The assessment of the quality of life of adults with intellectual disability: the use of self-report and report of others assessment strategies

The role of motivation in shaping social inclusion of people with intellectual disabilities in physical-sports activity contexts

The present study aims to test a model in which basic psychological needs (BPN) satisfaction in physical-sport activity contexts is associated with self-determined motivation, which, in turn, would predict the social inclusion of people with intellectual disabilities. A total of 286 people with intellectual disabilities (53.5% men) who reported engaging in physical-sport activities responded to a validated questionnaire about the satisfaction of their BPN, motivation (using the Self-determination index [SDI]), and social inclusion. A Pearson's bivariate correlation and structural equation modeling were conducted. The resulting model was reanalyzed in a multigroup analysis to test its invariance across self and proxy reports. Positive associations were found between the satisfaction of the BPN and the SDI. However, the SDI and social inclusion were positively associated only in proxy reports (βself = 0.07 vs. βproxy = 0.30). The tested model established positive relationships between the BPN and SDI in autonomy (βself = 0.21 vs. βproxy = 0.18), competence (βself = 0.47 vs. βproxy = 0.53), and relatedness (βself = 0.21 vs. βproxy = 0.23). Further research is needed to understand the factors leading to discrepancies between participants and proxies when relating the SDI to social inclusion in the context of physical-sport activity. However, the results obtained suggest that it would be optimal to develop contexts of practice for people with intellectual disabilities in which the satisfaction of their BPN is favored and that this has a positive impact on their motivation and social inclusion.

The use of proxy measurement of internal states in people with intellectual disability: A scoping review

BACKGROUND

The measurement of internal states of people with an intellectual disability is challenging. Given these difficulties, proxy respondents are sometimes used. However, the literature provides some caution about the validity of the use of proxy respondents.

AIMS

This review aims to identify the available evidence regarding the use of proxy respondents in the measurement of internal states of people with intellectual disabilities.

METHOD

The Arksey and O'Malley scoping review framework was used for this review, refined with the Joanna Briggs Institute Methodology.

RESULTS

Results indicate there are some differences in the findings reported with respect to the efficacy of the use of proxy respondents. These may be due to a number of inconsistencies and weaknesses in examinations of their utility.

CONCLUSIONS

If proxy-reports are to be useful in understanding the internal states of people with intellectual disability, researchers need to address the shortcomings revealed by this review.

Adapting the EQ-5D-3L for adults with mild to moderate learning disabilities

BACKGROUND

Approximately 1.5 million adults in the UK have a learning disability. The difference between age at death for this group and the general population is 26 years for females and 22 years for males. The NHS Long Term Plan (January 2019) recognises learning disabilities as a clinical priority area. People with a learning disability are often excluded from research by design or lack of reasonable adjustments, and self-reported health status/health-related quality of life questionnaires such as the EQ-5D are often not appropriate for this population. Here, we systematically examine the EQ-5D-3L (its wording, content, and format) using qualitative methods to inform the adaption of the measure for use with adults with mild to moderate learning disabilities.

METHODS

Think-aloud interviews with carers/advocates of learning-disabled adults were undertaken to explore the difficulties with completing the EQ-5D-3L. Alternative wording, language, structure, and images were developed using focus groups, stakeholder reference groups, and an expert panel. Data analysis followed a framework method.

RESULTS

The dimensions and levels within the EQ-5D-3L were deemed appropriate for adults with mild to moderate learning disabilities. Consensus on wording, structure, and images was reached through an iterative process, and an adapted version of the EQ-5D-3L was finalised.

CONCLUSION

The EQ-5D-3L adapted for adults with mild to moderate intellectual/learning disabilities can facilitate measurement of self-reported health status. Research is underway to assess the potential use of the adaptation for economic evaluation.

Validity and reliability of the persian version of the world health organization quality of life disabilities module

This study aimed to assess the validity and reliability of the world health organization quality of life questionnaire for people with intellectual disability (WHOQOL-DIS-ID). This was a cross-sectional study of 118 adults with intellectual disability. Internal consistency and temporal reliability were evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity of the structure was assessed using confirmatory factor analysis. Multiple linear regression analysis was performed to determine the factors associated with the quality of life. Cronbach's alpha for all, but not for discrimination area, as well as ICC for all questions except for 23 and 6, were higher than 0.7. The variables such as periodic check-up, number of friends, entertainment outside the home, parental separation, physical activity, unmet needs score, caregiver's mental health status, and available facilities were the predictors of QOL. The Persian version of the WHOQOL-DIS-ID shows acceptable validity and reliability.

Exploring spirituality and quality of life in individuals who are deaf and have intellectual disabilities

PURPOSE

While positive contributions of religion and spirituality (R/S) to quality of life (QOL) are confirmed by a growing body of evidence, only limited research has involved people with intellectual disabilities and so far, no studies included prelingually deaf individuals with intellectual disabilities. This study explores the role of R/S in people with intellectual disabilities and deafness living in three therapeutic living communities specifically adapted to their needs.

METHODS

Forty-one individuals (mean age: 46.93 years, 43.9% female) with prelingual deafness and mild to moderate intellectual disability participated in structured sign language interviews adapted to their cognitive-developmental level, regarding their QOL, individual spirituality and participation in spiritual practices in the community. Participants' QOL was assessed with an established short measure for QOL (EUROHIS-QOL) adapted to easy-to-understand sign language. With 21 participants, qualitative interviews were conducted. In addition, proxy ratings from caregivers were obtained.

