International Urology and Nephrology

, Volume 47, Issue 12, pp 2013–2021 | Cite as

Testing measurement equivalence of the SF-36 questionnaire across patients on hemodialysis and healthy people

  • Zahra Bagheri
  • Peyman JafariEmail author
  • Marjan Faghih
  • Elahe Allahyari
  • Tania Dehesh
Nephrology - Original article



Differential item functioning (DIF) occurs when members from different groups respond differently to particular items in a health-related quality of life (HRQoL) questionnaire after controlling for underlying HRQoL construct. This study aimed to assess DIF in the SF-36 questionnaire and its effect on comparing HRQoL scores across patients on HD and healthy people.


One hundred fifty patients on maintenance hemodialysis (HD) and 642 healthy individuals filled out the Persian version of the SF-36 questionnaire. Multiple-group multiple-indicator multiple-causes (MG-MIMIC) model was used to assess DIF across patients on HD and healthy population.


Sixteen out of 36 (44.4 %) items were flagged with DIF. Six out of 16 items (37.5 %) were flagged with uniform DIF, nine items (56.2 %) with non-uniform DIF, and one item (6.2 %) with both uniform DIF and non-uniform DIF. DIF items were associated with all subscales with the exception of the limitation due to physical problems and bodily pain subscales. The significant lower HRQoL scores of patients on HD in comparison with healthy people in the physical functioning and vitality subscales did not change after removing the items with uniform DIF.


Our findings revealed that patients on HD and healthy people perceived the meaning of the items in SF-36 questionnaire differently. Although the impact of DIF is minimal, the cross-group comparison across patients on HD and healthy people should be performed with caution.


Quality of life Patients on hemodialysis Healthy population Differential item functioning SF-36 



The authors are grateful to Dr Nasrin Shokrpour, Mr Hosain Argasi, and Mr Amin Borhani for English editing of this paper.

Compliance with ethical standards

This work was supported by the Grant Number 89-5299 from Shiraz University of Medical Sciences Research Council. This article was extracted from a scientific project conducted by a PhD student, Marjan Faghih. Written informed consent was obtained from the participants prior to enrollment in the study. The study was approved by the ethical committee of our institution, Shiraz University of Medical Sciences, and it was in accordance with the 1964 Helsinki declaration.

Conflict of interest

The authors declare that they have no conflict of interests.


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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Zahra Bagheri
    • 1
  • Peyman Jafari
    • 1
    Email author
  • Marjan Faghih
    • 1
  • Elahe Allahyari
    • 1
  • Tania Dehesh
    • 1
  1. 1.Department of BiostatisticsShiraz University of Medical SciencesShirazIran

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