Validation of the Quality of Life Inventory for patients with anxiety and depression

BACKGROUND: In 1992, Frisch et al (Psychol Assess. 1992;4:92-101) developed the Quality of Life Inventory (QOLI) to measure the concept of quality of life (QOL) because it has long been thought to be related to both physical and emotional well-being. However, the psychometric properties of the QOLI in clinical populations are still in debate. The present study examined the factor structure of QOLI and reported its validity and reliability in a clinical sample. METHOD: Two hundred seventeen patients with anxiety and depressive disorders completed the QOLI, and additional questionnaires measuring symptoms (Zung Self-rating Depression Scale, Beck Anxiety Inventory, Fear Questionnaire, Depression Anxiety Stress Scale-Stress) and subjective well-being (Satisfaction With Life Scale) were also used. RESULTS: Exploratory factor analysis via the principal components method, with oblique rotation, revealed a 2-factor structure that accounted for 42.73% of the total variance, and a subsequent confirmatory factor analysis suggested a moderate fit of the data to this model. The 2 factors appeared to describe self-oriented QOL and externally oriented QOL. The Cronbach alpha coefficients were 0.85 for the overall QOLI score, 0.81 for the first factor, and 0.75 for the second factor. CONCLUSION: Consistent evidence was also found to support the concurrent, discriminant, predictive, and criterion-related validity of the QOLI.     

Measuring quality of life]

The four broad domains of quality of life are the physical status and functional abilities, the psychological status and well-being, the social interactions and the economic status and factors. Health profiles attempt to measure all important aspects of Quality of Life (QOL). They offer a number of advantages and they also have some limitations. A number of QOL indexes have been recently developed to measure emotional and social functions, well-being as well as overall health status. Some scales used to evaluate QOL are function-specific as social interactions scales or daily living scales; others are disease-specific. For the severely mentally ill patients the most comprehensive and psychometrically best characterized scales have been recently reviewed. The Lehman's Structured Quality of Life interview for example based on comprehensive quality of life models, includes both subjective and objective QOL indicators and should be extensively used in french clinical studies.     

Hospital and community-based care for patients with chronic schizophrenia in Hong Kong

Background: There have been few studies on the impact of de-institutionalization on psychiatric patients' lives in Chinese culture. The objectives of the present study were: (1) to compare quality of life (QOL) of Chinese patients with schizophrenia living in three different treatment settings (hospital, long-stay care home and half-way house) in Hong Kong, and (2) to identify factors associated with patients' subjective well-being. Method: A matched-group design was used. Subjects (n = 204) living in the three treatment settings were matched according to age, sex, educational level, marital status, length of psychiatric illness and number of previous psychiatric admissions. Multiple measures for the evaluation of QOL included the Satisfaction With Life Scale (SWLS), WHO Quality of Life Measure-Abbreviated version-Hong Kong (WHOQOL-BREF-HK), Life Event List (LEL) and the Global Assessment Scale (GAS). Psychiatric symptoms were evaluated with the Brief Psychiatric Rating Scale (BPRS). Results: Significant differences in objective QOL indices (global level of functioning, number of life events and income) between subjects staying in hospital and community-based residential services were found in favour of the less restrictive community settings. However, with respect to global life satisfaction, subjects preferred the more secure settings despite their restrictiveness. Predictors of subjective well-being were educational level, negative life events and the BPRS items of somatic concern, anxiety and guilt feelings. The impact of negative life events on subjective well-being decreased over time. Conclusion: In a cohort of Chinese patients with chronic schizophrenia, community-based treatment settings had a positive impact on objective QOL indices but not on subjective well-being. Negative life events, education level, and the BPRS items of somatic concern, anxiety and guilt feelings were predictors of subjective well-being which seemed to adapt to external circumstances over time. Accepted: 1 October 2002 Correspondence to Dr. G. S. Ungvari     

The Life Satisfaction Matrix: an instrument and procedure for assessing the subjective quality of life of individuals with profound multiple disabilities

