Improving the Response Choices on the Veterans SF-36 Health Survey Role Functioning Scales

Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA.
The Journal of ambulatory care management 07/2004; 27(3):263-80. DOI: 10.1097/00004479-200407000-00010
Source: PubMed


Role functioning and its limitations due to one's health is an important aspect of health-related quality of life (HRQoL). The Medical Outcomes Study (MOS) SF-36 includes 2 role functioning scales: role limitations due to physical health problems (RP) or emotional problems (RE). Although they capture important concepts of HRQoL, these 2 scales have some limitations in their measurement properties. Using dichotomized sets of response choices, the scales are limited in their distributional properties (eg, higher standard deviation than other SF-36 scales) and ability to discriminate between clinically relevant groups. In this study, we ascertain the improvements to these 2 scales using 5-point ordinal response choices for each of the scale items. Two thousand one hundred sixty-two patients from the Veterans Health Study (VHS), an observational study of health outcomes in patients receiving ambulatory care, completed a health status questionnaire and a medical history. The health questionnaire included (1) the MOS SF-36, in which the RP and RE items used dichotomized yes/no responses; and (2) a set of modified RP and RE items that used 5-response choices for each of the items, ranging from "no, none of the time" to "yes, all of the time." We compared the original and modified RP and RE scales using internal consistency reliability and factor analysis. We tested item convergent and discriminant validity using multitrait scaling, and scale discriminant validity using ordinary least squares regression. Results indicate that the modifications to the original RP and RE scales accomplish important gains in the distributional properties of the scales. The floor and ceiling effects of the 2 scales have been reduced and the reliability of the RP scale has increased (0.87-0.95). Factor analysis and multitrait scaling tests indicate that the modified items have the same interpretation as the original items. Tests of discriminant validity indicate that the modified RP and RE scales have greater explanatory power for measures of disease burden, depression, and disease severity. The modified SF-36 role scales are clearly superior to the original versions. The modifications have increased the explained variability, suggesting greater explanatory power and more information obtained by the role functioning measures. The modified RP and RE are capturing a wider spectrum of disease severity, in part due to the lowering of the floor and raising of the ceiling of the scales. Additional work needs to test these improvements in other populations and to expand the analysis to track the responsiveness of the modified scales to clinically and socially important changes over time.

17 Reads
  • Source
    • "Using baseline and follow-up surveys, time-varying general health, behavioral, and occupational characteristics were included to evaluate whether certain subpopulations were more likely to newly report lupus or RA. General health was investigated using the physical and mental component summary scores from the Medical Outcomes Study Short Form 36-Item Health Survey for Veterans [26] [27] [28] [29] [30] [31]. Participants' component scores were categorized into quartiles. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to prospectively assess the association between deployment in support of the operations in Iraq and Afghanistan and newly reported lupus and rheumatoid arthritis while also considering the effects of demographic, behavioral, and occupational characteristics. A total of 77,047 (2001-2003) and 31,110 (2004-2006) participants completed the baseline Millennium Cohort questionnaire and were resurveyed approximately every 3 years. Longitudinal analyses were used to assess the adjusted association between deployment to Iraq and Afghanistan with and without combat exposures and newly reported disease. After adjusting, deployment was not significantly associated with newly reported lupus compared with nondeployers. However, compared with nondeployers, deployers with and without combat exposures were significantly less likely to newly report rheumatoid arthritis. Women, non-Hispanic black, and Hispanic participants had a significantly elevated risk for both diseases. Overall, deployment was not associated with an increased risk of newly reported lupus or rheumatoid arthritis.
    Full-text · Article · Nov 2011
  • Source
    • "Veterans have been shown to have lower overall HR-QOL than non-Veterans [8], and the Medical Outcomes Study Short Form 36 for Veterans (SF-36V) has been developed to better describe the veteran population [9] [10]. The SF-36 has been used to describe other HR-QOL difficulties with different diseases (eg, head and neck cancers [11]) and procedures (eg, total hip arthroplasty [12], hemodialysis [13]), but no studies have been performed comparing the impact of both comorbidities and having an ostomy on HR-QOL in Veterans Affairs (VA) patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous research suggests an ostomy worsens health-related quality of life (HR-QOL), but comorbidities also can affect HR-QOL. Eligible patients had abdominal operation with ostomy (cases) or similar procedure without ostomy (controls). Patients were recruited for this case-control study from 3 Veterans Affairs hospital medical and pharmacy records. Comorbidities were assessed with Charlson-Deyo Comorbidity Index. Multinomial logistic regression evaluated the impact of comorbidities and having an ostomy on HR-QOL, measured using the Medical Outcomes Study Short Form 36 for Veterans. A total of 237 ostomates (cases) and 268 controls were studied. Average age was 69 years; 64% of cases had colostomy, 36% ileostomy. Twenty-nine percent of patients had a high level of comorbidities. Cases and controls were similar except for reasons for undergoing surgery. High comorbidity was a significant predictor of low HR-QOL in 6 domains of the Short Form 36 for Veterans; having an ostomy was a significant predictor in 4. High comorbidity significantly influences low HR-QOL and impacted more domains than having an ostomy.
    Full-text · Article · Jan 2008 · American journal of surgery
  • Source
    • "Violent behavior was evaluated with a four item index used in evaluations of VA PTSD treatment programs (Rosenheck & Fontana, 2003). Role functioning was assessed with the role–emotional subscale from the Veterans Short Form-36 (SF−36; Kazis et al., 2004). Social contacts were evaluated with two items (Cronbach's alpha = .50) "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examined how treatment-seeking veterans with preexisting posttraumatic stress disorder (PTSD) (n = 178) were affected by vicarious exposure to the September 11 terrorist attacks. Participants were surveyed 0 to 5 months prior to 9/11 and resurveyed 6 months after the attacks. Half the patients reported that thoughts and feelings about 9/11 impaired their functioning some (37%) or most or all of the time (13%). However, there was little evidence that vicarious exposure to 9/11 altered the course of these patients' functioning. Mean symptom, substance use, and role functioning outcomes were unchanged from pre-9/11 levels. Time spent following media coverage of 9/11 events was weakly associated (r = .17 to .18, p < .05) with only two of eight functioning outcomes.
    Preview · Article · Dec 2005 · Journal of Traumatic Stress
Show more