Life Satisfaction Questionnaire 9

Last Updated

January 18, 2013

Purpose

Assesses various aspects of life satisfaction including:

Life as a whole
Self-care management
Contacts with friends
Vocational
Family life
Partner relationships
Financial
Leisure situations
Sex life

Link to Instrument

Instrument Details

Acronym LISAT-9, LSQ

Area of Assessment

Activities of Daily Living
Depression
General Health
Life Participation
Mental Health
Occupational Performance
Quality of Life
Social Relationships
Social Support

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Free. A copy of the LISAT-9 appears in:
Anke, A. G. W. and A. R. Fugl-Meyer (2003). "Life satisfaction several years after

Diagnosis/Conditions

Arthritis + Joint Conditions
Brain Injury Recovery
Cardiac Dysfunction
Cerebral Palsy
Multiple Sclerosis
Pain Management
Parkinson's Disease & Movement Disorders
Pulmonary Disorders
Spinal Cord Injury
Stroke Recovery
Vestibular Disorders

Stroke

Spinal Injuries

Non-Specific Patient Population

Chronic Pain

Brain Injury

The Life Satisfaction Questionnaire is available in 9- and 11-item versions.
The 9-item version contains a single item assessing overall life satisfaction, along with eight additional items that are domain-specific.
Items are answered on a 6-point Likert scale that ranges from 1 (very dissatisfied) to 6 (very satisfied).
No studies in SCI have used the 11-item version, an extension of the 9-item version, that adds 2 domains of somatic and psychological health.
Typically, when scored in group studies, the results are divided into dissatisfied (1-4) and satisfied (5-6).
A total Life Satisfaction score is computed as the mean of the item scores (range 1-6).

Number of Items

10-30 minutes

Required Training

No Training

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team in 2010; Updated with references from the chronic pain population by Julio Hernandez, SPT and Alfonso Poma, SPT in 2011; Updated by Jennifer Kahn, PT, DPT, NCS, Candy Tefertiller, PT, DPT, ATP, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Anna de Joya, PT, DSc and the TBI EDGE task force of the Neurology Section of the APTA in 2012.

ICF Domain

Participation

Measurement Domain

Activities of Daily Living

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: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

*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)

SCI EDGE

Recommendations based on level of care in which the assessment is taken:

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

Recommendations based on SCI AIS Classification:

	AIS A/B	AIS C/D
SCI EDGE	R	R

Recommendations for use based on ambulatory status after brain injury:

	Completely Independent	Mildly dependant	Moderately Dependant	Severely Dependant
TBI EDGE	N/A	N/A	N/A	N/A

Recommendations based on EDSS Classification:

	EDSS 0.0 – 3.5	EDSS 4.0 – 5.5	EDSS 6.0 – 7.5	EDSS 8.0 – 9.5
MS EDGE

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)
SCI EDGE	No	No	Yes	Not reported
TBI EDGE	No	No	No	Not reported

Considerations

Chronic SCI, Questionable unidimensionality (the idea that items should contribute to the measurement of only one attribute at a time) (Geyh et al, 2010) for the LISAT-9. Unidimensionality was established when two items were deleted (the “partner relations” and “family life” items).
In a Rasch analysis, the LiSAT yielded improved psychometrics when 2 items were deleted (partner relations and family life) and the response options were condensed from 6 point to 4 point scale, very dissatisfying, dissatisfying, satisfying, and very satisfying.
Chronic SCI, Cross cultural validity examined via Rasch analysis. There was evidence of cross-country bias with the LiSAT-9 (Geyh et al, 2010)
Chronic SCI, retrospective ratings of life satisfaction before SCI were much higher than ratings of current life satisfaction in the reference population suggesting possible memory bias or idealization of life before injury (van Koppenhagen et al, 2008)
Questionable unidimensionality (Geyh et al, 2010) for the LISAT-9. Unidimensionality was established when two items were deleted (the “partner relations” and “family life” items)
There was evidence of bias in different language versions of the LiSAT-9 (Geyh et al, 2010)

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Standard Error of Measurement (SEM)

