The Life Satisfaction Matrix: an instrument and procedure for assessing the subjective quality of life of individuals with profound multiple disabilities

Parent perspectives on the assessment of quality of life of their children with profound intellectual and multiple disabilities in the Netherlands

BACKGROUND

Assessing Quality of Life (QoL) of persons with profound intellectual and multiple disabilities (PIMD) is challenging, yet QoL plays an important role in medical decision-making processes concerning persons with PIMD. The perspectives of parents of children with PIMD on the assessment of their QoL have not been studied.

AIM

To explore the perspectives of parents on the assessment of QoL of their children.

METHODS

We conducted a qualitative study, forming three focus groups with 22 parents of children with PIMD to explore their views on what is necessary to assess QoL of their children and subsequently, who is best suited to assess QoL.

RESULTS

Parents describe a long-term relationship of the assessor with family (child and parents), with trust as an important aspect, as a requirement to assess QoL. Parents consider family members, preferably the parents themselves as the best assessors of QoL, followed by siblings. Professional caregivers, mostly mentioned by name, are considered the next alternative. Most parents thought that physicians do not know the child well enough to assess their QoL.

CONCLUSIONS

In conclusion, the parents of children with PIMD in our study consider trust and a long-term relationship essential for assessing QoL.

The missing piece. Physiological data as a factor for identifying emotions of people with profound intellectual and multiple disabilities

Introduction: The preferences of people with profound intellectual and multiple disabilities (PIMD) often remain unfulfilled since it stays challenging to decode their idiosyncratic behavior resulting in a negative impact on their quality of life (QoL). Physiological data (i.e. heart rate (variability) and motion data) might be the missing piece for identifying emotions of people with PIMD, which positively affects their QoL. Method: Machine learning (ML) processes and statistical analyses are integrated to discern and predict the potential relationship between physiological data and emotional states (i.e. numerical emotional states, descriptive emotional states and emotional arousal) in everyday interactions and activities of two participants with PIMD. Results: Emotional profiles were created enabling a differentiation of the individual emotional behavior. Using ML classifiers and statistical analyses, the results regarding the phases partially confirm previous research, and the findings for the descriptive emotional states were good and even better for the emotional arousal. Conclusion: The results show the potential of the emotional profiles especially for practitioners and the possibility to get a better insight into the emotional experience of people with PIMD including physiological data. This seems to be the missing piece to better recognize emotions of people with PIMD with a positive impact on their QoL.

Looking back, looking forward: Methodological challenges and future directions in research on persons with profound intellectual and multiple disabilities

BACKGROUND

Within the context of the Special Interest Research Group (SIRG) on Persons with Profound Intellectual and Multiple Disabilities (PIMD), researchers often discuss the methodological problems and challenges they are confronted with. The aim of the current article was to give an overview of these challenges.

METHODS

The challenges are centred on six topics. These reflect the main components of a study's design: (a) participant demarcation, (b) participant recruitment, (c) data collection and instruments, (d) data analysis, (e) ethics/including the "voice" of persons with PIMD and (f) theoretical models.

RESULTS

Next, to describing the specific challenges, possible solutions and pathways to address them are discussed. These are illustrated by recent studies by the authors and other researchers in the field.

CONCLUSIONS

The current contribution wants to stimulate further discussion and exchange of ideas, and the development of creative research techniques.

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.

Residential placement and quality of life for adults with severe autism spectrum disorders and severe-to-profound intellectual disabilities

Purpose

The purpose of this paper is to evaluate the relationship between some main characteristics of different living arrangements and the quality of life (QoL) of their users with severe intellectual disability and low-functioning autism spectrum disorders.

Design/methodology/approach

Study participants were assessed for ASD severity through the Childhood Autism Rating Scale or the Vineland Adaptive Behavior Scales (VABS): for behavioral problems with the aberrant behavior checklist (ABC); for perception of efficacy and satisfaction with care, through an adapted Visual Analogue Scale; and for QoL with the QoL inventory in residential environments (validated in French as Inventaire de la Qualité de Vie en Milieu Résidentiel). Because the goal was to define a “residential profile (RP),” the authors evaluated each participating residence with the Working Methods Scale and the questionnaire on residential parameters.

