Short Form 36
  1. Rehabilitation Measures Database
  2. Medical Outcomes Study Short Form 36

Medical Outcomes Study Short Form 36

Last Updated

Purpose

The SF-36 is a generic patient-reported outcome measure that quantifies health status and measures health-related quality of life.

Link to Instrument

Acronym SF-36; SF-36v2

Area of Assessment

Activities of Daily Living
Quality of Life

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Contact QualityMetric Incorporated for information regarding licensing fees for your institution.

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Brain Injury Recovery
  • Cancer Rehabilitation
  • Multiple Sclerosis
  • Pain Management
  • Parkinson's Disease & Movement Disorders
  • Spinal Cord Injury
  • Stroke Recovery

Populations

Brain Injury
Cancer
Mixed Populations
Non-Specific Patient Population
Parkinson's Disease
Spinal Injuries
Stroke

Key Descriptions

  • 36-item measure divided into 8 subscales and 2 composite domains.
    ?
  • The 8 subscales are:
    1) Physical Functioning
    2) Role Limitations due to Physical Problems
    3) General Health Perceptions
    4) Vitality
    5) Social Functioning
    6) Role Limitations due to Emotional Problems
    7) General Mental Health
    8) Health Transition
  • Respondents are asked to answer items referring to the past 4 weeks.
  • Recommended scoring system for the SF-36 is a weighted Likert system for each item.
  • Items within subscales are totaled to provide a summed score for each subscale or dimension.
  • Each of the 8 summed scores is linearly transformed onto a scale from 0 (negative health) to 100 (positive health) to provide a score for each subscale. Each subscale can be used independently.
  • For each domain (physical and mental composite):
    Mean score = 50
    Standard deviation = 10
  • Version 2 norms are based on the 1998 National Survey of Functional Health Status (NSFHS).
  • More information on Version 2 can be found on the SF-36 website: http://www.sf-36.org/tools/sf36html

Number of Items

36

Equipment Required

  • Suggests enlarged copy of item response options (Steffen & Seney 2008)

Time to Administer

10-60 minutes

10 minutes; 41 and 47 minutes, respectively, for individuals with paraplegia & tetraplegia (Anderson et al., 1999)

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated by Wendy Romney, PT, DPT, NCS, Cara Weisbach, PT, DPT, and the SCI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Sue Saliga PT, DHSc, CEEAA and the TBI EDGE task force of the Neurology section og the APTA in 2012. Updated by Erin Hussey, PT, DPT, MS, NCS and Cathy Harro PT, PhD and the PD EDGE task force of the Neurology Section of the APTA in 2013. Updated by Melissa Eden, PT, DPT, OCS in 2014; Updated by Carmen Capo-Lugo, PT, PhD and Dorian Rose PT, PhD and the Stroke Edge task force in 2016.

ICF Domain

Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
General Health

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

NR

LS

R

StrokEDGE

NR

R

R

Recommendations Based on Parkinson Disease Hoehn and Yahr stage: 

 

I

II

III

IV

V

PD EDGE

LS/UR

LS/UR

LS/UR

LS/UR

LS/UR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

NR

NR

NR

R

R

StrokEDGE

NR

R

R

R

R

TBI EDGE

NR

NR

NR

LS

LS

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

R

R

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

R

NR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

No

Yes

Yes

No

PD EDGE

No

No

Yes

Not reported

SCI EDGE

No

Yes

Yes

Not reported

StrokEDGE

No

Yes

Yes

Not reported

TBI EDGE

No

Yes

Yes

Not reported

Considerations

  • Physical function domain: significant floor effects for patients with SCI and other disabilities due to inability to perform some of the physical tasks described.

  • Lee et al. (2009) recommend that the SF-36 states “walkwheel” to improve responsiveness for patients with spinal cord injury.

  • Not recommended for:

    • Patients who cannot understand written or spoken language

    • Severely affected stroke survivors who require a proxy to complete the assessment

    • To document patient change (Dorman et al., 1999)

    • Some disadvantaged populations, slight declines in reliability may result (Turner-Bowker et al., 2002)

    • Postal administration of the SF-36 is not recommended (O'Mahony et al., 1998)

    • The Mental Health Subscale of SF-36 (MHI-5) (VanLeeuwen et al., 2012) may be used in the future to determine mental health and severe mental health problems in persons with SCI. Cut off scores are ≤ 72 and ≤ 60, respectively.

  • The SF-12 is a shorter version of the SF-36 containing 12 items; covers the summary physical health and mental health scales, but no information about each of the eight dimensions of the SF-36.

  • The SF-12 is beginning to be more commonly used in the TBI population. However, its psychometric properties in this population have not been specifically assessed (Nichol et al., 2011).

Parkinson's Disease

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Minimal Detectable Change (MDC)

Parkinsonism (included Parkinson Disease and Parkinson-plus syndromes): (Steffen & Seney, 2008; n = 37 (PD, n = 35; Parkinson-Plus, n = 2); mean age = 71 (12); mean disease duration = 14 (6) years; Hoehn and Yahr stages median score = 2 (range = 1 to 4); Stage 1: n = 3; Stage 2: n = 7; Stage 3: n = 9; Stage 4: n = 8; test-retest by same rater at 1-week interval; Administered SF-36 by direct interview)

MDC95 for each subscale of SF-36 (V1)

SF-36 Subscale 

MDC95 

Physical Functioning 

28 

Role limits - Physical 

45 

Bodily pain 

25 

General health 

28 

Vitality 

19 

Social functioning 

29 

Role limits - emotional 

45 

Mental health 

19 

Normative Data

Parkinson's Disease: (Banks & Martin, 2009; n = 339 with PD (164 male; 179 female); mean age = 54.6 (range 27-75); Version 2 of SF-36; tested multiple configurations to determine recommended model for use and if this scale useful for PD. Identified 8 subscales and 6 models: physical functioning [1], role-physical [2], bodily pain [3], general health [4], vitality [5], social functioning [6], role-emotional [7] and mental health [8]. Compared various models of subscale combinations and assessments and compared against typical recommendation that summary measures of physical health (scales 1–4) and mental health (scales 5–8) can also be calculated and used independently)

SF-36 subscale scores 

Mean 

SD

Physical functioning 

44.03

26.44

搁辞濒别–辫丑测蝉颈肠补濒&苍产蝉辫;

25.41 

34.24

Bodily pain

50.22

34.24

General health 

44.08

20.89

Vitality

36.08

20.12

Social functioning

57.05

25.81

搁辞濒别–别尘辞迟颈辞苍补濒

47.81

44.03

Mental health

61.10

19.57 

Parkinson's Disease: (Leonardi et al., 2012. N = 96 (n = 64 male); mean age = 64.1 (11.3; range 24-90); 74% married; 79.2% unemployed; Hoehn & Yahr stages: 1 = 13; 2 = 55; 3 = 22; 4 = 6; compared to normative data from general Italian population.)

