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SF-12: How to Score the SF-12 Physical and Mental Health Summary Scales

Authors:
  • John Ware Research Group
... The social, occupational, and psychological functioning was assessed by the Global Assessment of Functioning (GAF) scale [36], and the severity of illness was assessed using the Clinical Global Impression -Severity scale (CGI-S) [37]. HrQoL was measured using the indexes of the German versions of the EQ-5D-5L [5,6] based on German preference weights [38] and the SF-12 (SF-6D) [7,39] based on preference weights from the United Kingdom [40] as well as the visual analogue scale of the EQ-5D-5L (EQ-VAS) [6]. Furthermore, the mental component summary score (MCS) and physical component summary score (PCS) were calculated from the respective mental and physical dimensions of the SF-12 [39]. ...
... HrQoL was measured using the indexes of the German versions of the EQ-5D-5L [5,6] based on German preference weights [38] and the SF-12 (SF-6D) [7,39] based on preference weights from the United Kingdom [40] as well as the visual analogue scale of the EQ-5D-5L (EQ-VAS) [6]. Furthermore, the mental component summary score (MCS) and physical component summary score (PCS) were calculated from the respective mental and physical dimensions of the SF-12 [39]. Additional information on the constructs and scores of the measures used for the assessment of symptom severity and HrQoL are given in the Online Resource. ...
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Background The generic self-reported Recovering Quality of Life (ReQoL) measures were developed for measuring recovery-focused health-related quality of life (HrQoL) in persons with mental health conditions. The aim of this study was to assess the psychometric properties of the German version of the ReQoL measures in patients with affective disorders in Germany. Methods Data from a patient sub-sample in a randomized controlled trial have been used (N = 393). The internal consistency and the test–retest reliability of the ReQoL measures were assessed using Cronbach’s Alpha and the intra-class correlation coefficient (ICC). The concurrent validity and the known-group validity of the ReQoL measures were assessed using Pearson’s Correlation coefficient and Cohen’s d. The responsiveness was assessed using Glass' Δ and the standardized response mean (SRM). Results The reliability among the items of the ReQoL-20 was overall excellent. The ICC of the ReQoL-20 was r = 0.70, indicating moderate test–retest reliability. The concurrent validity of the ReQoL-20 with the clinical measure PHQ-9 was strong with a correlation coefficient of r = − 0.76. The known-group validity of the ReQoL-20 using PHQ-9 cut-off points was large with an effect size of d = 1.63. The ReQoL measures were sensitive to treatment response and remission of symptoms measured by the PHQ-9 with large effect sizes/SRM. Discussion The psychometric properties of the ReQoL measures for the assessment of patients with affective disorders were overall good. With the ReQoL, valid and reliable measures for the assessment of recovery-focused HrQoL for persons with affective disorders are available in German language.
... The SF-12 includes 12 items, with varying response options, and two summary scores are produced: Physical Component Summary (PCS), representing perceived physical health, and Mental Component Summary (MCS), representing perceived mental health. The PCS and MCS were scored separately using norm-based scoring (M = 50, standard deviation = 10; Ware et al., 1995): Sample items included "In general, would you say your health is (excellent, very good, good, fair, poor)," and "During the past 4 weeks how much did pain interfere with your normal work (including both working outside the home and housework)? (not at all, a little bit, moderately, quite a bit, extremely)." ...
... SD = 9.92) and MCS (M = 49.42, SD = 9.80) scores for women in the general U.S. population (Ware et al., 1995), and suggest that our sample perceived their physical and mental health to be lower than perceptions of women in the general U.S. population. See Table 1 for full details regarding the participants' characteristics, and descriptive statistics for the study indicators. ...
Article
This study examined whether body appreciation mediates the relationships between anti-fat microaggression experiences and perceived physical and mental health. Using a cross-sectional survey design, our study included 384 adult cisgender women in the United States. We found that anti-fat microaggression experiences had a negative association with body appreciation, and perceived physical and mental health. Body appreciation had a positive relationship to perceived physical and mental health. Our study further suggests that body appreciation is an important modifiable factor that mediates the relationships between anti-fat microaggression experiences and perceived mental and physical health. Implications for practice and research are discussed.
... Originally, Ware et al. [2,11] provided algorithms for constructing composite scores based on orthogonal principal component analysis (PCA) to create a physical composite summary (PCS) and a mental composite summary (MCS) for version 1 of the SF-36/12 Health Surveys. They aimed to create pure PCS and MCS scores with little overlapping variance. ...
