07/01/96 9:46 AM

A Microcomputer Program (sf36.exe) that GeneratesSAS Code for Scoring the SF-36 Health Survey

Ron D. Hays, Cathy D. Sherbourne, Karen L. Spritzer, Wil J. Dixon DRU-1437-PI

AbstractThis paper describes a microcomputer that can be used to generate SAS code that for scoring SF-36 Health Survey, one of the most widely used measures of health-related quality of life today. The generated SAS code scores the 8 SF-36 scales as well as the SF-36 physical and mental health composite scores. In addition, the program produces code that provides US general population normative scores, age and gender adjusted to one’s sample. The significance of the difference between the sample and the general population on each SF-36 scale score is also generated. Example input and output files are included. Selected SF-36 publications are cited. The SF-36 Health Survey items are given in the Appendix.

1

07/01/96 9:46 AM

A Microcomputer Program (sf36.exe) that GeneratesSAS Code for Scoring the SF-36 Health Survey

The SF-36 taps eight health concepts: physical functioning, bodilypain, role limitations due to physical health problems, role limitationsdue to personal or emotional problems, emotional well-being, socialfunctioning, energy/fatigue, and general health perceptions. It alsoincludes a single item that provides an indication of perceived changein health. These 36 items were adapted from longer instrumentscompleted by patients participating in the Medical Outcomes Study (MOS),an observational study of variations in physician practice styles andpatient outcomes in different systems of health care delivery (Hays &Shapiro, 1992; Stewart, Sherbourne, Hays, et al., 1992).

Scoring the Eight SF-36 Scales We recommend that responses be scored as described below (the RAND method). A somewhat different scoring procedure for the pain and general health scales was advocated by New England Medical Center (NEMC)investigators (Ware, Snow, Kosinski,, & Gandek, 1993). Although only our scoring recommendations for these scales are described here, the SAS program generator we provide scores these two scales both ways. Pain scale scores scored the RAND versus NEMC way correlated 0.99 in the MOS, with a mean difference of 3.33 (NEMC scoring yields lower pain scores on average). General health perception scale scores also correlated 0.99 in the MOS, with a mean difference of -1.37 (NEMC scoring yields higher general health scores on average). For further information about the scoring differences, see Hays, Sherbourne, and Mazel (1993). Scoring the SF-36 is a two-step process. First, pre-coded numericvalues are recoded per the scoring key given in Table 1. Note that allitems are scored so that a high score defines a more favorable healthstate. In addition, each item is scored on a 0 to 100 range so that thelowest and highest possible scores are set at 0 and 100, respectively.Scores represent the percentage of total possible score achieved. Instep 2, items in the same scale are averaged together to create the 8scale scores. Table 2 lists the items averaged together to create eachscale. Items that are left blank (missing data) are not taken intoaccount when calculating the scale scores. Hence, scale scoresrepresent the average for all items in the scale that the respondentanswered. If all items in a scale are missing, then the scale score is also missing. Example: Items 20 and 32 are used to score the measure of socialfunctioning. Each of the two items has 5 response choices. However, a

2

07/01/96 9:46 AM

high score (response choice 5) on item 20 indicates extreme limitations insocial functioning, while a high score (response choice 5) on item 32indicates the absence of limitations in social functioning. To score bothitems in the same direction, Table 1 shows that responses 1 through 5 foritem 20 should be recoded to values of 100, 75, 50, 25, and 0,respectively. Responses 1 through 5 for item 32 should be recoded tovalues of 0, 25, 50, 75, and 100, respectively. Table 2 shows that thesetwo recoded items should be averaged together to form the socialfunctioning scale. If the respondent is missing one of the two items, theperson's score will be equal to that of the nonmissing item. Table 3 presents information on the reliability, central tendencyand variability of the scales in the MOS when scored using this method. To use the enclosed programs, it is necessary to have a SAS dataset withthe SF-36 items in it. The program, sf36.exe, is used in combinationwith your SAS file of SF-36 items to create SAS code for scoring theSF-36 scales. In addition to having a SAS dataset with SF-36 items, you need tocreate an ASCII file that specifies the variable names you have assigned to the 36 SF-36 items in your study. When sf36.exe is executed, you will be asked for the name of the input file: WHAT FILE CONTAINS THE INPUT SETUP? Notice that the input file (sf36.in) consists of a list of 36 variable names, each entered on a separate row beginning in column one (see Table 4). The variable names need to be listed to correspond with the order of items presented in the Appendix. For example, the first item reads "In general, would you say your health is: Excellent, Very good, Good, Fair, Poor?" On the first row of the input file, you should list the variable name you assigned to this item. You need to list the actual SAS names used for your data set so that the generated SAS code will include rename statements linking your SAS names to the SAS names used in the generated code (the generated code uses names I1 through I36 following the order of items in the Appendix). If you use the same SAS names as assumed in the program (I1 throughI36), you can use the sf36.in file (see Table 4) as the input file when you execute sf36.exe. If you use different SAS names, you will have to create a

3

07/01/96 9:46 AM

file that reflects these differences (see sf36.ex, Table 5, for an example of adifferent input file). Note that you should not use the variable names I1 through I36 for variables other than the SF-36 items or SAS will not be able to distinguish the SF-36 items from these other variables. The program assumes that your dataset includes a continuous measureof AGE (named "AGE") and a gender variable called "MALE" (coded 0 =female, 1 = male). The sf36.exe program produces a file, sf36.sas, that contains SAS code for scoring the sf-36 scales. For the pain and general health scales, both the RAND and NEMC scoring are provided. Scale scores are created for persons that answer any of the items in a scale (Note that NEMC only creates scores for person who answer half or more of the items in a scale.) The SAS code in sf36.sas assumes that the name of the SAS datasetthat includes the SF-36 items is "TEMP" (see SET TEMP in the generatedSAS code). If your file has a different name, you should change thispart of the sf36.sas file to reflect that. Note that a raw data file,sf36.raw, is also produced and that this file is read by sf36.sas whenit is run. This raw data file includes information about US generalpopulation means and standard deviations (Ware et al., 1993)

Example of Using sf36.exe Table 5 provides an example of an input file, sf36.in2, for sf36.exe. In this example, the SF-36 items were assigned the SAS names T1 through T36 in the study in which they were used. The input file is read by sf36.exe and this information is used in creating the file, sf36.sas, shown in Table 6.

Scoring the SF-36 Physical and Mental Health Composite Scores Running sf36b.exe will produce SAS code, saved as sf36add.sas,that will create T-scores for the 8 SF-36 scales (using the US general population norms). In addition, physical and mental health composite scores for the SF-36 (Ware, Kosinkski, & Keller, 1994) and the SF-12 (Ware, Kosinski, & Keller, 1995, 1996) are produced. The sf36add.sas filecan be appended to sf36.sas for analyses of the SF-36 scales and composite scores. Running the resulting sf36.sas file yields the output shown for the sample data shown in Table 7. The output includes descriptive statistics for the 8 SF-36 scales andUS general population norms, age and gender adjusted to your sample. The SF-36 SAS names used are as follows:

4

07/01/96 9:46 AM

PHYFUN10 Physical functioning in your sample PFISFM Physical functioning in general population ROLEP4 Role limitations--physical in your sample RPSFM Role limitations--physical in general population PAIN2 Pain in your sample--RAND scoring SFPAIN Pain in your sample--NEMC scoring BPSFM Pain in general population GENH5 General health in your sample--RAND scoring SFGENH5 General health in your sample--NEMC scoring GENSFM General health in general population EMOT5 Emotional well-being in your sample MHSFM Emotional well-being in general population ROLEE3 Role limitations--emotional in your sample RESFM Role limitations--emotional in general population ENFAT4 Energy in your sample ENFTSFM Energy in general population SOCFUN2 Social function in your sample SFSFM Social function in general population

Table 7 illustrates the output of means, standard deviations, minimum and maximum values for each of these scales. Note that only the mean values are provided for the general population values (PFISFM, RPSFM, BPSFM, GENSFM, MHSFM, RESFM, ENFTSFM, SFSFM), because the standard deviations and ranges produced by SAS for these scales are not relevant (i.e., These variances and ranges because they are based on mean scores derived from age and gender subgroups of the general population, and are not the general population estimates of these statistics). In addition to the descriptive statistics, sf36.sas provides t-statistics (asymptotically z-statistics) for the significance of the difference between SF-36 scores in the sample compared to the US general population (ZPHY10, ZRP, ZBP, ZGENH, ZENFT, ZSF, ZRE, ZMHI). Finally, sf36.sas outputs SF-36 scale scores for the sample, corresponding T-scores for each scale, and the physical (AGG_PHYS) and mental health (AGG_MENT) composite T-scores. The sample size and descriptive statistics provided here may differ from the prior output, because in the prior output respondents are omitted if they have missing data on age or gender (these variables are needed to adjust the general population values to one’s sample).

