About

Short form-36 is a non-disease specific, generic scale used to assess the health-related quality of life in individuals. It includes 36 items divided into eight domains of well-being and health-related quality of life (HRQOL). It is a highly versatile tool for comparing the effect of various health conditions on the quality of life.

It has a special role in studying HRQOL in chronic disease conditions, which are the leading cause of disability and drop in the quality of life globally. SF-36 focuses on subjective quality of life, helping to assess the level of satisfaction with life as a whole. It does not have questions related to sickness, income, or social status.

SF-36 is considered one of the best measures of complete well-being and has been mentioned in hundreds of publications and research articles used to measure healthiness in various population groups.

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Introduction

Short form-36 is a non-disease specific, generic scale used to assess the health-related quality of life in individuals. It includes 36 items divided into eight domains of well-being and health-related quality of life (HRQOL). It is a highly versatile tool for comparing the effect of various health conditions on the quality of life.

It has a special role in studying HRQOL in chronic disease conditions, which are the leading cause of disability and drop in the quality of life globally. SF-36 focuses on subjective quality of life, helping to assess the level of satisfaction with life as a whole. It does not have questions related to sickness, income, or social status.

SF-36 is considered one of the best measures of complete well-being and has been mentioned in hundreds of publications and research articles used to measure healthiness in various population groups.

Methods

Most of the questions in SF-36 are about the life during past four weeks. The SF-36 can be completed within 5-10 minutes using Qolty.

Below are the eight domains that are measured through 36 questions to assess the physical, mental and social well-being:

  1. Physical functioning: It measures the ability to carry on both the vigorous activities like participating in sports or climbing stairs, to the moderate daily activities like bathing and getting dressed up.
  2. Physical roles limitation: It measures the ability to perform daily activities like moving things around the home or cleaning.
  3. Emotional roles limitation: a measure of the effect of emotional distress (anxiety or depression) in day-to-day activities.
  4. Social functioning: how the health effects the interaction with family members, friends, neighbors and other social relations?
  5. Bodily pain: a measure of the intensity of pain and interference in doing regular activities at work and home.
  6. General mental health: It assesses the feeling of happiness or depression/anxiety. Also, evaluates the interference of the emotional state of well-being.
  7. Vitality: It is the measure of feeling energetic or tired.
  8. General health perception: It measures the perception of the individuals about their health.

Once the questions have been the answered, result is auto-generated by the Qolty platform, offering flexibility and better data comparability over-time and in various population groups.

Applications

Adorno and Brasil-Neto 2013 studied the effectiveness of certain physiotherapy techniques in patients with chronic nonspecific low back pain. They employed the SF-36 scale to detect changes in the quality of life after the administration of the physical exercises.

Another study regarded SF-36 as a suitable instrument for chronic intestinal failure patients receiving home parental nutrition (Pironi et al., 2004).

It is a perfect tool for large-scale clinical and comparative studies for the assessment of the quality of life. A cost-effective method that is well integrated with automated platforms like Qolty, providing the added advantage of data manipulation. It can be used to assess the health status of individuals or the effectiveness of certain therapeutic approaches.

Translations

SF-36 is one of the most widely translated and validated scale to measure health-related quality of life. Apart from the US English, it has been translated into almost all the major European languages. Translations and validation studies are also available in most major Asian languages like Japanese or Persian (Fukuhara et al., 1998; Montazeri et al., 2005; Wagner et al., 1998).

Results and Data Analysis

Quality of life is estimated in various health conditions through 36 questions. SF-36 provides reliable and better results on automated platforms, where results are auto-generated (0%-100%). High scores represent better health, while the low score indicates bad health.

In one of the studies, quality of life was compared between healthy Italian population and those on home parenteral nutrition (HPN) for benign disease (Pironi et al., 2004).

Below is the assessment of the quality of life in patients suffering from non-specific chronic low back pain. The effectiveness of treatment has been evaluated.

Strengths and Limitations

Perhaps the biggest strength of SF-36 is its cross adaptability in various population and cultural groups. It is a non-disease specific, generic scale and can be implemented to measure the quality of life in numerous conditions. Availability of validation studies for various population groups means that it is the perfect tool for comparative studies, epidemiological research, and random clinical trials (Burholt & Nash, 2011; Contopoulos-Ioannidis et al., 2009).

