SF36健康自测量表Word文档格式.docx

SF36健康自测量表Word文档格式.docx

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RAND36-ItemHealthSurvey1.0QuestionnaireItems

SF-36Resources

∙TermsandConditionsforUsingtheSF-36

∙MOS36-ItemShortFormSurveyInstrument（SF-36）（EnglishPDF）

∙MOS36-ItemShortFormSurveyInstrument（SF-36）（ArabicPDF）

∙ScoringInstructionsforMOS36-ItemShortFormSurveyInstrument（SF-36）

Chooseoneoptionforeachquestionnaireitem.

1.Ingeneral,wouldyousayyourhealthis:

1-Excellent

2-Verygood

3-Good

4-Fair

5-Poor

2. 

Comparedtooneyearago,howwouldyourateyourhealthingeneral 

now?

1-Muchbetternowthanoneyearago

2-Somewhatbetternowthanoneyearago

3-Aboutthesame

4-Somewhatworsenowthanoneyearago

5-Muchworsenowthanoneyearago

Thefollowingitemsareaboutactivitiesyoumightdoduringatypicalday.Does 

yourhealthnowlimityou 

intheseactivities?

Ifso,howmuch?

Yes,limitedalot

Yes,limitedalittle

No,notlimitedatall

3. 

Vigorousactivities,suchasrunning,liftingheavyobjects,participatinginstrenuoussports

1

2

3

4. 

Moderateactivities,suchasmovingatable,pushingavacuumcleaner,bowling,orplayinggolf

5.Liftingorcarryinggroceries

6.Climbing 

several 

flightsofstairs

7.Climbing 

one 

flightofstairs

8.Bending,kneeling,orstooping

9.Walking 

morethanamile

10.Walking 

severalblocks

11.Walking 

oneblock

12.Bathingordressingyourself

Duringthe 

past4weeks,haveyouhadanyofthefollowingproblemswithyourworkorotherregulardailyactivities 

asaresultofyourphysicalhealth?

Yes

No

13.Cutdownthe 

amountoftime 

youspentonworkorotheractivities

14. 

Accomplishedless 

thanyouwouldlike

15.Werelimitedinthe 

kind 

ofworkorotheractivities

16.Had 

difficulty 

performingtheworkorotheractivities（forexample,ittookextraeffort）

asaresultofanyemotionalproblems 

（suchasfeelingdepressedoranxious）?

17.Cutdownthe 

18. 

19.Didn'

tdoworkorotheractivitiesas 

carefully 

asusual

20.Duringthe 

past4weeks,towhatextenthasyourphysicalhealthoremotionalproblemsinterferedwithyournormalsocialactivitieswithfamily,friends,neighbors,orgroups?

1-Notatall

2-Slightly

3-Moderately

4-Quiteabit

5-Extremely

21.Howmuch 

bodily 

painhaveyouhadduringthe 

past4weeks?

1-None

2-Verymild

3-Mild

4-Moderate

5-Severe

6-Verysevere

22.Duringthe 

past4weeks,howmuchdid 

pain 

interferewithyournormalwork（includingbothworkoutsidethehomeandhousework）?

2-Alittlebit

Thesequestionsareabouthowyoufeelandhowthingshavebeenwithyou 

duringthepast4weeks.Foreachquestion,pleasegivetheoneanswerthatcomesclosesttothewayyouhavebeenfeeling.

Howmuchofthetimeduringthe 

past4weeks...

Allofthetime

Mostofthetime

Agoodbitofthetime

Someofthetime

Alittleofthetime

Noneofthetime

23.Didyoufeelfullofpep?

4

5

6

24.Haveyoubeenaverynervousperson?

25.Haveyoufeltsodowninthedumpsthatnothingcouldcheeryouup?