Related Outcome Tools

Achievements (Box C)

Achievements include people’s possessions, relationships, accomplishments, etc.  The major domains include employment and education, marriage and spousal relations, sexuality, other major social relations such as friendships, leisure activities, spirituality and religion, healthcare, equipment and accessibility, and personal caregivers. 

Measuring achievements can be used to obtain either an objective perspective (societal viewpoint) on quality of life (QoL) or a subjective one (individual/insider viewpoint). 

When only taking the outsider’s perspective, tradition, achievements and statuses are judged in terms of societal standards and priorities (Box B), which then results in QoL as Utility (Box A)

When an individual's standards, needs, priorities, wants, etc., develop in reflection to society at large and are then compared by the individual to reality (Box C), this generates either negative or positive reactions and may be reflected in morale, life satisfaction, mood, etc. (subjective evaluations and reactions [Box E]).  Within this interaction, the construct of QoL as Social Well-Being emerges.

The main types of achievements include:

Statuses: Score of health based on level of functioning in a few areas and frequency of symptoms.

Performances: Frequency of activities, or difficulty in performing them.

Possessions: Acquisitions people obtain (i.e., money, relationships).

Relationships: Individuals discharging their roles in sets.

Sub-categories of Achievements and Related Constructs

Health-Related Quality of Life (HRQoL):  The construct of HRQoL is a major sub-category of QoL as Achievement.  This construct is most affected by disease or injury and by treatment, and stems from the well-known definition of health by the World Health Organization, which is: “a state of complete physical, mental, and social well-being and not merely the absence of diseases and infirmity”. 

The inclusion of the term ‘well-being’ is confusing, HRQoL measures typically have a focus on activities of daily living and major social roles (e.g., occupation, marital status), and attempt to combine physical and mental functioning to characterize the consequence of illness and injury.  In addition, disease specific HRQoL measures incorporate symptoms and dysfunctions relevant to the disorder.

Activities of Daily Living (ADLs): Daily self-care activities within an individual's place of residence, in outdoor environments, or both.

Instrumental Activities of Daily Living (IADLs): IADLs are ‘extended’ or ‘instrumental’ activities of daily living that include the performance of activities that are more complex than ADLs.

Participation: Participation may be defined as involvement in a life situation and participation problems as restrictions such as problems an individual may experience in involvement in life situations.  This construct is part of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework, which replaces the term Handicap (a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal – depending on age, sex, and social and cultural factors), and may be addressed from an objective (societal) or subjective (insider) perspective.

Community (Re)Integration: Community (re)integration is typically viewed as the presence and participation of the individual within his/her physical and psychosocial environment, or acquiring or resuming appropriate social roles, statuses, and activities and productive behaviours performed as part of relationships with family, friends, and others in ‘natural’ community settings.

Social Adjustment: Social adjustment may be defined as the harmonious relationship between persons and their entire environment, or with specific interaction partners.  The term originates from social psychiatry, or the special education/developmental disabilities field, and most definitions refer to more neutral aspects, such as “the degree to which a person fulfills the normative social expectations of behaviour that constitute his/her role” or “the individual’s ability to function in social roles”.

Social Health: Social health may refer to that dimension of an individual’s well-being that concerns how she/he gets along with other people, how other people react to her/him, and how she/he interacts with social institutions and social mores.

Independent Living: Independent living may be modeled to include the following factors: 1) the degree to which the individual could live in a less restrictive living situation; and 2) the degree to which the individual was productive as a member of society.

Key References:

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WHO. ICF: International Classification of Functioning, Disability and Health. Geneva: World Health Organization; 2002.

Dijkers MP. Community integration: Conceputal issues and measurement approaches in rehabilitation research. Top Spinal Cord Inj Rehabil 1998;4:1-15.

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DeJong G, Branch L, Corcoran P. Independent living outcomes on spinal cord injury: Multivariate analyses. Arch Phys Med Rehabil 1984;65:66-73.

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