For further information please contact either:

Ron D. Hays or Cathy D. Sherbourne RAND RAND

5

07/01/96 9:46 AM

1700 Main Street 1700 Main Street P.O. Box 2138 P.O. Box 2138 Santa Monica, CA 90407-2138 Santa Monica, CA 90407-2138 (310) 393-0411 Ext.7581 (Voice) (310) 393-0411 Ext. 7216 (Voice) (310) 393-4818 (FAX) (310) 393-4818 (FAX) Ronald_Hays@rand.org Cathy_Sherbourne@rand.org

6

07/01/96 9:46 AM

Selected SF-36 Publications (Including Those Cited Above)

Aaronson, N.K., Acquadro , C., Alonso, J., Apolone, G. Bucquet, D., Bullinger, M., Bungay, K., Fukuhara, S., Gandek, B., Keller, S., Razavi, D., Sanson-Fisher, R., Sullivan, M., Wood-Dauphinee, S., Wagner, A., & Ware, J. E. (1992). International quality of life assessment (IQOLA) project. Quality of Life Research, 1, 349-351.Anderson, R.T., Aaronson, N.K,. and Wilkin D. (1993). Critical review of the international assessments of health-related quality of life. Quality of Life Research, 2, 369-395.Andresen, E., Patrick, D. L., Carter, W. B., & Malmgren, J. A. (1995). Comparing the performance of health status measures for healthy older adults. Journal of the American Geriatrics Society, 43, 1030-1034.Barry, M. J., Walder-Corkery, E., Chang, Y., Tyll, L. T., Cherkin, D. C., & Fowler, F. J. (1996). Measurement of overall and disease-specific health status: Does the order of questionnaires make a difference? Journal of Health Services Research, 1, 20-27.Beusterien, K. M., Nissenson, A. R., Port, F. K., Kelly, M., Steinwald, B., & Ware, J. E. (1996). The effects of recombinant human erythropoietin on functional health and well-being in chronic dialysis patients. Journal of the American Society of Nephrology, 7, 763-773.Bouchet, C., Guillemin, F., & Briancon, S. (1996). Nonspecific effects in longitudinal studies: Impact on quality of life measures. Journal of Clinical Epidemiology, 49, 15-20.Bousquet, J., Bullinger, M., Fayol, C., Marquis, P., Valentin, B., & Burtin, B. (1994). Assessment of quality of life in patients with perennial allergic rhinitis with the French version of the SF-36 health status questionnaire. Journal of Allergy Clin Immunol, 94, 182-188.Bousquet, J., Knani, J., Dhivert, H., Richard, A., Chicoye, A., Ware, J.E., and Michel, F-B. (1994). Quality of life in asthma. I. Internal consistency and validity of the SF-36 questionnaire. American Journal of Respiratory and Critical Care Medicine, 149, 371-375.Brazier, J. (1993). The SF-36 health survey questionnaire - a tool for economists. Health Economics, 2, 213-215.Brazier, J.E., Harper, R., Jones, N.M.B., O'Cathain, A., Thomas, K.J., Usherwood, T., and Westlake, L. (1992). Validating the SF-36 health survey questionnaire: New outcome measure for primary care. British Medical Journal, 305, 160-4.

7

07/01/96 9:46 AM

Brazier, J., Jones, N., & Kind, P. (1993). Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire. Quality of Life Research, 2, 169-180.Bullinger M. (1996). German translation and psychometric testing of the SF-36 health survey: Preliminary results from the IQOLA project. Social Science and Medicine.Fifer S., Mathias SD, Patrick DL, Mazonson PD, Lubeck DP, Buesching DP. (1994). Untreated anxiety among adult primary care patients in a health maintenance organization. Archives of General Psychiatry, 51,740-750.Fryback, D.G., Dasbach, E.J., Klein, R., et al. (1993). The Beaver Dam Health Outcomes Study: Initial catalog of health state quality factors. Medical Decision Making, 13, 89-102.Ganz, P. A., Coscarelli, A., Fred, C., Kahn, B., Polinsky, M. L., & Petersen, L. (in press). Breast cancer survivors: Psychosocial concerns and quality of life. Breast Cancer Treatment and Research.Ganz, P. A., Day,R., Ware, J. E., Redmond, C., & Fisher, B. (in press). Baseline quality of life assessment in the National Surgical Adjuvant Breast and Bowel Project (NSABP) Breast Cancer Prevention Trial. Journal of the National Cancer Institute.Garratt, A.M., MacDonald, L.M., Ruta, D.A., Russell, I. T., Buckingham, J. K., & Krukowski, Z. H. (1993). Towards measurement of outcome

forK. patients with varicose veins. Quality in Health Care, 2, 5-10.

Garratt, A.M., Ruta, D.A., Abdalla, M.I., Buckingham, J.K., & Russell, I.T. (1993). The SF 36 health survey questionnaire: An outcome measure suitable for routine use within the NHS? British Medical Journal, 306, 1440-1444.Garratt, A. M., Ruta, D. A., Abdalla, M. I., & Russell, I. T. (1994). SF 36 health survey questionnaire: II. Responsiveness to changes in health status in four common clinical conditions. Quality in Health Care, 3, 186-192.Gliklich, R. E., & Hilinski, J. M. (1995). Longitudinal sensitivity of generic and specific health measures in chronic sinusitis. Quality of Life Research, 4, 27-32.Haley, S.M., McHorney, C.A., and Ware, J.E. (1994). Evaluation of the MOS SF-36 Physical Functioning scale (PF-10): I. Unidimensionality and reproducibility of the Rasch item scale. Journal of Clinical Epidemiology, 47, 671-684.

8

07/01/96 9:46 AM

Hays, R. D., Kravitz, R. L., Mazel, R. B., Sherbourne, C. D., DiMatteo, M. R., Rogers, W. H., & Greenfield, S. (1994). The impact of patient adherence on health outcomes for chronic disease patients in the Medical Outcomes Study. Journal of Behavioral Medicine, 17, 347-358.Hays, R. D., Marshall, G. N., Wang, E. Y. I., & Sherbourne, C. D. (1994). Four-year cross-lagged associations between physical and mental health in the Medical Outcomes Study. Journal of Consulting and Clinical Psychology, 62, 441-449.Hays, R. D., & Shapiro, M. F. (1992). An overview of generic health-related quality of life measures for HIV research. Quality of Life Research, 1, 91-97Hays, R.D., Sherbourne, C.D., & Mazel, R.M. (1993). The RAND 36-item health survey 1.0. Health Economics, 2, 217-227.Hays, R. D., Stewart, A. L., Sherbourne, C. D., & Marshall, G. N. (1993). The ‘states versus weights’ dilemma in quality of life measurement. Quality of Life Research, 2, 167-168.Hays, R. D., Wells, K.B., Sherbourne, C. B., Rogers, W. H., & Spritzer, K. (1995). Functioning and well-being outcomes of patients with depression compared to chronic medical illness. Archives of General Psychiatry, 52, 11-19Hill, S., Harries, U., & Popay, J. (1995). Is the short form 36 (SF-36) suitable for routine health outcomes assessment in health care for older people? Evidence from preliminary work in community based health services in England. Journal of Epidemiology and Community Health, 50, 94-98.Hornbrook, M. C., & Goodman, M. J. (1995). Assessing relative health plan risk with the RAND-36 Health Survey. Inquiry, 32, 56-74.Hueston, W. J., Mainous, A. G., & Schilling, R. (1996). Patients with personality disorders: Functional status, health care utilization, and satisfaction with care. Journal of Family Practice, 42, 54-60.Hunt, S. M., & McKenna, S. P. (1993). Measuring patients’ views of their health: SF 36 misses the mark. British Medical Journal, 307, 125. Jenkinson, C., Coulter, A., & Wright, L. (1993). Short form 36 (SF 36) health survey questionnaire: Normative data for adults of working age. British Medical Journal, 306, 1437-1440.Jenkinson, C., Lawrence, K., McWhinnie, D., & Gordon, J. (1995).

