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SF-36

See the SF-36: Links to the measure HERE and HERE

Description
The Short Form-36 (SF-36) is a 36 item questionnaire which measures Quality of Life (QoL) across eight domains, which are both physically and emotionally based. The eight domains that the SF36 measures are as follows: physical functioning; role limitations due to physical health; role limitations due to emotional problems; energy/fatigue; emotional well-being; social functioning; pain; general health. A single item is also included that identifies perceived change in health, making the SF-36 a useful indicator for change in QoL over time and treatment. It is free to use. Over 5000 published studies have been carried out using the SF-36, demonstrating its abilities as a global QoL Measure (applicable to many conditions and professions). There are subtly different scoring instructions (MOS and RAND). We describe the RAND instructions here.

The SF36 has been widely validated for numerous professions and patient groups and can be administered by clinicians or by the patient at home. If carried out by the patient at home clinic time will not be affected. It can take patients at least half an hour to complete the SF-36 and the scoring and interpretation will require some time by the clinician. This is described in later sections.

Shorter versions are available (e.g., the SF-12 or the SF-8) where time is a real issue. These can be accessed in the relevant links section below.

How to collect the data
You can either sit with the patient and complete the measure with them or you can allow them to complete the measure at the end of your session or while at home. This will depend on the needs of your service and the length of time that you have available to spend with the patient. The SF-36 can take some time to complete, so if time is limited it may be better to ask them to complete it at home and return it. If they are not attending your clinic again, providing a stamped addressed envelope for patients to return their completed forms in will improve your return rates. If you are completing the SF-36 with the patient they may ask you for your opinion on what to answer. You should encourage them to think about how they feel – it is not useful for you or them to note down your interpretation on the SF-36; it is about their feelings and their quality of life.

The SF-36 can be used either as an acute measurement or as a longer term measurement of QoL. To measure acute QoL simply ask patients to complete the questions in response to how they have felt in the last week. To measure longer term QoL as patients to complete the questions in response to how they have felt in the last four weeks.

How much data do you need to collect?
The SF-36 can be considered to be quite individual as it is measuring a patient’s quality of life. Because of this there are two answers to ‘how much data should I collect.’

  • If you are using the SF-36 as a clinical measure to demonstrate to a patient the change in their own individual progress, then really the measure is only relevant to them. So you should need to only collect one from the individual patients at timely and meaningful intervals (e.g., before and after a therapy or intervention).
  • If you are using the SF-36 as more of a service evaluation too (e.g., how has overall patient QoL changed over a period of time as a result of your service) then the basic rule applies – the more the better! At minimum you should collect between 30 and 50 SF-36’s from a representative group of patients. However, more would be useful if you have a large patient throughput.

What to do with your raw data – scoring the measure
The scoring instructions for the SF-36 are published here.

In summary, for each of the eight domains that the SF36 measures an aggregate percentage score is produced. The percentage scores range from 0% (lowest or worst possible level of functioning) to 100% (highest or best possible level of functioning).

You can calculate these through using a two-step system. Each of the question responses relate to a different pre-coded numeric value. Using Table 1 from the link above you can translate your raw scores. The raw scores are translated into one from 0 to 100, with 0 representing a very low level of QoL in that item and 100 representing a very positive response to that item. In the second step, you should take these translated scores and work out the mean average for each of the eight scales. The scale information can be found in Table 2 of the link above. To calculate the average you should add up the translated scores for each of the scale items. So, for example, add up the scores for questions 21 and 22 and divide by two to assess the scale ‘pain’; add up the scores for items 17, 18 and 19 and divide by three to assess the scale ‘role limitations due to emotional problems’; continue to do this for all eight scales.

You can further look at a summary of physical QoL (Physical Component Summary; PCS) and emotional QoL (Mental Component summary; MCS) by simply working out the mean average of all of the physically relevant questions and of all of the emotionally relevant items in the way described above.

It may be easier for you if you set up a computerised database (e.g., in MS Excel or similar) to calculate the percentages and averages for you rather than doing it by hand.

Interpreting your findings
The SF-36 measures QoL, which is really quite personal to each individual. Due to this it makes little sense to present normative values about what makes a ‘good’ or a ‘bad’ QoL. No normative values or cut-off scores are therefore presented. However, the scoring of the SF-36 indicates that 0% in a domain represents the poorest possible QoL and 100% indicates full QoL (the best possible result). Taking this into account, it is easy to see that higher the scores on the SF-36 indicate better QoL.

You should be looking at each of the eight domains (and if desired the MCS and PCS).

If you are using this as a clinical tool it is good to discuss with your patient how they feel about their scores and what it means to them. As QoL is very personal, two patients who have the same scores on the SF-36 may actually feel very different about their QoL.

If you are using the SF-36 to look at change in QoL (either for a group of patients or a single patient) you are looking for an increase in the scores to mark an improvement in QoL.

Reporting your findings
See also Stage 5: Reporting Outcomes 

We have not developed a template for reporting your outcomes for this measure. This is due to the very personal nature of QoL in each patient case. However we do have a number of suggestions:

  • Report what measure you have used and what it is. For example: “The RAND Short Form 36 (SF-36) was used to measure patient Quality of Life (QoL) in the clinic. The SF-36 is a generic measure of QoL that has been widely validated for use across a range of health care professions, settings and patients. It measures QoL across eight emotional and physical domains: physical functioning; role limitations due to physical health; role limitations due to emotional problems; energy/fatigue; emotional well-being; social functioning; pain; general health.”
  • Say whether you measured for acute or longer term QoL (one or four week, respectively).
  • Report your findings for each of the eight domains and give an indication of what this means for the patient.
  • If you have used the SF-36 to measure change in QoL following an intervention or course of treatment, what has the change been?
  • Say what you plan to do with these findings – are any actions required?


Relevant Publications
Ware, J.E., & Sherbourne, C.D. (1992). The MOS 36-item short-form health survey (SF-36). Medical Care, 30(6), 473-483.

Copyright/Intellectual property rights
The Medical Outcomes Trust (MOT), Health Assessment Lab (HAL) and QualityMetric Incorporated are the co-copyright holders of the SF-36, SF-12 and SF-8 Health Surveys. More details can be found here. To use the SF-36 you should contact the copyright holder.


You have reached the end of the guidance for this measure.  Move onto Stage 5: Reporting Outcomes.

Or go back to Stage 3: Considering Options to review other measures.

 

© Copyright 2012 NMAHP RU, Stirling University