Social Science and Medicine 52 (2001) 369–384 Subjective well-being and severe motor impairments: the Tetrafigap survey on the long-term outcome of tetraplegic spinal cord injured persons I. Ville*, J.-F. Ravaud, Tetrafigap Group 1 CERMES, INSERM U.502, IFRH (Federative Research Institute on Disability), Paris, France Abstract The purpose of the research described in this article is to study the effects of severe motor impairments on a person’s well-being, by attempting to throw light upon the inconsistencies found in the previous literature, which are due to problems of a conceptual and methodological nature. The data were gathered during the Tetrafigap survey on the long- term outcome of tetraplegic persons in France. This survey involved 1668 tetraplegic spinal cord injured people. We examine the relationships between the overall assessment of well-being as expressed by the people interviewed, and a range of clinical, social and psycho-social factors. A progressive approach, along with the use of adjustments via linear regressions, has allowed us to identify certain confounding factors, and to analyse the respective effects of the different types of variables studied. Thus current age, the age at which the impairment occurred and having or not having a professional activity do not have any direct links with the assessment of well-being, whereas the existence of pain and the subjective assessment of one’s own independence and of the severity of one’s disability are predictive factors. The functional independence indicators are only linked to well-being when they relate to situations in which the dependence creates embarrassment due to socio-cultural taboos. The loss of autonomy only affects well-being in as much as it imposes limits to social activity, whether they be relational or occupational. Living as a couple is a negative predictive factor if the couple were together prior to the impairment occurring. The overall results demonstrate the importance of moving beyond any conception of the impact of the impairments on well-being that is too exclusively focused on the individual, and of integrating the socio-cultural meanings of handicap situations and the dynamics of the interactions which take place therein. # 2001 Elsevier Science Ltd. All rights reserved. Keywords: Well-being; Spinal cord injury; Tetraplegia; Disability; Motor impairment Introduction Self-assessment of well-being is often considered to be an appropriate outcome measure, indicating the way in which people perceive and react to their health and to other non-medical aspects of their lives (Gill & Feinstein, 1994; Triemstra, Van Der Ploegg, Smit, Brie¨t, Ade´r & Rosendaal, 1998). The effect of acquiring motor impairments on subjective well-being has given rise to a number of studies which, more often than not, take place within the fields of physical medicine and rehabilitation. Such research traditionally looks at the impact of the clinical factors linked to the *Corresponding author. Tel.: +33-1-53-72-80-40; fax: +33- 1-53-72-80-49. E-mail address: ville@ext.jussieu.fr (I. Ville). 1 The Tetrafigap survey, carried out under the aegis of the ‘‘Association Francophone Internationale des Groupes d’Animation de la Paraple´gie’’ (AFIGAP), was performed thanks to the participation of the Tetrafigap group which involves 35 associated teams and the Tetrafigap Steering Committee which includes: D. Boulongne, M. Delcey, J.-F. De´ sert, M. Maury, J.-P. Pedelucq, J.-F. Ravaud and M. Tramblay. 0277-9536/01/$ - see front matter # 2001 Elsevier Science Ltd. All rights reserved. PII:S0277-9536(00)00140-4