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Short Form-36 for Veterans (SF-36V)
Please note that this section is an archive (last updated in June 2006). [disclaimer]
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Overview |
Instrument Reviews |
Construct Overviews |
Book Compendium Reviews |
Internet Site Reviews
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Practical Information
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Instrument Name:
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Short Form-36 for Veterans (SF-36V)
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Instrument Description:
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The SF-36V is an adapted form of the Medical Outcomes Study Short Form-36 (MOS SF-36; see the SF-36 Instrument Review), which is designed to be used specifically with veterans. The measure, consisting of the same eight sections as the MOS SF-36, is used to assess functional status. These sections are: physical functioning (PF), role limitations due to physical problems (RP), bodily pain (BP), general health perceptions (GH), energy/vitality (V), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH). (Ref: 1) The Veterans SF-36 can function as an indicator of case-mix when administered to a patient population at a point in time. (Ref: 3)
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Price:
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Free (public domain for research purposes; contact author)
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Administration Time:
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5-10 minutes
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Publication Year:
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1993
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Item Readability:
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Flesch-Kincaid grade level of 8.7. Items contain simple sentences and response options of approximately 15 words or less. Some items use outdated language (e.g. "full of pep"), but such language may be appropriate for the target population.
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Scale Format:
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Items in the RL and RE sections have been changed to a 5-point ordinal scale, differing from the SF-36 (range is from "No, none of the time" to "Yes, all of the time"). (Ref: 1, 6)
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Administration Technique:
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Self-administered, telephone-administered or interviewer-administered.
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Scoring and Interpretation:
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Scoring requires two steps. First, a linear transformation of raw scores to a range of 0 to 100 is performed on all but the RP and RE sections. This is based on the MOS algorithm. These other two sections, which have a five-point ordinal answer format, require item-level recoding based on the likelihood of responding “yes”. Five scale scores are summarized into a physical component score (PCS) and the remaining three scale scores are combined into a mental component score (MCS). The eight scales are standardized using z-score transformation from MOS SF-36 scale means and standard deviations drawn from the general U.S. population. The scoring algorithm is available from the author by request.
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Forms:
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There is also a 12-item version (SF-12V) also adapted for use in Veterans.
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Research Contacts
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Instrument Developers:
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Lewis E. Kazis, Sc.D modified the SF-36 for use in Veterans. John E. Ware, Jr., Ph.D. developed the original SF-36 for the Medical Outcomes Study.
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Instrument Development Location:
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Boston, MA
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Instrument Developer Email:
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lek@bu.edu
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Instrument Developer Website:
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www.bumc.bu.edu/
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Annotated Bibliography
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1. Jones D, Kazis L, Lee A, Rogers W, Skinner K, Cassar L, Wilson N, Hendricks A. Health status assessments using the Veterans SF-12 and SF-36: methods for evaluating outcomes in the Veterans Health Administration. J Ambul Care Manage. 2001 Jul;24(3):68-86. [PMID: 11433558]
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Purpose: The study aimed to assess differences in the cost of administering the SF-36V or SF-12V and the mode of administration (either by phone interview or by mail.) |
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Sample: 9029 Veterans randomly selected from six VA facilities across the U.S. The sample was predominantly male (95.5%), with a mean age of 60.9 years (s.d. = 14.0 years). |
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Methods: Patients were initially contacted by telephone for telephone administration of the SF-36V and SF-12V. After 12 unsuccessful contact attempts, the patients were administered the survey by mail, and after two non-returned mailings, up to three attempts were made to interview the patients by telephone. |
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Implications: Researchers attempting to administer such surveys need to consider the mode of administration due to the cost-effectiveness of mailing the survey without a telephone interview. Reliability coefficients for each SF-12V subscale were found to be similar regardless of the mode of administration. |
2. Kazis LE, Ren XS, Lee A, Skinner K, Rogers W, Clark J, Miller DR. Health status in VA patients: results from the Veterans Health Study. Am J Med Qual. 1999 Jan-Feb;14(1):28-38. [PMID: 10446661]
