An Integral assessment framework of health status in chronic obstructive pulmonary disease (COPD).
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.


OBJECTIVE
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.
Vercoulen
Jan H
JH
Department of Medical Psychology, Radboud University Nijmegen Medical Center, The Netherlands. j.vercoulen@ulc.umcn.nl
Daudey
Leonie
L
Molema
Johan
J
Vos
Petra J
PJ
Peters
Jeannette B
JB
Top
Mariska
M
Folgering
Hans
H
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000368:Aged; D015992:Body Mass Index; D004185:Disability Evaluation; D005080:Exercise Test; D005260:Female; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012803:Sick Role; D012919:Social Behavior