ABSTRACTUSING THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING TO CONCEPTUALIZE AND MEASURE QUALITY OF LIFE AMONG INDIVIDUALS WITH DISABILITIESByAllison R. Fleming Quality of life (QOL) is the underlying goal of all rehabilitation interventions. Researchers and policy makers have proposed that QOL is an important and useful way to measure the impact of services. However, conceptual ambiguity, difficulty with operational definitions and measurement, and the inherent vulnerability to value bias have challenged the adoption and utility of QOL as a practical application in rehabilitation counseling. Given the challenges that individuals with disabilities have faced in securing employment, social and economic independence, and freedom to function at the highest possible level, it is not surprising that improvements to QOL related to service provision have been operationalized by more tangible impacts such as employment or increased independence. Results from previous research provide strong reason to believe that QOL is much more complex, individually based perception than is indicated by a single measure as is typically used in outcome measurement. In this study, a comprehensive framework (the ICF) is used to conceptualize and measure QOL in two samples of adults with disabilities receiving educational and vocational services. Participants were recruited from a university resource center for persons with disabilities and from a large community rehabilitation service provider (CRP). The sample reported quality of life levels that are more typically observed in the general population (i.e., most people reported satisfaction), which lends support to the notion that reports of lower levels of QOL in individuals with disabilities is not universal, and may not be due to disability itself. When function, activity, participation, personal factors and environment were regressed on quality of life, one personal factor (level of education) and several components extracted from the ICF emerged as having strong relationships with QOL. These included level of education, difficulty with social relationships and inclusion, difficulty with mobility and self-care, the impact of the disability or health condition on the person or their family, and relational support and attitudes of family, friends, and acquaintances. When the student sample and CRP sample were analyzed separately, differences emerged that may be related to life circumstances (e.g., age, student status). The full model explained 26% of the variance in reported QOL. When the information that is typically used as outcomes of rehabilitation services (e.g., employment and independent living) were regressed on quality of life with demographic characteristics, a substantially lower proportion of the variance in QOL was explained by the data, indicating that the additional information provided by the ICF model improves our ability to conceptualize QOL. The results of the within-groups analysis provided more information specific to each sample. For students, the work/school and non-work activities added a more substantial portion of variance explained than in the CRP client sample. Function, activity, and participation data largely supported the domains of the ICF, with the exception that "participation" showed two dimensions: one related to social relationships and the other related to the impact of disability on self and family. The dimensions of environment were also examined, and findings indicated that there is significant overlap between social support and attitudes toward disability. The present study provides us with initial results to that support the utility of the ICF for conceptualizing disability and its impact in a way that is inclusive of personal and environmental factors, and providing a more comprehensive picture of QOL.
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