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PATIENT PERSPECTIVES AND QUALITY OF LIFE: EARLY PTClinResNet OUTCOMES

PATIENT PERSPECTIVES AND QUALITY OF LIFE: EARLY PTClinResNet OUTCOMES. COMBINED SECTIONS MEETING 2006 San Diego, CA February 1-5, 2006. Quality of Life: Conceptual and Measurement Issues. Bryan Kemp, Ph.D. Rehabilitation Research and Training Center on Aging With a Disability*

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PATIENT PERSPECTIVES AND QUALITY OF LIFE: EARLY PTClinResNet OUTCOMES

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  1. PATIENT PERSPECTIVES AND QUALITY OF LIFE: EARLY PTClinResNet OUTCOMES COMBINED SECTIONS MEETING 2006 San Diego, CA February 1-5, 2006

  2. Quality of Life:Conceptual 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

  3. CONTRIBUTORS Jason Kahan, PhD Rodney Adkins, PhD Judith Mitchell, PhD

  4. Three Outcomes of Rehabilitation Optimize Health (ICF Health and Impairment level) Improve Functioning (ICF Function level) Restore Quality of Life (ICF Participation level)

  5. What Is Meant By “Quality of Life”?

  6. 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 person’s own appraisal of life Flannigan’s Critical Incident approach Life satisfaction measures Limitations: difficult to improve through policy changes; issue of expectation

  7. Measures of QOL Have Been Divided by Dijkers (1999) Into Four Types Objective v. Subjective Single dimension v. Multiple dimensions

  8. Health-related Objective QOL Measures Examples: ADL scales IADL scales The SF-36

  9. 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?

  10. Gill and Feinstein (1994) reported 159 different measure of QOL

  11. 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”

  12. SF - 36 Two Composite Scores: Physical Health/Mental Health Norm based scoring (Max = 100)

  13. 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

  14. Negative Positive Quality Of Life

  15. Hard to Imagine Better Hard to Imagine Worse O.K. So-So Getting by Negative Positive Quality of Life Continuum

  16. Great! Hard to imagine better Very Distressing Hard to imagine worse So-So 1 2 3 4 5 6 7 QOL

  17. Cumulative Percentages (n=775) Lo Med Hi %

  18. 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)

  19. What Kind Of Activities Correlate With High Subjective QOL? Productive activities Family activities Intimacy, friendships and social activities

  20. Correlations of S-QOL With Other Variables In a Meta Analysis of 22 Studies Severity .05 Disability: .17 Participation: .38 Source: Dijkers, 1999, APMR

  21. CORRELATIONSOF S-QOL (n=475) Age: .05 Education: .09 Depression: -.66 Life satisfaction: .63 Source: RRTC on Aging With Disability

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