RESULTS

The participants' ratings of their individual spirituality (r = 0.334; p = 0.03) and spiritual practices-in-community (r = 0.514; p = 0.00) correlated positively with their self-reported QOL. Qualitative findings illustrate the importance of R/S and give insights into R/S concepts and practices.

CONCLUSIONS

Personal spirituality and participating in spiritual practices are positively related to self-reported quality of life in deaf individuals with intellectual disability (ID). As a consequence, access to spiritual and religious services should be included in comprehensive programs and society at large.

Development and Validation of Standardized Quality of Life Measures for Persons with IDD

The implications of the individual quality of life (QoL) model of Schalock and Verdugo have made it the most cited QoL model in the field of disability. The QoL model is understood as a conceptual and applied framework for action that allows the materialization of the rights of persons with disabilities through the multidimensional assessment of these persons using QoL indicators, and the development of actions guided by these values and supported by evidence. The purpose of this work is to present the foundations of this model and offer a step-by-step guide to developing standardized QoL assessment instruments and providing evidence that supports their use to implement the model in practice. This paper explores relevant topics such as: (a) the need to identify critical population groups and contexts; (b) the identification of QoL indicators for said groups and contexts; (c) the development of items focused on the assessment of personal outcomes; (d) provision to the items of validity evidence based on content and pilot measure design and (e) validation process to gather evidence that supports the uses of the instrument. Last, a framework that allows using the evidence on personal outcomes as disaggregated and aggregated data at different levels of the social system is presented, thus highlighting the role of the model as a change agent regarding individuals, organizations and schools, and public policy.

Health-related quality of life and medication use among individuals with Angelman syndrome

PURPOSE

The primary goal of this analysis is to describe the health-related quality of life (HRQoL), medical history, and medication use among adolescents and adults individuals with Angelman syndrome (AS).

METHODS

The analysis uses baseline data collected during the STARS study, a double-blind placebo controlled trial of gaboxadol (OV101) in adolescents and adults with AS. The HRQoL was estimated using EuroQoL 5-Dimension 5-Level (EQ-5D) health questionnaire proxy 1 version, which was completed by the caregivers. EQ-5D consists of two parts, a 5-dimension descriptive and a visual analogue scale (VAS) component. The utility score derived from EQ-5D ranges from 0 to 1 (perfect health) and VAS ranges from 0 to 100 (perfect health).

RESULTS

87 individuals with AS were included in the present analysis. The mean utility score was 0.44 ± 0.20 and VAS score was 84 ± 1.5. The EQ-5D data indicated that the self-care, mobility and daily activities were most impacted. All adolescents (100%) and most adults (93%) had at least moderate problems with self-care activities, such as washing or dressing themselves. More than half (55%) of the adolescents and adults had at least moderate issues with mobility and usual activities. Approximately, 30% of adolescents and adults had moderate to extreme problems with anxiety/depression. High baseline concomitant use of medications was observed across both age groups with an average of 5 medications being used per person.

CONCLUSION

This study highlights the impact of AS on HRQoL and medication utilization among adolescents and adults individuals with AS.

A person-centered approach to home and community-based services outcome measurement

In the United States, over 2.5 million people with disabilities are recipients of supports through the Center for Medicare and Medicaid Services (CMS) Home and Community-Based Services (HCBS) program. Recent decades have seen a growing focus on providing HCBS in a person-centered manner thereby supporting outcomes that are both important for and to the person. HCBS outcome measurement, however, has not kept pace with advancements in person-centered thinking as it relates to providing supports to people with disabilities. The concept of person-centered outcome measurement has been inadequately defined and is frequently misunderstood including by those in the measurement field. The authors first operationally define person-centered measurement and establish its importance within the context of HCBS and the recent CMS's Final Settings Rule. The important role that person-centered measurement has to play in quality improvement efforts in this area is then explored. A discussion is subsequently provided as to the challenges that are faced in person-centered measurement specific to the disability field. In addition to further conceptualizing and defining this form of measurement, recommendations are provided for moving the field forward.

Quality of life in adults with Down syndrome: A mixed methods systematic review

BACKGROUND

As the life expectancy of adults (aged ≥ 18 years) with Down syndrome increases for a plethora of reasons including recognition of rights, access, and technological and medical advances, there is a need to collate evidence about their quality of life.

OBJECTIVE

Using Schalock and Verdugo's multidimensional quality of life assessment model, this systematic review aimed to identify, synthesise and integrate the quantitative and qualitative evidence on quality of life in adults with Down syndrome via self-and proxy-reporting.

METHODS

Five databases were systematically searched: MEDLINE, CINAHL, PsycINFO, Scopus, and Web of Science to identify relevant articles published between 1980 and 2022 along with grey literature and reference lists from relevant studies. A mixed methods systematic review was performed according to the Joanna Briggs Institute methodology using the convergent integrated approach. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Thirty-nine studies were included: 20 quantitative, 17 qualitative, and 2 mixed methods studies. The synthesised findings were grouped into the 8 core domains of quality of life: personal development, self-determination, interpersonal relations, social inclusion, rights, emotional, physical and material well-being. Of the 39 studies, 30 (76.92%) reported on emotional well-being and 10 (25.64%) on rights. Only 7 (17.94%) studies reported that adults with Down syndrome have a good quality of life centred around self-determination and interpersonal relations. Most adults with Down syndrome wanted to become more independent, have relationships, participate in the community, and exercise their human rights. Self-reported quality of life from adults with Down syndrome was rated higher than proxy reported quality of life. Discrepancies in quality of life instruments were discovered.

