Quality of Life as an Outcome Measure of Rehabilitation Service?

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To ensure continued funding vocational rehabilitation (VR) agencies must provide documentation that they deliver effective services efficiently.  Although overall quality of life is an established goal of all VR services, short-term job placement has historically served as the primary measure of service outcomes. Despite its clear importance, job placement as an outcome measure provides little information about consumers and their needs in other life areas. Its limited focus can also obscure the benefits of rehabilitation services beyond vocational placement in treating the whole person.

The International Classification of Functioning (ICF) model is a comprehensive framework to conceptualize chronic illness and disability across the domains of body functions and structures, activity, and participation in society; it also accounts for the impact of personal and environmental factors on functioning. The ICF model is used to provide a picture of how an individual experiences disability and chronic illness across various life domains. Many researchers have advocated for the use of the ICF as a tool to systematically understand consumer’s rehabilitation needs, and to evaluate rehabilitation outcomes.


This study addressed the utility of the ICF model to assess quality of life (QOL) among adults with disabilities receiving vocational and educational services. Results found that the ICF model provided greater predictive validity for QOL than the traditional outcome measure of job placement.


Because research strongly supports the ICF model as a framework for assessing consumers’ quality of life, the following interventions are suggested:

  • To guide service plan development, use the ICF model to assess consumers’ functional skills, environmental supports, and opportunities for activity and participation in society at the beginning of service provision.  Beneficial services and areas of focus could include:
    •  Counseling and guidance
      — Social relationships or sources of support
      — Home and work environment
      — Community access
    • Vocational training/education
    • Durable medical equipment and rehabilitation technology
    • Supported employment
    • Transition services
  • Briefly assess consumers’ quality of life at both the beginning and end of service provision to evaluate the impact of service on the whole person.  This could be done with a simple question: “How would you rate the quality of your life?”

Bottom Line

Assessment of ICF domains and QOL before and after the provision of rehabilitation services can provide counselors with a more holistic picture of the individual.  This information can be used to better capture the benefits of rehabilitation services, and serve as a guide for counselors in providing more targeted needs.

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Source: Fleming, A. R., Fairweather, J. S., & Leahy, M. J. (2013). Quality of Life As a Potential Rehabilitation Service Outcome: The Relationship Between Employment, Quality of Life, and Other Life Areas. Rehabilitation Counseling Bulletin, 57(1), 9–22. doi:10.1177/0034355213485992

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