Findings

The RP allowed for the classification of the residences into three clusters. The authors found no clear relationship between QoL and the RP clusters, but the authors found the RP clusters to be significantly correlated with ABC factors F1 (irritability, agitation, crying) and F2 (lethargy, social withdrawal), and VABS scores for living, socialization, and motor skills.

Originality/value

RPs were more strongly correlated with ABC items and the ability to cope with everyday life than with QoL. The authors hypothesize that RP is correlated with both aberrant behavior and the autonomy of residents and that QoL remains relatively stable. Therefore, RP is correlated with the status of the residents; however, this appears not to be correlated with their QoL.

Deep Assessment: A Novel Framework for Improving the Care of People with Very Advanced Alzheimer's Disease

Best practice in understanding and caring for people with advanced Alzheimer's disease presents extraordinary challenges. Their severe and deteriorating cognitive impairments are such that carers find progressive difficulty in authentically ascertaining and responding to interests, preferences, and needs. Deep assessment, a novel multifaceted framework drawn from research into the experiences of others with severe cognitive impairments, has potential to empower carers and other support professionals to develop an enhanced understanding of people with advanced Alzheimer's disease and so deliver better calibrated care in attempts to maximize quality of life. Deep assessment uses a combination of techniques, namely, Behaviour State Observation, Triangulated Proxy Reporting, and Startle Reflex Modulation Measurement, to deliver a comprehensive and deep assessment of the inner states (awareness, preferences, likes, and dislikes) of people who cannot reliably self-report. This paper explains deep assessment and its current applications. It then suggests how it can be applied to people with advanced Alzheimer's disease to develop others' understanding of their inner states and to help improve their quality of life. An illustrative hypothetical vignette is used to amplify this framework. We discuss the potential utility and efficacy of this technique for this population and we also propose other human conditions that may benefit from research using a deep assessment approach.

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.

Measuring quality of life in people with intellectual and multiple disabilities: validation of the San Martín scale

Although there are numerous quality of life instruments in the, field of intellectual disability, most of them are addressed to those, people with the highest levels of functioning, while only a few are, suitable for people with the lowest levels (i.e., people with profound, and severe intellectual disabilities, or people with intellectual and, developmental disabilities and other significant medical conditions or, disabilities). This study provides reliability and validity evidence of, the San Martín Scale, a 95-item Likert scale questionnaire that is, completed by a third-party respondent. The validation sample was composed, of 1770 people from Spain with intellectual and developmental, disabilities that showed extensive or pervasive support needs (8.7% had, mild intellectual disability, 28.25% moderate, 41.6% severe, and 21.4%, profound). The age of the participants ranged between 16 and 77 years old, (M=7.78; SD=12.32). The results suggested that the eight quality of, life domains assessed on the scale are reliable (Cronbach's alpha ranging, from .821 to .933). Confirmatory Factor Analyses provided construct, validity evidences related to the internal structure of the San Martín, Scale, and indicated that the eight first-order factor solution provided, the best fit to the data over unidimensional and hierarchical solutions. Implications of these findings and guidelines for further research are, discussed.

Quality of life indicators for individuals with intellectual disabilities: extending current practice

Quality of life is a social construct that is measured by what are considered to be its most appropriate indicators. Quality of life measurement in intellectual disability reflects a variety of indicators, often grouped under life domains. Subjective and objective methods of measuring indicators each have strengths and drawbacks, but it is currently considered best to use both methods. Indicators of quality of life that are common to all people have been measured to date, although indicators that are unique to individuals are highly useful for enhancing individual development and for applying person-centered practice. Aggregate quality of life data from individuals may not always be the best source of information for evaluating policies and service practices. A case is made for supplementing quality of life frameworks or adopting other frameworks for these purposes, with the Capabilities Framework offered as an example. Further, an argument is made that a pragmatic approach might best be taken to policy and program evaluation, whereby the key criterion for using a conceptual framework and set of indicators is its usefulness in effecting positive change in people's lives.

