Single-change items did not measure change in quality of life

Adam J. Rose*, Naomi C. Sacks, Abhijit P. Deshpande, Shanta Y. Griffin, Howard J. Cabral, Lewis E. Kazis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objectives: The aim of this study was to demonstrate validity for the two items in the Veterans RAND 36 Item Health Survey (VR-36) that attempt to measure the change in health-related quality of life (HRQOL) over 1 year, using serial administrations of the full instrument as a gold standard. Study Design and Setting: A total of 1,117 subjects in the Veterans Health Study completed the VR-36 instrument at study inception and 1 year later. Using nonparametric correlation and factor analyses, we compared the single-change items (SCIs) with 1-year changes in the physical component score (PCS) and mental component score (MCS), the summary scores of the VR-36. Results: We found low correlations between the SCI and longitudinal changes in the PCS (0.21) and MCS (0.18) and moderate correlations between the SCI and the current PCS (0.50) and MCS (0.41). Factor analyses confirmed that the SCI loaded highly with current HRQOL. Conclusions: The two SCIs contained in the VR-36, which are intended to measure changes in health over the past year, are more highly correlated with current self-reported HRQOL. In this instrument, single-item measurements of health status change cannot be substituted for changes in serial measures of HRQOL.

Original languageAmerican English
Pages (from-to)603-608
Number of pages6
JournalJournal of Clinical Epidemiology
Issue number6
StatePublished - Jun 2008
Externally publishedYes

Bibliographical note

Funding Information:
The VHS was originally supported by grant SDR 91006.S from the Health Services Research and Development Service, Veterans Health Administration. This study was also supported by the Department of Health Policy and Management at the Boston University School of Public Health. Dr. Rose is supported by a training grant from the Department of Veterans Affairs Office of Academic Affairs, and by a Physician Training Award (PTAPM-97-185-04) from the American Cancer Society. Mr. Deshpande is supported by grants TI14430 and TI16675 from the Substance Abuse and Mental Health Services Administration and the Center for Substance Abuse Treatment. Dr. Griffin is supported by ARRTP grant #H133P020011 of the National Institute on Disability and Rehabilitation Research. SF-36 ® is a registered trademark of the Medical Outcomes Trust. The opinions expressed are the responsibility of the authors and do not necessarily represent the official views of the Department of Veterans Affairs or the National Institute on Disability and Rehabilitation Research. The authors thank Gabriel Shapiro for his expert technical assistance.


  • Change in health status
  • Global health status
  • Health services
  • Psychometrics
  • Quality of life
  • Veterans


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