7.1
1. In general, would you say your health is
7.2
2. Compared to one year ago, how would you rate your health in general now?
3. 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?
7.4
3a. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports.
7.5
3b. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
7.6
3c. Lifting or carrying groceries
7.7
3d. Climbing several flights of stairs
7.8
3e. Climbing one flight of stairs
7.9
3f. Bending, kneeling, or stooping
7.10
3g. Walking more than a mile
7.11
3h. Walking several blocks
7.12
3i. Walking one block
7.13
3j. Bathing or dressing yourself
4. 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?
7.15
4a. Cut down the amount of time you spent on work or other activities
7.16
4b. Accomplished less than you would like
7.17
4c. Were limited in the kind of work or other activities
7.18
4d. Had difficulty performing the work or other activities (for example, it took extra effort)
5. 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)?
7.20
5a. Cut down the amount of time you spent on work or other activities Yes
7.21
5b. Accomplished less than you would like
7.22
5c. Didn't do work or other activities as carefully as usual
7.23
6. Emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?
7.24
7. How much bodily pain have you had during the past 4 weeks?
7.25
8. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?
9. These questions are about how you feel and how things have been with you during the last 4 weeks. For each question, please give the answer that comes closest to the way you have been feeling
7.27
9a. Did you feel full of life?
7.28
9b. Have you been a very nervous person?
7.29
9c. Have you felt so down in the dumps that nothing could cheer you up?
7.30
9d. Have you felt calm and peaceful?
7.31
9e. Did you have a lot of energy?
7.32
9f. Have you felt downhearted and blue?
7.33
9g. Did you feel worn out?
7.34
9h. Have you been a happy person?
7.35
9i. Did you feel tired?
7.36
10. 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.)?
11. How true or false is each of the following statements for you?
7.38
11a. I seem to get sick a little easier than other people
7.39
11b. I am as healthy as anybody I know
7.40
11c. I expect my health to get worse
7.41
11d. My health is excellent
7.42
PF
7.43
SF
7.44
RP
7.45
RE
7.46
MH
7.47
VT
7.48
BP
7.49
GH
7.50
HT
7.51
PF Z
7.52
SF Z
7.53
RP Z
7.54
RE Z
7.55
MH Z
7.56
VT Z
7.57
BP Z
7.58
GH Z
7.59
Praw
7.60
Mraw
7.61
Physical component score
7.62
Mental component score
SF36_1
5: Excellent
4: Very good
3: Good
2: Moderate
1: Poor
SF36_2
5: Much better than a year ago
4: Slightly better than a year ago
3: About the same as a year ago
2: Slightly worse than a year ago
1: Much worse than a year ago
SF36_3
1: Yes, Limited a lot
2: Yes, Limited a Little
3: No, Not Limited at all
SF36_4
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
SF36_5
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
SF36_6
5: Not at all
4: Slightly
3: Moderately
2: Severe
1: Very Severe
SF36_7
6: None
5: Very mild
4: Mild
3: Moderate
2: Severe
1: Very severe
SF36_8
5: Not at all
4: A little bit
3: Moderately
2: Quite a bit
1: Extremely
SF36_9contra
5: All of the time
4: Most of the time
3: Some of the time
2: A little bit of the time
1: None of the Time
SF36_9
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
SF36_10
1: All of the time
2: Most of the time
3: Some of the time
4: A little bit of the time
5: None of the time
SF36_11
1: Definitely true
2: Mostly true
3: Don't know
4: Mostly false
5: Definitely false
SF36_11contra
5: Definitely true
4: Mostly true
3: Don't know
2: Mostly false
1: Definitely false