Quality of Life and Disability Perceptions: An ADO-Based Synthesis of Research on Persons with Physical Disabilities

Abstract

Objective: To synthesize evidence on how the attitudes and perceptions of persons with physical disabilities (PwD) relate to their quality of life (QoL), organized using the Antecedent–Decision–Outcome (ADO) framework. Methods: A systematic search of Scopus (last week of June 2025) identified studies using the terms “quality of life” AND “physical disability” AND (“attitude” OR “perception”), limited to English, articles, and the subject areas Health Professions, Psychology, Social Sciences, and Arts & Humanities. The search returned 124 records; two reviewers screened abstracts, moved 65 to full-text, and 41 met inclusion criteria focusing on PwD’s own attitudes/perceptions and their QoL. No formal risk-of-bias assessment was conducted. Results: Across disabilities predominantly of a physical/mobility nature (with frequent attention to spinal cord injury and multiple sclerosis), antecedents clustered as personal/clinical (symptoms, functional limitation), psychosocial (resilience, acceptance, perceived control), and environmental (accessibility, supports, technologies, social attitudes). Decisions were typically adaptive choices engagement in sports/leisure, uptake of assistive or tele-supports, pursuing employment/education, cultivating peer networks, and living-arrangement autonomy. Outcomes consistently linked resilience, acceptance, participation, and supportive environments with higher QoL, while pain, fatigue, depressive symptoms, and environmental barriers predicted poorer QoL. Methodologically, cross-sectional designs dominated; mixed-methods, longitudinal and interventional work was less common. Conclusions: PwD’s QoL emerges from a dynamic interplay of personal adaptation and enabling environments rather than impairment alone. Practice and policy should pair psychosocial strengthening (e.g., resilience/acceptance-based approaches) with environmental and technological enablement. Research should advance longitudinal, causal, and mixed-methods designs with transparent, standardized QoL and attitude measures.