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RehabMeasures Instrument

Quality of Well Being and Self-Administered Version

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Purpose

The QWB and QWB-SA is a preference-weighted measure of health status and overall well-being over the previous three days in four domains: mobility, physical activities, social activities, and symptom/problem complexes.

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Instrument Details

Acronym QWB and QWB-SA

Area of Assessment

General Health

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Not-for-profit use: Free use with signed copyright agreement. Optional assistance for scoring available for a fee.
For-profit use: Annual fee ($1000 / year for use plus $0.25 per administration) required with signed copyright agreement. Optional assistance for scoring available for an additional fee.

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Cardiac Dysfunction
  • Pediatric & Adolescent Rehabilitation
  • Spinal Cord Injury

Key Descriptions

  • 71 items
  • Minimum score = 0.0 (death), maximum score = 1.0 (full function)QWB is administered via interview, QWB-SA is administered via questionnaire.
  • QWB scores can be translated into quality-adjusted life years for policy analysis purposes.
  • Administration instructions may be found at: https://hoap.ucsd.edu/qwb-info/QWB-Manual.pdf
  • Scoring instructions are available via UCSD website once a signed copyright agreement is received: https://hoap.ucsd.edu/qwb-info/#

Number of Items

71

Time to Administer

10-15 minutes

Required Training

Training Course

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Rachel Tappan, PT, NCS, Eileen Tseng, PT, DPT , NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 5/2012. Follow up review by Ashley Heleine, OTS, Anna Holod, OTS, and Margaret Mathews, OTS.

ICF Domain

Participation

Measurement Domain

General Health

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

LS

 

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

LS

LS

 

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

Considerations

  • Current translations available include:
    • Spanish
    • German
    • Italian
    • Swedish
    • French-Canadian
    • Dutch

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

Older Adults and Geriatric Care

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Normative Data

Community Dwelling Adults

(Fryback et al, 2007; n = 3,844; age range = 35-89 years old; 42.7% male, 57.3% female)

 

Age (years)

Total Sample Size (n)

Gender

Mean QWB-SA Score (SD)

Gender

Mean QWB-SA Score (SD)

35-44

642

Male

0.69 (0.01)

Female

0.66 (0.01)

45-54

826

Male

0.68 (0.01)

Female

0.65 (0.01)

55-64

684

Male

0.65 (0.01)

Female

0.61 (0.02)

65-74

965

Male

0.65 (0.01)

Female

0.63 (0.01)

75-89

727

Male

0.60 (0.01)

Female

0.60 (0.01)

 

Older Adults

(Andresen et al, 1998; n = 301; mean age = 74.7(6.6) years; community dwelling older adults)

 

Gender

Age

Sample size

Mean Score (SD) on QWB-SA

Male

65-74

69

0.7065 (0.114)

Male

75+

55

0.6996 (0.100)

Female

65-74

84

0.7039 (0.084)

Female

75+

93

0.7018 (0.100)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

 

Older Adults

(Andresen et al, 1998)

  • Adequate correlation of QWB-SA with physical subscale scores of SF-36, including Physical Functioning (r = 0.511), Pain (r = 0.410), General Health (= 0.492) and Physical Summary Scale (r = 0.467)
  •  Poor to Adequate correlation of QWB-SA with mental and emotional subscale scores of SF-36, including Mental Health (r = 0.383), Social Functioning (r = 0.277), Role-Emotional (r = 0.167), and Mental Summary Scale (r = 0.223)

 

Community Dwelling Adults (≥ 45 years old):

(Fryback et al, 1997; n = 1,356; mean age = 64.1 years; 41.3% men, 58.7% women)

  •  Excellent correlation of QWB with Physical Functioning subscale of SF-36 (r = 0.690)
  • Adequate correlation of QWB with the following subscales of the SF-36: Role-Physical (r = 0.566), Bodily Pain (r = 0.560), General Health Perceptions (r = 0.522), Vitality (r = 0.505), Social Functioning (r = 0.397)
  •  Poor correlation of QWB with the Role-Emotional (r = 0.175) and Mental Health (r = 0.301) subscales of the SF-36

Floor/Ceiling Effects

Older Adults:

(Andresen et al, 1998)

