Measurement properties of assessment instruments of quality of life in people with spinal cord injury: A systematic review

A spinal cord injury or disease (SCI/D) is a devastating condition that affects all areas of a person’s life, including quality of life (QoL). Assessing this construct using clinical instruments with adequate measurement properties is fundamental for an effective multi-professional treatment. To identify the clinical instruments for assessing the QoL that present the best recommendation for use in people with SCI based on their measurement properties. The overall methodology was conducted according to Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic review guidance and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A literature search was conducted up to March 2023 on MEDLINE/PubMed, Web of Science, Scopus, CINAHL, and Embase databases. Seventy-seven studies were included in this review, and 49 instruments were identified. The overall methodological quality of all studies ranged from insufficient to sufficient, and the level of evidence ranged from very low to high confidence. Twenty-six instruments may have the potential to be recommended, and the other 23 should not be recommended. None of the QoL instruments can be highly recommended as the most suitable instrument for the construct and population of interest. The generic instruments SF-36, SF-12, QWB, WHOQOL-DIS, WHOQOL-BREF, QLI-SCI, QOLP-PD, LS Questions, Lisat-9, and BRFSS are the clinical instruments that have the best measurement properties tested and have the potential to be the current best recommendation for assessing QoL in individuals with SCI.

脊髓损伤或疾病（SCI/D）是一种破坏性极强的病症，会对患者生活的方方面面造成影响，其中包括生活质量（QoL）。采用具备合格测量学属性的临床测评工具对该构念进行评估，是开展高效多学科治疗的核心基础。本研究旨在基于测量学属性，筛选出适用于脊髓损伤患者、具备最优推荐价值的生活质量临床测评工具。本研究的整体方法学流程严格遵循健康测评工具遴选共识标准（COSMIN）系统评价指南开展，并按照《系统评价与元分析首选报告条目》（PRISMA）规范进行报告。研究于2023年3月前在MEDLINE/PubMed、Web of Science、Scopus、CINAHL及Embase数据库中开展文献检索。本次系统评价共纳入77项相关研究，筛选出49种测评工具。所有纳入研究的整体方法学质量介于不足至充足之间，证据等级则从极低可信度跨度至高可信度。其中26种测评工具具备推荐潜力，剩余23种则不具备推荐价值。目前尚无任何一款生活质量测评工具可被高度推荐为适配该研究构念与目标人群的最优工具。通用型测评工具SF-36、SF-12、QWB、WHOQOL-DIS、WHOQOL-BREF、QLI-SCI、QOLP-PD、LS Questions、Lisat-9及BRFSS是经过最优测量学属性验证的临床工具，具备成为当前脊髓损伤患者生活质量评估最优推荐工具的潜力。