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RehabMeasures Instrument

Stroke-Specific Quality of Life Scale

Last Updated

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 across 12 domains
  • Items are assessed on 5-point Guttman-type scales. Each item is answered using 1 of 3 different response sets:
    1: Total help; Couldn't do it at all; Strongly agree
    2: A lot of help; A lot of trouble; Moderately agree
    3: Some help; Some trouble; Neither agree nor disagree
    4: A little help; A little trouble; Moderately disagree
    5: No help needed; No trouble at all; Strongly disagree
  • 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 (# of items) include:
    1) Mobility (6)
    2) Energy (3)
    3) Upper Extremity Function (5)
    4) Work and Productivity (3)
    5) Mood (5)
    6) Self-care (5)
    7) Social Roles (5)
    8) Family Roles (3)
    9) Vision (3)
    10) Language (5)
    11) Thinking (3)
    12) Personality (3)
  • 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. Updated in Spring, 2023 by UIC Occupational Therapy Students Daila Al-Shekh, Lucy Chesla, Hayley Cohen, and Kaitlyn Maas under the direction of Susan Magasi, PhD, Associate Professor, Departments of Occupational Therapy and Disability Studies, UIC.

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: 

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

Standard Error of Measurement (SEM)

Stroke Patients: (Legris et al., 2018; n = 77, age => 18 with first-ever symptomatic stroke (ischemic stroke = 74 (96.1%) or intracranial hemorrhage = 3 (3.9%), mean age = 64.3 (15.4), male = 45 (58.4%), Patients enrolled 3 months after the index stroke; French translation of SS-QoL; SEM calculated; French version of SS-QoL)

 

Standard Error of Measurement by SS-QoL Domain

SS-QoL domain

SEM

Energy

0.612

Family roles

0.689

Language

0.255

Mobility

0.312

Mood

0.476

Personality

0.713

Self-care

0.210

Social roles

0.561

Thinking

0.532

Upper Extremity function

0.298

Vision

0.414

Work Productivity

0.537

 

Stroke Patients: (Pederson et al., 2018; = 125; Age => 18 with ischemic (n = 113, 90%) or hemorrhagic (= 12, 10%); Mean Age = 70.5 (13.1); Male = 77 (62%); Mean Time Post CVA for initial test = 3 months; test-retest sent to a sample of 40 subjects 12 months post CVA; Norwegian translation of SS-QoL)

Standard Error of Measurement by SS-QoL Domain

SS-QoL domain

SEM

Energy

0.41

Family roles

0.49

Language

0.21

Mobility

0.24

Mood

0.42

Personality

0.42

Self-care

0.26

Social roles

0.39

Thinking

0.49

Upper Extremity function

0.27

Vision

0.35

Work/Productivity

0.30

SS-QoL total

0.14

 

Stroke patients: (Odetunde et al., 2017; = 100 indigenous Yoruban stroke survivors (of at least 1 month) at secondary and tertiary health institutions in Southwestern Nigeria; males = 61; mean age = 55.27 (12.34); mean time post CVA = 20.81 (33.71) months (median time from stroke onset = 11 months); Yoruba version of SS-QoL; calculated SEM)

Standard Error of Measurement by SS-QoL Domain

SS-QoL domain

SEM

Energy

2.522

Family roles

2.810

Language

2.084

Mobility

2.580

Mood

3.017

Personality

2.038

Self-care

2.477

Social roles

3.495

Thinking

1.917

Upper Extremity function

2.480

Vision

1.245

Work/Productivity

1.886

SS-QoL Total

15.440

 

Stroke: (Sallam et al., 2019; n = 147 first-time stroke survivors; mean age = 59.63 (10.97), female = 78 (53%); Mean Time Post CVA = 11.96 (15.63) months; Arabic version—SSQOL-A)

Standard Error of Measurement by SSQOL-A Domain

SSQOL-A domain

SEM

Energy

0.196

Family roles

0.333

Language

0.213

Mobility

0.425

Mood

0.519

Personality

0.308

Self-care

0.302

Social roles

0.270

Thinking

0.523

Upper Extremity function

0.283

Vision

0.303

Work/Productivity

0.449

SSQOL-A Total

0.156

 