9

07/01/96 9:46 AM

Sensitivity to change of health status measures in a randomized controlled trial: Comparison of the COOP charts and the SF-36. Quality of Life Research, 4, 47-52.Jenkinson, C., Peto, V., & Coulter, A. (1994). Measuring change over time: A comparison of results from a global single item of health status and the multi-dimensional SF-36 health status survey questionnaire in patients presenting with menorrhagia. Quality of Life Research, 3, 317-321.Jenkinson, C., Peto, V., & Coulter, A. (1996). Making sense of ambiguity: Evaluation of internal reliability and face validity of the SF 36 questionnaire in women presenting with menorrhagia. Quality in Health Care, 5, 9-12.Jenkinson, C., and Wright, L. (1993). The SF-36 health survey questionnaire. Auditorium, 2, 7-12.Jenkinson, C. Wright, L., & Coulter, A. (1994). Criterion validity and reliability of the SF-36 in a population sample. Quality of Life Research, 3, 7-12.Johnson, P. A., Goldman, L., Orav, E. J., Garcia, T., Pearson, S. D., & Lee, T. H. (1995). Comparison of the Medical Outcomes Study Short-form 36-Item Health Survey in black patients and white patients with acute chest pain. Medical Care, 33, 145-160.Julious, S. A., George, S., & Campbell, M. J. (1995). Sample sizes for studies using the short form 36 (SF-36). Journal of Epidemiology and Community Health, 49, 642-644.Kantz, M.E., Morris, W.J. , Levitsky, K., Ware, J.E. and Davies, A.R. (1992). Methods for assessing condition-specific and generic functional status outcomes after total knee replacement. Medical Care, 30, MS240-MS252.Katz, J.N., Larson, M.G., Phillips, C.B., Fossel, A.H., and H Liang, M.H. (1992). Comparative measurement sensitivity of short and longer health status instruments. Medical Care, 30, 917-925.Kurtin, P.S., Davies, A.R., Meyer, K.B., DeGiacomo, J.M., & Kantz, M.E. (1992). Patient-based health status measures in outpatient dialysis: Early experience in developing an outcomes assessment program. Medical Care, 30, MS136-149; 1992.Lancaster, T.R, Singer, D.E., Sheehan, M.A., Oertel, L.B., Maraventano, S.W., Hughes, R.A., & Kistler, J.P. (1991). The impact of long-term Warfarin therapy on quality of life: Evidence from a randomized trial. Archives of Internal Medicine, 151, 1944-1949.Lansky, D., Butler, J.B.V., & Waller, F.T. (1992). Using health status measures in the hospital setting: From acute care to "outcomes

10

07/01/96 9:46 AM

management". Medical Care, 30, MS57-MS73.Levin, N.W., Lazarus, J.M., & Nissenson, A.R. (1993). National cooperative rHu erthropoletin study in patients with chronic renal failure - an interim report. American Journal of Kidney Disease, 22 (2, Suppl 1), 3-12.Litwin, M., Hays, R. D., Fink, A., Ganz, P. A., Leake, B., Leach, G. E., & Brook, R. H. (1995). Quality of life outcomes in men treated for localized prostate cancer. Journal of the American Medical Association, 273, 129-135.Lubeck, D.P, & Fries, J.F. (1993). Health status among persons infected with human immunodeficiency virus: A community-based study. Medical Care, 31, 269-276.Lyons, R. A., Perry, H. M., & Littlepage, B. N. (1994). Evidence for the validity of the Short-Form 36 Questionnaire (SF-36) in an elderly population. Age and Aging, 23, 182-184.Mangione, C. M. Phillips, R. S., Lawrence, M. G., Seddon, J. M., Orav, J., & Goldman, L. (1994). Improved visual function and attenuation of declines in health-related quality of life after cataract extraction. Archives of Opthalmology, 112, 1419-1425.Martin, C., Marquis, P., & Bonfils, S. (1994). A "quality of life questionnaire" adapted to duodenal ulcer therapeutic trials. Scandinavian Journal of Gastroenterology, 29, 40-43.Mathias, S. D., Fifer, S. K., Mazonson, P. D., Lubeck, D. P., Buesching, D. P., & Patrick, D. L. (1994). Necessary but not sufficient: The effect of screening and feedback on outcomes of primary care patients with untreated anxiety. Journal of General Internal Medicine, 9, 606-615.McCallum, J. (1995). The SF-36 in an Australian sample: Validating a new generic health status measure. Australian Journal of Public Health, 19, 160-166.McHorney, C.A., Kosinski, M., & Ware, J.E. (1994). Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: Results from a national survey. Medical Care, 32, 551-567.McHorney, C. A., & Ware, J. E. (1995). Construction and validation of an alternate form general mental health scale for the Medical Outcomes Study short-form health survey. Medical Care, 33, 15-28.McHorney, C.A., Ware, J.E., Lu, J.F.R., & Sherbourne, C.D. (1994). The MOS 36-item short-form health survey (SF-36): III. Tests of data quality, scaling assumptions, and validity among diverse patient groups. Medical Care, 32, 40-66.McHorney, C.A., Ware, J.E., & Raczek, A.E. (1993). The MOS 36- item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.

11

07/01/96 9:46 AM

Medical Care, 31, 247-263.McHorney, C.A., Ware, J.E., Rogers, W., Raczek, A.E., & Lu, J.F.R. (1992). The validity and relative precision of MOS Short- and Long- Form Health Status Scales and Dartmouth COOP Charts. Medical Care, 30, MS253-265.Meyer, K.B., Espindle, D.M., DeGiacomo, J.M., Jenuleson, C.S., Kurtin, P.S., & Davies, A.R. (1994). Monitoring dialysis patients' health status. American Journal of Kidney Diseases, 24, 267-279.Nerenz, D.R., Repasky, D.P., Whitehouse, F.W., & Kahkonen, D.M. (1992) Ongoing assessment of health status in patients with diabetes mellitus. Medical Care, 30, MS112-MS124.Paterson, C. (1996). Measuring outcomes in primary care: A patient generated measure, MYMOP, compared with the SF-36 health survey. British Medical Journal, 312, 1016-1020.Perneger, T., Allaz, A. Etter, J, & Rougemont A. (1995). Mental health and choice between managed care and indemnity health insurance. American Journal of Psychiatry, 152, 1020-1025.Perneger TV, Etter JF, & Rougemont A. (1996). Switching Swiss enrollees from indemnity health insurance to managed care: The effect on health status and satisfaction with care. American Journal of Public Health, 86, 388-393.Perneger, T., LePlege A., Etter J., & Rougemont A. (1995) Validation of a French-language version of the MOS 36-Item Short Form Health Survey (SF-36) in young healthy adults. Journal of Clinical Epidemiology, 48, 1051-1060.Phillips, R.C., & Lansky, D.J. (1992). Outcomes management in heart valve replacement surgery: Early experience. Journal of Heart Valve Disease, 1, 42-50.Rampal, P., Martin, C., Marquis, P., Ware, J. E., & Bonfils, S. (1994). A quality of life study in five hundred and eighty-one duodenal ulcer patients. Scandanavian Journal of Gastroenterology, 29, 44-51.Reuben, D.B., Valle, L.A., Hays, R.D., & Siu A.L. (1995). Measuring

