Concept of quality of life and health
In modern medicine, treatment outcomes are evaluated not only by objective data, but also by quality of life indicators. This term is based on the definition of health proposed by the World Health Organization (WHO). According to the WHO, health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.
The study of quality of life is always based on the patient's individual perception of their own functional capabilities. For a comprehensive assessment, four main characteristics are taken into account:
- Physical health indicators.
- The patient's psychological status.
- Level of independence in daily activities.
- Quality of social relationships.
Measurement tools: generic questionnaires
The primary tool for determining quality of life is surveying. Any questionnaire used must possess three key characteristics: reliability (yielding accurate measurements), validity (ensuring accuracy), and responsiveness (detecting changes occurring in the patient's condition).
Generic questionnaires assess the patient's status as a whole—changes in their functional or psychological sphere without analyzing the course of a specific disease. They are most justified in chronic pathologies (e.g., osteoarthritis) or for assessing long-term treatment outcomes.
Popular examples of generic scales:
- SF-36 (Short Form Health Survey). The patient completes the questionnaire independently. It includes 36 questions that form 8 scales: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. The main advantage is simplicity and accessibility.
- EQ (EuroQol). A short questionnaire consisting of only 5 questions.
Specific questionnaires in traumatology
Specific questionnaires are aimed at identifying the effect of treatment for a specific disease or injury. They are based on questions about performing highly specific functions and are most rational in acute trauma.
According to the assessment method, they are divided into two groups: those based solely on the patient's subjective assessment and those based on a combination of subjective sensations with objective data from physical examination (such as joint range of motion or limb axis deformity).
Examples of specific scales in orthopedics:
- Oxford — a universal scale for various joints.
- WOMAC — for assessing the lower extremity.
- DASH — for the upper extremity.
- IKDS, KOOS, KSS — designed for the knee joint.
- Harris — used for the hip joint.
Currently, not a single serious clinical study is conducted without assessing quality of life using these scales.
Role of therapeutic physical training in recovery
Improving a patient's quality of life directly depends on rehabilitation. Therapeutic physical training (exercise therapy) is a diverse, complex, and high-tech component of comprehensive treatment for patients with musculoskeletal system injuries.
In the post-immobilization period, exercise therapy is aimed at eliminating contractures, increasing muscle strength and endurance, and normalizing the functioning of the neuromuscular apparatus. Classes are held with medium or high intensity. In addition to therapeutic gymnastics and massage, hydrokinesiotherapy in a pool, mechanotherapy, targeted occupational therapy, and functional training (including the use of virtual reality) are actively incorporated.
In the rehabilitation period, the priority becomes preparing the patient for full daily and professional activities. Training and gaming methods aimed at developing speed, endurance, and coordination are used. This allows for the completion of fracture consolidation processes, the formation of full bone structure, and the elimination of residual symptoms: limp, hypotrophy, and coordination disorders.
Expert evaluation and permanent functional loss
If an injury leads to severe consequences, quality of life is assessed within the framework of medical and social expert evaluation. According to Federal Law No. 181-FZ of November 24, 1995, "On Social Protection of Disabled Persons in the Russian Federation," a patient can receive disability status. This is a person who has a health disorder with a persistent dysfunction of the body caused by pathology or the consequences of past injuries and defects.
To remember the properties of a quality questionnaire, use the abbreviation RVR: Responsiveness (sees changes), Validity (accurately measures what is needed), Reliability (gives an accurate result).
Class and exam questions
What is health according to the WHO definition?
This is a state of complete physical, mental, and social well-being, and not merely the absence of disease and physical infirmities.
How do generic and specific questionnaires differ?
Generic ones assess the patient's status as a whole and are good for assessing long-term outcomes or chronic pathologies. Specific ones focus on a specific joint or function, which is optimal for acute injuries.
What does the SF-36 questionnaire assess?
It consists of 36 questions that form 8 scales, including physical functioning, bodily pain, vitality, as well as emotional, social, and mental health.
What scales are used to assess the knee joint?
In traumatology and orthopedics, the specific questionnaires IKDS, KOOS, and KSS are most often used for the knee joint.
What else to study on this topic
- Application of exercise therapy means in the immobilization period.
- Features of the application of hydrokinesiotherapy and mechanotherapy.
- Functional training with biofeedback and virtual reality.
- Disability criteria and rules for conducting medical and social expert evaluation in case of injuries.
- Completion of fracture consolidation processes in the rehabilitation period.
Master the entire topic in the "Traumatology" course
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- Complete study guide on "Quality of Life in Traumatology" and 812 more pages of the subject
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Other topics in the section "General Questions of Traumatology and Orthopedics"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.