CONCLUSION

This review highlighted the need for a better systematic approach to improving the quality of life in adults with Down syndrome in targeted areas. Future research is required to evaluate self-and proxy-reporting methods and culture-specific quality of life instruments that are more appropriate for adults with Down syndrome. In addition, further studies should consider including digital assistive technologies to obtain self-reported quality of life data in adults with Down syndrome.

INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS REGISTRATION NUMBER

CRD42019140056.

Changes in the quality of life of persons with profound intellectual and multiple disabilities following community transition: A Canadian study

BACKGROUND

The goal of this research study was to measure changes in the quality of life (QoL) of adults with profound intellectual and multiple disabilities (PIMD) and complex care needs following their transition from a large institutional residence to smaller community homes in Central Canada.

METHOD

A pre- post-transition quasi-experimental time-series longitudinal study design was implemented to measure the impact of community transition on the QoL of study participants. QoL was assessed in eight domains (self-determination; emotional, physical, and material wellbeing; rights; personal development; social inclusion; and interpersonal relations) by proxy at two time points (Time 1: pre-transition and Time 2: at least 6 months post-transition) using the standardized tool San Martin Scale. The study group included 33 persons with PIMD and complex care needs (20 men [60%] and 13 women [40%]) aged 24-55 years (M = 42.52; SD = 8.07). Paired-samples t-test was conducted to determine significant changes in the QoL of study participants following their community transition.

RESULTS

Between pre- and post-transition, study participants experienced significant improvements in all the eight domains of QoL evaluated as well as in global QoL. Mean differences ranged from 5.67 (SD = 5.16, t₍₃₂₎ = 6.31, p = .001) for rights to 1.73 (SD = 3.10, t₍₃₂₎ = 3.19, p = .003) for physical wellbeing. Mean global QoL improved significantly from 99.97 (SD = 16.54) pre-transition to 120.42 (SD = 10.54) post-transition (M_diff = 17.55, t₍₃₂₎ = 6.69, p = .001).

CONCLUSIONS

This longitudinal study provides evidence of improved QoL for persons with PIMD following deinstitutionalization.

Proxy-report in individuals with intellectual disability: A scoping review

BACKGROUND

Views can be collected from individuals (self-report) or others on their behalf (proxy-report).

OBJECTIVE

We aimed to review the literature on methods and statistical approaches used to evaluate observer versus self-report responses from individuals with intellectual disability or Down syndrome.

METHODS

A series of key questions related to statistical approaches and data collection methods were formulated a priori to inform the search strategy and review process. These addressed the topics of self-report in individuals with intellectual disability, including Down syndrome. Using the National Library of Medicine database, PubMed, detailed literature searches were performed. The quality of available evidence was then evaluated, the existing literature was summarised, and knowledge gaps and research needs were identified.

RESULTS

Fifty relevant original articles were identified which addressed at least one key question. Study details, including: research design, internal validity, external validity, and relevant results are presented. Review of studies of individuals with intellectual disability which used a variety of statistical approaches showed mixed agreement between self-report and proxy-report.

CONCLUSION

Few studies identified to-date have used self-report from individuals with Down syndrome, but lessons from the existing intellectual disability literature can guide researchers to incorporate self-report from individuals with Down syndrome in the future.

Quality of Life Outcomes in a Community Cohort of Adults With an Intellectual Disability Using the Personal Outcome Scale

Objectives

Quality of life (QoL) is a multi-dimensional phenomenon composed of core domains that are influenced by personal characteristics, values, and environmental contributions. There are eight core domains of QoL aligned with both the United Nations and the International Association for the Scientific Study of Intellectual and Developmental Disabilities (IASSIDD). The Personal Outcome Scale (POS), is a semi-structured self and proxy instrument that specifically measures these aspects of QoL for people with an intellectual disability.

Methods

A total of 85 people with an intellectual disability and their primary keyworker (n = 85) took part in this study. A convenience sample recruitment strategy was employed to recruit participants during the calendar year from January–December 2020. Participants completed the self-report and proxy POS, and clinic-demographic data was also considered.

Results

QoL is higher in those who have a dedicated service planner and also for those with a less severe to profound disability. People who were in gainful employment reported significantly higher QoL as did those availing of outreach and residential services, over and above local services.

Conclusions

This research shows that there are distinct and specific factors that relate to QoL for people with an intellectual disability community-based services in Ireland. Future research could aim to investigate these longitudinally, and specifically how QoL relates to cognitive and functional outcomes.

Development and psychometric assessment of a psychological well-being instrument for adults with mild intellectual disability or borderline intellectual functioning

BACKGROUND

Measuring eudaimonic well-being is important to gain a complete picture of the well-being of individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF), but there is no measurement instrument available for this population coding for multiple dimensions of eudaimonic well-being.

AIMS

The current study developed and piloted a new instrument coding for eudaimonic well-being in individuals with MID-BIF.

METHODS AND PROCEDURES

The instrument (SPWB-ID) was adapted from Ryff's scales of psychological well-being, including subscales addressing purpose in life, environmental mastery, positive relationships, self-acceptance, personal growth, and autonomy. Adaptations were based on the literature and interviews with people with MID-BIF and experts in the field. The SPWB-ID was piloted among 103 adults with MID-BIF.

OUTCOMES AND RESULTS

The trimmed version of the SPWB-ID showed sufficient to good internal consistency and test-retest reliability. Hypothesis testing for construct validity suggested the subscales of the SPWB-ID measured well-being, showing moderate to high correlations with quality of life, and differences in eudaimonic well-being between participants with and without clinically relevant depression scores.

CONCLUSIONS AND IMPLICATIONS

The SPWB-ID reliably measures eudaimonic well-being in individuals with MID-BIF. This enables support providers to collect information on eudaimonic well-being, providing input for person-centred care and support for individuals with MID-BIF.

