SF-36健康自測量表

1、Terms and Con diti ons for Using the 36-Item Short Form Survey (SF-36)./health/surveys_tools/mos/36-item-short-form.html一，使用說明RAND hereby grants permissi on to use RAND 36-Item Short Form Health Survey in accorda nee with the followi ng con diti ons, which shall be assumed by all to have bee

2、 n agreed to as a eon seque nee of accept ing and using this doeume nt:1. Changes to the Health Survey may be made without the written permission of RAND. However, all such changes shall be clearly ide ntified as hav ing bee n made by the recipie nt.2. The user of this Health Survey accepts full res

3、ponsibility, and agrees to indemnify and hold RAND harmless, for the accuracy of any tran slati ons of the Health Survey into ano ther Ian guage and for any errors, omissi ons,misin terpretati ons, or con seque nces thereof.3. The user of this Health Survey accepts full responsibility, and agrees to

4、 indemnify and hold RAND harmless, for any con seque nces result ing 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 documentack no wledg ing that it was developed at RAND as part of the Medical Outcomes Study.

5、5. No further written permission is needed for use of this Health Surv二，英文量表.ran /health/surveystools/mos/36-item-short-form/survey-i nstrume nt.htmlRAND 36-Item Health Survey 1.0 Questionnaire ItemsSF-36 Resources? Terms and Conditions for Using the SF-36? MOS 36-Item Short Form Survey Instrum

6、ent (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 opti on for each questi onn aire item.1. In gen eral, would you say your health is: 1 - Excelle nt2 - Very good 3 - Good4 - Fair

7、5 - Poor2. Compared to one year ago, how would you rate your health in gen eralnowr1 - Much better now tha n one year agoSomewhat better now tha n one year ago3 - About the same2 丨 4 - Somewhat worse now than one year ago也 5 - Much worse now than one year agoThe following items are about activities

8、you might do during a typical day. Does activities? If so, how much?3. Vigorous activities , such as runnin g, lift ing heavy objects, participat ing in stre nu ous sports4. Moderate activities , such as moving a table, push ing a vacuum clea ner, bowli ng, or play ing golf5. Lift ing or carry ing g

9、roceries6. Climbi ng several flights of stairs7. Climbing one flight of stairs8. Bending, kn eeli ng, or stoop ingyour health now limit youin theseYes,limiteda Yes,limiteda No, not limited atlotlittleallE1r2E3r1in23r1r2r3r1E2c3r1n2r3c1r2E3r1E2G39. Walki ngmore tha n a mileDuring thepast 4 weeks, hav

10、e you had any of the follow ing problems with your work or other regular dailyactivitiesas a result of your physical health?10. Walki ng11. Walki ngseveral blocksone block12. Bathi ng or dress ing yourselfYes, limiteda Yes,limiteda No, not limited atlotlittleall1E2E J31n231r2313. Cut dow n the amoun

11、t of time you spe nt on work or other activities14. Accomplished less tha n you would like15. Were limited in theki nd of work or other activities16. Had difficultyperform ing the work or other activities (for example, it took extra effort)During thepast 4 weeks,have you had any of the following pro

12、blems with your work or other regular dailyactivitiesas a result of any emoti onal problems(such as feeli ng depressed or an xious)?17. Cut dow n theamount of time you spe nt on work or other activities18. Accomplished lesstha n you would like19. Did nt do work or other activities ascarefully as usu

13、alYes No門2啟2戶220. During the past 4 weeks , to what exte nt has your physical health or emoti onal problems in terfered with your normal social activities with family, friends, neighbors, or groups?1 - Not at all2 - Slightly3 - Moderately 4 - Quite a bit5 - Extremely21. How much bodily pain have you

14、 had duri ng thepast 4 weeks ? 1 - No ne2 - Very mild 3 - Mild旳 4 - Moderate5 - Severe刁 6 - Very severe22. During the past 4 weeks , how much did pain in terfere with your no rmal work (in cludi ng both work outside the home and housework)?1 - Not at all2 - A little bit3 - Moderately 亠 4 - Quite a b

15、it 旳 5 - ExtremelyThese questio ns are about how you feel and how thi ngs have bee n with youduri ng the past 4 weeks.For eachquesti on, please give the one an swer that comes closest to the way you have bee n feeli ng.past 4 weeksHow much of the time during the23. Did you feel full of pep?24. Have

16、you bee n a very n ervous pers on?25. Have you felt so dow n in the dumps that nothing could cheer you up?Allofthe Mostoftimetimen1n2n12C1c*2the A good bit of the Some ofthe A little time5of the Nonetimec3timer4timeE6C3r45E6r3E4二 5G6theAll ofthe Most oftimetimethe A good bit of the Some of timetimet

17、he A little oftimethe Nonetimethe26. Have you felt calm and peaceful?27. Did you have a lot of en ergy?28. Have you felt dow nhearted and blue?29. Did you feel worn out?30. Have you bee n a happy pers on?31. Did you feel tired?32. During the past 4 weeks , how much of the time has your physical heal

