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RehabMeasures Instrument

Life Satisfaction Questionnaire 9

Last Updated

Purpose

Assesses various aspects of life satisfaction including:

  • Life as a whole 
  • Self-care management 
  • Contacts with friends 
  • Vocational 
  • Family life 
  • Partner relationships 
  • Financial 
  • Leisure situations 
  • Sex life

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Instrument Details

Acronym LISAT-9, LSQ

Area of Assessment

Activities of Daily Living
Depression
General Health
Life Participation
Mental Health
Occupational Performance
Quality of Life
Social Relationships
Social Support

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Free. A copy of the LISAT-9 appears in:
Anke, A. G. W. and A. R. Fugl-Meyer (2003). "Life satisfaction several years after

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Brain Injury
  • Cardiac Dysfunction
  • Cerebral Palsy
  • Multiple Sclerosis
  • Pain Management
  • Parkinson's Disease + Neurologic Rehabilitation
  • Pulmonary Disorders
  • Spinal Cord Injury
  • Stroke Recovery
  • Vestibular Disorders

Key Descriptions

  • The Life Satisfaction Questionnaire is available in 9- and 11-item versions.
  • The 9-item version contains a single item assessing overall life satisfaction, along with eight additional items that are domain-specific.
  • Items are answered on a 6-point Likert scale that ranges from 1 (very dissatisfied) to 6 (very satisfied).
  • No studies in SCI have used the 11-item version, an extension of the 9-item version, that adds 2 domains of somatic and psychological health.
  • Typically, when scored in group studies, the results are divided into dissatisfied (1-4) and satisfied (5-6).
  • A total Life Satisfaction score is computed as the mean of the item scores (range 1-6).

Number of Items

9

Time to Administer

10-30 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team in 2010; Updated with references from the chronic pain population by Julio Hernandez, SPT and Alfonso Poma, SPT in 2011; Updated by Jennifer Kahn, PT, DPT, NCS, Candy Tefertiller, PT, DPT, ATP, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Anna de Joya, PT, DSc and the TBI EDGE task force of the Neurology Section of the APTA in 2012.

ICF Domain

Participation

Measurement Domain

Activities of Daily Living

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group / Unable to Recommend

NR

Not Recommended


Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

LS

LS

R

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

NR

NR

NR

LS

LS

 

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

R

R

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

 

 

 

 

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

Yes

Not reported

TBI EDGE

No

No

No

Not reported

Considerations

  • Chronic SCI, Questionable unidimensionality (the idea that items should contribute to the measurement of only one attribute at a time) (Geyh et al, 2010) for the LISAT-9. Unidimensionality was established when two items were deleted (the “partner relations” and “family life” items). 
  • In a Rasch analysis, the LiSAT yielded improved psychometrics when 2 items were deleted (partner relations and family life) and the response options were condensed from 6 point to 4 point scale, very dissatisfying, dissatisfying, satisfying, and very satisfying. 
  • Chronic SCI, Cross cultural validity examined via Rasch analysis. There was evidence of cross-country bias with the LiSAT-9 (Geyh et al, 2010) 
  • Chronic SCI, retrospective ratings of life satisfaction before SCI were much higher than ratings of current life satisfaction in the reference population suggesting possible memory bias or idealization of life before injury (van Koppenhagen et al, 2008) 
  • Questionable unidimensionality (Geyh et al, 2010) for the LISAT-9. Unidimensionality was established when two items were deleted (the “partner relations” and “family life” items)
  • There was evidence of bias in different language versions of the LiSAT-9 (Geyh et al, 2010) 

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Spinal Injuries

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Standard Error of Measurement (SEM)

Acute SCI : (Geyh et al, 2010; n = 243; mean age = 41.4 (13.6) years; within 14 days of injury; 47.7% complete, 43% incomplete, 8.6% unspecified)

LiSAT-9 Item-Level Standard Error (S.E.)

 

Domian

S.E.

