Reliability and validity of the Turkish version of short form 36 (SF-36) in patients with rheumatoid arthritis


  • Başak Bilir Kaya Erenköy Physical Theraphy and Rehabilitation Hospital
  • Afitap İçağasıoğlu SBÜ Medeniyet Üniversitesi Göztepe EAH Fiziksel Tıp ve Rehabilitasyon Bölümü


Reliability, Validity, Rheumatoid arthritis, SF-36


Aim: Investigating reliability and validity of the Turkish version of short form-36 (SF-36) in patients with rheumatoid arthritis

Methods: Demographic data of the patients with rheumatoid arthritis were recorded. Health Assessment Questionnaire (HAQ) and Short Form 36 (SF-36) were filled out. Disease activities were computed using Disease Activity Score 28 (DAS-28). Patients were recalled after three months and were asked to state how they felt compared to their first visit, and the same tests were repeated. 

Results: 141 patients were admitted (9.9% male, 90.1% female). In the reliability study of SF-36, the Cronbach alpha value of the subscales varied in the range 0.792-0.992, hence SF-36 was found to be highly reliable. The item total score correlations were computed for each subscale and were found to be in the ranges: 0.436-0.840 for physical functioning, 0.887-0.895 for role function (physical), 0.861-0.958 for pain, 0.564-0.892 for general health perception, 0.702-0.841 for vitality (energy/fatigue), 0.949-0.952 for social functioning, 0.396-0.473 for role function (emotional) and 0.456-0.824 for mental health. The SF-36 scores from two consecutive visits spaced 3 months apart were compared and the p values were found to be greater than 0.05. The validity study was conducted for the 63 patients whose reported conditions did not change between two visits. The test-retest relation was evaluated using intra-class correlation coefficients, which ranged from 0.51 to 0.78 and the correlations of the two tests were found to be statistically significant. The comparison of SF-36 scores from two consecutive visits, all with p>0.05, showed no statistically significant changes.  

Conclusions: The Turkish version of SF-36 was found to be reliable and valid in patients with rheumatoid arthritis.


Download data is not yet available.


Fries JF, Spitz P, Kraines RG, Holman HR Measurement of patient outcome in arthritis. Arthritis Rheum 1980;23(2):137–45

Kucukdeveci AA, Sahin H, Ataman S et al. Issues in crosscultural validity: example from the adaptation, reliability and validity testing of a Turkish version of the Standford Health Assessment Questionnaire. Arthritis & Rheumatism; Arthritis Care & Research. 2004;51(1):14-19.

Kirwan JR, Reeback JS Stanford Health Assessment Questionnaire modified to assess disability in British patients with rheumatoid arthritis. Br J Rheumatol 1986;25(2):206-9.

Leigh JP, Fries JF, Parikh N Severity of disability and duration of disease in rheumatoid arthritis. J Rheumatol 1992;19(12):1906-11.

Buchbinder R, Bombardier C, Yeung M, Tugwell P. Which outcome measure should be used in rheumatoid arthritis clinical trials? Clinical and quality-of-life measures’ responsiveness to treatment in a randomised controlled trial. Arthritis Rheum 1995;38(11):1568-80.

Carr A, Thompson P, Young A. Do health status measures (HSM) have a role in rheumatology? A survey of the use of and attitudes towards health status measures in the UK. Arthritis Rheum 1996; ACR Abstracts S261.

Wolfe F, Cathey MA. The assessment and prediction of functional disability in rheumatoid arthritis. J Rheumatol 1991;18(11):1774.

Leigh JP, Fries JF. Predictors of disability in a longitudinal sample of patients with rheumatoid arthritis. Ann Rheum Dis 1992;51(5):581-7.

Young A. Short-term outcomes in recent-onset rheumatoid arthritis. Br J Rheumatol 1995;34(suppl. 2):79-86.

