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RehabMeasures Instrument

WHO Quality of Life-BREF (WHOQOL-BREF)

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Purpose

The WHOQOL-BREF assesses quality of life (QOL) within the context of an individual's culture, value systems, personal goals, standards and concerns.

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instrument details

Acronym WHOQOL-BREF

Area of Assessment

Activities of Daily Living
General Health
Life Participation
Mental Health
Quality of Life
Social Relationships

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

CDE Status

NINDS CDE Notice of Copyright
World Health Organization Quality of Life Assessment (WHOQOL-BREF)
Availability
The instrument is freely available here: World Health Organization Quality of Life Assessment
Classification
Supplemental-Highly Recommended: Mitochondrial Disease (Mito):

 

 

  • Highly recommended for studies that have patient reported outcomes and/or measure quality of life
Supplemental: Spinal Cord Injury (SCI), SCI-Pediatric (16 years of age and older), and Parkinson's Disease (PD)
Exploratory: Cerebral Palsy (CP)

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Brain Injury
  • Multiple Sclerosis
  • Parkinson's Disease & Neurologic Rehabilitation
  • Pulmonary Disorders
  • Spinal Cord Injury
  • Stroke Recovery

Key Descriptions

  • A cross-culturally comparable quality of life measure. Developed collaboratively and field-tested across a number of cultural contexts.
  • Assesses quality of life within six different contexts - with QOL defined as “the individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” (WHOQOL group 1995).
  • WHOQOL-BREF is the short version of the WHOQOL 100 and is recommended for use when time is restricted or the burden on the respondent needs to be minimized. This survey has been used in large epidemiological studies and clinical trials.
  • A self-report questionnaire that contains 26 items and addresses 4 QOL domains: physical health (7 items), psychological health (6 items), social relationships (3 items) and environment (8 items). Two other items measure overall QOL and general health.
  • Items are rated on a 5-point Likert scale (low score of 1 to high score of 5) to determine a raw item score. Subsequently, the mean score for each domain is calculated, resulting in a mean score per domain that is between 4 and 20. Finally, this mean domain score is then multiplied by 4 in order to transform the domain score into a scaled score, with a higher score indicating a higher QOL. When transformed by multiplying x4, each domain score is then comparable with the scores used in the original WHOQOL-100.
  • Self-administration is recommended if the respondent has sufficient ability; if not, interviewer assisted or interview-administered forms should be used.
  • Available in 19 languages.

Number of Items

26

Equipment Required

  • Manual recommended as calculated and transformed scores on the posted document refer examiner to the manual for details on correct calculations

Time to Administer

15 minutes

10-15 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Raad and the Rehabilitation Measures Team in 2010; Updated with references from the dementia population by Amy Bussman, SPT and Sarah Falk, SPT in 2011; Updated by Rachel Tappan, PT, NCS and the SCI EDGE task force in 5/2012 and Anna de Joya, PT, DSc, NCS and the TBI EDGE task force of the Neurology Section of the APTA; Updated with references from the PD population by Erin Hussey, DPT, MS, NCS and the PD EDGE task force of the Neurology Section of the APTA in 6/2013.

Updated in 2020 by:

Sarah Camillone, OTS, University of Illinois at Chicago

Sareena Denis, OTS, University of Illinois at Chicago

Alexis Downes, OTS, University of Illinois at Chicago

Maddy Wolpow-Gindi, OTS, University of Illinois at Chicago

Eliza Tilson, College of William & Mary ’21 

ICF Domain

Activity
Participation
Environment

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

HR

Recommendations Based on Parkinson Disease Hoehn and Yahr stage: 

 

I

II

III

IV

V

PD EDGE

LS/UR

LS/UR

LS/UR

LS/UR

LS/UR

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

HR

HR

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 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)

PD EDGE

No

No

Yes

Not reported

SCI EDGE

No

Yes

Yes

Not reported

TBI EDGE

No

Yes

Yes

Not reported

Considerations

Interviewer-administration of the WHOQOL-BREF for older people is recommended.

Movement Disorders task force identified the WHOQOL-BREF as “suggested” measure but not as a “recommended” measure since it has reasonable psychometrics in other populations but limited evidence supporting application to those with Parkinson Disease (Martinez-Martin et al, 2011).

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

Stroke

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Normative Data

Acute Stroke: (Zalihic et al, 2010; n = 202; mean age = 72 (13) years; time since stroke not specified)

WHOQOL-BREF Norms by Gender:

 

 

 

Female

Male

 

Mean (SD)

Mean (SD)

Age: Mean (IR*)

75 (11.25)

71 (13.75)

Physical

40.3 (22.2)

47.0 (22.3)

Psychological

46.7 (20.9)

53.3 (18.8)

Social Relationships

63.3 (19.8)

60.7 (19.6)

Environment

52.6 (13.9)

55.8 (18.7)

 

 

*Interquartile  Range

 

 

 

 

Chronic Stroke: (Edwards & O’Connell, 2003; n = 74; mean age = 58.35 (14.80); mean time since stroke onset = 56.8 months)

Normative Data:

 

 

 

WHOQOL-BREF

 

 

Domain

Mean (SD)

Range

Physical

60.5 (21.2)

92.86

Psychological

59.8 (21.5)

100.00

Social Relationships

62.1 (25.4)

100.00

Environment

67.9 (19.1)

71.88

Q1: Quality of Life

3.7 (0.9)

4.00

Q2: Health

3.2 (1.2)

4.00

Content Validity

  • An exploration of the quality of life construct was conducted in 15 culturally diverse field centers to establish areas/facets that participating centers considered relevant to the assessment of quality of life (Harper, 1996)
  • WHOQOL-Bref is the abbreviated version of WHOQOL-100, which can examine the quality of life of individuals after undergoing interventions. This test has been shown to be successful across many cultures (Chapin et al, 2010)

Face Validity

  • Test items contributed from 15 culturally diverse centers were pooled together (Harper, 1996)

  • After clustering semantically equivalent questions, 236 items covering 29 facets were included in a final assessment

  • Pilot work involved administration of this standardized assessment to at least 300 respondents within each of the 15 centers

Brain Injury

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Normative Data

Traumatic Brain Injury: (Chiu et al, 2006; n = 199; mean age = 45.4 (20.3); time since injury = 1.0 (0.7) years; Glasgow Coma Scale scores at admission: score of 3-8 = 7.5%, score of 9-13 = 22.6%, score of 14-15 = 69.9%; Taiwanese sample)

Score Distributions

 

 

Domain

Mean

SD

Quality of Life

13.8

2.8

Physical Capacity

15.1

2.7

Psychological Well-Being

13.9

2.5

Social Relationships

14.2

2.5

Environment

13.7

2.1

Test/Retest Reliability

Traumatic Brain Injury: (Chiu et al, 2006)

Test Retest Reliability

 

 

Domain

ICC

Strength

Quality of Life

0.87

Excellent

Physical Capacity

0.86

Excellent

Psychological Well-Being

0.95

Excellent

Social Relationships

0.74

Adequate

Environment

0.90

Excellent

Internal Consistency

Traumatic Brain Injury: (Chiu et al, 2006)

Internal Consistency

 

 

Domain

Cronbach’s alpha

Strength

Quality of Life

0.75

Adequate

Physical Capacity

0.88

Excellent

Psychological Well-Being

0.89

Excellent

Social Relationships

0.79

Adequate

Environment

0.82

Excellent

Construct Validity

Traumatic Brain Injury: 

(Chiu et al, 2006)

  • Spearman’s correlation coefficients were 0.53 and 0.31 between physical capacity and the Glasgow Outcome Scale and the Barthel Index, respectively, -0.64 between psychological well-being and the Center for Epidemiological Studies Depression Scale (CES-D), 0.52 between psychological well-being and the Social Support, and 0.37 between social relationships and the Social Support Survey.