 

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%

 

Stroke Patients: (Legris et al., 2018; n = 77; French version of SS-QoL; MDC calculated)

Minimal Detectable Change by SS-QoL Domain and Confidence Interval

SS-QoL Domain

90% CI

95% CI

99% CI

Energy

1.42

1.70

2.23

Family roles

1.60

1.91

2.51

Language

 0.59

0.71

 0.93

Mobility 

0.73

 0.86

1.14

Mood

1.11

1.32

1.73

Personality 

1.66

1.98

2.60

Work/productivity

1.25

1.49

1.96

Vision

0.96

1.15

1.51

UE function

0.69

0.83

1.09

Self-care

0.49

0.58

0.77

Social roles

1.30

1.55

2.04

Thinking

1.24

1.48

1.94

 

Stroke Patients: (Pederson et al., 2018; = 125; Norwegian translation of SS-QoL; MDC calculated)

Minimal Detectable Change by SS-QoL Domain and Confidence Interval

SS-QoL Domain

90% CI

95% CI

99% CI

Energy

0.95

1.14

1.49

Family roles

1.14

1.36

1.79

Language

 0.49

0.58

 0.77

Mobility 

0.57

 0.67

0.89

Mood

0.98

1.16

1.53

Personality 

0.99

1.18

1.55

Work/productivity

0.70

0.84

1.10

Vision

0.80

0.95

1.25

UE function

0.64

0.76

1.00

Self-care

0.61

0.73

0.96

Social roles

0.91

1.08

1.42

Thinking

1.14

1.36

1.79

SS-QoL Total Score

 

0.32

 

0.38

 

0.50

 

Stroke patients: (Odetunde et al., 2017; = 100; Yoruba version of SS-QoL; calculated MDC)

Minimal Detectable Change by SS-QoL Domain and Confidence Interval

SS-QoL Domain

90% CI

95% CI

99% CI

Energy

5.87

6.99

9.19

Family roles

6.54

7.79

10.24

Language

4.85

5.78

7.59

Mobility 

6.00

7.15

9.40

Mood

7.02

8.36

10.99

Personality 

4.74

5.65

7.42

Work/productivity

4.39

5.23

6.87

Vision

2.90

3.45

4.53

UE function

5.77

6.87

9.04

Self-care

5.76

6.86

9.02

Social roles

8.13

9.69

12.73

Thinking

4.46

5.31

6.98

SS-QoL Total Score

 

35.92

 

42.80

 

56.25

 

Stroke: (Sallam et al., 2019; n = 147 first-time stroke survivors; Arabic version—SSQOL-A)

Minimal Detectable Change by SSQOL-A Domain and Confidence Interval

SSQOL-A Domain

90% CI

95% CI

99% CI

Energy

0.46

0.54

0.71

Family roles

0.77

0.92

1.21

Language

0.50

0.59

0.78

Mobility 

0.99

1.18

1.55

Mood

1.21

1.44

1.89

Personality 

0.72

0.85

1.12

Work/productivity

1.05

1.25

1.64

Vision

0.70

0.84

1.10

UE function

0.66

0.78

1.03

Self-care

0.70

0.84

1.10

Social roles

0.63

0.75

0.98

Thinking

1.22

1.45

1.90

SSQOL-A Total Score

 

0.36

 

0.43

 

0.57

 

 

 

 

 

 

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

Test/Retest Reliability

Stroke Patients: (Legris et al., 2018; n = 31; French version of SS-QoL)

  • Excellent test-retest reliability for all SS-QoL domains (ICC => 0.91)

 

Stroke Patients: (Pederson et al., 2018; n = 36; Norwegian translation of SS-QoL)

  • Excellent test-retest reliability for Upper Extremity Function and Work/Productivity domains (ρ = 0.94 for each)
  • Acceptable test-retest reliability for SS-QoL domains:
    • Mobility (ρ = 0.84)
    • Mood (ρ = 0.84)
    • Self-care (ρ = 0.89)
    • Social roles (ρ = 0.80)
    • Family roles (ρ = 0.79)
    • Language (ρ = 0.74)
    • Personality (ρ = 0.83)
    • SS-QoL Total (ρ = 0.89)
  • Questionable test-retest reliability for SS-QoL domains: Energy (ρ = 0.67), Vision (ρ = 0.35), and Thinking (ρ = 0.65)

