SF-36 (Short Form 36)

The SF-36 questionnaire (Short Form Health 36) version 1 is a further development of the Short-Form 20 score from the Medical Outcomes Study (MOS) in 1988.1-4 It was modified in 1996 with regards to some item formulations and possible answers resulting in the SF-36 v2.0.5

Content

The SF-36 consists of 36 questions and is a general health questionnaire assessing the patient’s health status using 8 different dimensions. Those are:

  • vitality – 4 questions
  • physical functioning – 10 questions
  • bodily pain – 2 questions
  • general health perceptions – 5 questions
  • physical role functioning – 4 questions
  • emotional role functioning – 3 questions
  • social role functioning – 2 questions
  • mental health – 5 questions
SF-36 (Short Form 36) 1
Scoring

When evaluating the SF-36 questionnaire, it is important to consider which version of the questionnaire is used, as there may be decisive differences between v1.0 and v2.0 concerning the scoring.

For evaluation of the SF-36 questionnaire v1.0, all answers are first converted into predetermined points using a scoring key. The average score of all questions of the respective health dimension, e.g. physical health, is then calculated so that 8 average scores are obtained for the 8 dimensions. These describe the patient’s state of health in the respective dimensions, which can then be assessed using comparison tables.

The possible score ranges from 0 to 100 points. 0 points represent the greatest possible limitation of health, while 100 points represent the absence of health restrictions.6

For evaluation of SF-36 v2.0 no publicly accessible information is available (see license).

Strengths

In 2009, a systematic review showed that the SF-36 is the most widely used patient reported outcome (PRO) instrument in clinical trials. It is thus one of the most established PRO scores in medicine and its validity has already been proven in numerous studies.1,2,7-11 It is also available in over 170 languages.12

Weaknesses

Containing 36 questions, the SF-36 is relatively lengthy compared to other general health surveys. One study showed that patients were able to answer an average of 5 questions per minute.13 Thus, it would take approximately 7 minutes to complete the SF-36 . Spending that much time answering a questionnaire is realistic in a research setting, but needs good time management, e.g. via electronic recording, to be of use in clinical practice..

License

The use of SF-36 v1.0 does not require licensing and is therefore free of charge.14 For the SF-36 v2.0 however, a license is required. The question of whether this involves costs is not discussed on the website of the rights holder. In our opinion, this is to be expected though.15

Conclusion

The SF-36 questionnaire is a globally established, validated and frequently used questionnaire that is used in various medical disciplines. It therefore has great clinical relevance and will presumably maintain it’s relevance in the future.

SOURCES:

  1. Stewart AL, Hays RD, Ware JE, Jr. The MOS short-form general health survey. Reliability and validity in a patient population. Med Care 1988;26:724-35.
  2. Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA 1989;262:907-13.
  3. https://campaign.optum.com/content/dam/optum/resources/Manual Excerpts/SF-36v2_Manual_Chapter_1.pdf. (Accessed November 20th, 2019)
  4. Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ 1993;2:217-27.
  5. Ware JE, Jr. SF-36 health survey update. Spine (Phila Pa 1976) 2000;25:3130-9.
  6. https://www.rand.org/health/surveys_tools/mos/36-item-short-form/scoring.html. (Accessed November 20th, 2019)
  7. Scoggins JF, Patrick DL. The use of patient-reported outcomes instruments in registered clinical trials: evidence from ClinicalTrials.gov. Contemp Clin Trials 2009;30:289-92.
  8. Marquis P, Fayol C, Joire JE. Clinical validation of a quality of life questionnaire in angina pectoris patients. Eur Heart J 1995;16:1554-60.
  9. Fryback DG, Lawrence WF, Martin PA, Klein R, Klein BE. Predicting Quality of Well-being scores from the SF-36: results from the Beaver Dam Health Outcomes Study. Med Decis Making 1997;17:1-9.
  10. Watson EK, Firman DW, Baade PD, Ring I. Telephone administration of the SF-36 health survey: validation studies and population norms for adults in Queensland. Aust N Z J Public Health 1996;20:359-63.
  11. Ware JE, Jr., Kosinski M, Gandek B, et al. The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998;51:1159-65.
  12. https://campaign.optum.com/optum-outcomes/what-we-do/health-surveys/sf-36v2-health-survey.html. (Accessed November 20th, 2019)
  13. Cella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol 2010;63:1179-94.
  14. https://www.rand.org/health/surveys_tools/mos/36-item-short-form/terms.html. (Accessed November 20th, 2019)
  15. https://campaign.optum.com/content/optum/en/optum-outcomes/what-we-do/health-surveys/sf-36v2-health-survey.html. (Accessed November 20th, 2019)

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