A method for measuring quality of life through subjective weighting of functional status.
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.
Stineman
Margaret G
MG
Department of Rehabilitation Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104-2676, USA.
Wechsler
Barbara
B
Ross
Richard
R
Maislin
Greg
G
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