07/01/96 9:46 AM

A Microcomputer Program (sf36.exe) that Generates

SAS Code for Scoring the SF-36 Health Survey
Ron D. Hays, Cathy D. Sherbourne, Karen L. Spritzer, Wil J. Dixon
DRU-1437-PI
Abstract
This paper describes a microcomputer that can be used to generate
SAS code that for scoring SF-36 Health Survey, one of the most widely
used measures of health-related quality of life today. The generated
SAS code scores the 8 SF-36 scales as well as the SF-36 physical and
mental health composite scores. In addition, the program produces
code that provides US general population normative scores, age and
gender adjusted to ones sample. The significance of the difference
between the sample and the general population on each SF-36 scale
score is also generated. Example input and output files are included.
Selected SF-36 publications are cited. The SF-36 Health Survey items
are given in the Appendix.

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A Microcomputer Program (sf36.exe) that Generates

SAS Code for Scoring the SF-36 Health Survey
The SF-36 taps eight health concepts: physical functioning, bodily
pain, role limitations due to physical health problems, role limitations
due to personal or emotional problems, emotional well-being, social
functioning, energy/fatigue, and general health perceptions. It also
includes a single item that provides an indication of perceived change
in health. These 36 items were adapted from longer instruments
completed by patients participating in the Medical Outcomes Study
(MOS),
an observational study of variations in physician practice styles and
patient outcomes in different systems of health care delivery (Hays &
Shapiro, 1992; Stewart, Sherbourne, Hays, et al., 1992).
Scoring the Eight SF-36 Scales
We recommend that responses be scored as described below (the
RAND method). A somewhat different scoring procedure for the pain
and general health scales was advocated by New England Medical
Center (NEMC)
investigators (Ware, Snow, Kosinski,, & Gandek, 1993). Although only
our scoring recommendations for these scales are described here, the
SAS program generator we provide scores these two scales both ways.
Pain scale scores scored the RAND versus NEMC way correlated 0.99 in
the MOS, with a mean difference of 3.33 (NEMC scoring yields lower
pain scores on average). General health perception scale scores also
correlated 0.99 in the MOS, with a mean difference of -1.37 (NEMC
scoring yields higher general health scores on average). For further
information about the scoring differences, see Hays, Sherbourne, and
Mazel (1993).
Scoring the SF-36 is a two-step process. First, pre-coded numeric
values are recoded per the scoring key given in Table 1. Note that all
items are scored so that a high score defines a more favorable health
state. In addition, each item is scored on a 0 to 100 range so that the
lowest and highest possible scores are set at 0 and 100, respectively.
Scores represent the percentage of total possible score achieved. In
step 2, items in the same scale are averaged together to create the 8
scale scores. Table 2 lists the items averaged together to create each
scale. Items that are left blank (missing data) are not taken into
account when calculating the scale scores. Hence, scale scores
represent the average for all items in the scale that the respondent
answered. If all items in a scale are missing, then the scale score is
also missing.
Example: Items 20 and 32 are used to score the measure of social
functioning. Each of the two items has 5 response choices. However,
a

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high score (response choice 5) on item 20 indicates extreme

limitations in
social functioning, while a high score (response choice 5) on item 32
indicates the absence of limitations in social functioning. To score
both
items in the same direction, Table 1 shows that responses 1 through 5
for
item 20 should be recoded to values of 100, 75, 50, 25, and 0,
respectively. Responses 1 through 5 for item 32 should be recoded to
values of 0, 25, 50, 75, and 100, respectively. Table 2 shows that
these
two recoded items should be averaged together to form the social
functioning scale. If the respondent is missing one of the two items,
the
person's score will be equal to that of the nonmissing item.
Table 3 presents information on the reliability, central tendency
and variability of the scales in the MOS when scored using this
method.
To use the enclosed programs, it is necessary to have a SAS
dataset with
the SF-36 items in it. The program, sf36.exe, is used in combination
with your SAS file of SF-36 items to create SAS code for scoring the
SF-36 scales.
In addition to having a SAS dataset with SF-36 items, you need to
create an ASCII file that specifies the variable names you have
assigned to
the 36 SF-36 items in your study. When sf36.exe is executed, you will
be asked for the name of the input file: WHAT FILE CONTAINS THE
INPUT SETUP?
Notice that the input file (sf36.in) consists of a list of 36 variable
names, each entered on a separate row beginning in column one (see
Table 4). The variable names need to be listed to correspond with the
order of items presented in the Appendix. For example, the first item
reads "In general, would you say your health is: Excellent, Very good,
Good, Fair, Poor?" On the first row of the input file, you should list the
variable name you assigned to this item. You need to list the actual
SAS names used for your data set so that the generated SAS code will
include rename statements linking your SAS names to the SAS names
used in the generated code (the generated code uses names I1
through I36 following the order of items in the Appendix).
If you use the same SAS names as assumed in the program (I1
through
I36), you can use the sf36.in file (see Table 4) as the input file when
you execute sf36.exe. If you use different SAS names, you will have to
create a

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file that reflects these differences (see sf36.ex, Table 5, for an example
of a
different input file). Note that you should not use the variable names
I1 through I36 for variables other than the SF-36 items or SAS will not
be able to distinguish the SF-36 items from these other variables.
The program assumes that your dataset includes a continuous
measure
of AGE (named "AGE") and a gender variable called "MALE" (coded 0 =
female, 1 = male).
The sf36.exe program produces a file, sf36.sas, that contains SAS
code for scoring the sf-36 scales. For the pain and general health
scales, both the RAND and NEMC scoring are provided. Scale scores
are created for persons that answer any of the items in a scale (Note
that NEMC only creates scores for person who answer half or more of
the items in a scale.)
The SAS code in sf36.sas assumes that the name of the SAS
dataset
that includes the SF-36 items is "TEMP" (see SET TEMP in the
generated
SAS code). If your file has a different name, you should change this
part of the sf36.sas file to reflect that. Note that a raw data file,
sf36.raw, is also produced and that this file is read by sf36.sas when
it is run. This raw data file includes information about US general
population means and standard deviations (Ware et al., 1993)
Example of Using sf36.exe
Table 5 provides an example of an input file, sf36.in2, for sf36.exe.
In this example, the SF-36 items were assigned the SAS names T1
through T36 in the study in which they were used. The input file is
read by sf36.exe and this information is used in creating the file,
sf36.sas, shown in Table 6.
Scoring the SF-36 Physical and Mental Health Composite
Scores
Running sf36b.exe will produce SAS code, saved as sf36add.sas,
that will create T-scores for the 8 SF-36 scales (using the US general
population norms). In addition, physical and mental health composite
scores for the SF-36 (Ware, Kosinkski, & Keller, 1994) and the SF-12
(Ware, Kosinski, & Keller, 1995, 1996) are produced. The sf36add.sas
file
can be appended to sf36.sas for analyses of the SF-36 scales and
composite scores. Running the resulting sf36.sas file yields the output
shown for the sample data shown in Table 7.
The output includes descriptive statistics for the 8 SF-36 scales and
US general population norms, age and gender adjusted to your
sample. The SF-36 SAS names used are as follows:

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PHYFUN10
Physical functioning in your sample
PFISFM
Physical functioning in general population
ROLEP4
Role limitations--physical in your sample
RPSFM
Role limitations--physical in general population
PAIN2
Pain in your sample--RAND scoring
SFPAIN
Pain in your sample--NEMC scoring
BPSFM
Pain in general population
GENH5
General health in your sample--RAND scoring
SFGENH5
General health in your sample--NEMC scoring
GENSFM
General health in general population
EMOT5
Emotional well-being in your sample
MHSFM Emotional well-being in general population
ROLEE3
Role limitations--emotional in your sample
RESFM
Role limitations--emotional in general population
ENFAT4
Energy in your sample
ENFTSFM
Energy in general population
SOCFUN2
Social function in your sample
SFSFM
Social function in general population
Table 7 illustrates the output of means, standard deviations,
minimum and maximum values for each of these scales. Note that
only the mean values are provided for the general population values
(PFISFM, RPSFM, BPSFM, GENSFM, MHSFM, RESFM, ENFTSFM, SFSFM),
because the standard deviations and ranges produced by SAS for
these scales are not relevant (i.e., These variances and ranges
because they are based on mean scores derived from age and gender
subgroups of the general population, and are not the general
population estimates of these statistics).
In addition to the descriptive statistics, sf36.sas provides t-statistics
(asymptotically z-statistics) for the significance of the difference
between
SF-36 scores in the sample compared to the US general population
(ZPHY10, ZRP, ZBP, ZGENH, ZENFT, ZSF, ZRE, ZMHI). Finally, sf36.sas
outputs SF-36 scale scores for the sample, corresponding T-scores for
each scale, and the physical (AGG_PHYS) and mental health
(AGG_MENT) composite T-scores. The sample size and descriptive
statistics provided here may differ from the prior output, because in
the prior output respondents are omitted if they have missing data on
age or gender (these variables are needed to adjust the general
population values to ones sample).
For further information please contact either:
Ron D. Hays
RAND

or

Cathy D. Sherbourne
RAND

07/01/96 9:46 AM

1700 Main Street

P.O. Box 2138
Santa Monica, CA 90407-2138
(310) 393-0411 Ext.7581 (Voice)
(310) 393-4818 (FAX)
Ronald_Hays@rand.org

1700 Main Street

P.O. Box 2138
Santa Monica, CA 90407-2138
(310) 393-0411 Ext. 7216 (Voice)
(310) 393-4818 (FAX)
Cathy_Sherbourne@rand.org

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Selected SF-36 Publications (Including Those Cited Above)

Aaronson, N.K., Acquadro , C., Alonso, J., Apolone, G. Bucquet, D.,
Bullinger, M., Bungay, K., Fukuhara, S., Gandek, B., Keller, S.,
Razavi, D., Sanson-Fisher, R., Sullivan, M., Wood-Dauphinee, S.,
Wagner, A., & Ware, J. E. (1992). International quality of life
assessment (IQOLA) project. Quality of Life Research, 1, 349-351.
Anderson, R.T., Aaronson, N.K,. and Wilkin D. (1993). Critical review of
the international assessments of health-related quality of life.
Quality of Life Research, 2, 369-395.
Andresen, E., Patrick, D. L., Carter, W. B., & Malmgren, J. A. (1995).
Comparing the performance of health status measures for healthy
older adults. Journal of the American Geriatrics Society, 43,
1030-1034.
Barry, M. J., Walder-Corkery, E., Chang, Y., Tyll, L. T., Cherkin, D. C.,
& Fowler, F. J. (1996). Measurement of overall and disease-specific
health status: Does the order of questionnaires make a difference?
Journal of Health Services Research, 1, 20-27.
Beusterien, K. M., Nissenson, A. R., Port, F. K., Kelly, M., Steinwald, B., &
Ware, J. E. (1996). The effects of recombinant human erythropoietin
on
functional health and well-being in chronic dialysis patients. Journal
of
the American Society of Nephrology, 7, 763-773.
Bouchet, C., Guillemin, F., & Briancon, S. (1996). Nonspecific
effects in longitudinal studies: Impact on quality of life
measures. Journal of Clinical Epidemiology, 49, 15-20.
Bousquet, J., Bullinger, M., Fayol, C., Marquis, P., Valentin, B.,
& Burtin, B. (1994). Assessment of quality of life in patients with
perennial allergic rhinitis with the French version of the SF-36 health
status questionnaire. Journal of Allergy Clin Immunol, 94, 182188.
Bousquet, J., Knani, J., Dhivert, H., Richard, A., Chicoye, A., Ware,
J.E., and Michel, F-B. (1994). Quality of life in asthma. I. Internal
consistency and validity of the SF-36 questionnaire. American
Journal
of Respiratory and Critical Care Medicine, 149, 371-375.
Brazier, J. (1993). The SF-36 health survey questionnaire - a tool for
economists. Health Economics, 2, 213-215.
Brazier, J.E., Harper, R., Jones, N.M.B., O'Cathain, A., Thomas, K.J.,
Usherwood, T., and Westlake, L. (1992). Validating the SF-36 health
survey questionnaire: New outcome measure for primary care.
British
Medical Journal, 305, 160-4.
Brazier, J., Jones, N., & Kind, P. (1993). Testing the validity of the
Euroqol and comparing it with the SF-36 health survey questionnaire.

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Quality of Life Research, 2, 169-180.

Bullinger M. (1996). German translation and psychometric testing
of the SF-36 health survey: Preliminary results from the IQOLA
project. Social Science and Medicine.
Fifer S., Mathias SD, Patrick DL, Mazonson PD, Lubeck DP, Buesching
DP.
(1994). Untreated anxiety among adult primary care patients in a
health
maintenance organization. Archives of General Psychiatry,
51,740-750.
Fryback, D.G., Dasbach, E.J., Klein, R., et al. (1993). The Beaver Dam
Health Outcomes Study: Initial catalog of health state quality factors.
Medical Decision Making, 13, 89-102.
Ganz, P. A., Coscarelli, A., Fred, C., Kahn, B., Polinsky, M. L., &
Petersen, L. (in press). Breast cancer survivors: Psychosocial
concerns
and quality of life. Breast Cancer Treatment and Research.
Ganz, P. A., Day,R., Ware, J. E., Redmond, C., & Fisher, B. (in press).
Baseline quality of life assessment in the National Surgical Adjuvant
Breast and Bowel Project (NSABP) Breast Cancer Prevention Trial.
Journal of the National Cancer Institute.
Garratt, A.M., MacDonald, L.M., Ruta, D.A., Russell, I. T., Buckingham,
J. K., & Krukowski, Z. H. (1993). Towards measurement of outcome
for
K. patients with varicose veins. Quality in Health Care, 2, 5-10.
Garratt, A.M., Ruta, D.A., Abdalla, M.I., Buckingham, J.K., & Russell, I.T.
(1993). The SF 36 health survey questionnaire: An outcome measure
suitable for routine use within the NHS? British Medical Journal,
306,
1440-1444.
Garratt, A. M., Ruta, D. A., Abdalla, M. I., & Russell, I. T. (1994). SF 36
health survey questionnaire: II. Responsiveness to changes in health
status in four common clinical conditions. Quality in Health Care,
3,
186-192.
Gliklich, R. E., & Hilinski, J. M. (1995). Longitudinal sensitivity of
generic and specific health measures in chronic sinusitis. Quality
of Life Research, 4, 27-32.
Haley, S.M., McHorney, C.A., and Ware, J.E. (1994). Evaluation
of the MOS SF-36 Physical Functioning scale (PF-10):
I. Unidimensionality and reproducibility of the Rasch item scale.
Journal of Clinical Epidemiology, 47, 671-684.
Hays, R. D., Kravitz, R. L., Mazel, R. B., Sherbourne, C. D., DiMatteo, M.
R.,
Rogers, W. H., & Greenfield, S. (1994). The impact of patient
adherence on

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health outcomes for chronic disease patients in the Medical

Outcomes
Study. Journal of Behavioral Medicine, 17, 347-358.
Hays, R. D., Marshall, G. N., Wang, E. Y. I., & Sherbourne, C. D. (1994).
Four-year cross-lagged associations between physical and mental
health in
the Medical Outcomes Study. Journal of Consulting and Clinical
Psychology, 62, 441-449.
Hays, R. D., & Shapiro, M. F. (1992). An overview of generic healthrelated
quality of life measures for HIV research. Quality of Life Research,
1, 91-97
Hays, R.D., Sherbourne, C.D., & Mazel, R.M. (1993). The RAND 36item
health survey 1.0. Health Economics, 2, 217-227.
Hays, R. D., Stewart, A. L., Sherbourne, C. D., & Marshall, G. N. (1993).
The states versus weights dilemma in quality of life measurement.
Quality of Life Research, 2, 167-168.
Hays, R. D., Wells, K.B., Sherbourne, C. B., Rogers, W. H., & Spritzer, K.
(1995). Functioning and well-being outcomes of patients with
depression compared to chronic medical illness. Archives of
General Psychiatry, 52, 11-19
Hill, S., Harries, U., & Popay, J. (1995). Is the short form 36 (SF-36)
suitable for routine health outcomes assessment in health care for
older people? Evidence from preliminary work in community based
health
services in England. Journal of Epidemiology and Community
Health,
50, 94-98.
Hornbrook, M. C., & Goodman, M. J. (1995). Assessing relative health
plan risk with the RAND-36 Health Survey. Inquiry, 32, 56-74.
Hueston, W. J., Mainous, A. G., & Schilling, R. (1996). Patients
with personality disorders: Functional status, health care utilization,
and satisfaction with care. Journal of Family Practice, 42, 54-60.
Hunt, S. M., & McKenna, S. P. (1993). Measuring patients views of
their
health: SF 36 misses the mark. British Medical Journal, 307, 125.
Jenkinson, C., Coulter, A., & Wright, L. (1993). Short form 36 (SF 36)
health survey questionnaire: Normative data for adults of working
age. British Medical Journal, 306, 1437-1440.
Jenkinson, C., Lawrence, K., McWhinnie, D., & Gordon, J. (1995).
Sensitivity to change of health status measures in a randomized
controlled trial: Comparison of the COOP charts and the SF-36.
Quality of Life Research, 4, 47-52.
Jenkinson, C., Peto, V., & Coulter, A. (1994). Measuring change
over time: A comparison of results from a global single item of

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10

health status and the multi-dimensional SF-36 health status survey

questionnaire in patients presenting with menorrhagia. Quality
of Life Research, 3, 317-321.
Jenkinson, C., Peto, V., & Coulter, A. (1996). Making sense of
ambiguity:
Evaluation of internal reliability and face validity of the SF 36
questionnaire in women presenting with menorrhagia. Quality in
Health
Care, 5, 9-12.
Jenkinson, C., and Wright, L. (1993). The SF-36 health survey
questionnaire. Auditorium, 2, 7-12.
Jenkinson, C. Wright, L., & Coulter, A. (1994). Criterion validity and
reliability of the SF-36 in a population sample. Quality of Life
Research, 3, 7-12.
Johnson, P. A., Goldman, L., Orav, E. J., Garcia, T., Pearson, S. D.,
& Lee, T. H. (1995). Comparison of the Medical Outcomes Study
Short-form 36-Item Health Survey in black patients and white
patients
with acute chest pain. Medical Care, 33, 145-160.
Julious, S. A., George, S., & Campbell, M. J. (1995). Sample sizes
for studies using the short form 36 (SF-36). Journal of
Epidemiology
and Community Health, 49, 642-644.
Kantz, M.E., Morris, W.J. , Levitsky, K., Ware, J.E. and Davies, A.R.
(1992).
Methods for assessing condition-specific and generic functional
status outcomes after total knee replacement. Medical Care, 30,
MS240-MS252.
Katz, J.N., Larson, M.G., Phillips, C.B., Fossel, A.H., and H Liang, M.H.
(1992). Comparative measurement sensitivity of short and longer
health status instruments. Medical Care, 30, 917-925.
Kurtin, P.S., Davies, A.R., Meyer, K.B., DeGiacomo, J.M., & Kantz, M.E.
(1992). Patient-based health status measures in outpatient dialysis:
Early experience in developing an outcomes assessment program.
Medical Care, 30, MS136-149; 1992.
Lancaster, T.R, Singer, D.E., Sheehan, M.A., Oertel, L.B., Maraventano,
S.W., Hughes, R.A., & Kistler, J.P. (1991). The impact of long-term
Warfarin therapy on quality of life: Evidence from a randomized trial.
Archives of Internal Medicine, 151, 1944-1949.
Lansky, D., Butler, J.B.V., & Waller, F.T. (1992). Using health status
measures in the hospital setting: From acute care to "outcomes
management". Medical Care, 30, MS57-MS73.
Levin, N.W., Lazarus, J.M., & Nissenson, A.R. (1993). National
cooperative rHu erthropoletin study in patients with chronic renal
failure - an interim report. American Journal of Kidney Disease,
22

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11

(2, Suppl 1), 3-12.

Litwin, M., Hays, R. D., Fink, A., Ganz, P. A., Leake, B., Leach, G. E.,
& Brook, R. H. (1995). Quality of life outcomes in men treated for
localized prostate cancer. Journal of the American Medical
Association, 273, 129-135.
Lubeck, D.P, & Fries, J.F. (1993). Health status among persons
infected with human immunodeficiency virus: A community-based
study. Medical Care, 31, 269-276.
Lyons, R. A., Perry, H. M., & Littlepage, B. N. (1994). Evidence for
the validity of the Short-Form 36 Questionnaire (SF-36) in an
elderly population. Age and Aging, 23, 182-184.
Mangione, C. M. Phillips, R. S., Lawrence, M. G., Seddon, J. M., Orav, J.,
& Goldman, L. (1994). Improved visual function and attenuation
of declines in health-related quality of life after cataract
extraction. Archives of Opthalmology, 112, 1419-1425.
Martin, C., Marquis, P., & Bonfils, S. (1994). A "quality of life
questionnaire" adapted to duodenal ulcer therapeutic trials.
Scandinavian Journal of Gastroenterology, 29, 40-43.
Mathias, S. D., Fifer, S. K., Mazonson, P. D., Lubeck, D. P.,
Buesching, D. P., & Patrick, D. L. (1994). Necessary but not
sufficient: The effect of screening and feedback on outcomes of
primary care patients with untreated anxiety. Journal of
General Internal Medicine, 9, 606-615.
McCallum, J. (1995). The SF-36 in an Australian sample: Validating
a new generic health status measure. Australian Journal of
Public Health, 19, 160-166.
McHorney, C.A., Kosinski, M., & Ware, J.E. (1994). Comparisons
of the costs and quality of norms for the SF-36 health survey
collected by mail versus telephone interview: Results from a national
survey. Medical Care, 32, 551-567.
McHorney, C. A., & Ware, J. E. (1995). Construction and validation of
an alternate form general mental health scale for the Medical
Outcomes Study short-form health survey. Medical Care, 33, 15-28.
McHorney, C.A., Ware, J.E., Lu, J.F.R., & Sherbourne, C.D. (1994).
The MOS 36-item short-form health survey (SF-36): III. Tests of data
quality, scaling assumptions, and validity among diverse patient
groups. Medical Care, 32, 40-66.
McHorney, C.A., Ware, J.E., & Raczek, A.E. (1993). The MOS 36item short-form health survey (SF-36): II. Psychometric and clinical
tests of validity in measuring physical and mental health constructs.
Medical Care, 31, 247-263.
McHorney, C.A., Ware, J.E., Rogers, W., Raczek, A.E., & Lu, J.F.R.
(1992). The validity and relative precision of MOS Short- and LongForm Health Status Scales and Dartmouth COOP Charts. Medical
Care,
30, MS253-265.

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12

Meyer, K.B., Espindle, D.M., DeGiacomo, J.M., Jenuleson, C.S., Kurtin,

P.S.,
& Davies, A.R. (1994). Monitoring dialysis patients' health status.
American Journal of Kidney Diseases, 24, 267-279.
Nerenz, D.R., Repasky, D.P., Whitehouse, F.W., & Kahkonen, D.M. (1992)
Ongoing assessment of health status in patients with diabetes
mellitus.
Medical Care, 30, MS112-MS124.
Paterson, C. (1996). Measuring outcomes in primary care: A patient
generated measure, MYMOP, compared with the SF-36 health survey.
British Medical Journal, 312, 1016-1020.
Perneger, T., Allaz, A. Etter, J, & Rougemont A. (1995). Mental health
and
choice between managed care and indemnity health insurance.
American Journal of Psychiatry, 152, 1020-1025.
Perneger TV, Etter JF, & Rougemont A. (1996). Switching Swiss
enrollees
from indemnity health insurance to managed care: The effect on
health
status and satisfaction with care. American Journal of Public
Health,
86, 388-393.
Perneger, T., LePlege A., Etter J., & Rougemont A. (1995) Validation of
a
French-language version of the MOS 36-Item Short Form Health
Survey
(SF-36) in young healthy adults. Journal of Clinical Epidemiology,
48,
1051-1060.
Phillips, R.C., & Lansky, D.J. (1992). Outcomes management in heart
valve replacement surgery: Early experience. Journal of Heart
Valve
Disease, 1, 42-50.
Rampal, P., Martin, C., Marquis, P., Ware, J. E., & Bonfils, S.
(1994). A quality of life study in five hundred and eighty-one
duodenal ulcer patients. Scandanavian Journal of
Gastroenterology,
29, 44-51.
Reuben, D.B., Valle, L.A., Hays, R.D., & Siu A.L. (1995). Measuring
physical function in community-dwelling older persons: a comparison
of
self-administered, interviewer-administered, and performance-based
measures. Journal of the American Geriatric Society, 43, 17-23.
Ruta, D. A., Abdalla, M. I., Garratt, A. M., Coutts, A., & Russell, I. T.
(1994). SF 36 health survey questionnaire: I. Reliability in two
patient based studies. Quality in Health Care, 3, 180-185.

