SF - 36 calidad de vida
4
8/19/2019 SF - 36 calidad de vida http://slidepdf.com/reader/full/sf-36-calidad-de-vida 1/4 PAPERS Short form 36 (SF 36) health survey questionnaire: normative data for adults of working age Crispin Jenkinson, Angela Coulter, Lucie Wright Abstract Objectives-To gain population norms for the short form 36 health survey questionnaire (SF36) in a large community sample and to explore the questionnaire's internal consistency and validity. Design-Postal survey by using a booklet contain- ing the SF 36 and several other items concerned with lifestyles and illness. Setting--The sample was drawn from computer- ised registers of the family health services authorities for Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire. Sample-13 042 randomly selected subjects aged 18-64 years. Main outcome measures-Scores for the eight health dimensions of the SF 36. Results-The survey achieved a response rate of 72 (n=9332). Internal consistency of the different dimensions of the questionnaire w as high. Norma- tive data broken down by age, sex, and social class were consistent with those from previous studies. Conclusions-The SF36 is a potentially valuable tool in medical research. The normative data provided here m ay further facilitate its validation and use. Introduction One of the most dramatic developments in health care in the past 10 years has been the increasing consensus about the importance of subjective accounts of health in monitoring medical outcomes.' Tradi- tional measures of morbidity and mortality are generally agreed to be too narrow to measure the potential benefits of health care interventions that can influence a wide number of variables such as physical mobility, emotional wellbeing, social life, and overall wellbeing.3 Researchers have developed many questionnaires which are specific for various illnesses and are intended to tap the various domains ill health can affect,'6 but the search for a generic questionnaire that is easy to administer, acceptable to patients, and short as well as being fullyvalidated has been a venture with few successes. One of the more widely used questionnaires has been the Nottingham health pro- file.7 This questionnaire contains 38 items, is accept- able to patients, and requires only a few minutes to complete. It has, however, been criticised because of its inability to detect low levels of disability that are important not only clinically but also to respon- dents.' A n ew measure has recently been introduced into this country that was developed from the Rand Corporation's health insurance experiment in the United States of America. The purposes and methods of the Rand study have been fully summarised elsewhere.' I The n ew questionnaire, developed from an original lengthy battery of questions, is the short form 36 (SF 36), a questionnaire containing 36 items covering nine variables. The purpose of the present paper is to provide population norms for the SF 36 from a large scale community sample. Community norms are important as they provide a base level of results on the question- naire. As the designers of the SF 36 have themselves stated, the problem with scale scores is that they do not lend themselves to easy interpretation.'2 This is especially true in questionnaires such as the SF 36, in which certain items are weighted. The designers suggest, however, that when normative data sets exist these can be used for comparison purposes with other populations and samples.'2 To date only one study has provided any normative data for the SF 36 in Britain. The purpose of that study, however, was not primarily to gain normative data and hence the sample size was smaller than the one we report here.3 As well as providing normative data we also studied the internal consistency and validity of the questionnaire and outline the possible limitations of which potential users must be aware. Methods The SF36 is a short questionnaire with 36 items which measure eight multi-item variables: physical functioning (10 items), social functioning (two items), role limitations due to physical problems (four items), role limitations due to emotional problems (three items), mental health (five items), energy and vitality (four items), pain (two items), and general perception of health (five items). There is a further unscaled single item on changes in respondents' health over the past year. For each variable item scores are coded, summed, and transformed on to a scale from 0 (worst possible health state measured by the questionnaire) to 100 (best possible health state). Minor modifications to the wording of six items on the SF 36 were made to make it acceptable for British subjects. The changes are similar to those reported in the Sheffield study.3 Our results are based on data gained from the Oxford healthy life survey. This was a postal survey in which the SF36 and questions on lifestyle and demo- graphics were incorporated into a booklet. A covering letter, explaining the purpose of the study, was sent with the questionnaire. To those who did not respond to the initial questionnaire a reminder on a postcard was sent about four to six weeks later. If this elicited no response then another questionnaire and covering letter were sent. In addition to the SF36 the questionnaire booklet contained questions on whether or not the respondents had any long standing illness and also whether they had consulted a medical practitioner in the past two weeks because of problems with their health. The questionnaire booklet was sent to 13 042 randomly selected subjects, unstratified by age or sex, BMJ VOLUM 306 29mAy1993 Health Services Research Unit, Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE Crispin Jenkinson, research officer in health outcomes Angela Coulter, deputy director Lucie Wright, research officer Correspondence to: Dr Jenkinson. BM J 1993;306:143740 1437
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Transcript of SF - 36 calidad de vida
8/19/2019 SF - 36 calidad de vida
http://slidepdf.com/reader/full/sf-36-calidad-de-vida 1/4
PAPERS
S h o r t
f o r m
3 6
( S F 3 6 )
h e a l t h
survey q u e s t i o n n a i r e :
n o r m a t i v e
d a t a
f o r
a d u l t s
o f
w o r k i n g
age
C r i s p i n J e n k i n s o n , A n g e l a
C o u l t e r ,
L u c i e
W r i g h t
A b s t r a c t
O b j e c t i v e s - T o
g a i n p o p u l a t i o n
n o r m s f o r t h e
s h o r t
f o r m 3 6
h e a l t h
s u r v e y q u e s t i o n n a i r e
( S F 3 6 )
i n a l a r g e c o m m u n i t y s a m p l e
a n d
t o
e x p l o r e
t h e
q u e s t i o n n a i r e ' s
i n t e r n a l c o n s i s t e n c y
a n d
v a l i d i t y .
D e s i g n - P o s t a l
s u r v e y
b y
u s i n g
a
b o o k l e t
c o n t a i n -
i n g
t h e SF 3 6
a n d
s e v e r a l
o t h e r
i t e m s
c o n c e r n e d
w i t h
l i f e s t y l e s
a n d i l l n e s s .
S e t t i n g - - T h e
s a m p l e
w a s
d r a w n f r o m
c o m p u t e r -
i s e d r e g i s t e r s
o f
t h e
f a m i l y
h e a l t h
s e r v i c e s a u t h o r i t i e s
f o r B e r k s h i r e , B u c k i n g h a m s h i r e ,
N o r t h a m p t o n s h i r e ,
a n d
O x f o r d s h i r e .
S a m p l e - 1 3
0 4 2
r a n d o m l y
s e l e c t e d
s u b j e c t s a g e d
1 8 - 6 4
y e a r s .
M a i n o u t c o m e
m e a s u r e s - S c o r e s
f o r
t h e
e i g h t
h e a l t h
d i m e n s i o n s
o f t h e
SF
3 6 .
R e s u l t s - T h e s u r v e y
a c h i e v e d a
r e s p o n s e
r a t e
o f
72 ( n = 9 3 3 2 ) .
I n t e r n a l
c o n s i s t e n c y
o f
t h e d i f f e r e n t
d i m e n s i o n s
o f t h e
q u e s t i o n n a i r e
was
h i g h .
Norma-
t i v e
d a t a b r o k e n
down
b y
a g e ,
s e x ,
a n d s o c i a l c l a s s
w e r e
c o n s i s t e n t
w i t h t h o s e f r o m
p r e v i o u s
s t u d i e s .
C o n c l u s i o n s - T h e
S F 3 6
i s a
p o t e n t i a l l y
v a l u a b l e
t o o l i n
m e d i c a l r e s e a r c h .
