Evaluation of measures used to assess quality of life after stroke

Background and Purpose-Assessment of quality of life (QOL) after stroke is becoming common with the recognition that evaluation of treatment should in clude quality as well as quantity of survival. This article will outline th e main conceptual and methodological issues in QOL assessment, highlight ad vantages and disadvantages of measures used in stroke QOL research, and dis cuss some unresolved issues. Summary of Review-We undertook a MEDLINE search using the keywords "stroke" and "quality of life" and reviewed 3 key texts on QOL measurement in strok e. Fifteen generic and 10 condition-specific measures used to assess QOL in stroke were identified and evaluated with the following criteria: reliabil ity, validity, responsiveness, precision, acceptability, suitability for pr oxy respondents, mode of administration, and use of patient-centered approa ches in development. Domains covered and level of comprehensiveness varied widely between generic and stroke-specific measures. No stroke-specific ins truments used patient-centered approaches in their development. Four stroke -specific measures (Frenchay Activities Index, Niemi QOL scale, Ferrans and Powers QOL Index-Stroke Version, and Stroke-Adapted Sickness Impact Profil e [SA-SIP30]) provided evidence of reliability and validity. Conclusions-The need remains for a patient-centered, psychometrically robus t, stroke-specific QOL measure. Patients should be involved in each stage o f instrument development. Caution is needed in the selection of an instrume nt to measure QOL after stroke. Although the Ferrans and Powers QOL Index-S troke Version, Niemi QOL;scale, SA-SIP30 and Sickness Impact Profile come c losest to satisfying many of the criteria outlined in this article, the sel ection of any individual instrument depends on the specific goals and const raints of a particular study.