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13

Ruta, D. A., Garratt, A. M., Chadha, Y. C., Flett, G. M., Hall, M. H.,
& Russell, I. T. (1995). Assessment of patients with menorrhagia:
How valid is a structured clinical history as a measure of health
status? Quality of Life Research, 4, 33-40.
Ruta, D. A., Garratt, A.M., Leng, M., Russell, I.T., & MacDonald, L.M.
(1994). A new approach to the measurement of quality of life: The
patient-generated index. Medical Care, 32, 1109-1126.
Ryan, C. F., & White, J. M. (1996). Health status at entry to
methadone maintenance treatment using the SF-36 health survey
questionnaire. Addiction, 91, 39-45.
Sherbourne, C. D., Hays, R. D., & Wells, K. B. (1995). Personal and
psychosocial risk factors for physical and mental health outcomes
and
course of depression among depressed patients. Journal of
Consulting and Clinical Psychology, 63, 345-355.
Sherbourne, C.D., Wells, K.B., & Judd, L.L. (1996). Functioning and
well-being of patients with panic disorder. American Journal of
Psychiatry, 153, 213-218.
Sherbourne, C.D., Wells, K.B., Meredith, L.S., Jackson, C.A., & Camp, P.
(in press). Comorbid anxiety disorder and the functioning and wellbeing
of chronically ill patients of general medical providers. Archives of
General Psychiatry.
Stewart, A. L., Sherbourne, C. D., Hays, R. D., Wells, K. B., Nelson, E.
C.,
Kamberg, C. J., Rogers, W. H., Berry, S. D., & Ware, J. E. (1992).
Summary
and discussion of MOS measures. In A. L. Stewart & J. E. Ware (eds.),
Measuring functioning and well-being: The Medical Outcomes
Study
approach. (pp. 345-371). Durham, NC: Duke University Press.
Sullivan, M., Karlsson, J., & Ware, J.E. (1994). The Swedish SF-36
health survey: I. Evaluation of data quality, scaling assumptions,
reliability, and construct validity across several populations. Social
Science and Medicine, 41, 1349-1358.
van Tulder, M.W., Aaronson, N.K., & Bruning, P.F. (1994). The quality
of life of long-term survivors of Hodgkin's disease. Annals of
Oncology, 5, 152-158.
Vickrey, B.G., Hays, R.D., Graber, J., Rausch, R., Engel, J., & Brook, R.H.
(1992). A health-related quality of life instrument for patients
evaluated for epilepsy surgery. Medical Care, 30, 299-319.
Vickrey, B. G., Hays, R. D., Rausch, R., Sutherling, W. W., Engel, J., &
Brook, R. H. (1994). Quality of life of epilepsy surgery patients
compared
with outpatients with hypertension, diabetes, heart disease, and/or
depressive symptoms. Epilepsia, 35, 597-607.

07/01/96 9:46 AM

14

Wagner, A. K., Keller, S. D., Kosinski, M., Baker, G. A., Jacoby, A.,
Hsu, M., Chadwick, D. W., & Ware, J. E. (1995). Advances in
methods for assessing the impact of epilepsy and antiepileptic
drug therapy on patients' health-related quality of life. Quality
of Life Research, 4, 115-134.
Ware, J.E. (1993). Measuring patients' views: The optimum
outcome measure: SF 36: a valid, reliable assessment of health
from
the patient's point of view. British Medical Journal, 306, 14291444.
Ware, J. E., Gandek, B., & the IQOLA Project Group. (1994). The SF-36
Health Survey: Development and use in mental health research and
the
IQOLA project. International Journal of Mental Health, 23, 4973.
Ware, J. E., Keller, S. D., Gandek, B., Brazier, J. E., Sullivan, M.,
& The IQOLA Project Group. (1995). Evaluating translations of
health status questionnaires: Methods from the IQOLA Project.
International Journal of Technology Assessment in Health
Care,
11, 525-551.
Ware, J.E., Kosinski, M., Bayliss, M.S., McHorney, C. A., Rogers, W. H.,
& Raczek, A. (1995). Comparison of methods for the scoring and
statistical analysis of SF-36 health profile and summary measures:
Summary of results from the Medical Outcomes Study. Medical
Care,
33, AS264-AS279.
Ware, J. E., Kosinski, M., & Keller, S. D. (1995). SF-12: How to score
the SF-12 physical and mental health summary scores.
Boston, MA:
The Health Institute, New England Medical Center.
Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 physical and
mental health summary scales: A Users Manual. Boston, MA:
The
Health Institue, New England Medical Center.
Ware, J.E., Kosinski, M., & Keller, S. D. (1996). A 12-item
short-form health survey: Construction of scales and preliminary
tests of reliability and validity. Medical Care, 34, 220-233.
Ware, J.E., and Sherbourne, C.D. (1992). The MOS 36-item shortform health survey (SF-36): I. Conceptual framework and item
selection. Medical Care, 30, 473-483.
Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36
Health
Survey: Manual and interpretation guide. Boston: The Health
Institute.
Weinberger M, Kirkman MS, Samsa GP, Cowper PA, Shortliffe EA,

07/01/96 9:46 AM

15

Simel DL, & Feussner JR. (1994). The relationship between glycemic
control and health-related quality of life in patients with non-insulin
dependent diabetes mellitus. Medical Care, 32, 1173-1181.
Weinberger, M., Nagle, B., Hanlon, J. T., Samsa, G. P., Schmader, K.,
Landsman, P. B., Uttech, K. M., Cowper, P. A., Cohen, H. J., &
Feussner, J. R. (1994). Assessing health-related quality of life
in elderly outpatients: Telephone versus face-to-face administration.
Journal of the American Geriatric Society, 42, 1295-1299.
Weinberger, M., Samsa, G.P., Hanlon, J.T., Schmader, K., Doyle, M.E.,
Cowper, P.A., Uttech, K.M., Cohen, H.J., & Feussner, J.R. (1991). An
evaluation of a brief health status measure in elderly veterans.
Journal
of the American Geriatrics Society, 39, 691-694.
Wells, K.B., Burnam, M.A., Rogers, W., Hays, R., & Camp, P. (1992).
The
course of depression in adult outpatients: Results from the Medical
Outcomes Study. Archives of General Psychiatry, 49, 788-794.
Wolinsky, F. D., & Stump, T. E. (1996). A measurement model of the
Medical Outcomes Study 36-item short-form health survey in a
clinical
sample of disadvantaged, older, black, and white men and women.
Medical Care, 34, 537-548.
Ziebland S. (1995). The short form 36 health status questionnaire:
Clues
from the Oxford region's normative data about its usefulness in
measuring
health gain in population surveys. Journal of Epidemiology and
Community Health, 49, 102-105.

07/01/96 9:46 AM

16

Table 1
STEP 1: RECODING ITEMS
ITEM NUMBERS

Change original response category

(a)
---------------------------------------------------

To recoded value of:

1,2,20,22,34,36

1
2
3
4
5

>
>
>
>
>

100
75
50
25
0

3,4,5,6,7,8,9,10,11,12

1 ----------- >
2 ----------- >
3 ----------- >

0
50
100

13,14,15,16,17,18,19

1 ----------- >
2 ----------- >

0
100

21,23,26,27,30

1
2
3
4
5
6

----------- >
----------- >
----------- >
----------- >
----------- >
----------- >

100
80
60
40
20
0

24,25,28,29,31

1
2
3
4
5
6

----------- >
----------- >
----------- >
----------- >
----------- >
----------- >

0
20
40
60
80
100

32,33,35

1
2
3
4
5

----------- >
----------- >
----------- >
----------- >
----------- >

0
25
50
75
100

(a) Precoded response choices as printed in the questionnaire.

07/01/96 9:46 AM

17

Table 2
STEP 2: AVERAGING ITEMS TO FORM SCALES

Scale

Physical functioning

Number Of

10

After Recoding Per Table 1,

Average The
Following
Items:
3 4 5 6 7 8 9 10 11 12

Role limitations due to physical health

13 14 15 16

Role limitations due to emotional

problems

17 18 19

Energy/fatigue

23 27 29 31

Emotional well-being

24 25 26 28 30

Social functioning

20 32

Pain

21 22

General health

1 33 34 35 36

07/01/96 9:46 AM

18

Table 3
RELIABILITY, CENTRAL TENDENCY AND VARIABILITY OF SCALES
IN THE MEDICAL OUTCOMES STUDY
Scale

Items

Alpha

Mean

SD

10

0.93

70.61

27.42

Role Functioning/physical

0.84

52.97

40.78

Role Functioning/emotional

0.83

65.78

40.71

Energy/fatigue

0.86

52.15

22.39

Emotional well-being

0.90

70.38

21.97

Social functioning

0.85

78.77

25.43

Pain

0.78

70.77

25.46

General Health

0.78

56.99

21.11

Health Change

59.14

23.12

Physical Functioning

Note. Data is from baseline of the Medical Outcomes Study (N = 2471), except for
Health change, which was obtained one-year later.

