Operationalising the quality of life construct in studies of alcohol and drug residential rehabilitation programme clients: A systematic review

December 2019
Fischer, J.A., Roche, A.M. and Kostadinov, V. (2019), Operationalising the quality of life construct in studies of alcohol and drug residential rehabilitation programme clients: A systematic review. Drug Alcohol Rev., 38: 674-689. doi:10.1111/dar.12981


Quality of life (QOL) is ‘an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns’[1]. Increasingly, it is recognised that QOL measures need to be incorporated into outcome assessments of AOD residential rehabilitation clients. However, ongoing ambiguity about how QOL is understood and measured in this context, is hampering its utility as a clinical tool. NCETA conducted a systematic review of operational definitions of QOL and the tools used to assess it by published studies conducted in residential rehabilitation treatment settings.


Electronic publication databases and manual searches were conducted for potential studies. The search was limited to peer-reviewed studies published in English between 1990-2018 located in a specialised AOD residential rehabilitation treatment program, and where QOL was the study’s focal point.


A total of 16 studies met the inclusion criteria and were included in the review. Less than half provided an operational definition of QOL. Twelve different instruments had been administered to assess client QOL, none of which had been specifically validated with residential rehabilitation populations.


There was a high degree of operational inconsistency in the application of QOL measures. Less than half of the included studies defined QOL, although amongst these studies there was a relatively cohesive understanding of QOL.

Different measurement instruments were used, suggesting little agreement on how best to measure the QOL of AOD residential rehabilitation clients. Most instruments did not allow residential rehabilitation clients to articulate their own understanding of QOL, or crucially, which aspects of QOL were personally important.

Consequently, despite a consensus about what QOL comprised, there was considerable variation in how it had been measured. At best, this hampers comparability of outcomes between services and studies. At worst, it may result in inappropriate tools being utilised and a concomitant decrease in the reliability and validity of research findings. In order to promote the ongoing and appropriate utilisation of QOL to guide service provision, greater consistency and rigour in the choice of measurement tools is required.

There is also a need to formalise an operational definition of QOL and to develop instrument(s) appropriate for use with residential rehabilitation clients. Meanwhile, researchers and practitioners are encouraged to consult with clients regarding their personal QOL priorities and select a valid and reliable instrument that adequately reflects the client’s needs.

[1] WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 1998;28: 551–8.