Archives of Osteoporosis

, 14:96 | Cite as

Transcultural adaptation and psychometric properties of the Korean version of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41)

  • Young-Kyun Lee
  • Ho-Joong Kim
  • Jung Wee Park
  • Seokhyung Won
  • Ji-Sup HwangEmail author
  • Yong-Chan Ha
  • Kyung-Hoi Koo
Original Article



We translated and adapted transculturally the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) for Korean patients. The translated Korean version of QUALEFFO-41 showed satisfactory reliability and validity.


The aim of this study was to translate the QUALEFFO-41 for Korean patients and then validate the Korean version of QUALEFFO-41.


Translation and transcultural adaptation of the QUALEFFO-41 was conducted according to the international recommendations. Ninety-seven patients (mean age, 73.6 years) with osteoporosis were participated in validating the Korean version of QUALEFFO-41. To test reliability, internal consistency was evaluated using Cronbach’s alpha coefficient. To test validity, convergent validity was assessed using correlation with the SF-12 and EQ-5D and discriminant validity was assessed using ROC curve analysis.


The English version of QUALEFFO-41 was translated and adapted to Korean without notable discrepancies. The Korean QUALEFFO-41 had good reliability with Cronbach’s alpha ranging from 0.733 to 0.942. QUALEFFO-41 had good correlations to SF-12 and EQ-5D. Compared with subjects without history of vertebral fracture (VF), those with history of VF showed significantly worse scores according to QUALEFFO-41, but not according to SF-12 or EQ-5D. ROC curve analysis revealed that the physical function domain of QUALEFFO-41 had significant ability to discriminate between subjects with and without history of VF, while SF-12 or EQ-5D did not.


The Korean version of QUALEFFO-41 demonstrated relevant internal consistency, convergent validity, and discriminant validity, which can be recommended to evaluate quality of life in Koreans.


Osteoporosis Quality of life Validation QUALEFFO-41 Korean 



We appreciate SR Kim for contributing to this study.

