• Generic health status measure that was introduced in 1992 and has been translated into various languages and is used world-wide.
  • Designed to be applied to all health conditions and assess health concepts which represent basic human values and were relevant to a person’s functional status and well-being.
    • contains 36 questions covering eight domains:
      1) Physical functioning
      2) Role limitations due to physical health problems
      3) Bodily pain
      4) General health
      5) Vitality
      6) Social functioning
      7) Role limitations due to emotional problems
      8) Mental health
  • The responses are based on a Likert scale. Both standard (4 week) and acute (1 week) recall versions are used.  Version 2 of the SF-36 was released in 1996 and some modifications were made to the format, the wording of the questions and to the response options.

Clinical Considerations

  • The SF-36 is the most widely used health survey and has been used in SCI. It has been used extensively to discriminate, evaluate and predict outcomes in various health conditions, but more work is required to study the validity of the questions and the proposed modifications to the questions for SCI patient population.
  • The questions related to walking and climbing stairs are seen to be insensitive to individuals with a complete SCI.

ICF Domain

Quality of Life

Administration

Administered by interviewer or self-administered.

Number of Items

36

Equipment

None

Scoring

  • The manual (which must be purchased) has a scoring algorithm to transform item scores to a 0-100 scoring system.
  • Norm based scoring, where the mean score for the general population is 50 with a standard deviation of 10, is also used (scoring algorithm in manual).
  • The SF-36 can also be scored using two summary scores, a physical and a mental component score, which are norm based.

Languages

The SF-36 has been translated into over 50 languages.

Training Required

None

Availability

Can be found by contacting Quality Metric (www.qualitymetric.com). There is a cost to buy the manuals as well as to use the tools (depending on how they will be used).

# of studies reporting psychometric properties: 17

Interpretability

MCID: not established in SCI, but for a sample of patients with osteoarthritis of the lower extremities (n=142, mean age: 65.1 yrs, 70.5% female, 61.5% had knee osteoarthritis, 35.2% used NSAIDS or analgesics):

SF-36 subscales: MCID for worsening MCID for improvement
Bodily pain 7.2 7.8
Physical function 5.3 3.3
Physical component summary 2.0 2.0

Reference: Angst et al. 2001. “Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities” Arthritis Care & Research, 45(4),  384–391. SEM & MDC: SF-36 score SEM and MDC (calculated from data in Lin et al. 2007):

SF-36 subscales: SEM MDC
Physical functioning 21.4 59.4
Role physical 14.7 40.8
Bodily pain 7.4 20.6
General health 7.9 21.8
Vitality 4.6 12.7
Social functioning 5.9 16.3
Role emotional 4.1 11.3
Mental health 7.4 20.6
  • There is published data and norms available for some health conditions as well as for the general population (Canada and United States).
  • Higher scores indicate higher levels of health.
  • Further research is needed on using the SF-36 for individuals with SCI to understand how they are answering the questions to ensure the data is valid.
  • Normative data for the SCI population have not been reported at this time
  • Published data on the SCI population is available for comparison (see Interpretability section of the Study Details sheet).

Reliability – Moderate to High

  • Moderate to High Inter-rater Reliability: ICC = 0.52-0.98
  • Moderate to High Intra-rater Reliability: ICC = 0.71-0.99
  • Moderate to High Internal Consistency: α = 0.72-0.98

(Lin et al. 2007; n=187; 151 males; 48 incomplete tetraplegia, 28 complete tetraplegia, 73 incomplete paraplegia, 38 complete paraplegia; mean time since injury: 7.4 years)

Validity – Low to Moderate

  • Moderate correlation with Life Satisfaction Questionnaire 9 (LISAT-9):
    ρ = 0.531
  • Low correlation with Functional Independence Measure (FIM):
    ρ = 0.094

(van Leeuwen et al. 2012; n=145; 104 males; 27 incomplete paraplegia, 65 complete paraplegia, 16 incomplete tetraplegia, 37 complete tetraplegia; 5 years post-discharge from inpatient rehabilitation)

  • Low to Moderate correlation with Beck Depression Inventory (BDI):
    r = 0.229-0.329

(Ataoglu et al. 2013; n=140; 104 males; mean age: 36.2 years; 79 ASIA A, 61 ASIA B-E; mean time since injury: 25.2 months)

Responsiveness

  • Significantly lower scores for individuals with SCI than the nondisabled group were reported on the Physical Functioning, Bodily Pain and Role-Physical domains.
  • However, all Vitality subscale items showed significant positive differential functioning for people with SCI when controlling for total physical health scores.

(Lin 2007, Bonne-Lee et al. 2008, Horner-Johnson et al. 2010)

Floor/Ceiling Effect

  • Floor effects and ceiling effects reported for the SF-36.
  • 3 subscales (role physical, social functioning, role emotion) exhibited ceiling effects between 22.5 and 75.3%.
  • 2 subscales (physical functioning and role physical) exhibited floor effects 24.2% and 36.3%, respectively.

