Using the satisfaction with life scale in people with Parkinson's disease: a validation study in different European countries.

BACKGROUND: Overall, people with chronic illnesses have lower life satisfaction compared to nonclinical populations. The objective of this international study was to examine the psychometric properties of the Satisfaction with Life Scale (SWLS) in patients with Parkinson's disease (PD). METHODS: PD patients (n = 350) were recruited and interviewed at different specialized services in the United Kingdom, Spain, Czech Republic, Italy, and The Netherlands. A questionnaire set including a measure of life satisfaction, quality of life (QoL), self-reported health and disability status, and sociodemographic information was used. Acceptability, reliability, and validity were examined. RESULTS: The internal consistency was good ( α = 0.81). The scale structure was satisfactory (comparative fit index = 0.99; root mean square error of approximation = 0.08). The SWLS was able to discriminate between healthy and unhealthy, disabled and nondisabled, and those perceiving a more severe impact of the disability on their lives. Concurrent validity using multiple linear regression models confirmed associations between SWLS and QoL and age. CONCLUSIONS: This study is the first to report on the use of the SWLS in PD patients in different European countries. It is a useful tool in assessing satisfaction with life in PD patients through the continuum of care.

The role of quality of care and attitude towards disability in the relationship between severity of disability and quality of life: findings from a cross-sectional survey among people with physical disability in China.

BACKGROUND: People with physical disability (PWPD) is the largest subgroup of people with disability (PWD) in China, but few studies have been conducted among this vulnerable population. The objective of this study was to investigate the level of quality of life (QoL), self-perceived quality of care and support (QOCS), severity of disability and personal attitude towards disability among people with physical disability in China, as well as to identify how QoL can be affected by severity of disability through QOCS and personal attitude towards disability among PWPD. METHODS: A cross-sectional study was conducted among 1,853 PWPD in Guangzhou, China. Data were collected on participants' QoL, QOCS, personal attitude towards disability and severity of disability. Structural equation modeling was used to examine the effects of the other variables on QoL. RESULTS: Even with a mild disability (mean score:1.72), relatively low levels of QoL (mean score: 2.65- 3.22) and QOCS (mean score: 2.95 to 3.28), as well as unfavorable personal attitude towards disability (mean score: 2.75 to 3.36) were identified among PWPD. According to SEM, we found that the influence of severity of physical disability on QoL is not only exerted directly, but is also indirectly through QOCS and their personal attitudes towards disability, with QOCS playing a more important mediating role than PWPD's attitudes towards their own disability. CONCLUSIONS: Unfavorable health status was identified among PWPD in China. Focusing on improvement of assistance and care services has the potential to substantially improve PWPD's QoL. Further research should focus on understanding the needs and their current state of health care of PWPD in China thus being able to develop better interventions for them.

Preliminary validation study of the Spanish version of the satisfaction with life scale in persons with multiple sclerosis.

PURPOSE: To assess Life Satisfaction, using the Satisfaction with Life Scale (SWLS), and to analyze its psychometric properties in Multiple Sclerosis (MS). METHOD: Persons with MS (n = 84) recruited at the MS Centre of Catalonia (Spain) completed a battery of subjective assessments including the SWLS, the World Health Organization Quality of Life instrument and disability module (WHOQOL-BREF, WHOQOL-DIS) and the Hospital Anxiety Depression Scale-Depression (HADS-D); sociodemographic and disability status data were also gathered. Psychometric properties of the SWLS were investigated using standard psychometric methods. RESULTS: Internal consistency (Cronbach's alpha coefficient) was 0.84. A factor analysis using a principal components method showed a one factor structure accounting for 62.6% of the variance. Statistically significant correlations were confirmed between SWLS with WHOQOL-BREF, WHOQOL-DIS and HADS-D. SWLS scores were significantly different between a priori defined groups: probable depressed versus nondepressed and participants perceiving a mild versus severe impact of disability on their lives. CONCLUSION: To the best of our knowledge, this study is the first to report on the psychometrics properties of the SWLS in persons with MS. It might be a valuable tool to use in appraising persons with MS through the continuum of care. IMPLICATIONS FOR REHABILITATION: The Spanish version of the Satisfaction with Life Scale (SWLS) is a reliable and valid instrument in Multiple Sclerosis (MS). The SWLS is able to discriminate between participants with low or high scores on depressive symptoms or disability impact on life. SWLS might be useful through the continuum of care in persons with MS, including Rehabilitation Services.

