Resilience Scale (RS)

1. Abstract

The Resilience Scale (RS), originally developed by Dr. Gail M. Wagnild and Dr. Heather M. Young in 1993, is one of the most widely utilized and rigorously validated psychometric instruments designed to quantify psychological resilience in adults and adolescents across diverse clinical, occupational, and community populations. Conceived through an extensive qualitative investigation of older women who had successfully navigated major life adversities, the Resilience Scale operationalizes psychological resilience as a positive personality trait and dynamic capacity that facilitates adaptive coping, psychological well-being, and positive behavioral adaptation in the face of acute stress, chronic adversity, and traumatic disruption. The instrument comprises 25 self-report items measured along a 7-point Likert response scale ranging from 1 (Strongly Disagree) to 7 (Strongly Agree), yielding a theoretical cumulative score between 25 and 175. Psychometric evaluations substantiate a robust two-factor higher-order structure representing Personal Competence (17 items capturing self-reliance, determination, mastery, resourcefulness, and perseverance) and Acceptance of Self and Life (8 items capturing equanimity, cognitive flexibility, adaptability, and balanced perspective), while reflecting five foundational theoretical characteristics: purposeful life (meaning), perseverance, equanimity, self-reliance, and existential aloneness. Across decades of empirical replication across multiple linguistic, cultural, and socio-demographic contexts, the RS demonstrates outstanding internal consistency (Cronbach’s α typically spanning .85 to .94; test-retest reliability intraclass coefficients ranging from .67 to .84), exceptional construct and criterion validity, and strong inverse correlations with depressive symptoms, perceived stress, anxiety, and perceived health vulnerability. Additionally, the instrument serves as the theoretical and empirical parent measure for the widely used 14-item short form (RS-14). This comprehensive article provides an exhaustive examination of the RS’s theoretical architecture, latent factor structure, psychometric parameters, administrative guidelines, and clinical and empirical utility.

2. Keywords

Resilience Scale, RS, Gail M. Wagnild, Heather M. Young, psychological resilience, Personal Competence, Acceptance of Self and Life, positive psychology, psychometrics, stress adaptation, coping mechanisms, adult resilience

3. Authors

The Resilience Scale was co-authored by:

• Gail M. Wagnild, PhD, RN: Formerly affiliated with the College of Nursing at Montana State University and the University of Washington School of Nursing. Dr. Wagnild is the Founder and Director of The Resilience Center (Worden, MT, USA), an independent research and educational institute dedicated to the investigation, clinical assessment, and development of resilience interventions across the lifespan.
• Heather M. Young, PhD, RN, FAAN: Professor and Dean Emerita at the Betty Irene Moore School of Nursing at the University of California, Davis (UC Davis Health, Sacramento, CA, USA). Dr. Young is a nationally renowned scholar in healthy aging, gerontological nursing, and long-term care systems.

Correspondence regarding commercial licensing, permissions, translated adaptations, and scoring materials is maintained through The Resilience Center (https://www.resiliencecenter.com).

4. Purpose

The fundamental purpose of the Resilience Scale (RS) is to assess an individual’s internal capacity to withstand, adapt to, and rebound from significant psychological stress, systemic adversity, physical illness, and traumatic life events. Prior to the development of the RS in the early 1990s, existing psychometric inventories often conceptualized adaptation primarily through the negative lens of psychopathology, vulnerability, and symptom manifestation—such as assessing depression, neuroticism, or post-traumatic stress symptomatology—or focused narrowly on pediatric cohorts surviving socioeconomic deprivation or severe familial dysfunction (as seen in early developmental psychology literature by Norman Garmezy, Emmy Werner, and Michael Rutter). Wagnild and Young recognized a vital diagnostic and empirical void: the absence of a standardized, general-population self-report instrument that directly evaluated salutogenic attributes and positive psychological resilience in adult populations.

