Measures of Health Related Quality of Life (HRQOL) are increasingly used in multi-site clinical trials to determine the impact of medical interventions on health. Because patients’ perceptions of QOL, of their physical and psychological health can vary cross-culturally, there is a need for measures that can be used reliably across populations. The aim of this study is to examine differences in patients’ perceptions of their health and QOL across 4 countries: Australia, Brazil, Netherlands and USA (two sites: Colorado and Michigan).

Outpatients with spinal cord injury and disease were administered the Spinal Cord Injury Quality of Life Basic Dataset, which includes 3 items related to health and QOL. Cognitive interviews were conducted to test for differences in patients’ responses to these items and their overall perception of QOL. Interviews were transcribed and coded by two independent reviewers. Themes were compared to ensure data uniformity.

Participants were 60% males with mean age of 52; average time since onset was 16.5 years; 56% with paraplegia; 37%, tetraplegia. While English-speaking patients described QOL as their ability to enjoy life in general, non-English speakers related QOL to specific situations and barriers to health and environment. Differences were observed in ratings of physical health. Patients in Melbourne, Australia and Colorado, USA rated theirs significantly lower than others (P<.005). Regional differences were found between the two USA sites. Colorado participants rated their physical health significantly lower than their Michigan counterparts.

Regional and country variations were noted in patients’ ratings of physical health and QOL definitions. These suggest the need for guidelines to adapt HRQOL measures to specific contexts in which they will be used. Cognitive interviews are useful in examining the equivalence of such measures. This is a critical step towards the development of a common measure of HRQOL for the use in international studies.