Assessment of quality of life and participation within an outpatient rehabilitation setting

Purpose. To evaluate the use of quality of life and participation measures in routine rehabilitation practice, determine the relationship between two scales and investigate their ability to evaluate change in a general outpatient population over a time of rehabilitation. Methods. This cohort study consisted of 55 patients admitted consecutively to an outpatient rehabilitation centre. All participants completed the WHOQOL-BREF and the London Handicap Scale (LHS) at admission and discharge. Results. Non-parametric statistical analysis demonstrated a significant change in the total scores of both the WHOQOL-BREF and LHS over time (Z = −4.33, P < 0.001 and Z = −4.40, P < 0.001 respectively) with ‘better’ scores on completion of rehabilitation. A strong correlation existed between the total WHOQOL-BREF and LHS scores both cross-sectionally (admission and discharge ρ > 0.7), and longitudinally (ρ = 0.63). Conclusions. Our study demonstrated a strong relationship between quality of life and participation, with change shown using both scales over a period of outpatient rehabilitation. Given the findings, it seems appropriate to use only one of these measures. The WHOQOL-BREF has a wider scope, being useful both to evaluate service delivery in a diverse outpatient population or when measuring an individual over time.

[1]  Silke Schmidt,et al.  Current issues in cross-cultural quality of life instrument development. , 2003, Archives of physical medicine and rehabilitation.

[2]  A. Chorus,et al.  Measuring participation according to the International Classification of Functioning, Disability and Health (ICF) , 2003, Disability and rehabilitation.

[3]  H. Dickson.  Handicap one year after a stroke: validity of a new scale. , 1995, Journal of neurology, neurosurgery, and psychiatry.

[4]  E M Backett,et al.  A quantitative approach to perceived health status: a validation study. , 1980, Journal of epidemiology and community health.

[5]  Development and evaluation of a new questionnaire for rating perceived participation1 , 2007, Clinical rehabilitation.

[6]  A. Beelen,et al.  Responsiveness of the Impact on Participation and Autonomy questionnaire. , 2002, Archives of physical medicine and rehabilitation.

[7]  M. Power,et al.  Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment , 1998 .

[8]  R L Hewer,et al.  The Frenchay Aphasia Screening Test: a short, simple test for aphasia appropriate for non-specialists. , 1987, International rehabilitation medicine.

[9]  W. Taylor,et al.  Quality of life of people with rheumatoid arthritis as measured by the World Health Organization Quality of Life Instrument, short form (WHOQOL-BREF): score distributions and psychometric properties. , 2004, Arthritis and rheumatism.

[10]  A. Cieza,et al.  Content comparison of health-related quality of life measures used in stroke based on the international classification of functioning, disability and health (ICF): a systematic review , 2007, Quality of Life Research.

[11]  S. Skevington,et al.  The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A Report from the WHOQOL Group , 2004, Quality of Life Research.

[12]  S. Wood-Dauphinée,et al.  Activity, participation, and quality of life 6 months poststroke. , 2002, Archives of physical medicine and rehabilitation.

[13]  S. Ueda,et al.  The subjective dimension of functioning and disability: what is it and what is it for? , 2003, Disability and rehabilitation.

[14]  D. Gottlieb,et al.  Is a day hospital rehabilitation programme associated with reduction of handicap in stroke patients? , 2004, Clinical rehabilitation.

[15]  Geoffrey A. Donnan,et al.  Quality of Life After Stroke: The North East Melbourne Stroke Incidence Study (NEMESIS) , 2004, Stroke.

[16]  G. Whiteneck,et al.  Quantifying handicap: a new measure of long-term rehabilitation outcomes. , 1992, Archives of physical medicine and rehabilitation.

[17]  Gavin Williams,et al.  The concurrent validity and responsiveness of the high-level mobility assessment tool for measuring the mobility limitations of people with traumatic brain injury. , 2006, Archives of physical medicine and rehabilitation.

[18]  K. Ottenbacher,et al.  Comparison of the Community Integration Questionnaire, the Craig Handicap Assessment and Reporting Technique, and the Disability Rating Scale in Traumatic Brain Injury , 2002, The Journal of head trauma rehabilitation.

[19]  J. Hunter,et al.  A comparison of three measures of progress in early lower limb amputee rehabilitation , 2001, Clinical rehabilitation.

