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Sf-36
Submitted To
Prof. Sk. Feroz Uddin Ahmed Advisor Department of Pharmacy Primeasia University
Submitted By
NAME : Arfia Chowdhury ID: 123-008-062 Semester: Fall, 2013
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Content
Page No.
Introduction . Medical Outcomes Study: 36-Item Short Form Survey . Difference between the SF-36 and the RAND-36 .. SF-36 Literature SF-36v2 Health Survey (Version 2.0) Construction of the SF-36 Scoring and Norms .. Layout . Type-size and Bolding Wording Changes . Psychometric Considerations SF-36 Measurement Model .. Five-Choice Response Scales Content of the SF-36 Health Survey Comparability of Results Acute (1-week recall) Form Administration Methods and Scoring . How much data need to collect .. Uses Limitations . Conclusion .. Reference .
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SF-36
Short-Form (36 questions) of Health Survey
Introduction
The Short Form (36) Health Survey is a survey of patient health. The SF-36 is a multi-purpose, shortform health survey with only 36 questions. It yields an 8-scale profile of functional health and wellbeing scores as well as psychometrically-based physical and mental health summary measures and a preference-based health utility index. It is a generic measure, as opposed to one that targets a specific age, disease, or treatment group. Accordingly, the SF-36 has proven useful in surveys of general and specific populations, comparing the relative burden of diseases, and in differentiating the health benefits produced by a wide range of different treatments. This book chapter summarizes the steps in the construction of the SF-36; how it led to the development of an even shorter (1-page, 2minute) survey form -- the SF-12; the improvements reflected in Version 2.0 of the SF-36; psychometric studies of assumptions underlying scale construction and scoring; how they have been translated in more than 50 countries as part of the International Quality of Life Assessment (IQOLA) Project; and studies of reliability and validity.
SF-36 Literature
The experience to date with the SF-36 has been documented in nearly 4,000 publications; citations for those published in 1988 through 2000 are documented in a bibliography covering the SF-36 and other instruments in the SF family of tools. The most complete information about the history and development of the SF-36, its psychometric evaluation, studies of reliability and validity, and normative data is available in the first of three SF-36 users manuals. This information was also summarized in the first two peer-reviewed articles about the SF-36. A second manual documents the
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development and validation of the SF-36 physical and mental component summary measures and presents norms for those measures. These users manuals have been updated to include more up-todate norms and other findings and to document the much improved Version 2.0 (SF-36v2), which are discussed below A fourth manual, first published in 1995 and recently updated presents similar information for the SF-12 Health Survey, an even shorter version constructed from a subset of 12 SF36 items. One of the most complete independent accounts of the development of the SF-36 along with a critical commentary is offered by McDowell and Newell (1996). More recently, the SF-36 was judged to be the most widely evaluated generic patient assessed health outcome measure in a bibliographic study of the growth of quality of life measures published in the British Medical Journal. Additional information about the SF-36 literature and a community forum for discussing old and new publications and the interpretation of results are available on the SF-36 web page (http://www.sf-36.com). The usefulness of the SF-36 in estimating disease burden and comparing disease-specific benchmarks with general population norms is illustrated in articles describing more than 200 diseases and conditions. Among the most frequently studied diseases and conditions, with 50 or more SF-36 publications each, are: arthritis, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, depression, diabetes, gastro-intestinal disease, migraine headache, HIV/aids, hypertension, irritable bowel syndrome, kidney disease, low back pain, multiple sclerosis, musculoskeletal conditions, neuromuscular conditions, osteoarthritis, psychiatric diagnoses, rheumatoid arthritis, sleep disorders, spinal injuries, stroke, substance abuse, surgical procedures, transplantation, and trauma. Translations of the SF-36 have been the subject of more than 500 publications involving investigators in 22 countries. Ten or more studies have been published from 13 countries.
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Layout
All responses to questions in Version 2.0 are printed in a left-to-right (also referred to as horizontal) format, rather than with the mixture of horizontal and vertical listings of response choices that were printed below questions in the MOS and in the original SF-36. Mixed formats of response choices confuse respondents and cause missing and inconsistent responses, particularly among the elderly. Other improvements include more consistent use of indenting, numbering of instructions, deletion of useless item labels, and a simpler formatting of boxes that are checked by respondents.
Wording Changes
Evidence from numerous focus group studies, formal cognitive tests, and from empirical studies in more than a dozen countries support the improvements in item wording and the changes in some terms used to identify health concepts adopted in Version 2.0. These improvements make the English-language SF-36 easier to understand and administer as well as making it more objective. Version 2.0 is also more comparable with translations of the SF-36. Because most of the improvements in item wording were developed during the process of translating and adapting the SF36 for use in other countries during the International Quality of Life Assessment (IQOLA) Project, Version 2.0 is sometimes referred to as the international version.
