1、Terms and Conditions 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 permission to use RAND 36-Item Short Form Health Survey in accordance with the following conditions, which shall be assumed by all to have b

2、een agreed to as a consequence of accepting and using this document:1. Changes to the Health Survey may be made without the written permission of RAND. However, all such changes shall be clearly identified as having been made by the recipient.2. The user of this Health Survey accepts full responsibi

3、lity, and agrees to indemnify and hold RAND harmless, for the accuracy of any translations of the Health Survey into another language and for any errors, omissions, misinterpretations, or consequences thereof.3. The user of this Health Survey accepts full responsibility, and agrees to indemnify and

4、hold RAND harmless, for any consequences resulting 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 document acknowledging that it was developed at RAND as part of the Medical Outcomes Study.5. No further writte

5、n permission is needed for use of this Health Surv二，英文量表/health/surveys_tools/mos/36-item-short-form/survey-instrument.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 Instrument

6、 (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 option for each questionnaire item.1. In general, would you say your health is: 1 - Excellent 2 - Very good

7、0;3 - Good 4 - Fair 5 - Poor2. Compared to one year ago, how would you rate your health in general now? 1 - Much better now than one year ago 2 - Somewhat better now than one year ago 3 - About the same 4 - Somewhat worse now than one year ago 5 - Much wo

8、rse now than one year agoThe following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Yes, limited a lotYes, limited a littleNo, not limited at all3. Vigorous activities, such as running, lifting

9、heavy objects, participating in strenuous sports 1 2 34. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf 1 2 35. Lifting or carrying groceries 1 2 36. Climbing several flights of stairs 1

10、 2 37. Climbing one flight of stairs 1 2 38. Bending, kneeling, or stooping 1 2 39. Walking more than a mile 1 2 310. Walking several blocks 1 2 311. Walking one block 1 2 312. Bathing or dr

11、essing yourself 1 2 3During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? YesNo13. Cut down the amount of time you spent on work or other activities 1

12、0;214. Accomplished less than you would like 1 215. Were limited in the kind of work or other activities 1 216. Had difficulty performing the work or other activities (for example, it took extra effort) 1 2During the past 4 weeks, have

13、 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)? YesNo17. Cut down the amount of time you spent on work or other activities 1 218. Accomplished

14、 less than you would like 1 219. Didn't do work or other activities as carefully as usual 1 220. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neig

15、hbors, or groups? 1 - Not at all 2 - Slightly 3 - Moderately 4 - Quite a bit 5 - Extremely21. How much bodily pain have you had during the past 4 weeks? 1 - None 2 - Very mild 3 - Mild 4 - Moderate 5 - Severe 6 - Very severe22. Du

16、ring the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? 1 - Not at all 2 - A little bit 3 - Moderately 4 - Quite a bit 5 - ExtremelyThese questions are about how you feel and how things hav

17、e 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. All of the timeMost of the timeA good bit of the timeSome of the timeA little of the timeNone of the

18、 time23. Did you feel full of pep? 1 2 3 4 5 624. Have you been a very nervous person? 1 2 3 4 5 625. Have you felt so down in the dumps that nothing could cheer you up? 1 2 3 4 5 626. Have you felt calm and pe

19、aceful? 1 2 3 4 5 627. Did you have a lot of energy? 1 2 3 4 5 628. Have you felt downhearted and blue? 1 2 3 4 5 629. Did you feel worn out? 1 2 3 4 5 630. Have you been a happy p

20、erson? 1 2 3 4 5 631. Did you feel tired? 1 2 3 4 5 632. 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, relativ

21、es, etc.)? 1 - All of the time 2 - Most of the time 3 - Some of the time 4 - A little of the time 5 - None of the timeHow TRUE or FALSE is each of the following statements for you. Definitely trueMostly trueDon't knowMostly falseDefinitely false33. I seem

22、to get sick a little easier than other people 1 2 3 4 534. I am as healthy as anybody I know 1 2 3 4 535. I expect my health to get worse 1 2 3 4 536. My health is excellent 1 2 3 4 5健康狀況調查問卷（SF36）及其使

23、用說明健康狀況調查問卷（SF36）以下問題是詢問您對自己健康狀況的看法，您自己覺得做日常活動的能力怎么樣。如果您不知如何回答是好，就請您盡量給出最好的答案，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： 非常好很好好一般差2跟一年前相比，您覺得您現在的健康狀況是：比一年前好多了比一年前好一些跟一年前差不多比一年前差一些比一年前差多了健康和日常活動3以下這些問題都與日常活動有關。請您想一想，您的健康狀況是否限制了這些活動？如果有限制，程度如何？請在每一行一個答案有限制 有限制 毫無限制很大 有些限制 限制（l）重體力活動，如：跑步、舉重物、參加劇烈運動等 （2

24、）適度的活動，如：移動一張桌子、掃地、打太極拳、做簡單體操等 （3）手提日用品，如買菜、購物等 （4）上幾層樓梯 （5）上一層樓梯 （6）彎腰、曲膝、下蹲 （7）步行 1600m以上的路程 （8）步行800m的路程 （9）步行 100m的路程 （10）自己洗澡、穿衣 4在過去四個星期里，您的工作和日常活動有無因為身體健康的原因而出現以下這些問題？對每條問題請回答“是”或“不是” 是 不是（1）減少了工作或活動的時間 （2）本來想要做的事情只能完成一部分 （3）想要干的工作和活動的種類受到限制 （4）完成工作或其他活動困難增多（比如需要額外的努力） 5在過去四個星期里，您的工作和日常活動有無因為

25、情緒的原因（如壓抑或者憂慮），而出現以下問題？對每條問題請回答“是”或“不是” 是 不是（l）減少了工作或活動的時間（2）本來想要做的事情只能完成一部分（3）干事情不如平時仔細 6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、鄰居或集體的正常社會交往？請一個答案：安全沒影響有一點影響中等影響影響很大影響非常大7過去四個星期里，您有身體疼痛嗎？完全沒有疼痛稍微有一點疼痛有一點疼痛中等疼痛嚴重疼痛很嚴重疼痛8.過去四個星期里，身體上的疼痛影響你的工作和家務事嗎？完全沒有影響有一點影響中等影響影響很大影響非常大您的感覺9以下這些問題有關過去一個月里您自己的感覺，對每一條問題

26、所說的事情，你的情況是什么樣的？請圈出最接近您的情況的那個答案。請在每一條問題后出一個答案持續的時間所有的時間大部分時間比較多時間一部分時間一小部分時間沒有這種感覺（l）您覺得生活充實（2）您是一個敏感的人（3）您情緒非常不好，什么事都不能使您高興（4）您心里很平靜（5）您做事精力充沛（6）你的情緒低落（7）你覺得精疲力盡（8）您是個快樂的人（9）您感覺厭煩（10）不健康影響了您的社會活動（如走親訪友等）總體健康情況10請看下列每一條問題，哪一種答案最符合您的情況？請在每一條問題后一個答案絕對正確大部分正確不能肯定大部分錯誤絕對錯誤（l）我好像比別人容易生病（2）我跟周圍人一樣健康（3）我認為我的健康狀況在變壞（4）我的健康狀況非常好 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： （l）該量表為MOS-SF36生存質量