T h e
n o r m a t i v e
d a t a
p r o v i d e d
h e r e
may
f u r t h e r f a c i l i t a t e
i t s v a l i d a t i o n
a n d
u s e .
I n t r o d u c t i o n
O n e o f
t h e m o s t d r a m a t i c
d e v e l o p m e n t s
i n h e a l t h
c a r e
i n t h e
p a s t
1 0
y e a r s
h a s
b e e n t h e
i n c r e a s i n g
c o n s e n s u s
a b o u t t h e
i m p o r t a n c e
o f
s u b j e c t i v e
a c c o u n t s
o f
h e a l t h
i n
m o n i t o r i n g
m e d i c a l o u t c o m e s . '
T r a d i -
t i o n a l m e a s u r e s
o f
m o r b i d i t y
a n d
m o r t a l i t y
a r e
g e n e r a l l y a g r e e d
t o b e
t o o
n a r r o w t o
m e a s u r e t h e
p o t e n t i a l
b e n e f i t s o f
h e a l t h c a r e
i n t e r v e n t i o n s
t h a t
c a n
i n f l u e n c e a
w i d e
n u m b e r o f
v a r i a b l e s
s u c h
a s
p h y s i c a l
m o b i l i t y ,
e m o t i o n a l
w e l l b e i n g , s o c i a l
l i f e ,
a n d
o v e r a l l
w e l l b e i n g . 3
R e s e a r c h e r s
h a v e
d e v e l o p e d
many
q u e s t i o n n a i r e s
w h i c h
a r e
s p e c i f i c
f o r v a r i o u s
i l l n e s s e s
a n d
a r e
i n t e n d e d
t o
t a p
t h e
v a r i o u s
d o m a i n s
i l l
h e a l t h
c a n
a f f e c t , ' 6
b u t
t h e s e a r c h
f o r a
g e n e r i c
q u e s t i o n n a i r e
t h a t
i s
e a s y
t o
a d m i n i s t e r , a c c e p t a b l e
t o
p a t i e n t s ,
a n d
s h o r t a s
w e l l
a s
b e i n g f u l l y
v a l i d a t e d
h a s
b e e n
a v e n t u r e
w i t h
f e w
s u c c e s s e s .
One
o f t h e m o r e
w i d e l y
u s e d
q u e s t i o n n a i r e s
h a s
b e e n t h e
N o t t i n g h a m
h e a l t h
p r o -
f i l e . 7
T h i s
q u e s t i o n n a i r e
c o n t a i n s 3 8
i t e m s ,
i s
a c c e p t -
a b l e
t o
p a t i e n t s ,
a n d
r e q u i r e s o n l y
a
f e w
m i n u t e s
t o
c o m p l e t e .
I t
h a s ,
h o w e v e r ,
b e e n c r i t i c i s e d b e c a u s e
o f i t s
i n a b i l i t y
t o d e t e c t
l o w l e v e l s o f
d i s a b i l i t y
t h a t
a r e
i m p o r t a n t
n o t
o n l y
c l i n i c a l l y
b u t
a l s o t o
r e s p o n -
d e n t s . '
A new m e a s u r e
h a s
r e c e n t l y
b e e n
i n t r o d u c e d i n t o
t h i s
c o u n t r y
t h a t
w a s
d e v e l o p e d
f r o m t h e
R a n d
C o r p o r a t i o n ' s
h e a l t h
i n s u r a n c e
e x p e r i m e n t
i n
t h e
U n i t e d
S t a t e s o f
A m e r i c a .
The
p u r p o s e s
a n d m e t h o d s
o f t h e
R a n d
s t u d y
h a v e
b e e n
f u l l y
s u m m a r i s e d
e l s e w h e r e . '
I
The
new
q u e s t i o n n a i r e ,
d e v e l o p e d
f r o m
a n
o r i g i n a l l e n g t h y
b a t t e r y
o f
q u e s t i o n s ,
i s t h e s h o r t
f o r m 3 6
( S F
3 6 ) , a q u e s t i o n n a i r e c o n t a i n i n g 3 6
i t e m s
c o v e r i n g n i n e v a r i a b l e s .
The
p u r p o s e o f
t h e
p r e s e n t p a p e r
i s t o
p r o v i d e
p o p u l a t i o n
n o r m s
f o r
t h e
SF 3 6 f r o m a l a r g e
s c a l e
c o m m u n i t y s a m p l e .
C o m m u n i t y n o r m s
a r e i m p o r t a n t
a s t h e y
p r o v i d e
a b a s e l e v e l o f
r e s u l t s o n t h e q u e s t i o n -
n a i r e . A s t h e d e s i g n e r s
o f
t h e SF 3 6
h a v e t h e m s e l v e s
s t a t e d ,
t h e
p r o b l e m
w i t h s c a l e
s c o r e s
i s t h a t t h e y d o
n o t
l e n d
t h e m s e l v e s t o e a s y i n t e r p r e t a t i o n . ' 2
T h i s i s
e s p e c i a l l y t r u e
i n
q u e s t i o n n a i r e s
s u c h
a s
t h e
SF
3 6 ,
i n
w h i c h c e r t a i n i t e m s
a r e
w e i g h t e d .
T h e d e s i g n e r s
s u g g e s t ,
h o w e v e r ,
t h a t w h e n n o r m a t i v e
d a t a
s e t s e x i s t
t h e s e c a n
b e
u s e d
f o r
c o m p a r i s o n
p u r po s e s w i t h
o t h e r
p o p u l a t i o n s
a n d
s a m p l e s . ' 2
To d a t e
o n l y
o n e
s t u d y h a s
p r o v i d e d
a n y n o rm a t i v e d a t a
f o r
t h e
SF 3 6 i n B r i t a i n .
The p u r p o s e o f
t h a t
s t u d y ,
h o w e v e r , w a s n o t p r i m a r i l y
t o
g a i n
n o r m a t i v e d a t a
a n d
h e n c e t h e s a m p l e s i z e
w a s
s m a l l e r t h a n t h e
o n e
w e
r e p o r t
h e r e . 3 A s w e l l
a s
p r o v i d i n g
n o r m a t i v e d a t a w e
a l s o
s t u d i e d
t h e
i n t e r n a l
c o n s i s t e n c y
a n d
v a l i d i t y
o f
t h e
q u e s t i o n n a i r e
a n d
o u t l i n e
t h e
p o s s i b l e
l i m i t a t i o n s o f
w h i c h
p o t e n t i a l
u s e r s
m u s t
b e a w a r e .
M e t h o d s
T h e SF36 i s a
s h o r t
q u e s t i o n n a i r e
w i t h 3 6
i t e m s
w h i c h
m e a s u r e
e i g h t
m u l t i - i t e m v a r i a b l e s :
p h y s i c a l
f u n c t i o n i n g
( 1 0 i t e m s ) ,
s o c i a l f u n c t i o n i n g ( t w o i t e m s ) ,
r o l e l i m i t a t i o n s d u e
t o
p h y s i c a l p r o b l e m s
( f o u r
i t e m s ) ,
r o l e l i m i t a t i o n s d u e
t o e m o t i o n a l
p r o b l e m s
( t h r e e
i t e m s ) ,
m e n t a l
h e a l t h
( f i v e i t e m s ) , e n e r g y
a n d v i t a l i t y
( f o u r i t e m s ) ,
p a i n
( t w o i t e m s ) ,
a n d
g e n e r a l
p e r c e p t i o n
o f h e a l t h
( f i v e
i t e m s ) .
