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RehabMeasures Instrument

Stroke Specific Quality of Life Scale

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Purpose

The SS-QOL assesses health-related quality of life specific to stroke survivors.

Link to Instrument

Instrument Details

Acronym SS-QOL

Area of Assessment

Behavior
Cognition
Functional Mobility
Language
Negative Affect
Personality
Quality of Life
Social Relationships
Upper Extremity Function

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Stroke Recovery

Populations

Key Descriptions

  • 49 items
  • Items are assessed on 5-point Guttman-type scales. Each item is answered using 1 of 3 different response sets.
  • Provides both summary and domain specific scores:
    1) Domain scores are composed of unweighted averages
    2) Summary scores are composed of an unweighted average of the 12 domain average scores
  • Scores range from 49-245.
  • Higher scores indicate better functioning.
  • The 12 domains include:
    1) Mobility
    2) Energy
    3) Upper Extremity Function
    4) Work and Productivity
    5) Mood
    6) Self-care
    7) Social Roles
    8) Family Roles
    9) Vision
    10) Language
    11) Thinking
    12) Personality
  • May be used with proxies, however research suggests agreement between patient and proxy was best for observable physical domains (Duncan et al., 2002).

Number of Items

49

Time to Administer

10-15 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Michele Sulwer, PT, DPT, NCS and Genevieve Pinto-Zipp, PT, EdD, of the StrokEDGE II, Neurology Section, APTA, in 3/2016

ICF Domain

Participation

Measurement Domain

Cognition
Emotion
General Health
Motor

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)

StrokEDGE

UR

UR

UR

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

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

NR

NR

NR

UR

UR

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)

StrokEDGE

No

No

Yes

Not reported

Considerations

  • Due to linguistic complexity, the SS-QOL may not be appropriate for patients with communication disabilities (Hilari and Byng, 2001).

  • SS-QOL-12 has good criterion validity, predicting 88-95% of the variance of the original SS-QOL. Mean differences between the SS-QOL-12 and SS-QOL and their 95% CI were generally within 0.1 points on a 1-5 scale (Post et al, 2011).

Stroke

back to Populations

Minimal Detectable Change (MDC)

Chronic Stroke: (Lin et al, 2011; n = 25 patients >6 months post stroke)

 

MDC95

% of patients exceeding MDC95

Mobility Subscale

5.9 points

9.5% - 28.4%

Self-Care Subscale

4.0 points

6.8% - 28.4%

UE Function Subscale

5.3 points

12.2% - 33.8%

Minimally Clinically Important Difference (MCID)

Chronic Stroke: (Lin et al, 2011; n = 74; patients >6 months post stroke)

 

MDC95

% of patients exceeding MDC95

Mobility Subscale

1.5 – 2.4 points

9.5% - 28.4%

Self-Care Subscale

1.2 – 1.9 points

6.8% - 28.4%

UE Function Subscale

1.2 – 1.8 points

12.2% - 33.8%

Normative Data

Acute Stroke: (Williams et al, 1999; n = 34; mean age = 61 years; patients assessed 1 & 3 months post stroke (+/- 1 week); mean Canadian Neurologic Scale at admission = 9.2)

Scores 1 and 3 Months After Stroke by HRQOL*

 

 

 

 

 

 

 

1 Month**

 

 

3 Months**

 

 

Measure

A Lot Worse

A Little Worse

Same

A Lot Worse

A Little Worse

Same

SS-QOL

3.23

3.61

4.19

3.10

3.89

4.35

SF-3

41

52

63

33

49

68

BI

93

91

97

92

98

99

NIHSS

3.4

3.2

1.5

2.4

1.1

1.1

*Overall HRQOL was rated by patients at both time points; **mean scores

Internal Consistency

Acute Stroke: (Williams et al, 1999):  

  • Excellent Internal Consistency: Cronbach's Alpha > 0.73 across all 12 domains

Domain

Items

Mean (SD)

Alpha

Energy

3

2.9  (1.44)

0.88

Family Roles

3

3.74 (1.28)

0.79

Language

5

4.41 (0.68)

0.85

Mobility

6

4.11 (0.84)

0.86

Mood

5

3.91 (1.03)

0.80

Personality

3

3.57 (1.21)

0.77

Self-care

5

4.51 (0.85)

0.89

Social Roles

5

3.07 (1.33)

0.85

Thinking

3

3.39 (1.21)

0.73

Upper Extremity Function

5

4.21 (0.94)

0.83

Vision

3

4.61 (0.72)

0.81

Work/Productivity

3

 3.67 (1.11)

0.75

 

Subarachnoid Haemorrhage: (Boosman et al, 2010; n = 141; 36.1±7.9 (23-52) months post-SAE)

  • Good internal consistency for all 12 domains: Cronbach’s Αlpha >= 0.80.