Background Assessing and measuring subjective quality of life (QOL) for individuals with profound multiple disabilities (PMD) remain amongst the most difficult challenges for theorists and practitioners in the field. The usual approaches using proxy reporting by familiar others have been demonstrated to be of questionable reliability and validity for persons with PMD. Method The author's continuing research into understanding the nature of subjective QOL of these individuals has led to the development and evaluating the Life Satisfaction Matrix (LSM), an instrument and procedure for assessing the subjective QOL of these individuals. Results Qualitative research that provides empirical evidence to support the assumptions underpinning, and face validity of, the LSM is described in this article. Conclusion Results of the study described herein demonstrate some potential to meet and overcome the above-mentioned challenges to assess and measure the subjective QOL of individuals with PMD.     

Predictors of health-related and global quality of life among young adults with difficult-to-treat epilepsy and mild intellectual disability

ObjectiveThis study evaluated predictors of health-related quality of life (HRQOL) and global quality of life (QOL) among young adults with difficult-to-treat epilepsy and mild intellectual disability.MethodsOne hundred and forty-two persons with epilepsy and cognitive problems were routinely screened on HRQOL, global QOL, and psychological distress four weeks after admission to a time-limited residential rehabilitation unit. The PESOS scales (PE = PErformance, SO = SOciodemographic aspects, S = Subjective evaluation/estimation) on epilepsy-specific problems were administered as measures of HRQOL; a questionnaire on life satisfaction and an item on overall QOL were used as measures of global QOL. Psychological distress was captured with the Symptom Checklist 90-R. Further data were gained from medical files. Quality-of- life predictors were identified using univariate methods and stepwise regression analyses.ResultsPsychological distress was the only predictor of all HRQOL and global QOL parameters. Seizure frequency was a predictor of most HRQOL variables. Other epilepsy variables affected only some HRQOL variables but were not associated with global QOL. Health-related quality of life did not seem to be strongly impaired. Only low correlations were found between HRQOL and global QOL.ConclusionThe notion of psychological distress as the most influential predictor of all QOL measures is in line with most findings on QOL in epilepsy. Former observations of weak associations between HRQOL and global QOL among patients with epilepsy and mild intellectual disability are supported. Thus, interventions to reduce psychological distress, besides epilepsy treatment, seem to be of great importance to improve QOL.     

Quality of life and its correlates in patients with bipolar disorder stabilized on lithium prophylaxis

The quality of life (QOL) of 50 bipolar disorder patients in remission (stabilized on lithium prophylaxis) was assessed and compared with that of clinically stable patients with schizophrenia (n = 20) and healthy subjects (n = 20). World Health Organization Quality of Life-Bref (WHOQOL-BREF) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to assess QOL in the three groups of subjects. The factors that contribute or influence QOL (i.e. stressful life events, social support, daily hassles) were also studied using standardized instruments in the study group. It was found that, compared to schizophrenia group, the bipolar group had significantly better QOL in all the domains of Q-LES-Q and the domains of general well-being, physical health and psychological health of the WHOQOL-Bref. The bipolar group had similar QOL scores in all other domains and higher scores in leisure time activity domain of Q-LES-Q, in comparison to the healthy group. The QOL in the bipolar group was better in patients who were younger and had a lesser severity of daily hassle. The present findings suggest that euthymic patients with bipolar disorder have a QOL that is comparable to that of healthy subjects. In contrast, patients with clinically stable schizophrenia have a poorer QOL. Occurrence of daily hassles contributes significantly to QOL in patients with bipolar disorder. However, the relatively limited variance explained by the independent variables included in the study, suggests the need to examine other (perhaps non-clinical) factors that may affect QOL.     

