Table of Contents

Quality of Life (RAND-36)

The RAND-36 measures ‘Health Related Quality of Life’, i.e. how health impacts an individual’s ability to function and his or her perceived well-being in physical, mental and social domains of life1). Section: Wellbeing & subjective health.
The RAND-36 is highly similar to the Short Form (36) Health Survey.
The full RAND-36 was performed at baseline and in the additional questionnaire EARQ. At several other assessments, only the first two items were assessed.
Note that quality of life is also assessed in Lifelines using the SWLS and EQ5D instruments.

Background

The RAND-36 is comprised of 36 items selected from a larger pool of items used in the RAND Medical Outcomes Study (MOS).
Twenty of the items are administered using a past 4 weeks reporting interval. RAND-36 assesses eight health concepts with multi item scales (35 items):

The additional items assess the general health perceived by participants (all on a 5-point Likert scale), either at the time of the questionnaire (RAND1), compared to a year ago (RAND2), or compared to the time of the previous questionnaire (RAND2A).

Scoring

Scores between 0-100% can be calculated for each of the eight domains/scales. A higher score is indicative for higher well-being.
In addition, domains representing physical and mental health can be summarized into a “physical component score” and a “mental component score”. Standard scoring procedures and syntaxes are available from Lifelines at request.

Validity

The reliability and validity of the RAND 36-Item Health Survey 1.0 were investigated in a population sample of 1,063 inhabitants of a Dutch township (Emmen), all age 18 or older. 35% were male and 65% were female and the mean age of the sample was 44.1 years 2).

To assure content validity in comparison with accepted definitions of health, multiple dimensions of health were included to the RAND-36 questionnaire. Dimensions of health that were most frequently included in health questionnaires, i.e. physical, social- and role functioning, mental health and general health perceptions were included. Two dimensions were included for which substantial empirical evidence existed, i.e. pain and vitality.
The predictive value of the RAND-36 has been established using the prevalence of chronic complaints as criterion. Step-wise multiple regression showed that the eight RAND-36-scales explained 41% variance of the number of chronic conditions, 34% of the number of chronic conditions requiring a medical consult and 29% of the conditions for which drugs were prescribed.
Construct validity of the RAND-36 is indicated by:

The internal consistency of the RAND-36 was moderate to high. Cronbach’s alpha values for the various scales varied from 0.71 for social functioning to 0.92 for physical functioning.
Test-retest correlations were based on repeated measurements after two and six months in groups of 159 and 410 persons respectively. Test-retest correlations using a two month time interval varied from 0.58 for social functioning to 0.82 for physical functioning. Using a six months interval, the test-retest correlations varied from 0.40 (role restrictions due to emotional problem) to 0.75 (general health perception). This is acceptable for an instrument that is required sensitive to health changes over time.
Responsiveness of the SF-36 (which is highly identical to RAND-36) has been demonstrated in the Whitehall II longitudinal cohort study (n=7267, mean follow-up=36 months)3). In this study, within-person change in scores on the SF-36 by age, sex, employment grade and disease status were measured. Health functioning, as measured by the SF-36 changed in hypothesized directions with age, employment grade and disease status, suggesting that the SF-36 and RAND-36 are sensitive to changes in health in general populations.
See also: 4) and 5).

