Cited by 914Stroke Rehabilitation and RecoveryHealth Systems, Economic Evaluations, Quality of LifeHealth Education and Validation

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Development of a Stroke-Specific Quality of Life Scale

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Williams, Linda S., Weinberger, Morris, Harris, Lisa E., Clark, Daniel O., Biller, José·1999·Stroke

DOI 10.1161/01.str.30.7.1362

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Abstract

Background and Purpose —Clinical stroke trials are increasingly measuring patient-centered outcomes such as functional status and health-related quality of life (HRQOL). No stroke-specific HRQOL measure is currently available. This study presents the initial development of a valid, reliable, and responsive stroke-specific quality of life (SS-QOL) measure, for use in stroke trials. Methods —Domains and items for the SS-QOL were developed from patient interviews. The SS-QOL, Short Form 36, Beck Depression Inventory, National Institutes of Health Stroke Scale, and Barthel Index were administered to patients 1 and 3 months after ischemic stroke. Items were eliminated with the use of standard psychometric criteria. Construct validity was assessed by comparing domain scores with similar domains of established measures. Domain responsiveness was assessed with standardized effect sizes . Results —All 12 domains of the SS-QOL were unidimensional. In the final 49-item scale, all domains demonstrated excellent internal reliability (Cronbach’s α values for each domain ≥0.73). Most domains were moderately correlated with similar domains of established outcome measures ( r 2 range, 0.3 to 0.5). Most domains were responsive to change (standardized effect sizes >0.4). One- and 3-month SS-QOL scores were associated with patients’ self-report of HRQOL compared with before their stroke ( P <0.001). Conclusions —The SS-QOL measures HRQOL, its primary underlying construct, in stroke patients. Preliminary results regarding the reliability, validity, and responsiveness of the SS-QOL are encouraging. Further studies in diverse stroke populations are needed.

