The ALSSQOL: balancing physical and nonphysical factors in assessing quality of life in ALS

BACKGROUND

There is no generally accepted instrument for measuring quality of life (QOL) in patients with ALS. Current instruments are either too heavily weighted toward strength and physical function or useful for the evaluation of individuals but of less utility in assessing large samples.

OBJECTIVE

To develop and evaluate the psychometric properties of an ALS-specific QOL instrument (the ALSSQOL) that would reflect overall QOL as assessed by the patient and would be valid and reliable across large samples.

METHODS

The ALSSQOL is based on the McGill Quality of Life Questionnaire (MQOL), modified by changes in format and by adding questions on religiousness and spirituality, items derived from interviews with ALS patients, and items identified from open-ended questions administered during the MQOL. The psychometric properties of the ALSSQOL were assessed by a prospective multicenter study in which participants completed the ALSSQOL, other instruments measuring overall QOL, and instruments assessing religiousness, spirituality, and psychological distress.

RESULTS

A 59-item ALSSQOL was developed; 342 patients evaluated its psychometric properties. Completion time averaged 15 minutes. Forty-six items loaded on six factors. The ALSSQOL demonstrated concurrent, convergent, and discriminant validity for the overall instrument and convergent validity for its subscales. Analysis of individual items permitted insight into variables of clinical importance.

CONCLUSIONS

This new ALS-specific quality of life instrument is a practical tool for the assessment of overall quality of life in individuals with ALS and appears to be valid and useful across large samples. Validation studies of a shortened version are now under way.

Folk medicine and health culture in contemporary society

Folk medicine comprises "unofficial health beliefs and practices" which rely heavily (but not exclusively) on oral transmission. It is one form of alternative medicine, and a major source for many other forms such as phytotherapy and mind/body medicine. While many folk medicine ideas and practices are associated with particular ethnic groups, many others are widely distributed throughout American society. Folk medicine is not dying out in the modern world. Because it has both medical benefits and risks, effective medical care with folk medicine requires awareness and discussion of its influence.

Culturally grounded review of research assumptions

In this article 11 assumptions underlying many discussions of alternative medicine are discussed and critiqued: that (1) cultural factors merely constitute noise in research data that can be removed by proper design; (2) the only proper goal of alternative medicine research is the incorporation of effective practices into medicine; (3) physicians are the primary consumers of good alternative medicine research; (4) control of pathology is the sole measure of the effectiveness of alternative medicine; (5) effects on pathology can be fully separated from effects on perception or quality of life; (6) effects on individual health should be the sole focus of alternative medical research; (7) medicine is aware of all sicknesses appropriate for alternative medicine research; (8) subjective data are less valuable than objective data; (9) the best leads for research come from recognizable systems with advocates; (10) more "modern-looking," highly articulated forms are necessarily better research "bets"; and (11) all good candidates for alternative medicine research are recognized as health practices by those who use them.

Epistemologies in religious healing

Religious beliefs in miraculous healing through prayer remain prevalent in modern society. Most such beliefs do not conflict with medical advice but some do. Conventional views have considered these beliefs incompatible with rational modern thought, predicting their demise and explaining their persistence in terms of non-rational thinking, "special logics" and psychological compartmentalization. However, attention to the actual beliefs of individuals often reveals them to be rationally ordered and empirically founded. Further, they do not usually involve disbelief of medical knowledge. Their differences from each other and from orthodox medical ideas arise from differing assumptions, the crediting of subjective experience, and the particular experiences of believers.