Orginal article
Performance of valued life activities reflected asthma-specific quality of life more than general physical function

https://doi.org/10.1016/j.jclinepi.2003.08.007Get rights and content

Abstract

Objective

We examined the prevalence of disability in valued life activities (VLAs) among a group of adults with asthma and the impact of general physical function and performance of VLAs on asthma-specific quality of life (QOL).

Study design and setting

Interview data collected from two waves of a longitudinal cohort study were used to examine the prevalence of disability in VLAs, the cross-sectional association of general function and performance of VLAs with QOL, and the longitudinal association of changes in general function and changes in performance of VLAs with changes in QOL. General function was assessed with the SF-12; VLAs were assessed with a newly developed measure.

Results

A substantial portion of subjects reported disability in VLAs. VLA function was a stronger predictor of QOL than general physical function in cross-sectional and longitudinal analyses.

Conclusion

Performance of VLAs is more closely tied to asthma-specific QOL than is general physical function.

Introduction

There is growing recognition that traditional clinical and physiologic measures do not provide a complete view of the impact of diseases on physical, social, or emotional well-being [1]. In response, health-related quality of life (QOL) measures are being increasingly integrated into clinical research to help us gain a broader perspective of the impact of disease on individuals' lives. A number of asthma-specific QOL measures have been developed; however, there seem to be only weak to moderate correlations between traditional clinical indices (e.g., measures of pulmonary function) and these QOL measures [2], [3], leading to questions about what factors patients consider in their evaluations of QOL.

Function seems to be an important component of QOL. Most measures of asthma-specific QOL include elements of physical, social, or emotional functioning [4], [5], [6], [7], [8], [9], [10]. General physical functioning, as measured by instruments such as the SF-36 [11], has been found to be associated with asthma-specific QOL [2], [12]. These measures of general physical function typically ask about difficulty performing actions, such as climbing stairs, lifting or carrying, bending or kneeling, and walking for specified distances, and usually do not attribute functional limitations to specific health conditions.

In analyses among groups of patients with specific chronic health conditions, measures of general function have been found to be less sensitive measures of the impact of disease on daily life than measures of complex functioning in daily life [13], [14], [15]. Measures of complex functioning seem to be more closely linked to perceptions of QOL and psychological well-being, possibly because limitations in complex activities are more sensitive to the effects of disease than the elements of basic physical functioning. For example, an individual's ability to participate in recreational activities may be affected by asthma symptoms that are much less severe than would be necessary to affect lifting or carrying or even walking several blocks. Yet, the effect of asthma on the ability to engage in recreational activities may have a tremendous effect on the individual's perceptions of her QOL.

Previous research has used the term “valued life activities” to refer to these complex life activities [13], [14], [15], [16], [17]. Valued life activities (VLAs) include the wide range of activities that individuals find meaningful or pleasurable, above and beyond activities that are necessary for survival or self-sufficiency. VLAs may include “any activity an individual finds pleasurable or meaningful, ranging from simple day-to-day tasks such as reading or listening to music to… interacting with family and friends or caring for oneself” [17]. VLAs have been most extensively studied among persons with arthritis. In these studies, performance of VLAs has been linked to life satisfaction and psychological wellbeing [14], [16], [18]. The loss of the ability to perform VLAs has been shown to be the strongest predictor among measures of function of the subsequent onset of new depressive symptoms [14], [16], and performance of VLAs also seems to be the type of function most closely related to satisfaction with functioning [15].

The purpose of these analyses was to examine the impact of general physical function and performance of VLAs on asthma-specific QOL. A secondary aim was to examine the prevalence of disability in VLAs among a group of adults with asthma.

Section snippets

Data source

We used data collected during a prospective, longitudinal cohort study of adults with asthma. Details of recruitment and of the initial follow-up have been previously reported [19], [20], [21], [22]. Briefly, we initially recruited adults with asthma from a random sample of board-certified pulmonary specialists, allergy/immunology specialists, and family practitioners in Northern California. In the present study, we used Wave 3 interviews conducted in 1996–1997 among 128 individuals to analyze

Performance of VLAs

Information describing responses to the VLA items at baseline and follow-up are shown in Table 2. Although the median ratings were 0 (no effect) for most items, responses to all items were distributed across the entire score range (0–10) at baseline and follow-up. Mean impact ratings for individual items including all respondents ranged from 0.6 (getting around by car) to 3.5 (having pets) at baseline and from 1.1 to 4.1 (same activity domains) at follow-up. Nearly all domains were rated as

Discussion

The asthma-specific VLA measure was found to be valid. The number of VLA domains affected by asthma was significantly associated with asthma severity, general physical function, and subjects' perceptions of asthma severity. The association with pulmonary function was also significant, even in this analysis, which used a small subset of the total sample. The VLA measure was responsive to changes in asthma severity and general function. Most importantly, the VLA measure was a significant

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