QUALITY OF LIFE IN REHABILITATION MEDICINE
Derick T. Wade (Rivermead Rehabilitation Centre, Oxford, Great Britain).
Quality of life (QoL) is a dangerous phrase. It means many things to many people, and should always be made more explicit. This talk will suggest that there are three domains of outcome in rehabilitation: the patient's social role functioning; the stress on the family; and the patient's well-being. The patient's well-being probably has two components. The simpler one is a freedom from pain and discomfort. The more complex one is a feeling that there is still point in living. This arises from and is reflected in the patient's emotional state. It is not synonymous with any of the recognised psychiatric states such as depression or anxiety. It can be conceived of as being related to the gap between a patient's current status and their aspirations and hopes. If the gap is too large or too small the quality of life is low. The goal of rehabilitation medicine is to adjust potential performance and expectations towards the optimal gap.
SUBJECTIVE QUALITY OF LIFE: CONCEPTUAL AND EMPIRICAL RELATIONSHIPS WITH THE COMPONENTS OF DISABLEMENT
Marcus J. Fuhrer (National Center for Medical Rehabilitation Research, Bethesda, Maryland, USA)
Prevailing conceptual models of disablement, such as the one promulgated by the WHO, focus principally on the objective sequelae of chronic impairments, e.g., disabilities and limitations in social role functioning. This presentation reflects the view that a more complete account requires consideration of effects on people's subjective quality of life. Subjective quality of life and its synonym, subjective well-being, refer to the degree to which people have positive thoughts and feelings about their lives, considered as a whole. The focus of the presentation is on empirical evidence of the extent to which the designated components of disablement--impairments, disabilities, and handicaps--are associated with people's subjective quality of life. Conclusions are summarized from the author's recently published paper that reviewed evidence from 19 studies of people with spinal cord injuries. The conclusions are compared with those from a yet unpublished meta-analysis by M. Dijkers, and they are viewed as well from the standpoint of studies that have focussed upon people with chronic physical impairments other than spinal cord injury.