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RCMAR Measurement Tools
Medical Outcomes Study
Short Form (SF-36)
Ware, J.E., K.K. Snow, M. Kosinski, B. Gandek of QualityMetric Inc.
Background and Development:
The SF-36 contains 36 items and measures eight domains of health:
physical functioning, role limitations due to physical health, bodily
pain, general health perceptions, vitality, social functioning, role
limitations due to emotional problems, and mental health. The SF-36
yields a score for each of these domains, as well as summary scores
for both physical and mental health and a single health utility index.
It can be self administered, computer administered, or given by a
trained interviewer in person or by telephone to persons ages 14 and
older, and can usually be completed in 5-10 minutes. Most of the items
in the survey ask respondents to consider a specific period of time,
or recall period, when responding. The SF-36 is available in a standard
form that uses a four-week recall period, and an acute form that uses
a one-week recall period.
Reliability measurements of the SF-36 are consistently good to excellent.
The Physical Functioning domain consistently exceeded Cronbach's alpha
of 0.90. Other domains had median Cronbach's alpha greater than 0.80
except for the Social Functioning domain (a two-item scale) with a
median of 0.76. Test-retest reliabilities for the eight domains were
good, ranging from 0.73 to 0.96. Validity of the SF-36 has been confirmed
through comparisons with other surveys and independent criteria such
as physical ability, health care usage, or ability to work. For more
details see Ware et al. (1993). Factor analysis confirmed a two-factor
construct for the SF-36 (physical and mental health) with low correlation
between the two.
Assessment in Elderly Populations:
Numerous studies have employed the SF-36 in elderly populations.
Assessment in Minority Populations:
The SF-36 has been translated and adapted for use in more than 50
countries. Recently, a Chinese-language version has been written employing
cultural adaptation, and tested in a population from mainland China
(Hangzhou) (Li et al. 2003).
The SF-36 has been used extensively in other studies.
Design Strengths and Weaknesses:
The SF-36 has become one of the standard survey tools in quality
of life research. Many other measurement tools have used the SF-36
as a source to measure external validity. It does not take long to
administer and the reliability and validity of the measure are good
For more information including license agreements go to: Quality
Li, L. H.M. Wang, and Y. Shen (2003) Chinese SF-36 Health Survey:
translation, cultural adaptation, validation, and normalisation. J.
Epidemiol. Community Health, 54(4), 259-263.
Ware, J.E., K.K. Snow, M. Kosinski, B. Gandek (1993, 2000) SF-36
Health Survey: Manual and Interpretation Guide. Lincoln, RI: QualityMetric