[20]  David Cella,et al.  Health outcomes assessment in vulnerable populations: measurement challenges and recommendations. , 2003, Archives of physical medicine and rehabilitation.

[21]  M. Dijkers.  Individualization in quality of life measurement: instruments and approaches. , 2003, Archives of physical medicine and rehabilitation.

[22]  Aneetha Skinner,et al.  The use of standardized outcome measures in rehabilitation centres in the UK , 1997, Clinical rehabilitation.

[23]  M. Schlossberg.  The Assessment of Aphasia and Related Disorders. 2nd ed. , 1984 .

[24]  P. Halligan,et al.  New wine in old bottles: the WHO ICF as an explanatory model of human behaviour , 2003, Clinical rehabilitation.

[25]  V. Wood,et al.  The Subjective Index of Physical and Social Outcome (SIPSO): a new measure for use with stroke patients , 2000, Clinical rehabilitation.

[26]  Christine Eiser,et al.  Measuring quality of life , 1997, Archives of disease in childhood.

[27]  J E Ware,et al.  Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey. , 1998, Journal of clinical epidemiology.

[28]  M. Kaste,et al.  Depression after stroke: results of the FINNSTROKE Study. , 1998, Stroke.

[29]  J. Darrah,et al.  Quality of Life: What Does It Mean in Rehabilitation? , 1998 .

[30]  I. Higginson,et al.  Are quality of life measures patient centred? , 2001, BMJ : British Medical Journal.

[31]  Shekhar Saxena,et al.  The WHO quality of life assessment instrument (WHOQOL-Bref): The importance of its items for cross-cultural research , 2004, Quality of Life Research.

[32]  D. Tulsky,et al.  Quality of life measurement in rehabilitation medicine: building an agenda for the future. , 2002, Archives of physical medicine and rehabilitation.

[33]  M. Power,et al.  Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment , 1998, Psychological Medicine.

[34]  D. Sarfati,et al.  A challenge to the cross-cultural validity of the SF-36 health survey: factor structure in Maori, Pacific and New Zealand European ethnic groups. , 2000, Social science & medicine.

[35]  Mary Lou Coad,et al.  THE COMMUNITY INTEGRATION QUESTIONNAIRE: A Comparative Examination , 1994, American journal of physical medicine & rehabilitation.

[36]  J. Woo,et al.  Cross-cultural validation of the London Handicap Scale in Hong Kong Chinese , 2001, Clinical rehabilitation.

[37]  D. Wade,et al.  Measurement in neurological rehabilitation. , 1992, Current opinion in neurology and neurosurgery.

[38]  J W Jutai,et al.  Issues for selection of outcome measures in stroke rehabilitation: ICF Participation , 2005, Disability and rehabilitation.

[39]  G. Miscio,et al.  How does stroke restrict participation in long‐term post‐stroke survivors? , 2005, Acta neurologica Scandinavica.

[40]  W. V. van Harten,et al.  Current use of outcome measures for stroke and low back pain rehabilitation in five European countries: first results of the ACROSS project , 2001, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[41]  Gerold Stucki,et al.  International Classification of Functioning, Disability, and Health (ICF): A Promising Framework and Classification for Rehabilitation Medicine , 2005, American journal of physical medicine & rehabilitation.

[42]  I. Ackerman,et al.  Evaluating quality of life in hip and knee replacement: Psychometric properties of the World Health Organization Quality of Life short version instrument. , 2006, Arthritis and rheumatism.

[43]  Initial validation of the Swedish version of the London Handicap Scale , 2006, Quality of Life Research.

[44]  R. D. de Haan,et al.  Handicap questionnaires: what do they assess? , 1999, Disability and rehabilitation.

[45]  R. Harwood,et al.  Measuring handicap: the London Handicap Scale, a new outcome measure for chronic disease. , 1994, Quality in health care : QHC.

[46]  V. Colotla,et al.  Psychological distress in workers with traumatic upper or lower limb amputations following industrial injuries. , 2003 .

[47]  D. Wade,et al.  The London handicap scale: a re-evaluation of its validity using standard scoring and simple summation , 2000, Journal of neurology, neurosurgery, and psychiatry.

[48]  C. Ward,et al.  On autonomy and participation in rehabilitation , 2002, Disability and rehabilitation.