A comparison of self-report, systematic observation and third-party judgments of church attendance in a rural Fijian Village

Social desirability reporting leads to over estimations of church attendance. To date, researchers have treated over-reporting of church attendance as a general phenomenon, and have been unable to determine the demographic correlates of inaccuracy in these self-reports. By comparing over eight months of observational data on church attendance (n = 48 services) to self-report in a rural Fijian village, we find that 1) self-report does not reliably predict observed attendance, 2) women with two or more children (≥ 2) are more likely to over-report their attendance than women with fewer children (≤ 1), and 3) self-report of religiosity more reliably predicts observed church attendance than does self-report of church attendance. Further, we find that third-party judgements of church attendance by fellow villagers are more reliably associated with observed church attendance than self-report. Our findings suggest that researchers interested in estimating behavioral variation, particularly in domains susceptible to social desirability effects, should consider developing and employing third-party methods to mitigate biases inherent to self-report.

The reporters' agreement in assessing the quality of life of young people with intellectual disabilities

A good evaluation of the quality of life (QoL) of young people with disability is essential to detect, monitor and report their support needs in research, and individual, institutional and policy planning. The aim of this study is to evaluate the reporters' agreement in the assessment of the QoL of young people with Intellectual Disabilities in transition to adulthood. Self and proxy-report version of INICO-FEAPS quality of life scale was used to assess 119 students of a post-compulsory educational program, being the proxy-report informed by one of their relatives. Results show poor intraclass correlations between informants. No discrepancies were found in the global QoL. However, small discrepancies were found for some dimensions. Young people's reports were higher for self-determination, personal development and interpersonal relationships. On the contrary, relatives' reports were higher for rights, material and physical wellbeing. The discrepancies in global QoL assessment were not related to student's severity, IQ, diagnosis or parent's gender. These findings underline the importance of young people's participation in the assessment of their QoL as well as the convenience of using both kind of informants when taking appropriate decisions in educational contexts during transition to adulthood.

Needs of older people with intellectual disabilities: variables influencing inter-respondent (client vs staff) agreement

Background: The importance of understanding the needs of older people with intellectual disabilities (IDs) is obvious, but the research available is limited. This study identifies the self-reported needs of older adults with IDs and compares them with staff reported needs regarding the same older adults with ID, therefore specifying and explaining agreements and disagreements. Method: The needs of 96 older adults with IDs were assessed through the Inventory of Identification of Needs (informant and self-report versions). Results: Both older people with IDs and staff reported quite diverse needs related to all the domains assessed by the IIN: physical health, literacy, information, meaningful activity, participation in the community, mental health, basics needs and accommodation. All the mean scores of the informant version of the IIN were higher than the ones of the self-report version. Agreement amongst informants was influenced by the prominence of needs, the accessibility to and the subjectivity of the information, and social desirability. Conclusions: A consumer-driven approach implies that services should be based on the needs identified.

Is it feasible to assess self-reported quality of life in individuals who are deaf and have intellectual disabilities?

PURPOSE

There is consensus that Quality of Life (QOL) should be obtained through self-reports from people with intellectual Disability (ID). Thus far, there have been no attempts to collect self-reported QOL from people who are deaf and have ID.

METHODS

Based on an established short measure for QOL (EUROHIS-QOL), an adapted easy-to-understand sign language interview was developed and applied in a population (n = 61) with severe-to-profound hearing loss and mild-to-profound ID. Self-reports were conducted at two time points (t₁ and t₂), 6 months apart. The Stark QOL, an established picture-based questionnaire, was also obtained at t₂ and three Proxy ratings of QOL (from caregivers) were conducted for each participant at t₁.

RESULTS

Self-reported QOL was successfully administered at both time points for 44 individuals with mild and moderate ID (IQ reference age between 3.3 and 11.8 years). The self-reports showed sufficient test-retest reliability and significant correlations with the Stark QOL. As anticipated, self-reported QOL was higher than proxy-reported QOL. Test-retest reliability and internal consistency were good for self-reported QOL.

CONCLUSION

Reliable and valid self-reports of QOL can be obtained from deaf adults with mild-moderate ID using standard inventories adapted to the linguistic and cognitive level of these individuals.

Addressing Quality of Life of Children With Autism Spectrum Disorder and Intellectual Disability

Despite the advances on the assessment of quality of life, this concept is barely studied and is riddled with important limitations for those with autism spectrum disorder (ASD). This article is aimed at validating a questionnaire to assess quality of life of children with ASD and intellectual disability (ID). Based on the KidsLife Scale, geared toward people with ID, the most reliable items for those with ASD were selected. Study participants were 420 persons, from 4 to 21 years old. Results indicated that the KidsLife-ASD Scale measured eight intercorrelated domains, had good reliability, and exhibited adequate evidences of validity. KidsLife-ASD emerges as a helpful tool to guide person-centered planning addressed at improving quality of life.

Capturing the complexity of healthcare for people with Down syndrome in quality indicators - a Delphi study involving healthcare professionals and patient organisations

BACKGROUND

Insight into quality of healthcare for people with Down Syndrome (DS) is limited. Quality indicators (QIs) can provide this insight. This study aims to find consensus among participants regarding QIs for healthcare for people with DS.

METHODS

We conducted a four-round Delphi study, in which 33 healthcare professionals involved in healthcare for people with DS and two patient organisations' representatives in the Netherlands participated. Median and 75-percentiles were used to determine consensus among the answers on 5-point Likert-scales. In each round, participants received an overview of participants' answers from the previous round.

