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This chapter will introduce the reader to an example on how an assessment instrument, based on the international classification of functioning, disability, and health can be developed. It lines out the reasoning behind the development of the new instrument as well as the methodology that was used. The instrument is a questionnaire designed to evaluate functioning in vocational rehabilitation – the work rehabilitation questionnaire (worq).in a further step the strengths and weaknesses of a generic instrument as the worq and the need for disease-specific or symptom-specific instruments and their respective roles in the vocational rehabilitation process will be discussed.in this context we also reflect on the role of environmental and personal factors when evaluating functioning in vocational rehabilitation.

Background. Health-related quality of life (HRQOL) has been frequently used as an outcome measure in disability-related studies, yet little is known about HRQOL in vocational rehabilitation (VR). Aim. To evaluate HRQOL in VR clients and identify factors associated with their HRQOL Design, setting and population. Cross-sectional study of 149 clients from 5 VR centers in Switzerland and Germany Methods. HRQOL was measured by 8 dimensions of the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and compared with sex-matched German population norms. Multiple regression analyses were conducted to identify whether VR-related variables (VR duration and type, sick leave duration) and depressive symptoms were associated with HRQOL dimensions independent of sociodemographics (age, sex, education) and clinical characteristics (type of disorders, number of comorbidities) Results. HRQOL in VR clients was significantly lower in all dimensions measured by the SF-36 compared to the general population. Returning to the former workplace and being oriented to a new job were associated with less functional limitation due to physical problems, less pain and better mental health. Being oriented to a new job was also associated with better vitality. Presence of depressive symptoms was negatively related with all dimensions of HRQOL. Overall, the regression models explained 10%-25% variance of the physical HRQOL domain and 18%-27% variance of the mental HRQOL domain. Conclusion. Multiple dimensions of HRQOL were significantly decreased in VR clients. Depressive symptoms were prevalent and contributed significantly to poorer HRQOL, thus should be considered in the VR process. Further research is needed to ascertain the effect of different VR types to HRQOL and to elaborate the role of depressive symptoms in HRQOL over time. Clinical Rehabilitation Impact. Rehabilitation professionals should be informed of the level of HRQOL in VR clients in order to tailor effective interventions to improve HRQOL by not only focusing on functional ability but also the psychological well-being.