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Measuring health-related quality of life for persons with mobility impairments: an enabled version of the short-form 36 (SF-36E)

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Abstract

Objective

Examine psychometric properties of the SF-36 and SF-36E for mobility-impaired individuals and assess whether the SF-36E yields higher health-related quality-of-life scores.

Methods

We altered the SF-36 Physical Function scale by substituting the word “go” for “walk” and “climb” and changed the stem to reflect function using assistive devices. We compared responses between versions for 201 individuals with disabilities (n = 95 wheelchair users, n = 48 other device users, 58 = no device users).

Results

Both surveys yielded reliable scores, but floor and ceiling effects occurred with both versions. Confirmatory factor analyses demonstrate good fit for the SF-36 and SF36E, but were compromised by low sample size. Respondents demonstrated significantly better Role Physical, Bodily Pain, and Vitality on the SF-36E, but worse General Health.

Conclusions

The World Health Organization framework, the International Classification of Functioning, Disability, and Health (ICF) suggests that it is important to know both what one can do without assistance (capacity) and what one can do with assistance (performance). Results suggest that the SF-36E successfully measures performance among mobility-impaired individuals, including wheelchair users. However, further validation studies of the SF-36 and SF-36E are warranted with samples of individuals with disabilities.

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References

  1. Ware, J. E., & 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.

    Article  PubMed  Google Scholar 

  2. 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. Medical Care, 31, 247–263.

    Article  PubMed  CAS  Google Scholar 

  3. Jenkinson, C. A., Coulter, A., & Wright, L. (1993). Short form 36 (SF36) health survey questionnaire: Normative data for adults of working age. British Medical Journal, 306, 1437–4140.

    Article  PubMed  CAS  Google Scholar 

  4. Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey: Manual and interpretation guide. Boston, MA: The Health Institute.

    Google Scholar 

  5. Gandek, B., Ware, J. E., Aaronson, N. K., Alonso, J., Apolone, G., Bjorner, J., Brazier, J., Bullinger, M., Fukuhara, S., Kaasa, S., Leplège, A., & Sullivan, M. (1998). Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven coutries: Results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51, 1149.

    Article  PubMed  CAS  Google Scholar 

  6. Alonso, J., Ferrer, M., Gandek, B., Ware, J. E., Aaronson, N.K., Mosconi, P., Rasmussen, N. K., Bullinger, M., Fukhara, S., Kaasa, S., & Leplege, A. (2004). Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) Project. Quality of Life Research, 13, 283–298.

    Article  PubMed  Google Scholar 

  7. Findler, M., Cantor, J., Haddad, L., Gordon, W., & Ashman, T. (2002). The reliability and validity of the SF-36 health survey questionnaire for use with individuals with traumatic brain injury. Brain Injury, 15, 715–723.

    Google Scholar 

  8. Jacoby, A., Baker, G. A., Steen, N., & Buck, D. (1999). The SF-36 as a health status measure for epilepsy: A psychometric assessment. Quality of Life Research, 8, 351–364.

    Article  PubMed  CAS  Google Scholar 

  9. Stoll, T., Gordon, C., Seifert, B., Richardson, K., Malik, J., Bacon, P. A, & Isenberg, D. A. (1997). Consistency and validity of patient administered assessment of quality of life by the MOS SF-36: Its association with disease activity and damage in patients with systemic lupus erythematosus. Journal of Rheumatoid Arthritis, 24, 1608–1614.

    CAS  Google Scholar 

  10. Mahler, D. A., & Mackowiak, J. I. (1995). Evaluation of the short-form 36-item questionnaire to measure health-related quality of life in patients with COPD. Chest, 107, 1585–1589.

    Article  PubMed  CAS  Google Scholar 

  11. Wang, W., Lopez, V., Ying, C. S., & Thompson, D. R. (2006). The psychometric properties of the Chinese version of the SF-36 health survey in patients with myocardial infarction in mainland China. Quality of Life Research, 15, 1525–1531.

    Article  PubMed  Google Scholar 

  12. McHorney, C. A., Ware, J. E., Lu, J. F., Sherbourne, C. D. (1994). The MOS 36-item short form health survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32, 44–66.

    Google Scholar 

  13. Andresen, E., Gravitt, G. W., Aydelotte, M. E., & Podgorski, C. A. (1999). Limitations of the SF-36 in a sample of nursing home residents. Age and Ageing, 28, 562–566.

    Article  PubMed  CAS  Google Scholar 

  14. Freeman, J. A., Hobart, J. C., Langdon, D. W., & Thompson, A. J. (2000). Clinical appropriateness: A key factor to outcome measure selection: The 36 item short form health survey in multiple sclerosis. Journal of Neurosurgery in Psychiatry, 68, 150–156.

    Article  CAS  Google Scholar 

  15. Hobart, J., Freeman, J., Lamping, D., Fitzpatrick, R., & Thompson, A. (2001) The SF-36 in multiple sclerosis: Why basic assumptions must be tested. Journal of Neurosurgery in Psychiatry, 71, 363–370.

    Article  CAS  Google Scholar 

  16. Vickrey, B. G., Hays, R. D., Genovese, B. J., Myers, L. W., & Ellison, G. W. (1997). Comparison of a generic to disease-targeted health-related quality of life measures for multiple sclerosis. Journal of Clinical Epidemiology, 50, 557–569.

    Article  PubMed  CAS  Google Scholar 

  17. Hagen, S., Bugge, C., & Alexander, H. (2003). Psychometric properties of the SF-36 in the early post-stroke phase. Journal of Advanced Nursing, 44, 461–68.

