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      El Cuestionario de Salud SF-36 español: una década de experiencia y nuevos desarrollos Translated title: The Spanish version of the Short Form 36 Health Survey: a decade of experience and new developments

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          Abstract

          Objetivo: El Cuestionario SF-36 es uno de los instrumentos de Calidad de Vida Relacionada con la Salud (CVRS) más utilizados y evaluados. Tras una década de uso este artículo revisa críticamente el contenido, propiedades métricas y nuevos desarrollos de la versión española. Métodos: Revisión de los artículos indizados en Medline (PubMed) y en las bases de datos IBECS e IME que han utilizado la versión española del cuestionario. Se seleccionaron los artículos con información sobre modelo de medida, fiabilidad, validez y sensibilidad al cambio del instrumento. Resultados: Se encontraron 79 artículos, 17 de los cuales describían características métricas del cuestionario. En el 96% las escalas superaron el estándar propuesto de fiabilidad (α de Cronbach) de 0,7. Las estimaciones agrupadas obtenidas por metaanálisis fueron superiores a 0,7 en todos los casos. El SF-36 mostró buena discriminación entre grupos de gravedad, correlación moderada con indicadores clínicos y alta con otros instrumentos de CVRS. El SF-36 predijo mortalidad y detectó mejoría tras la angioplastia coronaria, la cirugía de hipertrofia prostática benigna o la ventilación domiciliaria no invasiva. Los nuevos desarrollos descritos (puntuaciones basadas en normas, la versión 2, el SF-12 y el SF-8) mejoraron sus propiedades métricas y su interpretación. Conclusiones: El SF-36, conjuntamente con las nuevas versiones desarrolladas, es un instrumento muy adecuado para su uso en investigación y en la práctica clínica.

          Translated abstract

          Objective: The Short Form-36 Health Survey (SF-36) is one of the most widely used and evaluated generic health-related quality of life (HRQL) questionnaires. After almost a decade of use in Spain, the present article critically reviews the content and metric properties of the Spanish version, as well as its new developments. Methods: A review of indexed articles that used the Spanish version of the SF-36 was performed in Medline (PubMed), the Spanish bibliographic databases IBECS and IME. Articles that provided information on the measurement model, reliability, validity, and responsiveness to change of the instrument were selected. Results: Seventy-nine articles were found, of which 17 evaluated the metric characteristics of the questionnaire. The reliability of the SF-36 scales was higher than the suggested standard (Cronbach's alpha) of 0.7 in 96% of the evaluations. Grouped evaluations obtained by meta-analysis were higher than 0.7 in all cases. The SF-36 showed good discrimination among severity groups, moderate correlations with clinical indicators, and high correlations with other HRQL instruments. Moreover, questionnaire scores predicted mortality and were able to detect improvement due to therapeutic interventions such as coronary angioplasty, benign prostatic hyperplasia surgery, and non-invasive positive pressure home ventilation. The new developments (norm-based scoring, version 2, the SF-12 and SF-8) improved both the metric properties and interpretation of the questionnaire. Conclusions: The Spanish verion is a suitable instrument for use in medical research, as well as in clinical practice.

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          Quality of life measurement: bibliographic study of patient assessed health outcome measures.

          To assess the growth of quality of life measures and to examine the availability of measures across specialties. Systematic searches of electronic databases to identify developmental and evaluative work relating to health outcome measures assessed by patients. Types of measures: disease or population specific, dimension specific, generic, individualised, and utility. Specialties in which measures have been developed and evaluated. 3921 reports that described the development and evaluation of patient assessed measures met the inclusion criteria. Of those that were classifiable, 1819 (46%) were disease or population specific, 865 (22%) were generic, 690 (18%) were dimension specific, 409 (10%) were utility, and 62 (1%) were individualised measures. During 1990-9 the number of new reports of development and evaluation rose from 144 to 650 per year. Reports of disease specific measures rose exponentially. Over 30% of evaluations were in cancer, rheumatology and musculoskeletal disorders, and older people's health. The generic measures--SF-36, sickness impact profile, and Nottingham health profile--accounted for 612 (16%) reports. In some specialties there are numerous measures of quality of life and little standardisation. Primary research through the concurrent evaluation of measures and secondary research through structured reviews of measures are prerequisites for standardisation. Recommendations for the selection of patient assessed measures of health outcome are needed.
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            Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project.

