A Comparison of Quality of Life Measures in Husbands of Women with Breast Cancer

The Quality of Well-Being Scale (QWB-SA) and Medical Outcome Study SF-36 short form (SF-36) are popular health-related quality of life (HRQOL) assessment tools; however, it is unclear whether these measures overlap enough to be interchangeable, and if not, which might be a better choice. This study examined conceptual overlap, validity, and relation with psychosocial functioning of the QWB-SA and SF-36 in a sample of partners of women undergoing adjuvant treatment for breast cancer. Partners (n = 79) of breast cancer patients, recruited in a chemotherapy infusion clinic, completed the QWB-SA and SF-36 and additional psychosocial measures. Descriptive content review shows that both instruments provide a breadth of HRQOL coverage including physical health, mental health, social functioning, role functioning and general health perceptions; however, more QWB-SA scales suffered floor effects. Subscales correlated, with the strongest correlations between the QWB-SA total score and the mental health scales of the SF-36. The QWB-SA and the SF-36 Mental Health Component Summary score, but not the SF-36 Physical Component Summary score were strongly correlated to measures of mood, satisfaction with life, burden, and social support. The QWB-SA and SF-36 measure distinct aspects of HRQOL. Each instrument presents distinct advantages and disadvantages in coverage of particular domains. Labels assigned to SF-36 scales more accurately reflect what they measure. The SF-36 appeared more sensitive to the impact that psychological health played on overall assessment of HRQOL in these partners

Using the SF-36 with older adults: a cross-sectional community-based survey

OBJECTIVES: To assess the practicality and validity of using the SF-36 in a community-dwelling population over 65 years old, and obtain population scores in this age group. DESIGN: Postal survey, using a questionnaire booklet containing the SF-36 and other health related items, of all those aged 65 or over registered with twelve general practices. Non-respondents received up to two reminders at three-weekly intervals. SETTING: Twelve randomly selected general practices in Sheffield. SAMPLE: 9897 subjects aged 65 to 104. MAIN OUTCOME MEASURES: Scores for the eight dimensions of the SF-36 and a modified version of the physical functioning dimension. RESULTS: The SF-36 achieved a response rate of 82% (n=8117) and dimension completion rates of 86.4% to 97.7%. Internal consistency measured by Cronbach’s a exceeded 0.80 for all dimensions except social functioning. These results compare favourably with postal surveys of younger adults. Scores for older adults were calculated by age and sex. Comparison with data from younger people showed how physical health declines steeply with age, in marked contrast with mental health. CONCLUSIONS: The SF-36 is a practical and valid instrument to use in postal surveys of older people living in the community. The population scores provided here may facilitate its use in future surveys of older adults

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

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

Exploring the consistency of the SF-6D

Objective: The six dimensional health state short form (SF-6D) was designed to be derived from the short-form 36 health survey (SF-36). The purpose of this research was to compare the SF-6D index values generated from the SF 36 (SF-6D(SF-36)) with those obtained from the SF-6D administered as an independent instrument (SF-6D(Ind)). The goal was to assess the consistency of respondents answers to these two methods of deriving the SF-6D. Methods: Data were obtained from a sample of the Portuguese population (n = 414). Agreement between the instruments was assessed on the basis of a descriptive system and their indexes. The analysis of the descriptive system was performed by using a global consistency index and an identically classified index. Agreement was also explored by using correlation coefficients. Parametric tests were used to identify differences between the indexes. Regression models were estimated to understand the relationship between them. Results: The SF-6D(Ind) generates higher values than does the SF-6D(SF-36), There were significant differences between the indexes across sociodemographic groups. There was a significant ceiling effect in the SF-6D(Ind) a but not in the SF-6D(SF-36). The correlation between the indexes was high but less than what was anticipated. The global consistency index identified the dimensions with larger differences. Considerable differences were found in two dimensions, possibly as a result of different item contexts. Further research is needed to fully understand the role of the different layouts and the length of the questionnaires in the respondents' answers. Conclusions: The results show that as the SF-6D was designed to derive utilities from the SF-36 it should be used in this way and not as an independent instrument.Fundacao para a Ciencia e a Tecnologia (FCT