T h e r e i s a f u r t h e r
u n s c a l e d
s i n g l e
i t e m o n
c h a n g e s
i n
r e s p o n d e n t s '
h e a l t h o v e r
t h e p a s t
y e a r .
F o r e a c h v a r i a b l e
i t e m
s c o r e s
a r e c o d e d , s u m m e d ,
a n d t r a n s f o r m e d o n t o a
s c a l e
f r o m 0
( w o r s t
p o s s i b l e
h e a l t h
s t a t e m e a s u r e d
b y
t h e
q u e s t i o n n a i r e )
t o
1 0 0
( b e s t
p o s s i b l e
h e a l t h
s t a t e ) .
M i n o r m o d i f i c a t i o n s t o t h e
w o r d i n g
o f
s i x
i t e m s
o n t h e S F
3 6
w e r e m a d e t o
m a k e
i t
a c c e p t a b l e
f o r B r i t i s h s u b j e c t s .
T h e
c h a n g e s
a r e
s i m i l a r
t o t h o s e
r e p o r t e d
i n
t h e S h e f f i e l d s t u d y . 3
O u r r e s u l t s a r e b a s e d o n d a t a
g a i n e d
f r o m t h e
O x f o r d
h e a l t h y
l i f e
s u r v e y .
T h i s
w a s
a
p o s t a l
s u r v e y
i n
w h i c h
t h e
SF36
a n d
q u e s t i o n s
o n
l i f e s t y l e
a n d d e m o -
g r a p h i c s
w e r e
i n c o r p o r a t e d
i n t o
a
b o o k l e t .
A
c o v e r i n g
l e t t e r ,
e x p l a i n i n g t h e p u r p o s e
o f
t h e s t u d y ,
w a s s e n t
w i t h
t h e
q u e s t i o n n a i r e .
To t h o s e
who d i d
n o t
r e s p o n d
t o t h e i n i t i a l
q u e s t i o n n a i r e
a r e m i n d e r
o n a
p o s t c a r d
w a s
s e n t
a b o u t f o u r
t o s i x w e e k s
l a t e r .
I f
t h i s
e l i c i t e d
n o
r e s p o n s e
t he n a n o t he r
q u e s t i o n n a i r e
a n d
c o v e r i n g
l e t t e r
w e r e
s e n t .
I n a d d i t i o n t o t h e S F 3 6
t h e
q u e s t i o n n a i r e
b o o k l e t
c o n t a i n e d
q u e s t i o n s
o n w h e t h e r o r n o t t h e
r e s p o n d e n t s
h a d
a n y
l o n g
s t a n d i n g
i l l n e s s
a n d
a l s o
w h e t h e r t h e y
h a d
c o n s u l t e d
a
m e d i c a l
p r a c t i t i o n e r
i n
t h e p a s t
t w o
w e e k s
b e c a u s e
o f
p r o b l e m s
w i t h
t h e i r
h e a l t h .
T h e
q u e s t i o n n a i r e
b o o k l e t
w a s
s e n t
t o 1 3 0 4 2
r a n d o m l y
s e l e c t e d
s u b j e c t s ,
u n s t r a t i f i e d
b y a g e
o r
s e x ,
BMJ
VOLUM
3 0 6 29mAy1993
H e a l t h
S e r v i c e s
R e s e a r c h
U n i t , D e p a r t m e n t
o f
P u b l i c
H e a l t h
a n d P r i m a r y C a r e ,
U n i v e r s i t y
o f
O x f o r d ,
R a d c l i f f e
I n f i r m a r y ,
O x f o r d
OX2
6 HE
C r i s p i n
J e n k i n s o n ,
r e s e a r c h
o f f i c e r
i n h e a l t h
o u t c o m e s
A n g e l a
C o u l t e r ,
d e p u t y
d i r e c t o r
L u c i e W r i g h t , r e s e a r c h
o f f i c e r
C o r r e s p o n d e n c e
t o :
D r
J e n k i n s o n .
BMJ
1 9 9 3 ; 3 0 6 : 1 4 3 7 4 0
1 4 3 7
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T A B L E I V - M e a n ( S D ) s c o r e s a n d s a m p l e
s i z e s f o r
e i g h t
v a r i a b l e s
o f
SF36
f o r
m e n
b y
a g e
A g e ( y e a r s )
V a r i a b l e
1 8 - 2 4 2 5 - 3 4 3 5 - 5 4 4 5 - 5 4 5 5 - 6 4
P h y s i c a l f u n c t i o n i n g
9 2 - 8
( 1 6 - 8 )
9 3
9
( 1 4 - 2 )
9 1
9
( 1 4 - 5 )
8 7 - 9
( 1 7 - 4 )
8 0 - 0
( 2 2 - 1 )
n = 5 4 5
n =92 9 n=993 n=815
n = 6 8 1
S o c i a l f u n c t i o n i n g
9 0 - 2
( 1 6 - 4 )
9 1 - 3
( 1 6 - 3 )
9 0
5
( 1 7 - 0 )
8 9 - 8
( 1 8 - 7 )
8 6 - 9
( 2 2 - 6 )
n=556 n = 9 3 5 n = 1 0 0 9 n=844 n=7 29
R o l e
l i m i t a t i o n s :
P h y s i c a l
9 1 - 8
( 2 2 6 )
9 2 - 0
( 2 3 2 )
8 9 - 5
( 2 5 - 5 )
8 7 - 6
( 2 8
3 )
7 8 - 8
( 3 6 - 1 )
n = 5 5 7
n=928
n =
1 0 0 8 n=841 n=717
E m o t i o n a l
8 2 - 9
( 3 1 - 1 )
8 7 - 1
( 2 7 9 )
8 6 - 0
( 2 8
6 )
8 5 - 7
( 2 9 5 )
8 5 - 8
( 2 9
9 )
n = 5 6 0 n = 9 3 1 n = 1 0 0 8 n = 8 4 3 n = 7 1 4
M e n t a l
h e a l t h
7 4 - 8
( 1 5 - 4 )
7 5 - 8
( 1 5 - 2 )
7 5
0
( 1 6 - 1 )
7 6 - 0
( 1 6 - 7 3
7 8 - 0
( 1 7 - 3 )
n = 5 4 8
n =92 7 n =990
n=822 n=697
E n e r g y / v i t a l i t y
6 6 - 4 ( 1 7 - 1 )
6 4 - 5
( 1 7 - 3 )
6 3 - 5
( 1 8 - 6 )
6 2 - 9
( 1 9 9 )
6 2 - 9
( 2 0
3 )
n = 5 5 3 n=927 n=1001 n=83 7
n=707
P a i n
8 6 - 6
( 1 7 - 9 )
8 7 - 5
( 1 7 - 7 )
8 5 - 6
( 1 9 - 7 )
8 1 - 8
( 2 2 2 )
7 8 - 8
( 2 3 6 )
n = 5 5 5
n =934 n = 1 0 0 8 n=843 n = 7 2 4
G e n e r a l h e a l t h
p e r c e p t i o n s
7 2 - 0
( 2 0 - 1 )
7 6 - 7
( 1 7 - 7 )
7 4 - 1
( 1 8 - 5 )
7 2 - 0
( 2 0 - 1 )
6 8 - 1
( 2 2 - 9 )
n=838 n =92 9 n=998 n=838
n=709
T A B L E v-Mean ( S D )
s c o r e s a n d
