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SF-12

MEDICALOUTCOMESSTUDY (MOS) SHORT-FORMHEALTHSURVEY

This survey asks for your views about your health. This information will help you keep track of how you feel

how well you are able to do your usual activities. Answer every question by selecting the answer as indicated.

you are unsure about how to answer a question, please give the best answer you can.

1.In general, would you say your health is:

(1)Excellent (2)Very good (3)Good (4) Fair (5)Poor

The following questions are about activities you might do during a typical day. Does your health nowlimit yo

these activities? If so, how much?

Yes, Yes, No, not

limited limited limited

a lot a little at all

2. Moderate activities,such as moving a table, pushing

a vacuum cleaner, bowling, or playing golf (1) (2) (3)

3.Climbing severalflights of stairs (1) (2) (3)

During thepast 4 weeks, have you had any of the following problems with your work or other regular daily

activities as a result of your physical health?

Yes No

4. Accomplished lessthan you would like (1) (2)

5.Were limited in the kindof work or other activities (1) (2)

During thepast 4 weeks, have you had any of the following problems with your work or other regular daily

activities as a result of any emotional problems(such as feeling depressed or anxious)?

Yes No

6. Accomplished lessthan you would like (1) (2)

7.Didn't do work or other activities as carefullyas usual (1) (2)

8.During thepast 4 weeks, how much did pain interfere with your normal work (including both work outside

home and housework)?

(1)Not at all (2) A little bit (3) Moderately (4)Quite a bit (5)Extremely

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These questions are about how you feel and how things have been with you during the past 4 weeks. For each

question, please give the one answer that comes closest to the way you have been feeling.

How much of the time during thepast 4 weeks...

All of Most of A Good Some of A little of None of

the time the time Bit of the time the time the timethe Time

9.Have you felt calm and peaceful? (1) (2) (3) (4) (5) (6)

10.Did you have a lot of energy? (1) (2) (3) (4) (5) (6)

11.Have you felt downhearted and blue? (1) (2) (3) (4) (5) (6)

12.During thepast 4 weeks, how much of the time has your physical health or emotional problems interfered

your social activities (like visiting friends, relatives, etc.)?

(1)All of the time (2)Most of the time (3)Some of the time (4) A little of the time (5)None of the tim

SCORING

There are 3 steps involved in calculating the SF-12 Physical Component Summary(PCS) and Mental Component Summary (MCS) scores.Step 1. Check for missing or out-of-range values for items 11-22 (SF-12 portion ofcombined survey). If any missing or out-of-range values are found for those items, thePCS and MCS scores cannot be calculated.Step 2. Convert each item response into both physical and mental standardized valuesaccording to the table on the following page.Step 3. Sum the physical standardized values from step 2 across all 12 items and add56.57706 to create the SF-12 PCS score. Sum the mental standardized values in similarfashion and add 60.75781 to create the SF-12 MCS score.

Converting SF-12 Item Responses to Physical and Mental StandardizedValues:

Item Number Item Response Physical

Mental

Value Standardized Value Standardized

Value

1 (General Health) 1 0 0

2 -1.31872 -

0.06064

3 -3.02396

0.03482

4 -5.56461 -

0.16891

5 -8.37399 -

1.71175

2 (Moderate Activities) 1 -7.23216

3.93115

2 -3.45555

1.86840

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3 0 0

3 (Climbing Several Flights of Stairs) 1 -6.24397

2.68282

2 -2.73557

1.43103

3 0 0

4 (Accomplish less than you would like) 1 -4.616171.44060

2 0 0

5 (Limited in the kind of activities) 1 -5.51747

1.66968

2 0 0

6 (Accomplish less than you would like) 1 3.04365 -

6.82672

2 0 0

7 (Didnt do activities as carefully as usual) 1 2.32091

-5.69921

2 0 0

8 (Pain interferes with normal work) 1 0 0

2 -3.801300.90384

3 -6.50522

1.49384

4 -8.38063

1.76691

5 -11.25544

1.48619

9 (Felt calm and peaceful) 1 0

0

2 0.66514 -

1.94949

3 1.36689 -

4.09842

4 2.37241 -

6.31121

5 2.90426 -

7.92717

6 3.46638 -10.19085

10 (Have a lot of energy) 1 0

0

2 -0.42251 -

0.92057

3 -1.14387 -

1.65178

4 -1.61850 -3.29805

5 -2.02168 -

4.88962

6 -2.44706 -

6.02409

11 (Felt downhearted and blue) 1 4.61446 -16.15395

2 3.41593 -10.77911

3 2.34247 -

8.09914

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4 1.28044 -

4.59055

5 0.41188 -

1.95934

6 0 0

12 (Health interferes w/social activities) 1 -0.33682 -

6.297242 -0.94342 -

8.26066

3 -0.18043 -

5.63286

4 0.11038 -

3.13896

5 0 0

Cut Off Points: A cut off score of 50 can be used for PCS, and 42 for MCS.

There is an online scoring program:http://www.sf-36.org/demos/SF-12.html

One can also purchase software online for scoring the SF-12 or SF-36 Health Outcomes

survey:http://www.qualitymetric.com/products/ScoringSoftwareBasic.aspx

_______________________Ware JE, Jr. , Snow KK, Kosinski M, Gandek B: SF-36 Health Survey Manual and Interpretation Guide.

Boston, MA, The Health Institute, New England Medical Center, 1997.