    Article  PubMed  Google Scholar 

  18. Hobart, J. C., Williams, L. S., Moran, K., & Thompson, A. J. (2002). Quality of Life measurement after stroke: Uses and abuses of the SF-36. Stroke, 33, 1348–1356.

    Article  PubMed  Google Scholar 

  19. O’Mahoney, P. G., Rodgers, H., Thomson, R. G., Dobson R., & James, O. F. (1998). Is the SF-36 suitable for assessing health status of older stroke patients? Age and Ageing, 27, 19–22.

    Article  Google Scholar 

  20. Andresen, E. M., Fouts, B. S., Romeis, J. C., & Brownson, C. A. (1999). Performance of health-related quality of life instruments in a spinal cord injured population. Archives of Physical Medicine and Rehabilitation, 80, 877–884.

    Article  PubMed  CAS  Google Scholar 

  21. Mattson-Prince, J. (1997). A rational approach to long-term care: Comparing the independent living model with agency-based care for persons with high spinal cord injuries. Spinal Cord, 35, 326–331.

    Article  PubMed  CAS  Google Scholar 

  22. Meyers, A. R., & Andresen, E. M. (2000). Enabling our instruments: accommodation, universal design, and assured access to participation in research. Archives of Physical Medicine and Rehabilitation, 81(12 supplement 2), S5–S9.

    Article  PubMed  CAS  Google Scholar 

  23. Froehlich-Grobe, K., Figoni, S. F., Thompson, C., & White, G. W. Exploring the health of women with mobility impairments, manuscript under review.

  24. Marge, M. (1988). Health promotion for persons with disabilities: Moving beyond rehabilitation. American Journal of Health Promotion, 2(4), 29–44.

    Google Scholar 

  25. Rimmer, J. H. (1999). Health promotion for people with disabilities: The emerging paradigm shift from disability prevention to prevention of secondary conditions. Physical Therapy, 79(5), 495–502.

    PubMed  CAS  Google Scholar 

  26. ICF Beginner’s Guide Online. (2002). Towards a common for functioning, disability, and health. World Health Organization, Geneva. http://www.who.int/classifications/icf/site/beginners/bg.pdf.

  27. Mosier, C. I. (1943). On the reliability of a weighted composite. Psychometrika, 8(3), 161–168.

    Article  Google Scholar 

  28. Jöreskog, K., & Sörbom, D. (2001). LISREL 8: User’s reference guide. Lincolnwood, IL: Scientific Software International, Inc.

  29. Bollen, K. (1989). Structural equations with latent variables. New York: Wiley.

    Google Scholar 

  30. Browne, M., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. Bollen &J. Long (Eds.), Testing structural equation models (pp. 136–162). Newbury Park, CA: Sage.

    Google Scholar 

  31. Hu, L., & Bentler, P. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55.

    Article  Google Scholar 

  32. Hoyle, R., & Panter, A. (1995). Writing about structural equation models. In R. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  33. Fleiss, J. L. (1981). Statistical methods for rates and proportions (pp. 212–225). New York: Wiley.

  34. McHorney, C. A., & Tarlov, A. R. (2001). Individual-patient monitoring in clinical practice: Are available health status surveys adequate? Quality of Life Research, 4, 293–307.

    Article  Google Scholar 

  35. Gandek, B., Sinclair, S. J., Kosinski, M. A., & Ware, J. E. (2004). Psychometric evaluation of the SF-36 health survey in Medicare managed care. Health Care Financing Review, 25, 5–25.

    PubMed  Google Scholar 

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Acknowledgements

This work was funded, in part, by two grants from Centers for Disease Control and Prevention: the Office of Disability and Health grant to The University of Kansas (R04/CCR717707-01) and the Prevention Research Center at Saint Louis University (U48CCU710806). Thanks to study contributors: Stephen F. Figoni, PhD; Jessica Roberts, PhD; Dot Nary, MA; and Janet Marquis, PhD and to Kathleen Wyrwich, PhD, for her assistance with statistical analyses. Finally, thanks to the ILCs and respondents for participating.

Author information

Authors and Affiliations

  1. Gerontology Center, The University of Kansas, 1000 Sunnyside, Dole 3090, Lawrence, KS, 66045-7555, USA

    Katherine Froehlich-Grobe

  2. Department of Epidemiology and Biostatics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA

    Elena M. Andresen

  3. Saint Louis University School of Public Health, St. Louis, MO, USA

    Charlene Caburnay

  4. Research and Training Center on Independent Living, The University of Kansas, Lawrence, KS, USA

    Glen W. White

Authors
  1. Katherine Froehlich-Grobe
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  2. Elena M. Andresen
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  3. Charlene Caburnay
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  4. Glen W. White
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Corresponding author

Correspondence to Katherine Froehlich-Grobe.

Additional information

Results were presented to the DisAbility Forum of the American Public Health Association’s 131 Annual Meeting in San Francisco, CA in November 2003.

Appendices

Appendices

Appendix 1 Copy of the ten-item Physical Function section of the SF-36E
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Appendix 2 Covariance matrix of the SF-36E and SF-36
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Froehlich-Grobe, K., Andresen, E.M., Caburnay, C. et al. Measuring health-related quality of life for persons with mobility impairments: an enabled version of the short-form 36 (SF-36E). Qual Life Res 17, 751–770 (2008). https://doi.org/10.1007/s11136-008-9342-5

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  • DOI: https://doi.org/10.1007/s11136-008-9342-5

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