Towards improved ways of knowing children with profound multiple disabilities: introducing startle reflex modulation

OBJECTIVE

To propose startle reflex modulation (SRM) as an objective measure of emotions of children with profound multiple disabilities (PMD). Knowledge about emotion states of children with PMD is crucial to their individualised care and support. Proxy reporting, observational and physiological measures of emotion are reported in the literature. Despite advances in this science, the rigour of the findings and methods are contested. In this article, we introduce SRM; a neurophysiological measure untried with children with PMD, despite its well-known sensitivity to even subtle changes in affective processing without depending on explicit responses.

RESULTS

We propose a research agenda that aims to deliver a more comprehensive and accurate profile of the inner states of these children, based upon previous research undertaken using SRM.

CONCLUSION

It is suggested that this objective measure has potential to provide useful information about the inner emotional states of children with PMD.

See me, feel me. Using physiology to validate behavioural observations of emotions of people with severe or profound intellectual disability

BACKGROUND

Behavioural observations are the most frequently used source of information about emotions of people with severe or profound intellectual disabilities but have not yet been validated against other measures of emotion. In this study we wanted to validate the behavioural observations of emotions using respiration (rib cage contribution, total breath duration, inspiratory time, expiratory time, tidal volume, mean inspiratory flow, minute ventilation) and heart rate variability.

METHOD

Twenty-seven participants were presented with four negative and four positive stimuli. During the presentation the participants' respiration and heart rate variability was measured. Each behaviour of the participant was coded as emotive or not.

RESULTS

We found the hypothesised higher percentage rib cage contribution, marginal lower mean inspiratory flow and lower heart rate variability when the expressed emotions became more positive.

CONCLUSIONS

These results validate the use of behavioural observations to make inferences about emotions.

The tell-tale: what do heart rate; skin temperature and skin conductance reveal about emotions of people with severe and profound intellectual disabilities?

Identifying emotions in people with severe and profound intellectual disabilities is a difficult challenge. Since self-reports are not available, behaviour is the most used source of information. Given the limitations and caveats associated with using behaviour as the sole source of information about their emotions, it is important to supplement behavioural information with information from another source. As it is accepted that emotions consist of language, behaviour and physiology, in this article we investigated if physiology could give information about the emotions of people with severe and profound intellectual disabilities. To this aim we tested hypotheses derived from the motivational model of Bradley, Codispoti, Cuthbert, and Lang (2001) about the relation between heart rate and the valence of emotions and between heart rate, skin conductance and skin temperature and behavioural expressions of emotions of people with severe and profound intellectual disability. We presented 27 participants with 4 staff-selected negative and 4 staff-selected positive stimuli. The situations were videotaped and their heart rate, skin conductance and skin temperature was measured. Each behaviour of the participant was coded using the observational method developed by Petry and Maes (2006). As hypothesized, we found a lower heart rate when participants were presented with negative stimuli than when they were presented with positive stimuli in the first 6s of stimuli presentation. Their skin temperature was higher for the expression of low intensity negative emotions compared to the expression of low intensity positive emotions. The results suggest that, as with people without disability, heart rate and skin temperature can give information about the emotions of persons with severe and profound ID.

Review: a systematic review of quality of life measures for people with intellectual disabilities and challenging behaviours

BACKGROUND

The quality of life (QOL) construct is proposed as a method to assess service outcomes for people utilising disability services. With this in mind, the aim of this study was to conduct a systematic review of available QOL measures for people with intellectual disability (ID) to pinpoint psychometrically sound measures that can be routinely used for service evaluation.

METHOD

A systematic search of the disability literature published between 1980 and 2008 was conducted in order to identify appropriate QOL tools for use within an Australian context. Twenty-four QOL instruments were identified and each instrument was then evaluated against a set of psychometric and measurement criteria.

RESULTS

Six of the instruments examined were deemed to be psychometrically sound on the available information. No instruments were found that specifically assess QOL for people with ID who exhibit challenging behaviour. Most of the instruments assess QOL from a subjective perspective, use a questionnaire format and measure only some (not all) of the eight theoretically accepted domains of QOL.

CONCLUSIONS

More instruments that measure QOL need to be developed and rigorously validated. This is especially the case for high-needs disability populations like those individuals that exhibit challenging behaviour or have severe to profound ID, as it is questionable whether existing measures can be used with these populations.