Generic patient‐reported outcomes in child health research: a review of conceptual content using World Health Organization definitions

Aim Our aims were to (1) describe the conceptual basis of popular generic instruments according to World Health Organization (WHO) definitions of functioning, disability, and health (FDH), and quality of life (QOL) with health‐related quality of life (HRQOL) as a subcomponent of QOL; (2) map the instruments to the International Classification of Functioning, Disability and Health (ICF); and (3) provide information on how the analyzed instruments were used in the literature. This should enable users to make valid choices about which instruments have the desired content for a specific context or purpose. Method Child health‐based literature over a 5‐year period was reviewed to find research employing health status and QOL/HRQOL instruments. WHO definitions of FDH and QOL were applied to each item of the 15 most used instruments to differentiate measures of FDH and QOL/HRQOL. The ICF was used to describe the health and health‐related content (if any) in those instruments. Additional aspects of instrument use were extracted from these articles. Results Many instruments that were used to measure QOL/HRQOL did not reflect WHO definitions of QOL. The ICF domains within instruments were highly variable with respect to whether body functions, activities and participation, or environment were emphasized. Interpretation There is inconsistency among researchers about how to measure HRQOL and QOL. Moreover, when an ICF content analysis is applied, there is variability among instruments in the health components included and emphasized. Reviewing content is important for matching instruments to their intended purpose.     

Assessment of subjective health and health-related quality of life in persons with acquired or degenerative brain injury

PURPOSE OF REVIEW: Health-related quality of life is a new outcome variable in neurology. Several generic measures aim at assessing this variable in adults with neurological diseases. Disease-specific measures are still rare; however, individuals with neurological diseases frequently suffer from cognitive impairment, yet are often excluded from health-related quality of life investigations. When included in such studies, cognitive functioning is not monitored via neuropsychological evaluation, possibly leading to methodological problems. Papers from May 2004 until July 2005 are reviewed with respect to psychometric quality and information about persons after traumatic brain injury, stroke, Parkinson's disease or dementia. RECENT FINDINGS: Several new cross-sectional and longitudinal outcome studies are reviewed. The Medical Outcome Study Short Form with 36 items, the Sickness Impact Profile and the Nottingham Health Profile were identified as the most frequently used measures in neurology. For traumatic brain injury, two new generic instrument validations (Life Satisfaction Index-A, Subjective Quality of Life Profile) and one internationally validated disease-specific development (Quality of Life after Brain Injury) were found; for stroke, one disease-specific tool (Burden of Stroke Scale) was identified. In Parkinson's disease, the disease-specific health-related quality of life measure Parkinson's Disease Questionnaire-39 is well validated. In dementia, three dementia-specific instruments (Quality of Life for Dementia, Quality of Life in Late-Stage Dementia Scale and Quality of Life in Alzheimer's Disease Scale) seem to be valid. SUMMARY: In neurology, only a few measures have been developed and validated for respondents with cognitive impairment, often showing poorer validity results than studies involving healthy persons. Health-related quality of life assessment should therefore be validated in the specific diseases and, if necessary, combined with a neuropsychological evaluation and a disease-specific health-related quality of life measure.     

International clinimetric evaluation of the MG‐QOL15, resulting in slight revision and subsequent validation of the MG‐QOL15r

Introduction: The MG‐QOL15 is a validated, health‐related quality of life (HRQOL) measure for myasthenia gravis (MG). Widespread use of the scale gave us the opportunity to further analyze its clinimetric properties. Methods: We first performed Rasch analysis on >1,300 15‐item Myasthenia Gravis Quality of Life scale (MG‐QOL15) completed surveys. Results were discussed during a conference call with specialists and biostatisticians. We decided to revise 3 items and prospectively evaluate the revised scale (MG‐QOL15r) using either 3, 4, or 5 responses. Rasch analysis was then performed on >1,300 MG‐QOL15r scales. Results: The MGQOL15r performed slightly better than the MG‐QOL15. The 3‐response option MG‐QOL15r demonstrated better clinimetric properties than the 4‐ or 5‐option scales. Relative distributions of item and person location estimates showed good coverage of disease severity. Conclusions: The MG‐QOL15r is now the preferred HRQOL instrument for MG because of improved clinimetrics and ease of use. This revision does not negate previous studies or interpretations of results using the MG‐QOL15. Muscle Nerve 54 : 1015–1022, 2016     

