Stroke-Specific Quality of Life Scale

Stroke Patients: (Legris et al., 2018; n = 77, age => 18 with first-ever symptomatic stroke (ischemic stroke = 74 (96.1%) or intracranial hemorrhage = 3 (3.9%), mean age = 64.3 (15.4), male = 45 (58.4%), Patients enrolled 3 months after the index stroke; French translation of SS-QoL; SEM calculated; French version of SS-QoL)

Standard Error of Measurement by SS-QoL Domain

Stroke Patients: (Pederson et al., 2018; n = 125; Age => 18 with ischemic (n = 113, 90%) or hemorrhagic (n = 12, 10%); Mean Age = 70.5 (13.1); Male = 77 (62%); Mean Time Post CVA for initial test = 3 months; test-retest sent to a sample of 40 subjects 12 months post CVA; Norwegian translation of SS-QoL)

Standard Error of Measurement by SS-QoL Domain

Stroke patients: (Odetunde et al., 2017; n = 100 indigenous Yoruban stroke survivors (of at least 1 month) at secondary and tertiary health institutions in Southwestern Nigeria; males = 61; mean age = 55.27 (12.34); mean time post CVA = 20.81 (33.71) months (median time from stroke onset = 11 months); Yoruba version of SS-QoL; calculated SEM)

Standard Error of Measurement by SS-QoL Domain

Stroke: (Sallam et al., 2019; n = 147 first-time stroke survivors; mean age = 59.63 (10.97), female = 78 (53%); Mean Time Post CVA = 11.96 (15.63) months; Arabic version—SSQOL-A)

Standard Error of Measurement by SSQOL-A Domain

Chronic Stroke: (Lin et al, 2011; n = 25 patients >6 months post stroke)

Stroke Patients: (Legris et al., 2018; n = 77; French version of SS-QoL; MDC calculated)

Minimal Detectable Change by SS-QoL Domain and Confidence Interval

Stroke Patients: (Pederson et al., 2018; n = 125; Norwegian translation of SS-QoL; MDC calculated)

Minimal Detectable Change by SS-QoL Domain and Confidence Interval

Stroke patients: (Odetunde et al., 2017; n = 100; Yoruba version of SS-QoL; calculated MDC)

Minimal Detectable Change by SS-QoL Domain and Confidence Interval

Stroke: (Sallam et al., 2019; n = 147 first-time stroke survivors; Arabic version—SSQOL-A)

Minimal Detectable Change by SSQOL-A Domain and Confidence Interval

Chronic Stroke: (Lin et al, 2011; n = 74; patients >6 months post stroke)

Acute Stroke: (Williams et al, 1999; n = 34; mean age = 61 years; patients assessed 1 & 3 months post stroke (+/- 1 week); mean Canadian Neurologic Scale at admission = 9.2)

*Overall HRQOL was rated by patients at both time points; **mean scores

Stroke Patients: (Legris et al., 2018; n = 31; French version of SS-QoL)

• Excellent test-retest reliability for all SS-QoL domains (ICC => 0.91)

Stroke Patients: (Pederson et al., 2018; n = 36; Norwegian translation of SS-QoL)

• Excellent test-retest reliability for Upper Extremity Function and Work/Productivity domains (ρ = 0.94 for each)
• Acceptable test-retest reliability for SS-QoL domains:
  • Mobility (ρ = 0.84)
  • Mood (ρ = 0.84)
  • Self-care (ρ = 0.89)
  • Social roles (ρ = 0.80)
  • Family roles (ρ = 0.79)
  • Language (ρ = 0.74)
  • Personality (ρ = 0.83)
  • SS-QoL Total (ρ = 0.89)
• Questionable test-retest reliability for SS-QoL domains: Energy (ρ = 0.67), Vision (ρ = 0.35), and Thinking (ρ = 0.65)

Stroke patients: (Odetunde et al., 2017; n = 68; test-retest interval = 7 days; Yoruba version of SS-QoL)

