SF-36健康自测量表

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1、Terms and Con diti ons for Using the 36-Item Short Form Survey (SF-36).rand.org/health/surveys_tools/mos/36-item-short-form.html一，使用说明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 d.org/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门2启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健康状况调查问卷(SF 36)及其使用说明健康状况调查问卷(SF 36)有限制限制很大有限制有些限制无制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

20、不知 如何回答是好，就请您尽量给岀最好的答案，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3 以下这些问题都与日常活动有关。请您想一想， 限制，程度如何？您的健康状况是否限制了这些活动？如果有L请在每一行一个答案(I)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：移动一桌子、扫地、打太极拳、做简单体操等OOO(3)手提日用品，如买菜、购物等OOOL 口(4) 上几层楼梯OOO

21、(5) 上一层楼梯OOO(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”(1)减少了工作或活动的时间是O不是O(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OO(4)完成工作或其他活动困难增多(比如需要额外的努力)OO5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(如压抑或者忧虑)，而岀现以下问题?(1)减少了工作或活动的时间对每条

22、问题请回答“是”或“不是”是O不是O(2)本来想要做的事情只能完成一部分OO(3)干事情不如平时仔细OO6.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1-1居或集体的正常社会交往？:1请一个答案：11安全没影响O有一点影响O中等影响O影响很大O影响非常大O7.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O中等疼痛O严重疼痛O很严重疼痛O-8.过去四个星期里，身体上的疼痛影响你的工作和家务事吗？11-完全没有影响O有一点影响O中等影响O影响很大O影响非常大O您的感觉i9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

23、的情况是什么样的？请圈岀最接近您的情况的那个答案。:i请在每一条问题后岀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-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OOOOOO(3)您情绪非常不好，:占OOOOOO什么事都不能使您咼兴:(4)您心里很平静OOOOOO(5)您做事精力充沛OOOOOO(6)你的情绪低落OOOOOO(7)你觉得精疲力尽OOOOOO(8)您是个快乐的人OOOOOO(9)您感觉厌烦OOOOOO(10)不健康影响了您的社会活动(如走亲访OOOOOO 友等)总体健康情况r10 请看下列每一条问题，哪一种答案最符合您的情况？请在每

24、一条问题后一个答案绝对正确大部分正确不能冃疋大部分错误绝对错误(l)我好像比别人容易生病OOOOO,(2)我跟周围人一样健康OOOOO (3)我认为我的健康状况在变坏OOOOO(4)我的健康状况非常好OOOOO i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) Si36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(SF1

25、: 原始积分1分表示总体健康状况非常好，5分表示总体健康状况非常差，则在评分时，转化后原始积分应为：6转化前原始积分。原始积分需转化成标准积分(百分制) 标准积分=(原始积分该条目最低分值)X，转化公式为：100/(该条目最高分值该条目最低分值)SF36作为简明健康调查问卷，它从生理机能、生理职能、躯体疼痛、一般 健康状况、精力、社会功能、情感职能以及精神健康等8个方面全面概括了被调 查者的生存质量。1 .生理机能(PF： Physical Functioning):测量健康状况是否妨碍了正常的生理 活动。条目：3。2生理职能(RP Rol&Physica):测量由于生理健康问题所造成的职能限

26、制。条目：43躯体疼痛(BP: Bodily Pain)：测量疼痛程度以及疼痛对日常活动的影响。条 目：7，84一般健康状况(GH： General Health)：测量个体对自身健康状况及其发展趋 势的评价。条目：1, 105. 精力(VT： Vitality):测量个体对自身精力和疲劳程度的主观感受。条目：9.1,9.5, 9.7, 9.96. 社会功能(SF Social Functioning)：测量生理和心理问题对社会活动的数量和质量所造成的影响，用于评价健康对社会活动的效应。条目：6, 9.107. 情感职能(RE Rol&Emotional):测量由于情感问题所造成的职能限制。条目: 58. 精神健康(MH : Me ntal Health )：测量四类精神健康项目，包括激励、压抑、行为或情感失控、心理主观感受。条目：9.2, 9.3, 9.4, 9.6, 9.8另：健康变化(HT： Reported Health Tran sition),用于评价过去一年健康状况的 总体变化情况。条目2