Examining the Psychometric Properties of the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire in Two Samples of Youth with OCD

Researchers have demonstrated that quality of life (QOL) is an important construct to measure in individuals with mental health disorders, yet only a small amount of research has been dedicated to examining QOL and its response to treatment in children and adolescents with obsessive–compulsive disorder (OCD). The current study explored the psychometric properties of a measure of QOL, the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q), by examining the reliability, validity, and treatment sensitivity of this measure delivered in two separate RCTs for OCD (total N = 251 across both studies). Our results provide evidence for the reliability and validity of the PQ-LES-Q in adolescents with OCD (all Cronbach’s alphas >.89, convergent validity correlations significant at the p < .05 level), but that an adaptation of the measure many be necessary for valid use in younger children with OCD.     

Factors affecting quality of life in a multiracial sample of older persons with schizophrenia.

OBJECTIVE: There have been few studies of quality of life (QOL) among older persons with schizophrenia. The authors used an adaptation of Lehman's QOL model to examine factors that impact QOL in a multiracial urban sample of older persons with schizophrenia. METHODS: The schizophrenia group consisted of 198 community-dwelling persons aged 55 years and older who developed schizophrenia before age 45 years. A community comparison group (N = 113) was recruited using randomly selected block-groups. The QOL model consisted of four variable sets (demographic, objective, clinical, and subjective) comprising 19 independent variables. The dependent variable was the Quality of Life Index (QLI). RESULTS: The schizophrenia group had a significantly lower QLI score than the comparison group (21.7 versus 24.2; t = -5.36, df = 362, p = 0.001). Within the schizophrenia group, in bivariate analyses, 11 of 19 variables were significantly related to QLI. In regression analysis, six variables were significantly associated with the QLI: fewer depressive symptoms, more cognitive deficits, fewer acute life stressors, fewer medication side effects, lower financial strain, and better self-rated health. The model explained 55% of the variance in QLI, with the demographic, objective, psychiatric illness, and subjective variable sets accounting for 6%, 35%, 9%, and 5% of the variance, respectively. With the exception of the demographic set, each of the variable sets added significant variance. CONCLUSION: Our data confirmed earlier reports that older persons with schizophrenia have lower self-reported quality of life than their age-matched peers. Our findings suggest that the factors impacting on QOL are potentially ameliorable and therefore provide an opportunity to enhance the well-being of this population.     

Finding a focus for quality of life with aphasia: Social and emotional health,and psychological well-being

Background: Speech pathologists infrequently address the quality of aphasic people's lives in a direct manner in rehabilitation, most likely due to the difficulty in grasping the role of communication in quality of life (QOL). Despite considerable research into aphasic language impairments and communication disabilities, there is no clear evidence how aphasia impacts on clients' QOL. This paper reports on a comprehensive evaluation of 30 people with mild to moderate aphasia to determine which aspects of communication predict their QOL. A conceptual model of the relationship between communication and QOL was devised, using the disablement framework of the International Classification of Impairment, Activity and Participation Beta-2 Draft (ICIDH-2) (World Health Organisation, 1998). Communication was conceptualised as language impairment, functional communication ability and activity, and social participation. QOL included both health-related QOL (HRQOL) and psychological well-being concepts. Aims: The aim of this study was to investigate how measures of impairment, activity and participation, and measures of QOL related to each other for people with aphasia, for the purpose of: (1) determining which specific communication assessments were most predictive of their QOL; and (2) determining whether HRQOL or psychological well-being was represented more in relationships, thus indicating a focus for QOL in aphasia. Methods & Procedures: Thirty people aged 57-88 years (mean = 70.7yrs) with predominantly mild to moderate chronic aphasia (mean WAB AQ = 74.4, range 21.9-5.8; mean TPO = 41 mths, range 10-108 mths) participated in this study. In total, 13 standardised and specifically designed measures evaluated the different concepts of the model. Maximal multiple regression analysis illustrated which communication measures were most predictive of participants' HRQOL and psychological well-being. Outcomes & Results: Overall, aphasic people's communication predicted their psychological well-being and social health (a subscale of HRQOL). Specifically, the findings demonstrated that functional communication ability, and language functioning to a lesser degree, were implicated in QOL, providing evidence for particular speech pathology interventions in addressing clients' QOL. Finally, emotional health powerfully influenced the relationships among variables, and physiological/physical health was a determinant of social participation.     

