Mobility and Quality of Life: Improving methods of economic evaluation


  • disability, mobility impairment, mobility limitations, wheelchair, health economics, health-related quality of life


In the UK over 11 million people live with an impairment, disability or limiting chronic illness; approximately 6% of children, 16% of working age adults and 45% of the elderly are classified as disabled. Mobility impairments are one of the most common causes of disability, and many disabled people require mobility aids, such as wheelchairs, to move around independently. The NHS is the largest supplier of mobility-aids in the UK, however more evidence is needed to understand which mobility-aids are the most cost-effective means of improving the mobility and quality of life of people with mobility impairments.

In the NHS resources for healthcare are limited, therefore evidence is needed to guide decisions about resource allocation. The National Institute for Health and Care Excellence (NICE) provides independent guidance to the NHS based on evidence of cost-effectiveness. Cost-effectiveness analysis is used to calculate the additional cost of achieving an outcome, such as increased quality of life. For cost-effectiveness analysis NICE recommends an outcome measurement known as the quality-adjusted life year (QALY). A QALY is calculated by multiplying the amount of time spent in a given health state by the associated quality of life of that health state. Health states are assigned utilities which are values representing a person’s preference for that health state. QALYs are universal because both quantity and quality of life are measured; therefore they can be used and compared across lots of different conditions and treatments. This helps the NHS to make efficient decisions about the use of resources.

Health-related quality of life (questionnaires are designed to measure the impact that health has on quality of life and the positive or negative impacts of a medical treatment. These questionnaires are often preference-based, which means they can be used to calculate QALYs. Because these questionnaire tools are so generic they are sometimes not sensitive to disease or condition specific changes to health or quality of life. For instance, the EQ-5D (a widely used health-related quality of life outcome measure) asks people to rate their mobility using 1 of 5 options, none of which account for mobility other than walking, for instance using a mobility-aid. At present there are no mobility-related quality of life questionnaires which can be used to calculate QALYs.

The aim of this project is to develop a questionnaire tool to specifically measure quality of life related to mobility. This will help researchers and medical professionals to understand how mobility-aids improve the quality of life of people with mobility impairments. This project will involve interviewing people with mobility impairments about how mobility affects quality of life, then developing a questionnaire based on their responses. In order to create a scoring system, we will then ask a large of number of people to state their preferences for all of the different health states identified in the new questionnaire. Throughout the project we will test the questionnaire to make sure that it is valid and reliable.

If you would like find out more about this project, please contact chief investigator Dr Nathan Bray: / 07792670053
Short titleMobility and Quality of Life
Effective start/end date1/09/161/09/20
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