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Creation and Initial Validation of a Picture-Based Version of the Limitations of Activity Domain of the SF-36

Stothers, Bennett; Macnab, Andrew John MD

American Journal of Physical Medicine & Rehabilitation: October 2019 - Volume 98 - Issue 10 - p 937–941
doi: 10.1097/PHM.0000000000001256
Brief Report
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Those with limited language comprehension or literacy face problems completing written questionnaires evaluating their health or physical status on which treatment plans are based. This brief report describes how a picture-based version of the 10 items in the limitations of activities section of the short form 36 health survey questionnaire (SF-36) was developed iteratively and then piloted. Study participants were 101 community-living volunteers (58 female and 43 male volunteers aged 18–93 yrs) educated to postsecondary level (52), high school grades 10–12 (44), and grade 9 or less (5). They first completed the picture-based SF-36 LoA and described verbally and in writing what they understood each picture to mean and then completed the English text version of the SF-36 limitations of physical activities domain for comparison assessment. Additional feedback suggested where pictures could be altered to increase information capture. Subjects rated their health as 26.7% excellent, 25.7% very good, 29.8% good, 10.9% fair, and 6.9% poor. Analysis showed strong correlation between text-based SF-36 LoA questions and the picture-based visual score—VSF-36 LoA—(intraclass correlation coefficient = 0.98) with question 10 correlating highest (intraclass correlation coefficient = 0.90) and question 2 lowest (intraclass correlation coefficient = 0.82). The VSF-36 LoA is the first picture-based version of the SF-36; good correlation with the text-based version and global need warrants further development to aid those with limited literacy or language comprehension.

From the Departments of Kinesiology (BS) and Pediatrics (AJM), University of British Columbia, Vancouver, BC, Canada.

All correspondence should be addressed to: Andrew John Macnab, MD, Department of Pediatrics, University of British Columbia, Rm C234, BC Children’s Hospital, 4500 Oak St, Vancouver, BC, Canada V6H 3N1.

Bennett Stothers is in training.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Online date: June 26, 2019

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