Table 4.

Twelve-item Short-Form Health Survey (SF-12)

Items	Score	Grading system
In general, would you say your health is?	1	Excellent
	2	Very good
	3	Good
	4	Fair
	5	Poor
The following two questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf?	1	Yes, limited a lot
	2	Yes, limited a little
	3	No, not limited at all
Climbing several flights of stairs?	1	Yes, limited a lot
	2	Yes, limited a little
	3	No, not limited at all
During the past 4 weeks have you had any of the following problems with your work or other regular activities as a result of your physical health?
Accomplished less than you would like?	1	Yes
	2	No
Are limited in the kind of work or other activities?	1	Yes
	2	No
During the past 4 weeks, have you been limited in the kind of work you do or other regular activities as a result of any emotional problems (such as feeling depressed or anxious)?
Accomplished less than you would like?	1	Yes
	2	No
Cannot do work or other activities as carefully as usual?	1	Yes
	2	No
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
The next three questions are about how you feel and how things have been 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?
Have you felt calm and peaceful?	1	All of the time
	2	Most of the time
	3	A good bit of the time
	4	Some of the time
	5	A little of the time
	6	None of the time
Do you have a lot of energy?	1	All of the time
	2	Most of the time
	3	A good bit of the time
	4	Some of the time
	5	A little of the time
	6	None of the time
Have you felt downhearted and blue?	1	All of the time
	2	Most of the time
	3	A good bit of the time
	4	Some of the time
	5	A little of the time
	6	None of the time
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	A good bit of the time
	4	Some of the time
	5	A little of the time
	6	None of the time