Mujeres con discapacidad: significados de su condición y prácticas de inclusión / Women with disability: The meanings of their condition and social inclusion practices

Existen más de 400 millones de mujeres alrededor del mundo con diferentes discapacidades, de las cuales el 80% vive en países en desarrollo (UN, 2008). El objetivo de este estudio fue identificar los significados que han construido las mujeres con discapacidad en torno a su condición y las prácticas que realizan en relación con su inclusión y sus derechos. Se realizó un estudio mixto, en el que participaron 200 mujeres con discapacidad física que respondieron a dos cuestionarios, uno socio-demográfico y otro de calidad de vida. Se desarrollaron dos grupos focales y ocho entrevistas en profundidad. Los resultados muestran que la mayoría de participantes tienen un significado positivo de la discapacidad, la diferencian de la enfermedad, son independientes en sus actividades cotidianas, cuentan con escasa información sobre sus derechos, los mecanismos y escenarios para ejercerlos. Los resultados permiten formular recomendaciones para mejorar la inclusión social de mujeres con discapacidad.

Worldwide there are over 400 million women with some form of disability, and of these, 80% live in developing countries (U.N, 2008). With its focus on social inclusion and rights the present study aimed to examine the meanings which disabled women ascribe to their condition and the activities they engage in. The procedure was based on mixed methods and the sample comprised 200 women with a physical disability who responded to two questionnaires, one socio-demographic and ano-ther concerning quality of life. Two focus groups were created and eight in-depth interviews were conducted. The results showed that most of the participants ascribed a positive meaning to their disability and did not regard it as an illness. They were independent as regards daily activities but had limited information about their rights, as well as about the mechanisms and social spheres through or in which such rights might be exercised. The findings enable recommendations to be made regarding how to improve the social inclusion of women with disability

The Cornell-Brown scale for quality of life in dementia: Spanish adaptation and validation.

The objective of this study was to validate a Spanish version of the Cornell-Brown Scale (CBS) for quality of life (QoL) in dementia. One hundred persons with mild-to-moderate dementia (Diagnostic and Statistical Manual of the American Psychiatric Association, 4th edition) were recruited and interviewed at 5 Spanish centers to obtain sociodemographic information, health perceptions, depressive symptoms (Geriatric Depression Scale 15-item version), functional ability (Barthel Index), dementia severity (Mini-Mental State Examination), specific QoL (CBS), and generic QoL (World Health Organization Quality of Life-BREF version). Analysis was carried out using classical psychometric methods. Internal consistency reliability for the CBS was good (0.87). A priori hypotheses about the relationship between CBS and the World Health Organization Quality of Life-BREF version psychological domain and Geriatric Depression Scale 15-item version were confirmed, indicating good construct validity. Regarding contrasting groups' differences, CBS scores significantly differentiated between healthy and unhealthy and depressed and nondepressed participants but not between those with mild and moderate dementia. The exploratory factor analysis showed a 5-factor solution, which accounted for 63.9% of the total variance of CBS. This study is the first to report the factor structure of the CBS. These results indicate that CBS is a useful tool in assessing persons with dementia. Replication of these results with larger samples is advised. The Spanish version of the CBS is reliable and valid in persons with mild/moderate dementia who are living at home and with a known caregiver.

Reliability and validity of the Attitudes to Ageing Questionnaire (AAQ) in older people in Spain.

BACKGROUND: As ageing is a personal experience, an attitude to ageing questionnaire is essential for capturing the most realistic appraisal of this important stage of life. Our aim was to study the psychometric properties of the Attitudes to Ageing Questionnaire (AAQ) in a sample of Spanish older people. METHODS: A total of 242 participants aged 60 years and older were recruited from community centers, primary care centers, and family associations for the mentally ill and dementia. In addition to the AAQ, participants provided information on demographics, self-perception of health, comorbidity, health status (SF-12), depressive symptoms (GDS-30), and quality of life (WHOQOL-BREF and WHOQOL-OLD). Analysis was performed using standard psychometric techniques with SPSS v15.0. RESULTS: No floor and ceiling effects were found, and missing data were low. The internal consistency measured by Cronbach's alpha for AAQ subscales were 0.59, 0.70, and 0.73. Exploratory Factor Analysis produced a three-factors solution accounting for 34% of the variance. A priori expected associations were found between some AAQ subscales with WHOQOL-BREF domains, with WHOQOL-OLD, SF-12, and the GDS-30 indicating good construct validity. In general, AAQ subscales differentiated between participants with lower and higher levels of education, and between a priori defined groups of older people (non-depressed vs. depressed; those with higher vs. lower physical comorbidities, and non-carers vs. carers). CONCLUSIONS: The Spanish version of the AAQ questionnaire showed acceptable psychometric properties in a convenience sample of Spanish older people. It is a useful measure of attitude for use with older people in social and clinical services.

