Quality of life assessment using the short form 12 questionnaire is as reliable and sensitive as the short form 36 in distinguishing symptom severity in myocardial infarction survivors

Abstract

F rom the patient's perspective, disease severity is gauged by its impact on health related quality of life (HRQL), whereas medical practitioners tend to focus on clinical parameters such as symptoms, signs, and investigations. HRQL assessment can complement clinical evaluation but has not been widely incorporated into routine clinical practice, perhaps because of an association with research, lack of familiarity, difficulties with data interpretation, or concern that outpatients is busy enough.The short form 36 questionnaire (SF-36) 1 is an established HRQL tool that has been evaluated in a range of medical conditions 2 and for which normative data are available. 3Survivors of myocardial infarction have notably impaired HRQL compared with a normal population, detected more readily by the SF-36 than the Nottingham health profile (NHP). 4 5 Despite being relatively user friendly, the SF-36 can be time consuming, especially when combined with essential demographic and other questionnaires, leading to reduced response rates, incompleteness, and unreliability.We investigated whether a shorter questionnaire, the short form 12 (SF-12), which derives summary scores from specific items from the eight domains of the SF-36, might provide equally reliable and sensitive information in a post-infarction population. METHODThe patient population has been described before. 4 Briefly, we mailed a detailed questionnaire comprising demographic questions, Rose angina and dyspnoea scales, SF-36, and NHP to all patients who had: (1) been admitted in a single year to Nottingham's two hospitals; (2) sustained an acute myocardial infarction, based on World Health Organization criteria; and (3) survived at least four years. HRQL scores for the SF-12 were calculated. RESULTSTwo hundred and five of 960 confirmed infarctions died in hospital; a further 210 died over the next four years. Those with recurrent infarctions or resident outside our health district were excluded, leaving 476 study patients.Response rates A total of 424 (89%) patients responded; 421 (99%) answered some or all of the SF-36, making it possible to calculate physical and mental summary scores for 304 (72%). Based on mandated questions within the SF-36, equivalent SF-12 summary scores were calculated for 286 (68%); 278 (66%) had physical and mental summary scale scores for both the SF-36 and the SF-12. Patient characteristicsThere were no significant differences in the demographic characteristics of responders and non-responders. The mean (SD) age of those for whom SF-36 and SF-12 summary scores were available was 64 (9.97) years. One hundred and ninety eight (71%) were male, 231 (83%) had a Q wave infarction, and 108 (39%) an anterior infarction; 192 (69%) were Killip class 0 on admission, and 29 (10%) had had a previous myocardial infarction. When the questionnaire was dispatched, 63 (23%) were working, 167 (60%) retired, and 29 (10%) unable to work. Patient symptomsTwo hundred and seventy two (98%) of 278 who completed all of the SF-36 completed the Rose angina ques...

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“…A similar decrement of physical functioning has been observed in chronic medical conditions such as chronic obstructive pulmonary disease 17 and survivors of myocardial infarction. 18 Patients also completed a health rating scale ranging from 0 to 100, with 0 indicating death and 100 indicating perfect health. The mean score was 79.61.…”

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“…The validity and reliability of SF-12 have been evaluated in previous studies. Melville reported that SF-36 provides important quantitative information about the impact of diseases on health related quality of life [33] and Gandek reported that its internal consistency reliability was 0.83 to 0.93 for the eight scales and 0.94 and 0.89, respectively, for the physical and mental component summary measures [34].…”

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“…The literature suggests that quality of life is impaired many years after MI for those with persisting symptoms, 180 the effect being more marked in younger than older people. The same is reported for those with non-cardiac chest pain.…”