Content Validity

  • An exploration of the quality of life construct was conducted in 15 culturally diverse field centers to establish areas/facets that participating centers considered relevant to the assessment of quality of life (Harper, 1996)
  • WHOQOL-Bref is the abbreviated version of WHOQOL-100, which can examine the quality of life of individuals after undergoing interventions. This test has been shown to be successful across many cultures (Chapin et al, 2010)

 

Traumatic Brain Injury: (Chiu et al, 2006)

  • Unadjusted scores of the overall quality of life and general health facet and each domain of the WHOQOL-BREF did not significantly differ in severity levels as indicated by the Glasgow Coma Scale, Abbreviated Injury Scale to the Head (AIS-H), and post-traumatic amnesia. 
  • After adjustment for confounds, although the mean scores of the WHOQOL-BREF domains with regard to each indicator changed to some extent, the relationships between the three severity indicators and the four domains and the overall quality of life and general health facet of the WHOQOL-BREF remained similar.

Face Validity

  • Test items contributed from 15 culturally diverse centers were pooled together (Harper, 1996)

  • After clustering semantically equivalent questions, 236 items covering 29 facets were included in a final assessment

  • Pilot work involved administration of this standardized assessment to at least 300 respondents within each of the 15 centers

Floor/Ceiling Effects

Traumatic Brain Injury: (Chiu et al, 2006)

Floor/Ceiling Effect

 

 

Domain

Min (%)

Max (%)

Quality of Life

0.5

2.0

Physical Capacity

0.0

2.5

Psychological Well-Being

0.0

0.0

Social Relationships

0.5

3.0

Environment

0.0

0.0

Responsiveness

Traumatic Brain Injury: 

(Lin et al, 2010)

  • Study stated that WHO-QOL Bref had good responsiveness

 

Traumatic Brain Injury: 

(Chiu et al, 2006) 

Responsiveness of the WHOQOL-BREF with respect to employment status

 

 

 

Domain/facet

Employed Score change (SD)

Unemployed Score change (SD)

Effect Size

QOL

1.6 (2.87)

0.12 (3.00)

0.49

Physical Capacity

1.03 (2.61)

0.38 (2.98)

0.22

Psychological Well-Being

0.27 (2.27)

-0.93 (2.71)

0.44

Social Relationships

0.07 (2.78)

-0.30 (2.64)

0.14

Environment

1.00 (2.48)

-0.55 (2.35)

0.66

Alzheimer's Disease and Progressive Dementia

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Test/Retest Reliability

Dementia: (Lucas-Carrasco et al, 2011; = 104; mean age = 78.6 (7.2) years; time since onset of dementia not specified)

Test-retest Reliability

 

Domain

ICC, n=27 (retest within two weeks)

Physical

0.70*

Psychological

0.51*

Social Relationship

0.59*

Environment

0.61*

*P<0.1, ICC indicates intraclass correlation

 

Internal Consistency

Dementia: (Lucas-Carrasco et al, 2011)

  • Excellent internal consistency for entire scale (Cronbach's alpha = 0.88)

Internal Consistency by Domain:

 

Domain

Cronbach’s Alpha

Physical

0.78

Psychological

0.79

Social Relationship

0.54

Environment

0.70

Construct Validity

Dementia: (Lucas-Carrasco et al, 2011)

Discriminant Validity for all Domains:

 

 

 

 

 

Physical r

Psychological r

Social r

Environmental r

Association with r:

 

 

 

 

Overall QOL

0.336

0.560

0.232

0.528

DEMQOL-28 total

0.381

0.490

0.161

0.353

Geriatric Depression Scale

-0.529

-0.640

-0.236

-0.445

Barthel Index

0.462

0.214

0.292

0.184

MMSE

-0.011

0.049

0.258

0.298

No chronic health conditions

-0.425

-0.247

-0.144

0.002

Content Validity

  • An exploration of the quality of life construct was conducted in 15 culturally diverse field centers to establish areas/facets that participating centers considered relevant to the assessment of quality of life (Harper, 1996)
  • WHOQOL-Bref is the abbreviated version of WHOQOL-100, which can examine the quality of life of individuals after undergoing interventions. This test has been shown to be successful across many cultures (Chapin et al, 2010)

Face Validity

  • Test items contributed from 15 culturally diverse centers were pooled together (Harper, 1996)

  • After clustering semantically equivalent questions, 236 items covering 29 facets were included in a final assessment

  • Pilot work involved administration of this standardized assessment to at least 300 respondents within each of the 15 centers

Floor/Ceiling Effects

Dementia: (Lucas-Carrasco et al, 2011; n = 104; mean age = 78.6 (7.2) years; time since onset of dementia not specified)

Floor and Ceiling Effects by Domain

 

 

Domain

% of Floor

% of Ceiling

Physical

0

0

Psychological

0

0

Social Relationships

0

2.9

Spinal Injuries

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Standard Error of Measurement (SEM)

Traumatic Spinal Cord Injury: (Salvador-De La Barrera et al., 2018; n = 54; Mean Age = 45.5 (13.2); Spinal cord injury level: Cervical = 2, Thoracic = 28, Lumbar/sacral = 6; AIS A = 34, B = 7, C = 6, D = 7; Spanish sample)

  • SEM for entire group (n = 54) = 1.936 points (calculated from Salvador-De La Barrera et al., 2018)

Minimal Detectable Change (MDC)

Traumatic Spinal Cord Injury: (Salvador-De La Barrera et al., 2018)

  • MDC for entire group (n=54) = 5.37

Cut-Off Scores

Traumatic Spinal Cord Injury: (Salvador-De La Barrera et al., 2018)

  • Scoring 60 points or higher on the Spanish version of the Spinal Cord Independence Measure, version III, denoting anything higher as an individual being able to independently perform ADLs 

Normative Data

Traumatic Spinal Cord Injury: (Salvador-De La Barrera et al., 2018; n = 54; Mean Age = 45.5 (13.2); Spinal cord injury level: Cervical = 2, Thoracic = 28, Lumbar/sacral = 6; AIS A = 34, B = 7, C = 6, D = 7; Spanish sample)

  • Quality of Life = 66.2 (20.69)
  • General Health = 56.48 (22.35)
  • Physical = 61.55 (17.44)
  • Psychological = 67.76 (19.33)
  • Social relationship = 65.43 (21.37)
  • Environment = 69.09 (12.90)

Test/Retest Reliability

Traumatic Spinal Cord Injury: (Salvador-De La Barrera et al., 2018)

  • Adequate test-retest reliability (ICC = .85)

Chronic SCI: (Lin et al, 2007; n = 187; mean age = 42.9; mean time since injury = 7.4 years; 25.7% incomplete tetraplegia, 15.0% complete tetraplegia, 39.0% incomplete paraplegia, 20.3% complete paraplegia; Taiwanese sample)

Interrater/Intrarater Reliability:

 

 

 

 

Domain

Strength

Inter-observer (ICC)

Strength

Intra-observer (ICC)

Overall QoL / General Health

Adequate

0.63

Excellent

0.84

Physical Capacity

Excellent

0.88

Excellent

0.93

Psychological Well-being

Excellent

0.95

Excellent

0.98

Social Relationships

Adequate

0.56

Excellent

0.84

Environment

Excellent

0.80

Excellent

0.89

Internal Consistency

Traumatic Spinal Cord Injury: (Salvador-De La Barrera et al., 2018)

  • Full questionnaire had Excellent internal consistency (Cronbach’s alpha = 0.887) 
    • Physical health, Adequate, Cronbach’s alpha = 0.731
    • Psychological health, Excellent, Cronbach’s alpha = 0.859
    • Social relationships, Poor, Cronbach’s alpha = 0.68
  • Environment, Poor, Cronbach’s alpha = 0.65

Chronic SCI: (Lin et al, 2007; n = 187; mean age = 42.9; mean time since injury = 7.4 years; Taiwanese sample)

WHOQOL-BREF Alpha by Domain:

 

 

Scale

Strength

Alpha

Overall Quality of Life and General Health

Adequate

0.79

Physical Capacity

Excellent

0.87

Psychological Well-Being

Excellent

0.83

Social Relationships

Adequate

0.75

Environment

Excellent

0.86

SCI: (Jang et al, 2004; n = 111, mean age = 40 (13) years, mean time since SCI = 6 (6) years, complete tetraplegia = 23, incomplete tetraplegia = 28, complete paraplegia = 43, incomplete paraplegia = 17)

Internal Consistency for each domain:

