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RehabMeasures Instrument

Short Form 12 item (version 2) Health Survey

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Purpose

SF-12v2 is a shortened form (12 items) of the SF-36v2 Health Survey. This is a generic assessment of health-related quality of life (HR QOL) from the client/patient’s perspective. Survey is administered as a questionnaire and can be self-administered or completed through an interview.

Link to Instrument

Link to Instrument

Acronym SF-12v2

Area of Assessment

Life Participation
Mental Health
Negative Affect
Pain
Positive Affect
Quality of Life

Assessment Type

Patient Reported Outcomes

Cost

Not Free

Actual Cost

$150.00

Cost Description

Individuals can register and complete a demo sample of each survey for free. Use for professional, clinical, or research requires paid access and licensing agreement. Web link with summary of costs available, accessed June 2013. Costs were individual per items and ranged from $12 to $150
http://www.qualitymetric.com/WhatWeDo/2011ProductsServicesCatalog/tabid/326/Default.aspx
June, 2013: Item cost for parts of SF-12 ranged from $12 to 150 US dollars

Diagnosis/Conditions

  • Parkinson's Disease & Neurologic Rehabilitation
  • Stroke Recovery

Key Descriptions

  • The SF-12v2 addresses the same 8 domains as identified in the SF-36v2. However, due to brevity of the assessment, the only 2 scores obtained from this assessment are the physical health composite summary (PCS) and the mental health composite summary (MCS). In contrast with SF-36v2, the primary authors recommend against use of individual domain scores with the SF-12v2.
  • Both the SF-36v2 and the SF-12v2 were re-normed in 2009 and most current normative data is available for comparisons.
  • Eight Domains:
    1) Physical functioning (PF)
    2) Role – physical (RP)
    3) Bodily pain (BP)
    4) General health perceptions (GH)
    5) Vitality (V)
    6) Social functioning (SF)
    7) Role – emotional (RE)
    8) Mental health (MH)
  • An algorithm is used to generate the physical and mental health composite scores for comparison to normative data.
  • In normative data:
    1) The mean score is set to 50.
    2) Scores > 50 indicate better physical or mental health than the mean.
    3) Scores < 50 indicate worse physical or mental health than the mean.

Number of Items

12

Equipment Required

  • User manuals (administration guide; manual; quick start guide)

Time to Administer

3-5 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Erin Hussey, DPT, MS, NCS & the PD EDGE Task Force of the Neurology Section of the APTA.

ICF Domain

Participation

Measurement Domain

Emotion
General Health

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations Based on Parkinson Disease Hoehn and Yahr stage: 

 

I

II

III

IV

V

PD EDGE

LS/UR

LS/UR

LS/UR

LS/UR

LS/UR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

PD EDGE

No

No

No

Not reported

Considerations

Shortly after publication of SF-12 in 1996, the primary authors began the process of revision to both SF-36 and SF-12 to address criticisms of the surveys, leading to publication of SF-12v2 6 years later (2002). The RMD document providing summary of SF-36 includes studies specific to both v1 and v2 and readers are referred to that summary for some additional information. Changes made during revision were substantive, with items re-worked for clarity and the scale of several domains revised to address problems with responsiveness and ceiling/floor effects. Due to the significance of these changes and the rapid change from v1 to v2, the PD EDGE group initially reviewing SF-12 for a Rehab Measures summary document focused only on SF-12v2, thus intentionally leaving out a few studies that addressed any criticisms or strengths specific to Parkinson Disease using SF-12v1 (Jacobsson et al, 2012; Lindskov et al, 2007; Tan et al, 2013). The details of these studies are not included in this RMD since they used SF-12v1. Following is a brief summary of conclusions 

relevant to SF-12v1

  • Jakobsson et al, 2012; N = 4,278 elderly, 159 with PD, 89 post-stroke. Sweden. Although reporting acceptable reliability and consistency, authors provided criticism specific to the validity of elements of SF-12v1 using the 2-factor composite scales. In conclusion, they recommended against use of the v1 scale for patients with neurologic conditions such as stroke and PD. 
  • Lindskov et al, 2007. N = 96 with PD, Hoehn & Yahr stages 1-3; intervention study. Reported a lack of responsiveness with no significant change in either PCS or MCS composite scores for either experimental or control groups from baseline to outcome. They questioned whether the SF-12v1 was valid in construct for use with PD and other neurologic conditions. 
  • Tan et al, 2013; Systematic review, concluded that the validity of SF-12 has not yet been tested in Parkinson Disease. Within the systematic review, Lindskov et al, 2007 was rated as 1- for level of evidence based on the Scottish Intercollegiate Guidelines Network (SIGN). A 1 indicates a strong study while a minus indicator represents a study deemed high risk for bias due to methodology.

