Short form 36 (SF-36) health survey questionnaire: which normative data should be used? Comparisons between the norms provided by the Omnibus Survey in Britain, The Health Survey for England and the Oxford Healthy Life Survey Bowling A Bond M Jenkinson C Lamping D J Publ Health Med 1999 21 255 270 10.1093/pubmed/21.3.255

University of Oxford, Oxford, England, United Kingdom
Journal of Public Health Medicine 09/1999; 21(3):255-270. DOI: 10.1093/pubmed/21.3.255
Source: PubMed


Background Population norms for the attributes included in measurement scales are required to provide a standard with which scores from other study populations can be compared. This study aimed to obtain population norms for the Short Form 36 (SF-36) Health Survey Questionnaire, derived from a random sample of the population in Britain who were interviewed at home, and to make comparisons with other commonly used norms. Methods The method was a face-to-face interview survey of a random sample of 2056 adults living at home in Britain (response rate 78 per cent). Comparisons of the SF-36 scores derived from this sample were made with the Health Survey for England and the Oxford Healthy Life Survey. Results Controlling for age and sex, many of mean scores on the SF-36 dimensions differed between the three datasets. The British interview sample had better total means for Physical Functioning, Social Functioning, Mental Health, Energy/Vitality, and General Health Perceptions. The Health (interview) Survey for England had the lowest (worst) total mean scores for Physical Functioning, Social Functioning, Role Limitations (physical), Bodily Pain, and Health Percep- tions. The postal sample in central England had the lowest (worst) total mean scores for Role Limitations (emotional), Mental Health and Energy/Vitality. Conclusion Responses obtained from interview methods may suffer more from social desirability bias (resulting in inflated SF-36 scores) than postal surveys. Differences in SF- 36 means between surveys are also likely to reflect question order and contextual effects of the questionnaires. This indicates the importance of providing mode-specific popula- tion norms for the various methods of questionnaire

