fig4

Figure 4. The World Health Organization Quality of Life - Brief (WHOQOL-BREF) questionnaire contains 28 items to evaluate four domains. The Q1 and Q2 represent overall QoL and general health. The physical domain consists of pain and discomfort (Q3), dependence on medical substances and medical aids (Q4), energy and fatigue (Q10), mobility (Q15), sleep and rest (Q16), activities of daily living (Q17), and work capacity (Q18). The psychologic domain consists of positive feelings (Q5), spirituality/religion/personal beliefs (Q6), thinking/learning/memory/concentration (Q7), bodily image and appearance (Q11), self-esteem (Q19), and negative feelings (Q26). The social relations domain consists of personal relationships (Q20), sexual activity (21), practical social support (Q22), and being respected/accepted (Q27). The environment domain consists of freedom, physical safety, and security (Q8), physical environment (Q9), financial resources (Q12), opportunities for acquiring new information and skills (Q13), participation in and opportunities for recreation/leisure activities (Q14), home environment (Q23), health and social care: accessibility and quality (Q24), transport (Q25), and eating/food (Q28). The overall QoL and general health (Q1) deteriorated in the first year after operation. However, it gradually improved and even surpassed their pretreatment QoL score by the end of the second year after operation. Since then, the QoL reached a constant level. Similar curve could be found in pain and discomfort (Q3), activities of daily living (Q17), work capacity (Q18), negative feeling (Q26), and sexual activity (Q21). Otherwise, sleep and rest (Q16) and self-esteem (Q19) slowly improved during follow up after surgery. However, substances and medical aids (Q4), and spirituality/religion/personal beliefs (Q6), deteriorated after surgery and did not recovered in the end. Interestingly, some QoL, like personal relationships (Q20), practical social support (Q22), freedom/physical safety/security (Q8), transport (Q25), and eating/food (Q28), showed regular oscillation after surgery with year.