12

07/01/96 9:46 AM

physical function in community-dwelling older persons: a comparison of self-administered, interviewer-administered, and performance-based measures. Journal of the American Geriatric Society, 43, 17-23.Ruta, D. A., Abdalla, M. I., Garratt, A. M., Coutts, A., & Russell, I. T. (1994). SF 36 health survey questionnaire: I. Reliability in two patient based studies. Quality in Health Care, 3, 180-185.Ruta, D. A., Garratt, A. M., Chadha, Y. C., Flett, G. M., Hall, M. H., & Russell, I. T. (1995). Assessment of patients with menorrhagia: How valid is a structured clinical history as a measure of health status? Quality of Life Research, 4, 33-40.Ruta, D. A., Garratt, A.M., Leng, M., Russell, I.T., & MacDonald, L.M. (1994). A new approach to the measurement of quality of life: The patient-generated index. Medical Care, 32, 1109-1126.Ryan, C. F., & White, J. M. (1996). Health status at entry to methadone maintenance treatment using the SF-36 health survey questionnaire. Addiction, 91, 39-45.Sherbourne, C. D., Hays, R. D., & Wells, K. B. (1995). Personal and psychosocial risk factors for physical and mental health outcomes and course of depression among depressed patients. Journal of Consulting and Clinical Psychology, 63, 345-355.Sherbourne, C.D., Wells, K.B., & Judd, L.L. (1996). Functioning and well-being of patients with panic disorder. American Journal of Psychiatry, 153, 213-218.Sherbourne, C.D., Wells, K.B., Meredith, L.S., Jackson, C.A., & Camp, P. (in press). Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers. Archives of General Psychiatry.Stewart, A. L., Sherbourne, C. D., Hays, R. D., Wells, K. B., Nelson, E. C., Kamberg, C. J., Rogers, W. H., Berry, S. D., & Ware, J. E. (1992). Summary and discussion of MOS measures. In A. L. Stewart & J. E. Ware (eds.), Measuring functioning and well-being: The Medical Outcomes Study approach. (pp. 345-371). Durham, NC: Duke University Press.Sullivan, M., Karlsson, J., & Ware, J.E. (1994). The Swedish SF-36 health survey: I. Evaluation of data quality, scaling assumptions, reliability, and construct validity across several populations. Social Science and Medicine, 41, 1349-1358.van Tulder, M.W., Aaronson, N.K., & Bruning, P.F. (1994). The quality of life of long-term survivors of Hodgkin's disease. Annals of Oncology, 5, 152-158.

13

07/01/96 9:46 AM

Vickrey, B.G., Hays, R.D., Graber, J., Rausch, R., Engel, J., & Brook, R.H. (1992). A health-related quality of life instrument for patients evaluated for epilepsy surgery. Medical Care, 30, 299-319.Vickrey, B. G., Hays, R. D., Rausch, R., Sutherling, W. W., Engel, J., & Brook, R. H. (1994). Quality of life of epilepsy surgery patients compared with outpatients with hypertension, diabetes, heart disease, and/or depressive symptoms. Epilepsia, 35, 597-607.Wagner, A. K., Keller, S. D., Kosinski, M., Baker, G. A., Jacoby, A., Hsu, M., Chadwick, D. W., & Ware, J. E. (1995). Advances in methods for assessing the impact of epilepsy and antiepileptic drug therapy on patients' health-related quality of life. Quality of Life Research, 4, 115-134.Ware, J.E. (1993). Measuring patients' views: The optimum outcome measure: SF 36: a valid, reliable assessment of health from the patient's point of view. British Medical Journal, 306, 1429-1444.Ware, J. E., Gandek, B., & the IQOLA Project Group. (1994). The SF-36 Health Survey: Development and use in mental health research and the IQOLA project. International Journal of Mental Health, 23, 49-73.Ware, J. E., Keller, S. D., Gandek, B., Brazier, J. E., Sullivan, M., & The IQOLA Project Group. (1995). Evaluating translations of health status questionnaires: Methods from the IQOLA Project. International Journal of Technology Assessment in Health Care, 11, 525-551.Ware, J.E., Kosinski, M., Bayliss, M.S., McHorney, C. A., Rogers, W. H., & Raczek, A. (1995). Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: Summary of results from the Medical Outcomes Study. Medical Care, 33, AS264-AS279.Ware, J. E., Kosinski, M., & Keller, S. D. (1995). SF-12: How to score the SF-12 physical and mental health summary scores. Boston, MA: The Health Institute, New England Medical Center. Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 physical and mental health summary scales: A User’s Manual. Boston, MA: The Health Institue, New England Medical Center.Ware, J.E., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220-233.

14

07/01/96 9:46 AM

Ware, J.E., and Sherbourne, C.D. (1992). The MOS 36-item short- form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473-483.Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 Health Survey: Manual and interpretation guide. Boston: The Health Institute.Weinberger M, Kirkman MS, Samsa GP, Cowper PA, Shortliffe EA, Simel DL, & Feussner JR. (1994). The relationship between glycemic control and health-related quality of life in patients with non-insulin dependent diabetes mellitus. Medical Care, 32, 1173-1181.Weinberger, M., Nagle, B., Hanlon, J. T., Samsa, G. P., Schmader, K., Landsman, P. B., Uttech, K. M., Cowper, P. A., Cohen, H. J., & Feussner, J. R. (1994). Assessing health-related quality of life in elderly outpatients: Telephone versus face-to-face administration. Journal of the American Geriatric Society, 42, 1295-1299.Weinberger, M., Samsa, G.P., Hanlon, J.T., Schmader, K., Doyle, M.E., Cowper, P.A., Uttech, K.M., Cohen, H.J., & Feussner, J.R. (1991). An evaluation of a brief health status measure in elderly veterans. Journal of the American Geriatrics Society, 39, 691-694.Wells, K.B., Burnam, M.A., Rogers, W., Hays, R., & Camp, P. (1992). The course of depression in adult outpatients: Results from the Medical Outcomes Study. Archives of General Psychiatry, 49, 788-794.Wolinsky, F. D., & Stump, T. E. (1996). A measurement model of the Medical Outcomes Study 36-item short-form health survey in a clinical sample of disadvantaged, older, black, and white men and women. Medical Care, 34, 537-548.Ziebland S. (1995). The short form 36 health status questionnaire: Clues from the Oxford region's normative data about its usefulness in measuring health gain in population surveys. Journal of Epidemiology and Community Health, 49, 102-105.

15

07/01/96 9:46 AM

Table 1STEP 1: RECODING ITEMS

ITEM NUMBERS Change original response category (a)

To recoded value of:

1,2,20,22,34,36 1 ----------- > 1002 ----------- > 753 ----------- > 504 ----------- > 255 ----------- > 0

3,4,5,6,7,8,9,10,11,12 1 ----------- > 02 ----------- > 503 ----------- > 100

13,14,15,16,17,18,19 1 ----------- > 02 ----------- > 100

21,23,26,27,30 1 ----------- > 1002 ----------- > 803 ----------- > 604 ----------- > 405 ----------- > 206 ----------- > 0

24,25,28,29,31 1 ----------- > 02 ----------- > 203 ----------- > 404 ----------- > 605 ----------- > 806 ----------- > 100

32,33,35 1 ----------- > 02 ----------- > 253 ----------- > 504 ----------- > 755 ----------- > 100

(a) Precoded response choices as printed in the questionnaire.

16

07/01/96 9:46 AM

Table 2STEP 2: AVERAGING ITEMS TO FORM SCALES

Scale Number Of Items

After Recoding Per Table 1, Average The Following Items:

Physical functioning 10 3 4 5 6 7 8 9 10 11 12

Role limitations due to physical health 4 13 14 15 16

Role limitations due to emotional problems

3 17 18 19

Energy/fatigue 4 23 27 29 31

Emotional well-being 5 24 25 26 28 30

Social functioning 2 20 32

Pain 2 21 22

General health 5 1 33 34 35 36

17

07/01/96 9:46 AM

Table 3RELIABILITY, CENTRAL TENDENCY AND VARIABILITY OF SCALES

IN THE MEDICAL OUTCOMES STUDY

Scale Items Alpha Mean SD

Physical Functioning 10 0.93 70.61 27.42

Role Functioning/physical 4 0.84 52.97 40.78

Role Functioning/emotional 3 0.83 65.78 40.71

Energy/fatigue 4 0.86 52.15 22.39

Emotional well-being 5 0.90 70.38 21.97

Social functioning 2 0.85 78.77 25.43

Pain 2 0.78 70.77 25.46

General Health 5 0.78 56.99 21.11

Health Change 1 – – 59.14 23.12

Note. Data is from baseline of the Medical Outcomes Study (N = 2471), except for Health change, which was obtained one-year later.

