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2.0 Generic Instruments 2.

1 Physical, Emotionaland Social Functioning            According to Post (2014), the evaluation ofhealth-related quality of life (HRQoL) usually incorporates four health dimensions:       i.           Physical health,which include sensation, sign and symptoms of the disease and adverse effect ofthe treatment.    ii.           Mental health, whichincludes the state of emotional and psychological well-being. It can be rangingfrom a positive sense of well-being to negative sense of distress.

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  iii.           Social health, involvedthe ability to form interpersonal relationships and social engagement which asbe evaluate quantitatively and qualitatively.   iv.           Functional health,involved the ability to perform physical activity and social role- functioning.

 The generic instrumentsthat use to measure the HRQoL include Quality of Life Enjoyment and SatisfactionQuestionnaire (Q-LES-Q), Short-Form 36 Health Survey (SF-36) andPatient-Reported Outcome Measurement Information System (PROMIS). Q-LES-Q wasdeveloped for measurement of satisfaction experienced by respondents in dailyliving. It assesses respondent’s physical health, social relationships, subjectivefeelings, general and recreational activities and work, school or householdduties.

SF-36 is the most commonly used generic instrument for the measurementof functioning and well-being for Medical Outcomes Study. It includes eightdomains which are physical and social functioning, physical and emotional rolelimitations, mental health, general health perceptions, vitality and pain. Fromthese eight domains, Physical Component Summary (PCS) and Mental ComponentSummary (MCS) can be generated. PROMIS is used for the assessment of physical,mental and social functioning and consists of three major domains which isphysical, mental and social health. (Revicki et al.

, 2014)    Domain Framework for PROMIS Physical Health Mental Health Social Health Physical function Depression Satisfaction with participation in social roles Fatigue Anxiety Satisfaction with social roles and activities Pain intensity Anger Ability to participate in social roles and activities Interference Positive psychological function Social support Behaviour and quality Cognitive function Social isolation Sleep function Companionship Sexual function  Table 1: Domain Framework for PROMIS.             In a study of HRQoL among student in Malaysia with theage range from 5 to 18 years old, using PedsQoL 4.0 which assess the physical,emotional, social and school functioning of paediatric respondents, it wasfound that schoolchildren with Thalassaemia has a QoL 10% to 24% lower thanhealthy schoolchildren. Besides that, their emotional functioning is also lowerwhen compared with schoolchildren with other chronic illness such as acutelymphocytic leukaemia, lymphoma and brain tumour. Absenteeism of students withThalassemia for blood transfusion in hospital is the major cause of lowerschool functioning.

(Ismail et al.,2006)            A study conducted in Singapore with respondents agedabove 18 years old by using SF-36 and EQ-5D self-reported questionnaire,reported that patients with early stage hepatitis B have a similar HRQoL,especially their physical health with healthy people, unlike hepatitis Cpatients who show significant reduction in their HRQoL. They do not have anysignificant physical role limitation. Despite of less affected physical health,the effect of hepatitis B on mental health is higher, as more anxiety anddepression was reported. (Ong.

, 2006)                2.2 Visual Impairments            Visual impairment is one of the top ten disabilities inUnited State. About 20% of population with the age mare than 60 years old hasvisual impairment. Many studies done in Asia Pacific countries reported thatquality of life is affected by visual impairment, especially in geriatricpopulation. (Brown & Barrett, 2011)            A survey was done at 2010 in United State to determinethe correlation of visual impairment and health-related quality of life (HRQoL)in geriatric population with age more than 65 years. By using “Healthy daysmeasures” which developed by the Centers of Disease Control and Prevention(CDC), the physical and mental health as well as physical role limitation ofthe respondents was assessed. It was found that visual impairment result in asignificant reduction in HRQoL when compared with those without visualimpairment. The reduction of HRQoL is proportional to the severity of visualimpairment.

