Challenges with health-related quality of life assessment in arthroplasty patients: problems and solutions

Abstract

Assessment of health-related quality of life (HRQOL) using patient-reported outcomes in arthroplasty has become popular because it provides a unique perspective on successful elective procedures. However, challenges exist in the assessment of HRQOL in clinical practice and in clinical research. Patient compliance with multiple and sometimes lengthy HRQOL assessments administered at multiple follow-up visits is problematic. Many well-validated HRQOL instruments are available, and progress has been made in defining the minimal clinically important difference in hip and knee arthroplasty that denotes the minimal change perceived to be important by patients. Challenges in understanding the literature are attributable to the use of various HRQOL scales, with different scoring ranges and scoring algorithms, different interpretations of highest score, and differences in the presentation of raw versus transformed scores.

Figure 1

Graphic comparison of a single-item linear analog scale for a health-related quality of life assessment with a multi-item assessment scale for patients with lung cancer. The graph indicates that the single-item assessment had greater sensitivity to change over time—that is, greater variability—than did a multi-item assessment. (Reproduced with permission from Sloan JA, Dueck A: Issues for statisticians in conducting analyses and translating results for quality of life end points in clinical trials. J Biopharm Stat 2004;14:73-96.)