  • Physical Health: Adequate (Cronbach’s alpha = 0.75)
  • Psychological Health: Adequate (Cronbach’s alpha = 0.74)
  • Social Relationships: Poor (Cronbach’s alpha = 0.54)
  • Environment: Adequate (Cronbach’s alpha = 0.78)

 

Construct Validity

Convergent Validity:

Traumatic Spinal Cord Injury: (Salvador-De La Barrera et al., 2018)

  • Poor convergent validity was found for the physical domain of the WHOQOL-BREF with the Hospital Anxiety and Depression Scale (HADS) anxiety subscale (range r = - 0.295, p = 0.03) 
  • Adequate convergent validity was found between the physical, psychological, and social relationships domains of the WHOQOL-BREF and HADS depression subscale (r = - 0.480, r = - 0.554, and r = - 0.457 respectively and with p 0.001)
  • Adequate convergent validity was found between the overall QoL item and the general health item of the WHOQOL-BREF and the HADS depression subscale (r = - 0.443, p = 0.001 and r = - 0.356, p = 0.008 respectively)
  • Poor convergent validity was found between the physical domain of WHOQOL-BREF and the Duke UNC-11 (r = 0.268, p = 0.05)
  • Adequate convergent validity was found between the social relationship and the environment domain of WHOQOL-BREF and the Duke UNC-11 (r = 0.487, p < 0.001 and r = 0.423, p = 0.001, respectively) 

SCI: (Jang et al, 2004; SCI, n = 111, mean age = 40 (13) years; mean time since injury 6 (6) years; non-SCI, n = 169, mean age = 37 (12) years)

Discriminant validity of the WHOQOL-BREF assessment by t test:

 

 

 

 

Facet and Domain

Non-SCI (n = 169)

SCI (n = 111)

t

P

Overall QOL facet

13.92 (2.69)

12.14 (3.28)

4.94

< 0.001

General health facet

14.22 (2.72)

10.16 (3.27)

10.85

< 0.001

Physical health

15.44 (1.84)

11.41 (2.84)

13.23

< 0.001

Psychologic health

13.75 (2.12)

11.74 (2.73)

6.91

< 0.001

Social relationships

14.25 (2.21)

12.54 (2.58)

5.92

< 0.001

Environment

12.85 (2.13)

12.18 (2.55)

2.31

0.022

Values are mean (SD)

 

 

 

 

 

Chronic SCI: (Lin et al, 2007)

  • Each domain of the WHOQOL-BREF had Adequate to Excellent correlation with a global rating of health status on a 0-100 scale (r = 0.54-0.73)
  • Overall Quality of Life and General Health domains had Excellent correlation with General Health subscale of the SF-36 (r = 0.65)
  • Physical Capacity domain had Adequate to Excellent correlations with the Physical Functioning subscale (= 0.78), Role Physical subscale (= 0.51), and Bodily Pain subscale (r = 0.68) of the SF-36.
  • Psychological Well-Being domain had Poor to Excellent correlations with the Social Functioning subscale (r = 0.63), Role Emotional subscale (r = 0.37), and Mental Health subscale (r = 0.59) of the SF-36.
  • Social Relationships domain had Adequate correlation with the Social Functioning subscale (r = 0.43) of the SF-36.

 

SCI: (Jang et al, 2004)

  • Statistically significant mean differences were found between the SCI and non-SCI groups in all domains except the environmental domain after controlling for gender, education and employment status.

Content Validity

  • An exploration of the quality of life construct was conducted in 15 culturally diverse field centers to establish areas/facets that participating centers considered relevant to the assessment of quality of life (Harper, 1996)
  • WHOQOL-Bref is the abbreviated version of WHOQOL-100, which can examine the quality of life of individuals after undergoing interventions. This test has been shown to be successful across many cultures (Chapin et al, 2010)

Face Validity

  • Test items contributed from 15 culturally diverse centers were pooled together (Harper, 1996)

  • After clustering semantically equivalent questions, 236 items covering 29 facets were included in a final assessment

  • Pilot work involved administration of this standardized assessment to at least 300 respondents within each of the 15 centers

Floor/Ceiling Effects

Traumatic Spinal Cord Injury: (Salvador-De La Barrera et al., 2018)

  • Adequate floor and ceiling effects in the 4 domains (physical, psychological, social relationship and environment) with <2% effect present
  • Quality of life, Adequate ceiling effect with 11.1% reaching
  • General health, Adequate ceiling effects with 9.3% reaching 

Chronic SCI: (Lin et al, 2007)

  • Excellent with 0.0-1.3% of individuals reaching floor and 0.0-0.4% of individuals reaching ceiling effect on each domain

 

SCI: (Jang et al, 2004)

  • Adequate Floor Effect for General Health and Overall QOL domains with 5.4%-9.0% reaching floor.
  • Excellent Floor Effect for all other domains with 0.0% of individuals reaching floor.
  • Excellent Ceiling Effect with 0.0-1.8% of individuals reaching ceiling effect on each domain.

Responsiveness

SCI: (Lin et al, 2007)

Responsiveness Effects with respect to change in employment status:

  • Large Effect for Overall QOL and General Health (1.01)
  • Large effect for Physical Capacity (1.83)
  • Moderate effect for Psychological Well-being (0.78)
  • Large effect for Social Relationships (1.16)
  • Moderate effect for Environment (0.78)

Older Adults and Geriatric Care

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Normative Data

Community Dwelling Adults: (Huang et al; 2009; mean age = 70.96 (6.91) years, mean Activity-specific Balance Confidence Scale score = 79.89 (20.59) points; Taiwanese sample)

Normative Data

 

 

Healthy Community dwelling elderly adults:

 

 

WHOQOL subscale

Mean (SD)

Range

Physical health

14.14 (2.62)

6–20

Psychological

12.92 (2.44)

7–20

Social relationships

13.79 (1.90)

10–18

Environment

13.59 (1.92)

9–20

Interrater/Intrarater Reliability

Community Dwelling Older Adults: (Hwang et al, 2003; n = 1200; 43% had one, 27% had two, and 30% had > three chronic conditions; mean age = 73.4 (range = 65 to 103) years; Taiwanese sample)

Interrater/Intrarater Reliability:

 

 

 

 

 

Domain

Strength

Inter-observer

Strength

Intra-observer

Physical Capacity

Excellent

0.89

Excellent

0.94

Psychological Well-being

Excellent

0.95

Excellent

0.94

Social Relationships

Excellent

0.81

Excellent

0.77

Environment

Excellent

0.93

Excellent

0.92

Internal Consistency

Community Dwelling Older Adults: (Hwang et al, 2003)

  • Excellent for Physical Capacity domain (Cronbach’s alpha = 0.80)
  • Excellent for Psychological Well-being (Cronbach’s alpha = 0.81)
  • Adequate for Social Relationships (Cronbach’s alpha = 0.73)
  • Excellent for Environment (Cronbach’s alpha = 0.80)

Construct Validity

Community Dwelling Adults: (Huang et al, 2009)

Fear of falling measure

WHOQOL Sub-scale:

 

 

 

 

 

Physical

Psychological

Social

Environment

Total

FES

0.58***

0.45***

0.15

0.29**

0.46***

ABC

0.61***

0.48***

0.23**

0.25**

0.48***

GFFM

-0.63***

-0.36***

-0.22**

-0.30**

-0.46***

** p <  .01 Moderate
*** p <  .001 Excellent

 

 

 

 

 

 

Content Validity

  • An exploration of the quality of life construct was conducted in 15 culturally diverse field centers to establish areas/facets that participating centers considered relevant to the assessment of quality of life (Harper, 1996)
  • WHOQOL-Bref is the abbreviated version of WHOQOL-100, which can examine the quality of life of individuals after undergoing interventions. This test has been shown to be successful across many cultures (Chapin et al, 2010)

Face Validity

  • Test items contributed from 15 culturally diverse centers were pooled together (Harper, 1996)

  • After clustering semantically equivalent questions, 236 items covering 29 facets were included in a final assessment

  • Pilot work involved administration of this standardized assessment to at least 300 respondents within each of the 15 centers

Floor/Ceiling Effects

Community Dwelling Older Adults: (Hwang et al, 2003)

  • Excellent with 0.0-0.3% of individuals reaching floor and 0.0-0.8% of individuals reaching ceiling effect on each domain.

