NINDS CDE Notice of Copyright
Short Form 36-Item Health Survey (SF-36)
Short Form 36-Item Health Survey (SF-36)
The CDEs posted with this version of the SF-36 are specific to the Multiple Sclerosis Quality of Life Inventory (MSQLI). The National Institute of Health Neurological Disorder and Stroke (NINDS) received permission to post only the SF-36 version 1 questions that are used on the MSQLI.
The original SF-36 (i.e., SF-36 v1) is freely available in public domain:
Copyright holder: RAND Corporation - Please read Terms and Conditions for Using the 36-Item Short Form Health Survey
Please note: The SF-36-version 2 is separately validated and copyrighted from SF-36v1. CDEs are not posted for the SF-36v2 since the NINDS does not have permission to post the content of this version of the instrument. Please contact the copyright holders for permissions for use.
The Medical Outcomes Trust (MOT), Health Assessment Lab (HAL) and Quality Metric Health Outcomes Solutions, co-copyright holders of all SF-36v2®, SF-12v2®and SF-8™ Health Surveys, have merged their licensing and user registration programs, with the objectives of simplifying licensing and user registration and better meeting the needs of the many new academic, commercial, and other licensees. Use of SF-36 v2 and other SF Health Surveys versions require a signed license agreement.
Licensing agreement information for the SF-36v2®, SF-12v2® and SF-8™ Health Surveys can be found on the Quality Metric website:
NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a Generic Health-Related Quality of Life measure.
Supplemental - Highly Recommended: Parkinson's Disease (PD)
Supplemental: Amyotrophic Lateral Sclerosis (ALS), Chairi Malformation (CM), Facioscapulohumeral Muscular Dystrophy (FSHD), Friedreich's Ataxia (FA), Headache, Huntington's Disease (HD), Mitochondrial Disease (Mito), Multiple Sclerosis (MS), Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS),Myasthenia Gravis (MG), Myotonic Muscular Dystrophy (DM), Neuromuscular Diseases (NMD), Parkinson's Disease (PD), Spinal Muscular Atrophy (SMA), Sport-Related Concussion (SRC) Persistent/Chronic (3 months and greater post-concussion), Stroke, and Traumatic Brain Injury (TBI)
Exploratory: Cerebral Palsy (CP), Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH), Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months), and Spinal Cord Injury (SCI)-Pediatric
|Short Description of Instrument||
Construct measured: Health-related quality of life
Generic vs. disease specific: Generic
Means of administration: Interview or Self-Administered
Intended respondent: Patient
# of items: 36
# of subscales and names of sub-scales: 8 - Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, Mental Health
# of items per sub-scale: Varies
Background: The Short Form-36 was derived from the General Health Survey of the Medical Outcomes Study by Stewart and colleagues (1988). It is one of the most widely used generic measures of health-related quality of life and has been shown to discriminate between subjects with different chronic conditions and between subjects with different severity levels of the same disease. This instrument addresses health concepts that are relevant to patients from the patient's perspective.
|Scoring and Psychometric Properties||
Scoring: There are 36 items and measures of health across three domains - functional status, well-being and overall perceptions of health. The scoring system for the SF-36 is relatively complex and generates subscale scores for physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role-limitations due to emotional problems, and mental health.
There is no single overall score for the SF-36, instead, it generates 8 subscales and two summary scores. The physical component and the mental component summary scores, can also be derived from the SF-36. There are weighted sums of the questions in their section. Each scale is transformed into a 0-100 scale. The lower the score the more disability. Scores are also converted to z scores for comparison with general population.
Scoring corresponds to the use of the instrument. For SF-36 v1, scoring instructions are publicly available from the Rand Corporation.
Psychometric Properties: The SF-36 is highly validated. To date the properties of the SF-36 have not been evaluated in the mitochondrial disease population. In a multiple sclerosis (MS) population, the Cronbach's alphas for the various subscales of the SF-36 range from 0.67 to 0.94. There is considerable evidence for the validity of the SF-36 in a variety of populations including MS. (Vickrey et al., 1995) In this study, the physical functioning and role limitations due to physical problems subscales were the ones that best discriminated between MS patients and the normative U.S. population.
The SF-36 is easy to administer, covers a broad range of domains of health-related quality of life, and is among the most widely used of such measures. It is available in multiple languages. Availability of population-based normative data makes the SF-36 useful for comparative purposes. The availability of several subscales may be useful to investigators interested in testing hypotheses concerning these different areas of function.
The SF-36 is the most extensively evaluated health status survey, it is brief, and data can be compared to the U.S. normative population and across disease states. To keep the instrument brief, some health status concepts are missing, e.g., family functioning, sexual functioning, cognitive functioning, and sleep disorders. It is suitable for self- administration, computerized administration or administration by a trained interviewer in person or by telephone. It has been previously used in multiple myotonic dystrophy clinical trials; however, its responsiveness to change and relevance to this population is still unknown. The response rate for the population over age 65 is low.
Administration: Administration time is approximately 10 minutes. The SF-36 is a structured, self-report questionnaire that the patient can generally complete with little or no intervention from an interviewer. However, patients with visual or upper extremity impairments may need to have the SF-36 administered by a trained interviewer.
Advantages: Generic 36-item quality of life measure that include subscales for physical function, role limitations due to physical and emotional health, energy, emotional well- being, social functioning, pain and general health. Publicly available through RAND corp. Subscales are reliable. Intuitive 100 point based scoring system for each subscale.
Limitations: Measure is lengthy- 36 items (12 item scale may be more appropriate for sport concussion). Scoring conversion is challenging for the administrator and complicated. Lack of overall score. Clinical cut-off scores unavailable at this time.
Subpopulations: Intended for adult patients.
As a generalized questionnaire, it does a good job of characterizing differences in ME/CFS reported measures compared to healthy individuals and other pathological or fatiguing conditions. Consider the DePaul Symptom Questionnaire for better evaluation between and among ME/CFS patients.
Advantages: Clearly separates mental issues from physical issues - the SF-36 shows that the pain, loss of vitality, physical functioning and fatigue are not accompanied by mental problems. Provides objective measures for reduced functional status, bodily pain, functional impairment, and fatigue severity that are characteristic of ME/CFS. There are enough published studies available to compare results - given the heterogeneity of the illness/comorbidities such as FMS - it's nice to be able to have an relative abundance of studies to compare measures.
Limitations: Not designed to capture the post-exertional malaise characteristic of the illness. May have a "floor effect" that makes it hard to determine when there is a symptom flare that reduces dimensions of health over a shorter period of time. Doesn't describe the full range of symptoms ME/CFS patients experience such as cognitive, fatigability, PEM and sleep problems.
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Document last updated January 2022