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10.1161/str.27.10.1812 · DOI
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Method
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Method
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Background
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“(16), has 49 items and 12 subscales (energy = three items, family performance = three items, language = five items, physical activity = six items, mood = five items, personality = three items, self-care = five items, social functions = five items, mental status = three items, function of the upper limbs = five items,…”
Background
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Azad, S. M. A. K., Shilvy, N. E. N., & Rabby, A. A. (2021) · Bioresearch Communications · doi:10.3329/brc.v7i1.54250 · Cited by 4
“There are diseasespecific QoL scales such as Stroke Specific Quality of Life Scale (Williams et al., 1999), Dermatology Life Quality Index (Finlay and Khan, 1994) and chronic illness related quality of life scales.”
Cross-Validation of the Factorial Validity of the Stroke Impact Scale 3.0 in Patients With Stroke
Lee, S., Lin, G., Huang, Y., Huang, S., Chou, C.-Y., Chiang, H.-Y. A., & Hsieh, C. (2021) · American Journal of Occupational Therapy · doi:10.5014/ajot.2021.040659 · Cited by 4
Quality of Life Assessment in Post-Stroke Patients
Pacian, A. B., Kulik, T. B., Bednarz, J., Kaczoruk, M., & Kawiak‐Jawor, E. (2018) · Pielegniarstwo XXI wieku / Nursing in the 21st Century · doi:10.2478/pielxxiw-2018-0015 · Cited by 4
Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis
Faradonbeh, S. B., Azar, F. E. F., Rezapour, A., Hajahmadi, M., & Hajmiresmail, S. J. (2018) · Medical Journal of the Islamic Republic of Iran · doi:10.14196/mjiri.32.127 · Cited by 4
Unreported Summary Statistics in Trial Publications and Risk of Bias in Stroke Rehabilitation Systematic Reviews: An International Survey of Review Authors and Examination of Practical Solutions
Weir, C. J., Assi, V., Na, L., Lewis, S. C., Murray, G. D., Langhorne, P., & Brady, M. (2019) · Journal of Stroke Medicine · doi:10.1177/2516608519873476 · Cited by 4
Mediating Effects of Self-Care Competence on the Relationship between Uncertainty and Quality of Life in Stroke Patients
Jo, E.-H., Lee, S.-J., & Jo, J.-H. (2021) · Korean Journal of Adult Nursing · doi:10.7475/kjan.2021.33.1.56 · Cited by 4
Development of Dance Movement Therapy Program for Chronic Stroke Patient and Effect of its Application on Postural Stability Ability, Depression and Quality of Life
Hong, M. (2017) · 한국체육학회지 · doi:10.23949/kjpe.2017.09.56.5.43 · Cited by 4
Language deficits
Basso, A. (2005) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198526544.003.0016 · Cited by 4
Qualidade de vida de indivíduos com acidente vascular encefálico e de seus cuidadores
de Lima, M. L. (2010) · doi:10.11606/d.17.2010.tde-12022011-091900 · Cited by 4
AYURVEDIC MANAGEMENT OF STROKE WITH SPECIAL REFERENCE TO LEFT TEMPOROPARIETAL LOBE GLIOSIS: A CASE REPORT
Mamidi, P., & Gupta, K. (2014) · Journal of Pharmaceutical and Scientific Innovation · doi:10.7897/2277-4572.036212 · Cited by 3
A Study Evaluating the Aspects of Stroke-specific Quality of Life and Severity in Hypertensive Stroke Patients
Sridhar, T., Varghese, L. E., Hasharudeen, A., Saxena, A., Hiremath, J. S., Nyamagoud, S. B., Swamy, A. H. V., & Bhadri, G. N. (2024) · Asian Journal of Pharmaceutical Research and Health Care · doi:10.4103/ajprhc.ajprhc_40_24 · Cited by 3
Cognitive and emotional benefits of individual reminiscence therapy in elderly stroke survivors: study protocol for a randomized controlled study
Wang, S., Hu, M., Xue, Y., Chen, Y., Li, K., Lu, D., Liang, L., Jiang, J., Li, X., & Wu, C. (2025) · BMC Psychology · doi:10.1186/s40359-025-02939-y · Cited by 3
“Quality of life will be assessed using the Stroke-Specific Quality of Life Scale (Ss-QoL), a 49-item scale specifically designed for stroke patients [42].”
Impact of Nurse-Led Interventions on Health-Related Quality of Life (HRQOL) in Stroke Patients: A Systematic Review and Meta-Analysis
Li, Y., & Hu, S. (2025) · Clinical Nursing Research · doi:10.1177/10547738251354998 · Cited by 2
“Health-related quality of life (HRQoL) refers to a comprehensive concept that includes the physical, mental, and social dimensions of an individual’s life that may be influenced by health changes (Guzmán Sabogal, 2016; Williams et al., 1999).”
Development of a disease-specific health-related quality of life questionnaire for patients with post-stroke spasticity
Zhang, Y., Liu, B., Liu, Z., Wang, Y., Zhao, H., Zi, M.-J., Wang, L., Liu, H., Chen, Z., & Xie, Y. (2012) · 中医杂志：英文版 · doi:10.1016/s0254-6272(13)60091-6 · Cited by 3
Effects of Horticultural Occupational Therapy Program Using Healing Garden on Quality of Life of Chronic Stroke Patients
Kim, M. Y., Park, W. K., & Kim, S. Y. (2014) · Journal of people, plants, and environment · doi:10.11628/ksppe.2014.17.6.451 · Cited by 3
“Willianms et al.(1999) 이 개발하고, 국내에서 Moon(2004)이 번역한 내용을 사용하였으 며 신뢰도 검증에서 알파(α)값이 0.8로써 높은 것으로 확인되었다.”
Clinical Scales to Assess Patients with Stroke
Adams, H. P. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4160-5478-8.10021-1 · Cited by 4
Complementary and alternative therapies for poststroke depression
Song, K., Xiong, F., Wang, Y., Wang, H., Huang, A., & Zhang, H. (2020) · Medicine · doi:10.1097/md.0000000000021995 · Cited by 3
Depression and routinization following stroke
Villain, M., Sibon, I., Renou, P., Poli, M., & Swendsen, J. D. (2021) · Revue Neurologique · doi:10.1016/j.neurol.2020.08.012 · Cited by 3
Quality of Life in Patients with Cerebral Venous Sinus Thrombosis: A Study on Physical, Psychological, and Social Status of Patients in Long-term
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Prognosis After Stroke
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Evaluation of Self Efficacy and Quality of Life of Stroke Patients
TOPÇU, S., & Oğuz, S. (2021) · Hemşirelik Bilimi Dergisi · doi:10.54189/hbd.993300 · Cited by 3
Online neuropilates classes in chronic stroke patients: Protocol for a randomised controlled feasibility study
Cronin, E., & Monaghan, K. (2023) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2023.101068 · Cited by 3
“Quality of Life will be measured using the Stroke Specific Quality of Life Scale [41].”
Method
Stroke self-management program based on health behavior theory on neurological function and quality of life of post-ischemic stroke patients
Faizah, I., Kartini, Y., Sari, R. Y., Rohmawati, R., & Muhith, A. (2023) · Bali Medical Journal · doi:10.15562/bmj.v12i3.4404 · Cited by 3
The effect of motivational interviewing on patients with early post-stroke depression: a quasi-experimental study
Fu, Y., Zhang, Y., Deng, Q., Wang, Y., Su, S., Wang, Z., Xu, L., Lin, B., Li, Y., & Li, J. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06673-y · Cited by 3
“The SS-QOL developed by Williams [38] and translated to Chinese by [39] was used to assess stroke patients’ health-related quality of life.”
Development, construct validity, and reproducibility of a mimetic sealed jar measuring the dynamics of opening
Ellingson, A. M., McGee, C. W., Nuckley, D. J., Ferkul, M., & Mathiowetz, V. G. (2017) · Journal of Rehabilitation and Assistive Technologies Engineering · doi:10.1177/2055668317692222 · Cited by 3
Sexual dysfunction in women post stroke: The hidden morbidity
Chaturvedi, S. K., & Bhola, P. (2017) · Neurology India · doi:10.4103/0028-3886.201880 · Cited by 3
Effects of recreational therapy on functional independence of people recovering from stroke.
Williams, R., Barrett, J. L., Vercoe, H., Maahs-Fladung, C., Loy, D. P., & Skalko, T. K. (2007) · Therapeutic Recreation Journal · Cited by 3
The assessment of memory for memory rehabilitation
Bradley, V. A., Kapur, N., & Evans, J. (2005) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198526544.003.0011 · Cited by 3
Lifestyle Evaluation Using Wearable Technologies: Opportunities for Stroke Patients
Massé, F., Paraschiv-Ionescu, A., Ženko, B., Džeroski, S., & Aminian, K. (2013) · Biosystems & biorobotics · doi:10.1007/978-3-642-34546-3_153 · Cited by 3
Effects of Motor Imagery on Upper Extremity Functional Task Performance and Quality of Life among Stroke Survivors
Rajesh, T. (2015) · Disability CBR & Inclusive Development · doi:10.5463/dcid.v26i1.225 · Cited by 3
Assessment of quality of life among elderly stroke patients - preliminary report
Bejer, A., & Kwołek, A. (2008) · Physiotherapy · doi:10.2478/v10109-009-0006-y · Cited by 3
Quality of Life After Stroke
Birtane, M., & Taştekin, N. (2010) · Trakya University's Institutional Open Access System (Trakya University) · Cited by 3
İnme sonrası afazi ve yaşam kalitesi
Armağan, O. (2011) · Turkish Journal of Cerebrovascular Diseases · doi:10.5505/tbdhd.2011.69775 · Cited by 3
Evaluating User Gestures in Rehabilitation from Electromyographic Signals
Batista, T. V. V., de Moraes, R. M., Machado, L. S., & Valença, A. M. G. (2016) · IEEE Latin America Transactions · doi:10.1109/tla.2016.7459625 · Cited by 3
“Pretende-se, desta forma, verificar a possibilidade Evaluating User Gestures in Rehabilitation from Electromyographic Signals T. V. V. Batista, R. M. Moraes, L. S. Machado and A. M. G. Valença A de desenvolvimento futuro de um sistema de reabilitação para mãos em pacientes que sofreram AVC ou outras doenças que causam…”
BackgroundInfluential
Handicap and Quality of Life After Stroke
Asplund, K., & √Östr√∂m, M. (2002) · Informa Healthcare eBooks · doi:10.1201/9780203908884.ch3 · Cited by 3
Can memory impairment be effectively treated?
Glisky, E. L. (2005) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198526544.003.0012 · Cited by 3
Increasing physical activity in stroke survivors using STARFISH, an interactive smartphone application: Protocol for a randomised controlled trial
Paul, L., Campbell, E., Gray, C. M., Brewster, S. A., Ramsay, A., Gill, J. M. R., McFadyen, A. K., & Dybus, A. (2018) · Technology and Disability · doi:10.3233/tad-180196 · Cited by 4

