What Does It Mean ?: Anchoring Psychosocial Quality of Life Scale Score Changes with Reference to Concurrent Changes in
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WHAT DOES IT MEAN?: ANCHORING PSYCHOSOCIAL QUALITY OF LIFE SCALE SCORE CHANGES WITH REFERENCE TO CONCURRENT CHANGES IN REPORTED SYMPTOM DISTRESS RICHARDB. ANDERSON, EDD CoMMensa, Inc., Arlington, Massachusetts
As customarily presented, the results of quality of life (QOL) studies tend more to puz-
zle than to enlighten their intended audience of physicians, policy makers, and the general public. They ask, quite legitimately, what a difference of three “points” on the Rand Mental Health Index means. Or; a fortiori, a difference of 0.17 “standard deviations” or “responsiveness units.” How large need a difference be in order to justifr action or decision:‘ At the level of the individual question, the numbers have plain, intuitive content. But once they are combined into statistical abstractions, interpretation becomes much more diflcult. It is intrinsically easier to understand findings couched in symptom-distress terms than in psychosocial scales. People know the difference between hurting a little and hurting a lot. We have aimed here to transfer; via empirical analysis, some of this intuitive advantage into the psychosocial realm. In two parallel, multi-center clinical studies comparing the effects of drug treatments in hypertension and in angina, respectively, I003 patients completed, up to jive times at intervals of several weeks, a battery of psychosocial quality of life (PQOL) measures and, concurrently, an extensive symptom distress check list. The resulting databases yielded, for each combination of a PQOL subscale and a symptom distress (SD) index, over 200000 pairs of change scores, each associating some manifestation of PQOL change, between one visit and the next, with a concurrent SD change. We have documented a clear and surprisingly consistent association between changes in the level of reported symptom distress and concurrent psychosocial changes as measured by the Rand Mental Health Index. Withfurther refinement and consensus-building, QOL researchers should eventually be able to explain psychosocialfindings quantitatively with reference to the difference between “no distress” and “some distress,” or that between “some distress” and “very much distress. ’’ Key Words: Psychosocial quality of life; Symptom distress
Presented at the DIA Fifth Annual Symposium “Quality of Life Evaluation,” April 5-7, 1998, Hilton Head, South Carolina. Reprint address: Richard B. Anderson, EdD, CoMMensa, Inc., 82 Appleton Street, Arlington, MA 02174-5942.
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Richard B. Anderson
INTRODUCTION
The Problem: Opaque Quality of Life Findings QUALITY OF LIFE RESEARCH results can confuse their intended audience. Decision makers in government, industry, and the doctor’s office (on both sides of the stethoscope) can be forgiven a measure of uncertainty and frustration as they grapple with the published outcomes of outcomes research. What, they may legitimately ask, constitutes a meani
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