Fitzpatrick R, Ziebland S, Jenkinson C, Mowat A, Mowat A. Importance of sensitivity to change as a criterion for selecting health status measures. Quality Health Care 1992;1(2):89-93.

Liang MH, Jette AM. Measuring functional ability in chronic rheumatoid arthritis. A critical review. Arthritis Rheum 1981;24(1):80-6.

Ware JE, Sherbourne CD. The MOS 36-item short-form health status survey (SF-36). 1. Conceptual framework and item selection. Med Care 1992;30(6):473-83.

Koçyiğit H, Aydemir Ö, Ölmez N et al. SF-36’nın Türkçe için güvenilirliği ve geçerliliği. İlaç ve tedavi 1999;12:102-6.

Küçükdeveci A, Şahin H, Ataman Ş, Griffiths B, Tennant A. Issue in cross-cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of thr Stanford Health Assessment Questionnaire. Arthritis & Rheum 2004;51(1):14-9.

Aletaha D, Ward MM, Machold KP, Nell VPK, Stamm T, Smolen JS. Remission and active disease in rheumatoid arthritis. Defining criteria for disease activity states. Arthritis Rheum. 2005;52(9):2625-36.

Coronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16(3):297-334.

Jenkinson C, Peto V, Coulter A. Making sense of ambiguity: evaluation of internal reliability and face validity of SF-36 questionnaire in women presenting with menorrhagia. Qual Health Care 1996;5(1):9-12.

Hurst NP, Kind P, Ruta DA, Hunter M, Stubbings A. Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol 1997;36(5):551-9.

Kosinski M, Keller SD, Ware JE, Hatoum HT, Kong SX. The SF-36 health survey (SF-36) as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: relative validity of scales in relation to clinical measures of arthritis severity. Med Care 1999;37(5 suppl):23-39.

Talamo J, Frater A, Gallivan S, Young A. Use of the short form 36 (SF-36) for health status measurement in rheumatoid arthritis. Br J Rheumatol 1997;36(4):463-9.

Kvein TK, Smestad LM, Uhlig T. The responsiveness of generic and disease specific health health status measures in 759 patients with rheumatoid arthritis (RA). Arthritis Rheum 1996;39(suppl.):260.

Streiner DL, Norman GR. Health measurement scales. A practical guide to their development and use. New York: Oxford University Press; 1989.

Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: Manual and interpretation guide. Boston: The Health Institute. New England Medical Center, 1993.

Brazier JE, Harper R, Jones NMB et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992;305(6846):160-4.

Jenkinson C, Coulter A, Wright L: Short Form-36 (SF-36) health survey questionnaire: Normative data for adults of working age. BMJ 1993;306(6890):1437-1440.

Husted JA, Gladman DA, Farewell VT et al. Validating the SF-36 health survey questionnaire in patients with psoriatic arthritis. J Rheumatol 1997;24(3):511-7.

Stoll T, Gordon C, Seifert B et al. Consistency and validity of patient administered assessment of quality of life by the MOS SF-36; its association with disease activity and damage in patients with systemic lupus erythematosus. J Rheumatol 1997;24(8):1608-14.

Birrell FN., Hassell AB., Jones PW., Dawes PT. How does the short form 36 health questionnaire (SF-36) in rheumatoid arthritis (RA) relate to RA outcome measures and SF-36 population values? A cross-sectional study. Clin Rheumatol. 2000;19(3):195-9.

Russell AS, Conner-Spady B, Mintz A, Maksymowych WP. The responsiveness of generic health status measures as assessed in patients with rheumatoid arthritis receiving infliximab. J Rheumatol 2003;30(5):941–7.






Research Article

How to Cite

Bilir Kaya B, İçağasıoğlu A. Reliability and validity of the Turkish version of short form 36 (SF-36) in patients with rheumatoid arthritis. J Surg Med [Internet]. 2018 Feb. 5 [cited 2024 Apr. 13];2(1):11-6. Available from: