• The World Health Organization Quality of Life – BREF (WHOQOL-BREF) is a self-report questionnaire which assesses 4 domains of quality of life (QOL): physical health, psychological health, social relationships, and environment. In addition, there are 2 items that measure overall QOL and general health.
  • The assessment conceptually fits with the WHO definition of QOL. WHOQOL-BREF can provide data for both research and clinical purposes. Although it is a relatively brief instrument, its structure allows one to acquire specific information covering many aspects of life.
  • The WHOQOL(Bref) is short and easy to administer.
  • This scale was not developed for individuals with SCI, therefore, it is possible that there are some questions in the scale that are not relevant.
  • The WHOQOL(Bref) is grouped into 4 domains of QOL and 2 items that measure overall QOL and general health:

1.     Physical health (raw score range: 7-35)
2.     Psychological health (raw score range: 6-30)
3.     Social relationships (raw score range: 3-15)
4.     Environment (raw score range: 8-40)


Can be found here.

ICF Domain

Quality of Life


Approximately 10-15 minutes to complete the 26 items


Participants express how much they have experienced the items in the preceding 2 weeks on a 5-point Likert scale ranging from 1 (not at all) to 5 (completely).

Items scored 1-5. Raw domain score is the sum of respective item scores.

All domain scores are reported between 4 and 20 (mean scores for each multiplied by 4); for the scoring algorithm, see the User Manual (http://www.who.int/mental_health/publications/whoqol/en/index.html)

SPSS algorithm available for automatic scoring.




English, Chinese, Czech, Farsi, Indonesian, Polish, Russian and Thai.

Training Required



Can be found here.

# of studies reporting psychometric properties: 5

Reliability: Low to High

  • Moderate to High Inter-rater Reliability:
    ICC = 0.56-0.95
  • High Intra-rater Reliability:
    ICC = 0.84-0.93

(Lin, 2007; N=187, 151 male, mixed injury type, mean time since injury = 7.4 years)

(Salvador-De La Barrera et al. 2018, N=54 (44M); Mean age (SD): 45.5 (13.2); 20 CSCI, 28 TSCI, 6 LSCI)

  • Low to High Internal Consistency:
    Overall α = 0.73-0.89
    Physical Health Domain α = 0.73-0.87
    Psychological Domain α = 0.74-0.86
    Social Relationship Domain α = 0.54-0.75
    Environment Domain α = 0.65-0.86

(Lin, 2007; N=187, 151 male, mixed injury type, mean time since injury = 7.4 years)

(Salvador-De La Barrera et al. 2018, N=54 (44M); Mean age (SD): 45.5 (13.2); 20 CSCI, 28 TSCI, 6 LSCI)

(Xavier de Franca et al. 2011, N=47 (91.5% Male); Mean age (SD): 42.95 (14.12))

(Jang 2004, N=111; Mean age (SD): 40 (13); Complete tetraplegia=23, Incomplete tetraplegia=28, Complete paraplegia=43, Incomplete paraplegia=17)

(Miller et al. 2008, N=161 (77% Male); Mean age (SD): 46.88 (15.52))

Validity: Low to High

  • Moderate or higher correlation between WHOQOL- BREF subscales and the Short Form-36 (SF-36) subscales measuring similar constructs:
    r > 0.4

(Lin, 2007; N=187, 151 male, mixed injury type, mean time since injury = 7.4 years)

  • Low to High correlation between WHOQOL-BREF subscales and the Impact of Participation and Autonomy Questionnaire (IPAQ) subscales:
    r = -0.30 to -0.65

(Suttiwong et al., 2013; N=161, 77% male, mixed injury types, mean (SD) time since injury = 10.6 (7.1) years)


  • Stratified random sample by current employment status of 30 subjects, selected from those who had been employed before the SCI, were interviewed for a second time to recall their health related QoL at the time of the injury.
  • Effect Sizes:
    • Overall QOL and general health domain: 1.01
    • Physical Health Domain: 1.83
    • Psychological Health  Domain: 0.78
    • Social Relationship Domain: 1.16
    • Environment Domain: 0.78

(Lin et al. 2007)

Floor/ceiling effect

No floor or ceiling effects were reported.

Jang 2004, Lin et al. 2007


Dr. Ben Mortenson, John Zhu, Jeremy Mak, Gita Manhas

Date Last Updated

22 July 2020

Chan SC, Chan AP. The validity and applicability of the Chinese version of the Quebec User Evaluation of Satisfaction With Assistive Technology for people with spinal cord injury. Assist Technol 2006; 18: 25-33.

Chapin MH, Miller SM, Ferrin JM, Chan F, Rubin SE. Psychometric validation of a subjective well-being measure for people with spinal cord injury. Disability and Rehabilitation, 2004; 26(19):1135-1142.

Jang Y, Hsieh C-L, Wang Y-H, Wu Y-H. A validity study of the WHOQOL-BREF assessment in persons with traumatic spinal cord injury. Arch Phys Med Rehabil 2004;85:1890-5.

Lin M-R, Hwang H-F, Chen C-Y, Chiu W-T. Comparisons of the Brief Form of the World Health Organization Quality of Life and Short Form-36 for Persons with Spinal Cord Injuries. Am J Phys Med Rehabil 2007;86:104–113.s

Miller WC, Anton HA, Townson AF. Measurement properties of the CESD scale among individuals with spinal cord injury. Spinal Cord 2008; 46: 287-292.

Skevington S, Lofty M, O’Connell K. The World Health Organisation’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL Group. Qual Life Res 2004;13:299-310.

Suttiwong J, Vongsirinavarat M, Vachalathiti R, Chaiyawat P. Impact on participation and autonomy questionnaire: psychometric properties of the thai version. J Phys Ther Sci. 2013;25(7):769-74.

WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 1998;28:551-558.

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