s a m p l e
s i z e s
f o r
e i g h t
v a r i a b l e s
o f
SF36
f o r
w o m e n
b y a g e
A g e ( y e a r s )
V a r i a b l e
1 8 - 2 4
2 5 - 3 4 3 5 - 5 4 4 5 - 5 4
5 5 - 6 4
P h y s i c a l
f u n c t i o n i n g
9 0 - 1
( 1 6 - 4 )
9 2 - 9
( 1 3 - 3 )
8 9 - 4
( 1 6 - 1 )
8 4 - 8
( 1 8 - 3 )
7 4 8
( 2 3
5 )
n = 7 8 0 n=1 274
n=1183 n=917 n=6 84
S o c i a l
f u n c t i o n i n g 8 5 - 7
( 1 9 - 7 )
8 7 - 1
( 1 8 - 9 )
8 6 - 7
( 2 0 5 )
8 7 - 0
( 2 0 8 )
8 5 - 9
( 2 2 6 )
n = 7 9 1
n =
1 2 9 4
n =12 10 n=97 3
n=783
R o l e
l i m i t a t i o n s :
P h y s i c a l
8 8 - 6
( 2 5 . 5 )
8 6 - 9
( 2 9
2 )
8 4 - 0
( 3 2 0 )
8 2 - 4
( 3 2
0 )
7 6 - 6
( 3 6 9 )
n = 7 8 6
n = 1 2 9 4 n=1210 n = 9 6 0
n=75 7
E m o t i o n a l 7 8 - 8
( 3 3 0 )
8 0 - 6
( 3 4
0 )
8 0 - 3
( 3 3 6 )
8 0 - 8
( 3 3
6 )
8 3 - 3
( 3 2 - 5 )
n = 7 9 2
n =
1 2 9 1
n = 1 2 0 7 n=965
n=756
M e n t a l
h e a l t h
7 0 - 2
( 1 7 - 4 )
7 1 - 6
( 1 5 - 2 )
7 1 - 6
( 1 7 - 8 )
7 3 - 2
( 1 8 - 2 )
7 4 - 4
( 1 8 - 5 )
n = 7 8 7
n = 1 2 8 0
n=1187 n =950
n=742
E n e r g y / v i t a l i t y
5 9 - 8
( 1 9 - 4 )
5 8 - 3
( 1 9 - 5 )
5 8 - 2
( 1 9 9 )
5 9 4
( 2 0 3 )
5 9 0
( 2 1 - 4 )
n=784
n =
1 2 6 9 n = 1 2 0 0
n=957 n=7 63
P a i n
8 1 - 7
( 2 0 8 )
8 2 - 1
( 2 1 - 1 )
7 9 4
( 2 2 - 0 )
7 7 - 4
( 2 2 - 3 )
7 5 0
( 2 5 - 1 )
n=79 0
n =
1 2 9 9
n=1211 n=965
n=779
G e n e r a l
h e a l t h
p e r c e p t i o n s
7 2 - 1
( 2 0 3 )
7 7 - 3
( 1 8 - 5 )
7 4 - 1
( 2 0 - 3 )
7 3 - 1
( 1 9
9 )
6 8 - 0
( 2 2
0 )
n=7 87 n =
1 2 8 5
n = 1 1 9 0 n=950
n=747
D i s c u s s i o n
The r e s u l t s
o f
o u r
s t u d y p ro vi d e e vi d e n c e
f o r
t h e
i n t e r n a l
c o n s i s t e n c y o f
t h e d o m a i n s
o f t h e SF36 a n d
p r o v i d e
n o r m a t i v e d a t a , w h i c h
w i l l ,
we h o p e
b e
u s e f u l
t o r e s e a r c h e r s
who i n t e n d t o u s e t h i s
n e w
m e a s u r e o f
h e a l t h a s s e s s m e n t . B r a z i e r e t
a l
h a v e s u g g e s t e d t h a t t h e
SF
3 6 i s a c c e p t a b l e t o p a t i e n t s ,
h a s h i g h l e v e l s o f
i n t e r n a l v a l i d i t y ,
a n d
g o o d t e s t - r e t e s t p r o p e r t i e s . 3 The
q u e s t i o n n a i r e h a s a d v a n t a g e s o v e r , f o r
e x a m p l e , t h e
s i c k n e s s i m p a c t
p r o f i l e , ' 9
i n
t h a t i t i s
c o n s i d e r a b l y
s h o r t e r ,
a n d
t h e
N o t t i n g h a m h e a l t h
p r o f i l e , 7 8
w h i c h
h a s
b e e n f o u n d
t o
b e
i n s e n s i t i v e t o
l o w e r
l e v e l s
o f
d y s f u n c t i o n a n d d i s a b i l i t y . 3 9 R e s u l t s f r o m t h e SF36
h a v e
t h u s
f a r b e e n
e n c o u r a g i n g , b u t m o r e r e s e a r c h
i s
r e q u i r e d i n B r i t a i n t o d e t e r m i n e i t s v a l i d i t y ,
r e l i a b i l i t y ,
a n d s e n s i t i v i t y
t o
c h a n g e - o r r e s p o n s i v e n e s s
i n
p a t i e n t s w i t h
p a r t i c u l a r
i l l n e s s e s . A t
p r e s e n t
t h e r e i s
l i t t l e w o r k o n t h e l a s t o f t h e s e
p r o p e r t i e s
i n
h e a l t h
a s s e s s m e n t
q u e s t i o n n a i r e s i n g e n e r a l
a n d t h e
SF 3 6 i n
p a r t i c u l a r .
T h i s
a s p e c t ,
h o w e v e r ,
i s
i n c r e a s i n g l y s e e n
a s o n e o f
t h e
i m p o r t a n t
f e a t u r e s
o f
m e a s u r e s
o f
h e a l t h
s t a t u s ,
e s p e c i a l l y
i n a s s e s s m e n t s o f c l i n i c a l i n t e r v e n -
t i o n s . 2 0
2 1
C l i n i c i a n s
a n d
o t h e r u s e r s
o f
q u e s t i o n n a i r e s
s u c h a s
t h e SF36
s h o u l d
a l s o
c o n s i d e r
t h a t
o f f
t h e
s h e l f '
i n d i c e s
t h a t h a v e h i g h
l e v e l s o f
r e l i a b i l i t y ,
v a l i d i t y ,
a n d
r e s p o n s i v e n e s s
may
n o t
n e c e s s a r i l y
b e
a p p r o p r i a t e
f o r
w h a t
t h e y
w a n t t o
m e a s u r e .
The
SF
3 6 , f o r
e x a m p l e ,
c o n t a i n s n o v a r i a b l e o n
s l e e p ,
a n d a t r e a t m e n t a i m e d
a t
r e d u c i n g d i s t u r b a n c e
o f
s l e e p may
n o t b e
a p p r o p r i a t e l y
j u d g e d
b y
u s i n g
t h e SF 3 6 a l o n e . I n
m o s t
c a s e s
i t w i l l
b e
n e c e s s a r y
t o
u s e n o t o nl y a g e n e r i c q u e s t i o n n a i r e b u t
a l s o
o n e
d e s i g n e d
t o
t a p
v a r i a b l e s
s p e c i f i c
t o
t h e
p a r t i c u l a r
c a s e u n d e r
s t u d y .
