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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 qualiity of life
Supplemental: Spinal Cord Injury (SCI) and Parkinson’s Disease (PD)
Exploratory: Cerebral Palsy (CP)
Short Description of Instrument
The World Health Organization Quality of Life Assessment (WHOQOL-BREF) (The WHOOQOL Group, 1998; World Health Organization, 2004) was developed as short version of the WHOQOL-100 for use in situations where time is restricted, “the burden on the  respondent must be minimized” or “in large epidemiologic studies and clinical trials” (Jang et al., 2004). WHOQOL-BREF is an international cross-culturally comparable quality of life assessment instrument – assesses the individual’s perceptions in the context of their culture and value systems, and their personal goals, standards and concerns Using data from 15 sites collected during the WHOQOL-100 field trials, 26 questions from 24 facets grouped into 4 domains (Physical Health, Psychological, Social Relationships, and Environment) were selected for inclusion in the WHOQOL-BREF (World Health Organization, 2004). These questions were selected for their ability to explain a substantial portion of the variance within their parent facet and domain, for their relationship with the overall WHOQOL model and for their discriminant validity (The WHOOQOL Group, 1998; Lucas-Carrasco et al., 2011; Hirayama, et al., 2008).
Rationale/Justification
SCI: It has been used in SCI population and allows for comparisons with other conditions/samples. It has good psychometric properties (Jang et al., 2004; Lin et al, 2007; Hill et al. 2010).
 
Limitations: The WHOQOL-BREF is a self reporting questionnaire that would not be suitable for those with significant cognitive impairment.
Scoring
Four domain scores can be derived from the WHOQOL-BREF (World Health Organization, 1996). There are also 2 items that are examined separately: Question 1 which asks about the overall perception of QoL and Question 2 which asks about the overall perception of health). Each item is scored on a 5-point Likert scale (1(low) – 5(high)) and a mean score is calculated for each domain. The mean scores are subsequently transformed (multiplied by 4) into a scaled scores that are directly comparable to the scores used in the WHOQOL-100. These transformed scores range between 4-20. A second transformation method converts domain scores to a 0-100 scale.In general, higher scores denote a better quality of life (The WHOOQOL Group, 1998; World Health Organization, 1996, 2004).
 
Equations for computing domain scores:
 
Physical domain = ((6-Q3) + (6-Q4) + Q10 + Q15 + Q16 + Q17 + Q18) x 4.
 
Psychological domain = (Q5 + Q6 + Q7 + Q11 + Q19 + (6-Q26)) x 4.
Social Relationships domain = (Q20 + Q21 + Q22) x 4.
 
Environment domain = (Q8 + Q9 + Q12 + Q13 + Q14 + Q23 + Q24 + Q25) x 4.
 
Transformed Scale = [(Actual raw score – lowest possible raw score)/Possible raw score range] x 100
References
The WHOOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998;28(3):551–558.
 
World Health Organization. WHOQOL-BREF, Introduction, Administration, Scoring, and Generic Version of the Assessment. 1996; http://www.who.int/mental_health/media/en/76.pdf. Accessed 11 September, 2015.
 
World Health Organization. The World Health Organization Quality of Life (WHOQOL) -BREF. 2004; http://www.who.int/substance_abuse/research_tools/en/english_whoqol.pdf. Accessed 11 September, 2015.
 
Additional References:
 
Hill MR, Noonan VK, Sakakibara BM, Miller WC. Quality of life instruments and definitions in individuals with spinal cord injury: a systematic review. Spinal Cord. 2010;48(6):438-450.
 
Hirayama MS, Gobbi S, Gobbi LT, Stella F. Quality of life (QoL) in relation to disease severity in Brazilian Parkinson's patients as measured using the WHOQOL-BREF. Arch Gerontol Geriatrics. 2008;46(2):147–160.
 
Jang Y, Hsieh CL, Wang YH, Wu YH. A validity study of the WHOQOL-BREF assessment in persons with traumatic spinal cord injury. Arch Phys Med Rehabil. 2004;85(11):1890–1895.
 
Lin MR, Hwang HF, Chen CY, Chiu WT. Comparisons of the brief form of the World Health Organization Quality of Life and Short Form-36 for persons with spinal cord injuries. Am J Phys Med Rehabili. 2007;86(2):104–113.
 
Lucas-Carrasco R, Pascual-Sedano B, Galan I, Kulisevsky J, Sastre-Garriga J, Gomez-Benito J. Using the WHOQOL-DIS to measure quality of life in persons with physical disabilities caused by neurodegenerative disorders. Neuro-degenerative Dis. 2011;8(4):178–186.
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