 

Stroke patients: (Odetunde et al., 2017; = 68; test-retest interval = 7 days; Yoruba version of SS-QoL)

  • Acceptable test-retest reliability for Overall SS-QoL and Thinking, Work, Mobility, Self-care, Language, and Upper Extremity Function domains (ICC = 0.74-0.81)
  • Questionable test-retest reliability for Vision, Personality, Mood, Family role, Social role, and Energy domains (ICC = 0.47-0.69)

 

Stroke patients: (Lo et al., 2016; = 135; mean age = 58.90 (9.75); male = 63.7%; first-ever stroke = 88.9%; mean time post first CVA = 6.08 (5.24) years; 4 week interval between tests; Chinese version of instrument—SSQOL-C)

  • Questionable test-retest reliability (ICC for total score = 0.57, 95% CI = 0.27-0.77)

 

Stroke: (Sallam et al., 2019; n = 41 first-time stroke survivors; one week interval between test and retest; Arabic version—SSQOL-A))

  • Acceptable test-retest reliability for all SSQOL-A domains and Total SSQOL-A (ICC > 0.70)
  • Excellent test-retest reliability (ICC > 0.90) for Energy, Family role, Language, Self-Care, Upper Extremity Function, and Vision domains
  • No significant differences between the test-retest scores for any of the SSQOL-A domains or the total score using Wilcoxon’s signed rank test for dependent groups

 

 

Interrater/Intrarater Reliability

Stroke Patients: (Legris et al., 2018; n = 30; French version of SS-QoL)

  • Excellent interrater reliability for telephone interview 2 weeks post inclusion and again 2 months after enrollment for all SS-QoL domains (ICC => 0.88)

 

 

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).

 

Stroke Patients: (Legris et al., 2018; n = 77; French version of SS-QoL)

  • Excellent internal consistency for SS-QoL domains: Language (α = 0.82), Mobility (α = 0.88), Self-care (α = 0.91), Upper extremity function (α = 0.89), and Work/Productivity (α = 0.80)
  • Adequate internal consistency for SS-QoL domains: Mood (α = 0.72) and Social roles (α = 0.74)
  • Poor internal consistency for SS-QoL domains: Energy (α = 0.69), Family roles (α = 0.67), Personality (α = 0.58), Thinking (α = 0.65), and Vision (α = 0.65)

 

Stroke patients: (Odetunde et al., 2017; = 100; Yoruba version of SS-QoL)

  • Excellent: Chronbach’s alpha = 0.82 for Upper Extremity Function domain
  • Adequate: Chronbach’s alpha = 0.70-0.78 for Self-care, Language, Mobility, Work, Personality, Mood, Family role, and Social role domains
  • Poor: Chronbach’s alpha = 0.61-0.62 for Vision, Thinking, and Energy domains

 

Stroke patients: (Lo et al., 2016; = 135; mean age = 58.90 (9.75); male = 63.7%; first-ever stroke = 88.9%; mean time post first CVA = 6.08 (5.24) years; 4 week interval between tests; Chinese version of instrument—SSQOL-C)

  • Excellent Cronbach’s alpha for total scale (α = 0.93a)
  • Excellent Cronbach’s alpha for domains: Activitiesb (α = 0.89); Mood, energy, and family role(α = 0.86); Language (α = 0.90); and Upper extremity function (α = 0.81)
  • Adequate Cronbach’s alpha for domains: Relationshipsb (α = 0.75); Vision (α = 0.70); Basic needsb (α = 0.72); Personality (α = 0.74); and Transferb (α = 0.79)
  • Poor Cronbach’s alpha for domains: Thinking (α = 0.65) and Leisure and Work (α = 0.63)

aScores higher than 0.9 may indicate redundancy in the scale questions.

bIndicates a modified domain.