Life as a whole

0.07

Self care

0.05

Vocational situation

0.06

Financial situation

0.06

Leisure situation

0.06

Sexual life

0.06

Partner relations

0.07

Family life

0.06

Contact with friends

0.07

SE = Standard error of item location

 

Normative Data

Chronic SCI: (Post et al, 1998, n = 318; mean age  = 39.4(3.6) years; mean time since injury was 3.6 (1.9) years; Complete tetraplegia = 69, Incomplete tetraplegia = 65, Complete paraplegia = 93, Incomplete paraplegia = 91)

LiSAT-9 Mean Scores:

 

 

Age

n

LiSAT 9

18-25

49

4.5

26-35

89

4.3

36-45

70

4.3

46-55

63

4.1

56-65

43

4.3*

Sex

n

LiSAT 9

Men

236

4.3

Women

78

4.3

* p < .01
~ p < .001

 

 

 

Chronic SCI:  (Van Koppenhagen et al, 2008; n = 147; mean age  = 41.6 (14.5) years; mean time since injury = 25.3 (6.1) months; complete tetraplegia = 35; incomplete tetraplegia = 14; complete paraplegia = 70; incomplete paraplegia = 28)

Life Satisfaction Scores Before and 1 Year After SCI:

LiSAT-9

n

Before SCI

After SCI

Difference Between Scores Before and After SCI

 

 

 

 

 

Correlations Between Scores Before and After SCI

 

 

 

 

Mean (SD)

Mean (SD)

Mean (SD)

t

ES

 

Pearson r

Life as a whole

147

5.3 (1.0

4.3 (1.3)

1.0 (1.6)

7.37

0.8

 

.08

Self-care ability

147

5.7 (0.9)

4.2 (1.6)

1.5 (1.9)

9.40

1.2

 

.08

Leisure situation

147

5.1 (1.0)

4.6 (1.2)

0.5 (1.7)

4.37

0.5

 

.03

Vocational situation

99

5.1 (1.1)

4.1 (1.4)

1.1 (1.2)

6.60

0.9

 

.12

Financial situation

147

4.8 (1.2)

4.4 (1.4)

0.4 (1.6)

3.48

0.3

 

.27

Sexual life

144

4.9 (1.1)

3.3 (1.7)

1.6 (1.9)

10.06

1.1

 

.19

Partner relationship

109

5.5 (0.9)

5.1 (1.2)

0.4 (1.2)

3.11

0.4

 

.35

Family life

144

5.4 (0.8)

5.1 (1.0)

0.3 (1.1)

3.39

0.3

 

.24

Contact with friends

147

5.3 (0.9)

5.2 (1.0)

0.1 (1.2)

1.44

0.1

 

.15

LiSAT-9 total

147

5.2 (0.7)

4.5 (0.8)

0.8 (1.0)

9.35

1.0

 

.16

NOTE:  The items vocational situation  and partner relationships were not applicable to people without vocational activity or partner.  The ES = (mean first - mean last)/([SD before + SD after]/2).

Percentage Satisfied and Dissatisfied and Dissatisfied and Change of Life Satisfaction Domains Before and After Onset of SCI:

Domains

Satisfied Before SCI, n (%)

Satisfied After SCI, n (%)

If Dissatisfied Before SCI, After SCI

 

 

 

If Satisfied Before SCI, After SCI

 

 

 

 

 

Dissatisfied, n (%)

Satisfied, n (%)

Dissatisfied, n (%)

Satisfied, n (%)

Life as a whole

129 (88)

83 (57)

6 (4)

12 (8)

58 (40)

71 (48)

Self-care

134 (91)

89 (61)

4 (3)

9 (6)

54 (37)

80 (54)

Leisure

125 (85)

96 (65)

7 (5)

15 (10)

44 (30)

81 (55)

Vocational

84 (86)

51 (52)

7 (7)

7 (7)

40 (40)

44 (46)

Financial

109 (74)

95 (65)

20 (14)

18 (12)

32 (22)

77 (52)

Sex life

102 (73)

47 (34)

32 (23)

6 (4)

61 (44)

41 (29)

Partner relationship

92 (92)

83 (83)

4 (4)

4 (4)

13 (13)

79 (79)

Family life

128 (91)

118 (83)

4 (3)

9 (6)

19 (13)

109 (78)

Contact with friends

130 (88)

129 (88)

2 (1)

15 (10)

16 (11)

114 (78)

NOTE: Dissatisfied; LiSAT-9 scores 1-4; Satisfied: LiSAT-9 scores 5-6. 

