Quality of life in persons with spinal cord injury: comparisons with other populations

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The aim of this study was to identify the quality of life (QOL) measures commonly used to assess patients with spinal cord injury (SCI) and to summarize studies using common QOL measures that have been validated in SCI populations to compare scores in persons with SCI with those in a control population.


A systematic search of PubMed was conducted to identify studies using common QOL measures in persons with SCI and those comparing scores for QOL measures in an SCI population with scores in other populations. The authors sought comparative studies utilizing QOL measures for which validity and reliability analyses had been done.


Of 28 QOL measures found, validity and reliability studies had been conducted in patients with SCI for 5 measures. Twelve comparative studies compared QOL in SCI patients with QOL in healthy controls or in patients with other disabilities, or with normative data. The 36-Item Short Form Health Survey (SF-36) and the short version of the WHOQOL (WHOQOL-BREF) were the most widely used QOL instruments. Patients with SCI had a decreased QOL as compared with that in healthy controls or normative data, with the most pronounced deficits in the domains of physical functioning and physical role limitations. In 3 studies, patients with tetraplegia had a lower physical domain QOL than did those with paraplegia. Overall, however, the impact of injury level and injury completeness on QOL after SCI remains unclear due to a lack of longitudinal studies.


The SF-36 and WHOQOL-BREF are validated instruments that should be considered for use in SCI QOL studies. Future analysis of deficits in QOL among patients with SCI would benefit from the development of a QOL instrument specifically targeted to SCI. Longitudinal studies to assess the impact of injury level and injury completeness on SCI QOL are also needed.

Abbreviations used in this paper:CHART = Craig Handicap Assessment and Reporting Technique; LISAT = Life Satisfaction Questionnaire (9-item or 11-item); MCS = mental component summary score; PCS = physical component summary score; PROMIS = Patient Reported Outcomes Measurement Information System; QOL = quality of life; SCI = spinal cord injury; SF-36 = 36-Item Short Form Health Survey; SWLS = Satisfaction with Life Scale; WHOQOL-BREF = short version of the WHOQOL Assessment.

Article Information

Address correspondence to: Maxwell Boakye, M.D., Outcomes and Translational Research Center for Advanced Neurosurgery, University of Louisville, 220 Abraham Flexner Way, 1105, Louisville, Kentucky 40202. email: max.boakye@louisville.edu.

Please include this information when citing this paper: DOI: 10.3171/2012.6.AOSPINE1252.

© AANS, except where prohibited by US copyright law.



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    Graph showing the number of studies using common measures to evaluate QOL outcomes in patients with SCI. Number of studies was culled from citations from PubMed from 1998 to November 11, 2011. Common measures as reported in the title and abstract. ATDPA = Assistive Technology Device Predisposition Assessment; Burwood = Burwood Questionnaire; CIQ = Community Integration Questionnaire; COMQoL-A5 = Comprehensive Quality of Life Scale for Adults, version 5; Delighted-Terrible = Delighted-Terrible Scale; ICIQ-SF = International Consultation on Incontinence Questionnaire Short Form; King's Health = King's Health Questionnaire; LSS = Leisure Satisfaction Scale; PRISM = Patient Reported Impact of Spasticity Measure; PWI = Personal Wellbeing Index; QLI = QOL Index; QoLNA = Quality of Life & Needs Assessment; QOLP-PD = QOL Profile for Adults with Physical Disabilities; Qualiveen = 30-Item QOL measure; QWB = Quality of Well-Being; RNL = Reintegration to Normal Living; SCIQL-23 = Spinal Cord Injuries QOL 23-Item Questionnaire; SF-12 = 12-Item Short Form Health Survey; SIP68 = Sickness Impact Profile 68; SWBI = Sense of Well-being Index; 15D = 15-dimensional, standardized, self-administered measure of health-related QOL.

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    Flow chart depicting selection of studies comparing QOL in SCI populations with that in other populations.

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    Graph showing difference scores in comparing SF-36 scores in SCI patients with those in healthy controls. BP = bodily pain; GH = general health; MH = mental health; PF = physical functioning; R-E = role limitations–emotional; R-P = role limitations–physical; SF = social functioning; V = vitality. All group differences significant at p < 0.05, except for unshaded points, which represent nonsignificant group differences.

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    Graph showing difference scores in comparing SCI patients with population norms on SF-36 subscales. *Values interpolated from figure in Kreuter et al., 2005. All group differences significant at p < 0.05, except for unshaded points, which are not significantly different from each other.

  • View in gallery

    Bar graph demonstrating mean scores in patients with SCI and Australian population norms for WHOQOL domain scales in Barker et al., 2009. Pop = Australian population norms. All group differences significant at p < 0.001.


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