title: A method for measuring quality of life through subjective weighting of functional status.
abstract: OBJECTIVE
  To apply a new tool to understand the quality of life (QOL) implications of patients' functional status.
  
  
  METHODS
  Results from the Features-Resource Trade-Off Game were used to form utility weights by ranking functional activities by the relative value of achieving independence in each activity compared with all other component activities. The utility weights were combined with patients' actual levels of performance across the same activities to produce QOL-weighted functional status scores and to form "value rulers" to order activities by perceived importance.
  
  
  METHODS
  Persons with severe disabilities living in the community and clinicians practicing in various rehabilitation disciplines.
  
  
  METHODS
  Two panels of 5 consumers with disabilities and 2 panels of 5 rehabilitation clinicians.
  
  
  METHODS
  The 4 panels played the Features Resource Trade-Off Game by using the FIMT(TM) instrument definitions.
  
  
  METHODS
  Utility weights for each of the 18 FIM items, QOL-weighted FIM scores, and value rulers.
  
  
  RESULTS
  All 4 panels valued the achievement of independence in cognitive and communication activities more than independence in physical activities. Consequently, the unweighted FIM scores of patients who have severe physical disabilities but relatively intact cognitive skills will underestimate QOL, while inflating QOL in those with low levels of independence in cognition and communication but higher physical function.
  
  
  CONCLUSIONS
  Independence in some activities is more valued than in others; thus, 2 people with the same numeric functional status score could experience very different QOL. QOL-weighted functional status scores translate objectively measured functional status into its subjective meaning. This new technology for measuring subjective function-related QOL has a variety of applications to clinical, educational, and research practices.
authors.affiliation: Department of Rehabilitation Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104-2676, USA.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
authors.forename: Barbara
authors.initials: B
authors.lastname: Wechsler
authors.forename: Richard
authors.initials: R
authors.lastname: Ross
authors.forename: Greg
authors.initials: G
authors.lastname: Maislin
mesh_terms: D000203:Activities of Daily Living / Q000145:classification*; D001294:Attitude to Health; D015982:Bias; D002755:Choice Behavior; D003071:Cognition; D003142:Communication; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation*; D005716:Game Theory; D006801:Humans; D017567:Karnofsky Performance Status; D011594:Psychometrics; D011788:Quality of Life; D020127:Recovery of Function; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome