The SF-36 was developed from work done by the RAND Corporation and the Medical Outcomes Study (MOS), based on the measurement strategy of the RAND Health Insurance Study in the 1980s. SF-36 is a multi-purpose, short-form health survey with only 36 questions. It yields an 8-scale profile of functional health and well-being scores as well as psychometrically-based physical and mental health summary measures and a preference-based health utility index. The SF-36 can be either self-administered or administered by a trained interviewer, either in person or by telephone. Over the years, the SF-36 has been used in surveys of general and specific populations, for comparing the relative burden of diseases across different sub-groups and in differentiating the health benefits produced by health care treatments.
A newer version of the SF-36, the SF-36v2, was designed to make improvements to the original instrument. Refinements in item wording and format, and an increase in the range of scores covered were achieved without increasing respondent burden. Norms and guidelines are available for maintaining backward comparability with studies published with the first version of the SF-36, providing standardization between the two versions of the instrument and allowing for comparison of data sets for trend analyses.
SF-36 v2 Questionnaire
The approach most commonly used in the European community is the EQ-5D. This method has been advanced by a collaborative group from Western Europe known as the EuroQol group. The group, originally formed in 1987, comprises a network of international, multi-disciplinary researchers, originally from seven centers in England, Finland, the Netherlands, Norway, and Sweden. More recently, researchers from Spain as well as researchers from Germany, Greece, Canada, the US and Japan have joined the group.
The intention of this effort is to develop a generic currency for health that could be used commonly across Europe. The original version of the EuroQol had 14 health states in six different domains. More recent versions of the EuroQol, known as the EQ-5D, are now in use in a substantial number of clinical and population studies.
The Quality of Well-Being Scale (QWB) has been used in numerous clinical trials and studies over the years to evaluate medical and surgical therapies in conditions such as chronic obstructive pulmonary disease, HIV, cystic fibrosis, diabetes mellitus, atrial fibrillation, lung transplantation, arthritis, end stage renal disease, cancer, depression, and several other conditions. Further, the instrument has been used for health resource allocation modeling and served as the basis for an innovative experiment in the allocation of health care by the State of Oregon. Studies have also demonstrated that the QWB is responsive to clinical change derived from surgery or medical conditions such as rheumatoid arthritis, AIDS, and cystic fibrosis.
The self-administered form of the QWB (QWB-SA) was developed more recently. It has been shown to be highly correlated with the interviewer-administered QWB and to retain its psychometric properties. The QWB-SA combines preference-weighted values for symptoms and functioning. Symptoms are assessed by questions that ask about the presence or absence of different symptoms or conditions. Functioning is assessed by a series of questions designed to record functional limitations over the previous three days, within three separate domains (mobility, physical activity, and social activity). The four domain scores are combined into a total score that provides a numerical point-in-time expression of well-being that ranges from zero (0) for death to one (1.0) for asymptomatic optimum functioning.
The Health Utilities Index (HUI) is a family of generic health status and health related quality of life measures developed at McMaster University in Canada over the last 30 years. The HUI has been applied by hundreds of researchers around the world. Questionnaires which provide sufficient information to describe the health status of a subject at a point in time for both the HUI2 and HUI3 systems have been developed. The HUI2 was initially developed to assess outcomes among childhood cancer survivors. The attributes measured by the HUI2 are sensation (vision, hearing, speech), mobility, emotion, cognition, self-care, pain, and fertility. The HUI3 was originally developed for the 1990 Statistics Canada Ontario Health Survey, and measures eight attributes (vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain). Multiplicative multi-attribute utility functions for the HUI2 and HUI3 translate categorical data on health status collected in the questionnaires into interval scale single attribute utility scores and overall utility scores, reflecting overall health related quality of life.
While there is some overlap between HUI2 and HUI3, in other ways the two systems complement each other. HUI2 has been extensively used in clinical studies, providing useful benchmark results for comparisons. HUI3 has been used in four major Canadian population health surveys, providing extensive data on population norms.
The Health and Activities Limitations Index (HALex) was initially developed for use in the National Health Interview Survey, conducted by the National Center for Health Statistics in the 1980s and 1990s. The version of the measurement tool being used for this program of research was adapted from the original version, specifically to be used for telephone interview surveys conducted for the Behavioral Risk Factor Surveillance Survey (BRFSS) by the Center for Disease Control and Prevention (CDC), for calculating Healthy People 2000 Years of Healthy Life. This measurement instrument focuses on obtaining information on how health problems may inhibit or limit people in performing work-related functions or daily activities of life.
Minnesota Living with Heart Failure Questionnaire (MLHFQ) The Minnesota Living with Heart Failure questionnaire was designed in 1984 to measure the effects of heart failure and treatments for heart failure on an individual’s quality of life. The content of the questionnaire was selected to be representative of the ways heart failure can affect the key physical, emotional, social and mental dimensions of quality of life without being too long to administer during clinical trials or practice. To measure the effects of heart failure symptoms, functional limitations and psychological distress on an individual’s quality of life, the MLHFQ asks each person to indicate using a 6-point (zero to five) Likert scale how much each of 21 facets prevents them from living as they desire.
The questionnaire assesses the impact of frequent physical symptoms - shortness of breath, fatigue, peripheral edema, and difficulty sleeping - and psychological symptoms of anxiety and depression. In addition, the effects of heart failure on physical and social functioning are incorporated into the measure. Since treatments might have side effects in addition to ameliorating symptoms and functional limitations produced by heart failure, questions about side effects of medications, hospital stays and costs of care are also included to help measure the overall impact of a treatment on quality of life. Although the MLHFQ incorporates relevant aspects of the key dimensions of quality of life, the questionnaire was not designed to measure any particular dimension separately.
Minnesota Living with Heart Failure Questionnaire
Visual Functioning Questionnaire (VFQ-25) The National Eye Institute (NEI) sponsored the development of the VFQ-25 with the goal of creating a survey that would measure the dimensions of self-reported, vision-targeted health status that are most important for persons who have chronic eye diseases. Because of this goal, the instrument measures the influence of visual disabilities and visual symptoms on generic health domains such as emotional well-being and social functioning, in addition to task-oriented domains related to visual functioning.
The VFQ-25 consists of a base set of 25 vision-targeted questions representing 11 vision-related constructs. Both self-administered and interviewer administered versions of the instrument have been developed. The VFQ-25 generates the following vision-targeted subscales: global vision rating; difficulty with near vision activities; difficulty with distance vision activities; limitations in social functioning due to vision; role limitations due to vision; dependency on others due to vision; mental health symptoms due to vision; driving difficulties; limitations with peripheral and color vision; and ocular pain. In addition, the VFQ-25 contains the single general health rating question which has been shown to be a robust predictor of health and mortality in population-based studies.