            Few studies and no international comparisons have examined the impact of multiple chronic conditions on populations using a comprehensive health-related quality of life (HRQL) questionnaire. The impact of common chronic conditions on HRQL among the general populations of eight countries was assessed. Cross-sectional mail and interview surveys were conducted. Sample representatives of the adult general population of eight countries (Denmark, France, Germany, Italy, Japan, The Netherlands, Norway and the United States) were evaluated. Sample sizes ranged from 2031 to 4084. Self-reported prevalence of chronic conditions (including allergies, arthritis, congestive heart failure, chronic lung disease, hypertension, diabetes, and ischemic heart disease), sociodemographic data and the SF-36 Health Survey were obtained. The SF-36 scale and summary scores were estimated for individuals with and without selected chronic conditions and compared across countries using multivariate linear regression analyses. Adjustments were made for age, gender, marital status, education and the mode of SF-36 administration. More than half (55.1%) of the pooled sample reported at least one chronic condition, and 30.2% had more than one. Hypertension, allergies and arthritis were the most frequently reported conditions. The effect of ischemic heart disease on many of the physical health scales was noteworthy, as was the impact of diabetes on general health, or arthritis on bodily pain scale scores. Arthritis, chronic lung disease and congestive heart failure were the conditions with a higher impact on SF-36 physical summary score, whereas for hypertension and allergies, HRQL impact was low (comparing with a typical person without chronic conditions, deviation scores were around -4 points for the first group and -1 for the second). Differences between chronic conditions in terms of their impact on SF-36 mental summary score were low (deviation scores ranged between -1 and -2). Arthritis has the highest HRQL impact in the general population of the countries studied due to the combination of a high deviation score on physical scales and a high frequency. Impact of chronic conditions on HRQL was similar roughly across countries, despite important variation in prevalence. The use of HRQL measures such as the SF-36 should be useful to better characterize the global burden of disease.
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              Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment.

              This article describes the methods adopted by the International Quality of Life Assessment (IQOLA) project to translate the SF-36 Health Survey. Translation methods included the production of forward and backward translations, use of difficulty and quality ratings, pilot testing, and cross-cultural comparison of the translation work. Experience to date suggests that the SF-36 can be adapted for use in other countries with relatively minor changes to the content of the form, providing support for the use of these translations in multinational clinical trials and other studies. The most difficult items to translate were physical functioning items, which used examples of activities and distances that are not common outside of the United States; items that used colloquial expressions such as pep or blue; and the social functioning items. Quality ratings were uniformly high across countries. While the IQOLA approach to translation and validation was developed for use with the SF-36, it is applicable to other translation efforts.
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                Author and article information

                Journal
                gs
                Gaceta Sanitaria
                Gac Sanit
                Ediciones Doyma, S.L. (Barcelona, Barcelona, Spain )
                0213-9111
                April 2005
                : 19
                : 2
                : 135-150
                Affiliations
                [03] orgnameHospital Universitario de Asturias orgdiv1Servicio de Nefrología orgdiv2Unidad de Investigación en Resultados de Salud
                [05] Vizcaya orgnameHospital de Galdakao orgdiv1Unidad de Investigación España
                [04] Barcelona orgnameHospital Universitario Vall d'Hebron orgdiv1Servicio de Cardiología orgdiv2Unidad de Epidemiología España
                [06] Barcelona orgnameUniversitat Autònoma de Barcelona (UAB) España
                [02] Barcelona orgnameAgència d'Avaluació de Tecnologies i Recerca Mèdica (AATRM) de Catalunya España
                [01] Barcelona orgnameInstitut Municipal d'Investigació Mèdica (IMIM-IMAS) orgdiv1Unidad de Investigación en Servicios Sanitarios España
                Article
                S0213-91112005000200007 S0213-9111(05)01900200007
                10.1590/S0213-91112005000200007
                a240ff98-09b2-4952-85b2-d8062236a526

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 31 March 2004
                : 22 November 2004
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 103, Pages: 16
                Product

                SciELO Public Health


                SF-36,Calidad de vida relacionada con la salud,Validez,Fiabilidad,Cuestionarios,Health-related quality of life,Validity,Reliability,Questionnaires

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