Quality of Life Concepts

Secondary Health Conditions

The Short Form Health Survey (SF-12)

Description: A measure of perceived health (health-related quality of life [QoL]) that describes the degree of general physical health status and mental health distress [1].

Format: 12 items, derived from the physical and mental domains of the Short Form Health Survey-36 (SF-36).

Scoring: Norm-based. Separate summary scores are obtained for each of the physical and mental domains by summing across all 12 items for each. Higher scores indicate higher levels of health. Published data and norms for most health conditions in the general population have been reported for Canada and the USA.

Administration and Burden: Interviewer-administered; Self-administered. Approximately 3 minutes.

Psychometrics for SCI: In a study of veterans with SCI, the SF-12 was reported to have good discriminant function, convergent validity, and correlated strongly with the SF-36 [2].  However, a more thorough testing of its psychometric strengths is needed [2].

Languages: The SF-12 has been translated for use in over 40 languages.

QoL Concept: The SF-12 is a measure Health-Related QoL, which corresponds to Boxes B (societal standards and priorities) and C (achievements; health-related QoL) of Dijker’s Model.

Permissions/Where to Obtain: Copyrighted; The SF-12 can be purchased at the SF-36 website at: http://www.sf-36.org/.


  1. Ware JE, Kosinski M, Keller SD. How to Score the SF-12 Physical and Mental Health Summary Scales. 2nd ed. Boston: The Health Institute, New England Medical Center; 1995.

  2. Andresen EM, Fouts BS, Romeis JC, Brownson CA. Performance of health-related quality-of-life instruments in a spinal cord injured population. Arch Phys Med Rehabil 1999;80:877-84.

  3. Andresen EM, Meyers AR. Health-related quality of life outcomes measures. Arch Phys Med Rehabil 2000;81:S30-S45.


Pain SCI Studies: One longitudinal survey, two case-control study, one cross-sectional survey, one prospective longitudinal study.

  1. Putzke JD, Richards JS, Hicken BL, DeVivo MJ. Interference due to pain following spinal cord injury: important predictors and impact on quality of life. Pain 2002;100:231-42.

  2. Putzke JD, Richards JS, Dowler RN. The impact of pain in spinal cord injury: A case-control study. Rehabil Psychol 2000; 45:386-401.

  3. Cardenas DD, Bryce TN, Shem K, Richards JS, Elhefni H. Gender and minority differences in the pain experience of people with spinal cord injury. Arch Phys Med Rehabil 2004;85:1774-81.

  4. Nicholson Perry K, Nicholas MK, Middleton J, Siddall P. Psychological characteristics of people with spinal cord injury-related persisting pain referred to a tertiary pain management center. J Rehabil Res Dev  2009;46: 57-68.

  5. Wilson MW, Richards JS, Klapow JC, DeVivo MJ, Greene P. Cluster analysis and chronic pain: An empirical classification of pain subgroups in a spinal cord injury sample. Rehabil Psychol 2005;50:381-8.

Sensitivity to Impact: Putzke and colleagues (2002) conducted two studies on the predictive validity of multiple demographic, medical, and quality of life (QoL) variables after spinal cord injury (SCI), including the Craig Handicap and Assessment Reporting Technique (CHART), the Satisfaction with Life Scale (SWLS), and the Short-Form 12 (SF-12). The first study examined the predictive validity of these variables at 1 year post-SCI to self-reported interference 2 years post-injury. The prevalence of interference in daily activities secondary to pain decreased from year 1 to year 2. Higher satisfaction with life, physical health, and mental health at year 1 were associated with lower likelihood of pain interference at year 2.

The second study examined the predictive validity of the same variables in four groups of participants: (1) pain-free at years 1 and 2; (2) pain-free at year 1 and in pain at year 2; (3) in pain at year 1 and pain-free at year 2; (4) in pain at years 1 and 2. Groups 1 and 4 had similar levels of self-reported QoL, whereas groups 2 and 3 showed considerable difference in self-reported QoL across several domains. Higher scores on the mobility and social integration scales of the CHART were associated with lower levels of self-reported pain interference.