Internal Consistency

Chronic SCI: (Geyh et al, 2010)

  • Personal reliability index (Rasch-based correspondent to Cronbach’s alpha) = (0.86) 

 

Chronic SCI: (Post et al, 1998)

  • Adequate internal consistency (Chronbach's alpha = 0.74) 

 

Chronic SCI: (Post et al, 2012)

  • Adequate (Chronbach's alpha = 0.75) 
  • A multidimensional scale where lower IC might be expected (authors give example of satisfaction with self care potentially not being related to financial satisfaction).

Criterion Validity (Predictive/Concurrent)

Chronic SCI: (Post et al, 2012; n= 145) 

  • LiSat-9 with Life Satisfaction Questions (LS) Adequate r= 0.59 
  • Item 1, overall satisfaction question on LiSat-9 with LS now (vs prior to injury) Excellent r=0.72 
  • LiSat-9 with Satisfaction with Life Scale (SWLS) Excellent r=0.60 
  • Item 1, overall satisfaction question on LiSat-9 with overall satisfaction question, item 3 on SWLS Excellent r=0.60

 

 

LS

LiSat-9

SWLS

SF-mental health

Adequate 0.56

Adequate 0.52

Adequate 0.48

SIP –social functioning

Adequate -0.52

Adequate -0.45

Adequate -0.41

P< .01; SF-mental health = mental health scale of the short form 36; SIP- social functioning = social dimension of the Sickness Impact Profile -68, sum of mobility range and social behaviors scales. 

Construct Validity

Chronic SCI: (Post et al, 2012; n=145)

 

Divergent Validity

LS

LiSat-9

SWLS

FIM-motor

0.17*

0.29**

0.14

Level of injury

0.08

0.24**

0.21*

Completeness of injury

0.00

0.10

0.15

Cause of injury

0.17*

0.12

0.02

Age

-0.18*

-0.14

-0.19*

Gender

-0.01

-0.04

0.02

Education

0.01

0.00

0.05

*p<0.05; **p<0.01; FIM-motor = motor score on Functional Independence Measure; r <.03 = poor correlation

 

 

 

Floor/Ceiling Effects

Chronic SCI: (Post et al, 2012 n=145)

  • No floor or ceiling effects found (15% of respondents did NOT achieve the highest or lowest possible score)

Responsiveness

Chronic SCI: (van Koppenhagen, 2008 n= 147 one year post discharge from inpatient rehabilitation, differences between LiSat scores after SCI and retrospective scores prior to SCI. 

 

LiSat-9 domain 

Effect size of differences from before to after SCI 

Life as a whole 

0.8 (large) 

Self care 

1.2 (large) 

Leisure situation 

0.5 (moderate) 

Vocational situation 

0.9 (large) 

Financial situation 

0.3 (small) 

Sex life 

1.1 (large) 

Partner relationship 

0.4 (moderate) 

Family life 

0.3 (moderate) 

Contact friends 

0.1 (small) 

LiSat-9 total score 

1.0 (large)

Brain Injury

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Construct Validity

Mild Traumatic Brain Injury: Stalnacke 2007; n=163; LISAT-11 

  • The total score of LISAT-11 was statistically significantly correlated with the total Rivermead Post-Concussion Symptoms Questionnaire (RPQ)-score (r=-0.459, p<0.001), the total Impact of Event Scale (IES)-score (r=-0.365, p<0.001), the Community Integration Questionnaire (CIQ) -sub-scales social integration and productivity, the social support scales, Availability of Social Interaction (AVSI) and Availability of Attachment (AVAT) and the total Beck Depression Inventory (BDI) score (r=-0.642, p<0.001). 

