SF-36健康自测量表

Terms and Conditions for Using the 36-Item Short Form Survey (SF-36)

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

一，使用说明

RAND hereby grants permission to use RAND 36-Item Short Form Health Survey in accordance with the following conditions, which shall be assumed by all to have been agreed to as a consequence of accepting and using this document:

1. Changes to the Health Survey may be made without the written permission of RAND. However, all such changes shall be clearly identified as having been made by the recipient.

2. The user of this Health Survey accepts full responsibility, and agrees to indemnify and hold RAND harmless, for the accuracy of any translations of the Health Survey into another language and for any errors, omissions, misinterpretations, or consequences thereof.

3. The user of this Health Survey accepts full responsibility, and agrees to indemnify and hold RAND harmless, for any consequences resulting from the use of the Health Survey.

4. The user of the 36-Item Health Survey will provide a credit line when printing and distributing this document acknowledging that it was developed at RAND as part of the Medical Outcomes Study. 5. No further written permission is needed for use of this Health Surv

二，英文量表

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

RAND 36-Item Health Survey 1.0 Questionnaire Items SF-36 Resources

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Terms and Conditions for Using the SF-36

MOS 36-Item Short Form Survey Instrument (SF-36)(English PDF) MOS 36-Item Short Form Survey Instrument (SF-36)(Arabic PDF)

Scoring Instructions for MOS 36-Item Short Form Survey Instrument (SF-36)

Choose one option for each questionnaire item.

1. In general, would you say your health is:

1 - Excellent

2 - Very good

3 - Good

4 - Fair

5 - Poor

2. Compared to one year ago, how would you rate your health in general now?

1 - Much better now than one year ago

2 - Somewhat better now than one year ago

3 - About the same

4 - Somewhat worse now than one year ago

5 - Much worse now than one year ago

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?

Yes, limited a Yes, limited a No, not limited at lot little all 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports 4. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf 5. Lifting or carrying groceries 6. Climbing several flights of stairs 7. Climbing one flight of stairs 8. Bending, kneeling, or stooping 9. Walking more than a mile Yes, limited a Yes, limited a No, not limited at lot little all 1 1 1 2 2 2 3 3 3 10. Walking several blocks 11. Walking one block 12. Bathing or dressing yourself 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?

Yes No 1 1 1 1 2 2 2 2 13. Cut down the amount of time you spent on work or other activities 14. Accomplished less than you would like 15. Were limited in the kind of work or other activities 16. Had difficulty performing the work or other activities (for example, it took extra effort) 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)?