Putzke and colleagues (2000) examined the impact of pain on functioning across multiple QoL domains among males with SCI (N = 172; n = 86 with no pain interference, and n = 86 with extreme pain interference) using the CHART, the SWLS, and the SF-12. No group differences were found on the CHART physical independence and occupation sub-scales. Compared to the no pain interference group, the extreme pain interference group had significantly lower scores on the SWLS, the CHART total score, and the SF-12 physical health summary and mental summary.

Cardenas and colleagues (2004) used the SF-12 to examine gender and minority differences in the prevalence and severity of pain in persons with SCI (N = 7379) at 1, 5, 10, 15, 20, and 25 years post-injury (YPI). The prevalence of pain interference with work (PIWW) decreased over time, with the exception of women at 15 YPI, who reported higher PIWW than men. In addition, regression analyses showed that gender and YPI were significant predictors of PIWW.

Nicholson Perry and colleagues (2009) used the Multidimensional Pain Inventory - SCI Version (MPI-SCI), the SF-12, and the Hospital Anxiety and Depression Scale (HADS) to examine the psychological characteristics of a cohort of individuals with SCI and persisting pain (N = 45). Persons with SCI-related chronic pain had less life interference as measured by the sub-scale of the MPI-SCI than the general pain population, but received lower scores on the SF-12 mental component sub-scale. Usual pain intensity was significantly, but weakly, associated only with the MPI-SCI Life Interference subscale. There were no differences on the SF-12 physical functioning sub-scale between the group with SCI and pain, and the general pain sample.

Wilson and colleagues (2005) used a numerical rating scale of pain, one item on pain interference from the SF-12, and the Brief Patient Health Questionnaire (BPHQ) to determine the existence of homogeneous SCI pain sub-groups. Cluster analysis revealed 4 pain subgroups: 1) Low pain, characterized by low pain intensity, interference, and depression; 2) Positive adaptation to pain, characterized by high pain intensity, and low pain interference and depression; 3) Minimal distress, characterized by high pain intensity and pain interference, and low depression, and 4) Chronic pain syndrome, characterized by high pain intensity, interference, and depression.

Suggestions for Use: The SF-12 appears to be sensitive to the impact of SCI-related chronic pain but there are a number of noted issues with the tool.  

There is little evidence for the utility of the SF-12, as it only assesses mental and physical aspects. Retest and proxy reliability have not been reported, and it has been found to yield less precise scores than its longer version, the SF-36 [1]. In light of these limitations, it would be more prudent to use the SF-36 whenever possible. The SF-12 was found to have good discriminant function, convergent validity, and correlated strongly with the SF-36 [2] but more thorough testing of the psychometric properties of SF-12 is needed for the SCI population.

Despite these limitations, the SF-12 is thought to be more appropriate than the SF-36 by persons with SCI as it does not contain repeated questions about walking/climbing [2].

A few positive reports have been made regarding the tool’s ability to measure changes over time (e.g., between initial assessment and discharge).

The SF-12 has been used in several studies in persons with SCI, and endorsed as a valid measure in persons with chronic SCI [3]. The SF-12 is also collected by the National Spinal Cord Injury Statistical Centre (NSCISC) Database.

Additional References:

  1. Andresen EM, Meyers AR. Health-related quality of life outcomes measures. Arch Phys Med Rehabil 2000;81:S30-S45.

  2. Dunn J, Sinnott KA, Nunnerley J, Scheuringer M. Utilisation of patient perspective to validate clinical measures of outcome following spinal cord injury. Disabil Rehabil 2009;31:967-75.

  3. Andresen EM, Fouts BS, Romeis JC, Brownson CA. Performance of health-related quality-of-life instruments in a spinal cord injured population. Arch Phys Med Rehabil 1999;80:877-84.

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