 

Mean score (SD)

Normative data

t-test

p-value

SF-36 (v2)

 

 

 

 

 

Physical Functioning

72.0 (22.6)

84.46

?5.04

< 0.001

Role Physical

46.9 (38.9)

78.21

?7.88

< 0.001

Bodily Pain

58.9 (29.9)

73.67

?4.83

< 0.001

General Health

41.2 (20.5)

65.22

?11.44

< 0.001

Vitality

56.7 (20.1)

61.89

?2.52

0.013

Social Functioning

69.2 (27.6)

77.43

?2.93

0.004

Role Emotional

68.4 (40.3)

76.16

?1.88

0.063

Mental Health

64.6 (19.6)

66.50

?0.94

0.350

PCS

40.0 (8.8)

50

?11.09

< 0.001

MCS

46.7 (11.0)

50

?2.90

0.005

Test/Retest Reliability

Parkinsonism (included Parkinson Disease and Parkinson-plus syndromes): (Steffen & Seney, 2008; n = 37 (PD, n = 35, Parkinson-Plus, n = 2); mean age = 71 (12); mean disease duration = 14 (6) years; Hoehn and Yahr stages median score = 2 (range = 1 to 4); Stage 1: n = 3; Stage 2: n = 7; Stage 3: n = 9; Stage 4: n = 8; test-retest by same rater at 1-week interval; mean number of falls in the past 6 months = 7; Administered SF-36 (v1) by direct interview)

SF-36 Domain 

Test-Retest reliability 
(ICC) 

Physical Functioning 

0.80 Adequate 

Role Physical 

0.85 Excellent 

Bodily Pain 

0.89 Excellent 

General Health 

0.85 Excellent 

Vitality 

0.89 Excellent 

Social Functioning 

0.71 Adequate 

Role Emotional 

0.84 Excellent 

Mental Health 

0.83 Excellent

Internal Consistency

Parkinsonism (included Parkinson Disease and Parkinson-plus syndromes): (Steffen & Seney, 2008; n = 37; mean age = 71; mean disease duration = 14 (6) years); Hoehn and Yahr Stages range from 1 to 4; Stage 1: n = 3; Stage 2: n = 7; Stage 3: n = 9; Stage 4: n = 8; test-retest by same rater at 1-week interval; mean number of falls in the past 6 months = 7)

Internal Consistency for SF-36 v1 (Cronbach’s alpha):  [No source for this linked to SF-36v2]

SF-36 Domain 

Internal Consistency 
Cronbach’s alpha Strength 

Physical Functioning 

0.87 Excellent 

Role Physical 

0.74 Adequate 

Bodily Pain 

0.91 Excellent 

General Health 

0.80 Adequate 

Vitality 

0.91 Excellent 

Social Functioning 

0.84 Excellent 

Role Emotional 

0.89 Excellent 

Mental Health 

0.93 Excellent 

Parkinson's Disease: (Brown et al., n = 96 total (n = 58 with follow-up data and 38 without); mean age = 72 (88% white, 84% male); years of school = 15.7 (2.4); via standardized telephone interview at baseline and ~18 months (mean = 17.9 (4.2) months In PD subjects; Hoehn & Yahr stages not reported.)

Subscale (item #) 

Cronbach’s alpha 

Physical Functioning (10) 

0.94 Excellent

Role Limitations–Physical (4) 

0.81 Excellent 

Role Limitations–Emotional (3) 

0.98 Excellent 

Pain (2) 

0.85 Excellent

Emotional Well-Being (5) 

0.86 Excellent 

Energy (4) 

0.92 Excellent

General Health (5) 

0.76 Adequate

Social Function (2) 

0.98 Excellent 

Physical Health (PCS) 

0.93 Excellent 

Mental Health (MCS) 

0.97 Excellent

Criterion Validity (Predictive/Concurrent)

Parkinson's Disease: (Leonardi et al., 2012)

N = 86 all scales 

SF-36 PCS / Correlation Strength 

SF-36 MCS / Correlation Strength 

NMS Questionnaire / 

Correlation Strength 

WHO-DAS II summary score 

-0.70 / Excellent 

-0.52 / Adequate 

0.65 / Excellent 

NMS questionnaire 

-0.54 / Adequate 

-0.40 / Adequate 

-- 

NMS = non motor symptoms questionnaire; WHO-DAS II = World Health Organization Disability Assessment Schedule; Pearson correlations all significant at p < 0.0001

Parkinson's Disease: (Nilsson et al, 2010; n = 79 with diagnosis of idiopathic PD, 37 outpatient and 42 via survey; mean age 64 years (7.2) correlation study; 8.8 (2.3) days between testing sessions; duration of diagnosis = 15.9 (7.3) years; Hoehn & Yahr ratings not specified. Focus of study on FES (Swedish-13) & SAFFE (modified Survey of Activities and Fear of Falling in the Elderly))

  • Adequate correlation between SF-36v1 PF subscale and FES(s): Spearman's r = 0.66, p < 0.001 
  • Excellent correlation between SF-36v1 PF subscale and SAFFE:  Spearman's r = -0.76, p < 0.001

Construct Validity

Parkinson Disease: (Leonardi et al., 2012) 

  • Distinguish severity: SF-36v2 composite scores were significantly different between patients rated Hoehn & Yahr < 3 (n = 68) and those rated HY ≥ 3 (n = 28), with the more advanced group reporting lower composite scores on PCS (reduced by 16.8%) and MCS (reduced by 18.1%)

Content Validity

Items that compose the SF-36 were drawn from a number of prior measures including:

  • The General Psychological Well-Being Inventory (GPWBI) (Dupuy, 1984)

  • Physical and role functioning measures (Patrick, Bush, & Chen, 1973; Hulka & Cassel, 1973; Reynolds, Rushing, & Miles, 1974; Stewart, Ware, & Brook, 1981)

  • The Health Perceptions Questionnaire (HPQ) (Ware, 1976)

  • The Functioning and Well-Being Profile (FWBP) (Stewart & Ware, 1992)

Floor/Ceiling Effects

Parkinson's Disease: (Brown et al., 2009) regarding SF-36v1 {not located for SF-36v2}

  • Floor effects:SF-36v1 subscales: Role limitations – physical (51% scored min possible); Role limits – emotional (21.9% scored min possible).
  • Ceiling effects: SF-36v1 subscale: Role limitations – Emotional (75% scored max possible); Pain (15.6% scored max possible); Social function (29.2% scored max possible).