Exploring differential item functioning in the SF-36 by demographic, clinical, psychological and social factors in an osteoarthritis population

The SF-36 is a very commonly used generic measure of health outcome in osteoarthritis (OA). An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items work in the same way across subgroup of a population. That is, if respondents have the same 'true' level of outcome, does the item give the same score in different subgroups or is it biased towards one subgroup or another. Differential item functioning (DIF) can identify items that may be biased for one group or another and has been applied to measuring patient reported outcomes. Items may show DIF for different conditions and between cultures, however the SF-36 has not been specifically examined in an osteoarthritis population nor in a UK population. Hence, the aim of the study was to apply the DIF method to the SF-36 for a UK OA population. The sample comprised a community sample of 763 people with OA who participated in the Somerset and Avon Survey of Health. The SF-36 was explored for DIF with respect to demographic, social, clinical and psychological factors. Well developed ordinal regression models were used to identify DIF items. Results: DIF items were found by age (6 items), employment status (6 items), social class (2 items), mood (2 items), hip v knee (2 items), social deprivation (1 item) and body mass index (1 item). Although the impact of the DIF items rarely had a significant effect on the conclusions of group comparisons, in most cases there was a significant change in effect size. Overall, the SF-36 performed well with only a small number of DIF items identified, a reassuring finding in view of the frequent use of the SF-36 in OA. Nevertheless, where DIF items were identified it would be advisable to analyse data taking account of DIF items, especially when age effects are the focus of interest

Thai SF-36 health survey: tests of data quality, scaling assumptions, reliability and validity in healthy men and women

BACKGROUND: Since its translation to Thai in 2000, the SF-36 Health Survey has been used extensively in many different clinical settings in Thailand. Its popularity has increased despite the absence of published evidence that the translated instrument satisfies scoring assumptions, the psychometric properties required for valid interpretation of the SF-36 summated ratings scales. The purpose of this paper was to examine these properties and to report on the reliability and validity of the Thai SF-36 in a non-clinical general population. METHODS: 1345 distance-education university students who live in all areas of Thailand completed a questionnaire comprising the Thai SF-36 (Version 1). Median age was 31 years. Psychometric tests recommended by the International Quality of Life Assessment Project were used. RESULTS: Data quality was satisfactory: questionnaire completion rate was high (97.5%) and missing data rates were low (< 1.5% for all items). The ordering of item means within scales generally were clustered as hypothesized and scaling assumptions were satisfied. Known groups analysis showed good discriminant validity between subgroups of healthy persons with differing health states. However, some areas of concern were revealed. Possible translation problems of the Physical Functioning (PF) items were indicated by the comparatively low ceiling effects. High ceiling and floor effects were seen in both role functioning scales, possibly due to the dichotomous format of their response choices. The Social Functioning scale had a low reliability of 0.55, which may be due to cultural differences in the concept of social functioning. The Vitality scale correlated better with the Mental Health scale than with itself, possibly because a healthy mental state is central to the concept of vitality in Thailand. CONCLUSION: The summated ratings method can be used for scoring the Thai SF-36. The instrument was found to be reliable and valid for use in a general non-clinical population. Version 2 of the SF-36 could improve ceiling and floor effects in the role functioning scales. Further work is warranted to refine items that measure the concepts of social functioning, vitality and mental health to improve the reliability and discriminant validity of these scales

Health-related quality of life in people with aphasia: Implications for fluency disorders quality of life research