• Acceptable test-retest reliability for Overall SS-QoL and Thinking, Work, Mobility, Self-care, Language, and Upper Extremity Function domains (ICC = 0.74-0.81)
• Questionable test-retest reliability for Vision, Personality, Mood, Family role, Social role, and Energy domains (ICC = 0.47-0.69)

Stroke patients: (Lo et al., 2016; n = 135; mean age = 58.90 (9.75); male = 63.7%; first-ever stroke = 88.9%; mean time post first CVA = 6.08 (5.24) years; 4 week interval between tests; Chinese version of instrument—SSQOL-C)

• Questionable test-retest reliability (ICC for total score = 0.57, 95% CI = 0.27-0.77)

Stroke: (Sallam et al., 2019; n = 41 first-time stroke survivors; one week interval between test and retest; Arabic version—SSQOL-A))

• Acceptable test-retest reliability for all SSQOL-A domains and Total SSQOL-A (ICC > 0.70)
• Excellent test-retest reliability (ICC > 0.90) for Energy, Family role, Language, Self-Care, Upper Extremity Function, and Vision domains
• No significant differences between the test-retest scores for any of the SSQOL-A domains or the total score using Wilcoxon’s signed rank test for dependent groups

Stroke Patients: (Legris et al., 2018; n = 30; French version of SS-QoL)

• Excellent interrater reliability for telephone interview 2 weeks post inclusion and again 2 months after enrollment for all SS-QoL domains (ICC => 0.88)

Acute Stroke: (Williams et al, 1999):  

• Excellent Internal Consistency: Cronbach's Alpha > 0.73 across all 12 domains

Subarachnoid Haemorrhage: (Boosman et al, 2010; n = 141; 36.1±7.9 (23-52) months post-SAE)

• Good internal consistency for all 12 domains: Cronbach’s Αlpha >= 0.80.
• Excellent reliability of the Physical(α=0.96) and Psychosocial(α=0.95) Subscores and total score(α=0.97).

Stroke Patients: (Legris et al., 2018; n = 77; French version of SS-QoL)

• Excellent internal consistency for SS-QoL domains: Language (α = 0.82), Mobility (α = 0.88), Self-care (α = 0.91), Upper extremity function (α = 0.89), and Work/Productivity (α = 0.80)
• Adequate internal consistency for SS-QoL domains: Mood (α = 0.72) and Social roles (α = 0.74)
• Poor internal consistency for SS-QoL domains: Energy (α = 0.69), Family roles (α = 0.67), Personality (α = 0.58), Thinking (α = 0.65), and Vision (α = 0.65)

Stroke patients: (Odetunde et al., 2017; n = 100; Yoruba version of SS-QoL)

• Excellent: Chronbach’s alpha = 0.82 for Upper Extremity Function domain
• Adequate: Chronbach’s alpha = 0.70-0.78 for Self-care, Language, Mobility, Work, Personality, Mood, Family role, and Social role domains
• Poor: Chronbach’s alpha = 0.61-0.62 for Vision, Thinking, and Energy domains

Stroke patients: (Lo et al., 2016; n = 135; mean age = 58.90 (9.75); male = 63.7%; first-ever stroke = 88.9%; mean time post first CVA = 6.08 (5.24) years; 4 week interval between tests; Chinese version of instrument—SSQOL-C)

• Excellent Cronbach’s alpha for total scale (α = 0.93^a)
• Excellent Cronbach’s alpha for domains: Activities^b (α = 0.89); Mood, energy, and family role^b (α = 0.86); Language (α = 0.90); and Upper extremity function (α = 0.81)
• Adequate Cronbach’s alpha for domains: Relationships^b (α = 0.75); Vision (α = 0.70); Basic needs^b (α = 0.72); Personality (α = 0.74); and Transfer^b (α = 0.79)
• Poor Cronbach’s alpha for domains: Thinking (α = 0.65) and Leisure and Work (α = 0.63)

^aScores higher than 0.9 may indicate redundancy in the scale questions.

^bIndicates a modified domain.

