AnyQuest for Windows Questionnaire Definition File Version 2.32P ](` /VM  *3"Arial l"Arial l"Arial l"Arial l"Arial l"Arial l"Arial l"Arial l"Arial l"Arial l/+hp,. Short Form 12SF12English1.1 e{Gu` X)uX*% Questionnaire regarding your healthNeue Erklaerung Teil 2=U dThis survey asks for your views about your health. This information will help keep track of how you feel and how well you are able to do your usual activities.1,00 ?bpU dAnswer every question by marking one box. If you are unsure about how to answer a question, please give the best answer you can.2,00 r  X ,uX*+ In general, would you say your health is:Neue Erklaerung Teil 23 :{d Excellent100,000 3 {hd Very good75,00 b3@ {,dGood50,00 %b3 {dFair25,00(&30[{dPoor0,00$nTtD,NXzdI cannot answer this question0,00hnd,Xd$I don't want to answer this question0,00(rH X F&uX*cModerate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golfThis item is about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?Neue Erklaerung Teil 2X3{dYes, limited a lot0,00b30{,dYes, limited a little50,003{rdNo, not limited at all100,00nTth,NXzdI cannot answer this question0,00nd,Xd$I don't want to answer this question0,00r  XF&uX*$ Climbing several flights of stairsThis item is about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?Neue Erklaerung Teil 2X3{dYes, limited a lot0,00<b3{,dYes, limited a little50,003{rdNo, not limited at all100,00nTt,NXzdI cannot answer this question0,00n,Xd$I don't want to answer this question0,0076rx XF&uX*' Accomplished less than you would likeDuring the past four weeks, have you had the following problem with your work or other regular daily activities as a result of your physical health?Neue Erklaerung Teil 23@ {xdYes0,00S3{dNo100,00LnTt,NXzdI cannot answer this question0,00xn(,Xd$I don't want to answer this question0,00r XF&uX*8 Were limited in the kind of work or other activitiesDuring the past four weeks, have you had the following problem with your work or other regular daily activities as a result of your physical health?Neue Erklaerung Teil 2D3  {xdYes0,008S3< {dNo100,00 nTtL ,NXzdI cannot answer this question0,00Dn ,Xd$I don't want to answer this question0,00H)r)p) XF&uX*' Accomplished less than you would likeDuring the past four weeks, have you had the following problem with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?Neue Erklaerung Teil 2)3) {xdYes0,00)S3){dNo100,004)nTt\),NXzdI cannot answer this question0,00X)n\),Xd$I don't want to answer this question0,00 )rp*4* X #h,uX*< Didn't do work or other activities as carefully as usualDuring the past four weeks, have you had the following problem with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?Neue Erklaerung Teil 2*3* {xdYes0,004*S38*{dNo100,00*nTt*,NXzdI cannot answer this question0,00(*n*,Xd$I don't want to answer this question0,00*r|* X$*&uX*During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?Neue Erklaerung Teil 2*3*:{d Not at all100,00@*3P*{_d A little bit75,00*b3*{,d Moderately50,00D*/l3P*{d Quite a bit25,00*93*n{d Extremely0,00*nTt4*,NXzdI cannot answer this question0,00*n*,Xd$I don't want to answer this question0,00X*r*|* X+2&uX*" Have you felt calm and peaceful?This question is about how you feel and how things have been with you during the past 4 weeks. How much of the time during the past 4 weeks... Neue Erklaerung Teil 2*`*+{dAll of the time100,00*c`*{-dMost of the time80,00x* P`*{dA good bit of the time60,00*`*){dSome of the time40,00\*a`t*{+dA little of the time20,00* H`*}{dNone of the time0,00p *nTt *,NXzdI cannot answer this question0,00 *n( *,Xd$I don't want to answer this question0,00t *r *( * X3:&uX* Did you have a lot of energy?This question is about how you feel and how things have been with you during the past 4 weeks. How much of the time during the past 4 weeks... Neue Erklaerung Teil 2 *` *+{dAll of the time100,00 *c` *{-dMost of the time80,00| * P` *{dA good bit of the time60,00 *` *){dSome of the time40,00t*a`*{+dA little of the time20,00* H`*}{dNone of the time0,00t*nTt*,NXzdI cannot answer this question0,00 *n4*,Xd$I don't want to answer this question0,00|*r*8* X;B&uX*% Have you felt downhearted and blue?This question is about how you feel and how things have been with you during the past 4 weeks. How much of the time during the past 4 weeks... Neue Erklaerung Teil 2*`*+{dAll of the time0,00*c`(*{-dMost of the time20,00* P`*{dA good bit of the time40,00 *` *){dSome of the time60,00*a`*{+dA little of the time80,00* H`*}{dNone of the time100,00*nTt*,NXzdI cannot answer this question0,00 *nH*,Xd$I don't want to answer this question0,00*r ** XCI&uX*has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?2 During the past 4 weeks, how much of the time...Neue Erklaerung Teil 2*3*:{dAll of the time0,00(*3<*{_dMost of the time25,00*b3*{,dSome of the time50,00*/l34*{dA little of the time75,00*93*n{dNone of the time100,00*nTt4*,NXzdI cannot answer this question0,00*n*,Xd$I don't want to answer this question0,00*d------Physical FunctioningPhysical FunctioningPF@nM~@ Undefined v3 v4 2 avg*d------ Role Physical Role PhysicalRP@nM~@ Undefined v5 v6 2 avg *d------ Bodily Pain Bodily PainBP@nM~@ Undefinedv98d------General HealthGeneral HealthGH@nM~@ Undefinedv2<d------VitalityVitalityVT@nM~@ Undefinedv11@d------Social FunctioningSocial FunctioningSF@nM~@ Undefinedv13Dd------Role EmotionalRole EmotionalRE@nM~@ Undefined v7 v8 2 avgd------ Mental Health Mental HealthMH@nM~@ Undefined v10 v12 2 avgx*d------Physical Health SummaryPhysical Health SummaryPCS@nM~@ Undefinedv3 v4 v5 v6 v9 v2 6 avg*d------Mental Health SummaryMental Health SummaryMCS@nM~@ Undefinedv11 v13 v7 v8 v10 v12 6 avgThe SF-36 Health Survey 1993 by John E. Ware, Jr., Ph. D. et al Questionnaire definition file for AnyQuest for Windows 19.01.1997 by Jrg M. Sigle Cosmetically revised (a little) by Dr. Jrg M. Sigle, 23.03.2000 The SF-12 Health Survey 1995 by John E. Ware, Jr., Ph. D. et al Questionnaire definition file for AnyQuest for Windows 29.03.2000 by Jrg M. Sigle