Acute SCI : (Geyh et al, 2010; n = 243; mean age = 41.4 (13.6) years; within 14 days of injury; 47.7% complete, 43% incomplete, 8.6% unspecified)

LiSAT-9 Item-Level Standard Error (S.E.)
Domian	S.E.
Life as a whole	0.07
Self care	0.05
Vocational situation	0.06
Financial situation	0.06
Leisure situation	0.06
Sexual life	0.06
Partner relations	0.07
Family life	0.06
Contact with friends	0.07
SE = Standard error of item location

Normative Data

Chronic SCI: (Post et al, 1998, n = 318; mean age = 39.4(3.6) years; mean time since injury was 3.6 (1.9) years; Complete tetraplegia = 69, Incomplete tetraplegia = 65, Complete paraplegia = 93, Incomplete paraplegia = 91)

LiSAT-9 Mean Scores:
Age	n	LiSAT 9
18-25	49	4.5
26-35	89	4.3
36-45	70	4.3
46-55	63	4.1
56-65	43	4.3*
Sex	n	LiSAT 9
Men	236	4.3
Women	78	4.3
* p < .01 ~ p < .001

Chronic SCI: (Van Koppenhagen et al, 2008; n = 147; mean age = 41.6 (14.5) years; mean time since injury = 25.3 (6.1) months; complete tetraplegia = 35; incomplete tetraplegia = 14; complete paraplegia = 70; incomplete paraplegia = 28)

Life Satisfaction Scores Before and 1 Year After SCI:

LiSAT-9	n	Before SCI	After SCI	Difference Between Scores Before and After SCI			Correlations Between Scores Before and After SCI
		Mean (SD)	Mean (SD)	Mean (SD)	t	ES	Pearson r
Life as a whole	147	5.3 (1.0	4.3 (1.3)	1.0 (1.6)	7.37	0.8	.08
Self-care ability	147	5.7 (0.9)	4.2 (1.6)	1.5 (1.9)	9.40	1.2	.08
Leisure situation	147	5.1 (1.0)	4.6 (1.2)	0.5 (1.7)	4.37	0.5	.03
Vocational situation	99	5.1 (1.1)	4.1 (1.4)	1.1 (1.2)	6.60	0.9	.12
Financial situation	147	4.8 (1.2)	4.4 (1.4)	0.4 (1.6)	3.48	0.3	.27
Sexual life	144	4.9 (1.1)	3.3 (1.7)	1.6 (1.9)	10.06	1.1	.19
Partner relationship	109	5.5 (0.9)	5.1 (1.2)	0.4 (1.2)	3.11	0.4	.35
Family life	144	5.4 (0.8)	5.1 (1.0)	0.3 (1.1)	3.39	0.3	.24
Contact with friends	147	5.3 (0.9)	5.2 (1.0)	0.1 (1.2)	1.44	0.1	.15
LiSAT-9 total	147	5.2 (0.7)	4.5 (0.8)	0.8 (1.0)	9.35	1.0	.16

NOTE: The items vocational situation and partner relationships were not applicable to people without vocational activity or partner. The ES = (mean first - mean last)/([SD before + SD after]/2).

Percentage Satisfied and Dissatisfied and Dissatisfied and Change of Life Satisfaction Domains Before and After Onset of SCI:

Domains
Satisfied Before SCI, n (%)	Satisfied After SCI, n (%)	If Dissatisfied Before SCI, After SCI		If Satisfied Before SCI, After SCI
			Dissatisfied, n (%)	Satisfied, n (%)	Dissatisfied, n (%)	Satisfied, n (%)
Life as a whole	129 (88)	83 (57)	6 (4)	12 (8)	58 (40)	71 (48)
Self-care	134 (91)	89 (61)	4 (3)	9 (6)	54 (37)	80 (54)
Leisure	125 (85)	96 (65)	7 (5)	15 (10)	44 (30)	81 (55)
Vocational	84 (86)	51 (52)	7 (7)	7 (7)	40 (40)	44 (46)
Financial	109 (74)	95 (65)	20 (14)	18 (12)	32 (22)	77 (52)
Sex life	102 (73)	47 (34)	32 (23)	6 (4)	61 (44)	41 (29)
Partner relationship	92 (92)	83 (83)	4 (4)	4 (4)	13 (13)	79 (79)
Family life	128 (91)	118 (83)	4 (3)	9 (6)	19 (13)	109 (78)
Contact with friends	130 (88)	129 (88)	2 (1)	15 (10)	16 (11)	114 (78)

NOTE: Dissatisfied; LiSAT-9 scores 1-4; Satisfied: LiSAT-9 scores 5-6.

Internal Consistency

Chronic SCI: (Geyh et al, 2010)

Personal reliability index (Rasch-based correspondent to Cronbach’s alpha) = (0.86)

Chronic SCI: (Post et al, 1998)

Adequate internal consistency (Chronbach's alpha = 0.74)

Chronic SCI: (Post et al, 2012)

Adequate (Chronbach's alpha = 0.75)
A multidimensional scale where lower IC might be expected (authors give example of satisfaction with self care potentially not being related to financial satisfaction).

Criterion Validity (Predictive/Concurrent)

Chronic SCI: (Post et al, 2012; n= 145)

LiSat-9 with Life Satisfaction Questions (LS) Adequate r= 0.59
Item 1, overall satisfaction question on LiSat-9 with LS now (vs prior to injury) Excellent r=0.72
LiSat-9 with Satisfaction with Life Scale (SWLS) Excellent r=0.60
Item 1, overall satisfaction question on LiSat-9 with overall satisfaction question, item 3 on SWLS Excellent r=0.60

	LS	LiSat-9	SWLS
SF-mental health	Adequate 0.56	Adequate 0.52	Adequate 0.48
SIP –social functioning	Adequate -0.52	Adequate -0.45	Adequate -0.41

P< .01; SF-mental health = mental health scale of the short form 36; SIP- social functioning = social dimension of the Sickness Impact Profile -68, sum of mobility range and social behaviors scales.

Construct Validity

Chronic SCI: (Post et al, 2012; n=145)

Divergent Validity	LS	LiSat-9	SWLS
FIM-motor	0.17*	0.29**	0.14
Level of injury	0.08	0.24**	0.21*
Completeness of injury	0.00	0.10	0.15
Cause of injury	0.17*	0.12	0.02
Age	-0.18*	-0.14	-0.19*
Gender	-0.01	-0.04	0.02
Education	0.01	0.00	0.05
p<0.05; *p<0.01; FIM-motor = motor score on Functional Independence Measure; r <.03 = poor correlation

Floor/Ceiling Effects

Chronic SCI: (Post et al, 2012 n=145)

No floor or ceiling effects found (15% of respondents did NOT achieve the highest or lowest possible score)

Responsiveness

Chronic SCI: (van Koppenhagen, 2008 n= 147 one year post discharge from inpatient rehabilitation, differences between LiSat scores after SCI and retrospective scores prior to SCI.

LiSat-9 domain	Effect size of differences from before to after SCI
Life as a whole	0.8 (large)
Self care	1.2 (large)
Leisure situation	0.5 (moderate)
Vocational situation	0.9 (large)
Financial situation	0.3 (small)
Sex life	1.1 (large)
Partner relationship	0.4 (moderate)
Family life	0.3 (moderate)
Contact friends	0.1 (small)
LiSat-9 total score	1.0 (large)

Construct Validity

Mild Traumatic Brain Injury: Stalnacke 2007; n=163; LISAT-11

The total score of LISAT-11 was statistically significantly correlated with the total Rivermead Post-Concussion Symptoms Questionnaire (RPQ)-score (r=-0.459, p<0.001), the total Impact of Event Scale (IES)-score (r=-0.365, p<0.001), the Community Integration Questionnaire (CIQ) -sub-scales social integration and productivity, the social support scales, Availability of Social Interaction (AVSI) and Availability of Attachment (AVAT) and the total Beck Depression Inventory (BDI) score (r=-0.642, p<0.001).