The primary clinical and diagnostic aims of the Resilience Scale encompass several domains:

• Salutogenic Screening and Stratification: In clinical settings—including oncology, cardiology, chronic pain rehabilitation, and psychiatric outpatient care—the RS serves to identify baseline psychological coping reserves. Identifying patients with critically low resilience scores allows multidisciplinary teams to implement targeted, preemptive psychological interventions (such as cognitive-behavioral therapy, mindfulness-based stress reduction, or acceptance and commitment therapy) before acute physical stressors precipitate depressive decompensation or medical non-adherence.
• Therapeutic Outcome Tracking: The RS functions as an objective metric of longitudinal therapeutic progress. By measuring changes in resilience scores before, during, and following psychotherapeutic or behavioral health interventions, clinicians can assess whether patients are developing self-reliance, meaning-making capacities, and adaptive equanimity, rather than merely evaluating symptom reduction.
• Occupational and High-Stress Environments: Military organizations, emergency medical services, law enforcement agencies, and healthcare institutions utilize the RS to quantify psychological stamina, assess vulnerability to compassion fatigue and burnout, and evaluate the efficacy of organizational resilience training initiatives.
• Gerontological and Public Health Research: The scale enables gerontologists and epidemiologists to investigate the buffering mechanisms of resilience in late-life transitions, bereavement, cognitive preservation, physical disability, and the phenomenon of “successful aging” despite biological decline.

From a theoretical perspective, the purpose of the RS is grounded in the premise that resilience is an identifiable, relatively stable capacity composed of psychosocial resources that can be systematically identified, empirically quantified, and deliberately strengthened through self-reflection, therapeutic scaffolding, and cognitive restructuring.

5. Psychological Construct

The Resilience Scale operationalizes psychological resilience as a multi-layered psychological construct encompassing two major overarching empirical dimensions and five core experiential characteristics identified by Wagnild and Young through qualitative phenomenological inquiry.

The Two Empirical Dimensions

1. Personal Competence (17 Items): This dimension constitutes the operational core of psychological mastery, self-efficacy, and purposeful execution. It reflects an individual’s confidence in their own abilities, internal locus of control, resourcefulness, persistence, and disciplined drive. Individuals scoring high on Personal Competence believe that they can actively influence their life trajectories, maintain disciplined follow-through on their goals, and navigate complex or hostile circumstances through determination, cognitive restructuring, and intrinsic motivation. Representative items include Item 1 (“When I make plans, I follow through with them”), Item 10 (“I am determined”), Item 14 (“I have self-discipline”), and Item 23 (“When I’m in a difficult situation, I can usually find my way out of it”).
2. Acceptance of Self and Life (8 Items): This dimension reflects psychological flexibility, emotional equanimity, realistic optimism, and an existential coming-to-terms with the limitations and unpredictability of human existence. Rather than engaging in persistent cognitive avoidance, catastrophic thinking, or bitter rumination over immutable circumstances, high scorers demonstrate cognitive perspective, adaptability, self-compassion, and tolerance of ambiguity. They recognize that adversity is an inevitable component of life and maintain composure through humor, patience, and non-defensiveness. Representative items include Item 7 (“I usually take things in stride”), Item 8 (“I am friends with myself”), Item 12 (“I take things one day at a time”), and Item 25 (“It’s okay if there are people who don’t like me”).

The Five Underlying Theoretical Core Characteristics

Within these two broader factors, the items were theoretically generated to represent five distinct conceptual components that constitute the subjective experience of resilient living:

• Equanimity (Balance and Perspective): A balanced perspective toward one’s life and experiences. It indicates the ability to moderate extreme emotional reactions, maintain a sense of proportion, take things in stride, and utilize humor to de-escalate crisis states (e.g., Items 7, 16, 22).
• Perseverance (Persistence despite obstacles): The willingness to push forward, stay the course, and maintain dedication to one’s trajectory even in the presence of exhaustion, discouragement, or repeated setbacks (e.g., Items 1, 2, 10, 14, 20).
• Self-Reliance (Belief in one’s personal capabilities): A deep internal conviction that one has the capacity, energy, and knowledge to cope with life’s demands. While open to external collaboration, self-reliant individuals rely primarily on their internal compass and past accomplishments to navigate crises (e.g., Items 3, 5, 9, 13, 17, 24).
• Meaningfulness (Purpose in living): The profound recognition that life holds inherent value, coherence, and purpose, and that one’s contributions matter. It represents an existential anchor that prevents an individual from lapsing into nihilism or learned helplessness when suffering occurs (e.g., Items 4, 6, 11, 15, 21).
• Existential Aloneness (Authenticity and autonomy): The realization and acceptance that each person’s life path is unique, that ultimate responsibility for one’s choices rests with oneself, and that one can stand comfortably alone without requiring universal external validation (e.g., Items 5, 8, 25).