Stroke: (Sallam et al., 2019; n = 147 first-time stroke survivors; Arabic version—SSQOL-A)

• Excellent Cronbach’s alpha for Total SSQOL-A (α = 0.84)
• Excellent Cronbach’s alpha for domains: Energy (α = 0.91), Family role (α = 0.80), Language (α = 0.89), Mobility (α = 0.94), Mood (α = 0.84), Self-care (α = 0.88), Social role (α = 0.83), Thinking (α = 0.89), Upper extremity function (α = 0.92), Vision (α = 0.85), and Work/productivity (α = 0.87)
• Adequate Cronbach’s alpha for Personality domain (α = 0.78)

Chronic Stroke: (Lin et al 2010; n = 74; mean age = 54.11 (11.44) years; pre and post 3-week intervention; mean time since stroke 17.46 (17.67) months)

• Excellent correlation only between the SS-QOL Self-Care and FIM
• Adequate to poor correlations between the domains of the SS-QOL and the Fugl-Meyer Assessment, FIM, and Frenchay Activities Index
• Fair criterion validity of SS-QOL (ρ = .25–.31; P < .05).

Pre-treatment concurrent validity of the SS-QOL

* p < 0.05; ** p < 0.01; FMA = Fugl-Meyer Assessment; FIM = Functional Independence Measure; FAI = Frenchay Activities Index

Subarachnoid Haemorrhage: (Boosman et al, 2010; n = 141, mean age = 51.4 (12.3) years; mean time since SAH s/p aneurysm occlusion via clipping or coiling 36.1 (7.9) months

• Moderate to Strong correlation between all SS-QOL domains and Physical Subtotal scores with CFQ, LiSat-9, and HADS
• Weak to Moderate correlations between Physical SS-QOL subtotal and GOS

correlations > 0.24 were significant (p < 0.0033, two-tailed, using Bonferroni correction); GOS = Glasgow Outcome Scale; CFQ = Cognitive Failure Questionnaire; LiSat-9 = Life Satisfaction Checklist; HADS = Hospital Anxiety and Depression Scale

Acute Stroke: (Williams et al, 1999)

• Items in the language and thinking domains were not associated with items on the NIHSS.
  • These results may have occurred because patients with cognitive and language deficits were excluded from the study.

Stroke Patients: (Legris et al., 2018; n = 77; French version of SS-QoL)

Convergent Validity:

• Excellent convergent validity between Family roles domain and General Health Survey Short Form 36 (SF-36): Emotional and Physical Role Limitations (ρ = 0.61)
• Excellent convergent validity between Mobility domain and SF-36: Physical Function Subscale (ρ = 0.81)
• Excellent convergent validity between Self-care domain and Barthel Index (ρ = 0.89)
• Adequate convergent validity between Social roles domain and SF-36: Social Functioning Subscale (ρ = 0.45)
• Adequate  convergent validity between Work/Productivity domain and SF-36: Physical Role Limitations Subscale (ρ = 0.57)
• Poor convergent validity between Thinking domain and Mini Mental State Evaluation (MMSE) (ρ = 0.29)
• Poor convergent validity between Personality domain and Hospital Anxiety Depression scale (HAD) subscales: anxiety (ρ = -0.29)  and depression (ρ = -0.26)
• Adequate convergent validity between Language domain and National Institute of Health Stroke Scale: Aphasia and Dysarthria scores (ρ = -0.38)
• Adequate  convergent validity between Vision domain and National Institute of Health Stroke Scale: Visual field and ocular movements (ρ = -0.48)
• Excellent convergent validity between Energy domain and Fatigue Severity Scale (FSS) (ρ = -0.74)

Discriminant Validity:

• Significant differences between patients reporting a worse or better quality of life compared with their pre-stroke status for 9 of the 12 domain scores and the total score (p < 0.05).

Discriminant validity between self-rated quality of life groups at baseline compared with pre-stroke status for SS-QOL domains and total

^aGroup 1 = not worse QOL; Group 2 = worse QOL

• Significant differences between patients quality of life according to the modified Rankin score for 7 of the 12 domain scores and the total score.