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The eight scales are hypothesized to form two distinct higher-ordered clusters due to the physical and mental health variance that they have in common. Factor analytic studies have confirmed physical and mental health factors that account for 80-85% of the reliable variance in the eight scales in the U.S. general population, among MOS patients, and in general populations in Sweden and the UK. As of 1998, these studies had been replicated in more than a dozen countries. Three scales (PF, RP, BP) correlate most highly with the physical component and contribute most to the scoring of the Physical Component Summary (PCS) measure. The mental component correlates most highly with the MH, RE, and SF scales, which also contribute most to the scoring of the Mental
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Component Summary (MCS) measure. Three of the scales (VT, GH, and SF) have noteworthy correlations with both components.
SF-36 QUESTIONS
1. In general, would you say your health is: 2. Compared to one year ago, how would you rate your health in general now? 3. The following items are about activities you might do during a typical day. Does your health now limit you in these activities? Is so, how much? a.Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports b.Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf c. Lifting or carrying groceries d. Climbing several flights of stairs e. Climbing one flight of stairs f. Bending, kneeling, or stooping g. Walking more than a mile h. Walking several blocks i. Walking one block j. Bathing or dressing yourself 4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? a. Cut down on the amount of time you spent on work or other activities b. Accomplished less than you would like c. Were limited in the kind of work or other activities. d. Had difficulty performing the work or other activities (for example, it took extra effort) 5. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious) a. Cut down on the amount of time you spent on work or other activities b. Accomplished less than you would like c. Didnt do work or other activities as carefully as usual 6. During the past 4 weeks, to what extent has your physical health or emotional problems interfered
PF01 PF02 PF03 PF04 PF05 PF06 PF07 PF08 PF09 PF10
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BP1 BP2
with your normal social activities with family, frends, neighbors, or groups? 7. How much bodily pain have you had during the past 4 weeks? 8. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? 9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks a. Did you feel full of pep? b. Have you been a very nervous person? c. Have you felt so down in the dumps that nothing could cheer you up? d. Have you felt calm and peaceful? e. Did you have a lot of energy? f. Have you felt downhearted and blue? g. Did you feel worn out? h. Have you been a happy person? i. Did you feel tired? 10. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)? 11. How TRUE or FALSE is each of the following statements for you? a. I seem to get sick a little easier than other people b. I am as healthy as anybody I know c. I expect my health to get worse d. My health is excellent
VT1 MH1 MH2 MH3 VT2 MH4 VT3 MH5 VT4 SF2
Comparability of Results
To make Version 1.0 easier to interpret and directly comparable to published results based on Version 2.0, cross-sectional and longitudinal norms for general and specific populations were re-estimated for Version 1.0 using NBS for all eight scales and for the two summary measures. Further, national calibration studies were fielded in the U.S. in 1998 and 1999 to evaluate the effect of all improvements and to assure the comparability of average scores across Versions 1.0 and 2.0.
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Uses
Evaluating individual patients health status Researching the cost-effectiveness of a treatment Monitoring and comparing disease burden
Limitations
The survey does not take into consideration a sleep variable The survey has a low response rate in the >65 population
Conclusion
The SF-36 is a generic measure, as opposed to one that targets a specific age, disease, or treatment group. Thus, it has been useful in assessing the health of general and specific populations, comparing the relative burden of diseases, differentiating the health benefits produced by a wide range of treatments, and screening individual patients. The widespread applicability of the SF-36 is apparent in the more than 5,000 publications that have used this measure.
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Reference
http://www.rand.org/health/surveys_tools/mos/mos_core_36item.html
Garratt AM, Ruta DA, Abdalla MI, Buckingham JK, Russell IT. The SF-36 Health Survey Questionnaire: an outcome measure suitable for routine use within the NHS? British Medical Journal 1993; 306:14404. Garratt AM, Ruta DA, Abdalla MI, Russell IT. SF-36 Health Survey Questionnaire: II. responsiveness to changes in health status in four common clinical conditons. Quality in Health Care 1994; 3:186-92. Garratt AM, Schmidt L, Mackintosh A, Fitzpatrick R. Quality of life measurement: bibliographic study of patient assessed health outcome measures. British Medical Journal 2002; 324:1417-1421. Haley, S.M., McHorney, C.A., and Ware, J.E. "Evaluation of the MOS SF 36 Physical Functioning scale (PF 10): I. Unidimensionality and Reproducibility of the Rasch item scale," Journal of Clinical Epidemiology, 1994;47(6):671-684.
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