6. Theoretical Framework

The theoretical architecture of the Resilience Scale is situated at the intersection of salutogenesis, social-cognitive theory, existential psychology, and developmental psychopathology.

Unlike early psychiatric models that focused on pathogenetic risk factors, Wagnild and Young drew inspiration from Aaron Antonovsky’s salutogenic model and his concept of the Sense of Coherence (comprehensibility, manageability, and meaningfulness). Antonovsky posited that stressors are ubiquitous in human existence; therefore, the central scientific question is not why people become ill, but rather what enables certain individuals to create order out of chaos, maintain physiological equilibrium, and thrive despite extreme stressors. Wagnild and Young’s operationalization mirrors Antonovsky’s focus on internal generalized resistance resources (GRRs), framing resilience not as a passive absence of illness, but as an active, salutary personality framework.

Furthermore, the construct integrates Albert Bandura’s social-cognitive theory of self-efficacy. Bandura posited that an individual’s perceived self-efficacy—the subjective belief in one’s capability to execute courses of action required to manage prospective situations—regulates motivation, thought patterns, emotional states, and physiological reactivity during crises. In the RS, the Personal Competence subscale reflects strong mastery expectations derived from successful past performance (e.g., Item 13: “I can get through difficult times because I’ve experienced difficulty before”), self-regulatory fortitude, and an internal locus of control.

Existential philosophy—most prominently articulated in the psychotherapeutic paradigms of Viktor Frankl—serves as another theoretical cornerstone. In Man’s Search for Meaning, Frankl asserted that suffering ceases to be suffering the moment it finds a meaning, and that an individual’s primary drive is the will to meaning. The RS explicitly operationalizes this existential imperative within its Meaningfulness and Existential Aloneness components. Acceptance of personal responsibility and the recognition of life’s intrinsic value provide an existential buffer that absorbs traumatic impacts, enabling individuals to re-evaluate adversity as a catalyst for psychological growth rather than personal annihilation.

Lastly, Wagnild and Young grounded the scale in grounded theory and qualitative phenomenological research. In 1990, prior to scale construction, the authors conducted an in-depth qualitative study of 24 older women who had successfully adjusted following major life crises (such as widowhood, severe disability, or total economic disruption). Through rigorous constant comparative thematic analysis, the five core characteristics emerged directly from the lived experiences and verbatim descriptions of these resilient survivors. Thus, the RS possesses a rare theoretical authenticity: its items were derived inductively from real-world human triumph over adversity rather than purely deduced from top-down abstract psychiatric hypotheses.

7. Validity

The psychometric validity of the Resilience Scale has been rigorously documented across hundreds of independent peer-reviewed studies spanning adolescent, adult, and geriatric cohorts across clinical, non-clinical, and cross-cultural samples.

Construct and Factorial Validity

Construct validity was initially confirmed by Wagnild and Young (1993) through exploratory factor analysis, which established that the 25 items reliably measure two higher-order dimensions: Personal Competence and Acceptance of Self and Life. Subsequent confirmatory factor analyses across international investigations have substantiated acceptable to superior structural fit for both the original two-factor model and a hierarchical second-order model where a single latent global resilience construct accounts for the covariance between the two subscales.

Convergent Validity

Convergent validity is extensively supported by statistically robust, theoretically coherent correlations with established psychological instruments:

• Sense of Coherence: The RS demonstrates strong positive correlations with Antonovsky’s Sense of Coherence Scale (SOC), with Pearson correlation coefficients consistently falling between r = .55 and r = .72 (p < .001).
• Life Satisfaction and Well-Being: Scores on the RS correlate positively and substantially with the Satisfaction with Life Scale (SWLS; Diener et al.), ranging from r = .45 to r = .68, and the Philadelphia Geriatric Center Morale Scale (PGCMS; r = .54, p < .001).
• Self-Efficacy: Evaluations against the General Self-Efficacy Scale (GSES; Schwarzer & Jerusalem) yield persistent positive correlations between r = .60 and r = .75.
• Adaptive Coping Strategies: The RS correlates positively with task-oriented, problem-focused coping on the Coping Inventory for Stressful Situations (CISS; r = .40 to .58) and active coping subscales of the Brief COPE.

