SF-36健康自测量表

1、TermsandConditionsforUsingthe36-ItemShortFormSurvey(SF-36)/health/surveys_tools/mos/36-item-short-form.html一，使用说明RANDherebygrantspermissiontouseRAND36-ItemShortFormHealthSurveyinaccordancewiththefollowingconditions,whichshallbeassumedbyalltohavebeenagreedtoasaconsequenceofaccepting

2、andusingthisdocument:1. ChangestotheHealthSurveymaybemadewithoutthewrittenpermissionofRAND.However,allsuchchangesshallbeclearlyidentifiedashavingbeenmadebytherecipient.2. TheuserofthisHealthSurveyacceptsfullresponsibility,andagreestoindemnifyandholdRANDharmless,fortheaccuracyofanytranslationsoftheHe

3、althSurveyintoanotherlanguageandforanyerrors,omissions,misinterpretations,orconsequencesthereof.3. TheuserofthisHealthSurveyacceptsfullresponsibility,andagreestoindemnifyandholdRANDharmless,foranyconsequencesresultingfromtheuseoftheHealthSurvey.4. Theuserofthe36-ItemHealthSurveywillprovideacreditlin

4、ewhenprintinganddistributingthisdocumentacknowledgingthatitwasdevelopedatRANDaspartoftheMedicalOutcomesStudy.5. NofurtherwrittenpermissionisneededforuseofthisHealthSurv二，英文量表/health/surveys_tools/mos/36Jtem-short-form/survey-instrument.htmlRAND36-ItemHealthSurvey1.0QuestionnaireIte

5、msSF-36Resources?TermsandConditionsforUsingtheSF-36?MOS36-ItemShortFormSurveyInstrument(SF-36)(EnglishPDF)?MOS36-ItemShortFormSurveyInstrument(SF-36)(ArabicPDF)?ScoringInstructionsforMOS36-ItemShortFormSurveyInstrument(SF-36)Chooseoneoptionforeachquestionnaireitem.1. Ingeneral,wouldyousayyourhealthi

6、s:1 -Excellent2 -Verygood3-Good口4-Fairnow5-Poor2. Comparedtooneyearago,howwouldyourateyourhealthingeneral1-Muchbetternowthanoneyearago上2-Somewhatbetternowthanoneyearago3-Aboutthesame4-SomewhatworsenowthanoneyearagoI5-MuchworsenowthanoneyearagoThefollowingitemsareaboutactivitiesyoumightdoduringatypic

7、alday.Doesyourhealthnowlimityouintheseactivities?Ifso,howmuch?3. Vigorousactivities,suchasrunning,liftingheavyobjects,participatinginstrenuoussports4. Moderateactivities,suchasmovingatable,pushingavacuumcleaner,bowling,orplayinggolf5. Liftingorcarryinggroceries6. Climbingseveralflightsofstairs7. Cli

8、mbingoneflightofstairs8. Bending,kneeling,orstoopingYes,limitedaYes,limitedaNo,notlimitedatlotlittleall口12r3123123c123r12312r31E2r-39. Walkingmorethanamile10. Walkingseveralblocks11. Walkingoneblock12. BathingordressingyourselfYes,limitedaYes,limitedaNo,notlimitedatlotlittleall1231231 23Duringthepas

9、t4weeks,haveyouhadanyofthefollowingproblemswithyourworkorotherregulardailyactivitiesasaresultofyourphysicalhealth?YesNo213. Cutdowntheamountoftimeyouspentonworkorotheractivities14. Accomplishedlessthanyouwouldlike15. Werelimitedinthekindofworkorotheractivities16. Haddifficultyperformingtheworkorothe

10、ractivities(forexample,ittookextraeffort)Duringthepast4weeks,haveyouhadanyofthefollowingproblemswithyourworkorotherregulardailyactivitiesasaresultofanyemotionalproblems(suchasfeelingdepressedoranxious)?YesNo1212因用217. Cutdowntheamountoftimeyouspentonworkorotheractivities18. Accomplishedlessthanyouwo

11、uldlike19. Didntdoworkorotheractivitiesascarefullyasusual20. Duringthepast4weeks,towhatextenthasyourphysicalhealthoremotionalproblemsinterferedwithyournormalsocialactivitieswithfamily,friends,neighbors,orgroups?1-Notatallu2-Slightly二3-Moderately4-Quiteabitc5-Extremely21. Howmuchbodilypainhaveyouhadd

12、uringthepast4weeks?t1-None2-Verymild岂3-MildLI4-Moderate5-Severe6-Verysevere22. Duringthepast4weeks,howmuchdidpaininterferewithyournormalwork(includingbothworkoutsidethehomeandhousework)?1-Notatall:2-Alittlebit3-Moderately二4-Quiteabit壬5-ExtremelyThesequestionsareabouthowyoufeelandhowthingshavebeenwit

13、hyouduringthepast4weeks.Foreachquestion,pleasegivetheoneanswerthatcomesclosesttothewayyouhavebeenfeeling.Howmuchofthetimeduringthepast4weeks.AlloftheMostoftheAgoodbitoftheSomeoftheAlittleoftheNoneofthetimetimetimetimetimetime23.Didyoufeelfullofpep?123345超624.Haveyoubeenaverynervousperson?123345625.H