18

07/01/96 9:46 AM

Table 4

EXAMPLE INPUT FILE (sf36.in) For SF36.EXE

I1I2I3I4I5I6I7I8I9I10I11I12I13I14I15I16I17I18I19I20I21I22I23I24I25I26I27I28I29I30I31I32I33I34I35I36

19

07/01/96 9:46 AM

Table 5

EXAMPLE INPUT FILE (sf36.in2) For sf36.exe

T1T2T3T4T5T6T7T8T9T10T11T12T13T14T15T16T17T18T19T20T21T22T23T24T25T26T27T28T29T30T31T32T33T34T35T36

20

07/01/96 9:46 AM

Table 6EXAMPLE sf36.sas FILE Produced By sf36.exe

DATA TEMP1; SET TEMP;RENAMET1=I1T2=I2T3=I3T4=I4T5=I5T6=I6T7=I7T8=I8T9=I9T10=I10T11=I11T12=I12T13=I13T14=I14T15=I15T16=I16T17=I17T18=I18T19=I19T20=I20T21=I21T22=I22T23=I23T24=I24T25=I25T26=I26T27=I27T28=I28T29=I29T30=I30T31=I31

21

07/01/96 9:46 AM

T32=I32T33=I33T34=I34T35=I35T36=I36;RUN;*****************************************************************;DATA TEMP1;SET TEMP1;ARRAY RFIVEPT (I) I1 I2 I20 I22 I34 I36;ARRAY THREEPT (I) I3 I4 I5 I6 I7 I8 I9 I10 I11 I12;ARRAY TWOPT (I) I13 I14 I15 I16 I17 I18 I19;ARRAY RSIXPT (I) I21 I23 I26 I27 I30;ARRAY SIXPT (I) I24 I25 I28 I29 I31;ARRAY FIVEPT (I) I32 I33 I35;*****************************************************************;I1SF=I1;I21SF=I21;I22SF=I22;DO OVER RFIVEPT; IF RFIVEPT=1 THEN RFIVEPT=100; ELSE IF RFIVEPT=2 THEN RFIVEPT=75; ELSE IF RFIVEPT=3 THEN RFIVEPT=50; ELSE IF RFIVEPT=4 THEN RFIVEPT=25; ELSE IF RFIVEPT=5 THEN RFIVEPT=0;END;DO OVER THREEPT; IF THREEPT=1 THEN THREEPT=0; ELSE IF THREEPT=2 THEN THREEPT=50; ELSE IF THREEPT=3 THEN THREEPT=100;END;DO OVER TWOPT; IF TWOPT=1 THEN TWOPT=0; ELSE IF TWOPT=2 THEN TWOPT=100;END;DO OVER RSIXPT; IF RSIXPT=1 THEN RSIXPT=100; ELSE IF RSIXPT=2 THEN RSIXPT=80; ELSE IF RSIXPT=3 THEN RSIXPT=60; ELSE IF RSIXPT=4 THEN RSIXPT=40; ELSE IF RSIXPT=5 THEN RSIXPT=20; ELSE IF RSIXPT=6 THEN RSIXPT=0;END;DO OVER SIXPT;

22

07/01/96 9:46 AM

IF SIXPT=1 THEN SIXPT=0; ELSE IF SIXPT=2 THEN SIXPT=20; ELSE IF SIXPT=3 THEN SIXPT=40; ELSE IF SIXPT=4 THEN SIXPT=60; ELSE IF SIXPT=5 THEN SIXPT=80; ELSE IF SIXPT=6 THEN SIXPT=100;END;DO OVER FIVEPT; IF FIVEPT=1 THEN FIVEPT=0; ELSE IF FIVEPT=2 THEN FIVEPT=25; ELSE IF FIVEPT=3 THEN FIVEPT=50; ELSE IF FIVEPT=4 THEN FIVEPT=75; ELSE IF FIVEPT=5 THEN FIVEPT=100;END;*****************************************************************;IF I1SF=1 THEN I1SF=5.0; ELSE IF I1SF=2 THEN I1SF=4.4; ELSE IF I1SF=3 THEN I1SF=3.4; ELSE IF I1SF=4 THEN I1SF=2.0; ELSE IF I1SF=5 THEN I1SF=1.0;I1SF=(I1SF-1)*25;

23

07/01/96 9:46 AM

IF I21SF>.Z AND I22SF>.Z THEN DO; IF I22SF=1 AND I21SF=1 THEN I22SF=6; ELSE IF I22SF=1 AND 7>I21SF>1 THEN I22SF=5; ELSE IF I22SF=2 AND 7>I21SF>0 THEN I22SF=4; ELSE IF I22SF=3 AND 7>I21SF>0 THEN I22SF=3; ELSE IF I22SF=4 AND 7>I21SF>0 THEN I22SF=2; ELSE IF I22SF=5 AND 7>I21SF>0 THEN I22SF=1;END;IF I21SF<=.Z AND I22SF>.Z THEN DO; IF I22SF=1 THEN I22SF=6.0; ELSE IF I22SF=2 THEN I22SF=4.75; ELSE IF I22SF=3 THEN I22SF=3.5; ELSE IF I22SF=4 THEN I22SF=2.25; ELSE IF I22SF=5 THEN I22SF=1.0;END;IF I21SF=1 THEN I21SF=6.0; ELSE IF I21SF=2 THEN I21SF=5.4; ELSE IF I21SF=3 THEN I21SF=4.2; ELSE IF I21SF=4 THEN I21SF=3.1; ELSE IF I21SF=5 THEN I21SF=2.2; ELSE IF I21SF=6 THEN I21SF=1.0;I21SF=(I21SF-1)*20;I22SF=(I22SF-1)*20;***************************************************;PHYFUN10=MEAN(I3,I4,I5,I6,I7,I8,I9,I10,I11,I12);ROLEP4=MEAN(I13,I14,I15,I16);PAIN2=MEAN(I21,I22);SFPAIN=MEAN(I21SF,I22SF);GENH5=MEAN(I1,I33,I34,I35,I36);SFGENH5=MEAN(I1SF,I33,I34,I35,I36);EMOT5=MEAN(I24,I25,I26,I28,I30);ROLEE3=MEAN(I17,I18,I19);SOCFUN2=MEAN(I20,I32);ENFAT4=MEAN(I23,I27,I29,I31);RUN;****************************************************;

24

07/01/96 9:46 AM

DATA TEMP2; SET TEMP1;IF 18<=AGE AND MALE>=0 THEN DO;SFAGE1=0;SFAGE2=0;SFAGE3=0;SFAGE4=0;SFAGE5=0;SFAGE6=0;SFAGE7=0;SFAGE8=0;SFAGE9=0;SFAGE10=0;SFAGE11=0;SFAGE12=0;END;IF 18<=AGE<=24 AND MALE=1 THEN SFAGE1=1;IF 24<AGE<=34 AND MALE=1 THEN SFAGE2=1;IF 34<AGE<=44 AND MALE=1 THEN SFAGE3=1;IF 44<AGE<=54 AND MALE=1 THEN SFAGE4=1;IF 54<AGE<=64 AND MALE=1 THEN SFAGE5=1;IF 64<AGE AND MALE=1 THEN SFAGE6=1;IF 18<=AGE<=24 AND MALE=0 THEN SFAGE7=1;IF 24<AGE<=34 AND MALE=0 THEN SFAGE8=1;IF 34<AGE<=44 AND MALE=0 THEN SFAGE9=1;IF 44<AGE<=54 AND MALE=0 THEN SFAGE10=1;IF 54<AGE<=64 AND MALE=0 THEN SFAGE11=1;IF 64<AGE AND MALE=0 THEN SFAGE12=1;*********************************************************;DATA GENPOP;INFILE 'sf36.raw' MISSOVER;INPUT#1 PF1 1-5 PF2 6-10 PF3 11-15 PF4 16-20 PF5 21-25 PF6 26-30 PF7 31-35 PF8 36-40 PF9 41-45 PF10 46-50 PF11 51-55 PF12 56-60 #2 PF1S 1-5 PF2S 6-10

25

07/01/96 9:46 AM

PF3S 11-15 PF4S 16-20 PF5S 21-25 PF6S 26-30 PF7S 31-35 PF8S 36-40 PF9S 41-45 PF10S 46-50 PF11S 51-55 PF12S 56-60 #3 RP1 1-5 RP2 6-10 RP3 11-15 RP4 16-20 RP5 21-25 RP6 26-30 RP7 31-35 RP8 36-40 RP9 41-45 RP10 46-50 RP11 51-55 RP12 56-60 #4 RP1S 1-5 RP2S 6-10 RP3S 11-15 RP4S 16-20 RP5S 21-25 RP6S 26-30 RP7S 31-35 RP8S 36-40 RP9S 41-45 RP10S 46-50 RP11S 51-55 RP12S 56-60 #5 BP1 1-5 BP2 6-10