... Based on previous research and theory, the correlations between the unweighted and oblique RAND-36/12 composite scores measuring the same construct should be ≥ 0.95 [5,18,21]. Convergent validity was examined using Spearman rank coefficients between the composite scores and variables known to be related to HRQoL: age (years, continuous); sex (women = 0, men = 1); body mass index (units, continuous); physical activity (strenuous physical activity: never = 0, less than 1 h per week = 1, 1-2 h per week = 2, ≥ 3 h per week = 3), rheumatic disease (no = 0, yes = 1), and depression (no = 0, yes = 1) [2,11,[25][26][27][28]. A correlation ≥ 0.2 regarding convergent validity suggest an effect size that might be of practical importance [29]. ...
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Background The RAND-36 and RAND-12 (equivalent to versions 1 of the SF-36 Health Survey and SF-12 Health Survey, respectively) are widely used measures of health-related quality of life. However, there are diverging views regarding how to create the physical health and mental health composite scores of these questionnaires. We present a simple approach using an unweighted linear combination of subscale scores for constructing composite scores for physical and mental health that assumes these scores should be free to correlate. The aim of this study was to investigate the criterion validity and convergent validity of these scores. Methods We investigated oblique and unweighted RAND-36/12 composite scores from a random sample of the general Norwegian population ( N = 2107). Criterion validity was tested by examining the correlation between unweighted composite scores and weighted scores derived from oblique principal component analysis. Convergent validity was examined by analysing the associations between the different composite scores, age, gender, body mass index, physical activity, rheumatic disease, and depression. Results The correlations between the composite scores derived by the two methods were substantial (r = 0.97 to 0.99) for both the RAND-36 and RAND-12. The effect sizes of the associations between the oblique versus the unweighted composite scores and other variables had comparable magnitudes. Conclusion The unweighted RAND-36 and RAND-12 composite scores demonstrated satisfactory criterion validity and convergent validity. This suggests that if the physical and mental composite scores are free to be correlated, the calculation of these composite scores can be kept simple.
... Several instruments were developed to evaluate HRQoL using generic and specific questionnaires. While generic questionnaires have the advantage of being applicable to a wide range of populations and conditions, (e.g., SF-12 [8], SF-36 [9], EQ-5D [10], WHOQoL-BREF [11]), condition-specific instruments (focused on one particular health condition or illness) or population-specific tools (e.g., older person-specific) may be more sensitive and therefore more suitable for use within particular patient groups or populations. Brazier et al. [12] states that the EuroQoL and SF-12/SF-36 questionnaires can also be used for the elderly population. ...
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Background To evaluate the established interventions used for older adults, it is appropriate to use validated questionnaires for quality-of-life assessment. For older people, it is suitable to use specific questionnaires designed for old age and aging, with a lower number of questions. The aim of this research was to verify the psychometric properties of the Czech version of the OPQoL-brief questionnaire for seniors living in home environment in a community so that it can be used within the Czech Republic. Methods A cross-sectional study was performed on older adults in the Moravian-Silesian Region living at home. The study included 954 senior citizens (≥ 65 years, cognitively intact) (without diagnosed dementia, able to sign an informed consent). To test the psychometric properties of the created questionnaire, we tested the validity (construct validity, discriminant validity, convergent validity) and reliability (internal consistency, test–retest reliability). Results The single-factor model of the OPQoL-brief scale (CFI = 0.971, TLI = 0.959, RMSEA = 0.061, SRMR = 0.034, GFI = 0.960) was confirmed, for which excellent reliability was found (α = 0.921, ICC = 0.904). An inter-item correlation exceeding 0.5 was found for all items. Furthermore, a significant correlation was found between the overall score of OPQoL-brief and the scales measuring depression (r = − 0.520; p < 0.001), anxiety (r = − 0.355; p < 0.001), sense of coherence (r = 0.427; p < 0.001), and self-esteem (r = 0.428; p < 0.001). Conclusion The results of our research revealed that the shorter Czech version of the OPQoL-brief questionnaire has appropriate reliability and validity and can be recommended for both health and social services to assess the quality of life of senior citizens in a community.
... We did not use individual indicators of adverse childhood experiences because some cells were too small to run models. At the caregiver level, predisposing factors included the caregiver's age (>54 = 1 and ≤ 54 = 0), gender (female = 1 and male = 0), education (college and above = 1 and below college = 0), and physical and mental health (measured using Short Form Health Survey, standardized measures ranging from 0 to 100, with higher scores indicating better physical and mental health status; Ware, Kosinski, & Keller, 1998). Caregiver's age was treated as a dummy variable because age was constructed as a categorical variable with options "<35" "35-44" "45-54" and ">54" in the original data, and 54 was used as a cutoff because kinship caregivers' average age was about 54 years old (Denby, 2011). ...
