instruments. Patient profiles obtained by the framework are essential in individualizing treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Arrindell, W. A., & Ettema, J. H. M. (1986).SCL-90: Handleiding bij een multidimensionele psychopathologie-indicator [SCL- 90: Manual for a multifaceted measure of psychopathology]. Lisse, The Netherlands: Swets & Zeitlinger.
Arrindell, W. A., Heesink, J., & Feij, J. A. (1999). The Satisfaction With Life Scale (SWLS): Appraisal with 1700 healthy young adults in The Netherlands.Personality and Individual Differences, 26, 815–826.
Beck, A. T., Guth, D., Steer, R. A., & Ball, R. (1997). Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care.Behaviour Research and Therapy, 35, 785–791.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression.Archives of General Psychiatry, 4, 561–571.
Bergner, M., Bobbitt, R. A., Carter, W. B., & Gilson, B. S. (1981). The Sickness Impact Profile: Development and final revision of a health status measure.Medical Care, 19, 787–805.
Bowling, A. (1997). Theory of measurement. InMeasuring health: A review of quality of life measurement scales. (2nd ed., pp. 9–15). Buckingham: Philadelphia Open University Press.
Bowling, A. (2001a). Health-related quality of life: Conceptual meaning, use and measurement. InMeasuring disease: A review of disease-specific quality of life measurement scales. (2nd ed., pp. 1–22). Buckingham: Philadelphia Open University Press.
Bowling, A. (2001b). Respiratory conditions. InMeasuring disease: A review of disease-specific quality of life measurement scales (2nd ed., pp. 163–188). Buckingham: Philadelphia Open University Press.
Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix.Psychological Bulletin, 56, 81–105.
Cullen, D. L. (1999). Measures of functional status and quality of life in chronic pulmonary disease.Monaldi Archives for Chest Disease, 54, 183–185.
Curtis, J. R., Martin, D. P., & Martin, T. R. (1997). Patient-assessed health outcomes in chronic lung disease: What are they, how do they help us, and where do we go from here?American Journal of Respiratory and Critical Care Medicine, 156, 1032–1039.
Curtis, J. R., & Patrick, D. L. (2003). The assessment of health status among patients with COPD.European Respiratory Journal, 41(Suppl), 36s-45s.
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale.Journal of Personality Assessment, 49, 71–75.
Eifert, G. H., & Wilson, P. H. (1991). The triple response approach to assessment: A conceptual and methodological reappraisal.Behaviour Research and Therapy, 29, 283–292.
Gonzalez, E., Herrejon, A., Inchaurraga, I., & Blanquer, R. (2005). Determinants of health-related quality of life in patients with pulmonary emphysema.Respiratory Medicine, 99, 638–644.
Guyatt, G. H., Townsend, M., Berman, L. B., & Pugsley, S. O. (1987). Quality of life in patients with chronic airflow limitation.British Journal of Diseases of the Chest, 81, 45–54.
Hajiro, T., Nishimura, K., Tsukino, M., Ikeda, A., Oga, T., & Izumi, T. (1999). A comparison of the level of dyspnea vs disease severity in indicating the health-related quality of life of patients with COPD.Chest, 116, 1632–1637.
Henson, R. K., & Roberts, J. K. (2006). Use of exploratory factor analysis in published research: Common errors and some comment on improved practice.Educational and Psychological Measurement, 66, 393–416.
Jacobs, H. M., Luttik, A., Touw-Otten, F. W M. M., & De Melker, R. A. (1990). The sickness impact profile: Results of an evaluation study of the Dutch version [Dutch].Nederlands Tijdschrift voor Geneeskunde, 134, 1950–1954.
Jolliffe, I. T. (1986).Principal component analysis. New York: Springer-Verlag.
Jones, P. W. (2001). Health status measurement in chronic obstructive pulmonary disease.Thorax, 56, 880–887.
Jones, P. W., Quirk, F. H., & Baveystock, C. M. (1991). The St. George Respiratory Questionnaire.Respiratory Medicine, 85, 25–31.
Kaiser, H. F. (1970). An index of factorial simplicity.Psychometrika, 35, 401–415.
Leventhal, H., Benyamini, Y., Brownlee, S., Diefenbach, M., Leventhal, E. A., Patrick-Miller, L., et al. (1997). Illness representations: Theoretical foundations. In K. J. Petrie & J. A. Weinman (Eds.),Perceptions of health & illness (pp. 19–45). Amsterdam: Harwood Academic Publishers.
Little, R. J. A., & Rubin, D. B. (1987).Statistical analysis with missing data. New York: John Wiley and Sons.
