Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39)
A 39-item quality-of-life scale developed specifically for people with aphasia.
By Claire White
- Usually completed with an interviewer; adapted from the SS-QOL for use in aphasia.
- 39 items across 4 domains: physical, psychosocial, communication, and energy.
- Items rated 1 to 5, averaged, where higher means better quality of life.
Psychometrics
Ranges across the four domains, from Hilari et al. (2003), 95 people with long-term aphasia. The bar shows the weakest domain in each range. Higher is better.
What does the SAQOL-39 measure?
The SAQOL-39 was adapted from the Stroke-Specific Quality of Life scale (SS-QOL) to make it accessible to people with aphasia, through simplified language, a test book the person can read and hear at the same time, and interviewer support. The point of that work was to let people with aphasia report their own quality of life rather than have a relative report it for them.
The SS-QOL had twelve subdomains. Factor analysis on responses from people with aphasia did not reproduce them, and instead yielded 39 items in four domains.
What does a SAQOL-39 score mean?
Each item is rated 1 to 5. Items are averaged within a domain to give four domain scores, and averaged overall to give an overall score, so every score sits between 1 and 5 and higher is better.
| Domain | What it covers |
|---|---|
| Physical | Self-care, mobility, upper limb function, and work or productivity |
| Psychosocial | Mood, personality, thinking, vision, and family and social roles |
| Communication | Language, meaning speaking, understanding, reading, and writing |
| Energy | Fatigue and the energy available to get through the day |
There are no published cut-offs and no severity bands, so a single score means little on its own. It is read against the same person’s earlier scores, or against a group average in a study. Scores are not diagnostic. They reflect the person’s lived experience of aphasia, which is a different measurement from how impaired their language is on a test.
How the SAQOL-39 is administered
- Administered by
- Researchers or clinicians experienced with people who have had a stroke
- Format
- Usually interviewer-administered, with the questions shown in a test book. A self-completion form is available.
- Cost
- Free to take here.
- Published by
- City, University of London
- Age range
- Adults
- Available languages
- More than 38 translations, with varying evidence of validity
Which conditions is the SAQOL-39 used for?
Related instruments
- Communicative Effectiveness Index (CETI)The same everyday view of communication, rated by a family member instead
- Western Aphasia Battery (WAB-R)What language testing shows, as against what daily life feels like
- EQ-5DGeneric health-related quality of life, not specific to stroke or aphasia
- EORTC QLQ-C30The same domain-score design, built for cancer rather than stroke
SAQOL-39 questions, answered
How is the SAQOL-39 scored?
Each of the 39 items is rated 1 to 5, where 1 is the most trouble and 5 is none. Item scores are averaged within each domain to give four domain scores, and averaged overall to give an overall score. Every score therefore sits between 1 and 5, and higher is better.
What is a good SAQOL-39 score?
There is no published cut-off and no severity band, because quality of life is not a thing the scale is trying to detect the presence of. The number is most useful compared against the same person's earlier score, or against a group average in a study. A single score in isolation says less than a change in that score over time.
Who fills in the SAQOL-39?
The person who had the stroke, which is the point of it. The scale was built so that people with aphasia could answer for themselves rather than have a relative answer for them. An interviewer usually supports that, showing the questions in a test book and recording the answers. In the original study, 87 percent of people with long-term aphasia could complete it by self-report.
What is the difference between the SAQOL-39 and the SAQOL-39g?
Same 39 items, different scoring structure. The SAQOL-39 groups them into four domains and was validated in people with aphasia. The SAQOL-39g groups the same items into three domains, dropping the separate energy domain, and was validated in a general stroke population so that it can be used whether or not the person has aphasia.
Is the SAQOL-39 free?
Yes. It is free to take here. The scale, the administration guides, and the scoring forms are published by City, University of London.
Does the SAQOL-39 measure how severe my aphasia is?
No. It measures the impact on your life, which is a different question and often a different answer. Two people with the same score on a language battery can report very different quality of life. It is reference information, not a diagnosis.
Evidence, psychometrics and provenance
Developed by Katerina Hilari and colleagues at City, University of London, and published in 2003. A later paper regrouped the same 39 items into three domains as the SAQOL-39g, for use in stroke populations whether or not the person has aphasia.
- Acceptability
- 83 of 95 people with long-term aphasia (87%) could complete it by self-report
- Convergent validity
- r 0.55 to 0.67 against related measures (Hilari et al., 2003)
- Discriminant validity
- r 0.02 to 0.27 against unrelated measures (Hilari et al., 2003)
References
- 1.Hilari K, Byng S, Lamping DL, Smith SC. Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39): evaluation of acceptability, reliability, and validity. Stroke. 2003;34(8):1944-1950.
- 2.Hilari K, Lamping DL, Smith SC, Northcott S, Lamb A, Marshall J. Psychometric properties of the Stroke and Aphasia Quality of Life Scale (SAQOL-39) in a generic stroke population. Clin Rehabil. 2009;23(6):544-557.
- 3.SAQOL-39g: manual, forms and translations. City Access, City, University of London. Source of the administration format, cost, and language list.
This assessment uses a validated instrument and is reference information, not a diagnosis.