Validation of the side effect and life satisfaction (SEALS) inventory.

Diminished quality of life (QOL) is a common feature of epilepsy. It is generally more severe among patients with poor seizure control but prevalent, to a clinically significant degree, even among those whose seizures are well controlled. People with epilepsy frequently report diminished socialization, negative self image, feelings of stigmatization, reduced earnings potential, and diminished hope and ambition. Problems with antiepileptic drug (AED) therapy are common, and AED therapy is recognized as an important determinant of health-related quality of life (HRQOL). A clinically efficient psychometric instrument is needed to measure its impact. The Side Effect and Life Satisfaction (SEALS) inventory is a 38-item, patient-completed questionnaire designed to measure satisfaction with AED therapy. We tested its construct validity in comparison with three widely used psychometric instruments of similar design, the Profile of Mood States (POMS), the Hospital Anxiety and Depression (HAD) scale, and the Medical Outcomes Study-Cognitive Functioning (MOS-COG) scale. All four instruments were completed by 307 epilepsy patients. A matrix of Pearson's correlations was produced for the SEALS inventory and the comparative instruments. A statistically significant correlation was found for each planned comparison. We conclude that the SEALS inventory is a valid psychometric instrument, well suited for use in clinical investigations of AED therapy and in the practical, long-term management of epilepsy.     

Quality of life and health-related quality of life of adolescents with cerebral palsy

This study assessed quality of life (QOL) and health-related quality of life (HRQOL) of 203 adolescents with cerebral palsy (111 males, 92 females; mean age 16y [SD 1y 9mo]). Participants were classified using the Gross Motor Function Classification System (GMFCS), as Level I (n=60), Level II (n=33), Level III (n=28), Level IV (n=50), or Level V (n=32). QOL was assessed by self (66.5%) or by proxy (33.5%) with the Quality of Life Instrument for People With Developmental Disabilities, which asks about the importance and satisfaction associated with the QOL domains of Being, Belonging, and Becoming; HRQOL was captured through proxy reports with the Health Utilities Index, Mark 3 (HUI3), which characterizes health in terms of eight attributes, each having five or six ordered levels of function. GMFCS level was not a source of variation for QOL domain scores but was significantly associated with the eight HRQOL attributes and overall HUI3 utility scores (p<0.05). Some QOL domain scores varied significantly by type of respondent (self vs proxy; p<0.05). Overall HUI3 utility values were significantly but weakly correlated with QOL Instrument scores for Being (r=0.37), Belonging (r=0.17), Becoming (r=0.20), and Overall QOL (r=0.28), and thus explain up to 14% of the variance (r(2)). These findings suggest that although QOL and HRQOL are somewhat related conceptually, they are different constructs and need to be considered as separate dimensions of the lives of people with functional limitations.     

Adolescents with cerebral palsy: stability in measurement of quality of life and health-related quality of life over 1 year

