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Development and Validation of NEWSQOL®, the Newcastle Stroke-Specific Quality of Life Measure

Buck D.a · Jacoby A.a · Massey A.b · Steen N.c · Sharma A.d · Ford G.A.b
aDepartment of Primary Care, University of Liverpool, Liverpool, bFreeman Hospital Stroke Service, cCentre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, and dDepartment for Care of the Elderly, Aintree Hospital, Liverpool, UK Cerebrovasc Dis 2004;17:143–152 (DOI:10.1159/000075783)

Abstract

Background: A review of stroke-specific quality of life (QOL) measures indicated little evidence of their validity/reliability. Purpose: To describe the development/validation of a new measure – the Newcastle Stroke-Specific Quality of Life Measure (NEWSQOL). Methods: Phase I: qualitative interviews (28 stroke patients) determined QOL issues for inclusion in the measure. Initial items/response categories were pre-tested (30 patients). Administration of the NEWSQOL in the item reduction stage (100 patients) identified poorly performing items and factor analysis showed likely domains. Internal consistency was examined. Phase II: NEWSQOL and comparator measures were administered (106 patients) to examine validity/test-retest reliability. Results: Phase I: 140 items were identified for initial inclusion. Qualitative pre-testing led to an extensive revision. Item reduction resulted in a final measure of 56 items in 11 domains (feelings, activities of daily living/self-care, cognition, mobility, emotion, sleep, interpersonal relationships, communication, pain/sensation, vision, fatigue; Cronbach’s α = 0.71–0.90). Phase II: NEWSQOL domain scores, except cognition, were moderately/highly correlated (0.45–0.76) with relevant comparator measures. NEWSQOL domains feelings, communication and cognition low/moderately correlated with Barthel Index scores (–0.49 to –0.28), as predicted. Test-retest reliability was high (intraclass correlation coefficient range 0.78–0.92). Conclusions: NEWSQOL is an acceptable, patient-derived, interviewer-administered, stroke-specific QOL measure with evidence of reliability and validity, making it a promising instrument for assessing QOL after stroke. Involvement of relevant patients in determining the content and format considerably enhances confidence in its validity.

 

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