F u r t h e r m o r e , n o t a l l
q u e s t i o n n a i r e s a r e
a p p r o p r i a t e f o r
a l l
a g e
g r o u p s .
B r a z i e r
e t
a l r e p o r t e d
a
l o w e r
r e s p o n s e
r a t e
f o r t h e
T A B L E vI-Mean
( S D )
s c o r e s a n d
s a m p l e s i z e s f o r e i g h t
v a r i a b l e s
o f
SF36
b y
s t a n d a r d
o c c u p a t i o n a l
c l a s s i f i c a t i o n
O c c u p a t i o n a l
c l a s s i f i c a t i o n
V a r i a b l e
I
I I I I I n o n - m a n u a l I I I m a n u a l I V V
P h y s i c a l
f u n c t i o n i n g
9 3 - 4
( 1 1 - 7 )
90 4
( 1 5 - 4 )
8 8 9
( 1 6 - 5 )
8 7 - 6
( 1 9 - 5 )
8 7 - 6
( 1 8 - 8 )
8 4 - 3
( 2 1 . 3 )
n=3 87
n =2558 n=2 27 4
n =
1 5 6 6
n=988
n = 2 3 6
S o c i a l
f u n c t i o n i n g
9 1 - 0
( 1 6 - 7 )
8 9 - 0
( 1 8 - 2 )
8 7 - 8
( 1 9 - 6 )
8 8 - 6
( 1 9 - 3 )
8 7 - 6
( 1 9 9 )
8 5 - 7
( 2 1 - 3 )
n = 3 9 1 n =2 62 0 n=2 299
n =
1 6 1 6 n =
1 0 0 7
n=26 7
R o l e
l i m i t a t i o n s :
P h y s i c a l
8 9 - 9
( 2 5 - 2 )
8 6 - 7
( 2 8 8 )
8 6 1
( 2 9
3 )
8 7 - 1
( 2 9 - 1 )
8 4 - 6
( 3 1 - 8 )
8 2 - 8
( 3 3 0 )
n=390
n=26 26 n = 2 2 8 4
n =
1 6 0 8 n = 9 9 1
n=258
E m o t i o n a l
8 7 - 3
( 2 6 5 )
8 3 - 1
( 3 1 - 6 )
8 2 - 5
( 3 2 0 )
8 5 - 9
( 2 9 3 )
8 2 - 1
( 3 2
7 )
7 9 - 7
( 3 4 5 )
n = 3 9 1 n=2625
n=2283 n =
1 6 1 6 n=990
n = 2 6 0
M e n t a l
h e a l t h
7 6 - 6
( 1 4 - 7 )
7 5 - 2
( 1 6 - 2 )
7 2 - 9
( 1 7 - 2 )
7 4 - 6
( 1 7 - 3 )
7 2 - 9
( 1 8 - 0 )
7 0 - 8
( 2 0 - 0 )
n=3 84
n=2585
n =2 25 2 n=1573
n=978 n=258
E n e r g y / v i t a l i t y
6 3 - 7
( 1 8 - 8 )
6 1 - 9
( 1 9 - 0 )
6 0 - 1
( 1 9 - 4 )
6 2 - 0
( 2 0 - 1 )
6 0 - 8
( 2 0 0 )
5 8 - 7
( 2 0
3 )
n = 3 8 9
n = 2 5 9 5 n = 2 2 6 7
n=1599
n=987 n=258
P a i n 8 8 - 2
( 1 6 - 2 )
8 3 - 0
( 2 0
2 )
8 1 - 2
( 2 1 - 7 )
8 1 - 6
( 2 2
4 )
8 0 - 0
( 2 3
0 )
7 8 - 6
( 2 3
2 )
n =3 87 n =2 62 0 n = 2 2 9 6 n =1617 n=1008 n=26 6
G e n e r a l h e a l t h
p e r c e p t i o n s
7 5 - 1
( 1 7 - 8 )
7 5 - 2
( 1 8 - 6 )
7 4 - 3
( 1 9 - 5 )
7 2 - 8
( 2 0 - 1 )
7 2 - 1
( 2 0 8 )
7 0 3
( 2 1 - 2 )
n = 3 8 7 n=2587
n = 2 2 7 4 n =
1 6 0 4 n=988
n=255
T A B L E
v i I - M e a n ( S D )
s c o r e s
a n d
s a m p l e
s i z e s
f o r
e i g h t v a r i a b l e s
o f
S F 3 6
b y
s e l f
r e p o r t e d
l o n g s t a n d i n g
i U n e s s
a n d
c o n s u l t a t i o n
w i t h
d o c t o r
i n t w o w e e k s
b e f o r e c o m p l e t i o n o f q u e s t i o n n a i r e
R e s p on de nt s R e s p on de nt s
n o t
r e p o r t i n g r e p o r t i n g
R e s p o n d e n t s R e s p o n d e n t s
l o n g
s t a n d i n g l o n g s t a n d i n g
w ho
d i d
n o t
r e p o r t
w ho
d i d
r e p o r t
V a r i a b l e i l l n e s s i l l n e s s
m e d i c a l c o n s u l t a t i o n
m e d i c a l c o n s u l t a t i o n
P h y s i c a l
f u n c t i o n i n g
9 2 - 5
( 1 3 - 4 )
7 8 - 3
( 2 3
2 )
8 9 - 9
( 1 6 2 )
8 1 - 6
( 2 3 - 0 )
n = 6 3 0 1 n = 2 4 8 9
n=7245
n=1596
S o c i a l
f u n c t i o n i n g
9 1 - 3
( 1 5 - 8 )
8 0 - 2
( 2 4 8 )
9 0
5
( 1 6 - 9 )
7 6 - 9
( 2 6 0 )
n=6506 n = 2 6 2 1
n=7524 n=1671
R o l e
l i m i t a t i o n s :
P h y s i c a l
9 1 - 4
( 2 3 2 )
7 1 - 9
( 3 8 . 9 )
9 0 - 0
( 2 4 9 )
6 6 - 9
( 4 1 - 3 )
n = 6 4 6 8
n = 2 5 0 9
n = 7 4 6 1
n = 1 6 4 2
E m o t i o n a l
8 5 6
( 2 9
3 )
7 6 - 3
( 3 6 - 4 )
8 5 - 2
( 3 8 - 6 )
7 2
7
( 2 9 6 )
n = 6 4 8 5 n = 2 5 0 6
n = 7 4 7 2 n = 1 6 4 3
M e n t a l
h e a l t h 7 5 - 4
( 1 6 - 3 )
6 9 - 9
( 1 8 - 7 )
7 5 - 1
( 1 6 - 3 )
6 8 - 0
( 1 9
9 )
n = 6 3 6 7
n = 2 5 5 3
n = 7 3 5 7 n = 1 6 3 3
E n e r g y / v i t a l i t y
6 4 - 0
( 1 8 - 2 )
5 4
0
( 2 1 - 1 )
6 3 - 0
( 1 8 - 7 )
5 2 - 9
( 2 1 - 9 )
n = 6 4 0 3 n = 2 5 9 0
n=7415 n = 1 6 5 0
P a i n
8 6 - 3
( 1 7 - 9 )
6 9 - 8
( 2 5
4 )
8 4 - 6
( 1 8 - 8 )
6 7 - 7
( 2 7 - 6 )
n =64 97 n=2615 n =7529 n = 1 6 6 2
G e n e r a l h e a l t h
p e r c e p t i o n s
7 8 - 8
( 1 5 - 7 )
6 0 - 8
( 2 3
0 )
7 5 - 7
( 1 8 - 2 )
6 3 - 7
( 2 3 7 )
n=6402 n =2 584
n=741 7
n =
1 6 4 4
SF
3 6
among
t h o s e
o v e r
6 5
y e a r s ,
a n d
s u g g e s t e d
t h a t
d i f f e r e n t
q u e s t i o n n a i r e s may
b e
r e q u i r e d
f o r
t h i s
g r o u p . 3
T h e r e
a r e
c e r t a i n l y
s e v e r a l
q u e s t i o n n a i r e s
d e s i g n e d
s p e c i f i c a l l y
t o a s s e s s
t h e
h e a l t h
o f
t h i s
a g e
g r o u p ,
a n d
t h e y may
b e m o r e
a p p r o p r i a t e . 5
G a i n i n g
a
s u m m a r y
s c o r e
o r
s i n g l e
i n d e x
f i g u r e
f r o m t h i s
q u e s t i o n n a i r e
i s n o t
p o s s i b l e ,
y e t
w h i l e
q u e s t i o n -
n a i r e s
t h a t
c a n
b e
summed
t o
p r o v i d e
a
s i n g l e
f i g u r e
p e r m i t
e a s y c o m p a r i s o n s
b e t w e e n d i f f e r e n t
g r o u p s o f
p a t i e n t s ,
t h e y
may
n o t
a l w a y s t a p
d i m e n s i o n s
a p p r o -
p r i a t e
f o r
p a r t i c u l a r
g r o u p s .