  • Excellent reliability of the Physical(α=0.96) and Psychosocial(α=0.95) Subscores and total score(α=0.97).

Criterion Validity (Predictive/Concurrent)

Chronic Stroke: (Lin et al 2010; n = 74; mean age = 54.11 (11.44) years; pre and post 3-week intervention; mean time since stroke 17.46 (17.67) months)

  • Excellent correlation only between the SS-QOL Self-Care and FIM

  • Adequate to poor correlations between the domains of the SS-QOL and the Fugl-Meyer Assessment, FIM, and Frenchay Activities Index

  • Fair criterion validity of SS-QOL (ρ = .25–.31; P < .05).

 

Pre-treatment concurrent validity of the SS-QOL

SS-QOL Domain

FMA

FIM

FAI

UE Function

0.30*

0.39**

0.21

Self-care

0.27

0.65**

0.52**

Work/Productivity

0.27*

0.40**

0.44**

Family Roles

0.28*

0.38**

0.32**

Social Roles

0.34**

0.21

0.12

Mobility

0.03

0.38**

0.2

Energy

0.16

0.13

0.12

Language

0.08

0.15

0.22

Mood

0.01

0.23

0.16

Personality

0.1

0.19

0.06

Thinking

0.02

0.21

-0.04

Vision

0.02

0.21

-0.04

* p < 0.05; ** p < 0.01; FMA = Fugl-Meyer Assessment; FIM = Functional Independence Measure; FAI = Frenchay Activities Index

 

Subarachnoid Haemorrhage: (Boosman et al, 2010; n = 141, mean age = 51.4 (12.3) years; mean time since SAH s/p aneurysm occlusion via clipping or coiling 36.1 (7.9) months

  • Moderate to Strong correlation between all SS-QOL domains and Physical Subtotal scores with CFQ, LiSat-9, and HADS

  • Weak to Moderate correlations between Physical SS-QOL subtotal and GOS

SS-QOL Domain

GOS

CFQ

LiSat-9

HADS

Self-Care

0.42

-0.30

0.56

-0.42

Mobility

0.26

-0.39

0.55

-0.50

UE Function

0.33

-0.44

0.56

-0.48

Language

0.10

-0.53

0.42

-0.44

Vision

0.08

-0.38

0.41

-0.48

Work

0.14

-0.49

0.60

-0.61

Thinking

0.03

-0.65

0.40

-0.45

Family Roles

0.08

-0.40

0.57

-0.61

Social Roles

0.10

-0.40

0.62

-0.63

Personality

0.05

-0.43

0.51

-0.65

Mood

0.09

-0.43

0.57

-0.71

Energy

0.03

-0.42

0.44

-0.64

Physical Subscore

0.25

-0.52

0.64

-0.59

Psychological Subscore

0.07

-0.53

0.61

-0.73

correlations > 0.24 were significant (p < 0.0033, two-tailed, using Bonferroni correction); GOS = Glasgow Outcome Scale; CFQ = Cognitive Failure Questionnaire; LiSat-9 = Life Satisfaction Checklist; HADS = Hospital Anxiety and Depression Scale

Construct Validity

Acute Stroke: (Williams et al, 1999)

Construct Validity of SS-QOL Domains

 

 

 

 

SS-QOL Domain*

Established Measure

Strength

r2

p

Energy

SF-36 vitality

Adequate

0.51

< 0.001

Family Roles

SF-36 emotional and physical role limitations

Poor

0.29

< 0.001

Mobility

SF-36 physical function

Adequate

0.41

< 0.001

Mood

BDI

Adequate

0.43

< 0.001

Personality

BDI

Adequate

0.33

< 0.001

Self-care

BI

Adequate

0.45

< 0.001

Work/Productivity

SF-36 physical role limitations

Adequate

0.31

< 0.001

Overall SS-QOL score

Overall SF-36 score

Excellent

0.65

< 0.001

  • Items in the language and thinking domains were not associated with items on the NIHSS.