Subscale

% score min (0)

max (100)

Physical Functioning

4.2

3.1

Role Limitations—Physical

51.0

10.4

Role Limitations—Emotional

21.9

75.0

Pain

0.0

15.6

Emotional Well-Being

1.0

0.0

Energy

3.1

0.0

General Health

2.1

1.0

Social Function

6.3

29.2

BOLD = significant ceiling or floor effects

Stroke

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Normative Data

Chronic Stroke: (Anderson et al., 1996; n = 90; mean age = 72 (12) years; assessed 1 year post stroke; Australian version)

SF-36 Domain 

  Mean   

SD  

Physical functioning 

48

33

Role limits, physical  

 76 

 34 

Bodily pain

76

28

General health 

64

22

Vitality

56

20

Social functioning

86

23

Role limits, emotional

83

31

Mental health

77

22

Test/Retest Reliability

Chronic Stroke: (Dorman et al., 1998; n = 209; 3 weeks between assessments; mean time since stroke onset 64 (30) weeks)

Domain

Patient ICC

Proxy ICC

Combined ICC

Physical Functioning

0.80

0.59

0.74

Role Limits–physical

0.77

0.45

0.67

Bodily Pain

0.81

0.65

0.75

General Health

0.81

0.71

0.79

Vitality

0.77

0.55

0.70

Social Functioning

0.79

0.76

0.80

Role Limits–emotional

0.60

0.50

0.57

Mental Health

0.30

0.24

0.28

ICC = Intraclass Correlation Coefficient 

Interrater/Intrarater Reliability

Chronic Stroke: (Cabral et al., 2012; n = 120; chronic stroke > 6 months after stroke; Brazilian sample)

Reliability

ICC (95% CI)

p-value

Test-retest (1 rater)

0.89 (0.83-0.93)

<0.01

Inter-rater

(2 raters)

0.89 (0.83-0.93)

<0.01

Internal Consistency

Acute Stroke: (Hagen et al., 2003; n  = 136; mean age = 70 (11) years; assessed 1, 3 and 6 months post-stroke)

  • Adequate to Excellent internal consistency across domains (Cronbach's Alpha > 0.70) over multiple administrations (1, 3 and 6 months) except Vitality at 1 month post stroke (Cronbach's Alpha = 0.6824) and General Health at 3 months post-stroke (Cronbach's Alpha = 0.6650) 

Chronic Stroke: (Anderson et al., 1996) 

  • Excellent internal consistency (Cronbach's alpha > 0.7, except Vitality section):

SF-36 Domain

Strength

Cronbach's Alpha

Physical Functioning

Excellent

0.9

Role Limits–physical

Adequate

0.8

Bodily Pain

Excellent

0.9

General Health

Adequate

0.7

Vitality

Adequate

0.6

Social Functioning 

Adequate

0.7

Role Limits–emotional

Excellent

0.9
Mental Health

Adequate

0.7

Chronic Stroke: (Cabral et al., 2012; n = 120; chronic stroke > 6 months after stroke; Brazilian sample)

  • Adequate internal consistency across domains (Cronbach’s Alpha = 0.79)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:

Chronic Stroke: (Dorman et al., 1999; n = 688)

  • Adequate correlations between the EuroQol health-related quality of life and the SF-36's general health domain, r = 0.66
  • Poor correlations between SF-36 mental health domain and the EuroQol psychological functioning subtest
  • Excellent to Poor correlations between individual Barthel Index scores at five years and dimensions of the SF36. (Wilkinson et al, 1997; UK sample, n = 97, mean age at stroke = 61, mean follow-up 4.9 years)

SF36

r

Physical functioning

0.810

Social functioning

0.481

Role: physical

0.415

Role: emotional

0.217

Mental health

0.332

Vitality

0.500

Bodily pain

0.356

General health

0.438

Construct Validity

Convergent Validity:

Chronic Stroke: (Cabral et al., 2012; n = 120; chronic stroke > 6 months after stroke; Brazilian version)

Convergent Validity of SF-36-Brazilian Version & Nottingham Health Profile

Convergent Validity

Spearman ρ

Vitality

0.47

Pain

0.63

Mental health

0.70

Social functioning

0.43

Functional capacity

0.82

Total

0.80

Acute Stroke: (Ojo Owolabi, 2010; n = 100; > 1-month post-stroke)

  • All SF-36 subscales were significantly correlated with Stroke Levity Scale and modified Rankin Scale ((0.31< ρ magnitude < 0.67, 0.0000001 < p < 0.004).
  • SF-36 and Health-related Quality of Life in Stroke Patients (HRQOLISP):
    • Physical domain: Excellent correlation (ρ = 0.79)
    • Psychological domain: Adequate correlation (ρ = 0.69)
    • Social domain: Adequate correlation (ρ = 0.47)
    • Physical domain of HRQOLISP: Adequate to Excellent correlations with all SF-36 domains (0.30 < ρ < 0.78).
    • Spiritual domains of HRQOLISP: not correlated with SF 36 domains

Acute stroke: (Katona et al., 2015; n = 152; 57 (SD = 28) days of inpatient rehabilitation; authors did not designate version or language used)

  • Adequate correlations between EQ-5D Index and SF-36 physical domain:
    • Admission: r (Pearson) = 0.60; p < 0.001
    • Discharge: r (Pearson) = 0.68; p < 0.001
  • Poor correlations EQ-5D Index and SF-36 mental health domain:
    • Admission: r (Pearson) = 0.35; p < 0.05
    • Discharge: r (Pearson) = 0.43; p < 0.05

Sub-acute Stroke: (Ojo Owolabi, 2010; n = 100; > 1-month post-stroke)

  • All SF-36 domains sub-domains differed significantly among mRS strata  (0.000001 < p ≤ 0.023).

Content Validity

Items that compose the SF-36 were drawn from a number of prior measures including:

  • The General Psychological Well-Being Inventory (GPWBI) (Dupuy, 1984)

  • Physical and role functioning measures (Patrick, Bush, & Chen, 1973; Hulka & Cassel, 1973; Reynolds, Rushing, & Miles, 1974; Stewart, Ware, & Brook, 1981)

  • The Health Perceptions Questionnaire (HPQ) (Ware, 1976)

  • The Functioning and Well-Being Profile (FWBP) (Stewart & Ware, 1992)

Floor/Ceiling Effects

Acute Stroke: (Hagen et al., 2003; n = 153; 1 month post stroke)

SF-36 Domain

% Floor

% Ceiling

Physical Functioning

23

1

Role Physical

70

4

(Lack of) Bodily Pain

6

35

General Health

0

3

Vitality

4

0

Social Functioning

27

16

Role Emotional

37

26

Mental Health

0

2

Acute Stroke: (Ojo Owolabi et al., 2010; n = 100; > 1-month post-stroke)

SF-36 Domain

% Floor

% Ceiling

Physical Functioning

18

19

Role Physical

74

7

Role-emotional

58

30

Vitality

0

7

Mental Health

0

34

Social Functioning

6

19

Bodily Pain

2

35

General health

0

3

Health Transition

11

32


Chronic Stroke: (Anderson et al., 1996)

  • The SF-36 avoids the "ceiling effect" of most disability scales:

SF-36 Domain

% floor

% ceiling

Physical Functioning

4

6

Role Physical

7

53

(Lack of) Bodily Pain

2

43

General Health

2

2

Vitality

1

1

Social Functioning

3

67

Role Emotional

7

72

Mental Health

1

4

Chronic Stroke: (Cabral et al., 2012; n = 120; chronic stroke > 6 months after stroke; Brazilian sample)

