FAQ: Quality of Life Index
FAQ: Quality of Life Index
Many questions have been raised about the Quality of Life Index. Some of our users met with Carol Estwing Ferrans, the author of the tool, to have the most common questions answered.
Q: When some questions don’t apply, what should you do (for example, if the client has no children)?
A: There will always be at least one question with missing data, because the two employment questions are mutually exclusive. We also anticipated that a few other questions (such as children) would not apply to everyone. The scoring program for the QLI was developed in such a way that there is no need to replace missing data for items that truly do not apply. Scores will be calculated based on the items answered for each person, and will all range from 0 to 30, even with no replacement for missing data.
Q: What does it mean that the scores are "weighted"?
A: Each matched pair of satisfaction and importance questions are combined, so that the scores tell you how satisfied the person is with the things that matter most to him. The importance to the person determines how much impact the satisfaction rating has on the final score. For example, combinations of high importance and high satisfaction produce the highest scores. Combinations of high importance and high DISsatisfaction produce the lowest scores. Things that are of little importance have a smaller impact on the score.
Q: How do I use this information clinically?
A: You can use both the scores and items for your clinical practice. To give you an idea of what scores should cause concern, you can compare them with general population data. For example, let’s say a client has the following scores:
Your Client's Scores
General Population Mean
Health and functioning
Social and economic
Scores of 19 and below usually indicate a poorer quality of life in these areas. For this client, I would think that these scores indicate he/she is experiencing a poor quality of life regarding health and functioning, indicating there are significant problems here. The two subscales of 19 for social and economic and psychological/spiritual also indicate there are problems, but not as severe. The family subscale of course indicates that this client has a high quality of life in this area. The total score indicates that this client is experiencing a relatively poor quality of life in general.
You can also compare the client’s own scores with each other over time. For example, you can compare scores when he enters your cardiac rehabilitation program and then 3 months later. Previous studies have shown that a difference of 2-3 points is a clinically meaningful difference. A difference of 2-3 points in the total score of the Quality of Life Index has been associated with significant improvement in overall quality of life, self-image, physical symptoms, and general health in studies assessing change in quality of life.
To develop a treatment plan, you can examine the individual items in the subscales indicating problems, to identify the areas that have the greatest DISsatisfaction and are also the most important to the client. These would be the primary target areas.
Q: What are considered the "norms" for a cardiac or pulmonary patient?
A: Because there are wide ranges of severity of illness in cardiac and pulmonary diseases and treatments (for example, clients who have had bypass surgery, angioplasty, valve replacement, anti-arrythmics, etc.), there are no norms for cardiac and pulmonary patients, although you can compare your client’s scores with a large number of studies that have used the Quality of Life Index. A listing of these can be found on our website at
My recommendation is to use the general population for your comparison, since the ultimate goal is to achieve a quality of life as close to normal as possible.
Q: In what period of time would you expect to see changes, for example, 6 weeks or 12 weeks?
A: There is no answer to this question that would apply across all clients. However, we do know that angioplasty patients have shown significant improvement within 6 weeks after angioplasty and 3 months after bypass surgery, using the Quality of Life Index. The key is that there needs to be enough time for the client to see the translation of the intervention into the quality of their lives.
Q: We have heard that the SF-36 is a better measure. How does the Quality of Life Index compare to the SF-36?
A: The Quality of Life Index was found to be more sensitive to change than the SF-36 in a study of arrhythmia patients. All the participants completed both instruments. They also completed another questionnaire that specifically measured changes in arrhythmias. The arrhythmia-specific questionnaire was the most sensitive in detecting changes in arrhythmia, and the Quality of Life Index was the next most sensitive. The SF-36 was the worst of the three in detecting change in these patients. For more information, there is a review article that compares the Quality of Life Index with three other measures: DeVon, H. & Ferrans, C. (2003). Psychometric properties of four quality of life instruments used in cardiovascular populations. Journal of Cardiopulmonary Rehabilitation, 23, 122-138.
Q: Where can I get more information on this tool?
A: The web site for the Quality of Life Index is at
16 Mar 2004 08:53 PM MST
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