SF-36健康自测量表

TermsandConditionsforUsingthe36-ItemShortFormSurvey(SF-36)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TermsandConditionsforUsingtheSF-36MOS36-ItemShortFormSurveyInstrument(SF-36)(EnglishPDF)MOS36-ItemShortFormSurveyInstrument(SF-36)(ArabicPDF)ScoringInstructionsforMOS36-ItemShortFormSurveyInstrument(SF-36)Chooseoneoptionforeachquestionnaireitem.1.Ingeneral,wouldyousayyourhealthis:1-Excellent2-Verygood3-Good4-Fair5-Poor2.Comparedtooneyearago,howwouldyourateyourhealthingeneralnow?1-Muchbetternowthanoneyearago2-Somewhatbetternowthanoneyearago3-Aboutthesame4-Somewhatworsenowthanoneyearago5-MuchworsenowthanoneyearagoThefollowingitemsareaboutactivitiesyoumightdoduringatypicalday.Doesyourhealthnowlimityouintheseactivities?Ifso,howmuch?Yes,limitedalotYes,limitedalittleNo,notlimitedatall3.Vigorousactivities,suchasrunning,liftingheavyobjects,participatinginstrenuoussports1234.Moderateactivities,suchasmovingatable,pushingavacuumcleaner,bowling,orplayinggolf1235.Liftingorcarryinggroceries1236.Climbingseveralflightsofstairs1237.Climbingoneflightofstairs1238.Bending,kneeling,orstooping1239.Walkingmorethanamile123Yes,limitedalotYes,limitedalittleNo,notlimitedatall10.Walkingseveralblocks12311.Walkingoneblock12312.Bathingordressingyourself123Duringthepast4weeks,haveyouhadanyofthefollowingproblemswithyourworkorotherregulardailyactivitiesasaresultofyourphysicalhealth?YesNo13.Cutdowntheamountoftimeyouspentonworkorotheractivities1214.Accomplishedlessthanyouwouldlike1215.Werelimitedinthekindofworkorotheractivities1216.Haddifficultyperformingtheworkorotheractivities(forexample,ittookextraeffort)12Duringthepast4weeks,haveyouhadanyofthefollowingproblemswithyourworkorotherregulardailyactivitiesasaresultofanyemotionalproblems(suchasfeelingdepressedoranxious)?YesNo17.Cutdowntheamountoftimeyouspentonworkorotheractivities1218.Accomplishedlessthanyouwouldlike1219.Didn'tdoworkorotheractivitiesascarefullyasusual1220.Duringthepast4weeks,towhatextenthasyourphysicalhealthoremotionalproblemsinterferedwithyournormalsocialactivitieswithfamily,friends,neighbors,orgroups?1-Notatall2-Slightly3-Moderately4-Quiteabit5-Extremely21.Howmuchbodilypainhaveyouhadduringthepast4weeks?1-None2-Verymild3-Mild4-Moderate5-Severe6-Verysevere22.Duringthepast4weeks,howmuchdidpaininterferewithyournormalwork(includingbothworkoutsidethehomeandhousework)?1-Notatall2-Alittlebit3-Moderately4-Quiteabit5-ExtremelyThesequestionsareabouthowyoufeelandhowthingshavebeenwithyouduringthepast4weeks.Foreachquestion,pleasegivetheoneanswerthatcomesclosesttothewayyouhavebeenfeeling.Howmuchofthetimeduringthepast4weeks...AllofthetimeMostofthetimeAgoodbitofthetimeSomeofthetimeAlittleofthetimeNoneofthetime23.Didyoufeelfullofpep?12345624.Haveyoubeenaverynervousperson?12345625.Haveyoufeltsodowninthedumpsthatnothingcouldcheeryouup?123456AllofthetimeMostofthetimeAgoodbitofthetimeSomeofthetimeAlittleofthetimeNoneofthetime26.Haveyoufeltcalmandpeaceful?12345627.Didyouhavealotofenergy?12345628.Haveyoufeltdownheartedandblue?12345629.Didyoufeelwornout?12345630.Haveyoubeenahappyperson?12345631.Didyoufeeltired?12345632.Duringthepast4weeks,howmuchofthetimehasyourphysicalhealthoremotionalproblemsinterferedwithyoursocialactivities(likevisitingwithfriends,relatives,etc.)?1-Allofthetime2-Mostofthetime3-Someofthetime4-Alittleofthetime5-NoneofthetimeHowTRUEorFALSEiseachofthefollowingstatementsforyou.DefinitelytrueMostlytrueDon'tknowMostlyfalseDefinitelyfalse33.Iseemtogetsickalittleeasierthanotherpeople1234534.IamashealthyasanybodyIknow1234535.Iexpectmyhealthtogetworse1234536.Myhealthisexcellent12345健康状况调查问卷（SF－36）及其使用说明健康状况调查问卷（SF－36）以下问题是询问您对自己健康状况的看法，您自己觉得做日常活动的能力怎么样。如果您不知如何回答是好，就请您尽量给出最好的答案，并在本问卷最后的空白处写上你的注释与评论。请√一个答案1.总体来讲，您的健康状况是：非常好很好○好○□一般○差○2．跟一年前相比，您觉得您现在的健康状况是：比一年前好多了○比一年前好一些○跟一年前差不多○□比一年前差一些○比一年前差多了○健康和日常活动3．以下这些问题都与日常活动有关。请您想一想，您的健康状况是否限制了这些活动？如果有限制，程度如何？请在每一行√一个答案有限制有限制毫无限制很大有些限制限制（l）重体力活动，如：跑步、举重物、参加