SF-36 Domain

% Floor

% Ceiling

Vitality

6.7

5.8

Pain

9.2

13.3

Mental health

4.2

7.5

Social functioning

4.2

44.2

Functional capacity

8.3

3.3

Spinal Injuries

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Normative Data

Chronic Spinal Cord Injury: (Forchheimer et al., 2004; n = 215; mean age = 38.8 years; assessed > 1 year post traumatic SCI) 

SF-36 Domain 

Mean 

SD 

Physical functioning 

26.6 

11.5 

Role Physical 

40.7 

10.9 

Bodily pain 

42.2 

12.4 

General Health 

44.4 

11.8 

Vitalitiy 

46.8 

9.6 

Social Functioning 

43.0 

13.3 

Role Emotional 

49.0 

10.6 

Mental Health 

48.3 

11.0 

Physical Component Summary 

33.5 

10.1 

Mental Component Summary 

53.5 

11.6

Test/Retest Reliability

Chronic Traumatic Spinal Cord Injury: (Lin et al., 2007; n = 187; 4 weeks between assessments; mean time since injury = 7.8 years) 

20 random participants were selected to assess their original responses within 2 weeks; n = 10 by same interviewer (intra interviewer), n = 10 with a second interviewer (inter interviewer) 

SF-36 Domain

Intra interviewer 
(ICC)

Inter interviewer 
(ICC)

Physical Functioning

0.71

0.67

Role Physical

0.89

0.90

Bodily Pain

0.87

0.70

General Health

0.85

0.41

Vitality

0.93

0.86

Social Functioning

0.93

0.52

Role Emotional

0.99

0.98

Mental Health

0.77

0.57

Excellent Intra ICC > 0.9 in BOLD; Excellent Inter ICC > 0.7 in BOLD

Internal Consistency

Spinal Cord Injury: (Forchheimer et al., 2004)

  • Adequate to Excellent internal consistency across all domains (Chronbach’s Alpha = 0.76 to 0.90, mean = 0.82) 

SF-36 Domain

Internal Consistency 
(Cronbach’s alpha)

SF-36 Domain

Physical Functioning

0.98

Physical Functioning

Role Physical

0.94

Role Physical

Bodily Pain

0.79

Bodily Pain

General Health

0.82

General Health

Vitality

0.76

Vitality

Social Functioning

0.72

Social Functioning

Role Emotional

0.89

Role Emotional

Mental Health

0.78

Mental Health

Excellent internal consistency > 0.80 in BOLD; Adequate internal consistency 0.70-0.80

Chronic SCI: (van Leeuwen et al., 2012, n = 145, AIS A-D, 5 years post injury)

  • Adequate internal consistency of the Mental Health subscale of SF-36 (MHI-5), Cronbach’s α = 0.79

Criterion Validity (Predictive/Concurrent)

Chronic SCI: (Van Leeuwen et al., 2012) 

Concurrent Validity

Spearman Correlation

LiSat 9

0.531?

Neuroticism

-0.546?

SF- Vitality

0.528?

SF- general health

0.367?

Divergent Validity

 

FIM

0.094

SIP-mobility range

-0.283

Type of injury

-0.009

Completeness of injury

-0.008

Cause of injury

0.192

Demographics

 

Age

-0.020

Gender

-0.067

Education

0.028

? = Adequate validity 0.31-0.59; Poor validity ≤ 0.30; Van Leeuwen anticipated poor correlations with demographics and injury

Construct Validity

Chronic Spinal Cord Injury: (Forchheimer et al., 2004)

  • Excellent discriminant validity established between Physical capacity score (PCS) and Mental capacity score (MCS) constructs (r = -0.075)
  • Excellent convergent validity between impairment severity and PCS (F = 5.62, df = 3, p = 0.001)
  • Excellent Divergent validity between impairment severity and MCS scores (F = 0.175, df = 3, p = NS)

 

Chronic Spinal Cord Injury: (Lin et al., 2007) 

 

 

WHOQOL-BREF

 

 

 

 

SF-36

Rating Scale

Overall

Physical Capacity

Psych

Social

Environ

Rating Scale

---

0.68

0.73

0.64

0.54

0.57

Physical Functioning

0.71

0.57

0.78

0.57

0.50

0.54

Role physical

0.47

0.35

0.51

0.40

0.33

0.48

Bodily pain

0.64

0.52

0.68

0.56

0.48

0.55

General Health

0.72

0.65

0.69

0.62

0.45

0.59

Vitality

0.59

0.59

0.67

0.65

0.48

0.62

Social Functioning

0.50

0.52

0.62

0.63

0.43

0.58

Role Emotional

0.32

0.30

0.41

0.37

0.24

0.39

Mental Health

0.36

0.51

0.52

0.59

0.40

0.56

Excellent correlation > 0.60 in BOLD; Adequate correlation 0.31-0.59; Excellent to Adequate convergent validity between SF-36 and WHOQOL-BREF subscales

Chronic Spinal Cord Injury: (Anderson et al., 1999; n = 181 veterans with SCI who were hospitalized within 6 months of assessment)

  • Excellent to adequate correlations between SF-36 and Behavioral Risk Factor Surveillance System (BRFSS) subscales
    • Mental Capacity Summary to all BRFSS subscales (r = -0.427-0.761 )
    • Mental Health subscale to all BRFSS subscales (r = -0.446 - -0.795)
    • Vitality subscale to all BRFSS subscales (r = -0.450 - -0.789)
    • Social Functioning subscale to all BRFSS (r = -0.293 - -0.622)
    • Role Emotional subscale to all BRFSS (r = -0.290- -0.610)
  • Poor to Adequate correlations between SF-36 subscales Physical Functioning, Role Physical, Bodily Pain, General Health and Physical Summary and all BRFSS subscales (r = 0.065- 0.597)
  • Poor to Adequate correlations between SF-36 and Quality of Well Being (r = 0.044 to 0.417) (poor ≤ 0.03; adequate 0.31-0.59)
  • Adequate to Poor correlations between SF-36 and IADLs (r = -0.159- to -0.454)

Content Validity

Items that compose the SF-36 were drawn from a number of prior measures including:

  • The General Psychological Well-Being Inventory (GPWBI) (Dupuy, 1984)

  • Physical and role functioning measures (Patrick, Bush, & Chen, 1973; Hulka & Cassel, 1973; Reynolds, Rushing, & Miles, 1974; Stewart, Ware, & Brook, 1981)

  • The Health Perceptions Questionnaire (HPQ) (Ware, 1976)

  • The Functioning and Well-Being Profile (FWBP) (Stewart & Ware, 1992)

Responsiveness

Chronic Spinal Cord Injury: (Lin et al., 2007) 

  • Highly sensitive (ES = 0.60 & 0.92) with respect to employment status with Physical Functioning and Role Physical domains. 
  • Moderately sensitive (ES = 0.21-0.44) with respect to employment status with Social Functioning, Role Emotional and Mental Health domains 
  • Small responsiveness (ES = 0.00-0.16) with respect to employment status in Bodily Pain, General Health, and Vitality domains.

