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Cited by 38Health Systems, Economic Evaluations, Quality of LifeFibromyalgia and Chronic Fatigue Syndrome ResearchPsychometric Methodologies and Testing

Outcome measurement in functional somatic syndromes: SF-36 summary scores and some scales were not valid

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Schröder, Andreas, Oernboel, Eva, Licht, Rasmus W., Sharpe, Michael, Fink, Per·2012·Journal of Clinical Epidemiology
DOI 10.1016/j.jclinepi.2011.03.012
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Abstract

OBJECTIVE: This study aimed to test the validity of the 36-item Short-Form Health Survey (SF-36) scales and summaries in patients with severe functional somatic syndromes (FSS), such as fibromyalgia and irritable bowel syndrome. STUDY DESIGN AND SETTING: One hundred twenty patients with severe FSS enrolled in a randomized controlled trial filled in the SF-36 questionnaire. We tested for data quality, central scaling assumptions, and agreement with the conceptual model. RESULTS: Most SF-36 scales were found to be valid; however, three scales (role physical, role emotional, and general health) did not satisfy predefined criteria for construct validity, internal consistency, or targeting to the sample. The correlations between SF-36 scales differed considerably from those reported in the general population. As a consequence, the SF-36 summaries, physical component summary (PCS) and mental component summary (MCS), did not accurately reflect their underlying scales and were negatively correlated (r=-0.46, 95% CI [-0.60 to -0.31]). CONCLUSION: Although the SF-36 is a valuable instrument to assess perceived health in patients with severe FSS, there are problems with some of the scales and with the scoring procedure of the summaries. The SF-36 PCS may, therefore, not accurately measure the physical health status of these patients. Alternative summary measures are needed.

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  • A study has suggested that some subscales of the physical component summary of the SF-36 are not valid in patients with functional somatic disorders.

    “However, a study has suggested that some subscales of the PSC is not valid in patients with FSD [36]”

    From Internet-delivered treatment for patients suffering from severe functional somatic disorders: Protocol for a randomized controlled trial (2023) · cites this paper as [36]

    The Key findings report that three SF-36 scales contributing substantially to the physical component summary failed basic scaling assumptions. The study examined patients with severe functional somatic syndromes, so it does not establish the claim for patients with functional somatic disorders more generally. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • The SF-36 aggregate score has previously been used as the primary outcome in a comparable trial in adults due to well-known psychometric problems with the existing physical component score (PCS) and based on the rationale that these three subscales have shown to be key domains affected in this patient group.

    “This score has previously been used as the primary outcome in a comparable trial in adults39 due to well-known psychometric problems with the existing physical component score (PCS)73 and based on the rationale that these three subscales have shown to be key domains affected in this patient group.74”

    From Comparing group-based acceptance and commitment therapy (ACT) with enhanced usual care for adolescents with functional somatic syndromes: A study protocol for a randomised trial (2016) · cites this paper as [73]

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  • The SF-36 subscales PF, BP and VT have shown to be valid outcome measures in adult patients with severe FSS.

    “The primary outcome was the aggregate score ‘physical health’ derived from The 36-Item Short Form Health Survey (SF-36) subscales PF (physical functioning), BP (bodily pain) and VT (vitality) which all have shown to be valid outcome measures in adult patients with severe FSS [56].”

    From Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: A pilot study (2020) · cites this paper as [56]

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3 of the 72 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Deary IJ. A taxonomy of medically unexplained symptoms. J Psy- chosom Res 1999;47:51e9.
  2. Ware JE Jr, Kosinski M. SF-36 physical and mental health summary scales: a manual for users of version 1. 2nd edition. Lincoln, RI: QualityMetric Inc.; 2001.
  3. Taft C, Karlsson J, Sullivan M. Interpreting SF-36 summary health measures: a responsedreply. Qual Life Res 2001;10:415e20.
  4. Guthlin C, Walach H. MOS-SF 36-Structural equation modeling to test the construct validity of the second-order factor structure. Eur J Psychol Assess 2007;23(1):15e23.

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Authors
Schröder, A., Oernboel, E., Licht, R. W., Sharpe, M., & Fink, P.
Affiliations
  • Aarhus University Hospital (DK)
  • Royal Edinburgh Hospital (GB)
Corresponding author
Schröder, Andreas
ORCID
Venue
Journal of Clinical Epidemiology
Publisher
Elsevier BV
Published
2012-01
Volume
65
Issue
1
Pages
30-41
ISSN
0895-4356 (ISSN-L)
DOI
10.1016/j.jclinepi.2011.03.012
OpenAlex
W2059783081
Cited by
38
References
72
Citations by year
2026: 2 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 1 · 2020: 9 · 2019: 2 · 2018: 1 · 2017: 5 · 2016: 2 · 2015: 1 · 2014: 4 · 2013: 3 · 2012: 4
FWCI
8.92
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Clinical Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Keywords
functional somatic syndromes, SF-36, construct validity, psychometric validation, fibromyalgia, irritable bowel syndrome, physical component summary, mental component summary, scale correlation, health-related quality of life, outcome measurement
MeSH terms
Adult, Algorithms, Female, Fibromyalgia, Health Surveys, Humans, Male, Quality of Life, Surveys and Questionnaires, Research Design, Sampling Studies, Self-Assessment, Severity of Illness Index, Somatoform Disorders, Syndrome, Reproducibility of Results, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Sickness Impact Profile, Irritable Bowel Syndrome

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