Responsiveness

Community Dwelling Older Adults: (Hwang et al, 2003) Responsiveness Effects (Based on Guyatt’s method)

  • Large effect for Physical Capacity (ES = -1.42)
  • Large effect for Psychological Well-being (ES = -0.80)
  • Moderate effect for Social Relationships (ES = -0.46)
  • Moderate effect for Environment (ES = -0.71)
  • Moderate effect for Overall Quality of Life and General Health (ES = -0.56)

Parkinson's Disease

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Internal Consistency

Parkinson’s Disease: (Hendred & Foster, 2016; n = 96; Mean Age 62.4 5.3); Disease Duration = 5 (4.3); Average Hoehn & Yahr Stage = 2 (range 1-3)) 

  • Full questionnaire had Excellent internal consistency (Cronbach’s alpha = 0.93) 
    • Physical health, Excellent, Cronbach’s alpha = 0.85
    • Psychological health, Excellent, Cronbach’s alpha = 0.85 
    • Social relationships, Poor, Cronbach’s alpha = 0.65
    • Environment, Excellent, Cronbach’s alpha = 0.84

Parkinson Disease: (Hirayama et al, 2008; = 68 with PD (38 male/30 female; Age 66.6(8.9); Age at onset 58.6(9.9); Duration 8.0(6.2); Education 8.8(5.3) years; HY 1: n = 10, HY 1.5: n = 9, HY 2: n = 17, HY 2.5: n = 13, HY 3: n = 18, HY 4: n = 1). Mild = HY stages 1-1.5; Moderate = HY stages 2-2.5; Advanced = HY stages 3-4.)

  • For whole tool, Excellent internal consistency (Cronbach’s alpha = 0.91)
    • Physical capacity, Adequate, Cronbach’s alpha = 0.8
    • Psychological well-being, Adequate, Cronbach alpha = 0.76
    • Social relationships, Adequate, Cronbach alpha = 0.74
    • Environmental, Adequate, Cronbach alpha = 0.73

Construct Validity

Convergent Validity:

Parkinson’s Disease: (Hendred & Foster, 2016)

  • Poor convergent validity was found for the physical and environment domain of the WHOQOL-BREF with age (r = 0.25, p<.05 and r = 0.29, p<.01 respectively)
  • Poor convergent validity for social relationships of the WHOQOL-BREF and education (r = 0.22, p<.05)
  • Adequate convergent validity for the environment of the WHOQOL-BREF and education (r = 0.38, p<.01)
  • Adequate convergent validity for physical health and the environment on the WHOQOL-BREF in relation to levodopa equivalent daily dose (r = - 0.31, p<.01 for both domains)
  • Convergent validity was found for the 4 domains of the WHOQOL-BREF with Dysexecutive Questionnaire
    • Physical health, Adequate, r = - 0.42 (p < .01)
    • Psychological health, Adequate, r = - 0.54 (p < .01)
    • Social relationships, Adequate, r = - 0.40 (p < .01)
    • Environment, Adequate, r = - 0.37 (p < .01)
  • Convergent validity was found for the 4 domains of the WHOQOL-BREF with the Beck Depression Inventory II
    • Physical health, Adequate, r = - 0.45 (p < .01)
    • Psychological health, Excellent, r = - 0.72 (p < .01)
    • Social relationships, Adequate, r = - 0.51 (p < .01)
    • Environment, Adequate, r = - 0.58 (p < .01)
  • Convergent validity was found for the 4 domains of the WHOQOL-BREF with the Liebowitz Social Anxiety Scale
    • Physical health, Adequate, r = - 0.44 (p < .01)
    • Psychological health, Adequate, r = - 0.57 (p < .01)
    • Social relationships, Adequate, r = - 0.43 (p < .01)
    • Environment, Adequate, r = - 0.50 (p < .01)
  • Convergent validity was found for the 4 domains of the WHOQOL-BREF with the Apathy Evaluation Scale
    • Physical health, Adequate, r = - 0.40 (p < .01)
    • Psychological health, Excellent, r = - 0.61 (p < .01)
    • Social relationships, Adequate, r = - 0.57 (p < .01)
    • Environment, Adequate, r = - 0.56 (p < .01)
  • Convergent validity was found for the 4 domains of the WHOQOL-BREF with the Parkinson’s Disease Fatigue Scale
    • Physical health, Excellent, r = - 0.75 (p < .01)
    • Psychological health, Adequate, r = - 0.56 (p < .01)
    • Social relationships, Adequate, r = - 0.40 (p < .01)
    • Environment, Adequate, r = - 0.47 (p < .01)
  • Adequate convergent validity was found between physical health on the WHOQOL-BREF and physical activities of daily living (ADL) (r = 0.42, p<.01)
  • Poor convergent validity was found between the environment on the WHOQOL-BREF and physical ADL (r = 0.23, p<.05)
  • Convergent validity was found for the 4 domains of the WHOQOL-BREF with cognitive ADL
    • Physical health, Poor, r = 0.26 (p < .05)
    • Psychological health, Adequate, r = 0.33 (p < .01)
    • Social relationships, Poor, r = 0.22 (p < .05)
    • Environment, Poor, r = 0.26 (p < .05)

Parkinson Disease: (Schestatsky et al, 2006; = 21 PD and their caregivers; PD subjects (age 65.76(11.07), 76.2% male, duration of disease 6.78(4.46), Hoehn & Yahr mean stage = 2.55(1.06), mean MMSE 26.52(1.86), amount of antiparkinsonian meds 2.95(1.71), Caregivers, n = 21 (age 50.70(16.26), 90.4% female, 52.1% were wife/husband of subject, 25.9% son or daughter, 12% siblings, and 10% were professional care providers)

  • PD group: significant correlations (p < 0.05). Other interactions were either not significant at 0.05 or represented weak correlation.
    • QOL-BREF Psychological well-being, Adequate negative correlation with Duration of disease (r = -0.55; p = 0.01)
    • QOL-BREF Social interactions, Excellent negative correlation with Hoehn Yahr Stage (r = -0.7; p = 0.001).
    • QOL-BREF physical domain, Adequate positive correlation to number of people living in the home (r = 0.5; p = 0.02)
  • Caregiver group: significant correlations (p < 0.05). Other interactions were either not significant at 0.05 or represented weak correlation.
    • QOL-BREF social interactions, Adequate negative correlation to patient’s age (r = -0.43; p = 0.04).

Content Validity

  • An exploration of the quality of life construct was conducted in 15 culturally diverse field centers to establish areas/facets that participating centers considered relevant to the assessment of quality of life (Harper, 1996)
  • WHOQOL-Bref is the abbreviated version of WHOQOL-100, which can examine the quality of life of individuals after undergoing interventions. This test has been shown to be successful across many cultures (Chapin et al, 2010)

Face Validity

  • Test items contributed from 15 culturally diverse centers were pooled together (Harper, 1996)

  • After clustering semantically equivalent questions, 236 items covering 29 facets were included in a final assessment

  • Pilot work involved administration of this standardized assessment to at least 300 respondents within each of the 15 centers

Floor/Ceiling Effects

Parkinson’s Disease: (Hendred & Foster, 2016) 

  • Physical health, Excellent with 0% of individuals reaching the floor and the ceiling 
  • Psychological health, Excellent with 0% reaching the floor and Adequate with 1% reaching the ceiling 
  • Social relationships, Excellent with 0% reaching the floor and Adequate with 4.2% reaching the ceiling 
  • Environment, Excellent with 0% reaching the floor and Adequate with 3.1% reaching the ceiling  
  • Overall Quality of Life, Excellent floor effect with 0% reaching floor but Poor ceiling effect with 24% reaching the ceiling
  • General health, Adequate with 7.3% reaching the floor and 2.1% reaching the ceiling 

Non-Specific Patient Population

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Standard Error of Measurement (SEM)

Medical Students: (Ilić et al., 2019; n = 760; Mean Age = 23.7 (2.7); 6% identified as having a chronic disease; Serbian sample)

  • Physical health, SEM for entire group (n=760): 0.651 (calculated from Ilić et al., 2019)
  • Psychological health, SEM for entire group (n=760): 0.606 (calculated from Ilić et al., 2019)
  • Social relationships, SEM for entire group (n=760):  0.899 (calculated from Ilić et al., 2019)
  • Environment, SEM for entire group (n=760): 0.606 (calculated from Ilić et al., 2019)