(King & Roberts 2002, Van Leeuwen et al. 2012, Andresen et al. 1999, Lin 2007, Bonne-Lee et al. 2008)

Reviewer

Jane Hsieh, Dr. Carlos L. Cano-Herrera

Date Last Updated

31 December, 2024

Andresen EM, Fouts BS, Romeis JC, Brownson CA. Performance of health-related quality-of-life instruments in a spinal cord injured population. Arch Phys Med Rehabil, 1999; 80: 877-84.
http://www.ncbi.nlm.nih.gov/pubmed/10453762

Anton HA, Miller WC, Townson AF. Measuring fatigue in persons with spinal cord injury. Arch Phys Med Rehabil 2008; 89: 538-542.
http://www.ncbi.nlm.nih.gov/pubmed/18295634

Ataoğlu E, Tiftik T, Kara M, Tunç H, Ersöz M, Akkuş S. Effects of chronic pain on quality of life and depression in patients with spinal cord injury. Spinal Cord. 2013;51(1):23-6.
http://www.ncbi.nlm.nih.gov/pubmed/22547044

Conti A, Clari M, Garrino L, Maitan P, Scivoletto G, Cavallaro L, Bandini B, Mozzone S, Vellone E, Frigerio S. Adaptation and validation of the Caregiver Burden Inventory in Spinal Cord Injuries (CBI-SCI). Spinal Cord. 2019 Jan;57(1):75-82. https://pubmed.ncbi.nlm.nih.gov/30068985/

Ferfeli S, Galanos A, Dontas IA, Triantafyllou A, Triantafyllopoulos IK, Chronopoulos E. Reliability and validity of the Greek adaptation of the Modified Barthel Index in neurorehabilitation patients. Eur J Phys Rehabil Med. 2024 Feb;60(1):44-54. https://pubmed.ncbi.nlm.nih.gov/37877957/

Forchheimer M, McAweene M, Tate DG. Use of the SF-36 among persons with spinal cord injury. Am J Phys Med Rehabil, 2004; 83: 390-395.
http://www.ncbi.nlm.nih.gov/pubmed/15100631

Golhasani-keshtan F, Ebrahimzadeh MH, Fattahi AS, Soltani-moghaddas SH, Omidi-kashani F. Validation and cross-cultural adaptation of the Persian version of Craig Handicap Assessment and Reporting Technique (CHART) short form. Disabil Rehabil. 2013;35(22):1909-14.
http://www.ncbi.nlm.nih.gov/pubmed/23480647

Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations. Arch Phys Med Rehabil 2010;91:570-5.
http://www.ncbi.nlm.nih.gov/pubmed/20382289

King JT and Roberts MS. Validity and reliability of the Short Form-36 in cervical spondylotic myelopathy. J Neurosurg (Spine 2), 2002; 97:180-185.
http://www.ncbi.nlm.nih.gov/pubmed/12296676

Lee BB, Simpson JM, King MT, Haran MJ, Marial O. The SF-36 walk-wheel: a simple modification of the SF-36 physical domain improves its responsiveness for measuring health status change in spinal cord injury. Spinal Cord. 2009;47(1):50-5.
http://www.ncbi.nlm.nih.gov/pubmed/18560375

Lin M-R, Hwang H-F, Chen C-Y, Chiu W-T. Comparisons of the Brief Form of the World Health Organization Quality of Life and Short Form-36 for Persons with Spinal Cord Injuries. Am J Phys Med Rehabil 2007;86:104–113.
http://www.ncbi.nlm.nih.gov/pubmed/17075363

Marquez MA, Speroni A, Galeoto G, Ruotolo I, Sellitto G, Tofani M, Gonzàlez-Bernal J, Berardi A. The Moorong Self Efficacy Scale: translation, cultural adaptation, and validation in Italian; cross sectional study, in people with spinal cord injury. Spinal Cord Ser Cases. 2022 Feb 16;8(1):22. https://pubmed.ncbi.nlm.nih.gov/35173155/

Miller WC, Anton HA, Townson AF. Measurement properties of the CESD scale among individuals with spinal cord injury. Spinal Cord 2008; 46: 287-292.
http://www.ncbi.nlm.nih.gov/pubmed/17909558

Raichle KA, Osborne TL, Jensen MP, Cardenas D. The reliability and validity of pain interference measures in people with spinal cord injury. The Journal of Pain, 2006; 7(3): 179-186.
http://www.ncbi.nlm.nih.gov/pubmed/16516823

Tramonti F, Gerini A, Stampacchia G. Individualised and health-related quality of life of persons with spinal cord injury. Spinal Cord. 2014;52(3):231-5.
http://www.ncbi.nlm.nih.gov/pubmed/24343055

van Leeuwen CMC, van der Woude LHV, Post MWM. Validity of the mental health subscale of the SF-36 in persons with spinal cord injury. Spinal Cord, 2012; 00:1-7.
http://www.ncbi.nlm.nih.gov/pubmed/22487956

Vasilchenko E, Karapetian K, Finger M, Escorpizo R. Using the interviewer-administered version of Work Rehabilitation Questionnaire (WORQ) in Russia: cross-cultural adaptation and psychometric properties in traumatic spinal cord injury. Disabil Rehabil. 2022 Oct;44(21):6452-6461. https://pubmed.ncbi.nlm.nih.gov/34521310/