Brain Injury

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Normative Data

TBI: (Colantonio et al., 1998; n = 51; mean age = 18.28 (2.04) years; assessed 5 years post TBI) 

 

Mild (n = 24)

 

Moderate / Severe (n = 27)

 

 

Mean

SD

Mean

SD

Physical Functioning

84.91

22.02

75.43

35.43

Role Limits–physical

79.17

36.94

75.32

37.01

Bodily Pain

77.40

19.29

81.44

17.89

General Health

63.98

26.74

68.33

22.74

Vitality

53.54

9.83

52.90

13.79

Social Functioning

72.92

27.25

73.15

27.23

Mental Health

46.50

16.42

46.67

17.40

Role Limits–mental health

81.94

32.57

75.64

38.36

Mild Traumatic Brain Injury: (Emanuelson et al., 2003; n = 117, patients assessed at 3 months post injury; n = 101, patients assessed 1 year post injury; age = 16-60)

Domain in SF-36

Patients 3 Months (n = 117) Mean, SEM, median

Patients 1 Year (n = 101) Mean, SEM, median

Mean

SD

Median

Minimum

Maximum

PF

85.4 (1.9), 95

87.5 (2.1), 95

0.85

12.93

0.00

?35.00

60.00

RF

72.5 (3.5), 100

74.7 (3.8), 100

?0.42

30.07

0.00

?100.00

100.00

BP

66.7 (3.0), 72

72.2 (3.1), 74

1.31

25.52

0.00

?69.00

69.00

GH

68.3 (2.4), 72

70.9 (2.5), 72

0.78

17.67

0.00

?52.00

48.00

VT

59.3 (2.4), 60

62.3 (2.6), 65

1.86

19.97

0.00

?70.00

60.00

SF

81.6 (2.5), 100

83.2 (2.4), 100

?0.12

20.35

0.00

?62.50

50.00

RE

72.7 (2.4), 80

77.2 (3.7), 100

3.00

33.87

0.00

?100.00

100.00

MH

71.2 (2.4), 80

74.9 (2.2), 84

1.74

17.87

0.00

?48.00

56.00

PCS

48.4 (1.2), 52

49.1 (1.1), 52

?0.02

6.80

?0.06

?23.16

18.94

MCS

44.8 (1.2), 48

46.5 (1.3), 51

1.09

10.43

0.47

?36.97

36.67

PF = physical functioning; RF = role physical; BP = bodily pain; GH = general health; VT = vitality; SF = social functioning; RE = role emotional; MH = mental health; PCS = physical composite score; MCS = mental composite score

Mild Traumatic Brain Injury: (Emanuelson et al., 2003; n = 117, patients assessed at 3 months post injury; n = 101, patients assessed 1 year post-injury, aged = 16-60) 

Domain in SF-36

Patients 3 Months (n = 117) Mean, SEM, median

Patients 1 Year (n = 101) Mean, SEM, median

Physical Function

85.4 (1.9), 95

87.5 (2.1), 95

Role Functioning: Physical

72.5 (3.5), 100

74.7 (3.8), 100

Bodily Pain

66.7 (3.0), 72

72.2 (3.1), 74

General Health

68.3 (2.4), 72

70.9 (2.5), 72

Vitality

59.3 (2.4), 60

62.3 (2.6), 65

Social Functioning

81.6 (2.5), 100

83.2 (2.4), 100

Role Functioning: Emotional

72.7 (2.4), 80

77.2 (3.7), 100

Mental Health

71.2 (2.4), 80

74.9 (2.2), 84

Physical Composite

48.4 (1.2), 52

49.1 (1.1), 52

Mental Composite

44.8 (1.2), 48

46.5 (1.3), 51

Previously Untreated, Primary HNC: (Funk et al., 1997; n = 180, mean age 58.9 (range, 20-85))

US Norms

95% CI

HNC Pre-Surgery

95% CI

  

45-64 years

(n = 39)

        

  PCS

49.64

49.58-49.70

42.64

39.00-46.28

  MCS

50.53

50.47-50.59

41.97

38.25-45.69

55-64 years

(n = 51)

        

  PCS

45.90

45.82-45.98

43.82

40.94-46.70

  MCS

51.05

50.98-51.12

44.68

41.52-47.84

65-74 years

(n = 48)

        

  PCS

43.33

43.28-43.38

42.33

39.05-45.61

  MCS

52.68

52.54-52.72

49.87

46.88-52.86
 

HND pre-surgery (n = 180)

SC

HNC, 6 months post-surgery (n = 109)

SD

p - value

PCS

43.61

11.49

42.88

10.61

0.0470

MCS

45.05

11.97

47.19

11.82

0.1463

Test/Retest Reliability

Chronic Traumatic Spinal Cord Injury: (Lin et al., 2007; n = 187; 4 weeks between assessments; mean time since injury was 7.8 years); 20 random participants were selected to assess their original responses within 2 weeks; n = 10 by same interviewer (intra interviewer); n = 10 with a second interviewer (inter interviewer) 

SF-36 Domain 

Intra interviewer 
(ICC) 

Inter interviewer 
(ICC) 

Physical Functioning 

0.71

0.67

Role Physical 

0.89

0.90

Bodily Pain 

0.87 

0.70 

General Health 

0.85

0.41

Vitality 

0.93

0.86 

Social Functioning 

0.93

0.52 

Role Emotional 

0.99

0.98

Mental Health 

0.77 

0.57 

Excellent Intra ICC > 0.9 in BOLD; Excellent Inter ICC > 0.7 in BOLD

Internal Consistency

Traumatic Brain Injury: (Mackenzie et al., 2002; N =1230 (n = 1197 without proxy, n = 33 by proxy); age = 18-54 years; male = 66%)

The Cronbach's Alpha coefficient for the SF-36 health survey with the cognitive function scale

SF-36 Domain 

Cronbach's Αlpha Coefficient 

Strength 

Physical Functioning 

0.93 

Excellent 

Role Limits–physical 

0.88 

Excellent 

Bodily Pain 

0.89 

Excellent 

General Health 

0.77 

Adequate 

Vitality 

0.84 

Excellent 

Social Functioning 

0.82 

Excellent 

Role Limits–emotional 

0.87 

Excellent 

Mental Health 

0.88 

Excellent

Traumatic Brain Injury: (Findler et al., 2001; n = 597 (without disability, n = 271; mild TBI, n = 98; moderate-severe TBI, n = 228); mean age at interview: no disability, 38.5 (12.7) years; mild TBI, 41.7 (10.8) years; moderate-severe TBI, 35.7 (9.8) years)

  • Cronbach’s alpha ranged from 0.68-0.87 (Adequate to Excellent) for the comparison group, from 0.83-0.91 (Excellent) for the mild TBI group, and from 0.79-0.92 (Adequate to Excellent) for the moderate-severe TBI group

Traumatic Brain Injury: (Guilfoyle et al., 2011; n = 514; mean age = 36.6 (16.1) years; gender, male = 76.3%)

