Subjective weighting of disability: an approach to quality of life assessment in rehabilitation.

The impact of various disabilities may differ greatly from individual to individual. Therefore, for a full assessment of a rehabilitee, objective aspects of disability should be supplemented with disability perception. The purpose of this study was to construct a self-administered questionnaire of 39 abilities/activities based on the ICIDH D-code, with parallel questions about '(dis)ability' and 'impact'. The instrument was used to obtain data from 60 disabled people. Fifty forms (83%) were returned from 25 patients with spinal cord injury and 25 patients with rheumatoid arthritis. Mean time to fill out the questionnaire was 24 minutes. A first attempt to validate the 'weighted score' with an open question about the most negative aspects of the disease showed a (very) good correspondence in 74%. An information gain as a result of the impact question was noted in 44%. This instrument has attractive properties for clinical use and research purposes in rehabilitation medicine. It was developed for the identification of needs of individual patients. The 'weighted scores' allow the setting of priorities in an individually tailored rehabilitation programme. Future applications might include monitoring the progress of a rehabilitee and identification of group needs.