Quality of Life Concepts

Secondary Health Conditions

Satisfaction with Life Scale (SWLS)

Description: The SWLS is a global measure of life satisfaction [1]. Life satisfaction is one of three factors in the more general construct of subjective well-being (the others being positive and negative affective appraisal), but is thought to be more cognitive than emotionally driven.

Format: 5 items rated on a scale from 1 (strongly disagree) to 7 (strongly agree).

Scoring: The SWLS yields a global score by summing the scores of each question.  Scores may range from 5 to 35, with higher scores corresponding to greater life satisfaction.

Administration and Burden: Interviewer-administered; Self-administered. Approximately 5 minutes.

Psychometrics for SCI: The SWLS has favourable reliability and is associated with other measures of subjective well-being, including the General Health Questionnaire and the Symptom Checklist-90-R, as well as health attitudes, providing evidence for construct validity. Internal reliability is typically between .80 and .89, and test-retest reliability ranges from .83 (for a 2-week interval) to .54 (for a 4-year interval). Scores do not appear to be affected by sex, age, educational level, health insurance status, or social desirability, but are affected by marital status [2].

Languages: It is available in multiple languages.

QoL Concept: The SWLS is a global measure of Subjective Well-Being (Life Satisfaction), which corresponds to Box E (subjective evaluations and reactions; life satisfaction) of Dijker’s Model.

Permissions/Where to Obtain: Public Domain; The SWLS can be obtained at the Centre for Outcome Measurement in Brain Injury at:http://www.tbims.org/combi/swls/.


  1. Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess 1985;49:71-5.

  2. Dijkers MPJM. Correlates of Life Satisfaction among Persons with Spinal Cord Injury. Arch Phys Med Rehabil 1999;80:867-76.


Pain SCI Studies: Five cross-sectional surveys, one randomized, double blind, placebo-controlled trial, one pre-post intervention study.

  1. Tonack M, Hitzig SL, Craven BC, Campbell KA, Boschen KA, McGillivray CF. Predicting life satisfaction after spinal cord injury in a Canadian sample. Spinal Cord 2008; 46:380-5.

  2. Putzke JD, Richards JS, Dowler RN. The impact of pain in spinal cord injury: A case-control study. Rehabil Psychol 2000;45:386-401.

  3. Putzke JD, Richards, JS, Hicken BL, DeVivo MJ. Interference due to pain following spinal cord injury: important predictors and impact on quality of life. Pain 2002;100:231-42.

  4. Cardenas DD, Warms CA, Turner JA, Marshall H, Brooke MM, Loeser JD. Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial. Pain 2002;96:365-73.

  5. Wardell DW, Rintala DH, Duan Z, Tan G. A pilot study of healing touch and progressive relaxation for chronic neuropathic pain in persons with spinal cord injury. J Holist Nurs 2006;24:231-40.

  6. Widerstrom-Noga EG, Felix ER, Cruz-Almeida Y, Turk DC. Psychosocial subgroups in persons with spinal cord injuries and chronic pain. Arch Phys Med Rehabil 2007;88:1628-35.

  7. Widerstrom-Noga EG, Cruz-Almeida Y, Martinez-Arizala A, Turk DC. Internal consistency, stability, and validity of the spinal cord injury version of the multidimensional pain inventory. Arch Phys Med Rehabil 2006; 87:516-23.

Sensitivity to Impact: Tonack and colleagues (2008) used the Reintegration to Normal Living (RNL) along with the Satisfaction with Life Scale (SWLS) and a non-standardized study-specific questionnaire to examine the effects of chronic pain on life satisfaction and community participation in persons with spinal cord injury (SCI; N = 781). Results showed that persons with chronic pain had lower scores on the RNL and SWLS than persons without chronic pain.

Putzke and colleagues (2000) examined the impact of pain on functioning across multiple QoL domains among males with SCI (N = 172; n = 86 with no pain interference, and n= 86 with extreme pain interference) using the Craig Handicap and Assessment Reporting Technique (CHART), the SWLS, and the Short-Form 12 (SF-12). No group differences were found on the CHART physical independence and occupation sub-scales. Compared to the no pain interference group, the extreme pain interference group had significantly lower scores on the SWLS, the CHART total score, and the SF-12 physical health summary and mental summary scores.

Putzke and colleagues (2002) conducted two studies on the predictive validity of multiple demographic, medical, and QoL variables, including the CHART, the SWLS, and the SF-12. The first study examined the predictive validity of these variables at 1 year post-SCI to self-reported interference 2 years post-injury. The prevalence of interference in daily activities secondary to pain decreased from year 1 to year 2. Higher satisfaction with life, physical health, and mental health at year 1 were associated with lower likelihood of pain interference at year 2.

The second study examined the predictive validity of the same variables in four groups of participants: (1) pain-free at years 1 and 2; (2) pain-free at year 1 and in pain at year 2; (3) in pain at year 1 and pain-free at year 2; (4) in pain at years 1 and 2. Groups 1 and 4 had similar levels of self-reported QoL, whereas groups 2 and 3 showed considerable difference in self-reported QoL across several domains. Higher scores on the mobility and social integration scales of the CHART were associated with lower levels of self-reported pain interference.

A study by Cardenas and colleagues (2002) determined whether amitriptyline was efficacious in relieving chronic pain and improving pain-related physical and psychosocial function in persons with SCI (N = 84). Their battery of tests included the Brief Pain Inventory (BPI), the SWLS, and the CHART. Patients were assigned to either amitriptyline treatment or an active placebo. Regression analyses showed that pre-treatment scores explained a large and significant portion of variance of the post-treatment scores, and treatment group did not make a significant contribution.

Wardell and colleagues (2006) used the BPI to assess the role of Healing Touch (HT) in modulating chronic neuropathic pain in males with SCI (N= 12). Participants were assigned either to an HT group or a guided progressive relaxation group. There was a significant difference in the composite of interference scale of the BPI, with the HT group reporting less interference. Life satisfaction increased in the HT group, but not in the control group.

Widerstrom-Noga and colleagues (2007) used the Multidimensional Pain Inventory - SCI Version (MPI-SCI), the Pain Disability Index (PDI), the International Support Evaluation List (ISEL) and the SWLS to define adaptational subgroups in people with chronic pain and SCI (N = 89), and to compare these sub-groups with respect to demographic factors, level of injury, functional independence, pain disability, depressed mood, social support, and life satisfaction. Cluster analysis identified three subgroups of SCI chronic pain: (1) dysfunctional copers, characterized by greater pain severity, life interference, and affective distress scores, and lower levels of life control and activities scores, (2) interpersonally supported copers, characterized by moderately high pain severity, and higher life control, support from significant others, and activities scores, and (3) adaptive copers, characterized by lower pain severity, life interference, affective distress, support from significant others, activities, and higher life control scores.

Widerstrom-Noga and colleagues (2006) used the MPI-SCI, the PDI, the ISEL, and the SWLS to evaluate the internal consistency, stability, and construct validity of an SCI version of the MPI in persons with SCI (N = 161). Convergent validity was demonstrated through a strong correlation between the life interference subscale of the MPI-SCI and scores on the PDI. The MPI-SCI showed good convergent, discriminative, and concurrent reliability.

Suggestions for Use: The SWLS is a reliable and valid measure for the SCI population [1], and appears sensitive to the impact of pain. However, there are some noted limitations with the SWLS.  For instance, one item asks whether individuals would make changes in their life, which has been criticized as being irrelevant for this population [2]. In addition, it only yields a total score, so there is no differentiation between people who are more or less satisfied in each domain [3].

Despite these limitations, the SWLS is part of the data set collected by the National Spinal Cord Injury Statistical Centre (NSCISC) Database, and has been endorsed by the Spinal Cord Outcomes Partnership Endeavor (SCOPE) [4], which is a broad-based international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations. However, the endorsement has not been specific to assess the impact of bowel dysfunction.

Additional References:

  1. Dijkers MPJM. Correlates of Life Satisfaction among Persons with Spinal Cord Injury. Arch Phys Med Rehabil 1999;80:867-76.

  2. Tulsky DS, Rosenthal M. Quality of life measurement in rehabilitation medicine: Building an agenda for the future. Arch Phys Med Rehabil 2002;83:S1-S3.

  3. Post M, Noreau L. Quality of life after spinal cord injury. J Neurol Phys Ther 2005;29:139-46.

  4. Alexander MS, et al. Outcome measures in spinal cord injury: Recent assessments and recommendations for future directions. Spinal Cord 2009:1-10.

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