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Methods of assessing health-related quality of life and outcome for plastic surgery.

Increasingly, evidence is required of the effectiveness of health services. A central form of evidence is the outcome of health care as assessed by the patient. There is considerable scope for improving the methodology of research in plastic surgery. 1,2 This paper is intended to provide an overview of the potential role of patient-based outcome measures. In recent years, a vast array of questionnaires have been developed to assess the patient’s perspective. They are referred to here as patient-assessed outcome measures, but the literature variously terms them ‘health-related quality of life’, ‘quality of life’, ‘health status’, ‘functional status’, ‘subjective health status’, or sometimes just ‘outcome measures’. The main rationale for such measures is the fact that the majority of health care interventions have as either their primary or secondary purpose the improvement of one or more aspects of patients’ health-related quality of life (Table 1). To date, disproportionate attention in research in plastic surgery has focused on a narrow range of psychiatric and psychological dimensions of patients’ well-being. 3,4 However, one study indicated that patients receiving a range of plastic surgical interventions, when asked to identify areas of their lives most affected by their presenting problem, reported a wide range of problems including diverse physical symptoms, difficulties in personal relationships, problems in pursuing leisure activities, problems of self-concept and difficulties finding suitable clothes. 5 When this sample of patients also completed a standardised patient-assessed outcome measure (the SF-36 described below), a wide range of problems in physical, psychological and social function were identified prior to surgery and the same questionnaire provided unique evidence of improvements associated with surgery at follow-up. 5 There is now extensive evidence that proxy reports of patients’ health status and well-being, such as those provided by health professionals or carers, do not always agree with assessments patients make themselves; hence the