Hospitalized Trauma Population: (Kruithof et al., 2018; n = 202; Median Age = 63 (IQR 53-76); Median Days Admitted to Hospital = 5.5 (IQR 3-11); Median Injury Severity (ISS) = 9 (IQR 4-10); Dutch sample)

  • SEM for entire group (n = 202):
     

Minimal Detectable Change (MDC)

Medical Students: (Ilić et al., 2019)

  • Physical health, MDC for entire group (n=760): 1.80
  • Psychological health, MDC for entire group (n=760): 1.68
  • Social relationships, MDC for entire group (n=760): 2.49 
  • Environment, MDC for entire group (n=760): 1.68

Normative Data

Irritable Bowel Syndrome: (Jamali et al., 2015; n = 250, mean age = 29.6 (9.6) years; 135 female subjects and 115 male subjects; 67.6% low education status (under diploma); 90.8% reside in urban areas; 79.2% of subjects married; IBS subtypes IBS-D (27.6%), IBS-C (32.8%), IBMS-M (39.6%); self-reported symptom severity mild (52.8%), moderate (36.4%), severe (10.8%))

 

WHOQOL-BREF

 

Domain

 

Physical               23.67 ± 5.22

Psychological      19.36 ± 3.72

Social                  10.68 ± 2.51

Environmental     27.74 ± 5.04

 

Total                    85.69 ± 16.1

 

IBSQOL score     79.32 ± 24.5

 

State/Trait Anxiety Inventory score               92.25 ± 19.02

Beck Depression Inventory II score              15.91 ± 6.65

Caregivers of Relatives with psychiatric illnesses (Heyam et al., 2017; n=266; 52.6% male, 47.4% female; age range of 18-74; mean age=37.3(11.3);; 36.5% of caregivers were parents, 19.9% were spouses, 16.9% were siblings; 84.6% lived together with the ill relative; average length of caretaking = 3.9(2.0) years, in Jordan).

  • WHOQOL-BREF mean = 54.18(13.5), 26 items
  • physical health domain mean = 53.43(14.2), 7 items
  • psychological health domain mean = 57.51(13.7), 6 items
  • social relations domain mean = 53.3(21.9), 3 items
  • environmental domain mean = 52.41(16.2), 8 items

High-HIV-Risk Transgender Women: (Thompson et al., 2015; n = 312; mean age = 42 years, range of age 20 to 77 years. 83% non-white, 32% Latinas, 39% were laboratory-confirmed HIV-positive).

  • Overall quality of life (Item #1) M=3.69 (1.03)
  • Overall health (Item #2) M=3.72 (1.09)
  • Domain 1 - Physical M=66.08 (18.98)
  • Domain 2 - Psychological M=67.39 (17.84)
  • Domain 3 - Social M=65.00 (22.85)
  • Domain 4 - Environmental M=59.54 (17.74)

Adolescents: (Skevington, Dehner, Gillison, McGrath, & Lovell, 2014; n = 208; Mean Age = 16.35 (1.9); 59% male; 33% had acne, 22% had depressive symptoms, 19% had both; English sample)

  • General QoL, 4.25 (0.70)
  • General Health, 3.85 (0.85)
  • Physical health, 76.58 (12.66)
  • Psychological health, 67.70 (15.70)
  • Social relationships, 69.41 (19.20)
  • Environment, 70.72 (14.68)

 

Young Adult: (Skevington et al., 2014; n = 240; Mean Age = 22.9 (3.0); 47% male; English sample)

  • General QoL, 4.18 (0.73)
  • General Health, 3.96 (0.79)
  • Physical health, 78.83 (13.09)
  • Psychological health, 67.48 (15.64)
  • Social relationships, 70.66 (19.28)

Environment, 71.77 (12.03)

Medical Students: (Ilić et al., 2019)

WHOQOL-BREF          Mean    Standard Deviation

Perception of quality of life     3.87      0.794

Perception of health    3.92      0.853

Physical Health

Item 3   4.21      0.894

Item 4   4.77      0.577

Item 10 3.88      0.768

Item 15 4.11      0.943

Item 16 3.51      0.991

Item 17 3.97      0.733

Item 18 4.16      0.746

Psychological Health

Item 5   3.87      0.849

Item 6   4.56      0.742

Item 7   3.78      0.758

Item 11 4.44      0.751

Item 19 4.27      0.735

Item 26 3.63      0.958

Social Relationships

Item 20 4.35      0.646

Item 21 3.92      1.107

Item 22 4.35      0.646

Environment

Item 8   4.05      0.834

Item 9   3.13      1.065

Item 12 3.70      0.929

Item 13 4.37      0.713

Item 14 3.58      0.953

Item 23 4.26      0.770

Item 24 3.28      1.037

Item 25 3.47      1.079

 

Dental Students: (Al-Shibani & Reem Al-Kattan, 2019; n = 782; Saudi Arabian sample)

               Mean    SD

Physical           19.77    3.74

Psychological  17.64    3.04

Social  7.50      1.70

Environmental 33.72    5.24

Overall QoL     3.97      0.93

Satisfaction with health           3.78      1.05

Somali Refugees: (Redko et al., 2014; n = 303; n=253 with a current illness and n=50 without current illness; mean age = 47.7 (SD 18.2, range 15-93 years); sample of Somali refugees living in Ohio)

  • Physical = 44.69 (18.30)
  • Psychological = 52.83 (18.44)
  • Social = 50.04 (20.36)
  • Environmental = 46.32 (16.87)

Hospitalized Trauma Population: (Kruithof et al., 2018; n = 202; Median Age = 63 (IQR 53-76); Median Days Admitted to Hospital = 5.5 (IQR 3-11); Median Injury Severity (ISS) = 9 (IQR 4-10); Dutch sample)

Domain Mean    SD

Quality of Life    71         24

Health Satisfaction        60         26

Physical            55         20

Psychological   70         19

Social   73         18

Environmental   73         18

Test/Retest Reliability

Intimate partner violence survivors: (Ross et al., 2017; n = 284; age range from 18 to 58 years old; 94% married/living with a partner, 90% reported emotional violence, more than 61% physical violence, and 25% sexual violence; Thai sample)

  • Excellent reliability for the WHOQOL-BREF/Thao version (r = 0.87).

High-HIV-Risk Transgender Women: (Thompson et al., 2015)

  • Domain 1 - Physical, Acceptable reliability = 0.78
  • Domain 2 - Psychological, Acceptable reliability = 0.78
  • Domain 3 - Social, Unacceptable reliability = 0.65
  • Domain 4 - Environmental, Acceptable reliability = 0.77

Medical Students: (Ilić et al., 2019)

  • Physical health, Adequate test-retest reliability (ICC = 0.733)
  • Psychological health, Adequate test-retest reliability (ICC = 0.769)
  • Social relationships, Poor test-retest reliability (ICC = 0.491)
  • Environment, Adequate test-retest reliability (ICC = 0.769)

Internal Consistency

Caregivers of Relatives with psychiatric illnesses: (Heyam et al., 2017)

  • WHOQOL-BREF showed excellent internal consistency (Cronbach’s alpha = 0.92)
  • Physical health domain showed excellent internal consistency (Cronbach’s alpha = 0.80)
  • Psychological health domain showed adequate internal consistency (Cronbach’s alpha = 0.75)
  • Social relations domain showed poor internal consistency (Cronbach’s alpha = 0.69)
  • Environmental domain showed adequate internal consistency (Cronbach’s alpha = 0.79)

Item Internal Consistency:

  • Items in the physical health domain showed adequate to excellent item internal consistency correlations, with correlation coefficients ranging from 0.48 to 0.75
  • Items in the psychological domain showed adequate to excellent item internal consistency correlations, with correlation coefficients ranging from 0.58 to 0.76
  • Items in the social relations domain showed excellent item internal consistency correlations, with correlation coefficients ranging from 0.78 to 0.80
  • Items in the environmental domain showed excellent item internal consistency correlations, with correlation coefficients ranging from 0.63 to 0.72