Discriminant and Divergent Validity

Discriminant validity is evidenced by consistent, statistically significant negative correlations with psychopathological symptoms and emotional distress indices:

• Depressive Symptomatology: The RS correlates inversely with the Center for Epidemiologic Studies Depression Scale (CES-D; r = -.37 to -.60) and the Beck Depression Inventory (BDI-II; r = -.40 to -.55).
• Perceived Stress and Anxiety: Significant negative correlations are observed with Cohen’s Perceived Stress Scale (PSS-10; r = -.48 to -.62) and the Spielberger State-Trait Anxiety Inventory (STAI; r = -.45 to -.58).
• Neuroticism: On the NEO-PI-R and Big Five inventories, the RS demonstrates moderate to strong negative correlations with Neuroticism (r = -.42 to -.57) while showing positive associations with Extraversion (r = .38 to .50) and Conscientiousness (r = .45 to .60).

Predictive and Criterion Validity

Longitudinal and cross-sectional empirical investigations have demonstrated that higher RS scores predict positive clinical outcomes, including faster physical rehabilitation following cardiovascular events or orthopedic surgery, lower mortality in hemodialysis cohorts, greater glycemic control in diabetic adults, lower levels of burnout among nurses and medical residents, and higher academic persistence among at-risk university students. In late-life cohorts, Wagnild (2003) demonstrated that the RS distinguished between older adults who maintained high perceived health and community involvement despite significant physical comorbidity and those who perceived their health as poor, confirming strong criterion validity.

8. Reliability

The Resilience Scale has consistently demonstrated outstanding internal consistency and temporal stability across an expansive variety of empirical studies, demographic groups, and translated editions.

Internal Consistency Reliability

In their seminal validation study, Wagnild and Young (1993) administered the RS to a community sample of 810 older adults residing in the Pacific Northwest of the United States. The overall scale yielded a Cronbach’s alpha coefficient of α = .91, indicating exceptional internal consistency. The individual subscales also demonstrated solid reliability:

• Personal Competence Subscale: Cronbach’s α = .91 (17 items)
• Acceptance of Self and Life Subscale: Cronbach’s α = .81 (8 items)

Subsequent psychometric reviews and cross-cultural validations have mirrored these metrics. In a comprehensive review of 12 empirical studies utilizing the RS, Wagnild (2009) documented Cronbach’s alpha values ranging from .85 to .94 across diverse populations, including low-income rural mothers (α = .87), caregivers of Alzheimer’s patients (α = .89), public school educators (α = .91), cardiovascular patients (α = .93), and older adults experiencing bereavement (α = .90). International translations—including Swedish (α = .88), Russian (α = .89), Spanish (α = .93), German (α = .94), Brazilian Portuguese (α = .87), and Japanese (α = .90)—have corroborated the internal consistency of the measure across linguistic and cultural borders.

Test-Retest Stability

Temporal stability assessments have confirmed that the RS assesses a relatively stable personality disposition while retaining sensitivity to genuine therapeutic or situational change. In an initial stability trial over a 6-week interval with a non-clinical cohort, Wagnild and Young observed a test-retest correlation coefficient of r = .84 (p < .001). Other longitudinal studies report test-retest coefficients spanning from r = .67 to .84 across intervals varying from 2 weeks to 6 months. Intraclass correlation coefficients (ICC) across clinical test-retest designs routinely surpass .80, indicating high measurement repeatability.

9. Factor Analysis

The structural dimensionality of the Resilience Scale has been extensively evaluated using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

Exploratory Factor Analysis (EFA)

In the original scale construction study (Wagnild & Young, 1993), an EFA utilizing principal component analysis with orthogonal (Varimax) rotation was conducted on the 25 items with a sample of 810 community-dwelling adults. The initial unrotated factor solution yielded five eigenvalues greater than 1.0, accounting for 50.3% of the total variance. A scree plot inspection, along with conceptual interpretability criteria, indicated a clean, parsimonious two-factor solution that accounted for 44.0% of the total variance:

• Factor 1: Personal Competence: Accounted for 37.7% of the variance. Seventeen items loaded substantially on this factor (factor loadings ranging from .42 to .75). The items primarily reflect self-reliance, determination, mastery, persistence, resourcefulness, and self-belief under conditions of severe distress.
• Factor 2: Acceptance of Self and Life: Accounted for 6.3% of the variance. Eight items loaded predominantly on this factor (loadings ranging from .41 to .68). The items represent cognitive flexibility, equanimity, peaceful acceptance of personal limitations, and adaptability to immutable realities.