07/01/96 9:46 AM

19

Table 4
EXAMPLE INPUT FILE (sf36.in) For SF36.EXE
I1
I2
I3
I4
I5
I6
I7
I8
I9
I10
I11
I12
I13
I14
I15
I16
I17
I18
I19
I20
I21
I22
I23
I24
I25
I26
I27
I28
I29
I30
I31
I32
I33
I34
I35
I36

07/01/96 9:46 AM

20

Table 5
EXAMPLE INPUT FILE (sf36.in2) For sf36.exe
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
T13
T14
T15
T16
T17
T18
T19
T20
T21
T22
T23
T24
T25
T26
T27
T28
T29
T30
T31
T32
T33
T34
T35
T36

07/01/96 9:46 AM

21

Table 6
EXAMPLE sf36.sas FILE Produced By sf36.exe
DATA TEMP1;
SET TEMP;
RENAME
T1=I1
T2=I2
T3=I3
T4=I4
T5=I5
T6=I6
T7=I7
T8=I8
T9=I9
T10=I10
T11=I11
T12=I12
T13=I13
T14=I14
T15=I15
T16=I16
T17=I17
T18=I18
T19=I19
T20=I20
T21=I21
T22=I22
T23=I23
T24=I24
T25=I25
T26=I26
T27=I27
T28=I28
T29=I29
T30=I30
T31=I31

07/01/96 9:46 AM
T32=I32
T33=I33
T34=I34
T35=I35
T36=I36;RUN;
*****************************************************************;
DATA TEMP1;SET TEMP1;
ARRAY RFIVEPT (I) I1 I2 I20 I22 I34 I36;
ARRAY THREEPT (I) I3 I4 I5 I6 I7 I8 I9 I10 I11 I12;
ARRAY TWOPT (I) I13 I14 I15 I16 I17 I18 I19;
ARRAY RSIXPT (I) I21 I23 I26 I27 I30;
ARRAY SIXPT (I) I24 I25 I28 I29 I31;
ARRAY FIVEPT (I) I32 I33 I35;
*****************************************************************;
I1SF=I1;I21SF=I21;I22SF=I22;
DO OVER RFIVEPT;
IF RFIVEPT=1 THEN RFIVEPT=100;
ELSE IF RFIVEPT=2 THEN RFIVEPT=75;
ELSE IF RFIVEPT=3 THEN RFIVEPT=50;
ELSE IF RFIVEPT=4 THEN RFIVEPT=25;
ELSE IF RFIVEPT=5 THEN RFIVEPT=0;END;
DO OVER THREEPT;
IF THREEPT=1 THEN THREEPT=0;
ELSE IF THREEPT=2 THEN THREEPT=50;
ELSE IF THREEPT=3 THEN THREEPT=100;END;
DO OVER TWOPT;
IF TWOPT=1 THEN TWOPT=0;
ELSE IF TWOPT=2 THEN TWOPT=100;END;
DO OVER RSIXPT;
IF RSIXPT=1 THEN RSIXPT=100;
ELSE IF RSIXPT=2 THEN RSIXPT=80;
ELSE IF RSIXPT=3 THEN RSIXPT=60;
ELSE IF RSIXPT=4 THEN RSIXPT=40;
ELSE IF RSIXPT=5 THEN RSIXPT=20;
ELSE IF RSIXPT=6 THEN RSIXPT=0;END;
DO OVER SIXPT;

22

07/01/96 9:46 AM
IF SIXPT=1 THEN SIXPT=0;
ELSE IF SIXPT=2 THEN SIXPT=20;
ELSE IF SIXPT=3 THEN SIXPT=40;
ELSE IF SIXPT=4 THEN SIXPT=60;
ELSE IF SIXPT=5 THEN SIXPT=80;
ELSE IF SIXPT=6 THEN SIXPT=100;END;
DO OVER FIVEPT;
IF FIVEPT=1 THEN FIVEPT=0;
ELSE IF FIVEPT=2 THEN FIVEPT=25;
ELSE IF FIVEPT=3 THEN FIVEPT=50;
ELSE IF FIVEPT=4 THEN FIVEPT=75;
ELSE IF FIVEPT=5 THEN FIVEPT=100;END;
*****************************************************************;
IF I1SF=1 THEN I1SF=5.0;
ELSE IF I1SF=2 THEN I1SF=4.4;
ELSE IF I1SF=3 THEN I1SF=3.4;
ELSE IF I1SF=4 THEN I1SF=2.0;
ELSE IF I1SF=5 THEN I1SF=1.0;
I1SF=(I1SF-1)*25;

23

07/01/96 9:46 AM

IF I21SF>.Z AND I22SF>.Z THEN DO;

IF I22SF=1 AND I21SF=1 THEN I22SF=6;
ELSE IF I22SF=1 AND 7>I21SF>1 THEN I22SF=5;
ELSE IF I22SF=2 AND 7>I21SF>0 THEN I22SF=4;
ELSE IF I22SF=3 AND 7>I21SF>0 THEN I22SF=3;
ELSE IF I22SF=4 AND 7>I21SF>0 THEN I22SF=2;
ELSE IF I22SF=5 AND 7>I21SF>0 THEN I22SF=1;END;
IF I21SF<=.Z AND I22SF>.Z THEN DO;
IF I22SF=1 THEN I22SF=6.0;
ELSE IF I22SF=2 THEN I22SF=4.75;
ELSE IF I22SF=3 THEN I22SF=3.5;
ELSE IF I22SF=4 THEN I22SF=2.25;
ELSE IF I22SF=5 THEN I22SF=1.0;END;
IF I21SF=1 THEN I21SF=6.0;
ELSE IF I21SF=2 THEN I21SF=5.4;
ELSE IF I21SF=3 THEN I21SF=4.2;
ELSE IF I21SF=4 THEN I21SF=3.1;
ELSE IF I21SF=5 THEN I21SF=2.2;
ELSE IF I21SF=6 THEN I21SF=1.0;
I21SF=(I21SF-1)*20;I22SF=(I22SF-1)*20;
***************************************************;
PHYFUN10=MEAN(I3,I4,I5,I6,I7,I8,I9,I10,I11,I12);
ROLEP4=MEAN(I13,I14,I15,I16);
PAIN2=MEAN(I21,I22);SFPAIN=MEAN(I21SF,I22SF);
GENH5=MEAN(I1,I33,I34,I35,I36);
SFGENH5=MEAN(I1SF,I33,I34,I35,I36);
EMOT5=MEAN(I24,I25,I26,I28,I30);
ROLEE3=MEAN(I17,I18,I19);
SOCFUN2=MEAN(I20,I32);
ENFAT4=MEAN(I23,I27,I29,I31);RUN;
****************************************************;

24

07/01/96 9:46 AM

DATA TEMP2;
SET TEMP1;
IF 18<=AGE AND MALE>=0 THEN DO;
SFAGE1=0;SFAGE2=0;SFAGE3=0;SFAGE4=0;SFAGE5=0;
SFAGE6=0;SFAGE7=0;SFAGE8=0;SFAGE9=0;
SFAGE10=0;SFAGE11=0;SFAGE12=0;
END;
IF 18<=AGE<=24 AND MALE=1 THEN SFAGE1=1;
IF 24<AGE<=34 AND MALE=1 THEN SFAGE2=1;
IF 34<AGE<=44 AND MALE=1 THEN SFAGE3=1;
IF 44<AGE<=54 AND MALE=1 THEN SFAGE4=1;
IF 54<AGE<=64 AND MALE=1 THEN SFAGE5=1;
IF 64<AGE AND MALE=1 THEN SFAGE6=1;
IF 18<=AGE<=24 AND MALE=0 THEN SFAGE7=1;
IF 24<AGE<=34 AND MALE=0 THEN SFAGE8=1;
IF 34<AGE<=44 AND MALE=0 THEN SFAGE9=1;
IF 44<AGE<=54 AND MALE=0 THEN SFAGE10=1;
IF 54<AGE<=64 AND MALE=0 THEN SFAGE11=1;
IF 64<AGE AND MALE=0 THEN SFAGE12=1;
*********************************************************;
DATA GENPOP;
INFILE 'sf36.raw' MISSOVER;INPUT
#1 PF1 1-5
PF2

6-10

PF3 11-15
PF4 16-20
PF5 21-25
PF6 26-30
PF7 31-35
PF8 36-40
PF9 41-45
PF10 46-50
PF11 51-55
PF12 56-60
#2 PF1S 1-5
PF2S 6-10

25

07/01/96 9:46 AM
PF3S 11-15
PF4S 16-20
PF5S 21-25
PF6S 26-30
PF7S 31-35
PF8S 36-40
PF9S 41-45
PF10S 46-50
PF11S 51-55
PF12S 56-60
#3 RP1 1-5
RP2