E x i s t i n g q u e s t i o n n a i r e s
t h a t r e s u l t i n a
s i n g l e
i n de x h a ve
y e t
t o b e
v a l i d a t e d t o
e n s u r e t h e i r
a p p r o p r i a t e n e s s
f o r t h i s
t a s k . 2 2
I f
u s e d
w i t h
c o n s i d e r a t i o n t o
t h e p o i n t s
r a i s e d
a b o v e
t h e
SF 3 6 i s a
p o t e n t i a l l y
u s e f u l t o o l
f o r
m e a s u r i n g
h e a l t h
s t a t u s . We
w o u l d
a d v i s e
u s e r s
t o
r e t a i n
t h e
f o r m a t u s e d
i n
t h e
S h e f f i e l d s t u d y 3 a n d
t h e o n e
r e p o r t e d
h e r e . T h e r e
a r e
p r e s e n t l y
t h r e e
v e r s i o n s
a v a i l a b l e :
t h e
o r i g i n a l
q u e s t i o n n a i r e
m a d e a v a i l a b l e
BMJ
VOLUME 3 0 6 2 9 M Y1 9 9 3
1 4 3 9
8/19/2019 SF - 36 calidad de vida
http://slidepdf.com/reader/full/sf-36-calidad-de-vida 4/4
f r o m I n t e r S t u d y
( n o w
c a l l e d t h e
H e a l t h
O u t c o m e s
I n s t i t u t e ) i n
A m e r i c a ,
o n w h i c h t h e a n g l i c i s e d
v e r s i o n s
u s e d
i n t h e
S h e f f i e l d
s t u d y
a n d t h e
O x f o r d
h e a l t h y l i f e
s t u d y w e r e b a s e d , a n d t w o
m o r e r e c e n t
v e r s i o n s .
One
o f
t h e s e
a v a i l a b l e f r o m
J o h n W a r e a t t h e New E n g l a n d
M e d i c a l C e n t e r
H o s p i t a l 2
a n d
t h e o t h e r f r o m t h e
Rand
C o r p o r a t i o n . 2 3
The l a t t e r v e r s i o n s h a v e t h u s
f a r
n o t
b e e n v a l i d a t e d
f o r u s e i n
E n g l a n d a n d ,
d e s p i t e
t h e
r e l a t i v e l y
m i n o r
c h a n g e s
b e t w e e n
t h e s e
a n d
t h e
o r i g i n a l
q u e s t i o n n a i r e ,
we w o u l d
s u g g e s t t h a t
u s e r s
c o n t i n u e
t o u s e
t h e
o r i g i n a l
I n t e r S t u d y
v e r s i o n ,
a d a p t e d
f o r
u s e
i n
E n g l a n d .
We
t h a n k S u e
B r a d s h a w ,
P e t e r
B r o o k s ,
a n d
D i a n a
H a r w o o d f o r
h e l p
w i t h t h e a d m i n i s t r a t i o n o f t h e s u r v e y , S u e
Z i e b l a n d
f o r
c o m m e n t s o n
a n
e a r l i e r
d r a f t
o f
t h e p a p e r ,
B e r k s h i r e ,
B u c k i n g h a m s h i r e ,
N o r t h a m p t o n s h i r e ,
a n d
O x f o r d s h i r e F a m i l y
H e a l t h
S e r v i c e s A u t h o r i t i e s f o r
h e l p
i n
d r a w i n g
t h e s a m p l e , a n d O x f o r d
R eg i o n al H e a l t h
A u t h o r i t y
f o r f u n d i n g
t h e
s t u d y .
G e i g l e R , J o n e s
S .
O u t c o m e s
m e a s u r e m e n t : a
r e p o r t
f r o m
t h e f r o n t .
I n q u i r y
1 9 9 0 ; 2 7 : 7 - 1
3 .
2
W a r e J E , S h e r b o u m e CD . T h e
MOS
3 6 -i t em s h or t- f or m h e a l t h
s u r v e y
( S F - 3 6 )
1 :
c o n c e p t u a l f r a m ew o rk a n d
i t e m
s e l e c t i o n .
Me d C a r e
1 9 9 2 ; 3 0 :
4 7 3 - 8 3 .
3 B r a z i e r
J E , H a r p e r R ,
J o n e s NMB,
O ' C a t h a i n
A ,
Thomas
K J ,
U s h e r w o o d
T ,
e t a l . V a l i d a t i n g
t h e
S F - 3 6 h e a l t h
s u r v e y q u e s t i o n n a i r e :
new
o u t c o m e
m e a s u r e f o r
p r i m a r y c a r e . BMJ
1 9 9 2 ; 3 0 5 : 1 6 0 - 4 .
4
W i l k i n D , H a ll a m
L ,
D o g g e t t
M.
M e a s u r e s
o f
n e e d
a n d o u t c o m e
f o r p r i m a r y c a r e .
O x f o r d : O x f o r d
U n i v e r s i t y P r e s s ,
1 9 9 2 .
5 M c D o w e l l
I ,
N e w e l l C . M e a s u r i n g h e a l t h : a
g u i d e
t o
r a t i n g s c a l e s
a n d
q u e s t i o n n a i r e s .
New Y o r k :
O x f o r d
U n i v e r s i t y P r e s s ,
1 9 8 7 .
6
B o w l i n g
A. M e a s u r i n g
h e a l t h :
a r e v i e w
o f q u a l i t y
o f l i f e
m e a s u r e m e n t s c a l e s .
M i l t o n
K e y n e s : O p e n U n i v e r s i t y P r e s s , 1 9 9 1 .