RESULTS

Participants agreed (consensus was achieved) that a QI-set should provide insight into available healthcare, enable healthcare improvements, and cover a large diversity of quality domains and healthcare disciplines. However, the number of QIs in the set should be limited in order to prevent registration burden. Participants were concerned that QIs would make quality information about individual healthcare professionals publicly available, which would induce judgement of healthcare professionals and harm quality, instead of improving it.

CONCLUSIONS

We unravelled the complexity of capturing healthcare for people with DS in a QI-set. Patients' rights to relevant information have to be carefully balanced against providers' entitlement to a safe environment in which they can learn and improve. A QI-set should be tailored to different healthcare disciplines and information systems, and measurement instruments should be suitable for collecting information from people with DS. Results from this study and two preceding studies, will form the basis for the further development of a QI-set.

Identifying Predictors for Enhanced Outcomes for People With Intellectual and Developmental Disabilities

People with intellectual and developmental disabilities (IDD) often rely on Medicaid-funded services and supports to facilitate their daily living. The financial investment for these services is significant, yet little work has been conducted to understand how these investments affect life outcomes. This pilot study used a novel data integration approach to offer initial insights about how Medicaid expenditures relate to outcomes using Medicaid claims data, results of the National Core Indicators consumer survey, and data from the Supports Intensity Scale (SIS). Findings suggested that subpopulations of people with IDD who also had high behavioral needs or high medical needs had significantly higher expenditures than individuals with more typical SIS-assessed support needs. Regression analyses suggested mixed outcomes based on the factors we considered, including a finding that people with IDD who lived in sponsored residential care homes were more likely to engage in inclusive activities in the community than those who lived in larger congregate settings, or those who lived in a family home. Results of this pilot, when brought to scale, will be useful in examining the performance of state IDD service systems over time.

Generic preference-based health-related quality of life in children with neurodevelopmental disorders: a scoping review

AIM

To describe how generic preference-based health-related quality of life (HRQoL) instruments have been used in research involving children with neurodevelopmental disorders (NDD).

METHOD

A systematic search of nine databases identified studies that used generic preference-based HRQoL instruments in children with NDD. Data extracted following the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Review guidelines included type of NDD, instrument used, respondent type, justification, and critical appraisal for these selections.

RESULTS

Thirty-six studies were identified: four cost-utility analyses; 15 HRQoL assessments; five economic burden studies; three intervention studies; and nine 'other'. The Health Utilities Index (Mark 2 and Mark 3) and EuroQoL 5D (EQ-5D; three-level EQ-5D, five-level EQ-5D, and the youth version of the EQ-5D) instruments were most frequently used (44% and 31% respectively). The relatively low use of these instruments overall may be due to a lack of psychometric evidence, inconsistency in justification for and lack of clarity on appropriate respondent type and age, and geographical challenges in applying preference weights.

INTERPRETATION

This study highlights the dearth of studies using generic preference-based HRQoL instruments in children with NDD. The use of cost-utility analysis in this field is limited and validation of these instruments for children with NDD is needed. The quality of data should be considered before guiding policy and care decisions.

WHAT THIS PAPER ADDS

Limited use of generic preference-based health-related quality of life (HRQoL) instruments in studies on children with neurodevelopmental disorders. Only 11% of studies were cost-utility analyses. Inconsistencies in justification for choosing generic preference-based HRQoL instruments and respondent types.

Impact of the intellectual disability severity in the Spanish Personal Outcomes Scale

BACKGROUND

The interest in measuring quality of life (QoL) in persons with intellectual disability (ID) has brought about a number of QoL measurements for this population. These measurements need to address two issues that have contributed to enhancing the current instruments. First, the necessity to develop measures with adequate psychometric properties, which has been discussed in recent studies, and second, the agreement between experts in analysing objective and subjective perspectives, as well as the use of self-report to include the participation of the person with ID. The question that we set out to investigate in this paper is whether the measurements function properly for the person with ID, independent of their level of severity. We used the Spanish version of the Personal Outcomes Scale, as it is a psychometrically sound instrument and includes three sources of information (the person with ID, a professional and a family member).

METHOD

The sample was composed of 529 persons with ID (296 men, representing 55.95% of the total sample, and 233 women, with M_age  = 35.03, SD = 10.82) from several regions of Spain, along with their professional of reference and a family member. The severity variable was estimated for each item based on estimations of differential item functioning.

RESULTS

The results showed that several items were undervalued by the assessments if the severity of the ID was greater. Mainly, this difference was observed in the assessments by professionals and in the dimensions of rights, personal development and self-determination.

CONCLUSIONS

This paper focuses on the uses and interpretations of the results of the QoL measurements in the Personal Outcomes Scale. The results indicate that, in our sample, when people with high levels of ID are assessed, the functioning of some items are affected by the severity of this disability. For correct use, these items must be interpreted on the basis of the results obtained. Additionally, it is necessary to thoroughly review the QoL indicators for persons with severe or profound ID.

Assessing the validity of proxy caregiver reporting for potential palliative care outcome measures in Parkinson's disease

BACKGROUND

There is increasing interest in applying palliative care approaches for patients with Parkinson's disease. Methodological studies are needed to validate palliative care outcome measures for Parkinson's disease to build this evidence base. As many patients with Parkinson's disease have cognitive and/or communication issues, proxy outcome measures may improve the inclusivity and relevance of research.

AIM

To assess the validity of proxy caregiver reports for several potential palliative care outcome measures.

