Development of a trauma-specific quality-of-life measurement

Abstract

BACKGROUND: Complex, disease-specific factors help to determine posttraumatic quality of life (QoL), but current practice uses outcome measures generated from the general population. Trauma survivorship has grown rapidly, while defining the factors that influence posttraumatic QoL has lagged. This study sought to develop a valid and reliable trauma-specific QoL measure to help guide future posttraumatic research and clinical care. METHODS: Qualitative data were collected from adult trauma patients and their caregivers (Phase 1). Subsequent analysis of these data resulted in the development of a 59-item QoL questionnaire. The 59-item trauma-specific QoL (T-QoL) questionnaire was then administered to adult trauma patients (n = 394), and a factor analysis was conducted. The validity of the final T-QoL measurement tool was assessed (n = 111) using the Medical Outcomes Study 36-Item Short Form Health Survey version 2 (SF-36v2) and the PTSD Checklist-Civilian Version (PCL-C) (Phase 2). RESULTS: A five-component structure using 43 items seemed to best represent the data. The five components included emotional well-being, functional engagement, recovery/resilience, peritraumatic experience, and physical well-being. Four of the five components were found to have strong Cronbach's α scores (>0.7), demonstrating consistent interitem reliability. All subscales of the T-QoL correlated negatively with the PCL-C (p < 0.01), demonstrating that as the T-QoL increases, the likelihood of PTSD decreases. The physical well-being subscale of the T-QoL correlated significantly with the SF-36v2 physical component score, as did the emotional well-being subscale with the SF-36v2 mental component score (p < 0.05). CONCLUSION: This study used the experiences of trauma victims and their informal caregivers to develop a five-component, 43-item questionnaire with domains that are unique to trauma populations. Its accuracy and validity were confirmed using the PCL-C and the SF-36v2. We believe that the T-QoL represents a novel tool that can be used by trauma professionals to positively impact research efforts and clinical care. LEVEL OF EVIDENCE: Prognostic study, level II.