WHOQOL-BREF

The WHOQOL group defines the quality of life as a person’s perception of their position in life, in the context of the culture and value system in which they live, and in relation to their goals, expectations, standards, and concerns. For them, quality of life is thus subject to subjective assessment, embedded in a cultural, social, and environmental context. The WHOQOL-100 and WHOQOL-BREF were developed on this basis.²

The WHOQOL-BREF is a Patient-Reported Outcome (PRO) instrument that can assess the global health status of patients independently of disease across 4 health domains with 24 different domain aspects. Overall, it includes the 26 most important of its predecessor’s 100 questions, representing a considerable and necessary reduction.² The patient’s recall period covers the past 2 weeks. The WHOQOL-BREF is one of the best-known instruments that has been developed for cross-cultural comparisons of quality of life and is available in more than 40 languages.^{3 – 6}

Each dimension of the KOOS Score is calculated and evaluated independently and so a total of 5 different scores to evaluate the respective dimensions. The basic requirement for the evaluation of the KOOS is dimension is answered to at least 50%. This includes at least 5 questions under pain, 4 questions under symptoms, 9 questions under activities of daily living (ADL), 3 questions under sports and leisure (SPORT/REC), and 2 questions under quality of life (QoL).

First, one assigns the answer choices their pre-defined point values:

Then the calculation is made using the following formulas:

The possible score ranges in each case from 0 to 100 points. 100 points indicate no restrictions at all due to the affected knee, while 0 points indicate extreme problems/limitations.³

The WHOQOL-BREF is a validated and established questionnaire that, with a length of 26 questions, is an acceptable length for use in clinical trials and patient care. Despite its significant reduction in questions, compared to the WHOQOL-100, it could still show strong validity and good to excellent psychometric properties.^{2, 8 – 19} Its great relevance is expressed in its use in numerous studies to assess the health status of the respective patients.²⁰

Furthermore, it is a special feature that the WHOQOL-BREF includes an environmental domain that takes a closer look at the patient’s life circumstances, unlike other established PRO instruments such as the SF-36, EQ-5D-5L, or WHODAS 2.0.

In a large-scale validation study with over 11,000 patients, it was shown in some centers that there were individual items or questions that did not fit their domain clearly enough. For example, the physical safety item from the environment domain and the energy item from the physical health domain had a stronger correlation to the psychological health domain than to their domain of origin.⁸

The use and evaluation of the WHOQOL-BREF require licensing, although this does not come at a cost. The WHO requires the signing of a user agreement, in which further details about its intended use must be provided.

The signed document can be emailed to [email protected] and the desired questionnaire will be sent to you.¹ Our PRO consultants happily provide more in-detail information.

All in all, the WHOQOL-BREF is a valid, established, and meaningful PRO instrument for assessing the global health status of patients regardless of their disease. Its implementation is more feasible than in its original form due to its length of 26 questions, but it is not as short as many other short forms of questionnaires, such as the SF-12.

In principle, however, its length is acceptable for research and patient care. Last but not least, the constructional weaknesses in individual items do not impair its overall validity.