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What is the SF-36 questionnaire?

SF-36 is the main health survey questionnaire we use. The "SF" stands for "short form", and the "36" refers to the fact that it has 36 questions. It was originally developed in the USA, where a much longer questionnaire was tested by the federal health authorities. When that was subsequently reduced down to 36 questions - and still found to give reliable results - it became known as the "short" form.

SF-36 is the best-known questionnaire amongst experts in measuring health status. This is partly because it was so carefully developed in the first place, so that the results it produces are statistically reliable and valid. It is also because the issues it explores with the 36 questions apply to people having many different types of treatment, and in all the different states of health, from good to bad.

In particular, health researchers have found it invaluable in measuring the sometimes subtle changes in health that follow medical interventions, such as surgery, and in allowing comparison of one technique against another. Now, after SF-36 has been used in over 2,000 published research studies, we can be sure it will give relevant results when used in our hospitals.

The questions

The questions are designed to be easy to understand and relevant to most people's lives. The form only takes 5 to 10 minutes to complete. In Bupa we use SF-36 before surgery and then 12 weeks afterwards.

The 36 questions have been carefully chosen to measure all the aspects of health and wellbeing that, together, we call "quality of life".

Some questions ask about a person's physical functioning (walking, climbing stairs and so on). Others refer to the amount of pain experienced, or to energy levels or mood. There are also questions that try to understand how a person's health is affecting his or her ability to enjoy their social life, or to manage everyday tasks.

Examples of the questions are:

• How much bodily pain have you had during the past 4 weeks?
  - None
  - Very mild
  - Mild
  - Moderate
  - Severe
  - Very severe

 

• 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);
  - Cut down on the amount of time you spent on work or other activities,
  - Accomplished less than you would like,
  - Didn't do work or other activities as carefully as usual
  (Please answer Yes or No to these three questions)

The questionnaire has been thoroughly tested to see how much difference to expect, as a matter of chance, when a person fills in the same questions a second time, so we know what allowance to make for this.

For a patient having an operation to cure a physical problem such as a painful hip joint, it may seem strange to be asking not only questions about walking and climbing stairs, but also about mood and social life. In fact, no one question is more important than any other and much of the value of using a broad questionnaire like SF-36 is that it shows that physical and mental health are often both affected by surgery, and this effect varies from one procedure to another.

Examples

Men having surgery for a benign enlarged prostate seem to experience no net gain in physical health, but a small improvement in some aspects of mental health, when assessed again three months later. Women undergoing hysterectomy experience a small physical benefit but a large mental health improvement.

Links

Why does Bupa measure health outcomes?
What is the VF-14 questionnaire?
Health outcomes of Bupa operations
How to interpret physical and mental health scores

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