7
H u n t S ,
McEwen
J ,
McKenna
S P .
M e a s u r i n g
h e a l t h s t a t u s : a
n e w t o o l f o r
c l i n i c i a n s a n d
e p i d e m i o l o g i s t s .
J
R
C o l l
G e n
P r a c t
1 9 8 5 ; 3 5 : 1 8 5 - 8 .
8 H u n t
S ,
McEwen J , McKenna S P .
M e a s u r i n g h e a l t h
s t a t u s . L o n d o n :
Croom
H e l m , 1 9 8 6 .
9
K i n d
P , C a r r - H i l l R . T h e
N o t t i n g h a m
h e a l t h p r o f i l e : a
u s e f u l
t o o l f o r
e p i d e m i o l o g i s t s ?
S o c
S c i M e d
1 9 8 7 ; 2 5 : 9 0 5 - 1 0 .
10
W a r e
J E ,
B r o o k
RH , W i l l i a m s
KN,
S t e w a r t
A L ,
D a v i e s - A v e r y A .
C o n c e p t u a l -
i s a t i o n a n d m e a s u r e m e n t
o f h e a l t h f o r
a d u l t s
i n t h e h e a l t h
i n s u r a n c e
s t u d y . V o l
1 .
M o d e l
o f h e a l t h a n d
m e t h o d o l o g y .
S a n t a M o n i c a , C a l i f o m i a :
R a n d
C o r p ,
1 9 8 0 .
1 1 S t e w a r t A L , W a r e
J E , e d s .
M e a s u r i n g
f u n c t i o n i n g a n d
w e l l b e in g :
t h e
m e d i c a l
o u t c o m e s s t u d y
a p p r o a c h . L o n d o n :
D u k e
U n i v e r s i t y P r e s s , 1 9 9 2 .
12
S t e w a r t A L , H a y s
R D ,
W a r e
J E . M e t h o d s o f
v a l i d a t i n g t h e MOS
h e a l t h
m e a s u r e s .
I n :
S t e w a r t
A L ,
W a r e
J E , e d s .
M e a s u r i n g
f u n c t i o n i n g a n d
w e l l
b e i n g : t h e m e d i c a l
o u t c o m e s s t u d y a p p r o a c h . L o n d o n :
D u k e
U n i v e r s i t y
P r e s s ,
1 9 9 2 .
1 3
W r i g h t
L ,
Harwood D ,
C o u l t e r
A .
H e a l t h
a n d
l i f e s t y l e s i n t h e
O x f o r d
r e g i o n .
O x f o rd : H e a l th
S e r v i c e s
R e s e a r c h
U n i t , 1 9 9 2 .
14
O f f i c e o f P o p u l a t i o n
C e n s u s e s
a n d
S u r v e y s . S t a n d a r d o c c u p a t i o n a l
c l a s s i f i c a t i o n .
V o l 2 .
L o n d o n :
HMSO, 1 9 9 0 .
1 5 C r o n b a c h
L J .
C o e f f i c i e n t
a l p h a
a n d
t h e
i n t e m a l
s t r u c t u r e
o f t e s t s .
P s y c h o -
m e t r i k a 1 9 5 1 ; 1 6 : 2 9 7 - 3 3 4 .
1 6
H e l m s t a d t e r
GC . P r i n c i p l e s
o f p s y c h o l o g i c a l
m e a s u r e m e n t .
New Y o r k : A p p l e t o n -
C e n t u r y - C r o f t s ,
1 9 6 4 .
17
N u n n a l l y J C . P s y c h o m e t r i c t h e o r y . 2 n d
e d . New Y o r k :
McGraw
H i l l , 1 9 7 8 .
1 8
C a r m i n e s
E ,
Z e l l e r R . R e l i a b i l i t y
a n d
v a l i d i t y a s s e s s m e n t .
Q u a n t i t a t i v e a p p l i c a -
t i on s i n
t h e s o c i al s c i e n c e .
B e v e r l e y H i l l s :
S a g e ,
1 9 7 9 .
19
B e r g n e r
M, B o b b i t t R A , C a r t e r
WB,
G i ls o n B S .
T h e s i c k n e s s
i m p a c t
p r o f i l e :
d e v e l o p m e n t a n d f i n a l r e v i s i o n
o f
a
h e a l t h
s t a t u s
m e a s u r e .
Med
C a r e
1 9 8 1 ; 1 9 : 7 8 7 - 8 0 5 .
2 0
F i t z p a t r i c k
R ,
Z i e b l a n d
S , J e n k i n s o n
C ,
Mowat
A, Mowat
A. T h e
i m p o r t a n c e
o f
s e n s i t i v i t y
t o
c h a n g e a s a c r i t e r i o n
f o r s e l e c t i n g
h e a l t h
s t a t u s m e a s u r e s .
Q u a l i t y
i n H e a l t h C a r e
1 9 9 2 ; 1 : 8 9 - 9 3 .
2 1
Z i e b l a n d S ,
F i t z p a t r i c k
R , J e n k i n s o n C .
A s s e s s i n g
s h o r t
t e r m
o u t c o m e .
Q u a l i t y
i n
H e a l t h
C a r e
1 9 9 2 ; 1 ( 2 ) : 1 4 1 - 2 .
( L e t t e r . )
2 2
C a r r - H i l l
R ,
M o r r i s
J .
C u r r e n t
p r a c t i c e
i n
o b t a i n i n g
t h e
Q
i n
Q A L Y s :
a
c a u t i o n a r y
n o t e .
BM J
1 9 9 1 ; 3 0 3 : 6 9 9 - 7 0 1 .
2 3
R a n d H e a l t h
S c i e n c e s
P r o g r a m .
R a n d
3 6 - i t e m
h e a l t h
s u r v e y
1 . 0 .
S a n t a
M o n i c a :
R a n d , 1 9 9 2 .
( A c c e p t e d
16 M a r c h
1 9 9 3 )
D e p a r t m e n t o f
P u b l i c
H e a l t h , U n i v er s i t y o f
A b e r d e e n ,
F o r e s t e r h i l l ,
A b e r d e e n AB9 2 ZD
A n d r e w
G a r r a t t ,
r e s e a r c h
a s s i s t a n t
D a n n y A R u t a , l e c t u r e r
H e a l t h S e r v i c e s
R e s e a r c h
U n i t
Mona
I
A b d a l l a , r e s e a r c h
f e l l o w
J
K e n n e t h
B u c k i n g h a m ,
r e s e a r c h
f e f l o w
I a n T R u s s e l l ,
d i r e c t o r
C o r r e s p o n d e n c e
t o :
Mr G a r r a t t .
B M _
1 9 9 3 ; 3 0 6 : 1 4 4 0 - 4
T h e
SF 3 6 h e a l t h s u r v e y
q u e s t i o n n a i r e : a n
o u t c o m e m e a s u r e s u i t a b l e
f o r
r o u t i n e
u s e
w i t h i n
t h e NHS?