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Purpose: This article reported data from the Veterans Health Study in which functional status in Veterans was assessed using the SF-36V. |
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Sample: 2425 male U.S. Veterans of a total of 4137 ambulatory care patients contacted, representing a response rate of 59% .Women, who represented <5% of the site populations, were not included. |
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Methods: This study incorporated a four-year, prospective, observational design. A cross-sectional sample of ambulatory care patients was recruited from the following sites: a large tertiary care facility, a long-term care facility, and two ambulatory satellite clinics. Patients were randomly recruited by phone and mailed the survey. Patients received physical, clinical and mental health assessment and screened for depression Data were collected in three waves over an 8 month period. A brief health questionnaire was administered at 12, 24, and 48 months. The study participants ranged in age from 22-91 years, with a mean age of 62.4 years. Ninety-two percent of the participants were Caucasian, 41% had more than a high school education, and 51% had incomes less than $20,000. |
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Implications: The authors report that VA patients are different from non-VA patients and the general population in terms of demographics, education and distribution of illness. The authors also note that with the continuing use of the SF-36V by the VHA, the measure will become increasingly important in comparing Veteran care across regions, tracking annual health status changes in Veteran cohorts, and monitoring individual Veteran health. |
3. Perlin JB, Kazis LE, et. al. Health Status and Outcomes of Veterans: 1999 Large Health Survey of Veterans Executive Report. Office of Quality and Performance, Veterans Health Administration. 2000.
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Purpose: This document contains a brief overview of the SF-36V, information on its scoring algorithm, and includes an account of its use in the VHA. |
4. Kazis LE. The Veterans Sf-36 Health Status Questionnaire: Development and Application in the Veterans Health Administration. The Monitor. The Medical Outcomes Trust. 2000 Jan 5(1).
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Purpose: This article summarizes the development and use of the SF-36V in the Veterans Health Administration’s Veterans Health Study (begun in 1992) and in other VHA-sponsored studies. |
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Sample: The Veterans Health Study is a four-year prospective observational study of health outcomes in patients receiving ambulatory care from the Veterans Health Administration. A panel of 2425 patients has been followed annually since 1992. |
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Methods: Methods from several studies are mentioned in this article. |
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Implications: The VA has begun to use this instrument to measure disease burden, as an outcome measure, and to monitor health status for individual patients. Abstracts of several relevant studies are included in the manuscript. |
5. Guarino P, Peduzzi P, Donta ST, Engel CC, Clauw DJ, Williams DA, Skinner JS, Barkhuizen A, Kazis LE, Feussner JR. A multicenter two by two factorial trial of cognitive behavioral therapy and aerobic exercise for Gulf War veterans' illnesses: design of a veterans affairs cooperative study (CSP #470). Control Clin Trials. 2001 Jun;22(3):310-32. [PMID: 11384792]
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Purpose: The study assessed functional status in veterans with Gulf War Veterans' Illnesses who underwent a cognitive behavioral therapy and aerobic exercise intervention. |
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Sample: The study population consists of all veterans on active duty in the National Guard or in the Reserves who were deployed to the Southwest Asia Region of the Gulf War. Individuals were eligible to participate if they report two of the following three symptoms: fatigue that limits usual activities, musculoskeletal pain, or neurocognitive dysfunction. One thousand, three hundred and fifty-six veterans will be randomized to one of four study arms. |
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Methods: The SF-36V is administered by a research assistant at screen, baseline, 3 months, 6 months, and 12 month post-randomization. |
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Implications: The authors chose the PCS component score of the SF-36V to gauge the primary outcome measure because it uses five domains of physical health (GH, V, BP, RB, and PF) for a functional status assessment. |
6. Duffy SA, Terrell JE, Valenstein M, Ronis DL, Copeland LA, Connors M. Effect of smoking, alcohol, and depression on the quality of life of head and neck cancer patients. Gen Hosp Psychiatry. 2002 May-Jun;24(3):140-7. [PMID: 12062138]
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Purpose: The aim of this study was to evaluate the relationship of three factors (smoking, alcohol, and depression) on the quality of life among head and neck cancer patients for potential areas of intervention. |
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Sample: 81 head and neck cancer patients (83% male; 86% white) out of 117 participated in the study. They were recruited from a VA hospital and a university hospital. |
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Methods: A self-administered questionnaire was distributed to patients waiting for appointments in an otolaryngology clinic. |
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Implications: The SF-36V was administered to both Veterans and non-Veterans. Depression was negatively associated with all 8 components of the SF-36V in this population. |
7. Collins JF, Donta ST, Engel CC, Baseman JB, Dever LL, Taylor T, Boardman KD, Martin SE, Wiseman AL, Feussner JR. The antibiotic treatment trial of Gulf War Veterans' Illnesses: issues, design, screening, and baseline characteristics. Control Clin Trials. 2002 Jun;23(3):333-53. [PMID: 12057884]
