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Establishing a theoretical basis for quality of life measurement

Spence, NJ


NJ Spence



A literature review established a definition of Quality of Life (QoL) using thematic
analysis of the papers retrieved. The QoL definition included subjective and
objective elements and multiple domains and acknowledged the gap between
present and ideal QoL.
A literature search and reflective account were combined to establish theories
relevant to QoL, which were reviewed. A composite theory of QoL was proposed,
which included the International Classification of Functioning, Disability and
Health (ICF), needs, health, coping and a theory of eliciting responses. Whether
existing QoL instruments reflect the QoL definition or the composite theory was
Therefore, a systematic review was undertaken in 2007 of existing QoL
instruments to identify whether any of the sixty-nine texts met the clinical needs
of the Multidisciplinary team (MDT) in stroke rehabilitation. Findings indicated that
instruments were either psychometrically sound or individual. The review
identified a limited theoretical background to QoL instruments, necessitating a
theoretical review.
The systematic review was repeated to ensure currency, identifying four new
instruments. Instruments were screened against inclusion and exclusion criteria
for a theoretical review. A theoretical review critical appraisal tool was developed
using inductive methodology and was pilot tested. This developed a unique
theoretical critical appraisal tool that has the potential to be transferable to other
instruments. Seven instruments met the inclusion criteria and were subjected to a
detailed theoretical review. Recommendations were made to inform future
instrument development. Theoretical recommendations were combined with user requirements using
thematic analysis. Stroke patients', their carers' and health care professionals'
requirements of QoL instruments were established and triangulated with the QoL
definition, composite theory and QoL instruments. This stage validated the
definition and theory of QoL. The research concluded with recommendations for
future instrument development, informed by user opinion, establishing a
framework for future QoL developments.
Conclusion The redefined QoL producing a new evidence based QoL definition
reflecting changes in QoL thinking. The PhD produced a new theory of QoL
based upon clinical experience and evidence incorporating needs, coping and
social theories with the International Classification of Functioning (ICF). The QoL
theory is unique and adds to QoL knowledge. The definition and theory of QoL
were tested with stroke and subsequently revised incorporating omissions from
preceding theories. The PhD identified a framework for future QoL instrument
development. The PhD developed a new critical appraisal tool to evaluate
instruments theoretical underpinnings. The critical appraisal tool was piloted and
revised with QoL.


Spence, N. Establishing a theoretical basis for quality of life measurement. (Thesis). Salford : University of Salford

Thesis Type Thesis
Deposit Date Oct 3, 2012
Award Date Jan 1, 2010