Acquired Brain Injury: Eriksson et al, 2009; LISAT 11: n=116, 45 subjects with TBI, 71 with SAH;

The Rasch analysis of data revealed that all 11 items demonstrated acceptable goodness-of-fit to the Rasch model, supporting internal scale validity. All but 4 subjects (97%) in this sample also demonstrated acceptable goodness-of-fit in their responses. The principal component analysis of the residuals revealed that the LISAT-11 measures explained 70% of the variance in the data-set, further supporting unidimensionality in the data-set.

Traumatic Brain Injury: (Boonstra et al, 2012; LISAT -9: Dutch version; n=159 (22 participants with TBI)

The subgroup of patients with higher scores on the other instruments (Frenchay Activities Index (FAI); Nottingham Health Profile (NHP); Stroke-Adapted Sickness Impact Profile) differed significantly in terms of the corresponding LISAT scores from the subgroup with lower scores on the other instruments, except for one: patients with a higher score on the ‘outdoor activities’ domain in the FAI were more satisfied (i.e. had a higher Lisat score) regarding their contacts with friends and acquaintances than those with a lower score. However, this difference was not significant.

Cut-Off Scores

Chronic Stroke: (Visser-Meily et al, 2008; n = 119; mean age = 53 (9) years; 1 year and 3 years post stroke)

Scores of 1 to 4 are classified as ‘Dissatisfied’
Scores of 5 and 6 are classified as ‘Satisfied'

Normative Data

Chronic Stroke: (Visser-Meily et al, 2008)

Spouse Life Satisfaction 1 and 3 years after stroke
LiSAT-9		1 Year	3 Years
Life as a whole	Mean (S.D.)	4.35 (1.0)	4.31 (1.2)
	% dissatisfied	51%	52%
Self-care Mean	Mean (S.D.)	5.45 (0.8)	5.30 (0.9)
	% dissatisfied	10%	15%
Leisure	Mean (S.D.)	4.16 (1.3)	4.25 (1.1)
	% dissatisfied	52%	52%
Vocational situation	Mean (S.D.)	4.31 (1.2)	4.26 (1.2)
	% dissatisfied	45%	49%
Financial situation	Mean (S.D.)	4.37 (1.3)	4.27 (1.2)
	% dissatisfied*	41%	51%
Sexual life	Mean (S.D.)	3.62 (1.5)	3.35 (1.6)
	% dissatisfied*	67%	72%
Partner relations	Mean (S.D.)	4.86 (1.2)	4.64 (1.1)
	% dissatisfied**	28%	34%
Family life	Mean (S.D.)	4.89 (1.2)	4.78 (1.1)
	% dissatisfied	22%	28%
Contact with friends	Mean (S.D.)	4.59 (1.1)	4.59 (1.1)
	% dissatisfied	42%	40%
* p < 0.05. ** p < 0.01 (paired t-test or Man–Whitney test)

Test/Retest Reliability

Chronic Pain: (Boonstra et al., 2008; n= 51; mean age = 43 (12) years; mean duration of the current pain period = 5.8 (6.2) years)

Distribution of the LSQ-DV Scores for the Nine Domains:

First Assessment			Second Assessment
	n	Median	25th-75th percentile	n	Median	25th-75th percentile	P value	k (95% confidence limits)
Life as a whole	51	5	3-5	51	5	4-5	0.36	0.75 (0.62-0.89)
Self-care ability	51	5	4-6	51	5	5-6	0.06	0.65 (0.46-0.83)
Leisure situation	50	4	4-5	50	4	4-5	0.49	0.50 (0.28-0.72)
Vocational situation	49	4	3-5	49	4	3-5	0.84	0.57 (0.35-0.80)
Financial situation	50	4	3-5	50	4	4-5	0.79	0.78 (0.64-0.91)
Sexual life	43	4	3-5	44	5	4-5	0.62	0.82 (0.67-0.97)
Partner relationship	40	5	4-5	39	5	5-6	0.49	0.60 (0.23-0.96)
Family life	37	5	5-6	38	5	5-6	0.12	0.34 (-0.03-0.71)
Contact with friends	51	5	4-5	51	5	4-5	0.42	0.58 (0.38-0.79)
Mean Score	49	4.6	3.8-5.0	51	4.5	4.1-5.0	0.15	p = 0.74 (0.67-0.84)