6-10

RP3 11-15
RP4 16-20
RP5 21-25
RP6 26-30
RP7 31-35
RP8 36-40
RP9 41-45
RP10 46-50
RP11 51-55
RP12 56-60
#4 RP1S 1-5
RP2S 6-10
RP3S 11-15
RP4S 16-20
RP5S 21-25
RP6S 26-30
RP7S 31-35
RP8S 36-40
RP9S 41-45
RP10S 46-50
RP11S 51-55
RP12S 56-60
#5 BP1 1-5
BP2

6-10

26

07/01/96 9:46 AM
BP3 11-15
BP4 16-20
BP5 21-25
BP6 26-30
BP7 31-35
BP8 36-40
BP9 41-45
BP10 46-50
BP11 51-55
BP12 56-60
#6 BP1S 1-5
BP2S 6-10
BP3S 11-15
BP4S 16-20
BP5S 21-25
BP6S 26-30
BP7S 31-35
BP8S 36-40
BP9S 41-45
BP10S 46-50
BP11S 51-55
BP12S 56-60
#7 GEN1 1-5
GEN2

6-10

GEN3 11-15
GEN4 16-20
GEN5 21-25
GEN6 26-30
GEN7 31-35
GEN8 36-40
GEN9 41-45
GEN10 46-50
GEN11 51-55
GEN12 56-60
#8 GEN1S 1-5
GEN2S 6-10

27

07/01/96 9:46 AM
GEN3S 11-15
GEN4S 16-20
GEN5S 21-25
GEN6S 26-30
GEN7S 31-35
GEN8S 36-40
GEN9S 41-45
GEN10S 46-50
GEN11S 51-55
GEN12S 56-60
#9 ENFT1 1-5
ENFT2

6-10

ENFT3 11-15
ENFT4 16-20
ENFT5 21-25
ENFT6 26-30
ENFT7 31-35
ENFT8 36-40
ENFT9 41-45
ENFT10 46-50
ENFT11 51-55
ENFT12 56-60
#10 ENFT1S 1-5
ENFT2S 6-10
ENFT3S 11-15
ENFT4S 16-20
ENFT5S 21-25
ENFT6S 26-30
ENFT7S 31-35
ENFT8S 36-40
ENFT9S 41-45
ENFT10S 46-50
ENFT11S 51-55
ENFT12S 56-60
#11SF1
SF2

1-5

6-10

28

07/01/96 9:46 AM
SF3 11-15
SF4 16-20
SF5 21-25
SF6 26-30
SF7 31-35
SF8 36-40
SF9 41-45
SF10 46-50
SF11 51-55
SF12 56-60
#12 SF1S 1-5
SF2S 6-10
SF3S 11-15
SF4S 16-20
SF5S 21-25
SF6S 26-30
SF7S 31-35
SF8S 36-40
SF9S 41-45
SF10S 46-50
SF11S 51-55
SF12S 56-60
#13
RE1

1-5

RE2

6-10

RE3 11-15
RE4 16-20
RE5 21-25
RE6 26-30
RE7 31-35
RE8 36-40
RE9 41-45
RE10 46-50
RE11 51-55
RE12 56-60
#14

29

07/01/96 9:46 AM
RE1S

1-5

RE2S 6-10
RE3S 11-15
RE4S 16-20
RE5S 21-25
RE6S 26-30
RE7S 31-35
RE8S 36-40
RE9S 41-45
RE10S 46-50
RE11S 51-55
RE12S 56-60
#15
MH1

1-5

MH2

6-10

MH3 11-15
MH4 16-20
MH5 21-25
MH6 26-30
MH7 31-35
MH8 36-40
MH9 41-45
MH10 46-50
MH11 51-55
MH12 56-60
#16
MH1S

1-5

MH2S 6-10
MH3S 11-15
MH4S 16-20
MH5S 21-25
MH6S 26-30
MH7S 31-35
MH8S 36-40
MH9S 41-45
MH10S 46-50

30

07/01/96 9:46 AM
MH11S 51-55
MH12S 56-60 ;RUN;
*****************************;

31

07/01/96 9:46 AM

DATA TEST;
IF _N_=1 THEN SET GENPOP;
SET TEMP2;
PFISFM=(SFAGE1*PF1)+ (SFAGE2*PF2)+ (SFAGE3*PF3)+
(SFAGE4*PF4)+ (SFAGE5*PF5)+ (SFAGE6*PF6)+
(SFAGE7*PF7)+ (SFAGE8*PF8)+ (SFAGE9*PF9)+
(SFAGE10*PF10)+ (SFAGE11*PF11)+ (SFAGE12*PF12);
IF SFAGE1=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF1S;
ELSE IF SFAGE2=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF2S;
ELSE IF SFAGE3=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF3S;
ELSE IF SFAGE4=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF4S;
ELSE IF SFAGE5=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF5S;
ELSE IF SFAGE6=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF6S;
ELSE IF SFAGE7=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF7S;
ELSE IF SFAGE8=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF8S;
ELSE IF SFAGE9=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF9S;
ELSE IF SFAGE10=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF10S;
ELSE IF SFAGE11=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF11S;
ELSE IF SFAGE12=1 THEN ZPHY10=(PHYFUN10-PFISFM)/PF12S;
RPSFM=(SFAGE1*RP1)+(SFAGE2*RP2)+(SFAGE3*RP3)+
(SFAGE4*RP4)+ (SFAGE5*RP5)+ (SFAGE6*RP6)+
(SFAGE7*RP7)+ (SFAGE8*RP8)+ (SFAGE9*RP9)+
(SFAGE10*RP10)+ (SFAGE11*RP11)+ (SFAGE12*RP12);
IF SFAGE1=1 THEN ZRP=(ROLEP4-RPSFM)/RP1S;
ELSE IF SFAGE2=1 THEN ZRP=(ROLEP4-RPSFM)/RP2S;
ELSE IF SFAGE3=1 THEN ZRP=(ROLEP4-RPSFM)/RP3S;
ELSE IF SFAGE4=1 THEN ZRP=(ROLEP4-RPSFM)/RP4S;
ELSE IF SFAGE5=1 THEN ZRP=(ROLEP4-RPSFM)/RP5S;
ELSE IF SFAGE6=1 THEN ZRP=(ROLEP4-RPSFM)/RP6S;
ELSE IF SFAGE7=1 THEN ZRP=(ROLEP4-RPSFM)/RP7S;
ELSE IF SFAGE8=1 THEN ZRP=(ROLEP4-RPSFM)/RP8S;
ELSE IF SFAGE9=1 THEN ZRP=(ROLEP4-RPSFM)/RP9S;
ELSE IF SFAGE10=1 THEN ZRP=(ROLEP4-RPSFM)/RP10S;
ELSE IF SFAGE11=1 THEN ZRP=(ROLEP4-RPSFM)/RP11S;
ELSE IF SFAGE12=1 THEN ZRP=(ROLEP4-RPSFM)/RP12S;
BPSFM=(SFAGE1*BP1)+(SFAGE2*BP2)+(SFAGE3*BP3)+

32

07/01/96 9:46 AM
(SFAGE4*BP4)+ (SFAGE5*BP5)+ (SFAGE6*BP6)+
(SFAGE7*BP7)+ (SFAGE8*BP8)+ (SFAGE9*BP9)+
(SFAGE10*BP10)+ (SFAGE11*BP11)+ (SFAGE12*BP12);
IF SFAGE1=1 THEN ZBP=(SFPAIN-BPSFM)/BP1S;
ELSE IF SFAGE2=1 THEN ZBP=(SFPAIN-BPSFM)/BP2S;
ELSE IF SFAGE3=1 THEN ZBP=(SFPAIN-BPSFM)/BP3S;
ELSE IF SFAGE4=1 THEN ZBP=(SFPAIN-BPSFM)/BP4S;
ELSE IF SFAGE5=1 THEN ZBP=(SFPAIN-BPSFM)/BP5S;
ELSE IF SFAGE6=1 THEN ZBP=(SFPAIN-BPSFM)/BP6S;
ELSE IF SFAGE7=1 THEN ZBP=(SFPAIN-BPSFM)/BP7S;
ELSE IF SFAGE8=1 THEN ZBP=(SFPAIN-BPSFM)/BP8S;
ELSE IF SFAGE9=1 THEN ZBP=(SFPAIN-BPSFM)/BP9S;
ELSE IF SFAGE10=1 THEN ZBP=(SFPAIN-BPSFM)/BP10S;
ELSE IF SFAGE11=1 THEN ZBP=(SFPAIN-BPSFM)/BP11S;
ELSE IF SFAGE12=1 THEN ZBP=(SFPAIN-BPSFM)/BP12S;
GENSFM=(SFAGE1*GEN1)+(SFAGE2*GEN2)+(SFAGE3*GEN3)+
(SFAGE4*GEN4)+ (SFAGE5*GEN5)+ (SFAGE6*GEN6)+
(SFAGE7*GEN7)+ (SFAGE8*GEN8)+ (SFAGE9*GEN9)+
(SFAGE10*GEN10)+ (SFAGE11*GEN11)+ (SFAGE12*GEN12);
IF SFAGE1=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN1S;
ELSE IF SFAGE2=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN2S;
ELSE IF SFAGE3=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN3S;
ELSE IF SFAGE4=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN4S;
ELSE IF SFAGE5=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN5S;
ELSE IF SFAGE6=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN6S;
ELSE IF SFAGE7=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN7S;
ELSE IF SFAGE8=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN8S;
ELSE IF SFAGE9=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN9S;
ELSE IF SFAGE10=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN10S;
ELSE IF SFAGE11=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN11S;
ELSE IF SFAGE12=1 THEN ZGENH=(SFGENH5-GENSFM)/GEN12S;
ENFTSFM=(SFAGE1*ENFT1)+(SFAGE2*ENFT2)+(SFAGE3*ENFT3)+
(SFAGE4*ENFT4)+ (SFAGE5*ENFT5)+ (SFAGE6*ENFT6)+
(SFAGE7*ENFT7)+ (SFAGE8*ENFT8)+ (SFAGE9*ENFT9)+
(SFAGE10*ENFT10)+ (SFAGE11*ENFT11)+ (SFAGE12*ENFT12);
IF SFAGE1=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT1S;

