Quality of Life Concepts

Secondary Health Conditions

Reciprocal Support Scale (RSS)

Description: A measure of social support (received and given). Individuals rate the frequency with which they receive four types of support: social interaction, material assistance, emotional support, and nonpaid personal assistance [1].

Format: 8 items ranked on a seven-point scale (1 = never; 7 = always) on each type of support received from families, friends, and community. As well, the frequency with which upsetting things happen between the respondents and members of their family, their friends, or their community are recorded.

Scoring: Not available.

Administration and Burden: Interviewer-administered; Self-administered. Approximately 10 – 15 minutes.

Psychometrics for SCI: Alpha coefficients from a spinal cord injury (SCI) sample ranged from .70 to .76 for the four types of support, with an average of .73. The alpha for the upsets scale was only .55; however, low internal consistency is expected given that the scale sums interactions with three groups of people (family, friends, and community).

Language(s): English.

QoL Concept: The RSS is a measure of Subjective Well-Being (Social Support), which corresponds to Boxes C (achievements) and E (subjective evaluations and reactions) of Dijker’s Model.

Permissions/Where to Obtain: Not available.


  1. Anson CA, Stanwyck DJ, Krause JS. Social support and health status in spinal cord injury. Int J Paraplegia 1993;31:632-8.


Pressure Ulcer SCI Studies: Three cross-sectional observational studies:

  1. Saladin LK, Krause JS. Pressure ulcer prevalence and barriers to treatment after spinal cord injury: Comparisons of four groups based on race-ethnicity. NeuroRehabil 2009;24:57-66;

  2. Krause JS, Coker JL, Charlifue S, Whiteneck GG. Health outcomes among American Indians with spinal cord injury. Arch Phys Med Rehabil 2000;81:924-31;

  3. Anson CA, Stanwyck DJ, Krause JS. Social support and health status in spinal cord injury. Int J Paraplegia 1993 31:632-8.

Sensitivity to Impact: Saladin and Krause (2009) and Anson and colleagues (1993) both used the Reciprocal Support Scale (RSS), and found that the perceived inability to participate in supportive relationships with the members of one’s social network may be an independent risk factor for spinal cord injury (SCI)-related secondary health conditions, including pressure ulcers. Further, they reported that persons with low levels of social support had significantly more skin sores (pressure ulcers) and days spent with sores than persons with high levels of social support. 

Conversely, Krause and colleagues (2000), who examined health outcomes of American Indians with SCI, did not detect an association between pressure sores and social support as measured by the RSS. This lack of findings may be attributable to their use of self-report data from an American Indian sample, which has unknown generalizability to other SCI populations (Krause et al. 2000). 

Suggestions for Use: The RSS appears to be an appropriate measure of social support for the SCI population, but further work is needed to establish the psychometric properties and clinical utility of this scale in relation to pressure ulcer impact.

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