Performance of health-related quality of life instruments in a spinal cord injured population.

Andreson EM, Fouts BS, Romeis JC, Brownson CA Arch Phys Med Rehab 1999;(80):877–884

Objective: General Health Related Quality Of Life (HRQOL) surveys have not been well tested in populations with spinal cord injury (SCI). This study evaluated the performance of 5 such instruments.

Design: A cross-sectional survey with instruments administered in random order during computer-assisted interviews.

Setting: A Midwestern US veteran SCI program.

Subjects: One hundred eighty-three veterans with SCI ranging in age from 21 to 81 years (mean = 50.5).

Measures: The BRFSS HRQOL modules, the Quality of Well-Being scale (QWB), the Medical Outcomes Short-form 36 and Short-form 12 (SF–36, SF–12), and instrumental activities of daily living (IADL).

Results: Construct validity was supported by scores from the QWB, IADL, and physical health measures of the BRFSS and SF-36 showing greater impairment for quadriplegia than paraplegia. Similar constructs on the SF-36 and BRFSS were more strongly correlated than between the IADL and QWB; e.g., correlation between the SF-36 Vitality scale and the BRFSS "Days full of energy" questions was r=0.789 (p<0.01), whereas correlation between the IADL and QWB was r=-0.454 (p<0.01). Longer surveys (SF-36, QWB) were rated lower in subject acceptability.

Conclusion: These instruments have potential for research use among patients with SCI. More studies are needed to explore the best use of instruments with apparently different domains.