The stroke and aphasia quality of life scale (SAQOL-39g) in Greek:
Psychometric evaluation
K. Hilari1, 3, E. Efstratiadou1,3, M. Ignatiou1, V. Christaki1, E. Chelas1, I. Papathanasiou 1, 2, 3
1,
Division of Language and Communication Science, SHS, City University London,UK
2Department of Speech and Language Therapy, TEI of Western Greece Patras, Greece
3Thalis Aphasia Project, Department of Linguistics, School of Philosophy, University of Athens, Greece
Background
Study design
•Health-related quality of life (HRQL) reflects the impact of a health state on a person's ability to lead a fulfilling life.1
•HRQL measures allow the clinician to understand and measure the impact of disease on a client’s life as a whole2, to evaluate the efficacy of different
therapeutic interventions and service provisions3 and to incorporate the patient's perspective in clinical decision-making.4
•The Stroke and Aphasia Quality of Life scale-39 item generic version (SAQOL-39g) is an English questionnaire that measures HRQL in people with
stroke and aphasia.
•SAQOL- 39 has been translated and culturally adapted for use in Greece5, where currently there is no other measure for the assessment of HRQL
with people with aphasia.
•Interview-based psychometric study.
•Participants were over six months post-stroke and medically
stable. They had to be > 18 years old and to score ≥7/15 on the
receptive sub-tests of the Frenchay Aphasia Screening Test
(FAST) in order to be able to self-complete the measures used.
•Number of participants:
o Test-retest reliability was tested in a sample of
26 people with aphasia.
o Proxy and self-report agreement was tested on
23 of the above sample and their partners.
o Construct validity was tested on 60 people
with stroke 24 of whom had aphasia.
Current study
Two studies were carried out to examine the psychometric properties of the Greek SAQOL-39g :
a. test-retest reliability
b. proxy and self-report agreement and
•Measures:
c. construct validity
Participant characteristics
o Participants with stroke (+/- aphasia): Greek
SAQOL-39g, General Health Questionnaire-12,
Frenchay Activities Index, Montreal Cognitive
Assessment and Barthel Index.
o Proxies complete: Greek SAQOL-39g proxy
version, General Health Questionnaire-12 and
Caregiver Strain Index.
Results
•All participants were interviewed once except of the 26
participants which were tested for the test-retest reliability. They
were interviewed two times in a period of 2-14 days in order to
collect test-retest reliability data for the Greek SAQOL-39g
Test – retest reliability
Variable
Validity
Test - retest
Scale
Sub - domains
Participants n=60(%)
Participants n=26(%)
Gender
Female
Male
13 (21.7)
47 (78.3)
6 (23.1)
20 (76.9)
Proxy and self-report
agreement
Scale
Sub-domains
Age
Mean (S.D.) 66.68 (8.03) Mean (S.D.) 60.7 (10.7)
Range 42 – 86
Range 39 - 81
Ischaemic
Haemorrhagic
36 (60)
24 (40)
N/A
N/A
Aphasia
Aphasic
No Aphasic
24 (40)
36 (60)
26 (100)
0 (0)
ICC=0.96
ICC=0.83 – 0.99
• The Greek SAQOL-39g demonstrated excellent
test-retest reliability, proxy and self-report
agreement, internal consistency and good
convergent and discriminant validity.
a=0.96
a=0.83 – 0.99
• The findings suggest that the Greek SAQOL-39g
can be used to evaluate health-related quality of life
in stroke survivors with and without aphasia.
Validity
Convergent Validity
Overall score
Sub - domains
Discriminant Validity
Overall score
Sub – domains
This research has been co-financed by the European Union (European Social Fund – ESF) and Greek national funds through the Operational Program "Education and Lifelong
Learning" of the National Strategic Reference Framework (NSRF) - Research Funding Program:
THALIS – UOA - "Levels of impairment in Greek aphasia: Relationship with processing deficits, brain region,
and therapeutic implications", Principal Investigator: Spyridoula Varlokosta.
•Data analysed using standard psychometric methods.
Conclusions
Internal Consistency
Overall score
Sub – domains
Stroke type
ICC = 0.96
ICC = 0.89 – 0.97
• The results are in line with those of the SAQOL-39g
tested in the UK6.
r= 0.53 – 0.80
r= 0.54 – 0.89
• Using the Greek SAQOL-39g, proxy raters can
provide useful information on the HRQL of PWA.
r=0.52
r=0.04 – 0.48
• The client is the most appropriate source of
information on their own HRQL and proxy reports
should be used only when people with aphasia are
so severely affected that they are unable to selfreport.
References: 1. Bullinger M., Anderson R., Cella D., Aaronson N. Developing and evaluating cross cultural instruments: from minimum requirements to optimal models. Qual Life Res
1993; 2: 451- 459., 2. Patrick D.L., Erickson P. Assessing health-related quality of life for clinical decision making. In: Walker S.R., editor. Quality of life assessment: key issues in the
1990's. Dordrecht: Kluwer Academic Publishers; 1993.p.11 - 63., 3. De Haan R., Horn J., Limburg M., Van Der M.J., Bossuyt P. A comparison of five stroke scales with measures of
disability, handicap, and quality of life. Stroke 1993; 24: 1178 - 1181.,4. Mayou R., Bryant B. Quality of life in cardiovascular disease. BMJ 1993; 69: 460 - 466., 5. Kartsona A., Hilari
K. Quality of life in aphasia: Greek adaptation of the stroke and aphasia quality of life scale – 39 item (SAQOL – 39). Eura Medicophys 2007; 43: 27 - 35., 6. Hilari K., Byng S. Healthrelated quality of life in people with severe aphasia. International Journal of Language & Communication Disorders 2009; 44: 193 – 205.