Reliability and validity of the Spanish version of the World Health Organization-Five Well-Being Index in elderly.

AIMS: The World Health Organization (WHO)-Five Well-being Index (WHO-5) is a short 5-item index designed to assess the level of emotional well-being. The positive questions of the WHO-5, shifted towards measuring cheerfulness and the level of energy, work in the screening of depression. This paper describes the psychometric properties of the Spanish WHO-5 in older persons. METHODS: A total of 199 participants from community centers and primary care centers participated in the study completing a battery of measures: WHO-5, Quality of Life (WHOQOL-BREF), depressive symptoms (Geriatric Depression Scale [GDS-15]), as well as health and sociodemographic information. Analysis was performed using standard psychometric methods. RESULTS: Internal consistency reliability was good (Cronbach's α = 0.86). Exploratory factor analysis showed a one-factor solution which accounted for 66% of the total variance of WHO-5. Moderate-high correlations were found between WHO-5 and the WHOQOL-BREF and GDS-15 were confirmed, indicating good convergent validity. Discriminative validity was confirmed by the ability of the WHO-5 to differentiate between healthy and unhealthy and depressed and non-depressed participants (as measured by the GDS-15). CONCLUSIONS: The WHO-5 showed acceptable psychometric properties in elderly persons. It might be a useful tool to assess emotional well-being and to detect depressive symptoms among older persons in primary care and community centers.

The Validity of the WHO-5 as an Early Screening for Apathy in an Elderly Population.

Aim. The objective of our study has been to evaluate the WHO-5 as a new early screening instrument for apathy in a group of elderly persons. Methods. The WHO-5 was compared to the Geriatric Depression Scale (GDS-15). The GDS contains five items measuring well-being and ten items measuring depression. The internal validity of the WHO-5 (total score being a sufficient statistic) was evaluated with both parametric and nonparametric item response theory models. The external validity of the WHO-5 and the GDS was evaluated by ROC using depression as index of validity. Results. The item response theory analyses confirmed that the total score of the WHO-5 is a sufficient statistic. The ROC analysis shows an adequate sensitivity (61%) and specificity (84%). The GDS(15) and its two subscales obtained low sensitivity (25-42%), but high specificity (90-98%). Conclusion. The WHO-5 was found both internally and externally valid when considering decreased positive well-being to be an early indication of apathy reflecting that the wind has begun to be taken out of the "motivation sail."

Life satisfaction in persons with intellectual disabilities.

We appraised life satisfaction using the Satisfaction with Life Scale (SWLS), and analysed its psychometric properties in persons with intellectual disability (ID). Ninety-nine persons with ID from four services in Spain participated. A battery of subjective assessments was used, including the SWLS, a Quality of Life measure (WHOQOL-BREF), and health status and sociodemographic information. Psychometric properties of the SWLS were investigated using standard psychometric methods. Overall, our results showed that persons with ID were satisfied with their life (SWLS score 25-29). Internal consistency (Cronbach's alpha) was .79. A factor analysis using principal components method, showed a one factor structure accounting for 55.7% of the variance. Associations, using Spearman's rho correlation coefficients, were confirmed between SWLS with the overall QoL, satisfaction with health and WHOQOL-BREF total score. Regarding 'known group' differences, persons living in residential institutions had lower life satisfaction compared to persons living in community facilities or living at home, though differences were not statistically significant. Student t-tests showed that SWLS scores significantly discriminated between healthy and unhealthy; and those reporting higher satisfaction with their relationships, home environment and their jobs compared to participants with lower satisfaction levels. To our best knowledge, this study is the first to report on the psychometrics properties of the SWLS in persons with ID, both in Spain and internationally. It might be a promising tool to use, with other outcome measures, in appraising persons with ID in different services and types of care; also, it might guide policymakers on the implementation of policies for persons with ID.

Spanish version of the Geriatric Depression Scale: reliability and validity in persons with mild-moderate dementia.

