What tests are available? Perhaps, unsurprisingly, the book fails to include a large number of the available tests. However, it is surprising that several important disease areas are omitted, for example, anxiety and depression. Unfortunately, the omission of instruments appears to be non-random, with European work largely unrecognized.
Which tests are validated? The problem here is that by relying on chapters written by the test authors, much of the necessary information is hidden or overlooked. In particular, a large majority of the instruments reviewed fail to meet the reliability standard required for clinical trials. The poor reproducibility of the generic instruments such as the NHP, SIP and SF-36 explains why they perform so badly in clinical trials. As long as books such as this fail to point out these inadequacies, QoL measurement will never make the necessary developmental progress.
How does an investigator choose which test to use? It is not clear how investigators would select an appropriate instrument from the information available in the book. No objective assessment of the quality of the instruments reviewed is provided and, furthermore, no attempt is made to equate instruments or to compare their psychometric qualities.
What is the state-of-the-art in various areas? As has been commented on, many of the most advanced instruments have been omitted from the book. Consequently, it is not possible for readers to determine the `state-of-the-art'.
Spilker's book is a useful reference text that saves the need to search out a great deal of literature. However, it is not a book for the novice nor for the clinician seeking out the most appropriate instrument for a trial. Perhaps the weakest chapters are those describing methods of test development and adaptation. The information provided is, at best, out of date.
There are interesting and thoughtful contributions, notably those by Cleary (future directions), Barofsky (cognitive aspects), Levine (ethical perspective), Cella et al (cross-cultural instrument equating), Rittenhouse and O'Brien (threats to validity associated with randomized clinical trials) and Drummond (the future of pharmacoeconomics).
In conclusion, it seems likely that this book will come to be seen as the `bible' of QoL. It is to be hoped that future editions will reflect adequately the contribution of researchers from outside North America. Room must be made for the many condition-specific instruments available for clinical trials. This could be achieved by removal of several of the existing chapters that fall short of the quality required for such a text.