All 25 items exhibited item-to-total scale correlations exceeding .30 (ranging from .37 to .75), with the vast majority exceeding .50, supporting the retention of all 25 statements in the final published instrument.

Confirmatory Factor Analysis (CFA) and Model Fit

Subsequent psychometric examinations have tested alternative structural specifications via CFA across diverse global cohorts. Common models tested include:

1. Unidimensional Model: A single general resilience factor accounting for all 25 items. While this model demonstrates acceptable fit in some applied studies (justifying the common clinical practice of calculating a single cumulative total score), it typically produces slightly lower fit indices compared to multidimensional models.
2. Correlated Two-Factor Model: Representing the original empirical structure (Personal Competence and Acceptance of Self and Life as distinct yet correlated latent constructs). This model frequently yields superior fit indices: Comparative Fit Index (CFI) > .90; Tucker-Lewis Index (TLI) > .90; Root Mean Square Error of Approximation (RMSEA) ≤ .05 to .06; Standardized Root Mean Square Residual (SRMR) ≤ .05. The inter-factor correlation between the two latent dimensions is consistently high (typically r = .70 to .82), which justifies the second-order model.
3. Hierarchical / Second-Order Model: A higher-order Global Resilience factor explaining the covariance between the two first-order factors (Personal Competence and Acceptance of Self and Life). This model satisfies standard goodness-of-fit benchmarks and aligns with the theoretical assertion that individual sub-dimensions reflect an overarching psychological resilience trait.
4. Five-Factor Model: Derived from the five qualitative theoretical characteristics (Equanimity, Perseverance, Self-Reliance, Meaningfulness, Existential Aloneness). Although theoretically appealing, EFAs and CFAs have generally found that the high degree of multicollinearity among the five components makes a statistical five-factor model less parsimonious and psychometrically stable than the two-factor or unidimensional models.

10. Instrument / Measurement Tool

• Instrument Name: Resilience Scale (RS); also referred to as the RS-25 to distinguish it from its abbreviated derivative, the RS-14.
• Authors: Gail M. Wagnild, PhD, RN, and Heather M. Young, PhD, RN, FAAN.
• Construct Assessed: Psychological resilience (trait resilience, psychological stamina, adaptive capacity, and salutogenic coping resources).
• Instrument Type: Self-report psychological assessment / psychometric survey questionnaire.
• Target Population: Adults (aged 18 and older) and adolescents (with appropriate reading level, typically age 13+). Applicable across community, occupational, medical, and clinical psychiatric settings.
• Reading Level: Written at approximately a sixth-grade reading level (Flesch-Kincaid Grade Level ≈ 5.8).
• Administration Time: Approximately 5 to 10 minutes for complete self-administration.
• Item Count: 25 items. (The 14-item short version, RS-14, utilizes items 3, 6, 7, 8, 9, 10, 13, 14, 15, 16, 17, 18, 21, and 23).
• Subscales / Dimensions:
  • Personal Competence (17 items): Items 1, 2, 3, 4, 5, 6, 9, 10, 13, 14, 15, 17, 18, 19, 20, 23, 24.
  • Acceptance of Self and Life (8 items): Items 7, 8, 11, 12, 16, 21, 22, 25.
• Response Scale: 7-point Likert response scale scored as follows:
  • 1 = Strongly Disagree
  • 2 = Disagree
  • 3 = Somewhat Disagree
  • 4 = Neutral (Neither Agree nor Disagree)
  • 5 = Somewhat Agree
  • 6 = Agree
  • 7 = Strongly Agree
• Scoring and Interpretation Procedures:
  • Item Directionality: All 25 items are positively phrased; there are no reverse-coded items.
  • Total Score Calculation: Sum the numerical values of all 25 items. The resulting theoretical score ranges from a minimum of 25 to a maximum of 175.
  • Subscale Scores: Personal Competence scores range from 17 to 119; Acceptance of Self and Life scores range from 8 to 56.
  • Clinical Categorization Norms (Wagnild, 2009):
    • 25 – 115: Very Low Resilience (indicates marked vulnerability, compromised coping capacity, and high risk of psychological decompensation during adversity; clinical assessment and targeted intervention strongly indicated).
    • 116 – 130: Low Resilience (suggests fragile coping reserves, vulnerability to sustained stress, and benefit from resilience training or psychotherapy).
    • 131 – 144: Moderately Low to Moderate Resilience (indicates typical or average resilience; capable of managing routine challenges but vulnerable during chronic or catastrophic disruption).
    • 145 – 160: Moderately High Resilience (indicates solid psychological stamina, effective problem-solving skills, and healthy emotional balance under stress).
    • 161 – 175: Very High Resilience (exceptional coping capacity, robust self-efficacy, marked equanimity, and strong perseverance in the face of major adversity).