BACKGROUND: Depressive symptoms are prevalent among persons with dementia (PWD). Our aim was to assess the psychometric properties of the Spanish version of the Geriatric Depression Scale (GDS-15 and GDS-5) in PWD. METHODS: In this cross-sectional study, five healthcare centers providing care for PWD from two cities in Spain participated. Ninety-six community-dwelling PWD aged 55 years and older, living with a known caregiver, completed a battery of scales including the GDS-15 and GDS-5, the Cornell Scale Depression in Dementia (CSDD), a list of self-reported chronic health conditions (yes/no), severity of dementia (Mini-Mental State Examination), functional status (Barthel Index), generic quality of life (WHOQOL-BREF), and sociodemographic information. RESULTS: Cronbach's α coefficients were 0.81 and 0.72 for GDS-15 and GDS-5, respectively, providing evidence for acceptable internal consistency. Significant associations between the GDS-15/GDS-5, the Barthel Index, CSDD, and the WHOQOL-BREF were found. No significant differences were found on GDS-15/GDS-5 scores among dementia diagnostic groups (Alzheimer's disease, vascular dementia, mixed dementia, other dementia) or between mild (MMSE 21-26) and moderate (MMSE 10-20) dementia. Participants self-reporting depression on the comorbid condition list (yes) scored significantly higher on the GDS-15 and GDS-5 compared to those who reported not having depression. Exploratory factor analyses suggested a two-factor structure on GDS-15 which accounted for 41.6% of the variability, while the one-factor structure on the GDS-5 accounted for 48.1% of the variability. CONCLUSIONS: In general, this study provides evidence that GDS-15 and GDS-5 are suitable measures for screening depressive symptoms in community-dwelling PWD.

Calidad de vida en personas con demencia: revisión de escalas específicas de autoevaluación / Quality of life in people with dementia: review of self-assessment specific scales

El objetivo de este trabajo es revisar las escalas específicas de calidad de vida (CV) en el ámbito de la demencia, concretamente, las escalas de autoevaluación que pueden ser contestadas por la propia persona con demencia. A partir de estudios cualitativos en los que se ha recogido información de las propias personas con demencia, de cuidadores y de profesionales, se han construido diversas escalas, principalmente en EE.UU. e Inglaterra. Estas escalas incluyen aspectos comunes, como son aspectos relacionados con las actividades de la vida diaria, aspectos psicológicos, y sociales; algunas ya se han adaptado y validado a otros idiomas. En comparación con revisiones previas sobre el tema, la presente revisión actualiza la validación reciente de algunas de estas escalas al español. La evaluación de la CV en personas con demencia contribuye a reducir el estigma, a considerar a la persona como tal, e introduce un elemento humanístico en los sistemas de salud y social (AU)

The aim of this paper is to review specific measures of Quality of Life (QoL) for dementia, in particular, those scales that can be self-reported by the person with dementia. Data from qualitative studies including persons with dementia, caregivers and professionals has allowed the construction of scales, mainly in the US and England. These scales share common domains related to activities of daily living, psychological aspects and social relations. These scales are being adapted and translated into other languages. This review, compared to previous ones, updates recent validations of these scales into Spanish. Assessment of QoL in persons with dementia contributes to reduce stigma, considers the subject as a person, and introduces a humanistic element on the health and social systems (AU)

The WHO quality of life (WHOQOL) questionnaire: Spanish development and validation studies.

BACKGROUND: In the 1990s, the World Health Organization (WHO) undertook a project to develop an instrument (the WHOQOL) for measuring quality of life (QoL). The WHOQOL was developed in the framework of a collaborative project involving numerous centers in different cultural settings. This paper describes the psychometric properties of the Spanish WHOQOL during its development. METHODS: One thousand and eighty-two patients with physical health conditions, persons without any health condition, patients with schizophrenia, and family caregivers of patients with schizophrenia participated on the WHOQOL-100 and WHOQOL-BREF field trials. QoL self-assessment was completed, together with sociodemographic and health status questions. Analysis was performed using classical psychometric methods. RESULTS: Both versions of the WHOQOL showed satisfactory psychometric properties as follows: acceptability, internal consistency, and evidence of convergent and discriminant validity. CONCLUSIONS: The WHOQOL-100 and WHOQOL-BREF are suitable to use in patients with different health conditions, including schizophrenia, and in different populations, including caregivers. Spanish field trials are the first to report on use of the WHOQOL in persons with schizophrenia and caregivers. These results indicate that both versions are useful tools in assessing these groups, as the WHOQOL includes important dimensions commonly omitted from other generic QoL measures.