    • These results may have occurred because patients with cognitive and language deficits were excluded from the study.

Content Validity

Acute Stroke: (Williams et al, 1999)

  • Items and domains were developed through interviews conducted with stroke patients (n = 32 poststroke patients)

  • SS-QOL and International Classification of Functioning, Disability, and Health (ICF) categories were independently assessed by two healthcare professionals. 

    • Agreement across all but three concepts was acceptable; kappa ranged from 0.75 to 1.00 (Teixeira-Salmela et al, 2009)

Floor/Ceiling Effects

Acute Stroke: (Williams et al, 1999)

Domain

Items

% Floor

% Ceiling

Energy

3

17

18

Family Roles

3

4

35

Language

5

1

37

Mobility

6

1

23

Mood

5

1

30

Personality

3

4

23

Self-care

5

3

51

Social Role

5

9

14

Thinking

3

4

13

Upper Extremity Function

5

1

31

Vision

3

1

63

Work/Productivity

3

3

21

 

Subarachnoid Haemorrhage: (Boosman et al, 2009)

  • Ceiling effect present for 10/12 domains and for physical component. Most strongly self-care & vision domains.

Responsiveness

Acute Stroke: (Williams et al, 1999)

Domain

Responsiveness

SES*

Energy

mildly responsive

0.36

Family Roles

mildly responsive

0.41

Language

moderately responsive

0.63

Mobility

moderately responsive

0.53

Mood

mildly responsive

0.41

Personality

mildly responsive

0.20

Self-care

moderately responsive

0.55

Social Role

markedly responsive

0.83

Thinking

mildly responsive

0.36

Upper Extremity Function

mildly responsive

0.44

Vision

moderately responsive

0.59

Work/Productivity

moderately responsive

0.54

*Standardized Effect Sizes

 

Acute Stroke: (Lin et al 2010)

  • Responsiveness of the Stroke Impact Scale 3.0 (SIS) was found to be significantly larger than the SS-QOL total (Standard Response Mean difference = .36; 95% CI = .02 to .71)

Bibliography

Boosman, H., Passier, P., et al. (2010). “Validation of the Stroke Specific Quality of Life scale in patients with aneurysmal subarachnoid haemorrhage.” J Neurol Neurosurg Psychiatry 81:485-489. Find it on PubMed

Duncan, P. W., Lai, S. M., et al. (2002). "Evaluation of proxy responses to the Stroke Impact Scale." Stroke 33: 2593-2599. Find it on PubMed

Hilari, K. and Byng, S. (2001). "Measuring quality of life in people with aphasia: The Stroke Specific Quality of Life Scale." International Journal of Language & Communication Disorders 36(Suppl): 86-91. Find it on PubMed

Lin, K.-C., Fu, T., et al. (2011). “Assessing the Stroke-Specific Quality of Life for Outcome Measurement in Stroke Rehabilitation: Minimal Detectable Change and Clinically Important Difference. Health and Quality of Life Outcomes 9:5. Find it on PubMed

Lin, K.-C., Fu, T., et al. (2010). "Psychometric comparisons of the Stroke Impact Scale 3.0 and Stroke-Specific Quality of Life Scale." Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation 19(3): 435-443. Find it on PubMed

Muus, I., Williams, L. S., et al. (2007). "Validation of the Stroke Specific Quality of Life Scale (SS-QOL): test of reliability and validity of the Danish version (SS-QOL-DK)." Clin Rehabil 21(7): 620-627. Find it on PubMed

Post, M.W.M., Boosman, H., et al. (2011). “Development and validation of a short version of the Stroke Specific Quality of Life Scale.” J Neurol Neurosurg Psychiatry 82:283-286. Find it on PubMed

Teixeira-Salmela, L. F., Neto, M. G., et al. (2009). "Content comparisons of stroke-specific quality of life based upon the international classification of functioning, disability, and health." Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation 18(6): 765-773. Find it on PubMed

Williams, L. S., Weinberger, M., et al. (1999). "Measuring quality of life in a way that is meaningful to stroke patients." Neurology 53: 1839-1843. Find it on PubMed

Williams, L. S., Weinberger, M., et al. (1999). "Development of a stroke-specific quality of life scale." Stroke 30(7): 1362-1369. Find it on PubMed