Objectives To assess the growth of quality of life measures and to examine the availability of measures across specialties. Design Systematic searches of electronic databases to identify developmental and evaluative work relating to health outcome measures assessed by patients. Main outcome measures Types of measures: disease or population specific, dimension specific, generic, individualised, and utility. Specialties in which measures have been developed and evaluated. Results 3921 reports that described the development and evaluation of patient assessed measures met the inclusion criteria. Of those that were classifiable, 1819 (46%) were disease or population specific, 865 (22%) were generic, 690 (18%) were dimension specific, 409 (10%) were utility, and 62 (1%) were individualised measures. During 1990-9 the number of new reports of development and evaluation rose from 144 to 650 per year. Reports of disease specific measures rose exponentially. Over 30% of evaluations were in cancer, rheumatology and musculoskeletal disorders, and older people's health. The generic measures-SF-36, sickness impact profile, and Nottingham health profile-accounted for 612 (16%) reports. Conclusions In some specialties there are numerous measures of quality of life and little standardisation. Primary research through the concurrent evaluation of measures and secondary research through structured reviews of measures are prerequisites for standardisation. Recommendations for the selection of patient assessed measures of health outcome are needed.

Most researchers do not approach survey data collection ab initio, but rather draw on "conventional wisdom", often encapsulated in existing textbooks or in what they have been taught at undergraduate or postgraduate level. We thought, therefore, that it would be appropriate to preface our review of empirical studies with a summary of current "expert opinion" and then to seek confirming or refuting evidence from primary research. Sources of expert opinion were key texts on survey methods (e.g. 1,5,13,40 ). These were identified through the personal and institutional libraries of the research team. DatabasesIn our search for primary research studies, previous literature reviews and theoretical articles, we initially prioritised four electronic databases for searching:This review should be reviewed as a guide to best practice, not a definition of best practice. It is a decision aid, not a substitute for critical appraisal of the options available.

from InterStudy (now called the Health Outcomes Institute) in America, on which the anglicised versions used in the Sheffield study and the Oxford healthy life study were based, and two more recent versions Objective-To assess the validity, reliability, and acceptability of the short form 36 (SF36) health survey questionnaire (a shortened version of a battery of 149 health status questions) as a measure of patient outcome in a broad sample of patients suffering from four common clinical conditions. Design-Postal questionnaire, foliowed up by two reminders at two week intervals.Setting-Clinics and four training practices in north east Scotland.Subjects-Over 1700 patients aged 16-86 with one of four conditions-low back pain, menorrhagia, suspected peptic ulcer, or varicose veins-and a comparison sample of 900 members of the general population.Main outcome measures-The eight scales within the SF 36 health profile.Results-The response rate exceeded 75% in the patient population (1310 respondents). The SF36 satisfied rigorous psychometric criteria for validity and internal consistency. Clinical validity was shown by the distinctive profiles generated for each condition, each ofwhich differed from that in the general population in a predictable manner. Furthermore, SF 36 scores were lower in referred patients than in patients not referred and were closely related to general practitioners' perceptions ofseverity.Conclusions-These results provide support for the SF 36 as a potential measure of patient outcome within the NHS. The SF 36 seems acceptable to patients, internally consistent, and a valid measure of the health status of a wide range of patients. Before it can be used in the new health service, however, its sensitivity to changes in health status over time must also be tested.

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There is good evidence for reliability, validity and responsiveness for the SF-36, EQ-5D and NHP. There is more limited evidence for the COOP, SF-12 and SIP. The SF-36 is recommended where a detailed and broad ranging assessment of health is required, particularly in community dwelling older people with limited morbidity. The EQ-5D is recommended where a more succinct assessment is required, particularly where a substantial change in health is expected. Instrument content should be assessed for relevance before application. The concurrent evaluation of generic instruments in older people is recommended.