Tools

RAND-36 health survey

The RAND 36-Item Health Survey 1.0: the same items as the SF-36

The 36-Item Short Form Survey came out of the RAND Medical Outcomes Study. It is one of the most widely used measures of health-related quality of life in the world. The same 36 questions exist in two forms: the commercially licensed SF-36, and the RAND-36, which RAND publishes as a public document, available without charge. This page uses the RAND version and its official scoring.

The survey produces eight scale scores, each from 0 to 100: physical functioning, role limitations (physical and emotional), energy, emotional well-being, social functioning, pain, and general health. Because it is so widely used, you can compare your scores with published results, including from people with ME/CFS (see below the results).

It takes 5 to 10 minutes. Most questions refer to the past 4 weeks. For a fatigue-specific measure, see the Fatigue Severity Scale. For activity-level functional capacity in ME/CFS, see the FUNCAP questionnaire. For a quick well-being check, see the WHO-5.

This is not a diagnostic tool. The RAND-36 measures self-reported health-related quality of life; it does not diagnose any condition. Discuss your results with your doctor. Source: RAND 36-Item Health Survey 1.0. RAND surveys are public documents, available without charge. Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ. 1993;2(3):217–227.

1. In general, would you say your health is:

2. Compared to one year ago, how would you rate your health in general now?

The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?

3. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports

4. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf

5. Lifting or carrying groceries

6. Climbing several flights of stairs

7. Climbing one flight of stairs

8. Bending, kneeling, or stooping

9. Walking more than a mile

10. Walking several blocks

11. Walking one block

12. Bathing or dressing yourself

During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?

13. Cut down the amount of time you spent on work or other activities

14. Accomplished less than you would like

15. Were limited in the kind of work or other activities

16. Had difficulty performing the work or other activities (for example, it took extra effort)

During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?

17. Cut down the amount of time you spent on work or other activities

18. Accomplished less than you would like

19. Didn't do work or other activities as carefully as usual

20. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?

21. How much bodily pain have you had during the past 4 weeks?

22. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?

These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks…

23. Did you feel full of pep?

24. Have you been a very nervous person?

25. Have you felt so down in the dumps that nothing could cheer you up?

26. Have you felt calm and peaceful?

27. Did you have a lot of energy?

28. Have you felt downhearted and blue?

29. Did you feel worn out?

30. Have you been a happy person?

31. Did you feel tired?

32. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?

How TRUE or FALSE is each of the following statements for you?

33. I seem to get sick a little easier than other people

34. I am as healthy as anybody I know

35. I expect my health to get worse

36. My health is excellent

Understanding your RAND-36 scores

What the score measures

They have the same 36 questions, which came from the Medical Outcomes Study. The SF-36 is distributed with its own scoring rules under licence; the RAND 36-Item Health Survey 1.0 is RAND's version, with a simpler scoring method that is somewhat different, so scores from the two are not always directly comparable. This page uses RAND's scoring.

Each answer is recoded to a value from 0 to 100 using RAND's key, so that a higher value always means better health. The recoded answers are then averaged within eight scales: physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain and general health. There is no overall total, and question 2, on change in health over the past year, is reported on its own.

A score of 50 on a scale means your answers averaged halfway between the worst and best possible responses (RAND scoring instructions).

Score bands

There are no official cut-offs or bands. RAND publishes average scores from 2,471 patients at the start of the Medical Outcomes Study, for example 71 for physical functioning, 52 for energy/fatigue and 70 for emotional well-being. These are averages for patients, not healthy norms, so use them as a rough guide only.

Average scale scores (0 to 100): Medical Outcomes Study patients and people with ME/CFS
ScaleMOS patients (n = 2,471)ME/CFS (n = 170)
Physical functioning7130
Role limitations (physical)5320
Role limitations (emotional)6647
Energy / fatigue5216
Emotional well-being7051
Social functioning7929
Pain7128
General health5725

In a study of 170 people with ME/CFS in England, average scores out of 100 were 30 for physical functioning, 20 for role limitations due to physical health and 16 for vitality (energy), but 51 for mental health. Their summary scores were lower than published averages for 10 other chronic conditions. That study used version 2 of the SF-36 and its own scoring, so the numbers are a rough comparison rather than an exact match.

In that study (Nacul et al. 2011) physical scores were far lower than mental health, the reverse of the pattern in depression. If your profile looks like this, point it out to a clinician.

What a change in score means

No single minimal important change has been published for RAND-36 scales, and we found none for ME/CFS or long COVID. Most questions cover the past 4 weeks, so monthly is the shortest sensible gap. Look for a change that holds over two or more results, on the scales that matter most to you.

What it does not measure

The RAND-36 is a general measure of health-related quality of life. It does not diagnose anything, and it does not ask about post-exertional malaise, so it can miss the cost of activity that comes a day or two later. The post-exertional malaise questionnaire and FUNCAP cover that.

Taking this to your GP or consultant

Bring all eight scale scores with the date, your answer to the health change question, and your saved results over time. Say it is the RAND 36-Item Health Survey, which has the same questions as the SF-36; many clinicians will know it by that name. The physical functioning and role scales give a concrete picture of what you can no longer do, which can support a referral or a benefits claim alongside a clinician's report. It cannot show the cause. See also preparing for a GP appointment.

Sources