Vol. 17 Issue 12
The Medical Outcomes Study, In Short Form
There are not many individuals who have done research in the health care setting who have not heard of The Medical Outcomes Study short form, more popularly known as the SF-36. The SF-36 for some is considered a breakthrough instrument for measuring health status and outcomes from the patient's point of view.1
The SF-36 contains 36 items and measures eight domains of health including 1) physical functioning, 2) role limitations due to physical health, 3) bodily pain, 4) general health perceptions, 5) vitality (energy and fatigue), 6) social functioning, 7) role limitations due to emotional problems, and 8) mental health (psychological distress and well-being).
The SF-36 may be selfÐadministered, overseen by trained interviewers either in person or by telephone, or completed via computer. It was developed to be used across a variety of ages, beginning at 14 years.
The SF-36 takes approximately 5 to 10 minutes to complete, making it one of the more time-efficient surveys.2,3 The stated recommended use for the SF-36 is for surveys of general and disease specific populations, health policy evaluations, and clinical practice and research.1
The SF-36 has been used, and the validity and reliability assessed, in a variety of clinical studies with a variety of patient populations, including stroke, with a Medline search indicating more than 95 articles,3,4 Parkinson's disease,5 epilepsy,6 headaches7 and multiple scelerosis.8-10 These and other clinical studies have found the SF-36 to have adequate psychometric integrity.11,12 The eight domains, Cronbach's alpha and internal consistency are summed up in the table.
The two composite summary scores measure physical health and mental health and have reliability estimate scores that usually exceed .90.12 In a bibliographic study evaluating health outcome measures, Garratt et al. judged the SF-36 to be the most widely evaluated generic patient assessed health outcome measure used to measure quality of life.14
SF-36v2™ Health Survey
In 1996, Ware and colleagues introduced version 2.0 of the SF-36 (SF-36v2). This, they noted, was done to correct deficiencies identified in the original version.15 The improvements have been documented in the most recent users manual authored by the developers.16 Briefly, these improvements include:
Shortened, simplified, less ambiguous wording;
Improved layout for questions and answers in the self-administered forms;
Greater comparability with translations and cultural adaptations widely-used in the U.S. and in other countries;
Five-level response choices in place of dichotomous response choices for seven items in the two role functioning scales;
Five-level (in place of six-level) response categories to simplify items in the mental health (MH) and vitality (VT) scales.
Scoring of version 2 of the SF-36 is accomplished using norm-based scoring algorithms for all eight scales (T score transformations with mean 50±10 SD).16
It is highly recommended that the user's manual be obtained prior to attempting to use and interpret the responses for either version of the SF- 36. The manual can be obtained, as well as permission to use the measure(s) online at http://www.sf-36.org/tools/sfsurveys.aspx.17
Overall, the SF-36 appears to be a valid and reliable quality-of-life measure for individuals across many age and disease groups. Both clinicians and researchers working with the older adult population can use the SF-36 as a quick and easily administered way to assess function and quality of life.
1. Ware, J., & Sherbourne, C. (1992). The MOS 36-item short-form health survey (SF-36). 1. Conceptual framework and item selection. Med Care, 30, 473-483.
2. Ware, J.E., Snow, K., Kosinki, M., & Gandek, B. (1993). SF-36 Health survey manual and interpretation guide. Boston, MA: Nimrod Press.
3. Hobart, J., Williams, L., Moran, K., & Thompson, A. (2002). Quality of life measurement after stroke: Uses and abuses of the SF-36. Stroke, 33, 1348-1358.
4. Anderson, C., Laubscher, S., & Burns, R. (1996). Validation of the short form 36 (SF-36) health survey questionnaire among stroke patients. Stroke, 27, 1812-1816.
5. Pechevis, M., Clarke, C., et al. (2005). Effects of dyskinesias in Parkinson's disease on quality of life and health-related costs: A prospective European study. European Journal of Neurology, 12(12), 956-963.
6. Jacoby, A., Baker, G., Steen, N., & Buck, D. (1999). The SF-36 as a health status measure for epilepsy: A psychometric analysis. Quality of Life Research, 8, 351-364.
7. Monzon, M., & Lainesz, M. (1998). Quality of life in migraine and chronic daily headache patients. Cephalagia, 18, 638-634.
8. Freeman, J., Langdon, D., Hobart, J., & Thompson, A. (1996). Health-related quality of life in people with multiple sclerosis undergoing inpatient rehabilitation. Journal of Neurological Rehabilitation, 10, 185-194.
9. Rothwell, P., McDowell, A., Wong, C., & Dorman, P. (1997). Doctors and patients don't agree: Cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis. British Medical Journal, 314, 1580-1583.
10. The Canadian Burden of Illness Study Group. (1998). Burden of illness of multiple sclerosis: Part II: Quality of life. Canadian Journal of Neurological Science, 25, 31-38.
11. McHorney, C., Ware, J.E., & Raczek, A. (1993). The MOS 36-Item short form health survey (SF-36): Part II. Psychometric and Clinical Tests of validity in measuring physical and mental health constructs. Med Care, 31, 247-263.
12. Ware, J.E., & Sherbourne, C. (1992). The MOS 36-item short form health survey (SF-36.) Part I. Conceptual framework and item selection. Med Care, 30, 473-483.
13. Scott, K., Tobias, M., Sarfati, D., & Haslett, S. (1999). SF-36 health survey reliability, validity and norms for New Zealand. Australian and New Zealand Journal of Public Health, 23, 401-406.
14. Garratt, A., Schmidt, L., Mackintosh, A., & Fitzpatrick, R. (2002). Quality of life measurement: Bibliographic study of patient assessed health outcome measures. British Medical Journal, 324, 1417-1422.
15. Ware, J.E., & Kosinski, M. (1997). The SF-36 Health Survey (Version 2.0). Technical Note. Boston, MA: Health Assessment Lab.
16. Ware, J.E., Jr. (2000). SF-36 Health Survey update. Spine, 25, 3130-3139.
Dr. Lewis is a physical therapist in private practice and president of Premier Physical Therapy of Washington, DC. She lectures exclusively for GREAT Seminars and Books, Inc. Dr. Lewis is also the author of numerous textbooks. Her Website address is www.greatseminarsandbooks.com. Dr. Shaw is an assistant professor in the physical therapy program at the University of South Florida dedicated to the area of geriatric rehabilitation. She lectures exclusively for GREAT Seminars and Books in the area of geriatric function.