  • Excellent: 1% of respondents reached maximum score of 1.0 on the QWB-SA

Spinal Injuries

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Criterion Validity (Predictive/Concurrent)

SCI:

(Andresen et al, 1999; n = 183; mean age = 50.52 (SD = 12.73); mean time post-SCI = 17.92 (SD = 11.36) years, ranging from “a few months” to 55 years; veterans in inpatient and community, 4.4% lumbar SCI/42.6% thoracic injury/47.0% cervical injury)

  • Adequate correlation between QWB and the following measures: SF-36 Physical Summary score (r = 0.417) and SF-12 Physical Summary score (r = 0.340)
  • Poor correlation between QWB score and the following subscales of the SF-36: Physical Function (= 0.254), Role-Physical (r =0.290), Bodily Pain (r = 0.251), General Health (r = 0.261), Vitality (r = 0.164), Social Function (r = 0.283), Role-Emotional (r = 0.044), Mental Health (r = 0.114)
  • Poor correlation between QWB and the following measures: SF-36 Mental Summary score (r = 0.116) and SF-12 Mental Summary score (r = 0.164)

Construct Validity

Concurrent Validity

Chronic SCI:

(Stevens et al, 2008; n = 62; mean age = 35 (SD = 10) years; mean time post-SCI = 9 (SD = 9) years, at least 12 months for all subjects; 37% tetraplegia/63% paraplegia, 61% complete injury/39% incomplete injury)

  • Excellent correlation between QWB score and level of physical activity as measured by Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) measure (r = 0.75)

 

SCI:

(Andresen et al, 1999)

  • Adequate correlation between QWB score and 8-item Instrumental Activities of Daily Living (IADL) scale of Lawton and colleagues (r = -0.454)

Floor/Ceiling Effects

SCI:

(Andresen et al, 1999)

  • Excellent: 0.5% of respondents reached maximum score of 1.0 on the QWB, 0.0% of respondents reached minimum score of 0.0

Non-Specific Patient Population

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Normative Data

Adults with depression:

(Pyne et al, 2003; n=58; 20-70 years-old, mean age = 45.7(10.3); 78% male, 22% female; 83% unipolar depression, 17 % bipolar depression; 79% non-Hispanic white, 5% African American, 2% Asian, 4% Native-American, 5% other)

Gender

Setting

Sample Size

Mean QWB-SA Score (SD) Baseline

Male

Inpatient

33

0.383 (0.118)

Female

Inpatient

6

 

Male

Outpatient

12

0.479 (0.115)

Female

Outpatient

7

 

 

Migraines:

(Sieber et al., 2000; n = 89, 87% female, 13% male, age range = 36-64 years, mean age = 42.26 (9.8)

 

Instrument

Migraine Days Mean (SD)

Non-migraine Days Mean (SD)

Difference between Migraine Non-migraine

QWB

.612 (.079)

.730 (.114)

F1,6205 203; P, .01

QWB-SA

.492 (.157)

.628 (.149)

F1,6205 119; P< .01

 

 

Epilepsy 

(Gao et al, 2013; n=467)

 

Control Group

(n=323)

Experimental/ Epilepsy group

(n=144)

Mean age (SD)

36.15(16.406)

33.11(13.044)

Gender (%male)

40.7

52.1

Mean score QWB-SA (SD)

0.802(0.155)

0.657(0.135)

 

Test/Retest Reliability

General Population:

(Anderson et al, 1989; n = 681; probability sample from San Diego area)

  • Excellent test-retest reliability with Pearson product-moment correlation coefficients (ICC = 0.91-0.96)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Adults With Depression: (Pyne et al, 2003; n=58; 20-70 years-old, mean age = 45.7(10.3); 78% male, 22% female; 83% unipolar depression, 17 % bipolar depression)

  • Excellent correlation at baseline between QWB-SA and interviewer-QWB (r=0.63) and at 4 months between QWB-SA and interviewer QWB (r=0.60)
  • Adequate correlation at 4 weeks between QWB-SA and interviewer-QWB (r=0.43) and at 4 months between QWB-SA and the following measures: BDI (r=-0.53) and HRSD-17 (r=-0.55)
  • Poor correlation at 4 weeks between QWB-SA and the following measures: Beck Depression Inventory (BDI) (r=-0.27) and Hamilton Rating Scale for Depression (HRSD-17) (r=-0.27)

