Quality of life measures for people following stroke: a structured content review

Introduction: Patient Reported Outcome Measures (PROMs) are used widely to collect patient perspectives on their Health-Related Quality of Life (HRQoL) after stroke. Existing reviews on PROMs typically report the psychometric properties but rarely focus on the content validity. We performed a structured review of the content of items of stroke-specific HRQoL outcomes.

Methods: We searched four databases using a combination of terms (Stroke, HRQoL, PROMs) to choose the three most frequently used stroke-specific HRQoL-related PROMs. Two raters independently linked the items of the Stroke Impact Scale, Stroke Specific Quality of Life and the Stroke and Aphasia Quality of Life to the International Classification of Functioning, Disability and Health (ICF) and Item Perspective Classification (IPC). We compared the ICF codes to the ICF Core Sets for Stroke and calculated ICF linkage indicators.

Results: More than 75% of the content for all three PROMs is represented in the Comprehensive Stroke Core Set, indicating the universality and validity of the content of these PROMs. All three PROMs represent the content of the ICF Core Sets for Stroke to a similar extent. Most items use an Intensity response option and have a Descriptive perspective. On the IPC framework, most items have a Rational appraisal type and represent the Biological domain.

Conclusion: Clinicians and researchers should use patient goals as a reference to choose the appropriate PROM. A deeper understanding of the content of PROMs can help clinicians and researchers make informed decisions on which HRQoL outcomes to use among people following stroke.