PATIENT PERSPECTIVES AND QUALITY OF LIFE: EARLY PTClinResNet OUTCOMES

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PATIENT PERSPECTIVES AND QUALITY OF LIFE EARLY
PTClinResNet OUTCOMES

• COMBINED SECTIONS MEETING 2006
• San Diego, CA
• February 1-5, 2006

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Quality of LifeConceptual and Measurement
Issues

• Bryan Kemp, Ph.D.
• Rehabilitation Research and Training Center on
• Aging With a Disability
• Rancho Los Amigos National Rehabilitation Center
• Downey, California
• Funded by the National Institute on Disability
  and Rehabilitation Research

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CONTRIBUTORS

• Jason Kahan, PhD
• Rodney Adkins, PhD
• Judith Mitchell, PhD

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Three Outcomes of Rehabilitation

• Optimize Health (ICF Health and Impairment
  level)
• Improve Functioning (ICF Function level)
• Restore Quality of Life (ICF Participation
  level)

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What Is Meant By Quality of Life?
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History of Quality of Life Research

• Started during Eisenhower era
• Objective approach
• How is America doing? focus
• Social indicators approach (e.g., housing)
• Limitations small correlation with feelings
• Subjective approaches era
• Focus on persons own appraisal of life
• Flannigans Critical Incident approach
• Life satisfaction measures
• Limitations difficult to improve through
  policy changes issue of expectation

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Measures of QOL Have Been Divided by Dijkers
(1999) Into Four Types

• Objective v. Subjective
• Single dimension v. Multiple dimensions

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Health-related Objective QOL Measures

• Examples
• ADL scales
• IADL scales
• The SF-36

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Subjective Health QOL Questions

• How would you rate your overall health?
• Are you satisfied with your level of activity?
• Do you need assistance with any daily activities?

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Gill and Feinstein (1994) reported 159 different
measure of QOL
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Characteristics of the SF-36

• Two major factors Physical and Mental Health
• Sub-scales under each factor
• Questions framed in objective and some subjective
  terms
• According to Ware (Spine, 2000) the SF-36 is a
  health survey

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SF - 36
Two Composite Scores Physical Health/Mental
Health
Norm based scoring (Max 100)
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Subjective QOL Scale Used In Most Of Our Studies

• Single 7-point item visual analog scale
• Ranges from negative to positive QOL
• Used in several disability studies

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Hard to Imagine Better
Hard to Imagine Worse
O.K. So-So Getting by
Negative
Positive
Quality of Life Continuum
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Cumulative Percentages (n775)
Lo
Hi
Med

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Differences Between Objective and Subjective
Measures

• Objective appear to assess what people possess
  (health, education, income, spouse)
• Subjective appear to assess what people
  experience (satisfaction, success, meaning)

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What Kind Of Activities Correlate With High
Subjective QOL?

• Productive activities
• Family activities
• Intimacy, friendships and social activities

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Correlations of S-QOL With Other Variables In a
Meta Analysis of 22 Studies

• Severity .05
• Disability .17
• Participation .38

Source Dijkers, 1999, APMR
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CORRELATIONSOF S-QOL (n475)

• Age .05
• Education .09
• Depression -.66
• Life satisfaction .63

Source RRTC on Aging With Disability