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1、TermsandConditionsforUsingthe36-ItemShortFormSurvey(SF-36)http:/www.rand.org/health/surveys_tools/mos/36-item-short-form.html一，使用说明RANDherebygrantspermissiontouseRAND36-ItemShortFormHealthSurveyinaccordaneewiththefollowingconditions,whichshallbeassumedbyalltohavebeenagreedtoasaeonsequeneeofaccepting
2、andusingthisdoeument:1. ChangestotheHealthSurveymaybemadewithoutthewrittenpermissionofRAND.However,allsuchchangesshallbeclearlyidentifiedashavingbeenmadebytherecipient.2. TheuserofthisHealthSurveyacceptsfullresponsibility,andagreestoindemnifyandholdRANDharmless,fortheaccuracyofanytranslationsoftheHe
3、althSurveyintoanotherIanguageandforanyerrors,omissions,misinterpretations,orconsequencesthereof.3. TheuserofthisHealthSurveyacceptsfullresponsibility,andagreestoindemnifyandholdRANDharmless,foranyconsequencesresultingfromtheuseoftheHealthSurvey.4. Theuserofthe36-ItemHealthSurveywillprovideacreditlin
4、ewhenprintinganddistributingthisdocumentacknowledgingthatitwasdevelopedatRANDaspartoftheMedicalOutcomesStudy.5. NofurtherwrittenpermissionisneededforuseofthisHealthSurv二，英文量表http:/www.rand.org/health/surveystools/mos/36-item-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 -Excellent卜2-VerygoodJ3-GoodJ4-Fair5-Poornow2. Comparedtooneyearago,howwouldyourateyourhealthingeneral1-Muchbetternowthanoneyearago2 广-Somewhatbetternowthanoneyearago-AboutthesameYes,limitedaYes,limitedaNo,notlimitedatlotlittleall1厂2r3厂1231厂23V1厂23r1厂231厂2r3f-1E23J4-Somewhatworsenowthanoneyearag
7、o5-MuchworsenowthanoneyearagoThefollowingitemsareaboutactivitiesyoumightdoduringatypicalday.Doesyourhealthnowlimityouintheseactivities?Ifso,howmuch?3. Vigorousactivities,suchasrunning,liftingheavyobjects,participatinginstrenuoussports4. Moderateactivities,suchasmovingatable,pushingavacuumcleaner,bow
8、ling,orplayinggolf5. Liftingorcarryinggroceries6. Climbingseveralflightsofstairs7. Climbingoneflightofstairs8. Bending,kneeling,orstooping9. WalkingmorethanamileYes,limitedlotaYes,littlelimitedaNo,notlimitedatall10.Walkingseveralblocksf=1fI.12311.Walkingoneblockspqr(J1E2312.Bathingordressingyourself
9、1E23Duringthepast4weeks,haveyouhadanyofthefollowingproblemswithyourworkorotherregulardailyactivitiesasaresultofyourphysicalhealth?YesNo2CutdowntheamountoftimeyouspentonworkorotheractivitiesAccomplishedlessthanyouwouldlikeWerelimitedinthekindofworkorotheractivitiesHaddifficultyperformingtheworkorothe
10、ractivities(forexample,ittookextraeffort)Duringthepast4weeks,haveyouhadanyofthefollowingproblemswithyourworkorotherregulardailyactivitiesasaresultofanyemotionalproblems(suchasfeelingdepressedoranxious)?YesNo17. CutdowntheamountoftimeyouspentonworkorotheractivitiesAccomplishedlessthanyouwouldlikeDidn
11、tdoworkorotheractivitiesascarefullyasusual1220.Duringthepast4weeks,towhatextenthasyourphysicalhealthoremotionalproblemsinterferedwithyournormalsocialactivitieswithfamily,friends,neighbors,orgroups?丽1-Notatall2 -Slightly上3-Moderately匸4-Quiteabitc5-Extremely1-None2-Verymild3-Mild严I3 -Moderate4 -Severe
12、22. -VerysevereDuringthepast4weeks,howmuchdidpaininterferewithyournormalwork(includingbothworkoutsidethehomeandhousework)?1-Notatall2-Alittlebit3 -Moderately-Quiteabit丄5-ExtremelyThesequestionsareabouthowyoufeelandhowthingshavebeenwithyouduringthepast4weeks.Foreachquestion,pleasegivetheoneanswerthat
13、comesclosesttothewayyouhavebeenfeeling.timetimetime123123timetimetimer4r5Q6r4E56ntn456oftheAgoodbitoftheSomeoftheAlittleAlloftheMostoftheNoneoftheHowmuchofthetimeduringthepast4weeks.23. Didyoufeelfullofpep?24. Haveyoubeenaverynervousperson?25. Haveyoufeltsodowninthedumpsthatnothingcouldcheeryouup?Al
14、loftheMostoftimetimetheAgoodbittimeoftheSomeoftimetheAlittletimeoftheNoneofthetime26. Haveyoufeltcalmandpeaceful?27. Didyouhavealotofenergy?28. Haveyoufeltdownheartedandblue?29. Didyoufeelwornout?30. Haveyoubeenahappyperson?31. Didyoufeeltired?Duringthepast4weeks,howmuchofthetimehasyourphysicalhealt
15、horemotionalproblemsinterferedwithyoursocialactivities(likevisitingwithfriends,relatives,etc.)?J1-Allofthetime刀2-Mostofthetime3-Someofthetimer4-Alittleofthetime5-NoneofthetimeHowTRUEorFALSEiseachofthefollowingstatementsforyou.DefinitelytrueMostlytrueDontknowMostlyfalseDefinitelyfalseIseemtogetsickalittleeasierthanotherpeopleIamashealthyasanybodyIknowIexpectmyhealthtoget