Intimate partner violence survivors: (Ross et al., 2017)

  • Physical health, adequate (alpha = 0.79)
  • Psychological health and relationship, adequate (alpha = 0.74)
  • Self and spirituality, adequate (alpha = 0.75)
  • Safety and environment, excellent (alpha =0.80)

Adolescents: (Skevington et al., 2014)

 Across the 24 specific items, Excellent, Cronbach's alpha = 0.89

  • Physical health, Poor, Cronbach's alpha = 0.65
  • Psychological health, Adequate, Cronbach's alpha = 0.772
  • Social relationships, Poor, Cronbach's alpha = 0.66
  • Environment, Excellent, Cronbach's alpha = 0.803

 

Young Adult: (Skevington et al., 2014)

Across the 24 specific items, Excellent, Cronbach's alpha = 0.88

  • Physical health, Adequate, Cronbach's alpha = 0.715
  • Psychological health, Adequate, Cronbach's alpha = 0.784
  • Social relationships, Poor, Cronbach's alpha = 0.652
  • Environment, Excellent, Cronbach's alpha = 0.8695

Medical Students: (Ilić et al., 2019)

  • Physical health, Adequate, Cronbach’s alpha = 0.744
  • Psychological health, Adequate, Cronbach’s alpha = 0.777
  • Social relationships, Poor, Cronbach’s alpha = 0.533
  • Environment, Adequate, Cronbach’s alpha = 0.776

 

Dental Students: (Al-Shibani & Reem Al-Kattan, 2019)

  • Physical health, Poor, Cronbach’s alpha = 0.565
  • Psychological health, Poor, Cronbach’s alpha = 0.360
  • Social relationships, Poor, Cronbach’s alpha = 0.641
  • Environment, Poor, Cronbach’s alpha = 0.770

Somali Refugees: (Redko et al., 2014)

  • Poor: Physical domain Cronbach’s Alpha = 0.65
  • Adequate: Psychological domain Cronbach’s Alpha = 0.71
  • Adequate: Social domain Cronbach’s Alpha = 0.76
  • Excellent: Environmental domain Cronbach’s Alpha = 0.82

Hospitalized Trauma Population: (Kruithof et al., 2018)

  • Excellent: Physical domain Cronbach’s Alpha = 0.838
  • Excellent: Psychological domain Cronbach’s Alpha = 0.860
  • Poor: Social domain Cronbach’s Alpha = 0.675
  • Excellent: Environmental domain Cronbach’s Alpha = 0.849

Cataracts: (Gholami et al., 2016; n = 300; mean age = 68.11 (11.98); duration of disease: +30 years = 154 (51.3), -30 years = 146 (48.7); Iranian sample)

  • Adequate: Cronbach’s alpha = 0.889
    • Physical health = .810
    • Psychological Health = .765
    • Social Relationships = .731
    • Environmental Health = .714

Construct Validity

Convergent Validity:

Irritable Bowel Syndrome: (Jamali et al., 2015; n = 250)

  • Excellent: r = 0.82, P < 0.001

Caregivers of Relatives with psychiatric illnesses: (Heyam et al., 2017)

Item Discriminant Validity:

Each of the 24 items reported a higher correlation with its corresponding domain than with other domains, with all items but two being ranked as having either a poor or adequate correlation (correlation coefficients ranging from 0.11 to 0.62).

Intimate partner violence survivors: (Ross et al., 2017).

  •  Adequate negative correlation between the WHOQOL-BREF/Thai version and the Thai Depression Inventory (r= -0.55, p<0.01)

High-HIV-Risk Transgender Women: (Thompson et al., 2015)

  • Adequate: All correlations ranging from 0.33 (overall health to overall quality of life) to 0.55 (for the environmental domain to overall quality of life) (p < .001).

Somali Refugees: (Redko et al., 2014)

For the total sample, the Pearson’s correlation coefficients between the WHOQOL-BREF domains ranged from 0.55 to 0.76, which indicates adequate to excellent construct validity.

  • There was excellent correlation between the physical and psychological domains (r=0.70)
  • There was adequate correlation was between the physical and social domains (r=0.55)
  • There was excellent correlation was between the psychological and environmental domains (r=0.76)
  • There was excellent correlation between the environmental and physical domains (r=0.72)
  • There was excellent correlation between the psychological and social domains (r=0.60)
  • There was an excellent correlation between the social and environmental domains (r=0.64)
  • Correlation coefficients were excellent for all three items of the social domain (0.79 > r < 0.83)                                  
  • Correlation coefficients were mostly excellent for items within the physical domain (0.72 > r < 0.84) with only two items having adequate correlations (r = 0.50 and r = 0.65 for Q4 and Q3, respectively).
  • Correlation coefficients were excellent for the psychological domain (0.76 > r < 0.80), with only one adequate item (r = 0.53 for Q26).
  • The environmental domain showed adequate to excellent with items (0.44 > r < 0.81)

Discriminant Validity:

Refugees: (Redko et al., 2014)

  • Student’s t tests showed highly significant mean differences between with/without current illness subgroups for both overall quality of life (Q1) and satisfaction with health (Q2)
  • The social domain indicated a larger magnitude of difference between the subgroups, followed by physical, environmental, and psychological domains
  • The domains of overall quality of life (Q1) showed an excellent correlation (r = 0.694)
  • The domains of health satisfaction (Q2) showed an excellent correlation (r = 0.706)

Student’s t tests indicated significant differentiating power for all domains

Convergent Validity: (Kruithof et al., 2018)

Hospitalized Trauma Population

  • Adequate convergent validity was found for the environmental domain of the WHOQOL-BREF with all HRQoL* (range rs = 0.389 -- 0.456, all p<0.01) and psychological instruments** (range rs = -0.357 -- -0.521, all p<0.01)
  • Adequate convergent validity was found between the psychological domain of the WHOQOL-BREF and the Health Utility Index Mark 2 and 3 (rs = 0.401 and rs = 0.449 respectively and both p<0.01
  • Adequate convergent validity was found between the ‘overall QoL item’ of the WHOQOL-BREF and the Impact of Event Scale (IES) (rs = -0.331, p<0.01)
  • Poor convergent validity was found between the social domain of WHOQOL-BREF and the Hospital Anxiety and Depression Scale (rs = -0.276, p<0.01)
  • Poor convergent validity was found between the ‘general health’ item of the WHOQOL-BREF and the IES (rs = -0.287, p<0.01)
  • Poor convergent validity was found between the psychological domain of the WHOQOL-BREF and the IES (rs = -0.475, p<0.01)
  • Poor convergent validity was found between the social domain of the WHOQOL-BREF and the IES (rs = -.0232, p<0.01)

*HRQoL instruments include the Health Utility Index Mark 2 and 3

**Psychological instruments include Impact of Event Scale, the Hospital Anxiety and Depression Scale, and the EuroQol-five-dimension-3-level

Caregivers of Relatives with psychiatric illnesses: (Heyam et al., 2017)

Item Discriminant Validity:

  • Each of the 24 items reported a higher correlation with its corresponding domain than with other domains, with all items but two being ranked as having either a poor or adequate correlation (correlation coefficients ranging from 0.11 to 0.62).

Floor/Ceiling Effects

Hospitalized Trauma Population: (Kruithof et al., 2018)

  • Quality of life item: Adequate floor effect of 4% and poor ceiling effect of 41%
  • Health satisfaction item: Adequate floor effect of 6% and poor ceiling effect of 23%
  • Physical domain: Excellent floor effect of 0% and adequate ceiling effect of 2%
  • Psychological domain: Excellent floor effect of 0% and adequate ceiling effect of 6%
  • Social domain: Excellent floor effect of 0% and adequate ceiling effect of 18%
  • Environmental domain: Excellent floor effect of 0% and adequate ceiling effect of 9%

Cataracts: (Gholami et al., 2016; n = 300)

  • Poor - Adequate: Ceiling effects = 2.3% - 35.3%
  • Poor - Adequate: Floor effects = 1% - 32.3%

Mental Health

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Standard Error of Measurement (SEM)

Schizophrenia: (Su et al., 2014; n = 100; Mean Age = 49.16 (7.85); Mean Duration of Disease = 26.59 (8.08); Taiwanese sample)

  • SEM for entire group (n=100): 2.93 (5.55%).

