Measuring Health: A Review of Quality of Life Measurement Scales

By Ann Bowling | Go to book overview

3
MEASURING FUNCTIONAL ABILITY

There are a number of methodological techniques available for measuring function: direct physical tests of function, direct observation of behaviour and interviews with the person concerned or a third party. Each method has its limitations, as has been indicated. Direct observation is rarely used because it is so time consuming. Direct tests of functioning, such as range-of-limb movement, grip strength, walking time; or standards such as joint swelling, pain scores, morning stiffness, erythrocyte sedimentation rate and joint counts, while objective, may not necessarily give an accurate indication of ability or performance. Grip strength will tell you how much a patient can and will squeeze a bag on a particular day. Patients may be more concerned with subjective feelings and reductions in activities associated with daily living.

Most measures of functional disability are selfreport methods. Respondents are asked to report limitations on their activities of daily living (ADL). Sometimes researchers do not wish to use a long scale to measure functional status, usually because their questionnaires are already fairly lengthy, and they therefore prefer single-item questions. One well-known example is the British General Household Survey which limits its measure of functional status to questions:

Do you have any longstanding illness,
disability or infirmity? By longstanding I
mean anything that has troubled you over a
period of time or that is likely to affect you
over a period of time.

IF YES

Does this illness or disability limit your
activities in any way?

–Longstanding illness' is defined as a positive
answer to the first part of the question, and
–limiting longstanding illness' as a positive
answer to both parts of the question.
Respondents are also asked 'What is the
matter with you' and responses are categorised
into disease groups similar to International
Classification of Diseases categories.

(Office of Population Censuses and Surveys
1987; Office for National Statistics 2002)

The main criticism of this type of measure is that responses may vary with people–s expectations of health and illness and perceptions of limitations. Subjectivity is involved. People who are shortsighted might reply 'yes' or they might not define their condition as a 'longstanding illness, disability or infirmity' or as limiting. Also, people who are used to their conditions and the restrictions they impose may have adjusted to them and no longer define them as limiting. However, if a measure of perceived health status is required, rather than objective morbidity indicators, then this inherent subjectivity is the strength of the measure.

There are many measures of functional ability.

-19-

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