DESIGN

A cross-sectional study of Parkinson's disease patients and caregivers completed a battery of outcome measures relevant to palliative care including the Memorial Symptom Assessment Scale, Hospital Anxiety and Depression Scale, Prolonged Grief Questionnaire 12, Parkinson Disease Questionnaire 39, Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing, and Schwab and England. Intraclass correlation coefficients were used to assess agreement.

SETTING/PARTICIPANTS

A total of 50 Parkinson's disease patient and caregiver dyads recruited at an academic medical center, Veterans Affairs Medical Center, and community support groups.

RESULTS

There was moderate to good agreement for Schwab and England, Parkinson Disease Questionnaire 39 total, and majority of Parkinson Disease Questionnaire 39 subscales; moderate to good agreement for the Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing, Prolonged Grief Questionnaire 12, and Memorial Symptom Assessment Scale; and poor to moderate agreement for the Parkinson Disease Questionnaire 39 stigma, social support, and bodily pain subscales. Caregivers tended to attribute higher symptom severity than patients. We did not detect differences in intraclass correlation coefficient based on cognitive status but patients with advanced illness had significantly lower intraclass correlation coefficients for several outcomes.

CONCLUSIONS

Caution is indicated when considering caregiver proxy reporting for most outcomes assessed, particularly in Parkinson's disease patients with advanced disease.

Support values through the eyes of the patient: An exploratory study into long-term support of persons with refractory epilepsy

A significant group of persons affected by refractory epilepsy require a wide range of long-term support from professionals as well as informal support givers. To enhance person-centeredness, it is important to know which patient values are associated with long-term support. An Internet survey produced a total of 1176 statements from 289 persons with epilepsy for analysis. Statements were expressed in the respondent's own words and were related to positive experiences (704) as well as possible areas of improvement (472) regarding the support received in the past six months. Thematic summaries of the survey results were presented to four focus groups of persons with epilepsy and proxies with a request to formulate the most important patient values which should be observed in long-term support. In iterative sessions with a panel of epilepsy experts, a framework of twelve value domains was formulated, organized in four major value clusters. An example of how these value domains can be operationalized for use in practice is next presented as a checklist to help evaluate the support patients with long-term support needs actually receive. Correspondingly, two sets of reflective questions were formulated for informal and professional support givers for the purpose of evaluating and improving person-centeredness in their support practices.

Dimensionality and internal structure of the Colombian version of the INICO-FEAPS quality of life scale

BACKGROUND AND OBJECTIVE

Measuring quality of life (QoL) in people with intellectual disabilities (IDs) can help organisations and practitioners to implement evidence-based practices and develop person-centred planning and individualised supports. There is no reliable and valid instrument for assessing QoL in people with ID in Colombia. We investigated the internal structure of the Colombian version of the INICO-FEAPS scale and tested whether the scale identified the eight interrelated domains of the QoL conceptual framework originally described by.

METHOD

Data were collected from 602 adults with moderate levels of ID and respective proxies, who completed the self-report and the report by other scales, respectively. Five measurement models were tested through confirmatory factor analysis.

RESULTS

The eight correlated dimension model showed the best fit to the data. Reliability and convergent validity of the indicators were satisfactory in both versions of the scale (self-report and proxy report).

CONCLUSIONS

This study contributes to research on QoL measurement by providing the first empirical evidence regarding the dimensionality, internal structure and psychometric properties of the Colombian version of the INICO-FEAPS scale. Moreover, the study presents the first adaptation of a specific QoL scale for people with ID in Colombia, which may in the future be useful for implementing evidence-based practices and developing person-centred support plans.

Item response theory analysis applied to the Spanish version of the Personal Outcomes Scale

BACKGROUND

The study of measurements of quality of life (QoL) is one of the great challenges of modern psychology and psychometric approaches. This issue has greater importance when examining QoL in populations that were historically treated on the basis of their deficiency, and recently, the focus has shifted to what each person values and desires in their life, as in cases of people with intellectual disability (ID). Many studies of QoL scales applied in this area have attempted to improve the validity and reliability of their components by incorporating various sources of information to achieve consistency in the data obtained. The adaptation of the Personal Outcomes Scale (POS) in Spanish has shown excellent psychometric attributes, and its administration has three sources of information: self-assessment, practitioner and family. The study of possible congruence or incongruence of observed distributions of each item between sources is therefore essential to ensure a correct interpretation of the measure. The aim of this paper was to analyse the observed distribution of items and dimensions from the three Spanish POS information sources cited earlier, using the item response theory.

METHOD

We studied a sample of 529 people with ID and their respective practitioners and family member, and in each case, we analysed items and factors using Samejima's model of polytomic ordinal scales.

RESULTS

The results indicated an important number of items with differential effects regarding sources, and in some cases, they indicated significant differences in the distribution of items, factors and sources of information.

CONCLUSIONS

As a result of this analysis, we must affirm that the administration of the POS, considering three sources of information, was adequate overall, but a correct interpretation of the results requires that it obtain much more information to consider, as well as some specific items in specific dimensions. The overall ratings, if these comments are considered, could result in bias.

People with intellectual disability who are ageing: Perceived needs assessment

Background/Objective: Ageing and progressive increase in life expectancy in people with intellectual disability present significant challenges. The present study is to examine the needs that arise in the aging process of this population. To detect these needs is fundamental to ensure personal wellbeing; almost no psychometrically sound instruments have been developed. Method: A structured interview was developed and evaluated by a panel of 20 experts to obtain evidence of content validity. The interview was then applied to 1,173 people with intellectual disability. The ages ranged from 35 to 80 (M = 52.27; SD = 7.5). Results: The interview consisted of 93 items evaluating four areas: perceived needs, personal problems, future perspectives, and solutions required. The results demonstrated the proximity and relationship of the various needs evaluated. In addition it was observed that those with intellectual disability who were older, male and users of residential services tended to indicate more needs, problems, and required more solutions. Conclusions: The instrument has adequate evidence of validity, allowing the evaluation of specific needs of people with intellectual disability. The results advocate the design of transversal intervention policies in order to effectively meet the needs and requirements of this population.