Article
This study examined predisposing, enabling, and need factors associated with mental health (MH) services, the use of school-based, medical-based and specialty MH services, and the use of ≥ 2 MH services among children in kinship care. We analyzed a sample of children in kinship care (N = 718) selected from wave II of the National Survey on Child and Adolescent Well-Being II. Results indicated that child’s age, gender, ethnicity (being Hispanic) and clinically significant internalizing and externalizing problems were associated with their use of MH services. Furthermore, results indicated being Hispanic, older children, living in poverty primarily with male caregivers, and having clinically significant externalizing problems were associated with higher odds of receiving school-based MH services, while being a girl and living with caregivers with better physical health were associated with lower odds of receiving medical-based MH services. Experiencing household challenges and living with caregivers with better MH were associated with the odds of receiving specialty MH services. Experiencing household challenges, being Hispanic and older children, and living in formal kinship care were associated with higher odds of receiving ≥ 2 MH services. These findings suggest the importance of providing accessible and diverse MH services to children in kinship care.
... The SF-12 yields two subscales reflecting mental health-related (Mental Component Summary; MCS) and physical health-related (Physical Component Summary; PCS) well-being. PCS and MCS scores were computed and normalized according to published algorithms (Ware, Kosinski, & Keller, 1995). Scores on each subscale range from 0 to 100, with higher scores indicating better physical and mental health functioning. ...
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Background: There is increasing support for the use of meditation-based treatments for US military Veterans with posttraumatic stress disorder (PTSD). The Mantram Repetition Program (MRP), which is a portable meditative practice that features mindful repetition of a sacred phrase, is associated with significant reductions in PTSD symptom severity. Although regular practice is emphasized in meditation-based interventions, associations between frequency of practice and clinical outcomes are often not reported. Objectives: This study will examine whether the frequency of mantram repetition is associated with greater improvements in clinical outcomes. Methods: Veterans with PTSD participating in MRP (N = 160; combined experimental groups from two randomized controlled trials). Participants completed pre- and post-treatment self-report measures of anger and well-being and a clinician-administered interview of PTSD severity (CAPS-IV-TR). Veterans also reported average daily mantram repetition practice at post-treatment. We conducted a series of hierarchal multiple regression analyses. Results: When controlling for race/ethnicity and pre-treatment severity, higher frequency of mantram repetition practice was associated with significantly greater improvements (small effect sizes) in PTSD symptom severity (F(3,128) = 6.60, p < .001, β = .21, p = .007), trait anger (F(3,128) = 31.23, p < .001, β = .25, p < .001), state anger (F(3,110) = 17.62, p < .001, β = .16, p = .04), mental health well-being (F(3,128) = 28.38, p < .001, β = .14, p = .04), and spiritual well-being (F(3,127) = 13.15, p < .001, β = .23, p = .003), but not physical health well-being. Conclusions: Higher frequency of mantram repetition practice appears to have beneficial effects on clinical outcomes for Veterans with PTSD. Strategies that promote skills practice may be an important target for improving clinical outcomes for meditation-based interventions. Highlights: Higher frequency of meditation practice during Mantram Repetition Program was associated with greater reductions in PTSD symptoms and anger as well as improvements in well-being.Strategies to promote at-home meditation practice may optimize the benefits of MRP.
... The SF-12v2 is a condensed 12-item version of the SF-36 [35] that yields a physical and a mental health component summary score standardized to have a mean of 50 and a standard deviation of 10 [35,36]. ...
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Purpose Evidence for comparative and cost-effectiveness of weight-loss interventions is lacking as there are no obesity-specific measures fit for this purpose. This study aimed to estimate the extent to which a prototype of a brief, multi-dimensional obesity-specific Preference-Based Index of Weight-Related Quality of Life (PBI-WRQL) could fill this gap. Methods Longitudinal data from a Canadian bariatric cohort was used. Forty-eight items from the IWQoL-Lite, EQ-5D-3L, and SF-12V2 were mapped onto the WHO ICF domains, and one item was chosen for the dimension based on fit to the Rasch model. Individuals’ health ratings (0–100) were regressed on each dimension, and the regression coefficients for the response options were used as weights to generate a total score. Generalized estimation equations were used to compare measure parameters across groups and levels of converging constructs. Results Pre-surgery data were available on 201 people (Women: 82%; BMI: 48.8 ± 6.7 kg/m²; age: 43 ± 9.0 years) and on 125 (62%) at 6 months post-bariatric surgery. Seven dimensions with three response options formed the PB-WRQL prototype: Mobility/Physical Function, Pain, Depression, Participation, Energy, Peripheral Edema, and Dyspnea. The prototype showed substantial change (mean + 40) with bariatric surgery, higher than the EQ-5D (mean + 11.5). The prototype showed the strongest relationship with BMI at baseline (t = − 3.68) and was the most sensitive to change in BMI (t = − 3.42). Conclusion This study demonstrates that a brief, 7-dimension index weighted by health impact performed as well as the 31-item IWQoL-Lite and better than the EQ-5D-3L. These findings demonstrate the potential value of the brief PB-WRQL prototype index and support its further development using preference weights to reflect the current generation’s needs and concerns.