Maillé, A. R., Kaptein, A. A., De Haes, J. C., & Everaerd, W. T. (1996). Assessing quality of life in chronic non-specific lung disease: A review of empirical studies published beween 1980 and 1994.Quality of Life Research, 5, 287–301.
Maillé, A. R., Koning, C. J., Zwinderman, A. H., Willems, L. N., Dijkman, J. H., & Kaptein, A. A. (1997). The development of the Quality-of-Life for Respiratory Illness Questionnaire (QOL-RIQ): A disease-specific quality-of-life questionnaire for patients with mild to moderate chronic nonspecific lung disease.Respiratory Medicine, 91, 297–309.
Ogden, J. (2001). Theory and measurement: Conceptualization, operationalization, and the example of health status. In A. Vingerhoets (Ed.),Assessment in behavioral medicine (pp. 73–90). East Sussex, UK: Brunner-Routledge.
Pauwels, R. A., Buist, A. S., Calverley, P. M., Jenkins, C. R., & Hurd, S. S. (2001). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.American Journal of Respiratory and Critical Care Medicine, 163, 1256–1276.
Peck, D. F., & Shapiro C. M. (1990). Guidelines for the construction, selection, and interpretation of measurement devices. In D. F. Peck & C. M. Shapiro (Eds.),Measuring human problems (pp. 1–12). Chester: Wiley.
Santo Tomas, L. H., & Varkey, B. (2004). Improving health-related quality of life in chronic obstructive pulmonary disease.Current Opinion in Pulmonary Medicine, 10, 120–127.
Spilker, B., & Revicki, D. A. (1996). Taxonomy of quality of life. In B. Spilker (Ed.),Quality of life and pharmaeconomics in clinical trials (2nd ed., pp. 25–31). Philadelphia: Lippincott- Raven Publishers.
Stevens, J. P. (1992).Applied multivariate statistics for the social sciences. (2nd ed.) Hillsdale, NJ: Erlbaum.
Taillefer, M., Dupuis, G., Roberge, M., & Le May, S. (2003). Health- related quality of life models: Systematic review of the literature.Social Indicators Research, 64, 293–323.
Tammeling, G. J., & Quanjer, P. H. (1993). Standardized lung function testing.European Respiratory Journal, 6, 5–33.
Troosters, T., Casaburi, R., Gosselink, R., & Decramer, M. (2005). Pulmonary rehabilitation in chronic obstructive pulmonary disease.American Journal of Respiratory and Critical Care Medicine, 172, 19–38.
Tryon, W. W. (1991).Activity measurement in psychology and medicine. New York: Plenum Press.
Vercoulen, J. H. M. M., Bazelmans, E., Swanink, C. M. A., Fennis, J. F. M., Galama, J. M. D., Jongen, P. J. H., et al. (1997). Physical activity in chronic fatigue syndrome: Assessment and its role in fatigue.Journal of Psychiatric Research, 31, 661–673.
Vercoulen, J. H. M. M., Swanink, C. M. A., Galama, J. M. D., Fennis, J. F. M., Van der Meer, J. W. M., & Bleijenberg, G. (1994). Dimensional assessment in chronic fatigue syndrome.Journal of Psychosomatic Research, 38, 383–392.
Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life: A conceptual model of patient outcomes.Journal of the American Medical Association, 273, 59–65.
ZuWallack, R. L., Haggerty, M. C., & Jones, P. (2004). Clini- cally meaningful outcomes in patients with chronic obstructive pulmonary disease.The American Journal of Medicine, 117 (Suppl 12A), 49S-59S.
Author information
Authors and Affiliations
Corresponding author
Additional information
The study was supported by grants from the Dutch Asthma Foundation, GlaxoSmithKline, and the Department of Medical Psychology and Department of Pulmonary Diseases of Radboud University, Nijmegen Medical Center. We are indebted to Dr. F. van den Elshout (pulmonologist, Rijnstate Hospital, Arnhem) and Dr. R. Bunnik (pulmonologist, Maas Hospital, Boxmeer) for their contribution in the patient recruitment, and to the multidisciplinary Taskforce Assessment of the Department of Pulmonary Rehabilitation Unit for their invaluable contributions to the development of the conceptual models.
Rights and permissions
About this article
Cite this article
Vercoulen, J.H., Daudey, L., Molema, J. et al. An integral assessment framework of health status in chronic obstructive pulmonary disease (COPD). Int. J. Behav. Med. 15, 263–279 (2008). https://doi.org/10.1080/10705500802365474
Issue Date:
DOI: https://doi.org/10.1080/10705500802365474