Interacting with adults with congenital deafblindness: The experiences of disability support workers

BACKGROUND

This study aimed to gain greater insight into the perspectives of staff on their interactions with adults with congenital deafblindness in light of the research literature reporting these interactions to be lacking in quality and quantity.

METHOD

Data from interviews with 8 disability support workers were analysed using the approach described by Charmaz (2006).

RESULTS

Three key themes emerged from the interview data, which support and elaborate on findings of previous studies. These were (1) the construction of client happiness, (2) the rationalisation of client disengagement, and (3) imperatives of the staff role. These findings elucidate the reasons for staff behaviour in their interactions with adults with congenital deafblindness.

CONCLUSION

The findings suggest the need for staff policy and procedural documents to be explicit about the importance of social interaction between staff and clients.

Relationship between individual quality of life and family quality of life for people with intellectual disability living in Italy

BACKGROUND

There is substantial literature investigating quality of life (QoL) of individuals with intellectual disability (ID). QoL of families of people with ID is emerging as an important field of research. Despite this, there is a lack of studies regarding their relationship.

AIM

The present paper aimed to study the relationship between QoL scores of individuals with ID and members of their families.

METHODS

Twenty-seven parents or relatives of 27 adults with ID were recruited by four different research centres across Tuscany (Italy) to be interviewed through the Italian adaptation of the Family Quality of Life Survey - 2006 (FQoLS-2006), a tool developed for use in a multiple-country study on family QoL. The FQoLS-2006 was translated and adapted to Italian through three revisions. The last was submitted to the authors of the original version, who also maintain an electronic data file and data archive for statistical evaluations in various countries. QoL of persons with ID was assessed through the administration of the Quality of Life - Instrument Package. QoL scores were analysed to describe population characteristics and to examine the relationships among measures of individual and family QoL using correlations (Pearson and Spearman).

RESULTS

Findings showed that family ratings of QoL were generally low. Families interviewed reported a low level of QoL in 'Support from Others' and 'Community Interaction', while 'Family Relationships' and 'Health of the Family' rated higher. For individual QoL, individuals had the lowest scores in the area of 'Spiritual being' and higher scores in the area of 'Physical being'. Correlations examining possible relationships among Importance, Satisfaction and Opportunities found some statistically significant correlation coefficients between some aspects of the three main areas of individual QoL (Being, Belonging and Becoming) and the nine family domains. Most of these correlations regarded family 'Financial Well-Being', 'Family Relationships, 'Support from Service' and 'Support from Others' areas.

CONCLUSIONS

The results of this study suggest that QoL is perceived somewhat differently by individuals with ID and by members of their families. This difference could negatively impact QoL of people with ID, if their views are not taken into account when planning for family support. The relationships between individual and family QoL appear to be quite complex, and such complexity needs to be clarified in future research.

What makes them feel like they do? Investigating the subjective well-being in people with severe and profound disabilities

BACKGROUND

Because of the problems measuring subjective well-being in people with severe and profound intellectual disabilities, there are no studies to date which explore the factors contributing to the subjective well-being in these groups. We wanted to explore the client and service characteristics contributing to the subjective well-being of persons with severe and profound intellectual disabilities, as measured by the MIPQ (Ross & Oliver, 2003).

MATERIALS AND METHODS

The MIPQ was completed for 360 persons with severe or profound intellectual disabilities by a member of the direct support staff. They also provided us with information on client, service and informant characteristics.

RESULTS

We found that the subjective well-being of persons with profound intellectual disabilities was lower than the subjective well-being of people with mild, moderate or severe intellectual disabilities or people without disabilities. Client and informant characteristics but no service characteristics were found to have an influence on the subjective well-being of people with severe and profound intellectual disabilities.

CONCLUSION

As it is important for policy making to identify residence service and staff factors related to subjective well-being of persons with severe and profound intellectual disabilities, further research should try to identify these factors, taking in account the client characteristics that are found to be related to subjective well-being in this study.