Papers using Lifelines RAND-36 data

Variables

Label English Label Dutch Code Variable Assessment Age
How would you rate your health, generally speaking? Wat vindt u, over het algemeen genomen, van uw gezondheid? rand_generalhealth_adu_q_01 RAND1 1A 1B 1C 2A 2B 3A 3B ACTQ COVQ EARQ MAWQ NEXT 18+
Compared to a year ago, how would you rate your health, generally speaking? In vergelijking met een jaar geleden, hoe zou u nu uw gezondheid in het algemeen beoordelen? rand_generalhealth_adu_q_02 RAND2 1A 1B 1C 2A 2B 3A 3B EARQ NEXT 18+
compared to the time you filled in [lifelines questionnaire 2a-1], how would you rate your health, generally speaking? in vergelijking met de keer dat u [lifelines vragenlijst 2a-1] invulde, hoe zou u nu uw gezondheid in het algemeen beoordelen? rand_generalhealth_adu_q_02_v2 RAND2A ACTQ 18+
Does your health now limit you in the following activities? Wordt u door op dit moment beperkt bij deze bezigheden? Zo ja, in welke mate?
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports. Forse inspanning zoals hardlopen, zware voorwerpen tillen, inspannend sporten/ rand_physical_adu_q_03_a RAND3A 1A 3A EARQ 18+
Moderate activities, such as moving a table, pushing a vacuum cleaner, bicycling. Matige inspanning zoals het verplaatsen van een tafel, stofzuigen, fietsen rand_physical_adu_q_03_b RAND3B 1A 3A EARQ 18+
Lifting or carrying groceries. Tillen of boodschappen dragen rand_physical_adu_q_03_c RAND3C 1A 3A EARQ 18+
Climbing several flights of stairs. Een paar trappen oplopen rand_physical_adu_q_03_d RAND3D 1A 3A EARQ 18+
Climbing one flight of stairs. Een trap oplopen rand_physical_adu_q_03_e RAND3E 1A 3A EARQ 18+
Bending, kneeling or stooping. buigen, knielen of bukken rand_physical_adu_q_03_f RAND3F 1A 3A EARQ 18+
Walking more than a kilometer. meer dan een kilometer lopen rand_physical_adu_q_03_g RAND3G 1A 3A EARQ 18+
Walking half a kilometer. een halve kilometer lopen rand_physical_adu_q_03_h RAND3H 1A 3A EARQ 18+
Walking one hundred meters. honderd meter lopen rand_physical_adu_q_03_i RAND3I 1A 3A EARQ 18+
Bathing or dressing yourself. uzelf wassen of aankleden rand_physical_adu_q_03_j RAND3J 1A 3A EARQ 18+
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 state? Had u, ten gevolge van uw lichamelijke gezondheid, de afgelopen 4 weken een van de volgende problemen bij uw werk of andere dagelijkse bezigheden?
Cut down the amount of time you spent on work or other activities. U hebt minder tijd kunnen besteden aan werk of andere bezigheden rand_limitations_adu_q_04_a RAND4A 1A 3A EARQ 18+
Accomplished less than you would like. U hebt minder bereikt dan u zou willen rand_limitations_adu_q_04_b RAND4B 1A 3A EARQ 18+
Were limited in the kind of work or other activities. U was beperkt in het soort werk of het soort bezigheden rand_limitations_adu_q_04_c RAND4C 1A 3A EARQ 18+
Had difficulty performing the work or other activities (for example, it took extra effort). U had moeite met het werk of andere bezigheden (het kostte u bijvoorbeeld extra inspanning) rand_limitations_adu_q_04_d RAND4D 1A 3A EARQ 18+
Cut down the amount of time you spent on work or other activities. U hebt minder tijd kunnen besteden aan werk of andere bezigheden rand_limitations_adu_q_05_a RAND5A 1A 3A EARQ 18+
Accomplished less than you would like. U hebt minder bereikt dan u zou willen rand_limitations_adu_q_05_b RAND5B 1A 3A EARQ 18+
Didn't do work or other activities as carefully as usual. U hebt het werk of andere bezigheden niet zo zorgvuldig gedaan als u gewend bent rand_limitations_adu_q_05_c RAND5C 1A 3A EARQ 18+