SF-36 domain 

Alpha coefficient 

Strength 

Physical Function 

0.95 

Excellent 

Role Physical 

0.89 

Excellent 

Bodily Pain 

0.90 

Excellent 

General Health 

0.83 

Excellent 

Vitality 

0.83 

Excellent 

Social function 

0.82 

Excellent 

Role Emotional 

0.90 

Excellent 

Mental Health 

0.86 

Excellent

Construct Validity

Traumatic Brain Injury: (Findler et al., 2001; n = 597 (without disability, n = 271; mild TBI, n = 98; moderate-severe TBI, n = 228); mean age at interview: no disability, 38.5 (12.7) years; mild TBI, 41.7 (10.8) years; moderate-severe TBI, 35.7 (9.8) years)

Mild TBI:

  • Adequate to Excellent correlations (-0.50 to -0.63) were found between SF-36 scales pertaining directly to physical functioning (General Health, Physical Functioning, Physical Role, Bodily Pain, Vitality) and the Physical symptoms scale of the Symptoms Checklist (SCL) 
  • Excellent correlations between SF-36 scales and participants’ Health Problems List (HPL) responses (-0.60 to -0.75) 
  • Emotional Role and Mental Health scores were more strongly related to psychological factors (Cognitive and Affective/Behavioral) than to physical factors on the Symptom Checklist (SCL) 
  • Adequate to Excellent correlations (-0.52 to -0.77) were found between Beck Depression Inventory second edition (BDI-II) scores and the SF-36 subscales

Moderate to Severe TBI:

  • Correlations were lower and more uniform, strongest correlations found between the SF-36 Emotional Role scale and the SCL Affective/Behavioral scale (-0.53). 
  • Correlations between the Physical Functioning scale of the SF-36 and the Cognitive and Affective/Behavioural scales of the SCL were lower than other correlations between scales within this group (-0.11 and -0.19, respectively).

Traumatic Brain Injury: (Guilfoyle et al., 2010; n = 514; mean age= 36.6 (16.1) years; gender, male = 76.3%) 

  • Principal component analysis (PCA) of the correlation matrix of the eight SF-36 domains extracted a single PC with an eigenvalue exceeding unity, which explained 59.2% of the variance in the data 
  • The second PC extracted had an associated eigenvalue of 0.75, and accounted for only 9.4% of the variance

Known Groups 

Traumatic Brain Injury: (Findler et al., 2001; n = 597 (without disability, n = 271; mild TBI, n = 98; moderate-severe TBI, n = 228); mean age at interview: no disability, 38.5 (12.7) years; mild TBI, 41.7 (10.8) years; moderate-severe TBI, 35.7 (9.8) years) 

  • mild TBI and moderate to severe TBI groups reported significantly lower health status across all scales compared to the comparison group 
  • mild TBI group reported significantly lower scores (poorer health)on all scales compared to the moderate± severe TBI group, with the exception of Physical Function, where there were no differences between the two groups

Traumatic Brain Injury: (Jacobsson et al., 2010; n = 67; mild TBI, n = 32, moderate to severe TBI, n = 35; mean age at time of injury: mild TBI, 13 (13) years; moderate to severe TBI, 30 (12) years); gender: mild TBI, male= 75%; moderate to severe TBI, male = 77%; Swedish version of the SF-36)

 

SF-36PCS 

MCS 

SWLS 

Sex 

Age at Injury 

Injury Severity 

Time since injury 

Marital status 

Vocational situation 

SF-36: MCS 

-0.00 

                

SWLS 

0.41** 

0.48** 

              

Sex 

-0.19 

0.01 

-0.02 

            

Age at injury 

-0.14 

0.29* 

0.05 

0.23 

          

Injury severity 

0.20 

-0.10 

-0.06 

-0.03 

0.32** 

        

Time since injury 

0.13 

0.06 

0.30* 

-0.05 

-0.15 

0.10 

      

Marital status 

0.11 

0.06 

0.36** 

-0.01 

-.18 

-0.11 

0.08 

    

Vocational situation 

0.48** 

-0.02 

0.32** 

-0.11 

-0.37** 

0.13 

0.11 

0.21 

  

Self appraisal of the TBI 

-0.54** 

-0.12 

-0.46** 

0.09 

-0.05 

-0.31** 

-0.04 

-0.27* 

-0.35** 

Correlation (Spearman’s rho) is significant (two-tailed) at the *0.05 and **0.01 levels; SWLS-Satisfaction With Life Scale

Content Validity

Items that compose the SF-36 were drawn from a number of prior measures including:

  • The General Psychological Well-Being Inventory (GPWBI) (Dupuy, 1984)

  • Physical and role functioning measures (Patrick, Bush, & Chen, 1973; Hulka & Cassel, 1973; Reynolds, Rushing, & Miles, 1974; Stewart, Ware, & Brook, 1981)

  • The Health Perceptions Questionnaire (HPQ) (Ware, 1976)

  • The Functioning and Well-Being Profile (FWBP) (Stewart & Ware, 1992)

Floor/Ceiling Effects

Traumatic Brain Injury: (Guilfoyle et al, 2011; n = 514; mean age = 36.6 (16.1) years; gender, male = 76.3%) 

  • Floor effects were observed in two domains—Role Physical and Role Emotional—and ceiling effects were observed in four domains—Physical Function, Role Physical, Bodily Pain, and Role Emotional 

SF-36 domain 

Floor % 

Ceiling % 

Physical Function 

4.7% 

16.7 

Role Physical 

56.8 

19.1 

Bodily Pain 

2.0 

21.4 

General Health 

0.2 

5.1 

Vitality 

2.2 

2.8 

Social function 

7.3 

0.0 

Role Emotional 

43.9 

37.5 

Mental Health 

0.6 

4.0

Responsiveness

Mild Traumatic Brain Injury (mTBI): (Paniak et al.,1999; n = 120 with mild TBI; n = 120 control group; mean age: mTBI = 32.7 (11.9) years; control = 30.4 (11.6) years)

SF 36 Variable 

Effect Size 

Degree of Change

Physical Functioning 

3.5 

Moderate 

Social 

1.98 

Small

Role Functioning Physical 

2.72 

Moderate

Bodily Pain 

2.04 

Moderate

Mental Health 

0.90 

Small

Role Functioning Emotional 

0.96 

Small

Vitality 

1.78 

Small

General Health 

0.18 

Small

Mental

0.93

Small

Physical

2.48

Moderate

Traumatic Brain Injury: (Hawthorne et al., 2009; n = 66; mean age at time of injury = 36 (15) years; mean time since injury = 32 months; utilized SF-36 version 2)

SF 36 variable 

Effect Size 

Physical Functioning 

-0.56 

Role Functioning Physical 

-0.77 

Bodily Pain 

-0.38 

General Health 

-0.44 

Vitality 

-0.43 

Social Function 

-0.81 

Role Functioning Emotional 

-0.86 

Mental Health 

-0.70 

Physical 

-0.47 

Mental

-0.76

  • The largest effect sizes were for sub-scales assessing social, emotional, and mental health, but there were moderate to large effects across all of the eight sub-scales, suggesting that TBI may have very broad effects across many different life parts.

