SF-36 quality of life scale

Multidimensional instrument for health-related quality of life.

Complete all items based on your recent real-life experience.

Assessment

1. In general, would you say your health is:

2. Compared to one year ago, how would you rate your health in general now?

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

3b. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf

3c. Lifting or carrying groceries

3d. Climbing several flights of stairs

3e. Climbing one flight of stairs

3f. Bending, kneeling, or stooping

3g. Walking more than a mile

3h. Walking several blocks

3i. Walking one block

3j. Bathing or dressing yourself

4a. During the past 4 weeks, did you cut down the amount of time you spent on work or other activities because of your physical health?

4b. During the past 4 weeks, did you accomplish less than you would like because of your physical health?

4c. During the past 4 weeks, were you limited in the kind of work or other activities because of your physical health?

4d. During the past 4 weeks, did you have difficulty performing work or other activities because of your physical health?

5a. During the past 4 weeks, did you cut down the amount of time you spent on work or other activities because of emotional problems?

5b. During the past 4 weeks, did you accomplish less than you would like because of emotional problems?

5c. During the past 4 weeks, didn't you do work or other activities as carefully as usual because of emotional problems?

6. During the past 4 weeks, to what extent have your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?

7. How much bodily pain have you had during the past 4 weeks?

8. During the past 4 weeks, how much did pain interfere with your normal work, including both work outside the home and housework?

9a. Did you feel full of pep?

9b. Have you been a very nervous person?

9c. Have you felt so down in the dumps that nothing could cheer you up?

9d. Have you felt calm and peaceful?

9e. Did you have a lot of energy?

9f. Have you felt downhearted and blue?

9g. Did you feel worn out?

9h. Have you been a happy person?

9i. Did you feel tired?

9j. During the past 4 weeks, how much of the time have your physical health or emotional problems interfered with your social activities, like visiting with friends or relatives?

10a. I seem to get sick a little easier than other people.

10b. I am as healthy as anybody I know.

10c. I expect my health to get worse.

10d. My health is excellent.

Please complete all required fields first.

Important Notice

This resource is intended for educational purposes only and is intended for US healthcare professionals. Healthcare professionals should use independent medical judgment. All decisions regarding patient care must be handled by a healthcare professional and be made based on the unique needs of each patient.