 

Stroke: (Sallam et al., 2019; n = 147 first-time stroke survivors; Arabic version—SSQOL-A)

  • Excellent Cronbach’s alpha for Total SSQOL-A (α = 0.84)
  • Excellent Cronbach’s alpha for domains: Energy (α = 0.91), Family role (α = 0.80), Language (α = 0.89), Mobility (α = 0.94), Mood (α = 0.84), Self-care (α = 0.88), Social role (α = 0.83), Thinking (α = 0.89), Upper extremity function (α = 0.92), Vision (α = 0.85), and Work/productivity (α = 0.87)
  • Adequate Cronbach’s alpha for Personality domain (α = 0.78)

 

 

 

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.

 

Stroke Patients: (Legris et al., 2018; n = 77; French version of SS-QoL)

 

Convergent Validity:

  • Excellent convergent validity between Family roles domain and General Health Survey Short Form 36 (SF-36): Emotional and Physical Role Limitations (ρ = 0.61)
  • Excellent convergent validity between Mobility domain and SF-36: Physical Function Subscale (ρ = 0.81)
  • Excellent convergent validity between Self-care domain and Barthel Index (ρ = 0.89)
  • Adequate convergent validity between Social roles domain and SF-36: Social Functioning Subscale (ρ = 0.45)
  • Adequate  convergent validity between Work/Productivity domain and SF-36: Physical Role Limitations Subscale (ρ = 0.57)
  • Poor convergent validity between Thinking domain and Mini Mental State Evaluation (MMSE) (ρ = 0.29)
  • Poor convergent validity between Personality domain and Hospital Anxiety Depression scale (HAD) subscales: anxiety (ρ = -0.29)  and depression (ρ = -0.26)
  • Adequate convergent validity between Language domain and National Institute of Health Stroke Scale: Aphasia and Dysarthria scores (ρ = -0.38)
  • Adequate  convergent validity between Vision domain and National Institute of Health Stroke Scale: Visual field and ocular movements (ρ = -0.48)
  • Excellent convergent validity between Energy domain and Fatigue Severity Scale (FSS) (ρ = -0.74)

Discriminant Validity:

  • Significant differences between patients reporting a worse or better quality of life compared with their pre-stroke status for 9 of the 12 domain scores and the total score (< 0.05).

Discriminant validity between self-rated quality of life groups at baseline compared with pre-stroke status for SS-QOL domains and total

SS-QOL domain

Group 1a (n = 25) Mean (CI)

Group 2a (n = 52) Mean (CI)

p

Energy

4 (3.3-4.7)

3 (2-3.7)

< 0.001

Family Roles

5 (4.3-5.0)

3.3 (2.3-4.2)

< 0.001

Language

4.6 (4.2-4.8)

4.6 (4.2-5)

0.71

Mobility

5 (4.7-5)

4.2 (3.1-4.8)

< 0.001

Mood

4.6 (4-5)

4 (3.5-4.7)

0.028

Personality

4 (3-4.7)

3.3 (2.7-4)

0.07

Self-care

5 (5-5)

5 (4.5-5)

0.03

Social roles

4 (3-4.8)

3.1 (2.2-4.2)

0.01

Thinking

4 (3-4.7)

3.5 (2.8-4.7)

0.18

Upper extremity function

5 (4.8-5)

4.6 (3.9-5)

0.003

Vision

5 (5-5)

5 (4.5-5)

0.032

Work/Productivity

4.7 (4.3-5)

3.7 (2.7-4.3)

< 0.001

Total

4.5 (4.2-4.6)

3.8 (3.5-4.2)

< 0.001

aGroup 1 = not worse QOL; Group 2 = worse QOL

 

  • Significant differences between patients quality of life according to the modified Rankin score for 7 of the 12 domain scores and the total score.

