Looking back over the past 40 years, to include the 1980s when the multiattribute instruments were being developed, and consequently, with the smorgasbord of disease specific PROs with many claiming to capture quality of life in that disease state, there is little if any recognition of any understanding of fundamental measurement and the limitations imposed by the respective axioms. The result was a foregone conclusion, which was noted at the time by measurement theorists, that the various instruments would be restricted to

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