As with any health measure, SF-36 does have some limitations. It does not measure the quality of sleep, which is an important indicator of health in certain medical conditions. Further, it is not very suitable for the geriatric population group, especially those aged above 65 years of age (Andresen et al.,1999).

Cosmin Checklist

Reliability

  • Cronbach’s alpha computed for internal-consistency reliability exceeded 0.70 for all eight scales (Fukuhara et al., 1998)
  • The acceptable IC value is 0.70. In study A, the value of general health (alpha=0.73) and in Study B role physical (alpha = 0.75) was the closest to this threshold (Stull et al., 2014)
  • For all scores, the Cronbach’s alpha was greater than equal to 0.780. In Study 1 Cronbach’s alphas ranged from 0.78 for the GH scale to 0.97 for the RP scale. Cronbach’s alphas ranged from 0.76 for GH to 0.95 for PF in Study 2 (White et al., 2017).
  • With exception of the VT scale in the total Moroccan sample (α = 0.61) and the VT (α = 0.54) and the SF (α = 0.63) scales in the Moroccan-Arabic language subgroup, Cronbach’s alpha coefficients for the eight SF-36 scales were above 0.70 for all samples (Hoopman et al 2009).

Construct Validity

  • Significant positive correlations were found between physical functioning scores and 6MWT distance at 1 and 2 months (Spearman’s r = 0.31 and 0.36, respectively, p<0.01) (Antonescu et al., 2014).
  • At the end of Study A and Study B, PCS was moderately correlated with the pain VAS (r = −41 and −0.44). Other dimensions show only a weak or sometimes very weak relationship (Stull et al., 2014).

Test-Retest Reliability

  • Pearson’s product-moment correlation coefficients for the results of the questionnaires completed twice ranged from 0.78 to 0.93 (Fukuhara et al., 1998).
  • Intraclass correlation coefficients for all scales were equal to or above 0.731 (White et al., 2017)

Summary and Key Points

  • Outstanding tool for comparing health-related quality of life in different population groups.
  • SF-36 is a non-disease specific, generic scale
  • Translations are available in all the major global languages.
  • Integration with Qolty for better data manipulation and comparison.
  • Measures physical, mental and social well-being of the individual.

References

Andresen, E. M., Gravitt, G. W., Aydelotte, M. E., & Podgorski, C. A. (1999). Limitations of the SF-36 in a sample of nursing home residents. Age and Ageing, 28(6), 562–566.

Burholt, V., & Nash, P. (2011). Short Form 36 (SF-36) Health Survey Questionnaire: normative data for Wales. Journal of Public Health, 33(4), 587–603.

Contopoulos-Ioannidis, D. G., Karvouni, A., Kouri, I., & Ioannidis, J. P. A. (2009). Reporting and interpretation of SF-36 outcomes in randomised trials: systematic review. BMJ, 338, a3006.

Fukuhara, S., Bito, S., Green, J., Hsiao, A., & Kurokawa, K. (1998). Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. Journal of Clinical Epidemiology, 51(11), 1037–1044.

Marta Lúcia Guimarães Resende Adorno and Joaquim Pereira Brasil-Neto. (2013). Assessment of the quality of life through the SF-36 questionnaire in patients with chronic nonspecific low back pain. Acta Ortop Bras; 21(4): 202–207.

Montazeri, A., Goshtasebi, A., Vahdaninia, M., & Gandek, B. (2005). The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 14(3), 875–882.

Pironi, L., Paganelli, F., Mosconi, P., Morselli-Labate, A. M., Spinucci, G., Merli, C., … Miglioli, M. (2004). The SF-36 instrument for the follow-up of health-related quality-of-life assessment of patients undergoing home parenteral nutrition for benign disease. Transplantation Proceedings, 36(2), 255–258.

Wagner, A. K., Gandek, B., Aaronson, N. K., Acquadro, C., Alonso, J., Apolone, G., … Ware, J. E. (1998). Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51(11), 925–932.