BIMS SF36

Section 1 : SF36

SF36

Your health and well being

Main Questions

In general, would you say your health is: Excellent Very good Good Fair Poor Compared to one week ago, how would you rate your health in general now? Much better now than one week ago Somewhat better now than one week ago About the same as one week ago Somewhat worse now than one week ago Much worse now than one week ago

The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?

Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports Yes, limited a lot Yes, limited a little No, not limited at all Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or playing golf Yes, limited a lot Yes, limited a little No, not limited at all Lifting or carrying groceries Yes, limited a lot Yes, limited a little No, not limited at all Climbing several flights of stairs Yes, limited a lot Yes, limited a little No, not limited at all Climbing one flight of stairs Yes, limited a lot Yes, limited a little No, not limited at all Bending, kneeling or stooping Yes, limited a lot Yes, limited a little No, not limited at all Walking more than a kilometre Yes, limited a lot Yes, limited a little No, not limited at all Walking several hundred metres Yes, limited a lot Yes, limited a little No, not limited at all Walking one hundred metres Yes, limited a lot Yes, limited a little No, not limited at all Bathing or dressing yourself Yes, limited a lot Yes, limited a little No, not limited at all

During the past week, how much of the time have you had any of the following problems with your work orother regular daily activities as a result of your physical health?

Cut down on the amount of time you spent on work or other activities All of the time Most of the time Some of the time A little of the time None of the time Accomplished less than you would like All of the time Most of the time Some of the time A little of the time None of the time Were limited in the kind of work or other activities All of the time Most of the time Some of the time A little of the time None of the time Had difficulty performing the work or other activities (for example it took extra effort) All of the time Most of the time Some of the time A little of the time None of the time

During the past week, how much of the time have you had any of the following problems with your work orother regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)

Cut down on the amount of time you spent on work or other activities All of the time Most of the time Some of the time A little of the time None of the time Accomplished less than you would like All of the time Most of the time Some of the time A little of the time None of the time Did work or other activities less carefully than usual All of the time Most of the time Some of the time A little of the time None of the time During the past week, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbours or groups? Not at all Slightly Moderately Quite a bit Extremely How much bodily pain have you had during the past week? None Very Mild Mild Moderate Severe Very Severe During the past week, how much did pain interfere with your normal work? (including both work outside the home and housework) Not at all A little bit Moderately Quite a bit Extremely

These questions are about how you feel and how things have been with you during the past week. 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 week...

Did you feel full of life? All of the time Most of the time Some of the time A little of the time None of the time Have you been very nervous? All of the time Most of the time Some of the time A little of the time None of the time Have you felt so down in the dumps that nothing could cheer you up? All of the time Most of the time Some of the time A little of the time None of the time Have you felt calm and peaceful? All of the time Most of the time Some of the time A little of the time None of the time Did you have a lot of energy? All of the time Most of the time Some of the time A little of the time None of the time Have you felt downhearted and depressed? All of the time Most of the time Some of the time A little of the time None of the time Did you feel worn out? All of the time Most of the time Some of the time A little of the time None of the time Have you been happy? All of the time Most of the time Some of the time A little of the time None of the time Did you feel tired? All of the time Most of the time Some of the time A little of the time None of the time During the past week, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives etc) All of the time Most of the time Some of the time A little of the time None of the time

How true or false is each of the following statements for you?

I seem to get sick a little easier than other people Definitely true Mostly true Dont know Mostly false Definitely false I am as healthy as anybody I know Definitely True Mostly true Dont know Mostly false Definitely false I expect my health to get worse Definitely true Mostly true Dont know Mostly false Definitely false My health is excellent Definitely true Mostly true Dont know Mostly false Definitely false