Discriminant validity between quality of life according to the modified Rankin score for SS-QOL domains and total

SS-QOL domain

Group 1a (n = 25) Mean (CI)

Group 2a (n = 52) Mean (CI)

p

Energy

2.7 (2-3)

3.7 (2.7-4.5)

0.002

Family Roles

3 (2.3-3.7)

4.3 (4-5)

<0.001

Language

4.6 (4-4.8)

4.6 (4.2-5)

0.4

Mobility

3.2 (2.7-4.2)

4.8 (4.3-5)

< 0.001

Mood

4 (3.6-4.6)

4.4 (3.8-4.9)

0.15

Personality

4 (2.7-4.3)

3.7 (2.7-4.2)

0.68

Self-care

4.2 (3.4-5)

5 (5-5)

< 0.01

Social roles

2.8 (1.8-3.4)

4 (3-4.5)

0.003

Thinking

4 (2.7-4.7)

3.7 (3-4.7)

0.7

Upper extremity function

4 (3.2-4.4)

5 (4.8-5)

< 0.001

Vision

5 (4.3-5)

5 (4.7-5)

0.91

Work/Productivity

2.7 (2.3-3.3)

4.7 (4-5)

< 0.001

Total

3.6 (3.2-3.8)

4.3 (4.1-4.5)

< 0.001

aGroup 1: mRS > 1; Group 2: mRS = (0-1)

 

Stroke Patients: (Pederson et al., 2018; = 125: Norwegian translation of SS-QoL)

Convergent Validity:

  • Excellent convergent validity between SS-QOL total score and EuroQol Quality of Life Scale-5D (EQ-5D) total score (r = 0.73)
  • Excellent convergent validity Mobility domain and EQ-5D domain ‘Gait’ (r = 0.63)
  • Excellent convergent validity between Upper Extremity Function domain and EQ-5D domain ‘Usual activities’ (r = 0.62)
  • Excellent convergent validity between Work/Productivity domain and EQ-5D domain ‘Usual activities’ (r = 0.73)
  • Excellent convergent validity between Self-care domain and EQ-5D domain ‘Personal Hygiene’ (r = 0.68)
  • Excellent convergent validity between SS-QOL total and Quality of Life After Brain Surgery-Overall Scale (QOLIBRI-OS) total score (r = 0.71)
  • Adequate convergent validity between Energy domain EQ-5D Visual Analogue Scale (VAS) scale (r = 0.48)

Discriminant Validity:

  • Excellent negative correlation between SS-QOL total and Hospital Anxiety and Depression Scale (HADS) total score (r = -0.69)
  • Adequate negative correlation between Personality domain and HADs Depression score (r = -0.52)

 

Stroke patients: (Odetunde et al., 2017; = 100; Yoruba versions of SS-QoL and World Health Organization Quality of Life-BREF (WHOQoL-BREF))

Convergent validity

  • Significant correlations between Physical Health domain of WHOQoL-BREF and Mobility (= 0.28), Work/Productivity (= 0.35), and Energy (= 0.23) domains of SS-QoL
  • Significant correlations between Psychological Health domain of WHOQoL-BREF and Thinking (r = 0.24) and Mood (= 0.36) domains of SS-QoL
  • Significant correlation between Social Relationship domain of WHOQoL-BREF and Social Role (= 0.26) domain of SS-QoL
  • Significant correlations between Environmental domain of WHOQoL-BREF and Family Role (= 0.24) and Social Role (= 0.21) domains of SS-QoL

Discriminate validity

  • Item-domain correlations were comparable within each domain of the SS-QoL, with items in 10 of the 12 domains having correlations >0.7 (range = 0.711-0.920) with their hypothesized domains
    • A few of the items for the Self-care and Mood domains had item-domain correlations <0.7 (range = 0.594-0.630)

 

Stroke patients: (Lo et al., 2016; = 135; Chinese version of instrument—SSQOL-C)

Convergent Validity

  • Adequate to excellent correlation between SSQoL-C domains Activitiesa, Mood, energy, and family role (MEFR)a; Upper Extremity Function, Relationshipsa, Basic needsa, Leisure and worka; Transfera, and Total SSQoL-C score with the physical component score of the Chinese version of the Medical Outcomes Study Short-Form Health Survey (SF-36) (rs = 0.43 to 0.61; < 0.01, two-tailed)
  • Adequate to excellent correlation between Activitiesa and Basic Needsa domains of SSQOL-C with the Physical Functioning dimension score of SF-36 and total Barthel ADL Index score (rs = 0.51 to 0.77; < 0.01, two-tailed)
  • Adequate correlation between the Mood, Energy, and Family Rolea domain score of SSQOL-C with the Vitality, Physical Role, Emotional Role, and Mental Health dimension scores of SF-36 and total Chinese Version of the Stroke Self-Efficacy Questionnaire (SSEQ-C) (rs = 0.46 to 0.52; < 0.01, two-tailed)
  • Adequate correlation between Relationshipsa domain score of SSQOL-C with the Social Functioning dimension score of SF-36 (rs = 0.40; < 0.01, two-tailed)
  • Adequate correlation between Thinking domain score of SSQOL-C with the Mental Health dimension score of SF-36 (rs = 0.49; < 0.01, two-tailed)