33

07/01/96 9:46 AM
ELSE IF SFAGE2=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT2S;
ELSE IF SFAGE3=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT3S;
ELSE IF SFAGE4=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT4S;
ELSE IF SFAGE5=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT5S;
ELSE IF SFAGE6=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT6S;
ELSE IF SFAGE7=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT7S;
ELSE IF SFAGE8=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT8S;
ELSE IF SFAGE9=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT9S;
ELSE IF SFAGE10=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT10S;
ELSE IF SFAGE11=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT11S;
ELSE IF SFAGE12=1 THEN ZENFT=(ENFAT4-ENFTSFM)/ENFT12S;
SFSFM=(SFAGE1*SF1)+(SFAGE2*SF2)+(SFAGE3*SF3)+
(SFAGE4*SF4)+ (SFAGE5*SF5)+ (SFAGE6*SF6)+
(SFAGE7*SF7)+ (SFAGE8*SF8)+ (SFAGE9*SF9)+
(SFAGE10*SF10)+ (SFAGE11*SF11)+ (SFAGE12*SF12);
IF SFAGE1=1 THEN ZSF=(SOCFUN2-SFSFM)/SF1S;
ELSE IF SFAGE2=1 THEN ZSF=(SOCFUN2-SFSFM)/SF2S;
ELSE IF SFAGE3=1 THEN ZSF=(SOCFUN2-SFSFM)/SF3S;
ELSE IF SFAGE4=1 THEN ZSF=(SOCFUN2-SFSFM)/SF4S;
ELSE IF SFAGE5=1 THEN ZSF=(SOCFUN2-SFSFM)/SF5S;
ELSE IF SFAGE6=1 THEN ZSF=(SOCFUN2-SFSFM)/SF6S;
ELSE IF SFAGE7=1 THEN ZSF=(SOCFUN2-SFSFM)/SF7S;
ELSE IF SFAGE8=1 THEN ZSF=(SOCFUN2-SFSFM)/SF8S;
ELSE IF SFAGE9=1 THEN ZSF=(SOCFUN2-SFSFM)/SF9S;
ELSE IF SFAGE10=1 THEN ZSF=(SOCFUN2-SFSFM)/SF10S;
ELSE IF SFAGE11=1 THEN ZSF=(SOCFUN2-SFSFM)/SF11S;
ELSE IF SFAGE12=1 THEN ZSF=(SOCFUN2-SFSFM)/SF12S;
RESFM=(SFAGE1*RE1)+(SFAGE2*RE2)+(SFAGE3*RE3)+
(SFAGE4*RE4)+ (SFAGE5*RE5)+ (SFAGE6*RE6)+
(SFAGE7*RE7)+ (SFAGE8*RE8)+ (SFAGE9*RE9)+
(SFAGE10*RE10)+ (SFAGE11*RE11)+ (SFAGE12*RE12);
IF SFAGE1=1 THEN ZRE=(ROLEE3-RESFM)/RE1S;
ELSE IF SFAGE2=1 THEN ZRE=(ROLEE3-RESFM)/RE2S;
ELSE IF SFAGE3=1 THEN ZRE=(ROLEE3-RESFM)/RE3S;
ELSE IF SFAGE4=1 THEN ZRE=(ROLEE3-RESFM)/RE4S;
ELSE IF SFAGE5=1 THEN ZRE=(ROLEE3-RESFM)/RE5S;

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ELSE IF SFAGE6=1 THEN ZRE=(ROLEE3-RESFM)/RE6S;
ELSE IF SFAGE7=1 THEN ZRE=(ROLEE3-RESFM)/RE7S;
ELSE IF SFAGE8=1 THEN ZRE=(ROLEE3-RESFM)/RE8S;
ELSE IF SFAGE9=1 THEN ZRE=(ROLEE3-RESFM)/RE9S;
ELSE IF SFAGE10=1 THEN ZRE=(ROLEE3-RESFM)/RE10S;
ELSE IF SFAGE11=1 THEN ZRE=(ROLEE3-RESFM)/RE11S;
ELSE IF SFAGE12=1 THEN ZRE=(ROLEE3-RESFM)/RE12S;
MHSFM=(SFAGE1*MH1)+(SFAGE2*MH2)+(SFAGE3*MH3)+
(SFAGE4*MH4)+ (SFAGE5*MH5)+ (SFAGE6*MH6)+
(SFAGE7*MH7)+ (SFAGE8*MH8)+ (SFAGE9*MH9)+
(SFAGE10*MH10)+ (SFAGE11*MH11)+ (SFAGE12*MH12);
IF SFAGE1=1 THEN ZMHI=(EMOT5-MHSFM)/MH1S;
ELSE IF SFAGE2=1 THEN ZMHI=(EMOT5-MHSFM)/MH2S;
ELSE IF SFAGE3=1 THEN ZMHI=(EMOT5-MHSFM)/MH3S;
ELSE IF SFAGE4=1 THEN ZMHI=(EMOT5-MHSFM)/MH4S;
ELSE IF SFAGE5=1 THEN ZMHI=(EMOT5-MHSFM)/MH5S;
ELSE IF SFAGE6=1 THEN ZMHI=(EMOT5-MHSFM)/MH6S;
ELSE IF SFAGE7=1 THEN ZMHI=(EMOT5-MHSFM)/MH7S;
ELSE IF SFAGE8=1 THEN ZMHI=(EMOT5-MHSFM)/MH8S;
ELSE IF SFAGE9=1 THEN ZMHI=(EMOT5-MHSFM)/MH9S;
ELSE IF SFAGE10=1 THEN ZMHI=(EMOT5-MHSFM)/MH10S;
ELSE IF SFAGE11=1 THEN ZMHI=(EMOT5-MHSFM)/MH11S;
ELSE IF SFAGE12=1 THEN ZMHI=(EMOT5-MHSFM)/MH12S;
IF PHYFUN10=. THEN PFISFM=.;IF PFISFM=. THEN PHYFUN10=.;
IF ROLEP4=. THEN RPSFM=.;IF RPSFM=. THEN ROLEP4=.;
IF PAIN2=. THEN BPSFM=.;IF BPSFM=. THEN PAIN2=.;
IF BPSFM=. THEN SFPAIN=.;
IF GENH5=. THEN GENSFM=.;IF GENSFM=. THEN GENH5=.;
IF GENSFM=. THEN SFGENH5=.;
IF ENFAT4=. THEN ENFTSFM=.;IF ENFTSFM=. THEN ENFAT4=.;
IF SOCFUN2=. THEN SFSFM=.;IF SFSFM=. THEN SOCFUN2=.;
IF ROLEE3=. THEN RESFM=.;IF RESFM=. THEN ROLEE3=.;
IF EMOT5=. THEN MHSFM=.;IF MHSFM=. THEN EMOT5=.;RUN;
*****************************************************;
DATA TEST;SET TEST;RUN;
PROC MEANS;

