Original Article| Volume 60, ISSUE 3, P300-308, March 2007

Quality of Well-being profiles followed paths of health status change at micro- and meso-levels in trauma patients

  • John P. Anderson
    Corresponding author. Tel.: 858-534-2896; fax: 858-534-4642.
    Health Measurement and Policy Project 0622, Division of Health Care Sciences, Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0622, USA
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  • Troy L. Holbrook
    Division of Epidemiology, Department of Family and Preventive Medicine, University of California, 9500 Gilman Drive, La Jolla, CA 92093-0622, USA
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Published:September 01, 2006DOI:



      The objective of this study is to analyze Quality of Well-being Scale scores and profiles tracing Trauma Recovery Project (TRP) patient scores over time.

      Study Design and Setting

      A total of 787 TRP patients had complete preinjury and injury day data. Of these 787, 574 patients were followed up 6 months after hospital release. Analyses include persons with head injury vs. long bone and pelvic injury.


      Paired t-tests found significant differences for scores between each measurement point. Means analyses found significant variation on first day of hospitalization vs. 6-month recovery scores by injury site—head worse off than long bone and pelvic injury at first, but becoming better off 6 months after release from hospital. These effects were traced to specific symptom/problem complexes and functional limitations.


      Examination of such profiles can add significant information about health implications not obvious from overall scores. The size and direction of such contributions to overall scores may be reliably traced over time.


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      1. National Center for Health Statistics. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: US Dept. of Health and Human Services, Public Health Service. DHHS publication (PHS) 91-50213, 1991.

        • Kaplan R.M.
        • Bush J.W.
        Health related quality of life measurement for evaluation research and policy analysis.
        Health Psychol. 1982; 1: 61-80
        • Russell L.B.
        • Gold M.R.
        • Siegel J.E.
        • Daniels N.
        • Weinstein M.C.
        The role of cost-effectiveness analysis in health and medicine (Consensus Statement).
        JAMA. 1996; 276: 1172-1177
      2. Gold M.R. Siegel J.E. Russell L.B. Weinstein M.C. Cost-effectiveness in health and medicine. Oxford University Press, New York1996
        • Lee T.T.
        • Solomon N.A.
        • Heidenreich P.A.
        • Oehlert J.
        • Garber A.M.
        Cost-effectiveness of screening for carotid stenosis in asymptomatic persons.
        Ann Intern Med. 1997; 126: 333-346
        • Siegel C.
        • Laska E.
        • Meisner M.
        Statistical methods for cost-effectiveness analyses.
        Control Clin Trials. 1996; 17: 387-406
        • Siegel J.E.
        • Weinstein M.C.
        • Russell L.B.
        • Gold M.R.
        Recommendations for reporting cost-effectiveness analyses. Panel on cost-effectiveness in health and medicine.
        JAMA. 1996; 226: 1339-1341
        • Weinstein M.C.
        • Siegel J.E.
        • Gold M.R.
        • Kamlet M.S.
        • Russell L.B.
        Recommendation of the panel on cost-effectiveness in health and medicine.
        JAMA. 1996; 276: 1253-1258
        • Nelson E.C.
        • Berwick D.M.
        The measurement of health status in clinical practice.
        Med Care. 1989; 27: S77-S90
        • Bergner M.
        Quality of life, health status and clinical research.
        Med Care. 1989; 27: S148-S156
        • Patrick D.L.
        • Bergner M.
        Measurement of health status in the 1990s.
        Annu Rev Public Health. 1990; 11: 165-183
        • Crosby R.D.
        • Kolotkin R.L.
        • Williams G.R.
        Defining meaningful change in health-related quality of life.
        JCE. 2003; 56: 395-407
        • Twisk J.
        • Proper K.
        Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up.
        JCE. 2004; 57: 223-228
        • Kaasa S.
        • Knobel H.
        • Loge J.H.
        • Hjermstad M.J.
        Hodgkin's disease: quality of life in future trials.
        Ann Oncol. 1998; : 137-145
        • Nichol M.B.
        • Harada A.S.
        Measuring the effects of medication use on health-related quality of life in patients with rheumatoid arthritis: a review.
        Pharmacoeconomics. 1999; 16: 433-448
        • Osoba D.
        A taxonomy of the uses of health-related quality-of-life instruments in cancer care and the clinical meaningfulness of the results.
        Med Care. 2002; 40: 31-38
        • Anderson J.P.
        • Harris J.P.
        Impact of Meniere's disease on quality of life.
        Otol Neurotol. 2001; 22: 888-894
        • Anderson J.P.
        • Kaplan R.M.
        • Berry C.C.
        • Bush J.W.
        • Rumbaut R.G.
        Inter-day reliability of function assessment for a health status measure: the Quality of Well-being Scale.
        Med Care. 1989; 27: 1076-1083
        • Holbrook T.L.
        • Hoyt D.B.
        • Anderson J.P.
        • Hollingsworth-Fridlund P.
        • Shackford S.
        Functional limitations after major trauma: a more sensitive assessment using the Quality of Well-being Scale.
        J Trauma. 1994; 36: 74-79
        • Holbrook T.L.
        • Anderson J.P.
        • Sieber W.J.
        • Browner D.K.
        • Hoyt D.B.
        Outcome after major trauma: discharge and 6-month follow-up results from the Trauma Recovery Project.
        J Trauma. 1998; 45: 315-324
        • Holbrook T.L.
        • Anderson J.P.
        • Sieber W.J.
        • Browner D.
        • Hoyt D.B.
        Outcome after major trauma: twelve and eighteen-month follow-up results from the Trauma Recovery Project.
        J Trauma. 1999; 46: 765-773
        • Kaplan R.
        • Bush J.W.
        • Berry C.C.
        Health status: types of validity and the index of well-being.
        Health Serv Res. 1976; 11: 478-507
        • Ware Jr., J.E.
        • Snow K.K.
        • Kosinski M.
        • Gandek B.
        SF-36 Health Survey: manual and interpretation guide.
        The Health Institute, Boston, MA1993
        • McHorney C.A.
        • Ware Jr., J.E.
        • Raczek A.E.
        The MOS 36-item Short-Form Health Survey SF-36: II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.
        Med Care. 1997; 31: 247-263
        • Brazier J.
        • Jones N.
        • Kind P.
        Testing validity of the EuroQoL and comparing it to the SF-36 health survey questionnaire.
        Qual Life Res. 1993; 3: 169-180
      3. Erickson P, Wilson R, Shannon I. Years of Healthy Life. Healthy People 2000 Statistical Notes Number 7. USDHHS, Public Health Service, Centers for Disease Control and Prevention, NCHS. April, 1995.

        • Gold M.R.
        • Franks P.
        • McCoy K.I.
        • Fryback D.G.
        Toward consistency in cost-utility analyses: using national measures to create condition-specific values.
        Med Care. 1998; 36: 778-792
        • Bergner M.
        • Bobbitt R.A.
        • Carter W.B.
        • Gilson B.S.
        The sickness impact profile: development and final revision of a health status instrument.
        Med Care. 1981; 19: 787-805
        • MacKenzie E.J.
        • Shapiro S.
        • Moddy M.
        • Siegel J.H.
        • Smith R.T.
        Predicting post-trauma functional disability for individuals without severe brain injury.
        Med Care. 1986; 24: 377-387
        • Sackett D.L.
        • Torrance G.W.
        The utility of different health states as perceived by the general public.
        J Chronic Dis. 1978; 31: 697-704
        • Bombardier C.
        • Ware J.
        • Russell I.J.
        • Larson M.
        • Chalmers A.
        • Read J.L.
        Auranofin therapy and quality of life in patients with rheumatoid arthritis. Results of a multicenter trial.
        Am J Med. 1986; 81: 565-578
        • Harris J.P.
        • Anderson J.P.
        • Novak R.
        An outcomes study of cochlear implants in deaf patients. Archives of Otolaryngol.
        Head Neck Surg. 1995; 121: 398-404
        • Anderson J.P.
        • Bush J.W.
        • Berry C.C.
        Classifying function for health outcome and quality of life evaluation: self versus interviewer modes.
        Med Care. 1986; 24: 454-469
        • Anderson J.P.
        • Bush J.W.
        • Berry C.C.
        Internal Consistency Analysis: a method for studying the accuracy of function assessment for health outcome and quality of life evaluation.
        J Clin Epidemiol. 1988; 41: 127-137