The assessment of health-related quality-of-life (HRQoL) in rheumatoid arthritis (RA) is becoming increasingly common in both research and clinical practice. One of the most widely used tools for measuring HRQoL is the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). A group conducted a systematic review examining the impact of RA on HRQoL, measured using the SF-36.
Here’s what they did
They searched MEDLINE and Embase for observational studies reporting mean and standard deviation scores for each domain of the SF-36 in adult rheumatoid arthritis patients. Studies were reviewed in accordance with PRISMA guidelines, and a random-effects meta-analysis was performed.
Here’s what they found
They incuded 31 studies in the meta-analysis, including 22,335 patients.
Physical component summary: pooled mean score was 34.1 (95% CI: 22.0–46.1)
Mental component summary: pooled mean was 45.6 (95% CI: 30.3–60.8).
Age: Increased age was associated with reduced physical function and physical component summary (PCS) scores but improved mental health and mental component summary (MCS) scores.
Gender: Female gender was associated with improved scores on role physical, bodily pain and Physical Component Summary but reduced mental health and Mental Component Summary scores.
Disease duration: Longer disease duration was associated with improved Mental Component Summary scores.
The authors concluded
Patients with RA have a substantially reduced HRQoL in comparison to both other physical illnesses and in comparison to normative datasets from UK and USA populations.
The Musculoskeletal Elf’s view
The SF-36 is a multi-purpose, short-form health survey with 36 questions. It is a generic measure, as opposed to one that targets a specific age, disease, or treatment group. It has been widely used in almost 4,000 publications comparing the relative burden of diseases, and in differentiating the health benefits produced by a wide range of different treatments. The eight domains that the SF36 measures are as follows: physical functioning; role limitations due to physical health; role limitations due to emotional problems; energy/fatigue; emotional well-being; social functioning; pain; general health.
This review examined data from over 22 thousand people with RA but how do these scores relate to the general population in the UK? A UK study in 1999 reported data from 3542 men and 4442 women.
They reported mean physical component summary scores of 50.63 (men) and 49.54 (women) and mental component summary scores of 51.16 (men) and 49.17 (women). So in comparison people with RA on average had lower scores and thus it can be postulated that RA has a significant impact on quality of life.
What do you think?
- Do you think RA has a significant effect on quality of life of people with RA?
- Do you use the SF-36 with your RA patients?
- Matcham F, Scott IC, Rayner L, Hotopf M, Kingsley GH, Norton S, Scott DL, Steer S The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: a systematic review and meta-analysis. Semin Arthritis Rheum. 2014 Oct;44(2):123-30 [full text]
- C. Jenkinson, S. Stewart-Brown, S. Petersen, and C. Paice. Assessment of the SF-36 version 2 in the United KingdomJ Epidemiol Community Health. 1999 Jan; 53(1): 46–50. PMCID: PMC1756775 [abstract]
- SF-36 org
- PRISMA statement
- EQUATOR Network