This is due to the greater physical and mobility limitations inpatients with more severe visual impairment. However, there is no significant relationshipbetween the reduction in mental health and severity of visual impairment. Patientswith mild visual impairment have a mental health score similar to that withsevere visual impairment. The mental health is less affected by visual impairmentwhen compared with other chronic conditions. (Li et al., 2011)            On the other hand, the HRQoL of paediatric populationalso affected by visual impairment. A study done in children aged between 3 to16 years using Low Vision Quality of Life Questionnaire reported that the HRQoLwas reduced by 35.

6% in children with visual impairment in comparison withhealthy children. The reduction in HRQoL is affected by the age of thechildren. Older children have poorer HRQoL than younger children, probably dueto the increased demand of visual system, such as to drive and read more and smallerwords. (Chadha & Subramanian, 2010)            According to Brown and Barrett (2011), the poorer HRQoLand lower life statisfaction in people with visual limitation is associatedwith:       i.           activity limitations.People with visual impairment face difficulty even in doing daily tasks likebathing and dressing.

Besides that, they also not able to perform instrumentalactivities like housekeeping and cooking.      ii.           economic resources.People with visual impairment usually has lower income and facing financialproblem due to lower employment.

    iii.           social resources. Theyoften receive sympathy and pity from society which lower their self-esteem. Furthermore,they will face problem of social avoidance due to inability to participate insocial activities.   iv.

           psychologicalresources. Visual impairment diminishes one’s self-efficacy. They are unable tocontrol their life circumstances and often required help from others. In addition, relationshipbetween the HRQoL in people with visual impairment and their level of physicalactivity was study in 2015 by using WHO-Quality of Life (WHO-QOL-BREF). It wasfound that visually impaired patients who have perform physical activity regularlyhave a better HRQoL compared to those who are not. Regular physical activityincreases mental strength development and thereby, increases level ofhappiness.

Patients with regular physical activity have higher life satisfactionad motivation, although they face lots of difficulties in daily living. They tendto think less about their disability than those who have a sedentary lifestyle.(Kamelska & Mazurek, 2015) 2.3 Bodily Pain            According to International Association for the Study ofPain, pain is defined as an unpleasant physical sensation and emotionalexperience associated with actual or potential tissue damage. For most of thechronic diseases such as AIDS and cancer, pain is one of the major concern.

(Houlihan et al., 2004)            From a study conducted in United State, it was found thatpain has a great impact of patients’ HRQoL. Patients experience chronic painhas much lower HRQoL than healthy population with a lower SF-36 score, especiallyin the physical component score. Patients experience bodily pain has a lowerscore for physical functioning and physical role limitation. Pain greatly affectedtheir physical activities and mobility in daily life. (Georges et al.

, 2006)            A study done on paediatric patients experiencing painwith age range from 5 to 18 years old to evaluate their HRQoL from parents’prospective using the patient-report Child-Health Questionnaire (CHQ). It isreported that children experiencing pain have severe effect on their social andschool functioning. This is due to the high rate of absenteeism of childrenwith chronic pain and the inability to participate in school and family activities.(Houlihan et al.

, 2004)            In 2014, there was a research conducted to study thecorrelation between the intensity of pain with the HRQoL in elderly patient.From the score obtained from SF-36 questionnaire, the HRQoL is inverselyproportional to the intensity of pain. There is significant correlation betweenthe intensity of pain with the decrease in both physical and mental functioningof the patient. Besides physical and mental function, patients with chronicpain have poorer sleep quality compared to people without pain.

Thus, obesepatients have more negative impact on their HRQoL. The poor physical and mentalfunctioning is due to the effect of poor quality of sleep, as it willnegatively affect the cognition, memory and attention of the patient. Worse sleepquality also results in higher level of fatigue and aggressiveness. Furthermore,for patients with chronic pain who are obese, they experience higher intensityof pain in comparison with patient with normal body weight. In order to improvethe HRQoL of patients, treatment for pain should be considered.

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