This study assessed stability of measurement of quality of life (QOL) and health-related quality of life (HRQOL) over the course of 1 year among 185 adolescents (mean age 16y, SD 1 y 9 mo) with cerebral palsy (CP). Participants were classified on the Gross Motor Function Classification System as level I (n=55), II (n=30), III (n=27), IV (n=46), or V (n=27). QOL was assessed by self- (n=125) or proxy-report (n=60) with the Short Version of the Quality of Life Instrument for People with Developmental Disabilities (QOL Instrument), which describes domains of Being, Belonging, and Becoming. HRQOL was captured through parent proxy-reports with the Health Utilities Index Mark 3 (HUI3). Generalizability coefficients (G) for domain and Overall QOL scores on the QOL Instrument ranged from 0.50 to 0.73, indicating that between 50 and 73% of the variance was stable over 1 year. Stability on the HUI3 was excellent (G>0.90) for ambulation and overall utility scores; moderate (G=0.70-0.90) for speech, vision, dexterity, cognition, and hearing; and low for pain (G=0.48) and emotion (G=0.24). Correlations between scores on the two instruments were moderate even when adjustments were made for the lack of perfect stability over 1 year. This supports the notion that QOL and HRQOL are different aspects of life experience among adolescents with CP.     

Does the Relationship Between Physical Activity and Quality of Life Differ Based on Generic Versus Disease-Targeted Instruments?

Background  There has been an increased interest in the study of physical activity and its relationship with quality of life (QOL) and health-related quality of life (HRQL) in chronic disease conditions. The investigations have used either generic or disease-targeted instruments for measuring QOL and HRQL, but have not examined differences in the associations as a function of the types of instruments. Purpose  The present study examined the associations among physical activity, QOL, and HRQL using generic and disease-targeted instruments in persons with multiple sclerosis (MS). Methods  Participants were 292 individuals with MS who wore an accelerometer for 7 days and then completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Multiple Sclerosis Impact Scale-29 (MSIS-29), Leeds Multiple Sclerosis Quality of Life Scale (LMSQOL), Short Form-12 Health Survey (SF-12), and Satisfaction With Life Scale (SWLS). Results  Accelerometer counts and GLTEQ scores had similarly sized correlations with scores from generic (SF-12) and the disease-specific (MSIS-29) measures of HRQL and generic (SWLS) and the disease-specific (LMSQOL) measures of QOL. Path analysis indicated a similar pattern of directional relationships between accelerometer counts and GLTEQ scores with physical and mental HRQL and, in turn, physical and mental HRQL with QOL using generic and disease-targeted instruments. Conclusions  Our results suggest that in cross-sectional analysis, physical activity is similarly related with QOL and HRQL using generic and disease-targeted instruments in persons with MS. Funded by the National Institute of Neurological Diseases and Stroke (NS054050).     

Quality of Life of Epilepsy Surgery Patients as Compared with Outpatients with Hypertension,Diabetes, Heart Disease,and/or Depressive Symptoms

Summary: Health-related quality of life (HRQOL) of 166 adults who had previously undergone surgical treatment for intractable epilepsy was compared with that of outpatients with hypertension, diabetes, heart disease, andlor depressive symptoms. Eight self-reported HRQOL domains were evaluated and compared by the RAND 36-Item Health Survey 1.0: emotional well-being, social function, role limitations due to emotional problems, energy/fatigue, pain, role limitations due to physical problems, physical function, and general health perceptions. A pictorial item on overall QOL was also administered, for a total of 9 HRQOL domains. With adjustment made for age, gender, education, and comorbid conditions, 55 completely seizure-free patients scored higher (i.e., better health) than patients with hypertension in 6 of 9 domains, higher than diabetic patients in 8 of 9, higher than those with heart disease in all 9, and higher than those with depressive symptoms in all 9 (all p < 0.05). Sixty-seven patients still having seizures with impaired consciousness scored worse than hypertensive patients in 5 domains, worse than diabetic patients in 3, and worse than heart disease patients in 2; for all 3 conditions, these domains included emotional well-being and overall QOL (p < 0.05). These 67 patients, however, scored better than patients with depressive symptoms in all 9 domains, better than those with heart disease in 2, and better than those with diabetes in 1 (all p < 0.05). Forty-four other patients had only simple partial seizures (SPS); their scores were comparable to those of diabetic and heart disease patients on mental and social health scales but were higher (“better”) than those of these patients on physical health scales. HRQOL among patients who have undergone “curative” epilepsy surgery is better than that of patients who have hypertension, diabetes, heart disease, or depressive symptoms. Patients who have continued seizures with altered consciousness are worse off in terms of emotional well-being and overall QOL than all other patients, except for those with depressive symptoms.     