Authors: Williams, L. S., Weinberger, M., Harris, L. E., Clark, D. O., & Biller, J.
Affiliations: Regenstrief Institute (US)
From Roudebush Veterans Affairs Medical Center (L.S.W., M.W.); Departments of Neurology (L.S.W., J.B.) and Medicine (M.W., L.E.H., D.O.C.), Indiana University School of Medicine; and Regenstrief Institute for Health Care (L.S.W., M.W., L.E.H., D.O.C.), Indianapolis, Ind.
ORCID: Williams, Linda S.
Harris, Lisa E.
Clark, Daniel O.
Venue: Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1999-07
Volume: 30
Issue: 7
Pages: 1362-1369
ISSN: 0039-2499 (ISSN-L)
1524-4628
DOI: 10.1161/01.str.30.7.1362
OpenAlex: W2151560640
Cited by: 914
References: 19
Citations by year: 2026: 51 · 2025: 54 · 2024: 66 · 2023: 60 · 2022: 45 · 2021: 55 · 2020: 56 · 2019: 49 · 2018: 48 · 2017: 31 · 2016: 41 · 2015: 35 · 2014: 36 · 2013: 32 · 2012: 29
FWCI: 8.87
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Stroke (publishedVersion)
PubMed (publishedVersion)
Funders: Office of Research and Development
Health Services Research and Development
Topics: Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Health Sciences › Nursing › Research and Theory › Health Education and Validation
Keywords: stroke-specific quality of life, health-related quality of life, ischemic stroke, patient-centered outcomes, stroke trials, scale development, construct validity, responsiveness, internal consistency, patient interviews
MeSH terms: Adult, Affect, Aged, Cerebral Infarction, Brain Ischemia, Cognition, Fatigue, Female, Follow-Up Studies, Humans, Locomotion, Male, Middle Aged, Movement, Personality, Quality of Life, Surveys and Questionnaires, Role, Self Care, Speech, Vision, Ocular, Work, Reproducibility of Results

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