Discriminant validity between quality of life according to the modified Rankin score for SS-QOL domains and total

^aGroup 1: mRS > 1; Group 2: mRS = (0-1)

Stroke Patients: (Pederson et al., 2018; n = 125: Norwegian translation of SS-QoL)

Convergent Validity:

• Excellent convergent validity between SS-QOL total score and EuroQol Quality of Life Scale-5D (EQ-5D) total score (r = 0.73)
• Excellent convergent validity Mobility domain and EQ-5D domain ‘Gait’ (r = 0.63)
• Excellent convergent validity between Upper Extremity Function domain and EQ-5D domain ‘Usual activities’ (r = 0.62)
• Excellent convergent validity between Work/Productivity domain and EQ-5D domain ‘Usual activities’ (r = 0.73)
• Excellent convergent validity between Self-care domain and EQ-5D domain ‘Personal Hygiene’ (r = 0.68)
• Excellent convergent validity between SS-QOL total and Quality of Life After Brain Surgery-Overall Scale (QOLIBRI-OS) total score (r = 0.71)
• Adequate convergent validity between Energy domain EQ-5D Visual Analogue Scale (VAS) scale (r = 0.48)

Discriminant Validity:

• Excellent negative correlation between SS-QOL total and Hospital Anxiety and Depression Scale (HADS) total score (r = -0.69)
• Adequate negative correlation between Personality domain and HADs Depression score (r = -0.52)

Stroke patients: (Odetunde et al., 2017; n = 100; Yoruba versions of SS-QoL and World Health Organization Quality of Life-BREF (WHOQoL-BREF))

Convergent validity

• Significant correlations between Physical Health domain of WHOQoL-BREF and Mobility (r = 0.28), Work/Productivity (r = 0.35), and Energy (r = 0.23) domains of SS-QoL
• Significant correlations between Psychological Health domain of WHOQoL-BREF and Thinking (r = 0.24) and Mood (r = 0.36) domains of SS-QoL
• Significant correlation between Social Relationship domain of WHOQoL-BREF and Social Role (r = 0.26) domain of SS-QoL
• Significant correlations between Environmental domain of WHOQoL-BREF and Family Role (r = 0.24) and Social Role (r = 0.21) domains of SS-QoL

Discriminate validity

• Item-domain correlations were comparable within each domain of the SS-QoL, with items in 10 of the 12 domains having correlations >0.7 (range = 0.711-0.920) with their hypothesized domains
  • A few of the items for the Self-care and Mood domains had item-domain correlations <0.7 (range = 0.594-0.630)

Stroke patients: (Lo et al., 2016; n = 135; Chinese version of instrument—SSQOL-C)

Convergent Validity

• Adequate to excellent correlation between SSQoL-C domains Activities^a, Mood, energy, and family role (MEFR)^a; Upper Extremity Function, Relationships^a, Basic needs^a, Leisure and work^a; Transfer^a, and Total SSQoL-C score with the physical component score of the Chinese version of the Medical Outcomes Study Short-Form Health Survey (SF-36) (rs = 0.43 to 0.61; p < 0.01, two-tailed)
• Adequate to excellent correlation between Activities^a and Basic Needs^a domains of SSQOL-C with the Physical Functioning dimension score of SF-36 and total Barthel ADL Index score (rs = 0.51 to 0.77; p < 0.01, two-tailed)
• Adequate correlation between the Mood, Energy, and Family Role^a domain score of SSQOL-C with the Vitality, Physical Role, Emotional Role, and Mental Health dimension scores of SF-36 and total Chinese Version of the Stroke Self-Efficacy Questionnaire (SSEQ-C) (rs = 0.46 to 0.52; p < 0.01, two-tailed)
• Adequate correlation between Relationships^a domain score of SSQOL-C with the Social Functioning dimension score of SF-36 (rs = 0.40; p < 0.01, two-tailed)
• Adequate correlation between Thinking domain score of SSQOL-C with the Mental Health dimension score of SF-36 (rs = 0.49; p < 0.01, two-tailed)

Discriminant Validity

• Excellent correlation between Language, Thinking, and Personality domains of SSQOL-C with the total SSEQ-C score (rs = 0.23-0.30)
• Adequate correlation between Vision and Transfer^a domains of SSQOL-C with the total SSEQ-C score (rs = 0.34-0.35)

^aIndicates a modified domain.

