RAND 36-Item Health Survey 1.0: Scoring, Cutoffs & Interpretation
The free version of the original 36 Medical Outcomes Study health items, scored as eight 0-100 scales of physical, emotional and social functioning, pain, energy and general health. Higher scores mean better health.
Usage conditions apply.The RAND 36-Item Health Survey 1.0 is a public document. RAND grants permission to use it without fee or further written permission, provided a credit line acknowledges that it was developed at RAND as part of the Medical Outcomes Study and any wording changes are identified. It contains the same items as the original SF-36 but uses RAND's simpler scoring; 'SF-36' is a trademark of QualityMetric and this page does not use SF-36 scoring or norms.
Choose one option for each item. Items about the past 4 weeks refer to the last four weeks; items about activities refer to how your health limits you now.
Developed at RAND as part of the Medical Outcomes Study. Items reproduced verbatim (US spelling retained); no wording changes have been made.
01
In general, would you say your health is
Item score-
02
Compared to one year ago, how would you rate your health in general now?
Item score-
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?
03
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
Item score-
04
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Item score-
05
Lifting or carrying groceries
Item score-
06
Climbing several flights of stairs
Item score-
07
Climbing one flight of stairs
Item score-
08
Bending, kneeling, or stooping
Item score-
09
Walking more than a mile
Item score-
10
Walking several blocks
Item score-
11
Walking one block
Item score-
12
Bathing or dressing yourself
Item score-
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
Item score-
14
Accomplished less than you would like
Item score-
15
Were limited in the kind of work or other activities
Item score-
16
Had difficulty performing the work or other activities (for example, it took extra effort)
Item score-
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
Item score-
18
Accomplished less than you would like
Item score-
19
Didn't do work or other activities as carefully as usual
Item score-
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?
Item score-
21
How much bodily pain have you had during the past 4 weeks?
Item score-
22
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?
Item score-
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?
Item score-
24
Have you been a very nervous person?
Item score-
25
Have you felt so down in the dumps that nothing could cheer you up?
Item score-
26
Have you felt calm and peaceful?
Item score-
27
Did you have a lot of energy?
Item score-
28
Have you felt downhearted and blue?
Item score-
29
Did you feel worn out?
Item score-
30
Have you been a happy person?
Item score-
31
Did you feel tired?
Item score-
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.)?
Item score-
How TRUE or FALSE is each of the following statements for you.
33
I seem to get sick a little easier than other people
Item score-
34
I am as healthy as anybody I know
Item score-
35
I expect my health to get worse
Item score-
36
My health is excellent
Item score-
Scored locally in your browser - nothing is sent until you choose to.
0 of 36 answered
RAND-360 / 36
Choose one option for each item. Items about the past 4 weeks refer to the last four weeks; items about activities refer to how your health limits you now.
Developed at RAND as part of the Medical Outcomes Study. Items reproduced verbatim (US spelling retained); no wording changes have been made.
01
In general, would you say your health is
Item score-
02
Compared to one year ago, how would you rate your health in general now?
Item score-
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?
03
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
Item score-
04
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Item score-
05
Lifting or carrying groceries
Item score-
06
Climbing several flights of stairs
Item score-
07
Climbing one flight of stairs
Item score-
08
Bending, kneeling, or stooping
Item score-
09
Walking more than a mile
Item score-
10
Walking several blocks
Item score-
11
Walking one block
Item score-
12
Bathing or dressing yourself
Item score-
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
Item score-
14
Accomplished less than you would like
Item score-
15
Were limited in the kind of work or other activities
Item score-
16
Had difficulty performing the work or other activities (for example, it took extra effort)
Item score-
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
Item score-
18
Accomplished less than you would like
Item score-
19
Didn't do work or other activities as carefully as usual
Item score-
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?
Item score-
21
How much bodily pain have you had during the past 4 weeks?
Item score-
22
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?
Item score-
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?
Item score-
24
Have you been a very nervous person?
Item score-
25
Have you felt so down in the dumps that nothing could cheer you up?
Item score-
26
Have you felt calm and peaceful?
Item score-
27
Did you have a lot of energy?
Item score-
28
Have you felt downhearted and blue?
Item score-
29
Did you feel worn out?
