title: Health-related quality of life and the transformation of symptoms.
abstract: This paper traces the development of health-related Quality of Life instruments over the last half century. It identifies the emergence of key components of quality of life measurement in other health status questionnaires between about 1950 and 1980 and their formalization in Quality of Life instruments in the mid 1980s. The common developmental thread that linked these Quality of Life instruments and their precursors was the identification of 'distal symptoms' that represented the impact of illness beyond its immediate bodily manifestations. The measurement of distal symptoms through Quality of Life instruments also served to detach symptoms from their customary patho-physiological referent. Other contemporary examples of these free-floating symptoms reinforce the argument that the nature and meaning of symptoms has been transformed over recent decades.
authors.affiliation: Department of General Practice, King's College London, London, UK. david.armstrong@kcl.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
authors.forename: Richard
authors.initials: R
authors.lastname: Lilford
authors.forename: Jane
authors.initials: J
authors.lastname: Ogden
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
mesh_terms: D000203:Activities of Daily Living; D003933:Diagnosis; D006304:Health Status; D006801:Humans; D010147:Pain Measurement / Q000295:instrumentation; D010817:Physician-Patient Relations; D011594:Psychometrics / Q000295:instrumentation / Q000639:trends*; D011788:Quality of Life; D018434:Sickness Impact Profile; D012962:Sociology, Medical / Q000639:trends; D011795:Surveys and Questionnaires