WHO-QOL-BREF
Instrument for assessing general quality of life
The World Health Organisation Quality of Life BREF (WHO-QOL-BREF) is a validated tool for general quality of life assessment whose development was based on the WHOQOL-100 – a 100-item-version for quality of life evaluation. The 26 included items cover 4 main domains: physical quality of life, psychological quality of life, social relationships and environment. Although many of the original 100 items have not been used in the WHOQOL-BREF, the tool shows high correlation with the WHOQOL-100 and good psychometric values. Various medical disciplines are using the WHOQOL-BREF for clinical research and routine. Examples are the evaluation of patients health with diseases in the fields of orthopedics (spinal cord injuries), nephrology (hemodialysis patients), psychiatry (depression) and hepatology (liver transplantation outcome).
Indication
The WHO-QOL-BREF was developed for general quality of life assessment and is not specific for certain diseases or medical disciplines. The WHOQOL-BREF has – amongst other examples – found use in patients with traumatic spinal cord injuries and patient groups undergoing joint replacement, nephrological hemodialysis patients, psychiatric patients with depression and in the outcome evaluation after liver transplantation in hepatology.1, 2, 3, 4, 5
Items - Dimensions - Completion time
The survey consists of 26 questions with 5 response options each. Only one answer should be chosen.6
4 domains are included in the questionnaire: physical health (7 items), psychological health (6 items), social relationships (3 items) and environment (8 items). 2 additional questions are evaluating overall quality of life and general health.7
Phungrassami et al. measured a mean completion time of 13 minutes in a cohort of cancer patients.8
Scoring method of the WHO-QOL-BREF
The WHOQOL-BREF questionnaire produces 4 domain scores as a result. The answers of every question get linked with a point score from 1 (answer connected with the worst health state) to 5 (answer connected with the best health state). For each domain a mean score is calculated. In order to make it comparable to the WHOQOL-100 score each mean score is multiplied by 4 to get the final domain score. A second transformation can be made to a 0-100 scaling by using a given converting table. If more than 20% of the data is missing the assessment should be discarded. Where more than two items are missing from one domain, the domain score can not be calculated (except domain “social relationships” where a maximum of 1 item can be missed).7, 9
Score interpretation of the WHO-QOL-BREF
A higher score is connected with a better quality of life.
For the domain scores the score range reaches from 4 to 20 or from 0 to 100 if the second transformation has been performed. The 2 questions about overall quality of life and general health can be interpreted in addition to the domain scores.
World Health Organization, Geneva, Switzerland
No license is required to use this PROM. Costs do not have to be expected. A user agreement has to be transmitted to WHO and the requested questionnaire will be sent to the customer.
The WHOQOL-BREF is shorter than the original WHOQOL-100 but yet has a high correlation and good psychometric values. In addition to that the tool is different to other generic PROM’s because of the domain “environment” which is not included in many other general quality of life questionnaires.6
A paper that assessed the psychometric properties of the WHOQOL-BREF found out that some items correlate with the wrong domain scores and that the item-selection is not clear enough.15
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References
Jang, Yuh, et al. “A validity study of the WHOQOL-BREF assessment in persons with traumatic spinal cord injury.” Archives of Physical Medicine and Rehabilitation 85.11 (2004): 1890-1895.
Snell, Deborah L., et al. “Evaluating quality of life outcomes following joint replacement: psychometric evaluation of a short form of the WHOQOL-Bref.” Quality of Life Research 25.1 (2016): 51-61.
Sathvik, B. S., et al. “An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire.” Indian journal of nephrology 18.4 (2008): 141.
Naumann, Vicki J., and Gerard JA Byrne. “WHOQOL-BREF as a measure of quality of life in older patients with depression.” International Psychogeriatrics 16.2 (2004): 159-173.
O’carroll, Re, et al. “A comparison of the WHOQOL-100 and the WHOQOL-BREF in detecting change in quality of life following liver transplantation.” Quality of life research 9.1 (2000): 121-124.
Whoqol Group. “Development of the World Health Organization WHOQOL-BREF quality of life assessment.” Psychological medicine 28.3 (1998): 551-558.
World Health Organization. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. No. WHOQOL-BREF. World Health Organization, 1996.
Phungrassami, Temsak, et al. “Quality of life assessment in radiotherapy patients by WHOQOL-BREF-THAI: a feasibility study.” J Med Assoc Thai 87.12 (2004): 1459-65.
https://www.who.int/mental_health/evidence/who_qol_user_manual_98.pdf
Balalla, Shivanthi K., et al. “Validation of the WHOQOL-BREF and shorter versions using Rasch analysis in traumatic brain injury and orthopedic populations.” Archives of physical medicine and rehabilitation 100.10 (2019): 1853-1862.
Wang, Wen-Chung, et al. “Validating, improving reliability, and estimating correlation of the four subscales in the WHOQOL-BREF using multidimensional Rasch analysis.” Quality of Life Research 15.4 (2006): 607-620.
Lucas-Carrasco, Ramona. “The WHO quality of life (WHOQOL) questionnaire: Spanish development and validation studies.” Quality of life Research 21.1 (2012): 161-165.
Fleck, Marcelo P., Eduardo Chachamovich, and Clarissa Trentini. “Development and validation of the Portuguese version of the WHOQOL-OLD module.” Revista de Saúde Pública 40 (2006): 785-791.
https://www.who.int/tools/whoqol/whoqol-bref
Skevington, Suzanne M., Mahmoud Lotfy, and Kathryn A. O’Connell. “The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group.” Quality of life Research 13.2 (2004): 299-310.