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Purpose: The manuscript describes challenges in designing a multi-center trial, randomized clinical trial to evaluate the causal agent in Gulf War Veterans Illnesses through the use of antibiotics in a randomized controlled trial. For this trial, the SF-36V was used to assess functional status. |
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Sample: 2712 patients at 26 VA and two Department of Defense medical centers were screened. 491 met entry criteria and were enrolled into the study. |
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Methods: The physical component summary score was selected to measure overall functional status. |
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Implications: Used for eligibility purposed, the PCS score, if greater than 40, was one of several criteria in excluding patients from the study. |
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top
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Factors and Norms
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Factor Analysis Work:
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No information was found on this version. There has been factor analysis work performed on the MOS SF-36.
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Normative Information Availability:
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The VA national average for the PCS is 35.2 and 43.6 for the MCS. Standard deviation was not found, though the authors report these scores as being 1.5 (PCS) and 0.7 (MCS) standard deviations below those for the U.S. population. (Ref: 3) In a sample of male ambulatory care VA patients, the PCS score of 37.1 was more than 1 standard deviation worse than that of a national sample of non-VA medical system users (49.42). The MCS score of 47.8 was one-third of a standard deviation worse than that of the national sample (51.0). (Ref: 4)
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Reliability Evidence
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Test-retest:
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No information was found.
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Inter-rater:
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No information was found.
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Internal Consistency:
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In a sample of 9029 veterans with a mean age of 60.9 years (standard deviation = 14.0). Ninety-five percent of the sample consisted of men. (Ref: 1) , Cronbach’s alpha values were nearly identical for mail and telephone administrations. The authors reported the following values for the eight components (Ref: 1):
| Component
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Mail
Score
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Telephone
Score
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| PF
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0.94
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0.92
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| RP
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0.95
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0.91
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| BP
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0.86
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0.82
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| GH
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0.85
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0.80
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| V
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0.87
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0.87
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| SF
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0.87
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0.80
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| RE
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0.94
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0.93
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| MH
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0.89
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0.90
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Alternate Forms:
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No information was found.
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Validity Evidence
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Construct/ Convergent/ Discriminant:
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No information was found.
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Criterion-related/ Concurrent/ Predictive:
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No information was found.
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Content:
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No information was found.
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Responsiveness Evidence:
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No information was found.
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Scale Application in VA Populations:
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Yes. This instrument has been used almost exclusively in Veterans and has been adopted by the VHA for assessing functional status in Veterans. (Ref: 1-6)
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Scale Application in non-VA Populations:
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Yes. This instrument was used in a mixed population of Veterans and non-Veterans. (Ref: 5)
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Comments
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The advantage of the SF-36V over the MOS SF-36 is some improvement in precision at the lower end of the health status continuum. This is achieved by changing the scoring format in two of the sections from dichotomous to polytomous.
The SF-36V has been accepted by the VA as the standard for the assessment of general health status in veteran populations. For this reason, the SF-36V is likely to enjoy increasingly wide usage in VA studies and the associated opportunities for comparisons across studies.
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