During the past 4 weeks, to what extent has your Physical state or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups? In hoeverre heeft uw lichamelijke gezondheid of hebben uw emotionele problemen u de afgelopen 4 weken belemmerd in uw normale sociale bezigheden met gezin, vrienden, buren of anderen? rand_social_adu_q_06(_v2) RAND6 1A 3A EARQ 18+
How much bodily pain have you had during the past 4 weeks? Hoeveel pijn had u de afgelopen 4 weken? rand_pain_adu_q_07 RAND7 1A 3A EARQ 18+
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? In welke mate heeft pijn u de afgelopen vier weken belemmerd bij uw normale werkzaamheden (zowel werk buitenshuis als huishoudelijk werk)? rand_pain_adu_q_08(_v2) RAND8 1A 3A EARQ 18+
How much of the time during the past 4 weeks Hoe heeft u zich de afgelopen 4 weken gevoeld? 1A 3A EARQ
Did you feel full of pep? Voelde u zich levenslustig? rand_energy_adu_q_09_a RAND9A 1A 3A EARQ 18+
Have you been a very nervous person? Voelde u zich erg zenuwachtig? rand_emotional_adu_q_09_b RAND9B 1A 3A EARQ 18+
Have you felt so down in the dumps that nothing could cheer you up? Zat u zo erg in de put dat niets u kon opvrolijken? rand_emotional_adu_q_09_c RAND9C 1A 3A EARQ 18+
Have you felt calm and peaceful? Voelde u zich kalm en rustig? rand_emotional_adu_q_09_d RAND9D 1A 3A EARQ 18+
Did you have a lot of energy? voelde u zich erg energiek?/ Hoe heeft u zich de afgelopen 4 weken gevoeld? rand_energy_adu_q_09_e RAND9E 1A 3A EARQ 18+
Have you felt downhearted and blue? Voelde u zich neerslachtig en somber? rand_emotional_adu_q_09_f RAND9F 1A 3A EARQ 18+
Did you feel worn out? Voelde u zich uitgeblust? rand_energy_adu_q_09_g RAND9G 1A 3A EARQ 18+
Have you been a happy person? Voelde u zich gelukkig? rand_emotional_adu_q_09_h RAND9H 1A 3A EARQ 18+
Did you feel tired? Voelde u zich moe? rand_energy_adu_q_09_i RAND9I 1A 3A EARQ 18+
Did you feel control over your life? Voelde u controle over uw leven? EQRAND9J EARQ 18+
During the past 4 weeks, how much of the time has your Physical state or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)? Hoe vaak hebben uw lichamelijke gezondheid of emotionele problemen gedurende de afgelopen 4 weken uw sociale activiteiten (zoals bezoek aan vrienden of naaste familieleden) belemmerd? rand_social_adu_q_10(_v2) RAND10 1A 3A EARQ 18+
True or False? Waar of niet waar?
I seem to get sick a little easier than other people. Ik lijk gemakkelijker ziek te worden dan andere mensen rand_perception_adu_q_11_a RAND11A 1A 3A EARQ 18+
I am as healthy as anybody I know. Ik ben net zo gezond als andere mensen die ik ken rand_perception_adu_q_11_b RAND11B 1A 3A EARQ 18+
I expect my health to get worse. Ik verwacht dat mijn gezondheid achteruit zal gaan rand_perception_adu_q_11_c RAND11C 1A 3A EARQ 18+
My health is excellent. Mijn gezondheid is uitstekend rand_perception_adu_q_11_d RAND11D 1A 3A EARQ 18+
1)
Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med 2001; 33:350-357
2)
Van der Zee K, Sanderman R. Het meten van de algemene gezondheidstoestand met de RAND-36: een handleiding. Groningen: Noordelijk Centrum voor Gezondheidsvraagstukken; 1993
3)
Hemmingway H et al. Is the SF-36 a valid measure of change in population health? Results from the Whitehall II study. BMJ 1997; 315:1273-9
4)
Ware JE, Koskinski M, Keller SD. SF-36 physical and mental health summary scales: A user's manual 2nd ed. The Health Institute, Boston MA: 1994
5)
van der Zee K, Sanderman R, Heyink JW, de Haes H. Psychometric qualities of the RAND 36-item Health Survey 1.0: A Multidimensional Measure of General Health Status. Int J Behav Med 1996; 3(2):104-22