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The Short Health Scale: A Simple, Valid, Reliable, and Responsive Way of Measuring Subjective Health in Patients With Irritable Bowel Syndrome

Krarup, Anne L. MD, PhD*; Peterson, Emma*; Ringström, Gisela RN, PhD*,†; Törnblom, Hans MD, PhD*,†; Hjortswang, Henrik MD‡,§; Simrén, Magnus MD*,†

Journal of Clinical Gastroenterology: August 2015 - Volume 49 - Issue 7 - p 565–570
doi: 10.1097/MCG.0000000000000209
ALIMENTARY TRACT: Original Articles

Goals: To evaluate validity, reliability, and responsiveness of the Short Health Scale (SHS) in irritable bowel syndrome (IBS) patients.

Background: Subjective health assessment is central when treating patients with IBS. The “Short Health Scale” is a quick 4-item questionnaire covering most aspects of subjective health that has been validated for inflammatory bowel disease.

Study: To test validity, 451 patients with IBS (mean age, 38 y; 81% females) completed the SHS and questionnaires assessing IBS symptom severity (IBS-SSS), gastrointestinal (GI)-specific anxiety (VSI), and quality of life (IBSQOL). To evaluate reliability and responsiveness to changes, the questionnaires were repeated after 2 weeks in 18 patients, and after 12 weeks in 212 patients who had completed a patient-education program.

Results: Validity was documented with (1) gradually increasing mean scores for all 4 SHS items with increasing IBS-SSS (P<0.0001), and (2) correlations between the 4 SHS items and the corresponding items from the other subjective health assessment tools [item 1 (symptom burden): ρ=0.67, item 2 (daily function): ρ=−0.44 to −0.46, item 3 (disease-related worry): ρ=−0.51 to 0.57, item 4 (general well-being): ρ=−0.34 to −0.46, P<0.0001]. Reliability was confirmed (Spearman ρ>0.7 and intraclass correlations >0.7). Responsiveness was good with responders to the patient-education program (IBS-SSS reduction ≥50 points) having significant reductions in 3 of the SHS items (P<0.05), and borderline change for the fourth SHS item (P=0.06).

Conclusions: SHS is a health measure that shows promising evidence of validity, reliability, and responsiveness in IBS patients. It is quickly completed and evaluated, which supports its usefulness in the busy clinical practice.

Supplemental Digital Content is available in the text.

*Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy

Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg

Department of Clinical and Experimental Medicine, Division of Gastroenterology and Hepatology, Linköping University

§Department of Gastroenterology and Hepatology, UHL, County Council of Östergötland, Linköping, Sweden

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Supported by the Swedish Medical Research Council (grants 13409, 21691, and 21692), the Marianne and Marcus Wallenberg Foundation, University of Gothenburg, Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, and by the Faculty of Medicine, University of Gothenburg.

A.L.K., E.P., G.R., H.T., and M.S. performed the research, and collected and analyzed the data. A.L.K., E.P., G.R., H.T., H.H., and M.S. designed the research study and wrote the paper. A.L.K., H.H., and M.S. contributed to the design of the study.

H.H. has received unrestricted research grants from Abbvie and Ferring, and served as a Consultant/Advisory Board member for Abbvie, MSD, and Vifor Pharma. M.S. has received unrestricted research grants from Danone and AstraZeneca, and served as a Consultant/Advisory Board member for AstraZeneca, Danone, Novartis, Almirall, and Shire/Movetis. The remaining authors declare that they have nothing to disclose.

Reprints: Anne L. Krarup, MD, PhD, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden (e-mail:

Received March 10, 2014

Accepted June 17, 2014

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