Discriminant Validity

  • Excellent correlation between Language, Thinking, and Personality domains of SSQOL-C with the total SSEQ-C score (rs = 0.23-0.30)
  • Adequate correlation between Vision and Transfera domains of SSQOL-C with the total SSEQ-C score (rs = 0.34-0.35)

aIndicates a modified domain.

 

Stroke: (Sallam et al., 2019; n = 213: 147 first-time stroke survivors and 60 healthy subjects;  Mean Age of stroke survivors = 59.63 (10.97), female = 78 (53%); Mean Age of healthy subjects = 58.10 (11.73), female = 42 (70%); Arabic version—SSQOL-A)

Convergent Validitya

  • Excellent convergent validity between Health Survey Short Form 36 (SF-36): vitality and Energy domain (ρ = 0.86 to 0.94)
  • Excellent convergent validity between SF-36: Physical and Emotional Role limitations and Family Role domain (ρ = 0.89 to 0.98)
  • Excellent convergent validity between Language domain and NIHSS: dysarthria and aphasia scores (ρ = 0.86 to 0.96)
  • Excellent convergent validity between Mobility domain and SF-36: physical function (ρ = 0.90 to 0.95)
  • Excellent convergent validity between Mood domain and Beck Depression Inventory II (BDI-II) (ρ = 0.84 to 0.93)
  • Excellent convergent validity between Personality domain and BDI-II (ρ = 0.88 to 0.96)
  • Excellent convergent validity between Self-Care domain and Barthel Index (ρ = 0.91 to 0.98)
  • Excellent convergent validity between Social role domain and SF-36: social functioning (ρ = 0.87 to 0.95)
  • Excellent convergent validity between Thinking domain and NIHSS: orientation and command scores (ρ = 0.79 to 0.89)
  • Excellent convergent validity between Upper Extremity Function domain and Barthel Index (ρ = 0.88 to 0.97)
  • Excellent convergent validity between Vision domain with NIHSS: ocular movement and visual field scores (ρ = 0.81 to 0.92)
  • Excellent convergent validity between Work/Productivity domain and SF-36: physical role limitations (ρ = 0.82 to 0.92)

aRange of correlations for items to scale of the same domain.

 

Discriminant Validityb

  • Adequate to Excellent discriminant validity between Energy domain and SF-36: vitality (ρ = 0.14 to 0.40)
  • Adequate to Excellent discriminant validity between Family role domain and SF-36: physical and emotional role limitations (ρ = 0.21 to 0.39)
  • Adequate to Excellent discriminant validity between Mobility domain and SF-36: physical function (ρ = 0.16 to 0.51)
  • Adequate to Excellent discriminant validity between Self-care domain and Barthel Index (ρ = 0.17 to 0.39)
  • Adequate to Excellent discriminant validity between Social Role domain and SF-36: social functioning (ρ = 0.19 to 0.42)
  • Excellent discriminant validity between Thinking domain and NIHSS: orientation and command scores (ρ = 0.14 to 0.27)
  • Adequate to Excellent discriminant validity between Upper Extremity Function domain and Barthel Index (ρ = 0.16 to 0.53)
  • Excellent discriminant validity between Vision domain and NIHSS: ocular movement and visual field scores (ρ = 0.14 to 0.29)
  • Adequate to Excellent discriminant validity between Work/productivity domain and SF-36: physical role limitations (ρ = 0.18 to 0.48)

bRange of correlations of items to scale of other domains

 

 

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)

 

Stroke Patients: (Legris et al., 2018; n = 77; French version of SS-QoL)

  • Determined by stroke neurologists at the University Hospital of Dijon to analyze importance of questions and response modalities, participant comprehension, fluency of vocabulary, and accuracy of translation in comparison to the original.

