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World Health Organization Quality of Life Assessment (WHOQOL-BREF)
World Health Organization Quality of Life Assessment (WHOQOL-BREF)
| Availability |
Please visit this website for more information about the instrument: World Health Organization Quality of Life Assessment
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| Classification |
NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a Generic Health-Related Quality of Life measure.
Supplemental: Spinal Cord Injury (SCI), SCI-Pediatric (16 years of age and older), and Parkinson's Disease (PD)
Exploratory: Cerebral Palsy (CP)
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| 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).
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| Scoring and Psychometric Properties |
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 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
Psychometric Properties: Information on psychometric properties demonstrated in PD and other samples can be found in the Shirley Ryan Ability Lab Database here https://www.sralab.org/rehabilitation-measures/who-quality-life-bref-whoqol-bref
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| Rationale/Justification |
SCI-Specific:
Strengths: 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).
Weaknesses: The WHOQOL-BREF is a self report questionnaire that would not be suitable for those with significant cognitive impairment.
PD-Specific:
Strengths: Free, cross-culturally comparable, generic measure of QOL available in over 15 different languages.
Weaknesses: The strength of psychometric evidence varies across conditions. It has not been used extensively in PD and support for its use is promising but limited.
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| 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 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
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| References |
Key References:
Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998 May;28(3):551-8.
World Health Organization. WHOQOL-BREF, Introduction, Administration, Scoring, and Generic Version of the Assessment. 1996; https://apps.who.int/iris/handle/10665/63529 Accessed 09 August, 2022.
World Health Organization. The World Health Organization Quality of Life (WHOQOL) -BREF. 2004; https://www.who.int/tools/whoqol/whoqol-bref Accessed 11 September, 2015.
Additional References:
Arun MP, Bharath S, Pal PK, Singh G. Relationship of depression, disability, and quality of life in Parkinson's disease: a hospital-based case-control study. Neurol India. 2011 Mar-Apr;59(2):185-9.
Hendred SK, Foster ER. Use of the World Health Organization Quality of Life Assessment Short Version in Mild to Moderate Parkinson Disease. Arch Phys Med Rehabil. 2016 Dec;97(12):2123-2129.e1.
Hill MR, Noonan VK, Sakakibara BM, Miller WC; SCIRE Research Team. Quality of life instruments and definitions in individuals with spinal cord injury: a systematic review. Spinal Cord. 2010 Jun;48(6):438-50.
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 Geriatr. 2008 Mar-Apr;46(2):147-60.
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 Nov;85(11):1890-5.
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 Rehabil. 2007 Feb;86(2):104-13.
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. Neurodegener Dis. 2011;8(4):178-86.
Mueller R, Landmann G, Bechir M, Hinrichs T, Arnet U, Jordan X, Brinkhof MWG. Chronic pain, depression and quality of life in individuals with spinal cord injury: Mediating role of participation. J Rehabil Med. 2017 Jun 28;49(6):489-496.
Schestatsky P, Zanatto VC, Margis R, Chachamovich E, Reche M, Batista RG, Fricke D, Rieder CR. Quality of life in a Brazilian sample of patients with Parkinson's disease and their caregivers. Braz J Psychiatry. 2006 Sep;28(3):209-11.
Document last updated March 2024
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