Scoring the RAND SF-36-item
Health Survey 1.0

NOTE:   This information is derived from from the article:
Measuring Functional Health Status in the Chiropractic Office Using Self-Report Questionnaires

Goertz, Christine M   Top in Clin Chiro 1994:   1 (1):   51-59   The questionnaire itself is located on page 81-83

Scoring the RAND involves 3 steps

STEP 1:   SCORING QUESTIONS:

ITEM NUMBERS	ORIGINAL RESPONSE	RECORDED VALUE
1, 2, 20, 22, 34, 36	1	100
	2	75
	3	50
	4	25
	5	0

ITEM NUMBERS	ORIGINAL RESPONSE	RECORDED VALUE
3, 4, 5, 6, 7, 8, 9, 10, 11, 12	1	0
	2	50
	3	100

ITEM NUMBERS	ORIGINAL RESPONSE	RECORDED VALUE
13, 14, 15, 16, 17, 18, 19	1	0
	2	100

ITEM NUMBERS	ORIGINAL RESPONSE	RECORDED VALUE
21, 23, 26, 27, 30	1	100
	2	80
	3	60
	4	40
	5	20
	6	0

ITEM NUMBERS	ORIGINAL RESPONSE	RECORDED VALUE
24, 25, 28, 29, 31	1	0
	2	20
	3	40
	4	60
	5	80
	6	100

ITEM NUMBERS	ORIGINAL RESPONSE	RECORDED VALUE
32, 33, 35	1	0
	2	25
	3	50
	4	75
	5	100

 

STEP 2:   AVERAGING ITEMS TO FORM 8 SCALES:

SCALE	NUMBER OF ITEMS	AFTER RECORDING SCORES PER TABLE 1, AVERAGE THE FOLLOWING ITEMS
Physical functioning	10	3, 4, 5, 6, 7, 8, 9, 10, 11, 12
Role limitations due to physical health	4	13, 14, 15, 16
Role limitations due to emotional problems	3	17, 18, 19
Energy/ fatigue	4	23, 27, 29, 31
Emotional well being	5	24, 25, 26, 28, 30
Social functioning	2	20, 32
Pain	2	21, 22
General health	5	1, 33, 34, 35, 36

 

STEP 3:   FIGURING SCORES:

RAND recommends the following straightforward approach to scoring the RAND 36-Item Health Survey.

All questions are scored on a scale from 0 to 100, with 100 representing the highest level of functioning possible. Aggregate scores are compiled as a percentage of the total points possible, using the RAND scoring table (STEP I chart).

The scores from those questions that address each specific area of functional health status (STEP II chart) are then averaged together, for a final score within each of the 8 dimensions measured. (eg pain, physical functioning etc.)

For example, to measure the patient's energy/fatigue level, add the scores from questions 23, 27, 29, and 31. If a patient circled 4 on 23, 3 on 27, 3 on 29 and left 31 blank, use table 1 to score them.

An answer of 4 to Q23 is scored as 40, 3 to Q27 is scored as 60, and 3 to Q29 is scored as 40. Q31 is omitted. The score for this block is 40+60+40 =140. Now we divide by the 3 answered questions to get a total of 46.7. Since a score of 100 represents high energy with no fatigue, the lower score of 46.7% suggests the patient is experiencing a loss of energy and is experiencing some fatigue.

All 8 categories are scored in the same way. Using this questionnaire at the beginning and during the course of care, we can track the progress of the 8 parameters mentioned in the STEP II chart. Pretty nifty, eh?

A CHART TO MAINTAIN PATIENT SCORES IN THE FILE:

RAND SF-36	INITIAL SCORE	PRESENT SCORE	NORMS
PHYSICAL FUNCTIONING			84.2
ROLE LIMITATIONS DUE TO PHYSICAL HEALTH			81.0
ROLE LIMITATIONS DUE TO EMOTIONAL STRESSES			81.3
ENERGY/FATIGUE			60.9
EMOTIONAL WELL-BEING			74.7
SOCIAL FUNCTIONING			83.3
PAIN LEVELS			75.2
GENERAL HEALTH			72.0
Other QA's
GLOBAL WELL-BEING			>   2/10
OSWESTRY LB PAIN INDEX			>   5/50
NECK DISABILITY INDEX			>   5/50

You might consider adding these 3 questions to the survey of your patients. Thanks to Steven G. Yeomans, D.C. who teaches the Outcomes portion of LACC's rehabilitation diplomate program for providing these additional questions:

37.     In the past year, have you had 2 weeks or more during which you felt sad, blue or depressed; or when you lost all interest or pleasure in the things that you usually cared about or enjoyed?
Yes            No

38.     Have you had 2 years or more in your life when you felt depressed or sad most days, even if you felt okay sometimes?

Yes            No

39.     Have you felt depressed or sad much of the time in the past year?

Yes            No

You can use the last 3 questions to stage patients as:

37. YES = depression
38. YES = dysthemia
39. YES = dysthemia

In discussion with the patient, Dr. Yeomans suggests that you can say, "By your questionnaire you have scored yourself as depressed". In this way, you are not labeling the patient, but acknowledging what they have already told you. This provides an opportunity to discuss their feelings and to explore a potential referral for counselling.

Return to the Outcome Assessment Section

Since 3-01-1998

Updated 1-21-2007