 

Acquired Brain Injury: Eriksson et al, 2009; LISAT 11: n=116, 45 subjects with TBI, 71 with SAH; 

  • The Rasch analysis of data revealed that all 11 items demonstrated acceptable goodness-of-fit to the Rasch model, supporting internal scale validity. All but 4 subjects (97%) in this sample also demonstrated acceptable goodness-of-fit in their responses. The principal component analysis of the residuals revealed that the LISAT-11 measures explained 70% of the variance in the data-set, further supporting unidimensionality in the data-set. 

 

Traumatic Brain Injury: (Boonstra et al, 2012; LISAT -9: Dutch version; n=159 (22 participants with TBI) 

  • The subgroup of patients with higher scores on the other instruments (Frenchay Activities Index (FAI); Nottingham Health Profile (NHP); Stroke-Adapted Sickness Impact Profile) differed significantly in terms of the corresponding LISAT scores from the subgroup with lower scores on the other instruments, except for one: patients with a higher score on the ‘outdoor activities’ domain in the FAI were more satisfied (i.e. had a higher Lisat score) regarding their contacts with friends and acquaintances than those with a lower score. However, this difference was not significant.

Stroke

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Cut-Off Scores

Chronic Stroke: (Visser-Meily et al, 2008; n = 119; mean age = 53 (9) years; 1 year and 3 years post stroke)

  • Scores of 1 to 4 are classified as ‘Dissatisfied’ 
  • Scores of 5 and 6 are classified as ‘Satisfied'

Normative Data

Chronic Stroke: (Visser-Meily et al, 2008)

Spouse Life Satisfaction 1 and 3 years after stroke

 

 

 

LiSAT-9

 

1 Year

3 Years

Life as a whole

Mean (S.D.)

4.35 (1.0)

4.31 (1.2)

 

% dissatisfied

51%

52%

Self-care Mean

Mean (S.D.)

5.45 (0.8)

5.30 (0.9)

 

% dissatisfied

10%

15%

Leisure

Mean (S.D.)

4.16 (1.3)

4.25 (1.1)

 

% dissatisfied

52%

52%

Vocational situation

Mean (S.D.)

4.31 (1.2)

4.26 (1.2)

 

% dissatisfied

45%

49%

Financial situation

Mean (S.D.)

4.37 (1.3)

4.27 (1.2)

 

% dissatisfied*

41%

51%

Sexual life

Mean (S.D.)

3.62 (1.5)

3.35 (1.6)

 

% dissatisfied*

67%

72%

Partner relations

Mean (S.D.)

4.86 (1.2)

4.64 (1.1)

 

% dissatisfied**

28%

34%

Family life

Mean (S.D.)

4.89 (1.2)

4.78 (1.1)

 

% dissatisfied

22%

28%

Contact with friends

Mean (S.D.)

4.59 (1.1)

4.59 (1.1)

 

% dissatisfied

42%

40%

* p < 0.05.
** p < 0.01 (paired t-test or Man–Whitney test)

 

 

 

Chronic Pain

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Test/Retest Reliability

Chronic Pain: (Boonstra et al., 2008; n= 51; mean age = 43 (12) years; mean duration of the current pain period = 5.8 (6.2) years)

Distribution of the LSQ-DV Scores for the Nine Domains:

First Assessment

 

 

 

 

Second Assessment

 

 

 

 

 

 

 

n

Median

25th-75th percentile

n

Median

25th-75th percentile

P value

k  (95% confidence limits)

Life as a whole

51

5

3-5

51

5

4-5

0.36

0.75 (0.62-0.89)

Self-care ability

51

5

4-6

51

5

5-6

0.06

0.65 (0.46-0.83)

Leisure situation

50

4

4-5

50

4

4-5

0.49

0.50 (0.28-0.72)

Vocational situation

49

4

3-5

49

4

3-5

0.84

0.57 (0.35-0.80)

Financial situation

50

4

3-5

50

4

4-5

0.79

0.78 (0.64-0.91)

