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Purpose: An important area of quality of life research is the impact of illness and disability on patients’ quality of life. However, measurement of quality of life is complicated by many factors, including the fact that people tend to adapt physically and emotionally to their illness or disability. In general, it has been suggested that quality of life improves with time since the onset of disability, as physical functioning and symptoms improve, and as emotional adaptation occurs. We wanted to see whether a utility measure (the time trade off—TTO) would be able to capture this improvement, compared to other self-report measures of well-being.
Method: We identified 273 individuals who had undergone an amputation at the University of Michigan in the last 5 years. Of these individuals, 152 amputees completed and returned the survey. Subjects were asked questions about their type and level of amputation, overall quality of life, happiness, physical functioning, health utility, and demographics. The TTO measure asked participants to indicate how many months of life they would trade in exchange for having their limb back, healthy and fully functional (the TTO score was calculated from answers to a series of 10 forced choices, beginning with a “ping pong” set of extreme choices to make the trade-off evident).
Results: The TTO was correlated with measures of health; subjects who were willing to trade more time to have their limb restored reported more pain, and lower physical functioning (p’s <0.05). Pain declined with time since the amputation, while physical functioning increased (p’s<0.05). The time trade-off also captured this overall improvement: subjects were less willing to trade time as the number of months since their amputation increased (p<0.05). Various measures of subjective well-being, such as life satisfaction and mood, overall quality of life, and happiness were not correlated with time since amputation.
Conclusions: With amputees, we observed a decrease in pain and an increase in physical functioning with time since amputation. This improvement was apparently reflected in higher time trade-off utility values (indicating less willingness to trade life years for perfect health), but not with other subjective rating scales of well-being, including the 0-100 quality of life, the Diener Life Satisfaction scale, or measures of mood.
See more of Poster Session - Public Health; Methodological Advances
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)