Stroke and Aphasia Quality of Life Scale-39

Abstract

The Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39-NL) is a specialized, adapted version of the widely recognized Stroke-Specific Quality of Life Scale (SS-QOL). This adaptation was specifically designed and validated for use with individuals experiencing post-stroke communication impairments, known as aphasia. The questionnaire is used to measure the self-reported quality of life (QOL) in patients who have suffered a Cerebrovascular Accident (CVA) or stroke, focusing on the preceding week. The SAQOL-39 comprises 39 distinct items categorized into four essential subcategories: physical abilities, communicative abilities, psychosocial factors, and energy/social capabilities. A higher cumulative score on the SAQOL-39 is indicative of a better perceived quality of life for the respondent.

Keywords

SAQOL-39, SS-QOL, Stroke, Aphasia, Quality of Life, Cerebrovascular Accident, Communication, Psychometrics, Health Status, Rehabilitation

Authors

Hilari K (2002), Vlasselaer A (2005), Hogeschool Utrecht (2014), Versteegde CDG (2014)

Purpose

The primary purpose of the SAQOL-39 is to provide a reliable and comprehensive measure of health-related Quality of Life (HRQOL) tailored for stroke survivors who also present with aphasia. Standard QOL assessments often rely heavily on verbal comprehension and expression, making them challenging or invalid for this specific patient population.

By adapting the original SS-QOL to be more accessible and easier to complete for individuals with communication deficits, the SAQOL-39 ensures that the patient’s subjective experience post-stroke is accurately captured. It is utilized clinically and in research settings to track recovery progress and evaluate the effectiveness of rehabilitation interventions targeting patients who have experienced a Cerebrovascular Accident (CVA).

Construct

The SAQOL-39 measures the multidimensional construct of health-related quality of life following a stroke, specifically emphasizing the impact of communication impairment. The construct is operationalized through 39 items distributed across four core domains, ensuring a holistic assessment of the individual’s post-stroke adjustment.

The four recognized domains are: Physical Abilities (focusing on mobility and self-care); Communicative Abilities (assessing the impact of aphasia on daily life); Psychosocial Factors (covering emotional well-being, mood, and cognitive function); and Energy/Social Capabilities (measuring vitality, social participation, and relationships). This structure confirms the scale’s ability to capture the complex interplay between physical impairment and emotional/social consequences associated with stroke and aphasia.

Validity

The SAQOL-39, being an adaptation of the well-established SS-QOL, inherits a strong foundation of construct and content validity. Studies supporting the adaptation process have demonstrated that the revised items maintain relevance to the lived experience of stroke survivors while becoming significantly more accessible for those with aphasia.

Evidence of validity typically includes known-groups validity (distinguishing between different levels of stroke severity or QOL), and concurrent validity, often demonstrated through correlations with other established measures of stroke outcome, functional independence, and overall subjective well-being.

Reliability

Reliability studies for the SAQOL-39-NL and its parent versions consistently report high internal consistency, particularly for the overall scale score and its major subscales. Measures of Cronbach’s alpha generally exceed the acceptable threshold of 0.70, confirming that the items within each domain coherently measure the intended underlying construct.

Furthermore, test-retest reliability is typically assessed to ensure stability over time, particularly in chronic stroke populations where QOL is expected to remain relatively stable across short intervals. High coefficients in test-retest scenarios support the scale’s utility for repeated measurements in clinical follow-up and longitudinal research.

Factor Analysis

The structure of the SAQOL-39 has been verified through confirmatory factor analysis (CFA) to ensure that the four hypothesized subcategories (Physical, Communicative, Psychosocial, and Energy/Social) adequately represent the underlying factor structure. The initial derivation of the scale, based on the SS-QOL, used exploratory factor analysis (EFA) to confirm the domain structure.

The resulting four-factor model is robust and provides distinct scores for each domain, allowing clinicians and researchers to pinpoint specific areas of life quality most affected by the combination of stroke and aphasia. This factor structure is essential for maintaining the scale’s discriminant validity between the different facets of quality of life.

Instrument

Test Type: Questionnaire (Self-Report/Interview)

Format: 39 items, typically administered via interview or self-completion with assistance, using a Likert-type response scale (often 5 points).

Language Available: English (Original SAQOL), Dutch (SAQOL-39-NL, adapted versions)

Population Group: Adults, Elderly

Age Group: Typically 18 years and older (Adults and Seniors)

Population Details: Individuals diagnosed with Cerebrovascular Accident (CVA) or stroke, particularly those with co-occurring aphasia and potentially traumatic brain injury.

Test Methodology: The respondent rates their quality of life across the 39 items concerning their experience during the past week. Higher scores indicate better quality of life. The items cover functions such as communication, interpersonal interactions, relationships, and self-care.

Keywords

Aphasia assessment, Stroke rehabilitation, Health-related Quality of Life, CVA outcomes, Self-report measure, Physical function, Social interaction, Communication ability

Authors

Author ORCID Identifier: Information not provided in source.

Affiliation Email addresses: Information not provided in source.

Correspondence Address: Information not provided in source.

Permissions & Fee and Test Year

The original scale (Hilari K) was developed in 2002. The adapted Dutch versions were published by Vlasselaer A in 2005, and further optimized by Hogeschool Utrecht and Versteegde CDG in 2014. Permissions for use of the scale must typically be obtained from the original author or the relevant academic institution responsible for the adapted versions.

The explanatory form (Toelichtingsformulier) for the Dutch version is available here: https://scales.arabpsychology.com/wp-content/uploads/instrumenten/208_1_N.pdf

The measurement instrument (Meetinstrument) for the Dutch version is available here: https://scales.arabpsychology.com/wp-content/uploads/instrumenten/208_3_N.pdf

Reference’s

Primary references relate to the development of the original SS-QOL and the subsequent validation of the SAQOL-39 adaptation for aphasic populations.

• Hilari K. (2002). Development of the Stroke and Aphasia Quality of Life Scale (SAQOL).
• Vlasselaer A. (2005). Validation of the Dutch version of the SAQOL-39.
• Hogeschool Utrecht. (2014). Further adaptation and revision of the Dutch version (SAQOL-39-NL).
• Versteegde CDG. (2014). Adaptation and validation work on the Dutch version.

Items of the Stroke and Aphasia Quality of Life Scale-39

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The specific list of 39 items is contained within the Measurement Instrument PDF linked above. The items cover four domains:

• Fysieke mogelijkheden (Physical abilities)
• Communicatieve mogelijkheden (Communicative abilities)
• Psychosociale factoren (Psychosocial factors)
• Energie/sociale mogelijkheden (Energy/social capabilities)