Compliance with ethical standards

Conflict of interest



  1. 1.
    Gallagher J, Riggs B, Eisman J (1994) Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 90:646–650Google Scholar
  2. 2.
    Morales-Torres J, Gutierrez-Urena S, Rheumatology OCoP-ALoAf (2004) The burden of osteoporosis in Latin America. Osteoporos Int 15:625–632CrossRefGoogle Scholar
  3. 3.
    Lane A (1996) Direct costs of osteoporosis for New Zealand women. Pharmacoeconomics 9:231–245CrossRefGoogle Scholar
  4. 4.
    Johnell O, Kanis J (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897–902CrossRefGoogle Scholar
  5. 5.
    Johnell O, Kanis J (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733CrossRefGoogle Scholar
  6. 6.
    Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882CrossRefGoogle Scholar
  7. 7.
    Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. Jama 301:513–521CrossRefGoogle Scholar
  8. 8.
    Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:S12–S19CrossRefGoogle Scholar
  9. 9.
    Randell A, Nguyen T, Bhalerao N, Silverman S, Sambrook P, Eisman J (2000) Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 11:460–466CrossRefGoogle Scholar
  10. 10.
    Hennessy CH, Moriarty DG, Zack MM, Scherr PA, Brackbill R (1994) Measuring health-related quality of life for public health surveillance. Public Health Rep 109:665PubMedPubMedCentralGoogle Scholar
  11. 11.
    Mosteller F (1987) Implications of measures of quality of life for policy development. J Chronic Dis 40:645–650CrossRefGoogle Scholar
  12. 12.
    Ware JE Jr, Brook RH, Davies AR, Lohr KN (1981) Choosing measures of health status for individuals in general populations. Am J Public Health 71:620–625CrossRefGoogle Scholar
  13. 13.
    Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis J, Liberman U, Minne H, Reeve J (1997) Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis. Osteoporos Int 7:36–38CrossRefGoogle Scholar
  14. 14.
    Nuti R, Caffarelli C, Guglielmi G, Gennari L, Gonnelli S (2014) Undiagnosed vertebral fractures influence quality of life in postmenopausal women with reduced ultrasound parameters. Clin Orthop Relat Res 472:2254–2261CrossRefGoogle Scholar
  15. 15.
    Cooper C, Jakob F, Chinn C, Martin-Mola E, Fardellone P, Adami S, Thalassinos N, Melo-Gomes J, Torgerson D, Gibson A (2008) Fracture incidence and changes in quality of life in women with an inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO). Osteoporos Int 19:493–501CrossRefGoogle Scholar
  16. 16.
    Tosteson AN, Hammond CS (2002) Quality-of-life assessment in osteoporosis. Pharmacoeconomics 20:289–303CrossRefGoogle Scholar
  17. 17.
    Van Schoor N, Yu H, Bobula J, Lips P (2009) Cross-geographic region differences in quality of life in women with and without vertebral fracture. Osteoporos Int 20:1759–1766CrossRefGoogle Scholar
  18. 18.
    Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25:3186–3191CrossRefGoogle Scholar
  19. 19.
    Lee Y, Chung C, Koo K, Lee K, Lee D, Lee S, Park M (2011) Transcultural adaptation and testing of psychometric properties of the Korean version of the Hip Disability and Osteoarthritis Outcome Score (HOOS). Osteoarthr Cartil 19:853–857CrossRefGoogle Scholar
  20. 20.
    Lee Y-K, Chung CY, Park MS, Lee KM, Lee DJ, Lee SC, Koo K-H (2012) Transcultural adaptation and testing of psychometric properties of the Korean version of the Oxford hip score. J Orthop Sci 17:377–381CrossRefGoogle Scholar
  21. 21.
    Lee Y-K, Ha Y-C, Martin RL, Hwang D-S, Koo K-H (2015) Transcultural adaptation of the Korean version of the Hip Outcome Score. Knee Surg Sports Traumatol Arthrosc 23:3426–3431CrossRefGoogle Scholar
  22. 22.
    Tadic I, Vujasinovic Stupar N, Tasic L, Stevanovic D, Dimic A, Stamenkovic B, Stojanovic S, Milenkovic S (2012) Validation of the osteoporosis quality of life questionnaire QUALEFFO-41 for the Serbian population. Health Qual Life Outcomes 10:74CrossRefGoogle Scholar
  23. 23.
    Kim S-H, Jo M-W, Ahn J, Ock M, Shin S, Park J (2014) Assessment of psychometric properties of the Korean SF-12 v2 in the general population. BMC Public Health 14:1086CrossRefGoogle Scholar
  24. 24.
    Kim M-H, Cho Y-S, Uhm W-S, Kim S, Bae S-C (2005) Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases. Qual Life Res 14:1401–1406CrossRefGoogle Scholar
  25. 25.
    Kind P (1996) The EuroQoL instrument: an index of health- related quality of life. In: Spilker B (ed.). Quality of life and pharmacoeconomics in clinical trials 2:191–201Google Scholar
  26. 26.
    Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72CrossRefGoogle Scholar
  27. 27.
    Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334CrossRefGoogle Scholar
  28. 28.
    Xie F, Thumboo J, Lo N-N, Yeo S-J, Yang K-Y, Yeo W, Chong H-C, Fong K-Y, Li S-C (2007) Cross-cultural adaptation and validation of Singapore English and Chinese versions of the Lequesne Algofunctional Index of knee in Asians with knee osteoarthritis in Singapore. Osteoarthr Cartil 15:19–26CrossRefGoogle Scholar
  29. 29.
    McHorney CA, Tarlov AR (1995) Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res 4:293–307CrossRefGoogle Scholar
  30. 30.
    Nagammai T, Mohazmi M, Liew SM, Chinna K, Lai PSM (2015) Validation of the Malay version of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) in Malaysia. Qual Life Res 24:2031–2037CrossRefGoogle Scholar
  31. 31.
    Kocyigit H, Gülseren Ş, Erol A, Hizli N, Memis A (2003) The reliability and validity of the Turkish version of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Clin Rheumatol 22:18–23CrossRefGoogle Scholar
  32. 32.
    Azimi P, Shahzadi S, Azhari S, Montazeri A (2014) An outcome measure of functionality and quality of life in Iranian women with osteoporotic vertebral fractures: a validation study of the QUALEFFO-41. J Orthop Sci 19:860–867CrossRefGoogle Scholar
  33. 33.
    de Oliveira Ferreira N, Arthuso M, Da Silva RB, Pinto-Neto AM, Costa-Paiva L (2013) Validation of the Portuguese version of the quality of life questionnaire of the European foundation for osteoporosis (QUALEFFO-41) in Brazilian women with postmenopausal osteoporosis with vertebral fracture. Clin Rheumatol 32:1585–1592CrossRefGoogle Scholar
  34. 34.
    Rostom S, Allali F, Bahiri R, Abouqal R, Hajjaj-Hassouni N (2012) Psychometric properties evaluation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis in Arabic population. Rheumatol Int 32:2037–2049CrossRefGoogle Scholar
  35. 35.
    Pérez ER, Clark P, Wacher NH, Cardiel MH, García MPD (2008) Cultural adaptation and validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) in a Mexican population. Clin Rheumatol 27:151–161CrossRefGoogle Scholar
  36. 36.
    Cronbach L, Warrington W (1951) Time-limit tests: estimating their reliability and degree of speeding. Psychometrika 16:167–188CrossRefGoogle Scholar
  37. 37.
    Baczyk G, Opala T, Kleka P (2011) Quality of life in postmenopausal women with reduced bone mineral density: psychometric evaluation of the Polish version of QUALEFFO-41. Arch Med Sci 7:476–485CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • Young-Kyun Lee
    • 1
  • Ho-Joong Kim
    • 1
    • 2
  • Jung Wee Park
    • 1
  • Seokhyung Won
    • 1
  • Ji-Sup Hwang
    • 1
    Email author
  • Yong-Chan Ha
    • 3
  • Kyung-Hoi Koo
    • 1
    • 2
  1. 1.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSeongnamSouth Korea
  2. 2.Department of Orthopaedic SurgerySeoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of Orthopaedic SurgeryChung-Ang University College of MedicineSeoulSouth Korea

Personalised recommendations