26

07/01/96 9:46 AM

BP3 11-15 BP4 16-20 BP5 21-25 BP6 26-30 BP7 31-35 BP8 36-40 BP9 41-45 BP10 46-50 BP11 51-55 BP12 56-60 #6 BP1S 1-5 BP2S 6-10 BP3S 11-15 BP4S 16-20 BP5S 21-25 BP6S 26-30 BP7S 31-35 BP8S 36-40 BP9S 41-45 BP10S 46-50 BP11S 51-55 BP12S 56-60 #7 GEN1 1-5GEN2 6-10GEN3 11-15GEN4 16-20GEN5 21-25GEN6 26-30GEN7 31-35GEN8 36-40GEN9 41-45GEN10 46-50GEN11 51-55GEN12 56-60#8 GEN1S 1-5GEN2S 6-10

27

07/01/96 9:46 AM

GEN3S 11-15GEN4S 16-20GEN5S 21-25GEN6S 26-30GEN7S 31-35GEN8S 36-40GEN9S 41-45GEN10S 46-50GEN11S 51-55GEN12S 56-60#9 ENFT1 1-5 ENFT2 6-10 ENFT3 11-15 ENFT4 16-20 ENFT5 21-25 ENFT6 26-30 ENFT7 31-35 ENFT8 36-40 ENFT9 41-45 ENFT10 46-50 ENFT11 51-55 ENFT12 56-60 #10 ENFT1S 1-5 ENFT2S 6-10 ENFT3S 11-15 ENFT4S 16-20 ENFT5S 21-25 ENFT6S 26-30 ENFT7S 31-35 ENFT8S 36-40 ENFT9S 41-45 ENFT10S 46-50 ENFT11S 51-55 ENFT12S 56-60 #11SF1 1-5 SF2 6-10

28

07/01/96 9:46 AM

SF3 11-15 SF4 16-20 SF5 21-25 SF6 26-30 SF7 31-35 SF8 36-40 SF9 41-45 SF10 46-50 SF11 51-55 SF12 56-60 #12 SF1S 1-5 SF2S 6-10 SF3S 11-15 SF4S 16-20 SF5S 21-25 SF6S 26-30 SF7S 31-35 SF8S 36-40 SF9S 41-45 SF10S 46-50 SF11S 51-55 SF12S 56-60 #13 RE1 1-5 RE2 6-10 RE3 11-15 RE4 16-20 RE5 21-25 RE6 26-30 RE7 31-35 RE8 36-40 RE9 41-45 RE10 46-50 RE11 51-55 RE12 56-60 #14

29

07/01/96 9:46 AM

RE1S 1-5 RE2S 6-10 RE3S 11-15 RE4S 16-20 RE5S 21-25 RE6S 26-30 RE7S 31-35 RE8S 36-40 RE9S 41-45 RE10S 46-50 RE11S 51-55 RE12S 56-60 #15 MH1 1-5 MH2 6-10 MH3 11-15 MH4 16-20 MH5 21-25 MH6 26-30 MH7 31-35 MH8 36-40 MH9 41-45 MH10 46-50 MH11 51-55 MH12 56-60 #16 MH1S 1-5 MH2S 6-10 MH3S 11-15 MH4S 16-20 MH5S 21-25 MH6S 26-30 MH7S 31-35 MH8S 36-40 MH9S 41-45 MH10S 46-50

30

07/01/96 9:46 AM

MH11S 51-55 MH12S 56-60 ;RUN;*****************************;

31

07/01/96 9:46 AM

DATA TEST; IF _N_=1 THEN SET GENPOP; SET TEMP2;PFISFM=(SFAGE1*PF1)+ (SFAGE2*PF2)+ (SFAGE3*PF3)+ (SFAGE4*PF4)+ (SFAGE5*PF5)+ (SFAGE6*PF6)+ (SFAGE7*PF7)+ (SFAGE8*PF8)+ (SFAGE9*PF9)+ (SFAGE10*PF10)+ (SFAGE11*PF11)+ (SFAGE12*PF12); IF SFAGE1=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF1S; ELSE IF SFAGE2=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF2S; ELSE IF SFAGE3=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF3S; ELSE IF SFAGE4=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF4S; ELSE IF SFAGE5=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF5S; ELSE IF SFAGE6=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF6S; ELSE IF SFAGE7=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF7S; ELSE IF SFAGE8=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF8S; ELSE IF SFAGE9=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF9S; ELSE IF SFAGE10=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF10S; ELSE IF SFAGE11=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF11S; ELSE IF SFAGE12=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF12S;RPSFM=(SFAGE1*RP1)+(SFAGE2*RP2)+(SFAGE3*RP3)+ (SFAGE4*RP4)+ (SFAGE5*RP5)+ (SFAGE6*RP6)+ (SFAGE7*RP7)+ (SFAGE8*RP8)+ (SFAGE9*RP9)+ (SFAGE10*RP10)+ (SFAGE11*RP11)+ (SFAGE12*RP12); IF SFAGE1=1 THEN ZRP=(ROLEP4-RPSFM)/RP1S; ELSE IF SFAGE2=1 THEN ZRP=(ROLEP4-RPSFM)/RP2S; ELSE IF SFAGE3=1 THEN ZRP=(ROLEP4-RPSFM)/RP3S; ELSE IF SFAGE4=1 THEN ZRP=(ROLEP4-RPSFM)/RP4S; ELSE IF SFAGE5=1 THEN ZRP=(ROLEP4-RPSFM)/RP5S; ELSE IF SFAGE6=1 THEN ZRP=(ROLEP4-RPSFM)/RP6S; ELSE IF SFAGE7=1 THEN ZRP=(ROLEP4-RPSFM)/RP7S; ELSE IF SFAGE8=1 THEN ZRP=(ROLEP4-RPSFM)/RP8S; ELSE IF SFAGE9=1 THEN ZRP=(ROLEP4-RPSFM)/RP9S; ELSE IF SFAGE10=1 THEN ZRP=(ROLEP4-RPSFM)/RP10S; ELSE IF SFAGE11=1 THEN ZRP=(ROLEP4-RPSFM)/RP11S; ELSE IF SFAGE12=1 THEN ZRP=(ROLEP4-RPSFM)/RP12S;BPSFM=(SFAGE1*BP1)+(SFAGE2*BP2)+(SFAGE3*BP3)+

32

07/01/96 9:46 AM

(SFAGE4*BP4)+ (SFAGE5*BP5)+ (SFAGE6*BP6)+ (SFAGE7*BP7)+ (SFAGE8*BP8)+ (SFAGE9*BP9)+ (SFAGE10*BP10)+ (SFAGE11*BP11)+ (SFAGE12*BP12); IF SFAGE1=1 THEN ZBP=(SFPAIN-BPSFM)/BP1S; ELSE IF SFAGE2=1 THEN ZBP=(SFPAIN-BPSFM)/BP2S; ELSE IF SFAGE3=1 THEN ZBP=(SFPAIN-BPSFM)/BP3S; ELSE IF SFAGE4=1 THEN ZBP=(SFPAIN-BPSFM)/BP4S; ELSE IF SFAGE5=1 THEN ZBP=(SFPAIN-BPSFM)/BP5S; ELSE IF SFAGE6=1 THEN ZBP=(SFPAIN-BPSFM)/BP6S; ELSE IF SFAGE7=1 THEN ZBP=(SFPAIN-BPSFM)/BP7S; ELSE IF SFAGE8=1 THEN ZBP=(SFPAIN-BPSFM)/BP8S; ELSE IF SFAGE9=1 THEN ZBP=(SFPAIN-BPSFM)/BP9S; ELSE IF SFAGE10=1 THEN ZBP=(SFPAIN-BPSFM)/BP10S; ELSE IF SFAGE11=1 THEN ZBP=(SFPAIN-BPSFM)/BP11S; ELSE IF SFAGE12=1 THEN ZBP=(SFPAIN-BPSFM)/BP12S;GENSFM=(SFAGE1*GEN1)+(SFAGE2*GEN2)+(SFAGE3*GEN3)+ (SFAGE4*GEN4)+ (SFAGE5*GEN5)+ (SFAGE6*GEN6)+ (SFAGE7*GEN7)+ (SFAGE8*GEN8)+ (SFAGE9*GEN9)+ (SFAGE10*GEN10)+ (SFAGE11*GEN11)+ (SFAGE12*GEN12);IF SFAGE1=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN1S; ELSE IF SFAGE2=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN2S; ELSE IF SFAGE3=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN3S; ELSE IF SFAGE4=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN4S; ELSE IF SFAGE5=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN5S; ELSE IF SFAGE6=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN6S; ELSE IF SFAGE7=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN7S; ELSE IF SFAGE8=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN8S; ELSE IF SFAGE9=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN9S; ELSE IF SFAGE10=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN10S; ELSE IF SFAGE11=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN11S; ELSE IF SFAGE12=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN12S;ENFTSFM=(SFAGE1*ENFT1)+(SFAGE2*ENFT2)+(SFAGE3*ENFT3)+ (SFAGE4*ENFT4)+ (SFAGE5*ENFT5)+ (SFAGE6*ENFT6)+ (SFAGE7*ENFT7)+ (SFAGE8*ENFT8)+ (SFAGE9*ENFT9)+ (SFAGE10*ENFT10)+ (SFAGE11*ENFT11)+ (SFAGE12*ENFT12);IF SFAGE1=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT1S;

