Quality of Life Research

, 18:389 | Cite as

Disability meanings according to patients and clinicians: imagined recovery choice pathways

  • Margaret G. Stineman
  • Pamela M. Rist
  • Jibby E. Kurichi
  • Greg Maislin



The purpose of this study was to explore how the meaning of disability varies between patients with acute-onset activity limitations and clinicians, and between males and females.


Seventy-nine patients undergoing inpatient rehabilitation and 93 practicing rehabilitation clinicians in the USA developed personal recovery choice pathways through recovery preference exploration (RPE). Imagining complete dependence in 18 activities as diverse as eating and expression, each individual determined an optimal sequence of recovery. This sequence was used to determine the relative value of each activity compared with the other 17. Three comparisons were made by calculating the mean absolute difference (MAD) in median utilities, including patients versus clinicians, male versus female patients, and male versus female clinicians. The MAD shows the relative magnitude of disparity between each pair.


The MAD value between patients and clinicians was 3.4 times larger and 4.8 times larger than the MAD values between male and female patients and male and female clinicians, respectively.


The much larger difference in recovery preferences between patients and clinicians compared with differences between genders suggests that life contexts of being a patient with disabilities versus a clinician are more potent determinants of activity limitation perspectives than being a man or woman.


Activities of daily living Decision making Patient-centered care Patient care team Quality of life 



Recovery preference exploration


Mean absolute difference


International classification of functioning, disability, and health


World Health Organization


Quality of life


Functional Independence Measure


Schedule for the Evaluation of Individual Quality of Life


Canadian Occupational Performance Measure


Personal Computer



This research was supported in part by the National Institutes of Health grant R21 HD045881 from the National Institute of Child Health and Human Development. The opinions of the authors are not necessarily those of the supporting agencies.


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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Margaret G. Stineman
    • 1
    • 2
    • 3
  • Pamela M. Rist
    • 4
    • 5
  • Jibby E. Kurichi
    • 1
  • Greg Maislin
    • 6
    • 7
  1. 1.Department of Physical Medicine and RehabilitationSchool of Medicine, University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Physical Medicine and RehabilitationUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  6. 6.Division of Sleep MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  7. 7.Biomedical Statistical ConsultingWynnewoodUSA

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