Well-being in Australia--findings from the National Survey of Mental Health and Well-being

Background: The National Survey of Mental Health and Well-being in Australia has provided a rare opportunity to investigate not only the sociodemographic distribution of well-being, but also how it is related to impaired mental or physical health, to specific groups of psychiatric disorders and disability in daily life. Methods: A national household sample of 10,641 individuals (response rate 78 %) representative of the adult population was interviewed with the Composite International Diagnostic Interview and completed scales measuring recent symptoms, disablement and well-being. The latter was measured by the single item Life Satisfaction Scale of Andrews and Withey (1976) expressed as percentage, with 100 % being “delighted”. Results: The mean score for the Australian adult population was 70.4 % (95 % CI 70.0, 70.8), which matches the proposed universal norm. Men and women had very similar mean scores. Well-being was higher in persons with tertiary education and in those owning or purchasing their homes. It was lower in persons with physical or mental disorders, particularly depression. For alcohol use, a U-shaped relationship was found, whereby well-being was lower both in abstainers and in heavy users. Multiple regression analysis showed that when adjustment is made for confounders, women had higher life satisfaction than men and that high life satisfaction became less common with age in men, but even more so in women. Life satisfaction was impaired for respondents with high psychological distress, especially in the unemployed, the divorced and those with tertiary education, whether or not their symptoms led to a CIDI-A diagnosis of depression. Conclusion: The correlates of well-being are essentially in the expected direction. Depressive disorder has a stronger association with low well-being than other psychiatric diagnoses. Of particular interest is the existence of a small number of persons with current anxiety or depressive disorders who report having high life satisfaction. This deserves further investigation. Accepted: 4 July 2002 Correspondence to Dr. Keith Dear     

Leisure-time physical activity,anthropometrics, and body composition as predictors of quality of life domains after spinal cord injury: an exploratory cross-sectional study

The objective of the current work was to examine the relationships between quality of life(QOL)domains in persons with spinal cord injury(SCI)and their levels of weekly leisure-time physical activity(LTPA),anthropometric variables,and body composition variables.This exploratory cross-sectional study consisted of baseline data collected as part of a randomized clinical trial at a VA Medical Center and SCI center.A convenience sample of 36 community-dwelling persons with SCI participated in the current study.Outcome measures included the World Health Organization Quality of Life Short Form(WHOQOL-BREF),Leisure-Time Physical Activity Questionnaire for People with Spinal Cord Injury(LTPAQ-SCI),anthropomorphic measures(waist,hip,and abdominal circumference),and dual-energy x-ray absorptiometry(DXA)to quantify regional and total body composition.Multiple regression models suggested that engagement in LTPA accounted for 35.7%of the variance in physical health QOL,33.5%in psychological QOL,14.2%in social relationships QOL,and 38.2%in environmental QOL.Anthropometric measures accounted for 11.3%,3.1%,12.0%,and 6.7%of the variance in these QOL indices,respectively,and DXA indices accounted for 18.7%,17.5%,27.4%,and 21.9%.Within these models,the number of minutes of heavy LTPA per day uniquely predicted physical health QOL,the number of mild LTPA days per week uniquely predicted psychological QOL,and the amount of mild LTPA per day uniquely predicted environmental QOL.Bivariate analyses also suggested that android and trunk fat,as well as supine waist and abdominal circumferences,were positively associated with social relationships QOL.Encouraging individuals with SCI to engage in LTPA may robustly enhance multiple aspects of QOL while reducing the risk for cardiovascular and metabolic morbidities associated with SCI.Moreover,this may lead to a further understanding of how QOL may impact longitudinal intervention trials.The study protocol and procedures were reviewed and approved by the McGuire VA Research Institutional Review Board(IRB#02152,approval date August 9,2015;IRB#02375,approval date May 2,2018).