33

07/01/96 9:46 AM

ELSE IF SFAGE2=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT2S; ELSE IF SFAGE3=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT3S; ELSE IF SFAGE4=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT4S; ELSE IF SFAGE5=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT5S; ELSE IF SFAGE6=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT6S; ELSE IF SFAGE7=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT7S; ELSE IF SFAGE8=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT8S; ELSE IF SFAGE9=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT9S; ELSE IF SFAGE10=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT10S; ELSE IF SFAGE11=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT11S; ELSE IF SFAGE12=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT12S;SFSFM=(SFAGE1*SF1)+(SFAGE2*SF2)+(SFAGE3*SF3)+ (SFAGE4*SF4)+ (SFAGE5*SF5)+ (SFAGE6*SF6)+ (SFAGE7*SF7)+ (SFAGE8*SF8)+ (SFAGE9*SF9)+ (SFAGE10*SF10)+ (SFAGE11*SF11)+ (SFAGE12*SF12); IF SFAGE1=1 THEN ZSF=(SOCFUN2-SFSFM)/SF1S; ELSE IF SFAGE2=1 THEN ZSF=(SOCFUN2-SFSFM)/SF2S; ELSE IF SFAGE3=1 THEN ZSF=(SOCFUN2-SFSFM)/SF3S; ELSE IF SFAGE4=1 THEN ZSF=(SOCFUN2-SFSFM)/SF4S; ELSE IF SFAGE5=1 THEN ZSF=(SOCFUN2-SFSFM)/SF5S; ELSE IF SFAGE6=1 THEN ZSF=(SOCFUN2-SFSFM)/SF6S; ELSE IF SFAGE7=1 THEN ZSF=(SOCFUN2-SFSFM)/SF7S; ELSE IF SFAGE8=1 THEN ZSF=(SOCFUN2-SFSFM)/SF8S; ELSE IF SFAGE9=1 THEN ZSF=(SOCFUN2-SFSFM)/SF9S; ELSE IF SFAGE10=1 THEN ZSF=(SOCFUN2-SFSFM)/SF10S; ELSE IF SFAGE11=1 THEN ZSF=(SOCFUN2-SFSFM)/SF11S; ELSE IF SFAGE12=1 THEN ZSF=(SOCFUN2-SFSFM)/SF12S;RESFM=(SFAGE1*RE1)+(SFAGE2*RE2)+(SFAGE3*RE3)+ (SFAGE4*RE4)+ (SFAGE5*RE5)+ (SFAGE6*RE6)+ (SFAGE7*RE7)+ (SFAGE8*RE8)+ (SFAGE9*RE9)+ (SFAGE10*RE10)+ (SFAGE11*RE11)+ (SFAGE12*RE12); IF SFAGE1=1 THEN ZRE=(ROLEE3-RESFM)/RE1S; ELSE IF SFAGE2=1 THEN ZRE=(ROLEE3-RESFM)/RE2S; ELSE IF SFAGE3=1 THEN ZRE=(ROLEE3-RESFM)/RE3S; ELSE IF SFAGE4=1 THEN ZRE=(ROLEE3-RESFM)/RE4S; ELSE IF SFAGE5=1 THEN ZRE=(ROLEE3-RESFM)/RE5S;

34

07/01/96 9:46 AM

ELSE IF SFAGE6=1 THEN ZRE=(ROLEE3-RESFM)/RE6S; ELSE IF SFAGE7=1 THEN ZRE=(ROLEE3-RESFM)/RE7S; ELSE IF SFAGE8=1 THEN ZRE=(ROLEE3-RESFM)/RE8S; ELSE IF SFAGE9=1 THEN ZRE=(ROLEE3-RESFM)/RE9S; ELSE IF SFAGE10=1 THEN ZRE=(ROLEE3-RESFM)/RE10S; ELSE IF SFAGE11=1 THEN ZRE=(ROLEE3-RESFM)/RE11S; ELSE IF SFAGE12=1 THEN ZRE=(ROLEE3-RESFM)/RE12S;MHSFM=(SFAGE1*MH1)+(SFAGE2*MH2)+(SFAGE3*MH3)+ (SFAGE4*MH4)+ (SFAGE5*MH5)+ (SFAGE6*MH6)+ (SFAGE7*MH7)+ (SFAGE8*MH8)+ (SFAGE9*MH9)+ (SFAGE10*MH10)+ (SFAGE11*MH11)+ (SFAGE12*MH12); IF SFAGE1=1 THEN ZMHI=(EMOT5-MHSFM)/MH1S; ELSE IF SFAGE2=1 THEN ZMHI=(EMOT5-MHSFM)/MH2S; ELSE IF SFAGE3=1 THEN ZMHI=(EMOT5-MHSFM)/MH3S; ELSE IF SFAGE4=1 THEN ZMHI=(EMOT5-MHSFM)/MH4S; ELSE IF SFAGE5=1 THEN ZMHI=(EMOT5-MHSFM)/MH5S; ELSE IF SFAGE6=1 THEN ZMHI=(EMOT5-MHSFM)/MH6S; ELSE IF SFAGE7=1 THEN ZMHI=(EMOT5-MHSFM)/MH7S; ELSE IF SFAGE8=1 THEN ZMHI=(EMOT5-MHSFM)/MH8S; ELSE IF SFAGE9=1 THEN ZMHI=(EMOT5-MHSFM)/MH9S; ELSE IF SFAGE10=1 THEN ZMHI=(EMOT5-MHSFM)/MH10S; ELSE IF SFAGE11=1 THEN ZMHI=(EMOT5-MHSFM)/MH11S; ELSE IF SFAGE12=1 THEN ZMHI=(EMOT5-MHSFM)/MH12S;IF PHYFUN10=. THEN PFISFM=.;IF PFISFM=. THEN PHYFUN10=.;IF ROLEP4=. THEN RPSFM=.;IF RPSFM=. THEN ROLEP4=.;IF PAIN2=. THEN BPSFM=.;IF BPSFM=. THEN PAIN2=.;IF BPSFM=. THEN SFPAIN=.; IF GENH5=. THEN GENSFM=.;IF GENSFM=. THEN GENH5=.;IF GENSFM=. THEN SFGENH5=.; IF ENFAT4=. THEN ENFTSFM=.;IF ENFTSFM=. THEN ENFAT4=.;IF SOCFUN2=. THEN SFSFM=.;IF SFSFM=. THEN SOCFUN2=.;IF ROLEE3=. THEN RESFM=.;IF RESFM=. THEN ROLEE3=.;IF EMOT5=. THEN MHSFM=.;IF MHSFM=. THEN EMOT5=.;RUN;*****************************************************; DATA TEST;SET TEST;RUN;PROC MEANS;

35

07/01/96 9:46 AM

VAR PHYFUN10 ROLEP4 PAIN2 SFPAIN GENH5 SFGENH5 EMOT5 ROLEE3 ENFAT4 SOCFUN2;RUN;PROC MEANS N MEAN; VAR PFISFM RPSFM BPSFM GENSFMMHSFM RESFM ENFTSFM SFSFM;RUN;*****************************************************; PROC MEANS T PRT; VAR ZPHY10 ZRP ZBP ZGENH ZENFT ZSF ZRE ZMHI;RUN;*****************************************************; PROC CORR NOMISS ALPHA;VAR I3 I4 I5 I6 I7 I8 I9 I10 I11 I12; TITLE 'PHYSICAL FUNCTIONING';RUN; *****************************************************; PROC CORR NOMISS ALPHA;VAR I13 I14 I15 I16; TITLE 'ROLE LIMITATIONS--PHYSICAL';RUN; *****************************************************; PROC CORR NOMISS ALPHA;VAR I21 I22; TITLE 'PAIN--RAND SCORING';RUN; *****************************************************; PROC CORR NOMISS ALPHA;VARI21SF I22SF;TITLE 'PAIN--NEMC SCORING';RUN;*****************************************************; PROC CORR NOMISS ALPHA;VARI1 I33 I34 I35 I36;TITLE 'GENERAL HEALTH--RAND SCORING';RUN;*****************************************************;