Psychometric evaluation of the Dutch version of the Mood, Interest and Pleasure Questionnaire (MIPQ)

Recently, several instruments have been developed to measure the subjective component of the quality of life (QOL) of people with profound intellectual and multiple disabilities (PIMD). A next step, however, must be the further validation of these instruments. The present study aimed at evaluating the psychometric properties of one of these instruments, the Dutch version of the Mood, Interest and Pleasure Questionnaire (MIPQ). The MIPQ is a 25-item Likert scale questionnaire with two subscales (Mood and Interest and Pleasure). The MIPQ and the Aberrant Behavior Checklist were completed on 360 participants with severe or profound intellectual disabilities. About 27% of these participants were included in an examination of test-retest of and the inter-rater reliability of the MIPQ. The results suggest that the proposed two-factor structure did not show an adequate fit to our data. An exploratory factor analysis revealed a three-factor structure with positive mood, negative mood and interest as three correlated but distinct subscales. These results are in concurrence with the literature on positive emotions. High internal consistency (α ≥ .80), high inter-rater (r ≥ .69) and high test-retest reliability (r ≥ .86) were found, which indicates the reliable use of the MIPQ in the population of people with PIMD. Strong negative correlations between the MIPQ total score and the Aberant Behavior Checklist's 'lethargy, social withdrawal' subscale provides some evidence of the construct validity of the MIPQ. However, further validation of the MIPQ including other measures of subjective well-being is warranted.

Interaction between persons with profound intellectual and multiple disabilities and their partners: a literature review

BACKGROUND

High quality interactions are of crucial importance for quality of life of persons with profound intellectual and multiple disabilities (PIMD). This literature review describes and synthesises studies addressing the interaction between persons with PIMD and their partners.

METHOD

A computerised literature search using defined inclusion criteria yielded 15 articles.

RESULTS

The literature analysis revealed four components important in interactions: sensitive responsiveness, joint attention, co-regulation, and an emotional component. The abilities and disabilities, interactive behaviours, and personality of persons with PIMD influence these interactions. Additional influences are the partners' interactive strategies, knowledge, and perceptions and the context of the interaction.

CONCLUSIONS

An overview model integrates the results and forms a vehicle to facilitate our understanding of interactions with persons with high support needs. Methodological analyses of the studies show lacunae in current research. This review offers a starting point to guide future research and intervention.

Measuring the quality of life of people with profound multiple disabilities using the QOL-PMD: first results

The present study focused on the objective components of quality of life (QOL) of people with profound multiple disabilities (PMD). More specific, we aimed at evaluating different dimensions of QOL of people with PMD and investigating the association between their QOL and several personal (age, gender, intellectual capabilities, motor limitations, sensory limitations, physical and mental health status) as well as setting characteristics (location of the setting, type of setting, size of the setting, group size, group composition, staffing level and staff turnover). As a measure of the QOL of people with PMD we used the QOL-PMD, a questionnaire that we specifically developed for this purpose. To measure the personal and setting characteristics we also used a self-developed questionnaire. Forty-nine people with PMD were selected. For each of these people three informants were chosen who each filled out the QOL-PMD. To account for the clustered nature of the data, data were analysed by means of mixed models. Characteristics regarding the medical condition of the person with PMD turned out to be most strongly associated with the QOL-PMD scores. Other personal characteristics such as age, gender, motor limitations and sensory limitations did not have a significant effect on the QOL-PMD scores. With regard to the setting characteristics, location of the setting and staffing level turned out to have a significant effect on the QOL-PMD scores.

Quality of life for people with intellectual disabilities

PURPOSE OF REVIEW

As the quality of life for the mental health of people with intellectual disabilities has been identified as a comprehensive indicator of intervention efficacy, scientific interest around it is shifting from theoretical issues to the ways of measurement. Nevertheless, the daily assessment still awaits the addressing of the questions of what the essence of quality of life is, how it is really or effectively measurable, by whom and for what purpose it is done.

RECENT FINDINGS

The point well agreed upon is that the measurement should be based on both qualitative and quantitative variables from both subjective and objective positions. It should also be conducted through a comprehensive system that includes auto and hetero evaluations (if possible both by proxies and other external persons). Current instruments of assessment are too different from each other and refer to different levels of evaluation. This results in inappropriate applications to the assessment and care procedures.

SUMMARY

A need for more methodologically rigorous studies exists, which is tracked in terms of applicability to daily practice and content effectiveness. At both health policy and front-line staff levels, assessment should aim at mobilizing and revaluing resources that can help a person to embark on or to continue a life-span curriculum of life skills.