Hurdle

Short Form 12 (SF-12)

screening

Digital administration of Short Form 12 (SF-12) to collect structured patient inputs for validated score calculation and clinical follow-up.

Short Form 12 (SF-12)

Clinical intent

The SF-12 questionnaire (Short Form 12) is a general health questionnaire that allows statements to be made about the patient's state of health over 2 different dimensions. It is the short form of the Short Form 36 questionnaire (SF-36). Some patients have complained that completing 36 questions is cumbersome. Consequently, the originators of the SF-36 developed the SF-12 [1]. Using regression analysis, Ware et al. [1] were able to select 12 questions from the SF-36 that reliably produced scores that mirrored those from the SF-36. This calculation uses the second edition of the calculation as described by Ware et al. [2].

This version of the SF-12 is non-proprietary, and the scores calculated are in reference to the United States population profile at the time of the original publication in 1994. Subsequent updates to the SF-12 have been made that align the scores with more recent U.S. demographics. However, these updates are proprietary, unlike the original SF-12. Although differences in scores between different scoring systems for the sf-12 may be minor, clinicians and researchers should note the version of the SF-12 they are using.

Clinical interpretation

Generally, highest scores indicate better outcome and lowest worse.

References

[1] Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-233. doi:10.1097/00005650-199603000-00003 [2] How To Score the SF-12 Physical & Mental Health Summary Scales (Second Edition) [3] Other

Pathway

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Form preview

Interactive preview of the questionnaire. Not for clinical use. Responses are not stored.

Short Form 12 (SF-12) Questionnaire
Please complete this questionnaire. Your responses help your clinical team assess your symptoms and monitor progress over time.
In general, would you say your health is:
Please select whether your health now limits you when doing moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf?
Please select whether your health now limits you climbing several flights of stairs?
During the PAST FOUR WEEKS, have you ACCOMPLISHED LESS than you would like as a result of your physical health?
During the PAST FOUR WEEKS, were you limited in the KIND of work or other activities you do as a result of your physical health?
During the PAST FOUR WEEKS, did you ACCOMPLISHED LESS than you would like AS A RESULT OF ANY EMOTIONAL PROBLEMS, such as feeling depressed or anxious?
During the PAST FOUR WEEKS, you did not do work or other activities as CAREFULLY as usual AS A RESULT OF ANY EMOTIONAL PROBLEMS, such as feeling depressed or anxious?
During the PAST 4 WEEKS, how much did pain interfere with your normal work (including both work outside the home and housework)?
How much of the time during the PAST 4 WEEKS have you felt calm and peaceful?
How much of the time during the past 4 week did you have a lot of energy?
How much of the time during the PAST 4 WEEKS have you felt downhearted and blue?
How much of the time during the PAST 4 WEEKS has your PHYSICAL HEALTH OR EMOTIONAL PROBLEMS interfered with your social activities (like visiting with friends, relatives, etc.)?