title: The SF-36 scales are not accurately summarised by independent physical and mental component scores.
abstract: OBJECTIVE
  The Short Form 36 Health Status Questionnaire (SF-36) has eight scales that can be condensed into two components: physical component summary (PCS) and mental component summary (MCS). This paper investigates: (1) the assumption that PCS and MCS are orthogonal, (2) the applicability of a single model to different condition-specific subgroups, and (3) a reduced five-scale model.
  
  
  METHODS
  We performed a secondary analysis of two large-scale data sets that utilised the SF-36: the Health Survey for England 1996 and the Welsh Health Survey 1998. We used confirmatory factor analysis to compare hypothetical orthogonal and oblique factor models, and exploratory factor analysis to derive data-driven models for condition-specific subgroups.
  
  
  RESULTS
  Oblique models gave the best fit to the data and indicated a considerable correlation between PCS and MCS. The loadings of the eight scales on the two component summaries varied significantly by disease condition. The choice of model made an important difference to norm-referenced scores for large minorities, particularly patients with a mental illness or mental-physical comorbidity.
  
  
  CONCLUSIONS
  We recommend that users of the SF-36 adopt the oblique model for calculating PCS and MCS. An oblique five-scale model provides a more universal factor structure without loss of predictive power or reliability.
authors.affiliation: NPCRDC, The University of Manchester, 5th Floor, Williamson Building, Oxford Road, Manchester M13 9PL, UK. mark.hann@manchester.ac.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Hann
authors.forename: David
authors.initials: D
authors.lastname: Reeves
mesh_terms: D004739:England; D005163:Factor Analysis, Statistical; D006304:Health Status; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D015233:Models, Statistical; D011581:Psychological Tests; D011594:Psychometrics; D011795:Surveys and Questionnaires; D014852:Wales