The conventional approach by health care professionals was allopathic, focusing on the suppression of pathologic processes and achieving clinical outcomes. A more holistic approach has become more appropriate with the aim of improving HRQOL and various instruments have been developed to assess the effects the disease implicates on an individual’s life. HRQOL instruments are constructed to measure various health domains: physical, mental and social well-being. The effect that a condition has on these domains is identified by assessing the extent of the condition has on friendships, relationships and difficulties in daily functioning (Muragundi et al., 2012).
Application of HRQOL measures
The measures acquired by HRQOL instruments can be utilised in numerous ways. HRQOL measures are used to quantify the extent that condition impacts an individual’s life and compare the consequences with other chronic conditions.
There are two types of instruments used to assess HRQOL: generic and disease-specific. Generic HRQOL questionnaires broadly measure general health in terms of physical and emotional functioning, and are developed to be applied and compared amongst general populations, and also between different disease populations. Disease-specific HRQOL instruments are vital when measuring HRQOL in a population of patients with a particular condition as they incorporate the impact of the disease on relevant, narrower, health dimensions (Jackowski and Guyatt, 2003 and Muragundi et al., 2012).
Generic HRQOL Questionnaires
Short Form-36 Survey
The Short Form-36 Survey (SF-36) is a commonly used 36-item generic health survey that analyses eight health perceptions including physical items (general health perceptions, bodily pain, energy levels, physical functioning, role limitations due to physical health problems) and mental items (emotional well-being, social functioning and role limitations due to personal/emotional health problems). The algorithm generates eight scores based upon the selected answers and presents the data on a 0-100 scale, where higher values denote a greater perceived state of health (RAND, 2016). Several studies have identified that this is a reliable and value questionnaire in both generic population use and in patients with a specific condition. A limitation for using SF-36 in IBD patients is its low responsiveness in sensing changes in health status as time progresses (Jenkinson et al., 1994 and Bernklev et al., 2005).
IBD-Specific HRQOL Questionnaires
Impact III Form
The Impact III form is a 35-item questionnaire used regularly to assess the HRQOL children and adolescents with IBD. The instrument assesses five domains: symptoms, body image, worry about stool, concerns and socialising. Each item contributes to the calculated total score that ranges from 35-175, with a greater score indicating a higher degree of HRQOL. Multiple studies have commended the ease of understanding and completion by child respondents, and identified excellent levels of instrument reliability and validity, with the latter achieved by comparing scores between different severities of disease activity (intro?) (Otley et al., 2006, Ogden et al., 2011, Werner et al., 2014). However, one study reported that the test was only reliable upon the removal of two unidentified items (Abdovic et al., 2013).