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Introduction: HIV programmes across many countries in Africa have recently transitioned people living with HIV from efavirenz (EFV)- to dolutegravir (DTG)-containing antiretroviral therapy (ART). As both drugs are associated with neuropsychiatric adverse effects, this study assessed the mental health and HIV/ART-associated symptoms of people living with HIV before and after transition to DTG. Methods: The prospective DO-REAL cohort enrolled people starting DTG-based ART in Lesotho from February to December 2020. For this analysis within DO-REAL, we included adults changing from tenofovir disoproxil fumarate (TDF)/lamivudine (3TC)/EFV to TDF/3TC/DTG within first-line therapy. At transition and 16 weeks thereafter, participants completed the Patient Health Questionnaire-9 (PHQ-9; depression screening), the 12-item Short-Form Health Survey (SF-12; mental and physical health), and a modified HIV Symptom Index (mHSI; HIV/ART-related symptoms). We also assessed weight change. We used McNemar tests with Bonferroni corrections to assess binary outcomes. Clinicaltrials: gov: NCT04238767. Results: Among 1228 participants, 1131 completed follow-up. Of these, 60.0% were female, the median age was 46 years (interquartile range [IQR] 38-55), and the median time taking ART was 5.7 years (IQR 3.5-8.9). No change was observed for weight or overall PHQ-9 or SF-12 outcomes. However, three mHSI items decreased at follow-up: 'feeling sad/down/depressed' (bothered 6.0% vs. 3.3% of participants at least 'a little' before vs. after transition; adjusted p = 0.048); 'feeling nervous/anxious' (7.4% vs. 3.4%; adjusted p = 0.0009); and 'nightmares, strange/vivid dreams' (6.3% vs. 3.5%; adjusted p = 0.027). Individual PHQ-9 or SF-12 items also improved. Being symptom free across all measures increased from 5.1% to 11.4% (p < 0.0001). Conclusions: We observed no negative impacts and potential moderate improvements with DTG, providing further support for the rollout of DTG.
Article
Introduction A patient’s decision to undergo an elective orthopedic procedure is largely based on their symptoms and functional limitations. This point where patients choose to undergo surgery is known as the “tipping point”. The primary aim of this study is to determine the relationship between demographic parameters and the tipping-point for elective rotator cuff repair. The secondary aim is to investigate if the tipping-point is associated with mental health. The tertiary aim is to determine if the tipping-point changes over time. Methods Retrospective chart review was used to identify all patients who underwent primary arthroscopic rotator cuff repair between 01/01/2015 – 01/01/2020 with one of three board-certified orthopedic surgeons. Exclusion criteria included age <18 years, revision surgery, or incomplete datasets (American Shoulder and Elbow Surgeons [ASES], 12-item short form [SF-12], demographic information, surgical history). Preoperative ASES score was designated as the “tipping point” for an individual patient, with a lower score representing worse shoulder function and therefore a higher tipping point, and vice versa. Demographic parameters (age, sex, BMI, race, insurance), hand dominance, and surgical history extracted from chart review were analyzed to determine associations with tipping point. Results 2153 patients were identified from chart review, with 1731 included in final analysis. The patients had a mean age of 58.6 ± 9.66 years and mean BMI of 29.2 ± 6.02 kg/m². There was no significant difference in mean preop ASES score by year for the duration of this study (2015–2019, P=0.27). Worker’s compensation patients had a significantly lower mean preop ASES score than patients with commercial or government insurance (P<0.01). Spearman’s rank correlations showed no relationship between ASES score and patient demographics (age, sex, BMI, race, hand dominance), or between ASES and previous orthopedic surgery. Preop ASES showed a weakly positive correlation (ρ=0.26) with SF-12 Mental Component Score (MCS). Multivariate linear regression showed male sex is predictive of a lower tipping point (P<0.01), while higher BMI, African-American race, and history of arthroplasty are predictive of a higher tipping point (P≤0.02). Conclusion The tipping-point was not demonstrated to change over time in our analysis. Male sex is predictive of a lower tipping-point for arthroscopic rotator cuff repair, while elevated BMI, African-American race, worker’s compensation insurance, and prior arthroplasty are predictive of a higher tipping-point. Also, better mental health function is associated with a lower tipping-point.
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Background The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. Method In a randomized clinical trial with 188 individuals with SMIs, BPR ( n = 98) was compared to ACC ( n = 90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. Results Total costs per participant at 12-month follow-up were € 12,886 in BPR and € 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to €190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. Conclusions This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.
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