Minimal Detectable Change (MDC)

Schizophrenia: (Su et al., 2014; n = 100)

  •  MDC = 1.96 x SEM x square root of 2 = 8.12

Cut-Off Scores

Psychiatric Population: (Oliveira et al., 2016; n = 403; mean age = 43.15 (SD=12.38); diagnosis of schizophrenia = 36.5%)

  • chi-square ≤ 2
  • Comparative Fit Index (CFI) ≥ 0.95
  • Goodness of Fit Index (GFI) ≥ 0.95
  • Tucker-Lewis Index (TLI) ≥ 0.95
  • Root Mean Square Error of Approximation (RMSEA) ≤ 0.05
  • standardized root mean square residual (SRMR) ≤ 0.08

Normative Data

Alcoholism: (Barros da Silva Lima et al., 2005; n = 36, mean age = 46 (8.34) years; 63.9% severely dependent, 61.1% completed elementary education, 55.6% married, 52.8% reside with partner/children, 63.9% self-employed, 55% of subjects came from classes C, D, or E, representing low socioeconomic status; quality-of-life scores assessed after identification of alcohol addiction/dependecy)

 

    • WHOQOL

   Mild/Moderate (n = 13)                      Severe (n = 23)

Physical           70.6 (17.3)                                 53.6 (17.0)

Psychological   71.2 (9.7)                                   48.7 (15.4)

Social               74.4 (15.8)                                 58.3 (14.2)

Environmental  60.3 (10.8)                                 51.8 (13.3)

Schizophrenia: (Su et al., 2014; n = 100; mean age = 49.16 (7.85) years; mean onset = 22.57 (5.79) years; duration of disease = 26.59 (8.08) years; duration in institution = 17.40 (8.70) years; WHOQOL-Bref scores; Taiwanese sample)

  • Total = 52.83 (8.29)
    • Physical = 14.20 (2.27)
    • Psychological = 12.98 (2.72)
    • Social relations = 12.66 (2.78)
  • Environment = 12.93 (2.24)

Test/Retest Reliability

Schizophrenia: (Su et al., 2014)

  • Acceptable: (ICC = 0.81 - 0.88) > 0.7

Interrater/Intrarater Reliability

Schizophrenia: (Su et al., 2014)

  • Excellent test-retest reliability: (ICC = 0.81 - 0.88)

Internal Consistency

Alcoholism: (Barros da Silva Lima et al. 2005)

  • Excellent: Cronbach’s alpha range from 0.78-0.89

Substance Use Disorder: (Muller et al., 2019; n = 107)

  • Adequate - Poor: Chronbach’s alpha range from 0.541 - 0.792
    • Physical health: 0.763
    • Psychological health: 0.792
    • Environment: 0.762
    • Social relationships:  0.541

 

Alcohol use disorder: (Kirouac et al., 2017; n = 1383; individuals meet criteria for alcohol dependence according to the DSM-IV; average age = 44.4 years (SD = 10.2)).

  • For the full WHOQOL-BREF measure, internal consistency reliability at each timepoint was excellent (Cronbach alpha > 0.90).
  • Internal consistency for the physical health subscale was adequate at the first timepoint (Cronbach alpha = 0.768) and excellent at the other timepoints (Cronbach alpha = 0.819 and 0.816).
  • Internal consistency for the psychological health subscale was adequate at the first timepoint (Cronbach alpha = 0.770) and excellent at the other timepoints (Cronbach alpha = 0.837 and 0.821).
  • Internal consistency for the social relationships subscale was adequate at all three timepoints (Cronbach alpha = 0.718, 0.761, and 0.746).

Internal consistency for the environmental subscale was excellent at all three timepoints (Cronbach alpha = 0.812, 0.846, and 0.846).

Psychiatric Population: (Oliveira et al., 2016; n = 403)

  • Low - Excellent: Chronbach’s alpha range from 0.68 - 0.85
    • Psychological health: 0.85
    • Physical health: 0.73
    • Social relationships: 0.73
    • Environment: 0.68
  • Level of independence: 0.77

 

Schizophrenia: (Su et al., 2014)

  • Adequate - Poor: Chronbach’s alpha range from 0.68 - 0.76 [0.70 (physical), .70 (psychological), .68 (social), .76 (environmental)] 

Criterion Validity (Predictive/Concurrent)

Psychiatric Population: (Oliveira et al., 2016; n = 403)

Significant predictive validity (with the exception of the physical domain)

  • Overall QOL: PSY = 0.42***; PHY = 0.07; SOC = 0.10*; ENV = 0.12**; IND = 0.11*; Adjusted R2=0.38
  • General Health: PSY = 0.51***; PHY = 0.02; SOC = 0.03; ENV = 0.06; IND = 0.18***; Adjusted R2=0.44
  • General QOL: PSY = 0.52***; PHY = 0.05; SOC = 0.07; ENV = 0.10*; IND = 0.16***; Adjusted R2=0.51

PSY psychological domain; PHY physical domain; SOC social relationships domain; ENV environmental domain; IND level of independence domain. Standardized coefficients were reported.

* p<0.05, ** p<0.01, *** p<0.001

 

Schizophrenia: (Kheirabadi et al., 2016; n = 150; mean age = 35 (9.9))

Total scale SQOL for Concurrent Validity: 0.66 (P<0.01)

  • Interpersonal relationship: 0.66 (P<0.01)
  • Symptoms: 0.65 (P<0.01)
  • Signs: 0.53 (P<0.01)
  • Motivation/energy: 0.56 (P<0.01)

Construct Validity

Convergent Validity:

Alcoholism: (Barros da Silva Lima et al. 2005)

    • Moderate, physical domain mean correlation 0.54
    • Moderate, psychological domain mean correlation 0.57
    • Moderate, social domain mean correlation 0.40
    • Poor, environment domain mean correlation 0.38

Alcohol use disorder: (Kirouac et al., 2017)

  • Convergent validity of the WHOQOL-BREF was tested via bivariate correlations
  • Convergent validity of the total score of the WHOQOL-BREF showed excellent or adequate correlations with other indices of psychological functioning (correlation coefficients ranging from -0.315 to -0.683)
  • Convergent validity of the physical health subscale showed mostly adequate correlations with other indices of psychological functioning, with two poor correlations and one excellent (correlation coefficients ranging from -0.240 to -0.601)

The remaining subscales (psychological health, social relationships, and environment) demonstrated poor correlations with other indices of psychological functioning (correlation coefficients ranging from 0.000 to -0.074).

Psychiatric Population: (Oliveira et al., 2016; n = 403)

Significant correlation between item and domain

  • Excellent: Psychological domain correlation coefficient: 0.67 - 0.89
  • Excellent:  Physical domain correlation coefficient: 0.62 - 0.71
  • Excellent:  Social domain correlation coefficient: 0.69 - 0.81
  • Excellent:  Environmental domain correlation coefficient: 0.73 - 0.89
  • Excellent:  Level of independence domain correlation coefficient: 0.89 - 0.90

Responsiveness

Alcohol use disorder: (Kirouac et al., 2017)

  • Effect sizes comparing baseline subscale and total WHOQOL-BREF summary scores with week-26 and week-52 timepoints within the full sample were all moderate 
  • Effect sizes comparing Naltrexone versus Placebo and combined behavioral intervention versus medication management subscale and total WHOQOL-BREF summary scores with week-26 and week-52 timepoints all showed a small change

Cancer

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Minimally Clinically Important Difference (MCID)

Advanced Stage Lung Cancer Patients: (de Mol et al., 2018; n = 153; Mean Age = 63.4 (9.2); locally advanced (IIIB) = 19 (12.4), metastatic (IV) = 119 (77.8), other = 14 (9.2), unknown = 1 (0.7); Dutch sample)

  • Estimates of minimal clinically important differences on WHOQOL-BREF domains

Domains           0.5 SD  1 SEM

General Facet   0.876   

Physical Health 1.545    2.155

Psychological Health     1.259    1.914

Social Relationships      1.274    2.716

Environment     1.142    1.761

Internal Consistency

Advanced Stage Lung Cancer Patients: (do Mol et al., 2018)

