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== Evidence == === Reliability === * Internal consistency - Cronbach’s alpha (adequate) N= 159, P= patients with a vertebral fracture as a result of osteoporosis: 0.801<ref name=":0" /> - Cronbach’s alpha N=304, P= females with degenerative changes due to osteoporosis : 0.63-0.906<ref name=":2">Badia X, Díez-Pérez A, Alvarez-Sanz C, Díaz-López B, Diaz-Curiel M, Guillén F, GonzálezMacias J; Spanish GRECO Study Group. Measuring quality of life in women with vertebral fractures due to osteoporosis: a comparison of the OQLQ and QUALEFFO. Quality of Life Research. 2001;10(4):307-317.</ref> * Reliability of de questionnaire in patients with osteoporosis and at least one vertebral fracture is good: - N=159, P= patients with a vertebral fracture as a result of osteoporosis: kappa 0.54-0.90 (26 out of 41 questions kappa-score >/=0.70)<ref name=":0" /> - ICC, N=304, P=females with degenerative changes due to osteoporosis: 0.80-0.93<ref name=":2" /> - Test-retest reliability of most QUALEFFO-items was good, N=171, P=males and females (population sample): kappa 0.59-0.91 <ref name=":2" /> === Validity === * Correlation validity - QUALEFFO vs. SF-36 domains, N= 171, P= males and females (population sample): r = 0.57 to r = 0.87<ref name=":2" /> - QUALEFFO vs. GHQ-20, N= 89, P= females: r = 0.49<ref>Bergland A, Thorsen H, Kåresen R. Association between generic and disease-specific quality of life questionnaires and mobility and balance among women with osteoporosis and vertebral fractures. Aging Clin Exp Res. 2011 Aug;23(4):296-303.</ref> * Construct validity - The QUALEFFO has a good correlation with the SF-36<ref name=":0" />. * Discriminant validity - The QUALEFFO can distinguish between patients with a vertebral fracture and control group (x-ray vs. QUALEFFO, N=159, P=patients with a vertebral fracture: 78% had a fracture (>/=3 SD), in comparison to 7% from the control group<ref name=":0" /> - The score on the QUALEFFO was 49.8 +/- 19.2 in patients with osteopenia and significantly higher with patients with osteoporosis without vertebral fracture (avg. 58.1 +/- 13.3; p <0.05). In patients with osteoporosis with a previous vertebral fracture, the average score was also significantly higher (63.8 +/- 13.6 (p < 0.05))<ref>Jahelka B, Dorner T, Terkula R, Quittan M, Bröll H, Erlacher L. Health-related quality of life in patients with osteopenia or osteoporosis with and without fractures in a geriatric rehabilitation department. Wien Med Wochenschr. 2009 May;159(9-10):235-240.</ref>. === Responsiveness === * QUALEFFO-scores increase progressively if the individual has one or more vertebral fractures (especially lumbal): (p < 0.001) * Patients with a vertebral fracture have a significant score change on the QUALEFFO: (p < 0.05) * QUALEFFO-scores change in relation to the number of fractures a patient has<ref>Oleksik A, Lips PMD. Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. Journal of Bone and Mineral Research. 2000 Jul;15(7):1384–1392.</ref> * QUALEFFO-41: Effect size (ES) = 2.56, standardised response mean (SRM) = 4.32 and Guyatt value = 2.31<ref>Yilmaz F, Doğu B, Sahin F, Sirzai H1, Kuran B. Investigation of responsiveness indices of generic and specific measures of health related quality of life in patients with osteoporosis. J Back Musculoskelet Rehabil. 2014;27(4):391-7.</ref> <span style="font-size: 20px; font-weight: normal;" class="Apple-style-span"></span>

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