25• I—Physical function: mobility, dexterity, range of movement, physical activity;
activities of daily living: ability to eat, wash, dress
• II—Symptoms: pain; nausea; appetite; energy, vitality, fatigue; sleep and rest
• III—Global judgments of health
• IV—Psychological well-being: psychological illness, anxiety, depression; cop-
ing, positive well-being and adjustment, sense of control, self-esteem
• V—Social well-being: family and intimate relations; social contact, integration,
and social opportunities; leisure activities; sexual activity and satisfaction
• VI—Cognitive functioning: cognition, alertness, concentration, memory, confu-
sion, ability to communicate.
• VII—Role activities: employment, household management, financial concerns
• VIII—Personal constructs: satisfaction with bodily appearance, stigma and stig-
matizing conditions, life satisfaction, spirituality
• IX—Satisfaction with care: The most common types are those that measure psy-
chological well-being.
The Beck Depression Inventory contains 21 items that address symptoms of
depression [ 13 ]. The instrument was originally developed for use with psychiatric
patients but it is increasingly used to assess depression in the physically ill. They
provide an assessment of a particular dimension of health that is often more detailed
than that provided by disease-specific or generic instruments. There is a wide range
of data available for comparing and interpreting results. However, measures of psy-
chological well-being in particular were often developed with a primary objective
of discrimination in diagnosis and needs assessment. Therefore, the outcome mea-
sures appropriateness of such instruments should be tested carefully before use.
Generic
Generic instruments are designed to measure very broad aspects of health and are
therefore potentially suitable for a wide range of patient groups and the general
population. The Short-Form Health Survey (SF-36) is one of the most widely used
generic instruments [ 14 – 16 ]. It is a 36-item instrument that measures health across
eight dimensions of physical functioning, social functioning, role limitations due to
physical problems, and role limitations due to emotional problems, mental health,
vitality, pain, and general health perceptions. The dimension scores form physical
and mental component summary scores [ 16 , 17 ].
The main advantage of generic instruments is that they are suitable for use across
a broad range of health problems. They can be used for comparisons between treat-
ments for different patient groups to assess comparative effectiveness. They can
also be used with healthy populations to generate normative data that can be used to
compare different patient groups. Their broad scope means that they have potential
to capture the influence of comorbidity on health, as well as unexpected positive or
negative effects of an intervention. This makes them useful for assessing the impact
2 A Guide to PROMs Methodology and Selection Criteria