title: Development of a patient-centred conceptual framework of health-related quality of life in neuromyelitis optica: a qualitative study.
abstract: Neuromyelitis optica (NMO) is an auto-immune disease that can cause severe visual and mobility impairments. Research on health-related quality of life (HRQoL) in NMO is scarce, limiting knowledge on factors influencing HRQoL and support needs.
  
  
  
  This study provides the first qualitative exploration of HRQoL in NMO, conducted to provide a conceptual framework for the development of an NMO patient-reported outcome measure.
  
  
  
  Fifteen people with NMO (aged 18-74; 11 women, 4 men) participated in semi-structured interviews; data were analysed using constant comparative analysis.
  
  
  
  HRQoL in NMO is a multifaceted concept incorporating highly subjective perceptions of normality and meaning. Four major themes were identified: impact of physical symptoms on daily living, utilizing support to achieve independence, expectations for life and meaningful roles in life and purpose.
  
  
  
  Themes highlighted the importance of perceived normality, and its relationship to attaining life goals comparable to peers, as underpinning evaluations of HRQoL. Many people with severe disability reported a high HRQoL, suggesting the inappropriateness of assuming a negative HRQoL on the basis of an individual's neurological impairment.
  
  
  
  These findings further the conceptual understanding of HRQoL in NMO, informing patient-care approaches and the development of an NMO-specific patient-reported outcome measure.
authors.affiliation: School of Psychological Sciences, University of Manchester, Manchester, Lancashire, UK.|Walton Centre NHS Foundation Trust, Liverpool, Merseyside, UK.
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Methley
authors.affiliation: NMO Clinical Service, Walton Centre NHS Foundation Trust, Liverpool, Merseyside, UK.
authors.forename: Kerry
authors.initials: K
authors.lastname: Mutch
authors.affiliation: Neuropsychology Department, Walton Centre NHS Foundation Trust, Liverpool, Merseyside, UK.|Cardiff University, Glamorgan, UK.
authors.forename: Perry
authors.initials: P
authors.lastname: Moore
authors.affiliation: NMO Clinical Service, Walton Centre NHS Foundation Trust, Liverpool, Merseyside, UK.
authors.forename: Anu
authors.initials: A
authors.lastname: Jacob
mesh_terms: D005260:Female; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009471:Neuromyelitis Optica / Q000523:psychology*; D018802:Patient-Centered Care; D036301:Qualitative Research; D011788:Quality of Life
keywords: neurology; neuromyelitis optica; patient-centred; patient-reported outcome measure; qualitative; quality of life