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RAND 36-Item Health Survey v1.0 Questionnaire Items

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

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

    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?

  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

  10. Walking several blocks

  11. Walking one block

  12. Bathing or dressing yourself

    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?

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

  14. Accomplished less than you would like

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

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

    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)?

  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, 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)?

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

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

    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 4 weeks . . .

  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?

  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.)?

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

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

  34. I am as healthy as anybody I know

  35. I expect my health to get worse

  36. My health is excellent

Results RAND 36-Item Health Survey v1.0

Scores represent the percentage of total possible score achieved. (Total possible score is 100%)

Physical functioning:

Role limitations due to physical health:

Role limitations due to emotional problems:

Energy/fatigue:

Emotional well-being:

Social functioning:

Pain:

General health:

Health change:


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RAND 36 information

Results are calculated as described by: http://www.rand.org/health/surveys_tools/mos/mos_core_36item_scoring.html

This survey was reprinted with permission from the RAND Corporation. Copyright © the RAND Corporation. RAND's permission to reproduce the survey is not an endorsement of the products, services, or other uses in which the survey appears or is applied.