36-Item Short Form Survey (SF-36)

Original Editor - Evan Thomas

Top Contributors - Lauren Lopez, Claire Knott, Lucinda hampton and Evan Thomas

Objective

The 36-Item Short Form Survey (SF-36) is an oft-used, well-researched, self-reported measure of health. It stems from a study called the Medical Outcomes Study[1].

It comprises 36 questions which cover eight domains of health[2]:

1) Limitations in physical activities because of health problems.

2) Limitations in social activities because of physical or emotional problems

3) Limitations in usual role activities because of physical health problems

4) Bodily pain

5) General mental health (psychological distress and well-being)

6) Limitations in usual role activities because of emotional problems

7) Vitality (energy and fatigue)

8) General health perceptions

The SF-36 is often used as a measure of a person or population's quality of life (QOL).

Intended Population

The original authors designed the SF-36 to measure health at the individual level in clinical practice and research and at the population level for health policy evaluations, and general population surveys[2]. It has been used in thousands of research studies[3]. The SF-36 was originally designed as a generic health measure but has also been applied to specific disease populations.

Method of Use

Patients or individuals are asked to fill out the questionnaire (tick boxes) by themselves and then it is scored by a clinician or researcher. There are variations of the the SF-36; it is both licensed (Optum) and available freely online (Rand). Both sources are from different original authors and contain the same 36 questions and answers only differing slightly in the bodily pain and general health domains[4]. Users should document which version they are using and use the corresponding scoring system.

Scores for the different domains are converted and pooled using a scoring key, for a total score indicating a range of low to high QOL. Two component scores can also be tallied; a physical component summary and a mental component summary[4] but research suggests interpretation can be difficult and should be done in comparison to the overall score or profile[5][6]. Similarly, research also suggests that the SF-36 cannot be used as a single index of over all health-related QOL because it measures two dimensions (physical and mental)[3].

See Resources below for scoring instructions.

Evidence

Reliability

The SF-36 has been shown to be reliable for people with schizophrenia[7] and long-term survivors of childhood cancer[8].

Validity

The SF-36 has been shown to be valid for people with schizophrenia[7], stroke (the physical and mental health domains, the social functioning less so)[9], mobility disability in the elderly[10], community-dwelling older adults[11] and dyspnea in COPD[12].

Responsiveness

Research has shown the SF-36 to be the most responsive to change in workers with musculoskeletal disorders compared with similar generic health measures[13].

Miscellaneous

The SF-36 is available in multiple languages.

Resources

References

  1. Ware J. SF-36 Health Survey Update. Spine. 2000. 25; 24: 3130-3139.
  2. 2.0 2.1 Ware Jr., J.E. and Sherbourne, C.D. (1992) The MOS 36-Item Short-Form Health Survey (SF-36). I. Conceptual Framework and Item Selection. Medical Care, 30, 473-483. 
  3. 3.0 3.1 Lins L, Carvalho F. SF-36 total score as a single measure of health-related quality of life: Scoping review. SAGE Open Med. 2016. Published online 2016 Oct 4. doi: 10.1177/2050312116671725. Accessed 16 January 2020.
  4. 4.0 4.1 Laucis N, Hays R, Bhattacharyya T. Scoring the SF-36 in Orthopaedics: A Brief Guide. J Bone Joint Surg Am. 2015 Oct 7; 97(19): 1628–1634. Published online 2015 Oct 7. doi: 10.2106/JBJS.O.00030. Accessed 15 January 2020.
  5. Taft C, Karlsson J, Sullivan M. Do SF-36 summary component scores accurately summarize subscale scores? Qual Life Res. 2001. 10; 5:395-404.
  6. Ware JE, Kosinski M. Interpreting SF-36 summary health measures: a response. Qual Life Res. 2001;10(5):405-13; discussion 415-20.
  7. 7.0 7.1 Su, C.-T., Ng, H.-S., Yang, A.-L., & Lin, C.-Y. (2014). Psychometric evaluation of the Short Form 36 Health Survey (SF-36) and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) for patients with schizophrenia. Psychological Assessment. 2014. 26(3), 980–989
  8. Reulen R, Zeegers M, Jenkinson C. The use of the SF-36 questionnaire in adult survivors of childhood cancer: evaluation of data quality, score reliability, and scaling assumptions. Health Qual Life Outcomes. 2006. 4; 77 doi:10.1186/1477-7525-4-77. Accessed 16 January 2020.
  9. Anderson C, Laubscher S, Burns R. Validation of the Short Form 36 (SF-36) Health Survey Questionnaire Among Stroke Patients. Stroke. 1996;27:1812–1816. Accessed 16 January 2020.
  10. Syddall H, Martin H, Harwood R, Cooper C, Aihie Sayer A. The SF-36: A simple, effective measure of mobility-disability for epidemiological studies. J Nutr Health Aging. 2009; 13: 57-62.
  11. Walters S, Munro J, Brazier J. Using the SF-36 with older adults: a cross-sectional community-based survey. Age and Ageing. 2001; 30: 337-343. Accessed 16 January 2020.
  12. Mahler D, Mackowiak J. Evaluation of the Short-Form 36-Item Questionnaire to Measure Health-Related Quality of Life in Patients With COPD. Chest. 1995. 107; 6: 1585-1589.
  13. Beaton D, Hogg-Johnson S, Bombardier C. Evaluating changes in health status: Reliability and responsiveness of five generic health status measures in workers with musculoskeletal disorders. J Clin Epidemiol. 1997. 50; 1:79-93.