German translation and psychometric testing of the SF-36 Health Survey: Preliminary results from the IQOLA project
Abstract
International translation and psychometric testing of generic health outcome measures is increasingly in demand. Following the methodology developed by the International Quality of Life Assessment group (IQOLA) we report the German work with the SF-36 Health Survey. The form was translated using a forward-backward method with accompanying translation quality ratings and pilot tested in terms of translation clarity and applicability. Psychometric evaluation included Thurstone's test of ordinality and equidistance of response choices in 48 subjects as well as testing of reliability, validity, responsiveness and discriminative power of the form in crossectional studies of two samples of healthy persons and longitudinal studies of two samples of pain patients totalling 940 respondents. Quality ratings of translations were favorable, suggesting a high quality of both forward and backward translations. In the pilot study, the form was well understood and easily administered, suggesting high clarity and applicability. Thurstone's test revealed ordinality (in over 90% of the cases) and rough equidistance of response choices also as compared to the American original. On item and scale level, missing data were low and descriptive statistics indicated acceptable distribution characteristics. In all samples studied, discriminative item validity was high (over 90% scaling successes) and Cronbach's alpha reliabilities were above the 0.70 criterion with exception of one scale. Furthermore convergent validity, responsiveness to treatment and discriminative power in distinguishing between healthy and ill respondents was present. The preliminary results suggest that the SF-36 Health Survey in its German form may be a valuable tool in epidemiological and clinical studies. However further work as concerns responsiveness and population based norms is necessary.
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Two studies of very good quality found Cronbach's alpha >0.70 for seven of eight SF-36 subscales in each study.
“Two studies [48,52] of very good quality assessed the internal consistency of the subscales, finding a Cronbach's alpha O0.70 for seven of eight subscales in each study.”
From Evidence on the measurement properties of health-related quality of life instruments is largely missing in patients with low back pain: A systematic review (2018) · cites this paper as [48]
One study assessed the construct validity of the Nottingham Health Profile subscales compared to the SF-36 subscales, providing low quality evidence of sufficient construct validity, with 37 of 48 hypotheses met (77%).
“One study [48] assessed the construct validity of its subscales as compared to the SF-36 subscales, providing low quality evidence (due to risk of bias, Table 3) of sufficient construct validity as 37 of 48 hypotheses were met (77%, Appendix 2).”
From Evidence on the measurement properties of health-related quality of life instruments is largely missing in patients with low back pain: A systematic review (2018) · cites this paper as [48]
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- Authors
- Bullinger, M.
- Affiliations
- Institut für Medizinische Psychologie (DE)
- Corresponding author
- Bullinger, Monika
- ORCID
- Bullinger, Monika
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 1995-11
- Volume
- 41
- Issue
- 10
- Pages
- 1359-1366
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W1970784464
- Cited by
- 763
- References
- 26
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 29 · 2023: 16 · 2022: 30 · 2021: 40 · 2020: 41 · 2019: 26 · 2018: 32 · 2017: 41 · 2016: 19 · 2015: 38 · 2014: 30 · 2013: 42 · 2012: 25
- FWCI
- 31.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- SF-36 Health Survey, German translation, cross-cultural adaptation, health-related quality of life, translation quality, test-retest reliability, convergent validity, responsiveness, pain patients, population norms
- MeSH terms
- Back Pain, Chronic Disease, Cross-Sectional Studies, Cross-Cultural Comparison, Female, Germany, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Migraine Disorders, Pilot Projects, Psychometrics, Quality of Life, Surveys and Questionnaires, Self-Assessment, Translations, United States, Reproducibility of Results, Outcome Assessment, Health Care
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