35

07/01/96 9:46 AM
VAR
PHYFUN10 ROLEP4 PAIN2 SFPAIN GENH5 SFGENH5
EMOT5 ROLEE3 ENFAT4 SOCFUN2;RUN;
PROC MEANS N MEAN;
VAR
PFISFM RPSFM BPSFM GENSFM
MHSFM RESFM ENFTSFM SFSFM;RUN;
*****************************************************;
PROC MEANS T PRT;
VAR ZPHY10 ZRP ZBP ZGENH ZENFT ZSF ZRE ZMHI;RUN;
*****************************************************;
PROC CORR NOMISS ALPHA;VAR
I3 I4 I5 I6 I7 I8 I9 I10 I11 I12;
TITLE 'PHYSICAL FUNCTIONING';RUN;
*****************************************************;
PROC CORR NOMISS ALPHA;VAR
I13 I14 I15 I16;
TITLE 'ROLE LIMITATIONS--PHYSICAL';RUN;
*****************************************************;
PROC CORR NOMISS ALPHA;VAR
I21 I22;
TITLE 'PAIN--RAND SCORING';RUN;
*****************************************************;
PROC CORR NOMISS ALPHA;VAR
I21SF I22SF;
TITLE 'PAIN--NEMC SCORING';RUN;
*****************************************************;
PROC CORR NOMISS ALPHA;VAR
I1 I33 I34 I35 I36;
TITLE 'GENERAL HEALTH--RAND SCORING';RUN;
*****************************************************;

36

07/01/96 9:46 AM

PROC CORR NOMISS ALPHA;VAR

I1SF I33 I34 I35 I36;
TITLE 'GENERAL HEALTH--NEMC SCORING';RUN;
*****************************************************;
PROC CORR NOMISS ALPHA;VAR
I24 I25 I26 I28 I30;
TITLE 'EMOTIONAL WELL-BEING';RUN;
*****************************************************;
PROC CORR NOMISS ALPHA;VAR
I17 I18 I19 ;
TITLE 'ROLE LIMITATIONS--EMOTIONAL';RUN;
*****************************************************;
PROC CORR NOMISS ALPHA;VAR
I20 I32;
TITLE 'SOCIAL FUNCTION';RUN;
*****************************************************;
PROC CORR NOMISS ALPHA;VAR
I23 I27 I29 I31;
TITLE 'ENERGY';RUN;
*****************************************************;

37

07/01/96 9:46 AM

38

Table 7
EXAMPLE SAS Output from sf36.sas FILE
VariableNMeanStdDevMinimumMaximum

PHYFUN1017782.429378520.630043110.0000000100.0000000
ROLEP417790.254237319.41086260100.0000000
PAIN217784.209039517.386280825.0000000100.0000000
SFPAIN17781.124293819.007962720.0000000100.0000000
GENH517773.050847515.356103025.0000000100.0000000
SFGENH517774.542372915.148119527.0000000100.0000000
EMOT517775.570621515.594172720.0000000100.0000000
ROLEE317782.297551829.31015530100.0000000
ENFAT417768.107344616.819726020.0000000100.0000000
SOCFUN217778.954802320.73495330100.0000000

VariableNMean

PFISFM17791.7229944
RPSFM17789.2180226
BPSFM17780.0205650
GENSFM17777.1684746
MHSFM17774.9923164
RESFM17783.2776836
ENFTSFM17763.6044633
SFSFM17786.0232203

VariableTProb>|T|

ZPHY106.05827460.0001
ZRP0.18664980.8522
ZBP0.67505840.5005
ZGENH2.43582390.0159
ZENFT3.58965200.0004
ZSF4.54365980.0001
ZRE0.39984800.6898
ZMHI0.57175410.5682

07/01/96 9:46 AM

VariableNMeanStdDevMinimumMaximum

PHYFUN1018182.513812220.477794910.0000000100.0000000
PF_T18149.12197578.944260517.449501956.7595665
ROLEP418190.193370219.46767010100.0000000
RP_T18152.66124895.760127525.974680255.5628513
SFPAIN18180.977900618.962523220.0000000100.0000000
BP_T18152.32861738.049022626.445326860.4029282
SFGENH518174.243093915.132251027.0000000100.0000000
GH_T18151.00643047.502489427.583556363.7765672
EMOT518175.513812215.570130920.0000000100.0000000
EM_T18150.37291608.644362619.552268063.9673738
ROLEE318181.952117929.70422370100.0000000
RE_T18150.19906278.993874925.385517455.6636188
SOCFUN218179.005524920.61161950100.0000000
SF_T18147.94783749.211312412.640346457.3302476
ENFAT418167.845303916.759685220.0000000100.0000000
EN_T18153.25393518.030738430.327900868.6615009
AGG_PHYS18151.54141566.380391931.226129668.9868203
AGG_MENT18150.11323808.928171815.955009769.6975957

39

07/01/96 9:46 AM

40

APPENDIX: SF-36 QUESTIONNAIRE ITEMS

1.
In general, would you say your health is:
(Circle One Number)
Excellent.....................................
Very good....................................
Good...........................................
Fair..............................................
Poor.............................................
2.

1
2
3
4
5

Compared to one year ago, how would you rate your health in general now?

(Circle One Number)

Much better now than one year ago.............................
Somewhat better now than one year ago.....................
About the same............................................................
Somewhat worse now than one year ago.....................
Much worse now than one year ago.............................

1
2
3
4
5

The following items are about activities you might do during a typical day. Does your health now
limit you in these activities? If so, how much?
(Circle One Number on Each Line)
Yes,
Limited
a Lot
3.

Vigorous activities, such as running, lifting heavy

objects, participating in strenuous sports................

Yes,
Limited
a Little

No,
Not Limited
at All

Moderate activities, such as moving a table, pushing

a vacuum cleaner, bowling, or playing golf..............
1

5.

Lifting or carrying groceries.....................................

6.

Climbing several flights of stairs.............................

7.

Climbing one flight of stairs.....................................

8.

Bending, kneeling, or stooping.................................

9.

Walking more than a mile.....................................

10.

Walking several blocks..........................................

11.

Walking one block..................................................

12.

Bathing or dressing yourself....................................

4.

07/01/96 9:46 AM

41

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 your physical health?
(Circle One Number on Each Line)
Yes

No

Cut down the amount of time you spent on work or

other activities.........................................................

14.

Accomplished less than you would like.................

15.

Were limited in the kind of work or other activities.

16.

Had difficulty performing the work or other activities

(for example, it took extra effort).............................

13.

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)?
(Circle One Number on Each Line)
Yes

No

Cut down the amount of time you spent on

work or other activities.............................................

18.

Accomplished less than you would like.................

19.

Didnt do work or other activities as carefully as usual

20.

During the past 4 weeks, to what extent has your physical health or emotional problems
interfered with your normal social activities with family, friends, neighbors, or groups?
(Circle One Number)
Not at all..................................... 1
Slightly ....................................... 2
Moderately.................................. 3
Quite a bit................................... 4
Extremely.................................... 5

21.

How much bodily pain have you had during the past 4 weeks?

17.

(Circle One
None............................................
Very mild.....................................
Mild.............................................
Moderate.....................................
Severe.........................................
Very severe.................................

Number)
1
2
3
4
5
6

07/01/96 9:46 AM

22.

42

During the past 4 weeks, how much did pain interfere with your normal work (including
both work outside the home and housework)?
(Circle One Number)
Not at all..................................... 1
A little bit .................................... 2
Moderately.................................. 3
Quite a bit................................... 4
Extremely.................................... 5

These questions are about how you feel and how things have been with you during the past 4
weeks. For each question, please give the one answer that comes closest to the way you have
been feeling.
How much of the time during the past 4 weeks . . .
(Circle One Number on Each Line)
All
Most
of the of the
Time
Time
23.

Did you feel full of pep?.....................

24.

Have you been a very nervous person?

25.

Have you felt so down in the dumps

that nothing could cheer you up?......

26.

56

Have you felt calm and peaceful?......

27.

Did you have a lot of energy?............

28.

Have you felt downhearted and blue?

56

29.

Did you feel worn out?.......................

30.

Have you been a happy person?.......

31.

Did you feel tired?..............................

32.

A Good Some A Little None

Bit of
of the of the of the
the Time Time
Time
Time

During the past 4 weeks, how much of the time has your physical health or emotional
problems interfered with your social activities (like visiting with friends, relatives, etc.)?
(Circle One Number)
All of the time.............................. 1
Most of the time.......................... 2
Some of the time........................ 3
A little of the time....................... 4
None of the time......................... 5

07/01/96 9:46 AM

43

How TRUE or FALSE is each of the following statements for you.

(Circle One Number on Each Line)
Definitely Mostly
True
True
33.

Dont
Know

Mostly
False

Definitely
False

I seem to get sick a little easier than

other people............................................

34.

I am as healthy as anybody I know..........

35.

I expect my health to get worse..............

36.

My health is excellent..............................