  • Excellent: Physical domain Cronbach’s Alpha = 0.81
  • Adequate: Psychological domain Cronbach’s Alpha = 0.77
  • Poor: Social domain Cronbach’s Alpha = 0.57
  • Adequate: Environmental domain Cronbach’s Alpha = 0.77

 

Cancer Survivors: (Lin et al., 2019; n = 5702; Head/Neck cancer Mean Age = 55.89(11.38); Colorectal cancer Mean Age = 63.39(12.46); Liver Cancer Mean Age = 61.69(11.22); Lung Cancer Mean Age = 63.89(11.80); Gynecologic Cancer Mean Age = 52.68(12.87); Taiwanese sample)

  • Adequate to Excellent: Physical domain Cronbach’s Alpha = 0.794 - 0.834
  • Adequate to Excellent: Psychological domain Cronbach’s Alpha = 0.781 - 0.827
  • Poor: Social domain Cronbach’s Alpha = 0.487 - 0.657
  • Adequate to Excellent: Environmental domain Cronbach’s Alpha = 0.730 - 0.803

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Cancer Survivors: (Lin et al., 2019) 

  • Adequate to Excellent concurrent validity of the WHOQOL-BREF as evidenced by correlations between overall QoL and all domain scores (r = 0.30 to 0.60) and between general health and all domain scores (r = 0.31 to 0.68)

Construct Validity

Convergent validity:

Advanced Stage Lung Cancer Patients: (de Mol et al., 2018)

  • General health domain had poor to excellent correlation with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) (r = 0.17 - 0.49)
  • Physical health domain had poor to excellent correlation with the EORTC QLQ-C30 (r = 0.23 - 0.73)
  • Psychological health domain had poor to excellent correlation with the EORTC QLQ-C30 (r = 0.18 - 0.61)
  • Social health domain had poor correlation with the EORTC QLQ-C30 (r = 0.19)
  • Environment domain had poor to adequate correlation with the EORTC QLQ-C30 (r = 0.24 - 0.43)

Diabetes

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Normative Data

Type 2 Diabetes: (Reba et al., 2019; n = 344; Age > 18; follow-up from initial diagnosis 1 year; Ethiopian sample)

  • Physical health, 48.1 (20.4)
  • Psychological health, 52.1 (16.3)
  • Social relationships, 57.8 (14.8)
  • Environment, 52.3 (13.0)

Internal Consistency

Type 2 Diabetes: (Reba et al., 2019)

  • Physical health, Excellent, Cronbach’s alpha = 0.84
  • Psychological health, Adequate, Cronbach’s alpha = 0.74
  • Social relationships, Poor, Cronbach’s alpha = 0.58
  • Environment, Adequate, Cronbach’s alpha = 0.71

Intellectual Disability

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Internal Consistency

Autism Spectrum Disorder: (McConachie et al., 2018; n = 309; Mean Age = 42.96 (13.78); Mean Social Responsiveness Scale 2 score = 110.35 (26.81) (a measure of autism severity; cut-off for presence of autism is 52))

 

For the whole tool, Excellent, Cronbach's alpha = 0.93

  • Physical health, Excellent, Cronbach's alpha = 0.87
  • Psychological health, Excellent, Cronbach's alpha = 0.84
  • Social relationships, Poor, Cronbach's alpha = 0.68
  • Environment, Excellent, Cronbach's alpha = 0.84

Construct Validity

Autism Spectrum Disorder: (McConachie et al., 2018)

 

Discriminant validity for all domains:

            Physical r        Psychological r           Social r            Environmental r

HADS depression         -0.635***

Excellent          -0.756***

Excellent          -0.467***

Adequate          -0.590***

Adequate

HADS anxiety   -0.580***

Adequate          -0.600***

Excellent          -0.305***

Poor     -0.539***

Adequate

CHIEF-SF         -0.670***

Excellent          -0.465***

Adequate          -0.265***

Poor     -0.668***

Excellent

ISEL-12            0.315***

Adequate          0.455***

Adequate          0.538***

Adequate          0.500***

Adequate

COMQOL importance    -0.012

Poor     0.215***

Poor     0.115*

Poor     0.029

Poor

COMQOL satisfaction   0.682***

Excellent          0.792***

Excellent          0.590***

Adequate          0.724***

Excellent

*p<0.05; **p<0.01; ***p<0.001

HADS Hospital Anxiety and Depression Scale, CHIEF-SF Craig Hospital Inventory of Environmental Factors--Short Form, ISEL-12 Interpersonal Support Evaluation List-12, COMQOL Comprehensive Quality of Life questionnaire--Adult version

Mixed Populations

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Test/Retest Reliability

Transplant patients (n = 50), WHO-QoL-BREF data

   Pre                                 Post

Psychological       12.5 (2.6)                       14.9 (2.6)

Physical                10.6 (2.8)                       13.7 (2.7)

Social                   14.0 (2.8)                       15.2 (3.4)

Environment         14.2 (2.3)                       15.9 (2.3)

 

Liver controls (n = 21), WHO-QoL-BREF data

   Pre                                 Post

Psychological       13.9 (2.9)                       14.1 (2.7)

Physical                13.8 (3.5)                       13.0 (3.3)

Social                   14.8 (2.5)                        14.5 (2.4)

Environment         15.6 (2.2)                       14.5 (1.6)

Construct Validity

Liver Transplant (O’Carroll et al., 2000)

    • Pre-Transplant (n = 50, p < 0.001)
      • Physical: 0.82
      • Psychological: 0.92
      • Social: 0.95
      • Environment: 0.89
    • Post-transplant
      • Physical: 0.84
      • Psychological: 0.92
      • Social: 0.95
      • Environment: 0.89

Mixed Dermatological Diagnoses: (Evenhamre et. al, 2016)

WHOQoL-BREF and DLQI total Spearman’s correlation coefficient: 0.55

  • Sex
    • Men (n = 92): 0.58
    • Women (n = 106): 0.5
  • Dermatological diagnosis
    • Pruritus (n = 9): 0.19
    • Dermatitis (n = 47): 0.56
    • Psoriasis (n = 21): 0.79
    • Acne (n = 16): 0.15
    • Rosacea (n = 10): 0.76
  • WHOQoL-BREF domain (n =198)
    • Physical: 0.52
    • Social: 0.27
    • Environment: 0.49
    • Psychological: 0.47

Responsiveness

Mixed Dermatological Diagnoses: (Evenhamre et. al, 2016)

  • Questionnaires were set to 566 consecutive patients and the response rate was 38% (214 / 566 patients)

Liver Transplant (O’Carroll et al., 2000)

  • Standardized response means (SRM), n =50, measured via within-subject t-tests
    • Psychological 0.91 (0.99)
    • Physical 0.92 (1.00)
    • Social 0.43 (1.0)
    • Environment 0.74 (1.0)

Pulmonary Diseases

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Normative Data

COPD: (Liang et al., 2008; n = 211, all male subjects, mean age = 70.4 (8.1) years, mean FEV1 percent predicted 56.2%, mean FEV1/FVC ratio 56%, 67.6% of subjects had elementary school education or below, 87.3% of subjects lived with a spouse, 25% current smokers at time of study)

Floor/Ceiling Effects

COPD: (Liang et al., 2008)

  • No marked floor effect or ceiling effect (all domains < 7%)

 

WHOQOL-BREF

Domain                            (%) at floor                     (%) at ceiling

Physical                            1.0                                 0.5

Psychological                    1.0                                1.0

Social                                2.8                                5.2

Environmental                   0                                   0

Joint Pain and Fractures

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Normative Data

Joint Replacement: (Snell et al. 2015; n = 1008; mean age = 68.6 (10.1) years; 44.3% male subjects; 70.3% New Zealand European ethnicity; joint replaced total knee (33.1%), total hip (52.4%), uni-knee (14.5%); number of months post operation 6 months (26.6%), 12 months (38.3%), 24 months (1.7%), 60 months (33.3%))

Internal Consistency

Joint Replacement: (Snell et al. 2015; n = 1008)

 

  • High internal consistency: α = 0.86

Construct Validity

Joint Replacement: (Snell et al. 2015; n = 1008)

  • Adequate convergent and discriminant validity: r = 0.47 - 0.82, p < 0.001

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