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Performance of the Dutch SF-36 version 2 as a measure of health-related quality of life in patients with rheumatoid arthritis

Peter M ten Klooster1*, Harald E Vonkeman12, Erik Taal1, Liseth Siemons1, Lidy Hendriks3, Alphons J L de Jong4, Ellen A J Dutmer5, Piet L C M van Riel6 and Mart A F J van de Laar12

Author Affiliations

1 Department of Psychology, Health and Technology, University of Twente, PO Box 217, Enschede, AE 7500, The Netherlands

2 Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede, The Netherlands

3 Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands

4 Department of Rheumatology, Rijnstate Hospital, Arnhem, The Netherlands

5 Department of Rheumatology, Gelderse Vallei Hospital, Ede, The Netherlands

6 Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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Health and Quality of Life Outcomes 2013, 11:77  doi:10.1186/1477-7525-11-77

Published: 8 May 2013



The aim of this study was to examine the measurement properties of the Dutch SF-36 version 2 (SF-36v2) health survey in patients with rheumatoid arthritis (RA).


Scaling assumptions, internal reliability, and internal construct validity were examined using available data from 1884 RA patients included in the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. External construct validity and responsiveness to change were examined using baseline and 6-month follow-up data from a subset of 387 early RA patients participating in the DREAM remission induction cohort.


The individual items of the SF-36v2 adequately met scaling assumptions, although four items correlated too highly with items from different scales. Internal consistency was high for all eight scales and the physical and mental health components underlying the scales were replicated, supporting the use of the standard scoring algorithms. The SF-36v2 scales demonstrated minimal floor effects and ceiling effects were noteworthy only for the role-physical, social functioning, and role-emotional scales. Correlations with other core measures were as expected and the SF-36v2 showed excellent known-groups validity in distinguishing between patients with low or moderate-high disease activity. All scales related to physical health showed moderate to large responsiveness to change in patients that achieved low disease activity at six months.


The SF-36v2 appears to be a psychometrically sound tool for the assessment of health-related quality of life of Dutch patients with RA.