2024年1月10日发(作者：变速箱排名)

Terms and Conditions for Using the 36-Item Short

Form Survey (SF-36)

/health/surveys_tools/mos/

一，使用说明

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 been 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 responsibility, 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 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 written permission is needed for use of this Health Surv

二，英文量表

/health/surveys_tools/mos/36-item-short-form/

RAND 36-Item Health Survey 1.0 Questionnaire Items

SF-36 Resources

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Terms and Conditions for Using the SF-36

MOS 36-Item Short Form Survey Instrument (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

3 - Good

4 - Fair

5 - Poor

2. 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 worse now than one year ago

The 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 Yes, limited a No, not limited at

lot

little

all

1

1

1

1

1

1

1

2

2

2

2

2

2

2

3

3

3

3

3

3

3

3. Vigorous activities, such as running, lifting heavy objects, participating in

strenuous sports

4. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or

playing golf

5. Lifting or carrying groceries

6. Climbing several flights of stairs

7. Climbing one flight of stairs

8. Bending, kneeling, or stooping

9. Walking more than a mile

Yes, limited a Yes, limited a No, not limited at

lot

little

all

1

2

3

10. Walking several blocks

11. Walking one block

1

2

12. Bathing or dressing yourself

1

2

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 your physical health?

Yes

No

13. Cut down the amount of time you spent on work or other activities

1

2

14. Accomplished less than you would like

1

2

15. Were limited in the kind of work or other activities

1

2

16. Had difficulty performing the work or other activities (for example, it took extra effort)

1

2

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)?

3

3

Yes

No

1

1

1

2

2

2

17. Cut down the amount of time you spent on work or other activities

18. Accomplished less than you would like

19. Didn\'t do work or other activities as carefully as usual

20. 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?

1 - Not at all

2 - Slightly

3 - Moderately

4 - Quite a bit

5 - Extremely

21. 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 severe

22. During 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 - Extremely

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

All of the Most of the A good bit of the Some of the A little of the None of the

time

time

time

time

time

time

1

1

1

2

2

2

3

3

3

4

4

4

5

5

5

6

6

6

23. Did you feel full of pep?

24. Have you been a very nervous person?

25. Have you felt so down in the dumps that nothing could

cheer you up?

All of the Most of the A good bit of the Some of the A little of the None of the

time

time

time

time

time

time

1

1

1

1

1

1

2

2

2

2

2

2

3

3

3

3

3

3

4

4

4

4

4

4

5

5

5

5

5

5

6

6

6

6

6

6

26. Have you felt calm and peaceful?

27. Did you have a lot of energy?

28. Have you felt downhearted and blue?

29. Did you feel worn out?

30. Have you been a happy person?

31. Did you feel tired?

32. 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.)?

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 time

How TRUE or FALSE is each of the following statements for you.

Definitely true33. I seem to get sick a little easier than other people

1

34. I am as healthy as anybody I know

1

35. I expect my health to get worse

1

36. My health is excellent

1

Mostly true 2

2

2

2

Don\'t know

3

3

3

3

4

4

4

4

Definitely false 5

5

5

5

Mostly false

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）

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。如果您不知如何回答是好，就请您尽量给出最好的答案，并在本问卷最后的空白处写上你的注释与评论。

1.总体来讲，您的健康状况是：

2．跟一年前相比，您觉得您现在的健康状况是：

健康和日常活动

请√一个答案

非常好

很好

好

一般

差

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

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3．以下这些问题都与日常活动有关。请您想一想，您的健康状况是否限制了这些活动？如果有限制，程度如何？

（l）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：移动一张桌子、扫地、打太极

拳、做简单体操等

（3）手提日用品，如买菜、购物等

（4）上几层楼梯

（5）上一层楼梯

（6）弯腰、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

请在每一行√一个答案

有限制 有限制 毫无

限制很大 有些限制 限制

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4．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？

（1）减少了工作或活动的时间

（2）本来想要做的事情只能完成一部分

（3）想要干的工作和活动的种类受到限制

（4）完成工作或其他活动困难增多（比如需要额外的努力）

对每条问题请回答“是”或“不是”

是 不是

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5．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

出现以下问题？

（l）减少了工作或活动的时间

（2）本来想要做的事情只能完成一部分

（3）干事情不如平时仔细

居或集体的正常社会交往？

7．过去四个星期里，您有身体疼痛吗？

对每条问题请回答“是”或“不是”

是 不是

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6．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

请√一个答案：

安全没影响

有一点影响

中等影响

影响很大

影响非常大

完全没有疼痛

稍微有一点疼痛

有一点疼痛

中等疼痛

严重疼痛

很严重疼痛

完全没有影响

有一点影响

中等影响

影响很大

影响非常大

没有这种感觉

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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？

您的感觉

你的情况是什么样的？请圈出最接近您的情况的那个答案。

持续的时间 所有的时间

（l）您觉得生活充实

（2）您是一个敏感的人

（3）您情绪非常不好，什么事都不能使您高兴

（4）您心里很平静

（5）您做事精力充沛

（6）你的情绪低落

（7）你觉得精疲力尽

（8）您是个快乐的人

（9）您感觉厌烦

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大部分时间

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请在每一条问题后√出一个答案

比较多时间

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一部分时间

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一小部分时间

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9．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，

（10）不健康影响了您的社会活动（如走亲访友等）

总体健康情况

（l）我好像比别人容易生病

（2）我跟周围人一样健康

（3）我认为我的健康状况在变坏

（4）我的健康状况非常好

绝对

正确

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请在每一条问题后√一个答案

大部分

正确

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不能

肯定

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错误

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绝对

错误

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10．请看下列每一条问题，哪一种答案最符合您的情况？

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：

（l）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）SF～36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1（SF1）：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），转化公式为：

标准积分=（原始积分－该条目最低分值）×100／（该条目最高分值－该条目最低分值）。

说 明

SF-36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：Role-Physical）：测量由于生理健康问题所造成的职能限制。条目：4

3．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：7，8

4．一般健康状况（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：1，10

5．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：9.1，9.5，9.7，9.9

6．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：6，9.10

7．情感职能（RE：Role-Emotional）：测量由于情感问题所造成的职能限制。条目：5

8．精神健康（MH：Mental 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 Transition），用于评价过去一年内健康状况的总体变化情况。条目2

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