[Quality of life in people with dementia: review of self-assessment specific scales]. / Calidad de vida en personas con demencia: revisión de escalas específicas de autoevaluación.

The aim of this paper is to review specific measures of Quality of Life (QoL) for dementia, in particular, those scales that can be self-reported by the person with dementia. Data from qualitative studies including persons with dementia, caregivers and professionals has allowed the construction of scales, mainly in the US and England. These scales share common domains related to activities of daily living, psychological aspects and social relations. These scales are being adapted and translated into other languages. This review, compared to previous ones, updates recent validations of these scales into Spanish. Assessment of QoL in persons with dementia contributes to reduce stigma, considers the subject as a person, and introduces a humanistic element on the health and social systems.

[Validation of the WHOQOL-BREF quality of life questionnaire among Chilean older people]. / Validación del cuestionario de calidad de vida (WHOQOL-BREF) en adultos mayores chilenos.

BACKGROUND: The WHOQOL-BREF is a generic questionnaire to measure quality of life created by the Study Group on Quality of Life of the World Health Organization. AIM: To adapt and evaluate the psychometric properties of the Spanish version of the WHOQOL-BREF instrument in a group of Chilean older subjects living in Metropolitan Santiago. MATERIAL AND METHODS: A linguistic-cultural adaptation of the Spanish version of the WHOQOL-BREF was performed and tested in a pilot study. Subsequently, the modified scale was applied to a group of 1186 older women aged 72 ± 8 years and 334 men aged 72 ± 7 years. The psychometric properties such as internal consistency, item-total correlation of responses, and construct validity were evaluated. A confirmatory factor analysis was done to check if the dimensions described in the original version, were evaluated. Analyses were performed with STA-TA statistical software 10.0 and LISREL 8.50. RESULTS: Confirmatory factor analysis confirmed that the dimensions physical health, psychological, social relationships and environment, described by the authors in their original description, were maintained. The instrument had a good internal consistency with a Cronbach alpha of 0.88 for the total scale and ranging from 0.70 to 0.79 in each of the dimensions. CONCLUSIONS: The evaluated version of the WHOQOL-BREF has an acceptable reliability and validity, and suggests that it is suitable for the assessment of Quality of Life in elderly people in Chile.

Suitability of the WHOQOL-BREF and WHOQOL-OLD for Spanish older adults.

BACKGROUND: People are living longer and healthier than at any other time point in history. Therefore, in the last decade, international interest has focussed on the study of quality of life (QoL) in older people. Our aim was to study the psychometric properties of the generic QoL measure WHOQOL-BREF (WHOQOL, World Health Organization Quality of Life) and specific older adult module WHOQOL-OLD in a sample of 286 Spanish elderly. METHODS: Participants were 60 years and older from community centres, primary care centres, family associations and nursing homes. The following information was collected: demographics, self-perception of health, depressive symptoms (Geriatric Depression Scale, GDS-30), functional status (SF-12) and QoL (WHOQOL-BREF and WHOQOL-OLD). Analysis was performed using classic psychometric techniques with SPSS v15.0. RESULTS: We found no ceiling and floor effects, and missing data was low. The internal consistency measured by Cronbach's alpha was 0.90 for the WHOQOL-BREF total scale and 0.80 for the WHOQOL-OLD. A priori expected associations were found between WHOQOL-BREF and WHOQOL-OLD with the SF-12 and the GDS-30, indicating good construct validity. WHOQOL-BREF and WHOQOL-OLD domain scores differentiated between participants with lower and higher level of education, and between groups of older people (healthy vs. unhealthy; non-depressed vs. depressed; non-carers vs. carers and non-residents vs. residents). CONCLUSIONS: The WHOQOL-BREF and WHOQOL-OLD questionnaires demonstrate acceptable psychometric performance in a convenience sample of Spanish older people. They are valuable measures of QoL for use with older people.

Perceptions of persons with Parkinson's disease, family and professionals on quality of life: an international focus group study.

