Quality of Life Assessment

It is very difficult to define QoL, as it is a multidimensional construct. As poetically written by Mount and Scott [6], try to define QoL is like assessing the beauty of a rose: no matter how many measurements are made (for example size, smelling, colour), the full beauty of the rose is never captured. Having in mind this concept, it is easy to understand why, in the literature, there are many definitions of QoL:

- The extent to which hopes and ambitions are matched by experience [7].

- An individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a wideranging concept affected in a complex way by the person's physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment [8].

- Appraisal of one's current state against some ideal

- The things people regard as important in their life

- An individual's sense of well-being in the somatic, emotional and social domains [11].

Even if we can presume the existence of some "universal features", QoL is an individual concept, which was born as an interaction between expectations, experience, social influence and pressure. Each of these points can weigh differently in different people. We can find patients heavily affected by health and functional problems that can report a better QoL than the general population. This was called the "disability paradox" by Albrecht and Devlieger [12]. Also, QoL is a dynamic concept that changes not only among people but also in the same individual and in different stages of life. Coping strategies are likely to change during life in response to ageing, stress and difficulties. For all these reasons, the first researchers felt like they were in front of the tower of Babel [13].

As will be discussed in more detail later in the chapter, researchers' efforts to create tests to measure QoL have been successful and there is a consensus among clinicians about which domains can be explored by QoL tests: physical, emotional, social and cognitive functions.

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