36

07/01/96 9:46 AM

PROC CORR NOMISS ALPHA;VAR I1SF I33 I34 I35 I36; TITLE 'GENERAL HEALTH--NEMC SCORING';RUN; *****************************************************; PROC CORR NOMISS ALPHA;VAR I24 I25 I26 I28 I30; TITLE 'EMOTIONAL WELL-BEING';RUN; *****************************************************; PROC CORR NOMISS ALPHA;VAR I17 I18 I19 ; TITLE 'ROLE LIMITATIONS--EMOTIONAL';RUN; *****************************************************; PROC CORR NOMISS ALPHA;VAR I20 I32; TITLE 'SOCIAL FUNCTION';RUN; *****************************************************; PROC CORR NOMISS ALPHA;VAR I23 I27 I29 I31; TITLE 'ENERGY';RUN; *****************************************************;

37

07/01/96 9:46 AM

Table 7EXAMPLE SAS Output from sf36.sas FILE

Variable N Mean Std Dev Minimum Maximum---------------------------------------------------------------------PHYFUN10 177 82.4293785 20.6300431 10.0000000 100.0000000ROLEP4 177 90.2542373 19.4108626 0 100.0000000PAIN2 177 84.2090395 17.3862808 25.0000000 100.0000000SFPAIN 177 81.1242938 19.0079627 20.0000000 100.0000000GENH5 177 73.0508475 15.3561030 25.0000000 100.0000000SFGENH5 177 74.5423729 15.1481195 27.0000000 100.0000000EMOT5 177 75.5706215 15.5941727 20.0000000 100.0000000ROLEE3 177 82.2975518 29.3101553 0 100.0000000ENFAT4 177 68.1073446 16.8197260 20.0000000 100.0000000SOCFUN2 177 78.9548023 20.7349533 0 100.0000000---------------------------------------------------------------------

Variable N Mean---------------------------PFISFM 177 91.7229944RPSFM 177 89.2180226BPSFM 177 80.0205650GENSFM 177 77.1684746MHSFM 177 74.9923164RESFM 177 83.2776836ENFTSFM 177 63.6044633SFSFM 177 86.0232203---------------------------

Variable T Prob>|T|--------------------------------ZPHY10 -6.0582746 0.0001ZRP 0.1866498 0.8522ZBP 0.6750584 0.5005ZGENH -2.4358239 0.0159ZENFT 3.5896520 0.0004ZSF -4.5436598 0.0001ZRE -0.3998480 0.6898ZMHI 0.5717541 0.5682--------------------------------

38

07/01/96 9:46 AM

Variable N Mean Std Dev Minimum Maximum---------------------------------------------------------------------PHYFUN10 181 82.5138122 20.4777949 10.0000000 100.0000000PF_T 181 49.1219757 8.9442605 17.4495019 56.7595665ROLEP4 181 90.1933702 19.4676701 0 100.0000000RP_T 181 52.6612489 5.7601275 25.9746802 55.5628513SFPAIN 181 80.9779006 18.9625232 20.0000000 100.0000000BP_T 181 52.3286173 8.0490226 26.4453268 60.4029282SFGENH5 181 74.2430939 15.1322510 27.0000000 100.0000000GH_T 181 51.0064304 7.5024894 27.5835563 63.7765672EMOT5 181 75.5138122 15.5701309 20.0000000 100.0000000EM_T 181 50.3729160 8.6443626 19.5522680 63.9673738ROLEE3 181 81.9521179 29.7042237 0 100.0000000RE_T 181 50.1990627 8.9938749 25.3855174 55.6636188SOCFUN2 181 79.0055249 20.6116195 0 100.0000000SF_T 181 47.9478374 9.2113124 12.6403464 57.3302476ENFAT4 181 67.8453039 16.7596852 20.0000000 100.0000000EN_T 181 53.2539351 8.0307384 30.3279008 68.6615009AGG_PHYS 181 51.5414156 6.3803919 31.2261296 68.9868203AGG_MENT 181 50.1132380 8.9281718 15.9550097 69.6975957---------------------------------------------------------------------

39

07/01/96 9:46 AM

APPENDIX: SF-36 QUESTIONNAIRE ITEMS

1. In general, would you say your health is:(Circle One Number)

Excellent...................................... 1Very good..................................... 2Good............................................. 3Fair............................................... 4Poor.............................................. 5

2. Compared to one year ago, how would you rate your health in general now?

(Circle One Number)Much better now than one year ago.............................. 1Somewhat better now than one year ago..................... 2About the same.............................................................. 3Somewhat worse now than one year ago...................... 4Much worse now than one year ago.............................. 5

The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?(Circle One Number on Each Line)

Yes, Yes, No,Limited Limited Not Limited

a Lot a Little at All

3. Vigorous activities, such as running, lifting heavyobjects, participating in strenuous sports................. 1 2 3

4. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf.............. 1 2 3

5. Lifting or carrying groceries...................................... 1 2 3

6. Climbing several flights of stairs.............................. 1 2 3

7. Climbing one flight of stairs...................................... 1 2 3

8. Bending, kneeling, or stooping.................................. 1 2 3

9. Walking more than a mile...................................... 1 2 3

10. Walking several blocks........................................... 1 2 3

11. Walking one block.................................................... 1 2 3

12. Bathing or dressing yourself...................................... 1 2 3

40

07/01/96 9:46 AM

During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?(Circle One Number on Each Line)

Yes No13. Cut down the amount of time you spent on work or

other activities........................................................... 1 2

14. Accomplished less than you would like................. 1 2

15. Were limited in the kind of work or other activities. 1 2

16. Had difficulty performing the work or other activities(for example, it took extra effort).............................. 1 2

During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?

(Circle One Number on Each Line)

Yes No17. Cut down the amount of time you spent on

work or other activities.............................................. 1 2

18. Accomplished less than you would like................. 1 2

19. Didn’t do work or other activities as carefully as usual 1 2

20. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?

(Circle One Number)Not at all....................................... 1Slightly ........................................ 2Moderately................................... 3Quite a bit.................................... 4Extremely..................................... 5

21. How much bodily pain have you had during the past 4 weeks?(Circle One Number)

None............................................. 1Very mild...................................... 2Mild............................................... 3Moderate...................................... 4Severe.......................................... 5Very severe.................................. 6

41

07/01/96 9:46 AM

22. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?

(Circle One Number)Not at all....................................... 1A little bit ..................................... 2Moderately................................... 3Quite a bit.................................... 4Extremely..................................... 5

These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling.

How much of the time during the past 4 weeks . . .(Circle One Number on Each Line)

All Most A Good Some A Little Noneof the of the Bit of of the of the of theTime Time the Time Time Time Time

23. Did you feel full of pep?...................... 1 2 3 4 5 6

24. Have you been a very nervous person? 1 2 3 4 5 6

25. Have you felt so down in the dumps that nothing could cheer you up?...... 1 2 3 4 5 6

26. Have you felt calm and peaceful?...... 1 2 3 4 5 6

27. Did you have a lot of energy?............ 1 2 3 4 5 6

28. Have you felt downhearted and blue? 1 2 3 4 5 6

29. Did you feel worn out?........................ 1 2 3 4 5 6

30. Have you been a happy person?........ 1 2 3 4 5 6

31. Did you feel tired?............................... 1 2 3 4 5 6

32. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?

(Circle One Number)All of the time.............................. 1Most of the time........................... 2Some of the time......................... 3A little of the time........................ 4None of the time.......................... 5

42

07/01/96 9:46 AM

How TRUE or FALSE is each of the following statements for you.

(Circle One Number on Each Line)

Definitely Mostly Don’t Mostly DefinitelyTrue True Know False False

33. I seem to get sick a little easier than other people............................................. 1 2 3 4 5

34. I am as healthy as anybody I know.......... 1 2 3 4 5

35. I expect my health to get worse.............. 1 2 3 4 5

36. My health is excellent............................... 1 2 3 4 5

43