Non-Specific Patient Population

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Normative Data

General Population: (Ware et al., 1994) 

  • General population mean for SF-36 component scores (not specific to head and neck cancer) = 50 (10)

Content Validity

Items that compose the SF-36 were drawn from a number of prior measures including:

  • The General Psychological Well-Being Inventory (GPWBI) (Dupuy, 1984)

  • Physical and role functioning measures (Patrick et al., 1973; Hulka & Cassel, 1973; Reynolds et al.,1974; Stewart et al., 1981)

  • The Health Perceptions Questionnaire (HPQ) (Ware, 1976)

  • The Functioning and Well-Being Profile (FWBP) (Stewart & Ware, 1992)

Cancer

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Normative Data

Previously Untreated Primary HNC: (Funk et al., 1997; n = 180, mean age = 58.9 years (range = 20-85 years))

US Norms

HNC Pre-Surgery

95% CI

HNC Post-Surgery

95% CI

45-64 years

(n = 39)

 

 

 

  

  PCS

49.64

49.58-49.70

42.64

39.00-46.28

  MCS

50.53

50.47-50.59

41.97

38.25-45.69

55-64 years

(n = 51)

 

 

 

  

  PCS

45.90

45.82-45.98

43.82

40.94-46.70

  MCS

51.05

50.98-51.12

44.68

41.52-47.84

65-74 years

(n = 48)

 

 

 

  

  PCS

43.33

43.28-43.38

42.33

39.05-45.61

  MCS

52.68

52.54-52.72

49.87

46.88-52.86

 

 

HND pre-surgery (n = 180)

SC

HNC, 6 months post-surgery (n = 109)

SD

p-value

PCS

43.61

11.49

42.88

10.61

0.0470

MCS

45.05

11.97

47.19

11.82

0.1463

Internal Consistency

Patients Undergoing Surgery for Oral or Oropharyngeal SCCA: (Rogers et al., 1998; n = 48, mean age (SD) = 61 (12) years)

Subscale

Cronbach's Alpha

Physical functioning

0.95

Role limitation, physical

0.92

Role limitation, mental

0.86

Social functioning

0.77

Mental health

0.78

Energy/Vitality

0.72

Pain

0.81

General health perception

0.79

Laryngeal cancer (Italian version): (Mosconi et al., 2000; n = 165 age (SD) = 64 (9.2) years; patients are 0-262 months post-treatment)

Subscale

Cronbach's alpha

Physical functioning

0.88

Role limitation, physical

0.83

Role limitation, mental

0.84

Social functioning

0.91

Mental health

0.81

Energy/Vitality

0.81

Pain

0.85

General health perception

0.69

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

Patients within 2 Years of Diagnosis for Head and Neck Cancer: (Karvonen-Gutierrez et al., 2008; n = 495)

  • When controlling for demographic, health behavior and clinical variables, QOL as measured by the SF-36, the PCS score is significantly associated with survival (hazard ratio = 0.86; 95% CI = 0.80-0.93).
  • For every 5-point increase in the PCS score, the risk of death decreased 0.14 times.

Construct Validity

Patients with Cancer of the Upper Aero Digestive Tract: (Chen et al., 2001)

MDADI Subscales

 

 

 

 

 

SF-36 Subscales

Global

Emotional

Functional

Physical

Physical functioning

0.29

0.36

0.31

0.40

Role - physical

0.31

0.33

0.37

0.38

Bodily Pain

0.21

0.23

0.24

0.26

General Health

0.21

0.33

0.28

0.32

Vitality/Energy

0.34

0.50

0.45

0.52

Social Functioning

0.44

0.50

0.45

0.51

Role - Emotional

0.34

0.40

0.42

0.43

Mental Health

0.27

0.30

0.29

0.34

PCS

0.25

0.30

0.29

0.34

MCS

0.44

0.54

0.51

0.54

Construct validity of the MD Anderson Dysphagia Index (MDADI) was determined through correlating the subscales of the SF-36 and MDADI; Spearman correlation coefficient strength: > 0.60 = strong, 0.40-0.60 = moderate to substantial, < 0.40 = weak)

Patients with Head and Neck Cancer Who Underwent Selective or Modified Radical Neck Dissection: (Taylor et al., 2002; n = 54; minimum postoperative convalescence period = 11 months) 

Convergent Validity of the Neck Dissection Impairment Index (NDII):

Subscale

Correlation to NDII

Physical functioning

0.50

Role limitation, physical

0.60

Role limitation, mental

0.59

Social functioning

0.62

Mental health

0.56

Energy/Vitality

0.44

Pain

0.32

General health perception

0.55

Spearman or Pearson correlations not specified


Patients Undergoing Surgery for Oral or Oropharyngeal SCCA: (Rogers et al., 1998)

Correlation between SF-36 and University of Washington Hand and Neck Questionnaire:

Subscale

Pearson's Correlation

Physical functioning

0.61, p < 0.001

Role limitation, physical

0.66, p < 0.001

Role limitation, mental

0.47, p < 0.01

Social functioning

0.54, p < 0.001

Mental health

-0.08

Energy/Vitality

0.43, p < 0.01

Pain

0.61, p < 0.001

General health perception

0.42, p < 0.01
  • Spearman correlation coefficients:
    • SF-36 with European Organization for 嫩B研究院 and Treatment of Cancer (EORTC): r = 0.83
    • SF-36 with University of Washington Head and Neck Disease-Specific Measure (UW-QOL): r = 0.80

Laryngeal Cancer (Italian version): (Mosconi et al., 2000)

  • Convergent Validity - all within subscale coefficients > 0.40
  • Discriminant Validity - higher item-scale correlations found within the subscale than between the subscales

Content Validity

Items that compose the SF-36 were drawn from a number of prior measures including:

  • The General Psychological Well-Being Inventory (GPWBI) (Dupuy, 1984)

  • Physical and role functioning measures (Patrick, Bush, & Chen, 1973; Hulka & Cassel, 1973; Reynolds, Rushing, & Miles, 1974; Stewart, Ware, & Brook, 1981)

  • The Health Perceptions Questionnaire (HPQ) (Ware, 1976)

  • The Functioning and Well-Being Profile (FWBP) (Stewart & Ware, 1992)

Floor/Ceiling Effects

Patients Undergoing Surgery for Oral or Oropharyngeal SCCA: (Rogers et al., 1998)

  • No floor or ceiling effects

Responsiveness

Laryngeal Cancer: (Mosconi et al., 2000; Italian version)

SF36 Subscale

Effect Size

Physical functioning

0.45

Role limitation, physical

0.78

Role limitation, mental

0.40

Social functioning

0.66

Mental health

0.29

Energy/Vitality

0.04

Pain

0.88

General health perception

0.74
   

Component Summary Scores

  