Criterion Validity (Predictive/Concurrent)

Prior Trauma: (Anke & Fugl-Meyer, 2003; n = 69; median age = 26 (range 12-72) years; assessments conducted 3 years post injury)

Trauma patients satisfied or very satisfied with life:
Domain	Satisfied Before Trauma	Satisfied 3 years later~
Life as a whole	75%	41%***
Sexual life	65%	48%*
Partner relationship	64%	58%
Family life	74%	66%
ADL	100%	81%***
Contact with friends	81%	64%*
Leisure	71%	39%***
Vocational situation	69%	31%***
Financial situation	48%	25%**
~ chi-square test * p < 0.001 p < 0.01 * p < 0.05

Bibliography

Anke, A. G. W. and Fugl-Meyer, A. R. (2003). "Life satisfaction several years after severe multiple trauma–a retrospective investigation." Clinical rehabilitation 17(4): 431. Find it on PubMed

Boonstra, A. M., Reneman, M. F., et al. (2008). "Reliability of the Life Satisfaction Questionnaire to assess patients with chronic musculoskeletal pain." International Journal of Rehabilitation Research 31(2): 181-183. Find it on PubMed

Borg, T., Berg, P., et al. (2010). "Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures. A prospective observational study with two years follow-up." Injury 41(4): 400-404. Find it on PubMed

Eriksson, G., Kottorp, A., et al. (2009). "Relationship between occupational gaps in everyday life, depressive mood and life satisfaction after acquired brain injury." Journal of Rehabilitation Medicine 41(3): 187-194.

Geyh, S., Fellinghauer, B. A. G., et al. (2010). "Cross-cultural validity of four quality of life scales in persons with spinal cord injury." Health and Quality of Life Outcomes 8: 94.

Post, M. W., de Witte, L. P., et al. (1998). "Predictors of health status and life satisfaction in spinal cord injury." Arch Phys Med Rehabil 79(4): 395-401. Find it on PubMed

Post, M. W., van Leeuwen, C. M., et al. (2012). "Validity of the Life Satisfaction questions, the Life Satisfaction Questionnaire, and the Satisfaction With Life Scale in persons with spinal cord injury." Arch Phys Med Rehabil 93(10): 1832-1837. Find it on PubMed

Stalnacke, B. M. (2007). "Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury." Brain Inj 21(9): 933-942. Find it on PubMed

van Koppenhagen, C. F., Post, M. W., et al. (2008). "Changes and determinants of life satisfaction after spinal cord injury: A cohort study in The Netherlands." Archives of physical medicine and rehabilitation 89(9): 1733-1740.

van Koppenhagen, C. F., Post, M. W., et al. (2008). "Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands." Arch Phys Med Rehabil 89(9): 1733-1740. Find it on PubMed

Visser-Meily, A., Post, M., et al. (2008). "Psychosocial functioning of spouses in the chronic phase after stroke: Improvement or deterioration between 1 and 3 years after stroke?" Patient Education and Counseling 73(1): 153-158. Find it on PubMed

Visser, M. R., Oort, F. J., et al. (2005). "Methods to detect response shift in quality of life data: a convergent validity study." Qual Life Res 14(3): 629-639. Find it on PubMed

Wolters Gregorio, G., Stapert, S., et al. (2011). "Coping styles within the family system in the chronic phase following acquired brain injury: its relation to families' and patients' functioning." J Rehabil Med 43(3): 190-196. Find it on PubMed

Last Updated

Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Cost Description

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Standard Error of Measurement (SEM)

Normative Data

Internal Consistency

Criterion Validity (Predictive/Concurrent)

Construct Validity

Floor/Ceiling Effects

Responsiveness

Construct Validity

Cut-Off Scores

Normative Data

Test/Retest Reliability

Criterion Validity (Predictive/Concurrent)

Bibliography

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