The health and suffering scale: Item reduction, reliability and validity among women undergoing rehabilitation for exhaustion and long-lasting pain.

The scale was tested only among women undergoing rehabilitation and women students, so it says nothing about men. The reference group was health-care students, not the general population, and the patients were older, less educated and more often job seeking. Sample sizes for factor analysis were at a minimum, with subject-to-item ratios of 8:1 and 6:1, so the factor structure could be misleading. A re-test was done only in students, not in patients, because patients were not expected to be stable during rehabilitation. HSS responses were missing for 9.8% of patient observations; all missing patient responses had no slider movement, and they were treated as zero. Internal consistency was very high (0.95 in patients and 0.94 in students), which the authors said indicates item redundancy. The item reduction may have shifted the construct toward perceived meaning in life rather than broader health and suffering. The scale showed ceiling effects in the student group, limiting separation among healthier women. The study evaluated the scale, not its effect on rehabilitation outcomes.

The authors declared no conflicts of interest and no financial interest. The named funder was AFA Försäkring.

Do not assume this scale is ready to guide treatment decisions for all patients. It was tested only among women, repeat scores in the student group were fair to moderate, and missing patient responses were counted as zero.