Physical

1.1

Mental

0.09

Reference: first level of treatment extent; 0.60 indicates an important magnitude of change

Mixed Populations

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Construct Validity

Multiple Neurologic Diagnosis (polio, acute stroke, and TBI): McNaughton et al., 2005; n = 308, Polio n = 38, Stroke n = 181, TBI n = 89; mean age: polio = 62.5 (11.3), stroke = 74.4 (12.0), TBI = 34.0 (17.8); gender, female = polio 27%, stroke = 96%, TBI = 32%) 

  • examined validity of the mental component score (MCS) and physical component score (PCS) 
  • Principal component analysis (PCA) on the 12-month measures for subjects with stroke and TBI: 2 dimensions might account for a large proportion of the variability in the data set 
  • Varimax rotation shows that the 2-factor model has 85% of the variance of the underlying variables with 1 factor loading mainly onto the Barthel Index, Functional Independence Meausre (FIM), PCS,Community Integration Questionnaire (CIQ), and London Handicap Scale (LHS) and the other factor mainly onto the MCS

Content Validity

Items that compose the SF-36 were drawn from a number of prior measures including:

  • The General Psychological Well-Being Inventory (GPWBI) (Dupuy, 1984)

  • Physical and role functioning measures (Patrick, Bush, & Chen, 1973; Hulka & Cassel, 1973; Reynolds, Rushing, & Miles, 1974; Stewart, Ware, & Brook, 1981)

  • The Health Perceptions Questionnaire (HPQ) (Ware, 1976)

  • The Functioning and Well-Being Profile (FWBP) (Stewart & Ware, 1992)

Bibliography

Anderson, C., Laubscher, S., et al. (1996). "Validation of the Short Form 36 (SF-36) health survey questionnaire among stroke patients." Stroke 27: 1812-1816.

Andresen, E. M., Fouts, B. S., et al. (1999). "Performance of health-related quality-of-life instruments in a spinal cord injured population." Arch Phys Med Rehabil 80(8): 877.

Banks, P. and Martin, C. R. (2009). "The factor structure of the SF-36 in Parkinson's disease." J Eval Clin Pract 15(3): 460-463.

Brown, C. A., Cheng, E. M., et al. (2009). "SF-36 includes less Parkinson Disease (PD)-targeted content but is more responsive to change than two PD-targeted health-related quality of life measures." Qual Life Res 18(9): 1219-1237.

Cabral, D. L., Glória, E. C., et al. (2012). "Comparisons of the Nottingham Health Profile and the SF-36 health survey for the assessment of quality of life in individuals with chronic stroke." Rev Bras Fisioter 16: 301-308.

Dorman, P., Slattery, J., et al. (1998). "Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke. United Kingdom Collaborators in the International Stroke Trial." Stroke 29: 63-68.

Dorman, P. J., Dennis, M., et al. (1999). "How do scores on the EuroQol relate to scores on the SF-36 after stroke?" Stroke 30: 2146-2151.

Emanuelson, I., Andersson Holmkvist, E., et al. (2003). "Quality of life and post-concussion symptoms in adults after mild traumatic brain injury: a population-based study in western Sweden." Acta Neurol Scand 108(5): 332-338.

Findler, M., Cantor, J., et al. (2001). "The reliability and validity of the SF-36 health survey questionnaire for use with individuals with traumatic brain injury." Brain Inj 15(8): 715-723.

Forchheimer, M., McAweeney, M., et al. (2004). "Use of the SF-36 among persons with spinal cord injury." Am J Phys Med Rehabil 83(5): 390-395.

Guilfoyle, M. R., Seeley, H. M., et al. (2010). "Assessing quality of life after traumatic brain injury: examination of the short form 36 health survey." J Neurotrauma 27(12): 2173-2181.

Hagen, S., Bugge, C., et al. (2003). "Psychometric properties of the SF-36 in the early post-stroke phase." J Adv Nurs 44(5): 461-468.

Jacobsson, L. J., Westerberg, M., et al. (2010). "Health-related quality-of-life and life satisfaction 6-15 years after traumatic brain injuries in northern Sweden." Brain Inj 24(9): 1075-1086.

Katona, M., Schmidt, R., et al. (2015). "Predictors of health-related quality of life in stroke patients after neurological inpatient rehabilitation: A prospective study." Health Qual Life 13: 58. 

Lee, B. B., Simpson, J. M., et al. (2009). "The SF-36 walk-wheel: a simple modification of the SF-36 physical domain improves its responsiveness for measuring health status change in spinal cord injury." Spinal Cord 47(1): 50-55.

Leonardi, M., Raggi, A., et al. (2012). "Relationships between disability, quality of life and prevalence of nonmotor symptoms in Parkinson’s disease." Parkinsonism Relat Disord 18(1): 35-39.

Lin, M. R., Hwang, H. F., et al. (2007). "Comparisons of the brief form of the World Health Organization Quality of Life and Short Form-36 for persons with spinal cord injuries." American journal of physical medicine & rehabilitation 86(2): 104-113.

MacKenzie, E. J., McCarthy, M. L., et al. (2002). "Using the SF-36 for characterizing outcome after multiple trauma involving head injury." J Trauma 52(3): 527-534.

Martinez-Martin, P., Jeukens-Visser, M., et al. (2011). "Health-related quality-of-life scales in Parkinson's disease: critique and recommendations." Mov Disord 26(13): 2371-2380.

McNaughton, H. K., Weatherall, M., et al. (2005). "Functional measures across neurologic disease states: Analysis of factors in common." Arch Phys Med Rehabil 86(11): 2184-2188.

Nilsson, M. H., Drake, A. M., et al. (2010). "Assessment of fall-related self-efficacy and activity avoidance in people with Parkinson's disease." BMC Geriatr 10(1): 78.

Ojo Owolabi, M. (2010). "Psychometric properties of the HRQOLISP-40: A novel, shortened multiculturally valid holistic stroke measure." Neurorehabil and Neural Repair 24: 814-825. 

O'Mahony, P. G., Rodgers, H., et al. (1998). "Is the SF-36 suitable for assessing health status of older stroke patients?" Age Ageing 27: 19-22.

Paniak, C., Phillips, K., et al. (1999). "Sensitivity of three recent questionnaires to mild traumatic brain injury-related effects." J Head Trauma Rehabil 14(3): 211-219.

Steffen, T. and Seney, M. (2008). "Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism." Phys Ther 88(6): 733-746.

Turner-Bowker, D., Bartley, P., et al. (2002). "SF-36? Health Survey & “SF” Bibliography:(1988–2000)." Lincoln, RI: Quality Metric Incorporated.

van Leeuwen, C. M., van der Woude, L. H., et al. (2012). "Validity of the mental health subscale of the SF-36 in persons with spinal cord injury." Spinal Cord 50(9): 707-710.

Wilkinson, P. R., Wolfe, C. D., et al. (1997). "Longer term quality of life and outcome in stroke patients: is the Barthel index alone an adequate measure of outcome?" Qual Health Care 6(3): 125-130.

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