Item score-
30
Have you been a happy person?
Item score-
31
Did you feel tired?
Item score-
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.)?
Item score-
How TRUE or FALSE is each of the following statements for you.
33
I seem to get sick a little easier than other people
Item score-
34
I am as healthy as anybody I know
Item score-
35
I expect my health to get worse
Item score-
36
My health is excellent
Item score-
0 of 36 answered
Scoring & cutoffs
How scoring works.
Each response is recoded to a 0-100 value so that a higher score always means better health (RAND Table 1). Each scale score is the mean of the recoded items in that scale (RAND Table 2); items left blank are ignored, so a scale is the average of the items answered. There is no total score and no diagnostic cutoff - scores are compared with a reference population or the person's own baseline. Item 2 (health compared with one year ago) is recoded but reported on its own, not in any scale.
Reference values are the Medical Outcomes Study baseline sample of 2,471 patients with chronic conditions (rand.org scoring page, Table 3): physical functioning 70.6 (SD 27.4), role-physical 53.0 (40.8), role-emotional 65.8 (40.7), energy/fatigue 52.2 (22.4), emotional well-being 70.4 (22.0), social functioning 78.8 (25.4), pain 70.8 (25.5), general health 57.0 (21.1). These are patient means, not general-population norms. RAND's scoring differs from the licensed SF-36 (linear recoding of the general health and pain items; no PCS/MCS).
The RAND 36-Item Health Survey 1.0 is a generic measure of health-related quality of life. It covers eight domains of health as the person experiences them: physical functioning, role limitations caused by physical health, role limitations caused by emotional problems, energy and fatigue, emotional well-being, social functioning, pain and general health perceptions. A single additional item asks how health compares with one year ago. Because it is generic rather than disease-specific, scores can be compared across conditions and against reference populations.
Each domain is reported as a separate 0-100 scale in which higher scores mean better health; there is no total score and no diagnostic cutoff. In mental health services it is most useful as a functional and quality-of-life outcome alongside symptom scales such as the PHQ-9 or GAD-7: it captures whether a person is working, socialising and feeling energetic, not only whether their symptoms have fallen. The items are identical to those of the original SF-36; only the scoring of two scales differs (Hays, Sherbourne & Mazel, 1993).
Where it comes from.
The 36 items were drawn from the longer instruments used in the Medical Outcomes Study (MOS), a large US study of how practice style and health-system factors affected patient outcomes. Ware and Sherbourne published the item set as the MOS 36-Item Short-Form Health Survey (SF-36) in Medical Care in 1992. Hays, Sherbourne and Mazel at RAND then published the RAND 36-Item Health Survey 1.0 in Health Economics in 1993, using the same items with a simpler scoring algorithm and presenting T-scores for the eight scales and two factor-derived physical and mental health composites.
The two instruments diverged commercially rather than scientifically. The SF-36 name became a trademark, with item wording and scoring controlled first by the Medical Outcomes Trust and later licensed through QualityMetric; version 2 requires a licence and fee. RAND released its version as a public document that anyone may use with a credit line. The RAND-36 has since been translated and normed in several countries, including a Dutch general-population study of 1,063 adults (VanderZee et al., 1996) and a Swedish reference study of 3,422 adults (Ohlsson-Nevo et al., 2021).
How well it performs.
Internal consistency is good to excellent. In the MOS baseline sample of 2,471 patients, Cronbach's alpha ranged from 0.78 (pain, general health) to 0.93 (physical functioning). The Swedish general-population study of 3,422 adults reported alphas from 0.82 (general health) to 0.94 (physical functioning), with all eight scales above 0.80 (Ohlsson-Nevo et al., 2021). Factor analysis supports a two-factor structure - physical (physical functioning, role-physical, pain, general health) and mental (energy, social functioning, role-emotional, emotional well-being) - although a Dutch study found the fit only partly satisfactory (VanderZee et al., 1996).
Test-retest data come mainly from the SF-36, which uses the same items: two-week retest correlations ranged from 0.60 (social functioning) to 0.81 (physical functioning) in Brazier et al. (1992). The main weakness is distributional. The two role-limitation scales, built from yes/no items, show marked floor and ceiling effects: in the Swedish sample 64% of respondents scored the maximum on role-emotional and 59% on role-physical, while 19% scored the minimum on role-physical.