 

Mental Health Subscale: (Sarkin et al., 2012; Sample 1: n = 3,844, age range = 35-89; Sample 2: n = 535, age range = 35-89; Sample 3: n = 915, age range = 18-89)

  • Excellent correlation between QWB-SA Mental Health Subscale and SF-36 Mental Health component (Sample 1: r = -0.663; Sample 2: r = -0.690), SF-36 Mental Health Scale (Sample 1: r = -0.698; Sample 2: r = -0.723), EQ-5D anxiety/depression item (Sample 1: r = 0.608; Sample 2: r = 0.609); HUI2 emotion scale for Sample 1 (r = -.0631); POMS depression-dejection scale and POMS TMD (Sample 2: r = 0.767; r = 0.768).
  • Adequate correlation between the QWB-SA Mental Health Subscale and the HUI2 emotion scale for Sample 2 (r = -0.591), Recovery Markers Quest (Sample 3: r = -0.368), MHSIP functioning, outcomes, and social components (Sample 3: r = -0.397; r = -0.398; r = -0.373).
  • Poor correlation between the QWB-SA and the IMR management scale (Sample 3: r = -0.248).

Arthritis

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Normative Data

Arthritis

(Frosch et al, 2004; n= 896)

 

 

Control Group (n=562)

Experimental/Arthritis

(n=334) 

Mean age (SD)

46.7 (16.7)

55.1 (16.1)

Gender (% female)

57.0

83.7

Mean Score on QWB-SA (SD)

0.651(0.134)

0.515(0.130)

 

Bibliography

Anderson, J. P., Kaplan, R. M., et al. (1989). "Interday reliability of function assessment for a health status measure. The Quality of Well-Being scale." Medical Care 27(11): 1076-1083. Find it on PubMed

Andresen, E. M., Fouts, B. S., et al. (1999). "Performance of health-related quality-of-life instruments in a spinal cord injured population." Archives of Physical Medicine and Rehabilitation 80(8): 877-884. Find it on PubMed

Andresen, E. M., Rothenberg, B. M., et al. (1998). "Performance of a self-administered mailed version of the Quality of Well-Being (QWB-SA) questionnaire among older adults." Medical Care 36(9): 1349-1360. Find it on PubMed

Frosch, D.L., et al. (2004). Validity of self-administered quality of well-being scale in musculoskeletal disease. Arthritis Care & Research Arthritis & Rheumatism, 51(1), 28-33.Find it on PubMed

Fryback, D. G., Dunham, N. C., et al. (2007). "US norms for six generic health-related quality-of-life indexes from the National Health Measurement study." Medical Care 45(12): 1162-1170. Find it on PubMed

Fryback, D. G., Lawrence, W. F., et al. (1997). "Predicting Quality of Well-being scores from the SF-36: results from the Beaver Dam Health Outcomes Study." Medical Decision Making 17(1): 1-9. Find it on PubMed

Gao, L., et al. (2013). Validation of a Chinese version of the Quality of Well-Being Scale-Self-Administered (QWB-SA) in patients with epilepsy. Epilepsia, 54(9), 1647-1657Find it on PubMed

Pyne, J. M., et al. (2003). Use of the quality of well-being self-administered version (QWB-SA) in assessing health-related quality of life in depressed patients. Journal of Affective Disorders, 76(1-3), 237-247Find it on PubMed

Sarkin, A. J., et al. (2012). Development and validation of a mental health subscale from the Quality of Well-Being Self-Administered. Qual Life Res Quality of Life Research, 22(7), 1685-1696Find it on PubMed

Sieber, W., et al. (2000). Assessing the impact of migraine on health-related quality of life: an additional use of the Quality of Well-being Scale-Self-administered. Headache: The Journal Of Head & Face Pain, 40(8), 662-671Find it on PubMed

Stevens, S. L., Caputo, J. L., et al. (2008). "Physical activity and quality of life in adults with spinal cord injury." Journal of Spinal Cord Medicine 31(4): 373-378. Find it on PubMed

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