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Parkinson's Disease

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Test/Retest Reliability

General US population: 

(Cheak-Zamora et al, 2009; SF-12v2; N = 20,661, mean age = 44.4 (17.5); 55.3% female; years of education mean = 12.02 (3.7). PCS score mean = 49.2 (11.0); MCS mean score = 50.2 (10.1). Data collected for 2 years, from January 2003 through December 2005 through Medical Expenditure Panel Survey (MEPS)) 

Test-Retest reliability with administration 1 year apart; 

  • PCS: excellent test-retest reliability (ICC = 0.78) 
  • MCS for n = 4,960: adequate test-retest reliability (ICC = 0.60)

Internal Consistency

General US population: 

(Cheak-Zamora et al, 2009; SF-12v2) 

  • Excellent internal consistency (Mosier alpha > 0.80) for both PCS (alpha = 0.88) and MCS (alpha = 0.82)

Criterion Validity (Predictive/Concurrent)

General US Population:

(Cheak-Zamora et al, 2009; SF-12v2) 

Concurrent validity

  • Adequate PCS with comparable EuroQOL variables at r = 0.56 – 0.61 (p < 0.01) 
  • Adequate MCS with EuroQOL at r = 0.38 - 0.61 for EQ preference, anxiety/depression, general health, and perceived mental health) 
  • Poor to Adequate correlations PCS with EuroQOL self care (r = 0.32), anxiety/depression (r = 0.24) and perceived mental health (r = 0.38) 
  • Poor correlation MCS with EQ domains at r = 0.21 - 0.32 for mobility, self-care, usual activity, pain, and perceived health.

Construct Validity

General US Population:

(Cheak-Zamora et al, 2009; SF-12v2) 

Discriminant Validity 

  • PCS able to distinguish between groups without limitations (PCS = 51.79) and those reporting functional work limitations (PCS = 33.52). F-ratio = 6.09, p < 0.001) with large effect size (d = 1.6) of work limits on PCS. 
  • PCS able to distinguish between those without limitations (PCS = 42.51) and those reporting functional limitations (PCS = 32.73) with F-ratio = 1.3, p < 0.001). Moderate effect (d = 0.88) of functional limits on PCS. 
  • Chronic conditions: PCS distinguished for chronic conditions with higher effect sizes associated with more conditions, ranging from 1 condition (d = 0.48) to 5, 6, and 7 (d = 2.66, 3.46, and 8.47, respectively). 
  • MCS able to distinguish between groups without cognitive limits (MCS = 50.93) and those reporting cognitive limits (MCS = 39.12) with F-ratio = 3.23, p < 0.001. Cognitive limits effect size on MCS, d = 0.93) 
  • MCS – Chronic conditions. MCS distinguish the groups with & without chronic conditions, with more chronic conditions associated with lower PCS scores. F-ratio = 2.37, p < 0.001). Larger effect sizes for greater number of chronic conditions, ranging from 1 condition (d = 0.114) to 6 or more conditions (d > 1.0).

Floor/Ceiling Effects

General US population: 

(Cheak-Zamora et al, 2009) 

  • Reported there were no floor or ceiling effects within the range and distribution of scores: PCS (range: 7.02 to 76.54) and MCS (range: 1.42 to 76.5)

Bibliography

Cheak-Zamora, N. C., Wyrwich, K. W., et al. (2009). "Reliability and validity of the SF-12v2 in the medical expenditure panel survey." Qual Life Res 18(6): 727-735. Find it on PubMed  

Jakobsson, U., Westergren, A., et al. (2012). "Construct validity of the SF-12 in three different samples." J Eval Clin Pract 18(3): 560-566. Find it on PubMed  

Lindskov, S., Westergren, A., et al. (2007). "A controlled trial of an educational programme for people with Parkinson's disease." J Clin Nurs 16(11C): 368-376. Find it on PubMed

Tan, S. B., Williams, A. F., et al. (2014). "Effectiveness of multidisciplinary interventions to improve the quality of life for people with Parkinson's disease: A systematic review." Int J Nurs Stud 51(1): 166-174. Find it on PubMed