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World%20Health%20Organization%20Quality%20of%20Life%20Assessment%20(WHOQOL-BREF)
Availability
Please visit this website for more information about the instrument: World Health Organization Quality of Life Assessment
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)
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).
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
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.
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
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