18、th or emoti onal problemsin terferedwith your social activities (like visit ing with frien ds, relatives, etc.)?J 1 - All of the time 2 - Most of the time3 - Some of the time4 - A little of the time也 5 - None of the timeHow TRUE or FALSE is each of the following statements for you.Defi nitely trueDo

19、nt knowMostly falseDefi ni tely false33. I seem to get sick a little easier tha n other people34. I am as healthy as an ybody I know35. I expect my health to get worse36. My health is excellentn 1Mostly true25健康狀況調(diào)查問卷(SF 36)及其使用說明健康狀況調(diào)查問卷(SF 36)有限制限制很大有限制有些限制無制以下問題是詢問您對自己健康狀況的看法，您自己覺得做日?；顒拥哪芰υ趺礃?。如果您

20、不知 如何回答是好，就請您盡量給岀最好的答案，并在本問卷最后的空白處寫上你的注釋與評論。請“一個答案1總體來講，您的健康狀況是：非常好很好O好O一般O差O2 跟一年前相比，您覺得您現(xiàn)在的健康狀況是：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?；顒? 以下這些問題都與日常活動有關(guān)。請您想一想， 限制，程度如何？您的健康狀況是否限制了這些活動？如果有L請?jiān)诿恳恍幸粋€答案(I)重體力活動，如：跑步、舉重物、參加劇烈運(yùn)動等(2)適度的活動，如：移動一桌子、掃地、打太極拳、做簡單體操等OOO(3)手提日用品，如買菜、購物等OOOL 口(4) 上幾層樓梯OOO

21、(5) 上一層樓梯OOO(6)彎腰、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在過去四個星期里，您的工作和日?；顒佑袩o因?yàn)樯眢w健康的原因而出現(xiàn)以下這些問題？ 對每條問題請回答“是”或“不是”(1)減少了工作或活動的時(shí)間是O不是O(2)本來想要做的事情只能完成一部分OO(3)想要干的工作和活動的種類受到限制OO(4)完成工作或其他活動困難增多(比如需要額外的努力)OO5在過去四個星期里，您的工作和日?；顒佑袩o因?yàn)榍榫w的原因(如壓抑或者憂慮)，而岀現(xiàn)以下問題?(1)減少了工作或活動的時(shí)間對每條

22、問題請回答“是”或“不是”是O不是O(2)本來想要做的事情只能完成一部分OO(3)干事情不如平時(shí)仔細(xì)OO6.在過去的四個星期里，你的健康或情緒不好在多大程度上影響了您與家人、朋友、鄰1-1居或集體的正常社會交往？:1請一個答案：11安全沒影響O有一點(diǎn)影響O中等影響O影響很大O影響非常大O7.過去四個星期里，您有身體疼痛嗎？完全沒有疼痛O稍微有一點(diǎn)疼痛O有一點(diǎn)疼痛O中等疼痛O嚴(yán)重疼痛O很嚴(yán)重疼痛O-8.過去四個星期里，身體上的疼痛影響你的工作和家務(wù)事嗎？11-完全沒有影響O有一點(diǎn)影響O中等影響O影響很大O影響非常大O您的感覺i9以下這些問題有關(guān)過去一個月里您自己的感覺，對每一條問題所說的事情，你

23、的情況是什么樣的？請圈岀最接近您的情況的那個答案。:i請?jiān)诿恳粭l問題后岀一個答案持續(xù)的時(shí)間所有的大部分比較多一部分一小部沒有這-時(shí)間時(shí)間時(shí)間時(shí)間分時(shí)間種感覺(1)您覺得生活充實(shí)OOOOOO(2)您是一個敏感的人OOOOOO(3)您情緒非常不好，:占OOOOOO什么事都不能使您咼興:(4)您心里很平靜OOOOOO(5)您做事精力充沛OOOOOO(6)你的情緒低落OOOOOO(7)你覺得精疲力盡OOOOOO(8)您是個快樂的人OOOOOO(9)您感覺厭煩OOOOOO(10)不健康影響了您的社會活動(如走親訪OOOOOO 友等)總體健康情況r10 請看下列每一條問題，哪一種答案最符合您的情況？請?jiān)诿恳粭l問題后一個答案絕對正確大部分正確不能冃疋大部分錯誤絕對錯誤(l)我好像比別人容易生病OOOOO,(2)我跟周圍人一樣健康OOOOO (3)我認(rèn)為我的健康狀況在變壞OOOOO(4)我的健康狀況非常好OOOOO i如果您有注釋或評論，請寫在下面：非常感謝您的合作！請按要求將這份表填好后交還給我們評分原則：(I)該量表為MOS-SF36生存質(zhì)量量表中文版。(2 )評分原則是分量表及各條目積分越高，則表示健康狀況越佳。(3) Si36量表包括36個條目，可歸納為8個分量表，詳見正文。(4 )評分的標(biāo)準(zhǔn)化：條目積分的正向化處理