0.78–0.93
CRONBACH'S α (MOS)
Eight scales, n=2,471 (Hays et al., 1993)
0.82–0.94
CRONBACH'S α (SWEDEN)
General population, n=3,422 (2021)
0.60–0.81
TEST–RETEST, 2 WK
Same items, SF-36 (Brazier et al., 1992)
64%
CEILING, ROLE-EMOTIONAL
Swedish general population
How it compares to the alternatives.
Instrument
Items
Time
When to reach for it
RAND-36
36 items
~5–10 min
Free with a credit line. Eight 0–100 scales, no total score, no cutoffs.
WHO disability measure, free for non-commercial use. Better when functioning, not health perception, is the question.
Right tool, wrong tool.
The RAND-36 is intended as a patient-reported outcome and profile measure, not a screen. In clinical practice it suits intake and discharge assessment where functioning and quality of life matter as much as symptom counts, service-level outcome monitoring across mixed diagnoses, and research or audit that needs SF-36-comparable domain scores without licence fees. It is completed by the person themselves, on paper or screen, in about five to ten minutes.
Scores should be interpreted against a stated reference - the MOS chronic-illness means, a national general-population norm, or the person's own earlier score - and reported scale by scale. Where a single summary index is needed for health-economic analysis, the EQ-5D is the better choice; where the question is a specific disorder, use a disorder-specific screen and keep the RAND-36 for the functional picture. It was developed and normed in adults and has not been validated for children.
Reach for it when
-A generic health-related quality-of-life outcome alongside symptom scales at intake and discharge.
-Comparing functioning across diagnoses or services where a disease-specific measure would not travel.
-Research or audit that needs SF-36-comparable domain scores without licence fees.
-Capturing role and social functioning that symptom scales such as the PHQ-9 miss.
Reach for something else when
-You need PCS/MCS summary scores or SF-36 national norms - use the licensed SF-36.
-You need a utility index for cost-effectiveness analysis - use the EQ-5D.
-You want a screen or severity measure for a specific disorder; the RAND-36 has no cutoffs.
-Time is tight or the person is very unwell - the WHO-5 or SF-12 is quicker.
-Children or adolescents; the RAND-36 was developed and normed in adults.
Reading the score with care.
Read each scale score against a reference mean and its spread rather than as an exact value. In the MOS sample the standard deviations range from about 21 points (general health) to 41 points (role scales), so a difference of a few points between two people is not meaningful. For change within one person, the commonly cited minimally important difference for RAND-36 and SF-36 scales is 3 to 5 points on the 0-100 scale (Samsa et al., 1999, summarised by Hays & Morales, 2001); many trials treat 5 points as the practical threshold and 10 points as a medium effect. The two role-limitation scales are the least precise: because they are built from yes/no items, one changed answer moves a four-item scale by 25 points, and floor and ceiling effects limit their ability to register change at the extremes.
What it cannot tell you.
The RAND-36 is a descriptive profile, not a diagnostic or screening instrument. It has no total score, no cutoffs and no built-in interpretation, so it is only as useful as the reference data it is compared with; the MOS means published by RAND come from US patients with chronic conditions in the late 1980s, not from a contemporary general population.
The yes/no role-limitation scales are coarse and show substantial floor and ceiling effects, and ceiling effects also appear on social functioning and pain in healthy samples. Two of the emotional well-being items load partly on the energy scale. The instrument was developed and normed in adults; there is no validation for children, and completion by proxy or by people with significant cognitive impairment has not been established. Because RAND scoring differs from SF-36 scoring on the pain and general health scales and lacks PCS/MCS, results are not interchangeable with published SF-36 summary norms, and 'SF-36' should not be used to describe RAND-36 results.
How licensing works.
The RAND 36-Item Health Survey 1.0 is a public document. RAND grants permission to use it without fee or further written permission, provided a credit line acknowledges that it was developed at RAND as part of the Medical Outcomes Study and any wording changes are identified. It contains the same items as the original SF-36 but uses RAND's simpler scoring; 'SF-36' is a trademark of QualityMetric and this page does not use SF-36 scoring or norms.
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