Psychometric evaluation of stroke specific and generic quality of life instruments: A COSMIN-based systematic review

Stroke is a leading cause of long-term disability, significantly affecting physical, psychological and social well-being. Quality of life (QoL) and health-related quality of life (HRQoL) are essential outcomes reported by patients in stroke rehabilitation. This systematic review evaluated and compared psychometric properties of generic and stroke-specific instruments using the COSMIN guidelines. They were searched in PubMed, PEDro, and Cochrane Library (1992-December 2025). Eleven non-experimental studies were included. Stroke-specific tools such as SS-QOL-17 and HRQOLISP-40 demonstrated superior content validity, structural validity, and response compared to generic measures such as SF-36, WHOQOL-100, and EQ-5D. SS-QOL-17 showed excellent internal consistency, while HRQOLISP-40 demonstrated strong responsiveness to clinical change. Evidence of inter-test and replication reliability and cross-cultural validity remains limited across instruments. Stroke-specific measures appear to be more sensitive to multidimensional stroke outcomes. In addition to evaluating measurement characteristics, this review proposes a new model of psychometric maturity to classify instruments according to their degree of validation according to COSMIN standards. In addition, a screening algorithm is developed to help researchers and clinicians choose the right tools for quality of life based on study objectives, stroke stage, and domain priorities. More high-quality psychometric validation studies are needed to strengthen reliability and cultural applicability.