 

Stroke patients: (Lo et al., 2016; = 135; Chinese version of instrument—SSQOL-C)

  • The content validity of the SSQoL-C was determined by an expert panel of two physicians, one nurse academic, one nurse manager, one advanced practice nurse, and two registered nurses who rated each item on its relevance to stroke survivors’ HRQOL using a 4-point Likert scale (1 = “very inappropriate” to 4 = “very appropriate.”
    • Excellent Content Validity Index (CVI) of SSQOL-C computed as percentage of items scoring “3” or above = 0.99.

 

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.

 

Stroke Patients: (Legris et al., 2018; n = 77; French version of SS-QoL)

Ceiling Effects

  • Adequate ceiling effects for SS-QoL domains: Energy (7.8%), Personality (10.4%), Social roles (10.4%), and Thinking (13.0%)
  • Poor ceiling effects for SS-QoL domains: Family roles (28.6%), Language (24.7%), Mobility (31.2%), Mood (23.4%), Self-care (77.9%), Upper extremity function (50.7%), Vision (66.2%), and Work/Productivity (26.0%)

Floor Effects

  • Excellent floor effects (0%) for SS-QoL domains: Language, Mobility, Mood, Self-care, Thinking, Vision
  • Adequate effects for SS-QoL domains: Energy (2.6%, Family roles (1.3%), Personality (2.6%), Social roles (2.6%), Upper extremity function (1.3%), and Work/Productivity (3.9%)

 

Stroke Patients: (Pederson et al., 2018; = 125; Norwegian translation of SS-QoL)

Ceiling Effects

  • Adequate ceiling effect for SS-QOL total score (8.8%) and Social roles domain (15.9%)
  • Poor ceiling effects for all other SS-QOL domains (>20%)

Floor Effects

  • Adequate ceiling effects for Total SS-QOL and all domains (0.8-11.1%)

 

Stroke patients: (Lo et al., 2016; = 135; Chinese version of instrument—SSQOL-C)

Ceiling Effects

  • Excellent: no ceiling effect for SSQoL-C total score.
  • Adequate ceiling effects found for Activitiesa, Mood, energy, and family rolea, Upper extremity function; Relationshipsa; Thinking; Personality; Leisure and Worka (0.74% - 14.81%)
  • Poor ceiling effects found for Language, Basic Needsa, Transfera, and Vision (31.85% - 66.67%)
  • Overall, fewer than 15% of participants scored the highest possible score in all domains except four.

Floor Effects

  • Excellent: no floor effects for domains: Activitiesa, Vision, Leisure and Work and for SSQoL-C Total score.
  • Adequate floor effects for domains: Mood, energy, and family role; Language; Upper extremity function; Relationshipsa, Thinking; Basic needsa, Personality; and Transfera (0.74% - 10.37%)
  • Overall, fewer than 15% of participants scored the lowest possible score in each domain.

 

Stroke: (Sallam et al., 2019; n = 147 first-time stroke survivors; Arabic version—SSQOL-A)

  • Adequate floor effects for all domains and Total SSQOL-A (< 20%)
  • Adequate ceiling effects (< 20%) for domains: Energy, Family role, Language, Mobility, Personality, Social role, Thinking, Work/Productivity, and for Total SSQOL-A
  • Poor ceiling effects (> 20%) for domains: Mood, Self-care, Upper extremity function, and vision

 

 

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)

 

Stroke Patients: (Legris et al., 2018; Effect Size (ES) calculated in patients who reported a change in their quality of life between the enrollment visit and their pre-stroke status; assessed at 14 days after inclusion and 60 days after enrollment; French version of SS-QoL)

  • Large Change for Energy domain (ES = 1.04, = 57)
  • Small Change for Social roles (ES = 0.04, = 15) and Work/Productivity (ES = 0.14, n = 42) domains
  • Moderate Change for all other SS-QOL domains (ES = 0.26-0.65, = 15-40)

 

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