Andrew
G a r r a t t ,
Danny
A
R u t a ,
Mona
I
A b d a l l a , J K e n n e t h B u c k i n g h a m , I a n
T
R u s s e l l
A b s t r a c t
O b j e c t i v e - T o
a s s e s s t h e v a l i d i t y , r e l i a b i l i t y , a n d
a c c e p t a b i l i t y
o f t h e
s h o r t f o r m
3 6
( S F 3 6 ) h e a l t h
s u r ve y q u e s t i o n n a i r e
( a s h o r t e n e d v e r s i o n
o f a
b a t t e r y o f 1 4 9 h e a l t h s t a t u s q u e s t i o n s ) a s a
m e a s u r e
o f
p a t i e n t o u t c o m e
i n
a
b r o a d s a m p l e o f p a t i e n t s
s u f f e r i n g f r o m
f o u r
c ommo n
c l i n i c a l
c o n d i t i o n s .
D e s i g n - P o s t a l q u e s t i o n n a i r e , f o l i o w e d
u p
b y t w o
r e m i n d e r s a t t w o w e e k
i n t e r v a l s .
S e t t i n g - C l i n i c s
a n d f o u r t r a i n i n g
p r a c t i c e s
i n
n o r t h
e a s t S c o t l a n d .
S u b j e c t s - O v e r
1 7 0 0 p a t i e n t s a g e d 1 6 - 8 6
w i t h o n e
o f
f o u r c o n d i t i o n s - l o w
b a c k p a i n ,
m e n o r r h a g i a ,
s u s p e c t e d
p e p t i c
u l c e r ,
o r
v a r i c o s e v e i n s - a n d a
c o m p a r i s o n s a m p l e
o f
9 0 0 members
o f
t h e g e n e r a l
p o p u l a t i o n .
M a i n
o u t c o m e
m e a s u r e s - T h e e i g h t
s c a l e s
w i t h i n
t h e
SF
3 6 h e al t h p r o f i l e .
R e s u l t s - T h e
r e s p o n s e r a t e
e x c e e d e d
75 i n
t h e
p a t i e n t p o p u l a t i o n ( 1 3 1 0
r e s p o n d e n t s ) .
T h e S F 3 6
s a t i s f i e d
r i g o r o u s
p s y c h o m e t r i c
c r i t e r i a
f o r v a l i d i t y
a n d i n t e r n a l
c o n s i s t e n c y .
C l i n i c a l
v a l i d i t y
w a s
s h o w n
b y
t h e d i s t i n c t i v e
p r o f i l e s g e n e r a t e d
f o r e a c h c o n -
d i t i o n ,
e a c h o f w h i c h
d i f f e r e d f r o m t h a t
i n
t h e
g e n e r a l
p o p u l a t i o n
i n
a
p r e d i c t a b l e
m a n n e r .
F u r t h e r m o r e ,
SF 3 6 s c o r e s
w e r e
l o w e r
i n r e f e r r e d
p a t i e n t s t h a n i n
p a t i e n t s
n o t
r e f e r r e d
a n d w e r e
c l o s e l y
r e l a t e d
t o
g e n e r a l
p r a c t i t i o n e r s '
p e r c e p t i o n s
o f
s e v e r i t y .
C o n c l u s i o n s - T h e s e r e s u l t s
p r o v i d e
s u p p o r t f o r
t h e SF
3 6
a s
a
p o t e n t i a l m e a s u r e
o f
p a t i e n t
o u t c o m e
w i t h i n t h e
NHS.
T h e
SF
3 6
s e e m s
a c c e p t a b l e
t o
p a t i e n t s , i n t e r n a l l y c o n s i s t e n t ,
a n d a v a l i d m e a s u r e
o f t h e h e a l t h s t a t u s o f a w i d e
r a n g e
o f
p a t i e n t s .
B e f o r e i t c a n b e u s e d i n t h e new h e a l t h
s e r v i c e ,
h o w e v e r ,
i t s
s e n s i t i v i t y t o
c h a n g e s
i n
h e a l t h
s t a t u s
o v e r
t i m e must a l s o b e t e s t e d .
I n t r o d u c t i o n
The
govemment
h a s r e s p o n d e d t o t h e n e e d f o r
e f f i c i e n t p r o v i s i o n
o f h e a l t h
c a r e
b y i n t r o d u c i n g
m a n a g e d c o m p e t i t i o n
i n t o
t h e N at i o n a l H e a l t h
S e r v i c e . '
I n
t h e
i n t e r n a l
m a r k e t
h e a l t h a u t h o r i t i e s a n d
f u n d h o l d i n g p r a c t i c e s may p u r c h a s e c a r e
f r o m c o m -
p e t i n g
p r o v i d e r
u n i t s .
I f
t h e
r e f o r m s a r e t o b e s u c c e s s -
f u l ,
t h e n
p u r c h a s e r s
w i l l
r e q u i r e
v a l i d ,
r e l i a b l e ,
a n d
s e n s i t i v e
m e a s u r e s
o f o u t c o m e
t o a l l o w t h e m
t o a l l o c a t e
s c a r c e r e s o u r c e s
i n
t h e
m o s t
c o s t
e f f e c t i v e
m a n n e r .
S i m i l a r l y ,
s e r v i c e p r o v i d e r s
who
c a n
d e m o n s t r a t e t h e
e f f e c t i v e n e s s
o f
t h e
c a r e
t h e y p r o vi d e
i n
i m p r o v i n g
p a t i e n t
o u t c o m e w i l l b e
b e t t e r p l a c e d t o c o m p e t e f o r
p u r c h a s e r f u n d s . W i t h o u t s u c h
i n f o r m a t i o n h e a l t h
c a r e w i l l b e
p u r c h a s e d
o n
t h e b a s i s
o f
c o s t
a l o n e ,
w i t h
s e r i o u s
c o n s e q u e n c e s
f o r
i t s
q u a l i t y .
Few o u t c o m e
m e a s u r e s c u r r e n t l y a v a i l a b l e f o r
r o u t i n e u s e
s a t i s f y
t h e c r i t e r i a o f
v a l i d i t y , r e l i a b i l i t y ,
a n d
s e n s i t i v i t y t o c h a n g e s
i n
h e a l t h
s t a t u s . F o r
e x a m p l e ,
t h e
N o t t i n g h a m
h e a l t h
p r o f i l e
h a s b e e n c r i t i c i s e d f o r
f a i l i n g
t o d e t e c t l o w
l e v e l s o f
m o r b i d i t y . 2
A
m e a s u r e
t h a t d e s e r v e s c a r e f u l
c o n s i d e r a t i o n
i s
t h e
s h o r t f o r m
3 6
( S F
3 6 )
h e a l t h
s u r v e y q u e s t i o n n a i r e . 3 4
T h e
SF36
i s
a
s h o r t e n e d
v e r s i o n o f a
b a t t e r y
o f
1 4 9 h e a l t h s t a t u s
q u e s t i o n s
d e v e l o p e d
a n d t e s t e d
o n a
p o p u l a t i o n
o f o v e r
2 2 0 0 0
p a t i e n t s a s p a r t
o f
t h e
m e d i c a l
o u t c o m e
s t u d y , 5
6
d e s i g n e d
t o
h e l p
u n d e r s t a n d
how
s p e c i f i c
c o m p o n e n t s
o f
t h e A m e r i c a n h e a l t h
c a r e
s y s t e m
a f f e c t
t h e
o u t c o m e s
o f
c a r e . A
k e y
o b j e c t i v e
o f
t h e
s t u d y
w a s
t o
d e v e l o p
m o r e p r a c t i c a l
t o o l s
f o r
m o n i t o r i n g p a t i e n t
o u t c o m e s
i n
1 4 4 0
BMJ VOLUME
3 0 6
2 9 M Y1 9 9 3