A new scale for the measurement of quality of life in children with intellectual disability

BACKGROUND

Children and adolescents with intellectual disabilities make up a group which is in urgent need of an adequate operationalisation of the quality of life construct, not only to improve individual personal outcomes but also to develop and implement evidence based practices. For that reason, and with the aim of answering the growing demand for an adequate evaluation instrument for this group, the KidsLife scale was developed.

METHOD

This research provides evidence of the reliability and validity of the scale, which is composed of 96 items spread over eight subscales, and completed by a third-party respondent. The validation sample comprised 1060 people with intellectual disability, with ages ranging from 4 to 21 years old (M=13.51; SD=5.04).

RESULTS

The results suggest that the eight quality of life domains assessed on the scale are reliable (Cronbach's alpha ranging from 0.812 to 0.949). The evidence of the validity of the construct provided by Confirmatory Factor Analysis also demonstrated adequate indexes of fit for the eight-domain model.

DISCUSSION

Future lines of research which may use the KidsLife Scale are suggested and discussed.

Validation of the Portuguese version of the Personal Outcomes Scale

BACKGROUND/OBJECTIVE

Quality of life (QOL) is actually helpful to organizations for guiding personalized support plans and enhance personal outcomes. However, there is a lack of consensus about the QOL construct in the field of intellectual disability (ID). This study aims (a) to analyze the first-order factor structure (i.e., eight domains) of the Portuguese version of the Personal Outcomes Scale (POS), and (b) to compare two alternative models of the higher factor structure of the QOL construct (i.e., Salamanca and Schalock).

METHOD

Both aims were investigated by examining self-report and report-of-others measures. Data were collected from 1,264 adults with mild or moderate levels of ID and respective proxies.

RESULTS

Results from confirmatory factor analysis (CFA) showed evidence of suitable psychometric properties of the QOL dimensions. Findings also highlighted that the first-order model was more robust than either of the two second-order models. Nevertheless, the Schalock structure was stronger than the Salamanca structure.

CONCLUSIONS

Although further research is needed, the results reveal that the Portuguese POS may be a valid and reliable instrument to measure QOL of adults with ID. The implication of these results are discussed highlighting the scale as a useful tool to serve as the basis for planning and evaluating personalized supports.

Social/economic costs and health-related quality of life in patients with fragile X syndrome in Europe

OBJECTIVE

To estimate the social/economic costs of fragile X syndrome (FXS) in Europe and to assess the health-related quality of life (HRQOL) of patients and caregivers.

METHODS

A cross-sectional study was conducted in a sample of European countries. Patients were recruited through patients' associations. Data on their resource use and absence from the labour market were retrospectively obtained from an online questionnaire. Costs were estimated by a bottom-up approach and the EuroQol-5 Domain (EQ-5D) questionnaire was used to measure patients' and caregivers' HRQOL.

RESULTS

Five countries were included in the analysis. The mean annual cost of FXS per patient varied from €4951 in Hungary to €58,862 in Sweden. Direct non-healthcare costs represented the majority of costs in all countries but there were differences in the share incurred by formal and informal care among those costs. Costs were also shown to differ between children and adults. Mean EQ-5D utility score for adult patients varied from 0.52 in France (n = 42) to 0.73 in Hungary (n = 2), while for caregivers this score was consistently inferior to 0.87.

CONCLUSION

Our findings underline that, although its prevalence is low, FXS is costly from a societal perspective. They support the development of tailored policies to reduce the consequences of FXS on both patients and their relatives.

The Diagnostic Guideline for Anxiety and Challenging Behaviour for Persons with Intellectual Disabilities: Preliminary Outcomes on Internalizing Problems, Challenging Behaviours, Quality of Life and Clients' Satisfaction

BACKGROUND

People with intellectual disabilities are vulnerable to develop psychopathology (in particular anxiety) and related challenging behaviour. A diagnostic guideline was developed to support professionals to better diagnose and thus treat psychopathology and related CB. This study examined preliminary outcomes from the application of this guideline.

METHOD

A comparative multiple case study with an experimental and a control condition.

RESULTS

The application of the guideline showed a trend of decreases of internalizing problems (P = 0.07) and anxiety/depressed problems (P = 0.09). We found no statistically significant decreases of externalizing problems and no increases in perceived quality of life as compared with care as usual. Clients were not more satisfied with the support they received for coping with their emotional and behaviour problems.

CONCLUSION

The application of the Diagnostic Guideline for Anxiety and Challenging Behaviour did not show statistically significant changes in externalizing problems and Quality of Life. Despite the small sample size of n = 59, we did find a trend in decreasing internalizing problems and anxiety/depressed problems. Further research into either or not confirming these trends is recommended.

Predictors of quality of life in people with intellectual disability in Bosnia and Herzegovina

Quality of life (QOL) of people with intellectual disability is increasingly becoming the target for intervention and a measure of success of different support programs. Knowing the predictors of QOL might make the support programs more effective. In the present study, QOL of 152 persons with intellectual disability was assessed through the personal outcomes scale (POS)-self report. Total score on the POS was used as a dependent variable and age, sex, level of intellectual disability, employment status and marriage status were assessed as the potential predictors of QOL. The statistically significant predictors of QOL were level of intellectual disability and employment status. These predictors explained 19% of variance in POS scores. The results of this study indicate that the strategies aimed at increasing the QOL of people with disability must focus on finding and expanding the employment opportunities for people with intellectual disability. The role of non-governmental organizations (NGOs) can be very significant in this regard. The article concludes with a discussion of how predictors of QOL outcomes reported by other investigators could be incorporated into the policies and practices of NGOs to enhance person-referenced QOL outcomes.

