Quality of Life for Osteoporosis (Qualeffo)

Original Editor - Marleen Moll

Top Contributors - Marleen Moll, Kim Jackson and Lauren Lopez  

Objective

The Quality of Life Questionnaire (QUALEFFO-41) is developed by the International Osteoporosis Foundation (IOF) and measures the changes in everyday functioning, wellbeing and health related quality of life in patients with vertebral fractures[1]. The questionnaire includes questions in the domains pain, physical function, social function, general health perception and mental health function[2]. The QUALEFFO-41 score decreases with increasing number of vertebral fractures[3][4].

Intended Population

Individuals with vertebral fractures as a result of osteoporosis[5].

Method of Use

The questionnaire is currently available in the following languages: English, English US, Bulgarian, Czech, Danish, Dutch, Finnish, French, German, Greek, Hungarian, Italian, Korean, Polish, Portuguese, Portuguese Brazil, Romanian, Russian, Spanish, Spanish Argentina, Spanish Chile, Spanish Mexico, Spanish US, Swedish and Thai.

The patient fills out the entire questionnaire, which measures quality of life on 5 domains (pain, activities of daily living, jobs around the house, mobility, leisure/ social activities, general health perception and mental function). The therapist then uses the scoring algorithm to a total score.

Reference

Individuals with a vertebral fracture will score lower on the questionnaire than healthy individuals of the same age and gender[5].

Evidence

Reliability

  • Internal consistency - Cronbach’s alpha (adequate) N= 159, P= patients with a vertebral fracture as a result of osteoporosis: 0.801[1] - Cronbach’s alpha N=304, P= females with degenerative changes due to osteoporosis : 0.63-0.906[6]
  • Reliability of de questionnaire in patients with osteoporosis and at least one vertebral fracture is good: - N=159, P= patients with a vertebral fracture as a result of osteoporosis: kappa 0.54-0.90 (26 out of 41 questions kappa-score >/=0.70)[1] - ICC, N=304, P=females with degenerative changes due to osteoporosis: 0.80-0.93[6] - Test-retest reliability of most QUALEFFO-items was good, N=171, P=males and females (population sample): kappa 0.59-0.91 [6]

Validity

  • Correlation validity - QUALEFFO vs. SF-36 domains, N= 171, P= males and females (population sample): r = 0.57 to r = 0.87[6] - QUALEFFO vs. GHQ-20, N= 89, P= females: r = 0.49[7]
  • Construct validity - The QUALEFFO has a good correlation with the SF-36[1].
  • Discriminant validity - The QUALEFFO can distinguish between patients with a vertebral fracture and control group (x-ray vs. QUALEFFO, N=159, P=patients with a vertebral fracture: 78% had a fracture (>/=3 SD), in comparison to 7% from the control group[1] - The score on the QUALEFFO was 49.8 +/- 19.2 in patients with osteopenia and significantly higher with patients with osteoporosis without vertebral fracture (avg. 58.1 +/- 13.3; p <0.05). In patients with osteoporosis with a previous vertebral fracture, the average score was also significantly higher (63.8 +/- 13.6 (p < 0.05))[8].

Responsiveness

  • QUALEFFO-scores increase progressively if the individual has one or more vertebral fractures (especially lumbal): (p < 0.001)
  • Patients with a vertebral fracture have a significant score change on the QUALEFFO: (p < 0.05)
  • QUALEFFO-scores change in relation to the number of fractures a patient has[9]
  • QUALEFFO-41: Effect size (ES) = 2.56, standardised response mean (SRM) = 4.32 and Guyatt value = 2.31[10]

Links

References

  1. 1.0 1.1 1.2 1.3 1.4 Lips P, Cooper C, Agnusdei F, Caulin F, Egger P, Johnell O, Kanis JA, Liberman U, Minne H, Reeve J, Reginster Y, Vernejoul MC, Wiklund I. Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis. Osteoporos Int. 1997;7:36-38.
  2. Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis JA, Kellingray S, Leplege A, Liberman UA, McCloskey E, Minne H, Reeve J, Reginster JY, Scholz M, Todd C, de Vernejoul MC, Wiklund I: Quality of life in patients with vertebral fractures: Validation of the quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Osteoporos Int 1999, 10(2):150–60. 10.1007/s001980050210
  3. Cooper C, Harvey N, Dennison E: Worldwide epidemiology of osteoporotic fractures. In Innovation in skeletal medicine. Edited by Reginster. J Rizzoli R Elsevier 2008, 95: 112.
  4. Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J: Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 2000, 15(7):1384–1392. 10.1359/jbmr.2000.15.7.1384
  5. 5.0 5.1 Smits- Engelsman BCM, Bekkering GE, Hendriks HJM. KNGF-richtlijn Osteoporose. Nederlands Tijdschrift voor Fysiotherapie. 2005;115(1):suppl.
  6. 6.0 6.1 6.2 6.3 Badia X, Díez-Pérez A, Alvarez-Sanz C, Díaz-López B, Diaz-Curiel M, Guillén F, GonzálezMacias J; Spanish GRECO Study Group. Measuring quality of life in women with vertebral fractures due to osteoporosis: a comparison of the OQLQ and QUALEFFO. Quality of Life Research. 2001;10(4):307-317.
  7. Bergland A, Thorsen H, Kåresen R. Association between generic and disease-specific quality of life questionnaires and mobility and balance among women with osteoporosis and vertebral fractures. Aging Clin Exp Res. 2011 Aug;23(4):296-303.
  8. Jahelka B, Dorner T, Terkula R, Quittan M, Bröll H, Erlacher L. Health-related quality of life in patients with osteopenia or osteoporosis with and without fractures in a geriatric rehabilitation department. Wien Med Wochenschr. 2009 May;159(9-10):235-240.
  9. Oleksik A, Lips PMD. Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. Journal of Bone and Mineral Research. 2000 Jul;15(7):1384–1392.
  10. Yilmaz F, Doğu B, Sahin F, Sirzai H1, Kuran B. Investigation of responsiveness indices of generic and specific measures of health related quality of life in patients with osteoporosis. J Back Musculoskelet Rehabil. 2014;27(4):391-7.