11. Permissions & Fee and Test Year

• Year of Initial Publication: 1993 (Development and Psychometric Evaluation of the Resilience Scale published in the Journal of Nursing Measurement).
• Copyright and Intellectual Property: The Resilience Scale (RS-25), the 14-Item Resilience Scale (RS-14), and all associated derivative forms are copyrighted intellectual property owned exclusively by Dr. Gail M. Wagnild and The Resilience Center.
• Commercial and Clinical Licensing: The Resilience Scale is a proprietary psychometric instrument. It is NOT in the public domain. Clinicians, commercial organizations, healthcare corporations, and sponsored clinical trials must purchase appropriate administration licenses, scoring manuals, or computerized test access directly through The Resilience Center (www.resiliencecenter.com).
• Non-Commercial Academic & Research Access: Academic researchers, graduate students, and non-profit investigators may apply to The Resilience Center for discounted or non-profit research licensing. An academic research agreement must typically be executed prior to study initiation, specifying sample size, methodology, and anticipated publication parameters. Unauthorized reproduction, digital distribution, online publication of testing forms, or unauthorized linguistic translations without written authorization constitutes copyright infringement.

12. References

• Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress and stay well. Jossey-Bass.
• Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman and Company.
• Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction With Life Scale. Journal of Personality Assessment, 49(1), 71–75. https://doi.org/10.1207/s15327752jpa4901_13
• Frankl, V. E. (1984). Man’s search for meaning. Washington Square Press.
• Lundman, B., Strandberg, G., Eisemann, M., Gustafson, Y., & Brulin, C. (2007). Psychometric evaluation of the Swedish version of the Resilience Scale. Scandinavian Journal of Caring Sciences, 21(2), 229–237. https://doi.org/10.1111/j.1471-6712.2007.00461.x
• Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy scale. In J. Weinman, S. Wright, & M. Johnston (Eds.), Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35–37). NFER-NELSON.
• Wagnild, G. M. (2003). Resilience and successful aging: Comparison among low and high income older adults. Journal of Gerontological Nursing, 29(12), 42–49. https://doi.org/10.3928/0098-9134-20031201-09
• Wagnild, G. M. (2009a). A review of the Resilience Scale. Journal of Nursing Measurement, 17(2), 105–113. https://doi.org/10.1891/1061-3749.17.2.105
• Wagnild, G. M. (2009b). The Resilience Scale user’s guide for the US English version of The Resilience Scale and The 14-Item Resilience Scale (RS-14). The Resilience Center.
• Wagnild, G. M. (2010). Special report on the 25-Item Resilience Scale. The Resilience Center.
• Wagnild, G. M., & Young, H. M. (1990). Resilience among older women. Image: The Journal of Nursing Scholarship, 22(4), 252–255. https://doi.org/10.1111/j.1547-5069.1990.tb00224.x
• Wagnild, G. M., & Young, H. M. (1993). Development and psychometric evaluation of The Resilience Scale. Journal of Nursing Measurement, 1(2), 165–178.
• Windle, G., Bennett, K. M., & Noyes, J. (2011). A methodological review of resilience measurement scales. Health and Quality of Life Outcomes, 9, Article 8. https://doi.org/10.1186/1477-7525-9-8

13. Items of the Scale