SF-36
|
In general, would you say your health is: |
1 |
Appraisal |
Excellent (1); Very good (2); Good (3); Fair (4); Poor (5) |
Intensity |
General Health |
|
nd-gh |
|
|
Compared to one year ago, how would you rate your health in general now |
2 |
Much better now than one year ago (1); Somewhat better now than one year ago (2); About the same (3); Somewhat worse now than one year ago (4); Much worse now than one year ago (5). |
Intensity |
Health |
|
nd-gh |
|
|
The following items are about activities you might do during a typical day. Does your health now limit youin these activities? If so, how much? |
3a |
Descriptive: Performance |
Yes, limited a lot (1); Yes, limited a little (2); No, not limited at all (3). |
Intensity |
Vigorous activities |
Running/ lifting heavy objects/ participating in strenuous sports |
d Activities and participation (vigorous activities) |
d4552 Running / d4300 Lifting / d9201 Sports |
Strenuous sports, vigorous |
3b |
|
Moderate activities |
moving a table/ pushing a vacuum cleaner/ bowling/ sweeping |
d Activities and participation (moderate activities) |
d430 Lifting and carrying objects/ d6403 Using household appliances/ d9201 Sports / d6402 Cleaning living area |
Bowling, moderate |
|
3c |
|
|
|
Lifting or carrying groceries |
|
d430 Lifting and carrying objects |
|
Groceries |
3d |
Climbing |
|
d4551 Climbing |
|
Several flights of stairs |
3e |
Climbing |
|
d4551 Climbing |
|
One flight of stairs |
3f |
Mobility |
Bending/ kneeling/ or stooping |
d4 Mobility |
d4101 Squatting / d4102 Kneeling/ d4105 Bending |
|
3g |
Walking |
|
d4501 Walking long distances |
|
More than a kilometer |
3h |
Walking |
|
d4501 Walking long distances |
|
Several blocks |
3i |
Walking |
|
d4500 Walking short distances |
|
One block |
3j |
Self-care |
Bathing/ dressing yourself |
d5 Self-care |
d510 Washing oneself / d540 Dressing |
|
During the past 4 weeks, have you had any of the following problems with your work or other regular daily activ- ities as a result of your physical health? |
4a |
Appraisal |
Yes or Not |
Confirmation |
Physical health |
Work / Regular daily activity |
nd-ph |
d850 Remunerative employ- ment / d230 Carrying out daily routine |
Cut down the amount of time |
4b |
Physical health |
Work / Regular daily activity |
nd-ph |
d850 Remunerative employ- ment / d230 Carrying out daily routine |
Accomplished less |
|
4c |
Descriptive: Performance |
|
|
Physical health |
Work / Regular daily activity |
nd-ph |
d850 Remunerative employ- ment / d230 Carrying out daily routine |
|
4d |
Physical health |
Work / Regular daily activity |
nd-ph |
d850 Remunerative employment / d230 Carrying out daily routine |
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)? |
5a |
Appraisal |
Yes or Not |
Confirmation |
Emotional problem |
Work / Regular daily activity |
nd-mh |
d850 Remunerative employment / d230 Carrying out daily routine |
Depressed / anxious |
5b |
Emotional problem |
Work / Regular daily activity |
nd-mh |
d850 Remunerative employment / d230 Carrying out daily routine |
Accomplished less activities |
5c |
Descriptive: Performance |
Emotional problem |
Work / Regular daily activity |
nd-mh |
d850 Remunerative employment / d230 Carrying out daily routine |
As carefully as usual |
During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups? |
6 |
Descriptive: Performance |
Not at all (1); Slightly (2); Moderately (3); Quite a bit (4); Extremely (5). |
Intensity |
Normal social activities |
Physical health / Emotional problems |
d750 Informal social relationships |
nd-ph / nd-mh |
Family, friends, neighbors, or groups |
How much bodily pain have you had during the past 4 weeks? |
7 |
Descriptive: Performance |
None (1); Mild (2); Leve (3); Moderate (4); Severe (5); Very severe (6). |
|
Body pain |
|
b280 Pain |
|
|
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? |
8 |
Appraisal |
Not at all (1); A little bit (2); Moderately (3); Quite a bit (4); Extremely (5). |
|
Pain interference |
|
b280 pain |
|
|
These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... |
9a |
Descriptive: Performance |
All of the time (1); Most of the time (2); A good bit of the time (3); Some of the time (4); A little of the time (5); None of the time (6). |
|
Feel full of pep |
|
b1300 Energy level |
|
|
|
9b |
|
|
|
Nervous |
|
b152 Emotional functions (nervous) |
|
A lot |
9c |
Feel so down |
|
b152 Emotional functions (feel down) |
|
|
9d |
Calm and peaceful |
|
b1263 Psychic stability |
|
|
9e |
Have energy |
|
b1300 Energy level |
|
|
9f |
Feel downhearted and blue |
|
b1265 Optimism (blue) |
|
|
9g |
Worn out |
|
b1300 Energy level (worn out) |
|
|
9h |
Happy |
|
b152 Emotional functions |
|
|
9i |
Tired |
|
b1300 Energy level (tired) |
|
|
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)? |
10 |
|
All of the time (1); Most of the time (2); Some of the time (3); A little of the time (4); None of the time (5). |
|
Social activities |
Physical health / Emotional Problems |
d9205 Socializing |
nd-ph / nd-mh |
(Visiting friends, relatives) |
How TRUE or FALSE is each of the following statements for you. |
11ª |
Appraisal |
Definitely true (1); Mostly true (2); Don't know (3); Mostly false (4); Definitely false (5). |
|
To get sick |
|
nd-hc |
|
A little easier than other people |
11b |
|
Be healthy |
|
nd-gh |
|
As anybody I know |
11c |
|
Health |
|
nd-gh |
|
To get worse |
11d |
|
Health |
|
nd-gh |
|
Excellent |