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Validity of the SF-36 Health Survey as an outcome measure for trials in people with spinal cord injury

By Mark Haran, Madeleine King, Martin Stockler, Obad Marial and Bonne Lee


The SF-36 was interviewer-administered to 305 subjects at recruitment. Feasibility, content validity and internal consistency were assessed. We tested a priori hypotheses about discriminative, convergent and divergent validity. Interviewer-assisted administration was feasible. The content validity of several domains (Physical Function, Role Physical, Social Function and Role Emotional) was compromised by the irrelevance of some items and response options. Resultant ceiling and floor effects may limit the SF-36?s ability to detect changes over time. The SF-36 was able to discriminate differences between people with: tetraplegia versus paraplegia (in the Physical Function and Physical Composite scores); injuries that were recent ( 4 years) (in the Vitality, Social Function and Mental Health domain and Mental Composite scores), and who were employed versus unemployed (in the Physical Function, Social Function, Mental Health and Mental Composite scores). It was not able to discriminate between groups dichotomised by age, injury completeness or gender. The convergent and divergent validity of all SF-36 domains was as in other populations, except for correlations involving the Physical Function scale which were poor. Internal consistency was similar to that in other populations (Cronbach?s alpha from 0.75 to 0.92); the SF-36 has sufficient precision for population-based and clinical research in spinal cord injury. The SF-36 is useful for comparing the health status of people with spinal cord injury to that of other populations, but supplementation with a disease-specific health status measure may be necessary for trials of interventions in people with spinal cord injuries.Quality of life, outcome measures, sf-36

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  1. (1994). A critical appraisal of quality-of-life measurements.
  2. (1995). A life-span theory of control. Psychol Rev
  3. (1997). A rational approach to long term care: comparing the independent living model with agency-based care for persons with high spinal cord injuries. Spinal cord
  4. (1988). A sharper Bonferroni procedure for multiple tests of significance. Biometrika
  5. (1999). a Trial-specific Module. J Clin Epidemiol
  6. (1998). Adaptation and validation of the SF-36 Health Survey for use in Australia.
  7. (1994). Adjustment to traumatic spinal cord injury. A longitudinal study of self-reported quality of life. Paraplegia
  8. (1991). An evaluation of a brief health status measure in elderly veterans.
  9. (1999). Assessment of the SF-36 version 2 in the United Kingdom.
  10. Australian Bureau of Statistics.
  11. (1993). Changing attitudes toward life. Aging with spinal cord injury.
  12. Clinical epidemiology – the architecture of clinical research.
  13. (1951). Coefficient alpha and the internal structure of tests. Psychometrika
  14. (1999). Correlates of life satisfaction among persons with spinal cord injury. Arch Phys Med Rehabil
  15. (1987). Definitions and dimensions of quality of life. In: Aaronson
  16. (1997). Dialysis adequacy and self-reported health status in a group of CAPD patients.
  17. (1989). Effect sizes for interpreting changes in health status. Med Care
  18. (1994). Evidence for the validity of the short form 36 questionnaire (SF36) in the elderly population. Age Ageing
  19. (1998). Gandek B; for the IQOLA Project.
  20. (1993). Guide to the uniform dataset for medical rehabilitation (Adult FIM).
  21. (2005). Health status rated with the Medical Outcomes Study 36-Item Short-Form Health Survey after spinal cord injury.
  22. (2002). Health-related quality of life after spinal cord injury. Disability and Rehabilitation
  23. (1995). Individual-patient monitoring in clinical practice: are available health status surveys adequate? Quality of Life Research
  24. (1997). Later health-related quality of life in adults who have sustained spinal cord injury in childhood. Spinal Cord
  25. (1994). Life satisfaction and well-being measures in ventilator assisted individuals with traumatic tetraplegia. Arch Phys Med Rehabil
  26. (1997). Long-term psychological outcomes in spinal cord injured persons: results of a controlled trial using cognitive behaviour therapy. Arch Phys Med Rehabil
  27. (1987). Measuring change over time: assessing the usefulness of evaluative instruments.
  28. (1991). Measuring functioning, well-being, and other generic health concepts. In: Osoba
  29. (1996). Measuring Health: A Guide To Rating Scales and Questionnaires. Second edition,
  30. (1987). Measuring the quality of life of patients with respiratory diseases.
  31. (1992). Methods of validating the MOS health measures.
  32. (1995). Monitoring health outcomes from the patients’ point of view: A primer. Integrated Therapeutics
  33. (1998). Mortality following spinal cord injury. Spinal Cord
  34. (2000). Patient-based health status assessments in an outpatient psychiatry setting. Psychiatric Services
  35. (1992). Patient-based status measures in outpatient dialysis: Early experiences in developing an outcomes assessment program. Medical Care
  36. (1999). Performance of health-related quality of life instruments in a spinal cord injured population.
  37. (1987). Prediction of long-term survival of persons with spinal cord injury: an 11-year prospective study. Rehabil Psychol
  38. (1964). Principles of psychological measurement.
  39. (1990). Psychological consequences of spinal injury: A review of the literature.
  40. (1978). Psychometric Theory.
  41. (1998). Quality of life and traumatic spinal injury. Arch Phys Med Rehabil
  42. (2002). Quality of life in individuals with spinal cord injury. Arch Phys Med Rehabil
  43. (1998). Relationship of health status and functional independence to neurological impairment in spinal cord injury [abstract]. Arch Phys Med Rehabil
  44. (1979). Reliability and validity assessment. Quantitative applications in social science.
  45. (1991). Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation
  46. (2000). Response Shift: a Coping Perspective. In
  47. (1985). Severely mobility-disabled people assess their quality of lives.
  48. (1994). SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Health Assessment Lab,
  49. (1991). Spinal cord injuries: Clinical functional, and emotional status. Spine
  50. (1982). Spinal Cord Injuries.
  51. (1983). Staff and patient perception of patient mood. Rehabil Psychol
  52. (1988). Statistical power analysis for the behavioural sciences. Second edition. Hillsdale NJ: Lawrence Erlbaum Associates;
  53. (1997). Statistics notes: Cronbach’s alpha. BMJ
  54. (1998). Testing the measurement properties of the Short Form-36 Health Survey in a frail elderly population.
  55. (2000). The introduction of the NSW Spinal Injuries Database System.
  56. (1992). The MOS 36-item short form health survey (SF-36). I. Conceptual framework and item selection. Med Care
  57. (1994). The MOS-36 short form health survey (SF36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care
  58. (1995). The Principles And Practice Of Statistics In Biological Research. Third Edition.
  59. (1996). The pursuit of happiness.
  60. (1999). The SF-36 health survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis. Med Care
  61. (1993). The SF-36 health survey questionnaire: an outcome measure suitable for use in the NHS? Br Med J
  62. (1995). The SF-36 in an Australian sample: Validating a new, generic health status measure.
  63. (1995). The status of health assessment. Annu Rev Public Health
  64. The validity and relative precision of the MOS short- and long-form health status scales and Dartmouth COOP charts: results from the medical outcomes study. Med Care 1992; 30 (suppl):
  65. (1992). Trends in spinal cord injury demographics and treatment outcomes between 1973 and 1986. Arch Phys Med Rehabil
  66. (1998). Use of the SF-36 Health Status Survey with a chronically disabled low back pain population: Strengths and limitations.
  67. (1995). Using MOS SF36 in general practice outcomes research.
  68. (1992). Validating the SF-36 health survey questionnaire: a new outcome measure for primary care. Br Med Journal
  69. (1998). Windows Software – Release 12. Copyright

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