14、aveyoufeltsodowninthedumpsthatnothingcouldriOI此此cheeryouup?12345626. Haveyoufeltcalmandpeaceful?27. Didyouhavealotofenergy?28. Haveyoufeltdownheartedandblue?29. Didyoufeelwornout?30. Haveyoubeenahappyperson?31. Didyoufeeltired?AlltimeoftheMosttimeoftheAgoodtimebitoftheSomeoftimetheAlittletimeoftheNo

15、neofthetime01r2c3C45E16L1r234561r234561r234561r2345601r234口5口632.Duringthepast4weeks,howmuchofthetimehasyourphysicalhealthoremotionalproblemsinterferedwithyoursocialactivities(likevisitingwithfriends,relatives,etc.)?1-Allofthetime12-Mostofthetime3-SomeofthetimeDefinitelytrueMostlytrueDontknowMostlyf

16、alseDefinitelyfalse4-Alittleofthetime5-NoneofthetimeHowTRUEorFALSEiseachofthefollowingstatementsforyou.33. Iseemtogetsickalittleeasierthanotherpeople34. IamashealthyasanybodyIknow35. Iexpectmyhealthtogetworse36. Myhealthisexcellent健康状况调查问卷(SF-36)及其使用说明健康状况调查问卷(SJ36)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

17、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O好O一般O差O2 .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O比一年前好一些O跟一年前差不多O比一年前差一些O比一年前差多了O健康和日常活动口口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限制很大有些限制(l)重体力活动，如：跑步、举重物、参加剧烈运动等(2)适度的活动，如：移动一张桌子、扫地、打太极拳、做简单体操等OOO口口：f(3)手提日用

18、品，如买菜、购物等OOO(4)上几层楼梯OOO(5)上一层楼梯OOON(6)弯腰、曲膝、下蹲OOO(7)步行1600m以上的路程OOO(8)步行800m的路程OOO(9)步行100m的路程OOO(10)自己洗澡、穿衣OOO4 .在过去四个星期里，您的工作和日常活动有无因为身体健康的原因而出现以下这些问题？：对每条问题请回答“是”或“不是”!是不是(1)减少了工作或活动的时间OO口(2)本来想要做的事情只能完成一部分OO!(3)想要干的工作和活动的种类受到限制OO1口(4)完成工作或其他活动困难增多(比如需要额外的努力)OO1口5 .在过去四个星期里，您的工作和日常活动有无因为情绪的原因(如压抑

19、或者忧虑)，而!出现以下问题？对每条问题请回答“是”或“不是”是不是I(1)减少了工作或活动的时间ooi(2)本来想要做的事情只能完成一部分oOI(3)干事情不如平时仔细ooi6 .在过去的四个星期里，你的健康或情绪不好在多大程度上影响了您与家人、朋友、邻居或集体的正常社会交往？请，一个答案：安全没影响OI有一点影响o!中等影响oi口影响很大o|影响非常大o|7 .过去四个星期里，您有身体疼痛吗？完全没有疼痛O!稍微有一点疼痛O|有一点疼痛O1中等疼痛O|口严重疼痛O1很严重疼痛O8 .过去四个星期里，身体上的疼痛影响你的工作和家务事吗？完全没有影响O有一点影响O中等影响OI口影响很大O影响非

20、常大O您的感觉9 .以下这些问题有关过去一个月里您自己的感觉，对每一条问题所说的事情，你的情况是什么样的？请圈出最接近您的情况的那个答案。I请在每一条问题后，出一个答案持续的时间所有的大部分比较多一部分一小部没有这I时间时间时间时间分时间种感觉(1)您觉得生活充实OOOOOO(2)您是一个敏感的人OOOOOO1口.一H*BJ1一a-一ILB*士4USI.H士*UI*1ILB.4！.Mi|(3)您情绪非常不好，什么事都不能使您高兴。口(4)您心里很平静OOOOOOI1(5)您做事精力充沛OOOOOOI(6)你的情绪低落OOOOOO(7)你觉得精疲力尽OOOOOOI(8)您是个快乐的人OOOOOO

21、Ifh-fum-M-rui(9)您感觉厌烦OOOOOO!i(而丁区健康影而了恁-,的社会活动(如走亲访OOOOOOi友等)一意#s康情猊10.请看下列每一条问题，哪一种答案最符合您的情况？请在每一条问题后，一个答案施d天部分示能天部分维对正确正确肯定错误错误I(I)莪原森正丽75房空后一一-一oo-o-o口,-(2TaBilA-SSoo-ooo|口Ih!h，!ITBF!n9TBinBl!BHBTI!ITBf:,hn=hBH4(3)我认为我的健康状况在ooooo口变坏I04ral，0a,r_&m口a4k上0ar，&n-ade-u-4上上1a41j4uu0dnadk0ar*4iaasajma工r14m-a1a4工l40l-a-a4人ana，k!a|(4)我的健康状况非常好ooooo|口i!mcE)!*mnvc：，vt，nvc*w一，“i，!irv*r*tm,arrirw*，*vk*b!hvr如果您有注释或评论，请写在下面：非常感谢您的合作！请按要求将这份表填好后交还给我们评分原则：(I)该量表为MOS-SF36生存质量量表中文版。(2)评分原则是分量表及各条目积分越高，则表示健康状况越佳。(3)S436量表包括36个条目，可归纳为8个分量表，详见正文。(4)评分的标准化：条目积分的正向化处理：有些条目的原始积分越高，反而健康状况越差，需做正向化，如条目1(SFD