Stroke: (Sallam et al., 2019; n = 213: 147 first-time stroke survivors and 60 healthy subjects;  Mean Age of stroke survivors = 59.63 (10.97), female = 78 (53%); Mean Age of healthy subjects = 58.10 (11.73), female = 42 (70%); Arabic version—SSQOL-A)

Convergent Validity^a

• Excellent convergent validity between Health Survey Short Form 36 (SF-36): vitality and Energy domain (ρ = 0.86 to 0.94)
• Excellent convergent validity between SF-36: Physical and Emotional Role limitations and Family Role domain (ρ = 0.89 to 0.98)
• Excellent convergent validity between Language domain and NIHSS: dysarthria and aphasia scores (ρ = 0.86 to 0.96)
• Excellent convergent validity between Mobility domain and SF-36: physical function (ρ = 0.90 to 0.95)
• Excellent convergent validity between Mood domain and Beck Depression Inventory II (BDI-II) (ρ = 0.84 to 0.93)
• Excellent convergent validity between Personality domain and BDI-II (ρ = 0.88 to 0.96)
• Excellent convergent validity between Self-Care domain and Barthel Index (ρ = 0.91 to 0.98)
• Excellent convergent validity between Social role domain and SF-36: social functioning (ρ = 0.87 to 0.95)
• Excellent convergent validity between Thinking domain and NIHSS: orientation and command scores (ρ = 0.79 to 0.89)
• Excellent convergent validity between Upper Extremity Function domain and Barthel Index (ρ = 0.88 to 0.97)
• Excellent convergent validity between Vision domain with NIHSS: ocular movement and visual field scores (ρ = 0.81 to 0.92)
• Excellent convergent validity between Work/Productivity domain and SF-36: physical role limitations (ρ = 0.82 to 0.92)

^aRange of correlations for items to scale of the same domain.

Discriminant Validity^b

• Adequate to Excellent discriminant validity between Energy domain and SF-36: vitality (ρ = 0.14 to 0.40)
• Adequate to Excellent discriminant validity between Family role domain and SF-36: physical and emotional role limitations (ρ = 0.21 to 0.39)
• Adequate to Excellent discriminant validity between Mobility domain and SF-36: physical function (ρ = 0.16 to 0.51)
• Adequate to Excellent discriminant validity between Self-care domain and Barthel Index (ρ = 0.17 to 0.39)
• Adequate to Excellent discriminant validity between Social Role domain and SF-36: social functioning (ρ = 0.19 to 0.42)
• Excellent discriminant validity between Thinking domain and NIHSS: orientation and command scores (ρ = 0.14 to 0.27)
• Adequate to Excellent discriminant validity between Upper Extremity Function domain and Barthel Index (ρ = 0.16 to 0.53)
• Excellent discriminant validity between Vision domain and NIHSS: ocular movement and visual field scores (ρ = 0.14 to 0.29)
• Adequate to Excellent discriminant validity between Work/productivity domain and SF-36: physical role limitations (ρ = 0.18 to 0.48)

^bRange of correlations of items to scale of other domains

Acute Stroke: (Williams et al, 1999)

• Items and domains were developed through interviews conducted with stroke patients (n = 32 poststroke patients)
• SS-QOL and International Classification of Functioning, Disability, and Health (ICF) categories were independently assessed by two healthcare professionals. 
  • Agreement across all but three concepts was acceptable; kappa ranged from 0.75 to 1.00 (Teixeira-Salmela et al, 2009)

Stroke Patients: (Legris et al., 2018; n = 77; French version of SS-QoL)

• Determined by stroke neurologists at the University Hospital of Dijon to analyze importance of questions and response modalities, participant comprehension, fluency of vocabulary, and accuracy of translation in comparison to the original.

Stroke patients: (Lo et al., 2016; n = 135; Chinese version of instrument—SSQOL-C)

• The content validity of the SSQoL-C was determined by an expert panel of two physicians, one nurse academic, one nurse manager, one advanced practice nurse, and two registered nurses who rated each item on its relevance to stroke survivors’ HRQOL using a 4-point Likert scale (1 = “very inappropriate” to 4 = “very appropriate.”
  • Excellent Content Validity Index (CVI) of SSQOL-C computed as percentage of items scoring “3” or above = 0.99.

