Self-Rated Health and Quality of Life in Slovak Rheumatoid Arthritis Patients

Self-rated health (SRH) and Quality of Life (QoL) have become very fashionable in medical research and patient care in the past two decades. The frequency of medical publications on these topics has expanded exponentially since the 1980s. Patient-reported self-evaluations, in particular on health-related QoL, have become accepted as important, sometimes even the most important, outcomes for both the evaluation and comparison of treatments and for the assessment and management of individual patients. SRH and QoL are concepts that carry the promise of great opportunities in the sense that they bring a ‘potential breath of fresh air in understanding of health, illness and health care’, as expressed by Albrecht and Fitzpatrick (1994). They appeal to patients, their families and friends, clinicians, planners and politicians alike. Part of the reason for the increasing popularity of these concepts is that they appear to be relevant and useful in many ways. SRH is one of the most important predictor variables in studies of health outcomes. It is a powerful predictor of mortality, morbidity, utilisation of health care services, hospitalisation or health protective behaviour. The QoL concept is holistic and it takes into account of a broad range of outcomes that are consistent with the complexities of human life; it focuses on the needs of the individual and so it is acceptable to patients and relatives; it takes into account improvements in function or distress that fall short of a complete cure; it can be applied across disciplines to compare different interventions for different disorders using the same measure of outcome. Patient-reported health-assessments are valuable since they can be used by health personnel as a screening tool to identify patients who are at increased risk of adverse health outcomes. They stimulate doctor-patient communication on psychosocial issues and they may warrant tailored physical or psychological intervention by a health care provider, enabling improvements in the health and quality of life in patients with a chronic disease. In dealing with chronic diseases it has been suggested that the services for people with a chronic disease address the enhancement of QoL rather than cure. According to health policy, an attempt should be made to make the lives of people suffering from chronic diseases worth living despite their disease. Central to all of these ideas is the use of SRH and QoL as outcome measures. In addition, an important aspect of understanding the meaning of QoL is the relationship between the various domains or levels of QoL This thesis focuses on self-ratings of health and quality of life by patients with recent-onset rheumatoid arthritis. The study forms part of a larger longitudinal research project – the European Research on Incapacitating DIseases and Social Support (EURIDISS), in which besides Slovakia five other European countries were involved, in particular France, the Netherlands, Norway, Sweden and the United Kingdom (Northern Ireland). The conceptual framework of the study is based on three theoretical models: the Disease-Handicap Model (DHM), Spilker’s Quality of Life (QoL) model and Lazarus and Folkman’s Stress-Coping Theory.