SF36健康自测量表.docx

SF36健康自测量表.docx

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SF36健康自测量表

TermsandConditionsforUsingthe36-ItemShortFormSurvey（SF-36）

.rand.org/health/surveys_tools/mos/36-item-short-form.html

一，使用说明

RANDherebygrantspermissiontouseRAND36-ItemShortFormHealthSurveyinaccordancewiththefollowingconditions,whichshallbeassumedbyalltohavebeenagreedtoasaconsequenceofacceptingandusingthisdocument:

1.ChangestotheHealthSurveymaybemadewithoutthewrittenpermissionofRAND.However,allsuchchangesshallbeclearlyidentifiedashavingbeenmadebytherecipient.

2.TheuserofthisHealthSurveyacceptsfullresponsibility,andagreestoindemnifyandholdRANDharmless,fortheaccuracyofanytranslationsoftheHealthSurveyintoanotherlanguageandforanyerrors,omissions,misinterpretations,orconsequencesthereof.

3.TheuserofthisHealthSurveyacceptsfullresponsibility,andagreestoindemnifyandholdRANDharmless,foranyconsequencesresultingfromtheuseoftheHealthSurvey.

4.Theuserofthe36-ItemHealthSurveywillprovideacreditlinewhenprintinganddistributingthisdocumentacknowledgingthatitwasdevelopedatRANDaspartoftheMedicalOutcomesStudy.

5.NofurtherwrittenpermissionisneededforuseofthisHealthSurv

二，英文量表

.rand.org/health/surveys_tools/mos/36-item-short-form/survey-instrument.html

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

 1

 2

 3

5.Liftingorcarryinggroceries

 1

 2

 3

6.Climbing several flightsofstairs

 1

 2

 3

7.Climbing one flightofstairs

 1

 2

 3

8.Bending,kneeling,orstooping

 1

 2

 3

9.Walking morethanamile

 1

 2

 3

10.Walking severalblocks

 1

 2

 3

11.Walking oneblock

 1

 2

 3

12.Bathingordressingyourself

 1

 2

 3

Duringthe past4weeks,haveyouhadanyofthefollowingproblemswithyourworkorotherregulardailyactivities asaresultofyourphysicalhealth?

Yes

No

13.Cutdownthe amountoftime youspentonworkorotheractivities

 1

 2

14. Accomplishedless thanyouwouldlike

 1

 2

15.Werelimitedinthe kind ofworkorotheractivities

 1

 2

16.Had difficulty performingtheworkorotheractivities（forexample,ittookextraeffort）

 1

 2

Duringthe past4weeks,haveyouhadanyofthefollowingproblemswithyourworkorotherregulardailyactivities asaresultofanyemotionalproblems （suchasfeelingdepressedoranxious）?

Yes

No

17.Cutdownthe amountoftime youspentonworkorotheractivities

 1

 2

18. Accomplishedless thanyouwouldlike

 1

 2

19.Didn'tdoworkorotheractivitiesas carefully asusual

 1

 2

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）?

 1-Notatall

 2-Alittlebit

 3-Moderately

 4-Quiteabit

 5-Extremely

Thesequestionsareabouthowyoufeelandhowthingshavebeenwithyou duringthepast4weeks.Foreachquestion,pleasegivetheoneanswerthatcomesclosesttothewayyouhavebeenfeeling.

Howmuchofthetimeduringthe past4weeks...

Allofthetime

Mostofthetime

Agoodbitofthetime

Someofthetime

Alittleofthetime

Noneofthetime

23.Didyoufeelfullofpep?

 1

 2

 3

 4

 5

 6

24.Haveyoubeenaverynervousperson?

 1

 2

 3

 4

 5

 6

25.Haveyoufeltsodowninthedumpsthatnothingcouldcheeryouup?

 1

 2

 3

 4