Acute Stroke: (Williams et al, 1999)

Subarachnoid Haemorrhage: (Boosman et al, 2009)

• Ceiling effect present for 10/12 domains and for physical component. Most strongly self-care & vision domains.

Stroke Patients: (Legris et al., 2018; n = 77; French version of SS-QoL)

Ceiling Effects

• Adequate ceiling effects for SS-QoL domains: Energy (7.8%), Personality (10.4%), Social roles (10.4%), and Thinking (13.0%)
• Poor ceiling effects for SS-QoL domains: Family roles (28.6%), Language (24.7%), Mobility (31.2%), Mood (23.4%), Self-care (77.9%), Upper extremity function (50.7%), Vision (66.2%), and Work/Productivity (26.0%)

Floor Effects

• Excellent floor effects (0%) for SS-QoL domains: Language, Mobility, Mood, Self-care, Thinking, Vision
• Adequate effects for SS-QoL domains: Energy (2.6%, Family roles (1.3%), Personality (2.6%), Social roles (2.6%), Upper extremity function (1.3%), and Work/Productivity (3.9%)

Stroke Patients: (Pederson et al., 2018; n = 125; Norwegian translation of SS-QoL)

Ceiling Effects

• Adequate ceiling effect for SS-QOL total score (8.8%) and Social roles domain (15.9%)
• Poor ceiling effects for all other SS-QOL domains (>20%)

Floor Effects

• Adequate ceiling effects for Total SS-QOL and all domains (0.8-11.1%)

Stroke patients: (Lo et al., 2016; n = 135; Chinese version of instrument—SSQOL-C)

Ceiling Effects

• Excellent: no ceiling effect for SSQoL-C total score.
• Adequate ceiling effects found for Activities^a, Mood, energy, and family role^a, Upper extremity function; Relationships^a; Thinking; Personality; Leisure and Work^a (0.74% - 14.81%)
• Poor ceiling effects found for Language, Basic Needs^a, Transfer^a, and Vision (31.85% - 66.67%)
• Overall, fewer than 15% of participants scored the highest possible score in all domains except four.

Floor Effects

• Excellent: no floor effects for domains: Activities^a, Vision, Leisure and Work and for SSQoL-C Total score.
• Adequate floor effects for domains: Mood, energy, and family role; Language; Upper extremity function; Relationships^a, Thinking; Basic needs^a, Personality; and Transfer^a (0.74% - 10.37%)
• Overall, fewer than 15% of participants scored the lowest possible score in each domain.

Stroke: (Sallam et al., 2019; n = 147 first-time stroke survivors; Arabic version—SSQOL-A)

• Adequate floor effects for all domains and Total SSQOL-A (< 20%)
• Adequate ceiling effects (< 20%) for domains: Energy, Family role, Language, Mobility, Personality, Social role, Thinking, Work/Productivity, and for Total SSQOL-A
• Poor ceiling effects (> 20%) for domains: Mood, Self-care, Upper extremity function, and vision

Acute Stroke: (Williams et al, 1999)

*Standardized Effect Sizes

Acute Stroke: (Lin et al 2010)

• Responsiveness of the Stroke Impact Scale 3.0 (SIS) was found to be significantly larger than the SS-QOL total (Standard Response Mean difference = .36; 95% CI = .02 to .71)

Stroke Patients: (Legris et al., 2018; Effect Size (ES) calculated in patients who reported a change in their quality of life between the enrollment visit and their pre-stroke status; assessed at 14 days after inclusion and 60 days after enrollment; French version of SS-QoL)

• Large Change for Energy domain (ES = 1.04, n = 57)
• Small Change for Social roles (ES = 0.04, n = 15) and Work/Productivity (ES = 0.14, n = 42) domains
• Moderate Change for all other SS-QOL domains (ES = 0.26-0.65, n = 15-40)