5
Sources
958
Studies
52143
Questions
502
Persons
For the following questions, please circle the number that best corresponds to your views.
Below are a number of statements that people often use to describe themselves. Please read each statement and then circle the appropriate number next to that statement to indicate your answer. There are no right or wrong answers. Your own impression is the only thing thing that matters.
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)?
During the past 4 weeks, how much did pain interfere with your normal work? (including both work outside the home and housework)
During the past 4 weeks, were you 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)
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?
Does your health limit you in these activities? If so, how much? Moderate activities, such as: moving a table, pushing a vacuum cleaner, bowling, or playing golf
