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      Correlated physical and mental health summary scores for the SF-36 and SF-12 Health Survey, V.1

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          Abstract

          Background

          The SF-36 and SF-12 summary scores were derived using an uncorrelated (orthogonal) factor solution. We estimate SF-36 and SF-12 summary scores using a correlated (oblique) physical and mental health factor model.

          Methods

          We administered the SF-36 to 7,093 patients who received medical care from an independent association of 48 physician groups in the western United States. Correlated physical health (PCS c) and mental health (MCS c) scores were constructed by multiplying each SF-36 scale z-score by its respective scoring coefficient from the obliquely rotated two factor solution. PCS c-12 and MCS c-12 scores were estimated using an approach similar to the one used to derive the original SF-12 summary scores.

          Results

          The estimated correlation between SF-36 PCS c and MCS c scores was 0.62. There were far fewer negative factor scoring coefficients for the oblique factor solution compared to the factor scoring coefficients produced by the standard orthogonal factor solution. Similar results were found for PCS c-12, and MCS c-12 summary scores.

          Conclusion

          Correlated physical and mental health summary scores for the SF-36 and SF-12 derived from an obliquely rotated factor solution should be used along with the uncorrelated summary scores. The new scoring algorithm can reduce inconsistent results between the SF-36 scale scores and physical and mental health summary scores reported in some prior studies.

          (Subscripts C = correlated and UC = uncorrelated)

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          Most cited references15

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          The RAND-36 measure of health-related quality of life.

          The RAND-36 is perhaps the most widely used health-related quality of life (HRQoL) survey instrument in the world today. It is comprised of 36 items that assess eight health concepts: physical functioning, role limitations caused by physical health problems, role limitations caused by emotional problems, social functioning, emotional well-being, energy/fatigue, pain, and general health perceptions. Physical and mental health summary scores are also derived from the eight RAND-36 scales. This paper provides example applications of the RAND-36 cross-sectionally and longitudinally, provides information on what a clinically important difference is for the RAND-36 scales, and provides guidance for summarizing the RAND-36 in a single number. The paper also discusses the availability of the RAND-36 in multiple languages and summarizes changes that are incorporated in the latest version of the survey.
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            Interpreting SF-36 summary health measures: a response.

            In response to questions raised about the "accuracy" of SF-36 physical (PCS) and mental (MCS) component summary scores, particularly extremely high and low scores, we briefly comment on: how they were developed, how they are scored, the factor content of the eight SF-36 subscales, cross-tabulations between item-level responses and extreme summary scores, and published and new tests of their empirical validity. Published cross-tabulations between SF-36 items and PCS and MCS scores, reanalyses of public datasets (N = 5919), and preliminary results from the Medicare Health Outcomes Survey (HOS) (N = 172,314) yielded little or no evidence in support of Taft's hypothesis that extreme scores are an invalid artifact of some negative scoring weights. For example, in the HOS, those (N = 432) with "unexpected" PCS scores worse than 20 (which, according to Taft, indicate better mental health rather than worse physical health) were about 25% more likely to die within two years, in comparison with those scoring in the next highest (21-30) category. In this test and in all other empirical tests, results of predictions supported the validity of extreme PCS and MCS scores. We recommend against the interpretation of average differences smaller than one point in studies that seek to detect "false" measurement and we again repeat our 7-year-old recommendation that results based on summary measures should be thoroughly compared with the SF-36 profile before drawing conclusions. To facilitate such comparisons, scoring utilities and user-friendly graphs for SF-36 profiles and physical and mental summary scores (both orthogonal and oblique scoring algorithms) have been made available on the Internet at www.sf-36.com/test.
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              The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

              Studies of the factor structure of the SF-36 Health Survey are an important step in its construct validation. Its structure is also the psychometric basis for scoring physical and mental health summary scales, which are proving useful in simplifying and interpreting statistical analyses. To test the generalizability of the SF-36 factor structure, product-moment correlations among the eight SF-36 Health Survey scales were estimated for representative samples of general populations in each of 10 countries. Matrices were independently factor analyzed using identical methods to test for hypothesized physical and mental health components, and results were compared with those published for the United States. Following simple orthogonal rotation of two principal components, they were easily interpreted as dimensions of physical and mental health in all countries. These components accounted for 76% to 85% of the reliable variance in scale scores across nine European countries, in comparison with 82% in the United States. Similar patterns of correlations between the eight scales and the components were observed across all countries and across age and gender subgroups within each country. Correlations with the physical component were highest (0.64 to 0.86) for the Physical Functioning, Role Physical, and Bodily Pain scales, whereas the Mental Health, Role Emotional, and Social Functioning scales correlated highest (0.62 to 0.91) with the mental component. Secondary correlations for both clusters of scales were much lower. Scales measuring General Health and Vitality correlated moderately with both physical and mental health components. These results support the construct validity of the SF-36 translations and the scoring of physical and mental health components in all countries studied.
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                Author and article information

                Journal
                Health Qual Life Outcomes
                Health and Quality of Life Outcomes
                BioMed Central|1
                1477-7525
                2007
                7 September 2007
                : 5
                : 54
                Affiliations
                [1 ]Global Health Economics, Amgen, Inc., Thousand Oaks, CA, USA
                [2 ]UCLA, School of Public Health, Los Angeles, CA, USA
                [3 ]UCLA, Department of Medicine, Los Angeles, CA, USA
                [4 ]RAND, Health Program, Santa Monica, CA, USA
                Article
                1477-7525-5-54
                10.1186/1477-7525-5-54
                2065865
                17825096
                a3e08c0b-52de-43e9-a67e-5fce0910424c
                Copyright © 2007 Farivar et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 January 2007
                : 7 September 2007
                Categories
                Research

                Health & Social care
                Health & Social care

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