Fragile X syndrome: economic burden and health-related quality of life of patients and caregivers in France

BACKGROUND

Fragile X syndrome (FXS) is the main hereditary cause of intellectual disability. Although the associated burden appears to be considerable, to date no study has comprehensively assessed the cost incurred because of FXS, including its specific impact on health-related quality of life and the burden on caregivers using standardised quantitative tools. The aim of this article is to provide data in order to increase awareness of the repercussions of FXS on patients and caregivers as well as on the health and social care systems in France.

METHODS

A retrospective cross-sectional study was carried out on 145 patients recruited through Le Goëland X-Fragile and Mosaïques, the French FXS patient associations. Data on their demographic characteristics and resource use were obtained from an online questionnaire, and costs were estimated by a bottom-up approach. The EQ-5D health questionnaire was used to measure patients' and caregivers' health-related quality of life. Perceived burden of care was measured using the Zarit Caregiver Burden Interview. The Barthel index, a non-utility-based assessment, was used to measure patients' level of dependence.

RESULTS

The annual total direct cost of FXS was estimated at €25 800 per patient. The main contributors were informal care provided by the main caregiver (€10 500) and social services (€8400). Healthcare costs, estimated at €2700, represented only a minor share. Mean EQ-5D utility scores were 0.49 for patients and 0.75 for caregivers. The mean burden for caregivers as measured by the Zarit Caregiver Burden Interview was 39.9.

CONCLUSIONS

Fragile X syndrome requires significant resources that are mainly of a non-medical nature and are higher for children than for adults. Compared with related diseases, it constitutes a particularly high burden for caregivers. Using a bottom-up approach and a wide range of standardised measures, this study underscores the need for greater awareness of the burden of FXS as well as an assessment of new and existing interventions to address it.

Operationalisation of quality of life for adults with severe disabilities

BACKGROUND

The operationalisation of quality of life for people with more severe disabilities has been acknowledged in the published research for more than two decades. This study aims to contribute to our knowledge and understanding of the quality of life of adults with severe disabilities by developing a set of quality of life indicators appropriate to this population using a Delphi method and the eight-domain conceptual model proposed by Schalock & Verdugo (2002).

METHOD

The participating panel in the Delphi method included 12 experts who evaluated each proposed item according to four criteria: suitability, importance, observability and sensitivity. Descriptive analyses were used to select the best items in each of the four rounds of this Delphi study, as well as examining the coefficients of concordance that were calculated for the final pool of items.

RESULTS

The four rounds of the Delphi study resulted in a final pool of 118 items (91 that were considered valid in the first round plus 27 items proposed, reformulated or discussed in the following rounds). Importance and sensitivity were the criteria that received the highest and lowest ratings, respectively, but also the ones that had the highest and lowest mean coefficients of concordance. Experts showed the strongest agreement for items related to material well-being, while the weakest was found for items related to personal development.

CONCLUSIONS

This study further contributes to our understanding of how to operationalise and measure quality of life in adults with severe disabilities. The item pool generated may prove helpful in the development of instruments for the measurement of quality of life-related outcomes in this population.

Proxy and self-reported Quality of Life in adults with intellectual disabilities: Impact of psychiatric symptoms, problem behaviour, psychotropic medication and unmet needs

Proxies often underestimate the subjective Quality of Life (QoL) of adults with intellectual disability (ID). However, little is known about the reasons for these differences. Accordingly, the purpose of the present study is to, firstly, compare the self-reported QoL of adults with ID with proxy reports from staff of sheltered working and housing facilities, and, secondly, to identify possible differences of the impact of four potential predictor variables. Data of 102 adults with ID were collected as part of the MEMENTA study ('Mental health care provision for adults with ID and a mental disorder'). Results show that self-report QoL scores ranged from 72.6 to 86.8. Both proxies consistently reported lower QoL scores and agreement between self and proxy ratings was predominantly poor. Unmet needs and psychotropic medication were identified as the most important predictors of reduced self-rated QoL, whereas an increase of psychiatric symptoms, problem behaviours, and psychotropic medication best predicted the reduced QoL proxy ratings. To conclude, proxies still have to strive for a more holistic approach in surrogate QoL assessments and according to adults with ID, service providers should focus on a reduction of unmet needs and psychotropic medication to further improve QoL.

Psychometric properties of the Spanish version of the Personal Outcomes Scale

Personal outcomes-related quality of life provides information about the impact of individualized supports and services that are provided to people with intellectual disability. The Personal Outcomes Scale (POS) is a valid and reliable instrument that measures these outcomes using two parts, self-report and report by others. Based on the POS, the aim of this study is to provide a new psychometric study of the instrument that allows the evaluation of the three principal informers involved in the enhancement of individual's quality of life: individual with intellectual disability, professional and family member. This approach overcomes the limitations of the POS. For the self-report were involved 529 people with intellectual disability. A professional (N = 522) and a family member (N = 462) separately participated for the report by others versions to assess personal outcomes for each participant. The reliability study provides appropriate values for the first and second order factors with α values being higher than .82. The construct validity analysis provides an adjustment of the theoretical model, particularly regarding the assessments from professionals. Results show this instrument is adequate to evaluate personal outcomes and giving the guidelines for making policy and practice decisions.