Sexual life

43

4

3-5

44

5

4-5

0.62

0.82 (0.67-0.97)

Partner relationship

40

5

4-5

39

5

5-6

0.49

0.60 (0.23-0.96)

Family life

37

5

5-6

38

5

5-6

0.12

0.34 (-0.03-0.71)

Contact with friends

51

5

4-5

51

5

4-5

0.42

0.58 (0.38-0.79)

Mean Score

49

4.6

3.8-5.0

51

4.5

4.1-5.0

0.15

p = 0.74 (0.67-0.84)

Non-Specific Patient Population

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Criterion Validity (Predictive/Concurrent)

Prior Trauma: (Anke & Fugl-Meyer, 2003; n = 69; median age = 26 (range 12-72) years; assessments conducted 3 years post injury)

 

Trauma patients satisfied or very satisfied with life:

 

 

Domain

Satisfied Before Trauma

Satisfied 3 years later~

Life as a whole

75%

41%***

Sexual life

65%

48%*

Partner relationship

64%

58%

Family life

74%

66%

ADL

100%

81%***

Contact with friends

81%

64%*

Leisure

71%

39%***

Vocational situation

69%

31%***

Financial situation

48%

25%**

~ chi-square test

*** p < 0.001

** p < 0.01

* p < 0.05

 

 

Bibliography

Anke, A. G. W. and Fugl-Meyer, A. R. (2003). "Life satisfaction several years after severe multiple trauma–a retrospective investigation." Clinical rehabilitation 17(4): 431. Find it on PubMed

Boonstra, A. M., Reneman, M. F., et al. (2008). "Reliability of the Life Satisfaction Questionnaire to assess patients with chronic musculoskeletal pain." International Journal of Rehabilitation Research 31(2): 181-183. Find it on PubMed

Borg, T., Berg, P., et al. (2010). "Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures. A prospective observational study with two years follow-up." Injury 41(4): 400-404. Find it on PubMed

Eriksson, G., Kottorp, A., et al. (2009). "Relationship between occupational gaps in everyday life, depressive mood and life satisfaction after acquired brain injury." Journal of Rehabilitation Medicine 41(3): 187-194.

Geyh, S., Fellinghauer, B. A. G., et al. (2010). "Cross-cultural validity of four quality of life scales in persons with spinal cord injury." Health and Quality of Life Outcomes 8: 94. 

Post, M. W., de Witte, L. P., et al. (1998). "Predictors of health status and life satisfaction in spinal cord injury." Arch Phys Med Rehabil 79(4): 395-401. Find it on PubMed

Post, M. W., van Leeuwen, C. M., et al. (2012). "Validity of the Life Satisfaction questions, the Life Satisfaction Questionnaire, and the Satisfaction With Life Scale in persons with spinal cord injury." Arch Phys Med Rehabil 93(10): 1832-1837. Find it on PubMed

Stalnacke, B. M. (2007). "Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury." Brain Inj 21(9): 933-942. Find it on PubMed

van Koppenhagen, C. F., Post, M. W., et al. (2008). "Changes and determinants of life satisfaction after spinal cord injury: A cohort study in The Netherlands." Archives of physical medicine and rehabilitation 89(9): 1733-1740. 

van Koppenhagen, C. F., Post, M. W., et al. (2008). "Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands." Arch Phys Med Rehabil 89(9): 1733-1740. Find it on PubMed 

Visser-Meily, A., Post, M., et al. (2008). "Psychosocial functioning of spouses in the chronic phase after stroke: Improvement or deterioration between 1 and 3 years after stroke?" Patient Education and Counseling 73(1): 153-158. Find it on PubMed

Visser, M. R., Oort, F. J., et al. (2005). "Methods to detect response shift in quality of life data: a convergent validity study." Qual Life Res 14(3): 629-639. Find it on PubMed

Wolters Gregorio, G., Stapert, S., et al. (2011). "Coping styles within the family system in the chronic phase following acquired brain injury: its relation to families' and patients' functioning." J Rehabil Med 43(3): 190-196. Find it on PubMed

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