PURPOSE: Parkinson's disease (PD) is a progressive neurodegenerative disorder. Motor and non-motor symptoms have an impact on persons' lives. To what extent this is effecting persons' quality of life (QOL) is not clear. Therefore, the aim of this qualitative study was to identify factors that persons perceive as eminently important for QOL. METHOD: Focus groups were employed with persons with PD, caregivers and health professionals. RESULTS: The results, obtained through thematic and conceptual qualitative analysis, largely support the framework of domains and facets of the World Health Organization Quality of Life (WHOQOL) assessment instrument. Three new themes were identified, reflecting (i) practical adaptations to PD, (ii) personal adaptations to PD and (iii) the ability to communicate and the availability of communication supports. CONCLUSION: This study demonstrated that focus groups are a valid and reliable way of eliciting views on QOL from persons with PD, caregivers and professionals. The focus group method confirmed the original WHOQOL parameters and also provided some new QOL themes. In addition, the results of this study pointed out that the impact of PD on QOL goes beyond the physical, social and emotional domains of health-related QOL (HRQOL).

Validación del cuestionario de calidad de vida (WHOQOL-BREF) en adultos mayores chilenos / Validation of the WHOQOL-BREF quality of life questionnaire among Chilean older people

Background: The WHOQOL-BREF is a generic questionnaire to measure quality of life created by the Study Group on Quality of Life of the World Health Organization. Aim: To adapt and evaluate the psychometric properties of the Spanish version of the WHOQOL-BREF instrument in a group of Chilean older subjects living in Metropolitan Santiago. Material and Methods: A linguistic-cultural adaptation of the Spanish version of the WHOQOL-BREF was performed and tested in a pilot study. Subsequently, the modified scale was applied to a group of 1186 older women aged 72 ± 8 years and 334 men aged 72 ± 7 years. The psychometric properties such as internal consistency, item-total correlation of responses, and construct validity were evaluated. A confirmatory factor analysis was done to check if the dimensions described in the original version, were evaluated. Analyses were performed with STA-TA statistical software 10.0 and LISREL 8.50. Results: Confirmatory factor analysis confirmed that the dimensionsphysical health, psychological, social relationships and environment, described by the authors in their original description, were maintained. The instrument had a good internal consistency with a Cronbach alpha of 0.88 for the total scale and rangingfrom 0.70 to 0.79 in each of the dimensions. Conclusions: The evaluated version of the WHOQOL-BREF has an acceptable reliability and validity, and suggests that it is suitable for the assessment of Quality of Life in elderly people in Chile.

The Spanish version of the dementia quality of life questionnaire: a validation study.

BACKGROUND: The aim of the study was to adapt and validate culturally the dementia-specific health-related quality of life instrument (HRQoL) into Spanish for patients with mild to moderate dementia. METHODS: Two forward translations, a reconciled version, and then a back translation were completed and subjected to expert review. A total of 112 patients with dementia, diagnosed according to DSM-IV criteria, from six centres providing care for persons with dementia in Spain participated in the study. The following patient-reported information was obtained by interview: demographics, subjective perception of health, depressive symptoms (Geriatric Depression Scale-15; GDS-15), functional ability (Barthel Index), and both generic (World Health Organization Quality of Life; WHOQOL-BREF) and dementia-specific quality of life (DQoL). RESULTS: The Spanish version of the DQoL showed acceptable psychometric properties. Internal consistency (Cronbach's alpha) was acceptable for most of the DQoL scales. As expected, associations were found between DQoL scales and the WHOQOL-BREF psychological domain and the GDS-15, indicating good validity. Neither functional status nor severity of dementia was associated with QoL; but depressive symptoms and self-reported feeling ill had a negative association on QoL. CONCLUSIONS: The results showed that the Spanish version of the DQoL has comparable psychometric properties to the US version. The DQoL appears to be a reliable and valid instrument intended to be administered to patients with mild/moderate dementia who are living at home.

The Quality of Care and Support (QOCS) for people with disability scale: development and psychometric properties.

This paper describes the development of a Quality of Care and Support (QOCS) scale for use with adult persons with physical and intellectual disabilities. In the pilot phase of the study, 12 centers from around the world carried out focus groups with people with physical and disabilities, their carers, and with professionals in order to identify themes that were relevant for their quality of care. Items generated from the focus groups were then tested in a pilot study with 1400 respondents from 15 different centers worldwide, with items being tested and reduced using both classical and modern psychometric methods. A field trial study was then carried out with 3772 respondents, again with the use of both classical and modern psychometric methods. The outcome of the two rounds of data collection and analysis is a 17-item module for assessment of quality of care in physically or intellectually disabled people. Further modifications are also proposed for the use of the QOCS with adults with intellectual disabilities, including simplification of wording of some of the items, the use of a three-point response scale, and the inclusion of smiley faces.