Abstract It is increasingly important that clinicians address the health-related quality of life (HRQOL) of adults with communication disorders in clinical practice. The overall aim of this paper is to draw conclusion about the suitability of the Short Form 36 Health Survey for the communication disorders of aphasia and stuttering. This study reports on the impact of post-stroke aphasia on 30 Australian older adults’ HRQOL. It also comments on the capacity of the SF-36 to measure HRQOL in this population, specifically whether it is sensitive to the three known determinants of post-stroke HRQOL – emotional, physical and social functioning. Comparisons with other data are made to assist interpretation of the SF-36 subscale scores: with 75 older adults with no history of neurological conditions; and with data from the 1995 National Health Survey data. The main findings are: (1) adults with post-stroke aphasia have similar HRQOL to their peers on six subscales, but significantly lower Role emotional and Mental health HRQOL; (2) a substantial number of aphasic adults reported depressive mood; and (3) aphasic adults with depressive mood have significantly worse HRQOL on six subscales than aphasic adults without depressive mood, but similar Role emotional and Body pain HRQOL. In conclusion, stroke and aphasia have minimal impact on older adults’ HRQOL as measured by the SF-36, which conflicts with an established evidence base of the negative consequences of aphasia on life. Thus, the SF-36 is not advisable for use with aphasic adults. Implications of these findings for aphasia and stuttering are discussed. Educational objectives: The reader will be able to: (a) describe the impact of aphasia and depressive mood on quality of life; (b) compare the impact of aphasia on the quality of life of adults to adults who do not have aphasia; (c) describe the similarities and differences between quality of life of adults with aphasia and adults who stutter; and (d) describe the strengths and limitations of the SF-36 as a measure of quality of life in adults who stutter versus adults with aphasia

The estimation of a preference-based measure of health from the SF-36

This paper reports on the findings of a study to derive a preference-based measure of health from the SF-36 for use in economic evaluation. The SF-36 was revised into a six-dimensional health state classification called the SF-6D. A sample of 249 states defined by the SF-6D have been valued by a representative sample of 611 members of the UK general population, using standard gamble. Models are estimated for predicting health state valuations for all 18,000 states defined by the SF-6D. The econometric modelling had to cope with the hierarchical nature of the data and its skewed distribution. The recommended models have produced significant coefficients for levels of the SF-6D, which are robust across model specification. However, there are concerns with some inconsistent estimates and over prediction of the value of the poorest health states. These problems must be weighed against the rich descriptive ability of the SF-6D, and the potential application of these models to existing and future SF-36 data set

Health and wellbeing outcomes for defendants entering the Alcohol-MERIT program

Aim: To assess whether the NSW Alcohol-MERIT program improves the health and wellbeing of defendants. Method: Before their participation in the Alcohol-MERIT program, the health and wellbeing of 123 defendants was measured using the SF-36, Kessler-10 psychological distress scale and the SADQ for alcohol dependence level. These defendants were then followed-up two and six months after this baseline interview. Changes in the SF-36, Kessler-10 and SADQ responses were examined between: (1) baseline and the two-month interview and; (2) baseline and the six-month interview. Results: Two months after commencing the Alcohol-MERIT program, there were significant improvements in the SF-36 scores for defendants across four of the eight dimensions, significantly lower levels of psychological distress (Kessler-10) and lower levels of dependence on alcohol (SADQ). Six months after commencing the Alcohol-MERIT program, there were significant improvements in the SF-36 scores for defendants across six of the eight dimensions, significantly less psychological distress and dependence on alcohol. Conclusion: Defendants reported significant improvements in their health and wellbeing after participating in the Alcohol-MERIT program. However, attributing these improvements to the Alcohol-MERIT program alone is not possible given the absence of a relevant comparison group

Estimating a preference-based index from the Japanese SF-36

Objective: The main objective of the study was to estimate a preference-bascd Short Form (SF)-6D index from the SF-36 for Japan and compare it with the UK results. Study Design and Setting: The SF-6D was translated into Japanese. Two hundred and forty-nine health states defined by this version of the SF-6D were then valued by a representative sample of 600 members of the Japanese general population using standard gamble (SG). These health-state values were modeled using classical parametric random-effect methods with individual-level data and ordinary least squares (OLS) on mean health-state values, together with a new nonparametric approach using Bayesian methods of estimation. Results: All parametric models estimated on Japanese data were found to perform less well than their UK counterparts in terms of poorer goodness of fit, more inconsistencies, larger prediction errors and bias, and evidence of systematic bias in the predictions. Nonparametric models produce a substantial improvement in out-of-sample predictions. The physical, role, and social dimensions have relatively larger decrements than pain and mental health compared with those in the United Kingdom. Conclusion: The differences between Japanese and UK valuations of the SF-6D make it important to use the Japanese valuation data set estimated using the nonparametric Bayesian technique presented in this article. (C) 2009 Elsevier Inc. All rights reserved