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    • "This latter formula defines clinically significant change as movement to within two standard deviations of the mean of the normal population on a particular variable. Normative data from the functional population was used to calculate cut-off scores to determine whether participants were in the normal population at post-treatment and follow-up (Lovibond and Lovibond, 1995; Bowling et al., 1999; Fairbank and Pynsent, 2000; Van Damme et al., 2002). This approach to clinical significance testing is more stringent than several other methods of measuring minimal clinically important differences (Dworkin et al., 2008). "
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    ABSTRACT: Objectives: This pilot study investigated the feasibility and clinical utility of implementing a novel, evidence-informed, interdisciplinary group intervention—Mindfulness Based Functional Therapy (MBFT)—for the management of persistent low back pain (LBP) in primary care. MBFT aimed to improve physical and psychological functioning in patients with persistent LBP. Design: A single-group repeated measures design was utilized to gather data about feasibility, effect sizes, clinically significant changes and patient satisfaction. Setting: A community sample of 16 adults (75% female), mean (SD) age 47.00 (9.12) years (range 26–65 years), with mean (SD) LBP duration of 8.00 (9.00) years participated, using a simulated primary care setting at Curtin University in Australia. Intervention: MBFT is an 8-week group intervention co-facilitated by psychology and physiotherapy disciplines. Content includes: mindfulness meditation training, cognitive-functional physiotherapeutic movement retraining, pain education, and group support. Main outcome measures: Several validated self-report measures were used to assess functional disability, emotional functioning, mindfulness, pain catastrophizing, health-related quality of life at baseline, post-intervention, and 6 months follow-up. Results: Adherence and satisfaction was high, with 85% of participants highly satisfied with MBFT. Clinical significance analysis and effect size estimates showed improvements in a number of variables, including pain catastrophizing, physical functioning, role limitations due to physical condition, and depression, although these may have occurred due to non-intervention effects. Conclusions: MBFT is feasible to implement in primary care. Preliminary findings suggest that a randomized controlled trial is warranted to investigate its efficacy in improving physical and emotional functioning in people with disabling persistent LBP.
    Full-text · Article · Aug 2014 · Frontiers in Psychology
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    • "A surprising finding within this review was the variation in prevalence estimates for CMD caseness between the population studies, even when restricted to those which used the same questionnaire and threshold. The population studies identified within this review are often used as a population reference for measures of mental health [66], but this study shows that the comparison may differ depending on which population study is chosen. Whilst both the British Household Panel Survey and Health Survey for England are considered to recruit representative samples, there is still a difference between the prevalence of CMD caseness for these surveys, indicating that this either results from a sampling effect or from the sensitivity of the GHQ to other factors which may differ between surveys. "
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    ABSTRACT: The general health questionnaire (GHQ) is commonly used to assess symptoms of common mental disorder (CMD). Prevalence estimates for CMD caseness from UK population studies are thought to be in the range of 14-17%, and the UK occupational studies of which we are aware indicate a higher prevalence. This review will synthesise the existing research using the GHQ from both population and occupational studies and will compare the weighted prevalence estimates between them. We conducted a systematic review and meta-analysis to examine the prevalence of CMD, as assessed by the GHQ, in all UK occupational and population studies conducted from 1990 onwards. The search revealed 65 occupational papers which met the search criteria and 15 relevant papers for UK population studies. The weighted prevalence estimate for CMD across all occupational studies which used the same version and cut-off for the GHQ was 29.6% (95% confidence intervals (CIs) 27.3-31.9%) and for comparable population studies was significantly lower at 19.1% (95% CIs 17.3-20.8%). This difference was reduced after restricting the studies by response rate and sampling method (23.9% (95% CIs 20.5%-27.4%) vs. 19.2% (95 CIs 17.1%-21.3%)). Counter intuitively, the prevalence of CMD is higher in occupational studies, compared to population studies (which include individuals not in employment), although this difference narrowed after accounting for measures of study quality, including response rate and sampling method. This finding is inconsistent with the healthy worker effect, which would presume lower levels of psychological symptoms in individuals in employment. One explanation is that the GHQ is sensitive to contextual factors, and it seems possible that symptoms of CMD are over reported when participants know that they have been recruited to a study on the basis that they belong to a specific occupational group, as in nearly all "stress" surveys.
    Full-text · Article · Nov 2013 · PLoS ONE
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    • "We changed our original protocol's threshold score for being within a normal range on this measure from a score of ⩾85 to a lower score as that threshold would mean that approximately half the general working age population would fall outside the normal range. The mean (s.d.) scores for a demographically representative English adult population were 86.3 (22.5) for males and 81.8 (25.7) for females (Bowling et al. 1999). We derived a mean (s.d.) score of 84 (24) for the whole sample, giving a normal range of 60 or above for physical function. "
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    ABSTRACT: Background A multi-centre, four-arm trial (the PACE trial) found that rehabilitative cognitive behaviour therapy (CBT) and graded exercise therapy (GET) were more effective treatments for chronic fatigue syndrome (CFS) than specialist medical care (SMC) alone, when each was added to SMC, and more effective than adaptive pacing therapy (APT) when added to SMC. In this study we compared how many participants recovered after each treatment. Method We defined recovery operationally using multiple criteria, and compared the proportions of participants meeting each individual criterion along with two composite criteria, defined as (a) recovery in the context of the trial and (b) clinical recovery from the current episode of the illness, however defined, 52 weeks after randomization. We used logistic regression modelling to compare treatments. Results The percentages (number/total) meeting trial criteria for recovery were 22% (32/143) after CBT, 22% (32/143) after GET, 8% (12/149) after APT and 7% (11/150) after SMC. Similar proportions met criteria for clinical recovery. The odds ratio (OR) for trial recovery after CBT was 3.36 [95% confidence interval (CI) 1.64–6.88] and for GET 3.38 (95% CI 1.65–6.93), when compared to APT, and after CBT 3.69 (95% CI 1.77–7.69) and GET 3.71 (95% CI 1.78–7.74), when compared to SMC (p values ⩽0.001 for all comparisons). There was no significant difference between APT and SMC. Similar proportions recovered in trial subgroups meeting different definitions of the illness. Conclusions This study confirms that recovery from CFS is possible, and that CBT and GET are the therapies most likely to lead to recovery.
    Full-text · Article · Jan 2013 · Psychological Medicine
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