Table 1 Overview of SF-6Dv2 Forms A and B
From: Development of the SF-6Dv2 health utility survey: comprehensibility and patient preference
Category | Form A | Form B |
|---|---|---|
Instructions | The next six questions ask about different aspects of your health. For each question, please select the one response that best describes your health | The next six items concern different aspects of your health. For each item, please select the one statement that best describes your health |
Physical functioning | 1. Does your health now limit you in your physical activities, for example vigorous activities (such as running, lifting heavy objects, participating in strenuous sports), moderate activities (such as moving a table, pushing a vacuum cleaner, bowling or playing golf), or bathing and dressing? Not limited at all in vigorous activities Limited a little in vigorous activities Limited a little in moderate activities Limited a lot in moderate activities Limited a lot in bathing and dressing | Physical functioning Your health does not limit you in vigorous activities (such as running, lifting heavy objects, participating in strenuous sports) Your health limits you a little in vigorous activities Your health limits you a little in moderate activities (such as moving a table, pushing a vacuum cleaner, bowling, or playing golf) Your health limits you a lot in moderate activities Your health limits you a lot in bathing and dressing |
Role functioning | 2. During the past 4 weeks, how much of the time have you accomplished less than you would like at work or during other regular daily activities as a result of your physical health or emotional problems? None of the time A little of the time Some of the time Most of the time All of the time | Role functioning (Ability to work or do regular daily activities) in the past 4 weeks You accomplished less than you would like none of the time You accomplished less than you would like a little of the time You accomplished less than you would like some of the time You accomplished less than you would like most of the time You accomplished less than you would like all of the time |
Pain | 3. During the past 4 weeks, how much bodily pain have you had? None Very mild pain Mild pain Moderate pain Severe pain Very severe pain | Pain in the past 4 weeks You had no bodily pain You had very mild bodily pain You had mild bodily pain You had moderate bodily pain You had severe bodily pain You had very severe bodily pain |
Vitality | 4. During the past 4 weeks, how much of the time did you feel worn out? None of the time A little of the time Some of the time Most of the time All of the time | Vitality in the past 4 weeks You felt worn out none of the time You felt worn out a little of the time You felt worn out some of the time You felt worn out most of the time You felt worn out all of the time |
Social functioning | 5. 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.)? None of the time A little of the time Some of the time Most of the time All of the time | Social Functioning in the past 4 weeks Your health limited your social activities none of the time Your health limited your social activities a little of the time Your health limited your social activities some of the time Your health limited your social activities most of the time Your health limited your social activities all of the time |
Mental health | 6. During the past 4 weeks, how much of the time have you felt depressed or very nervous? None of the time A little of the time Some of the time Most of the time All of the time | Mental Health in the past 4 weeks You felt depressed or very nervous none of the time You felt depressed or very nervous a little of the time You felt depressed or very nervous some of the time You felt depressed or very nervous most of the time You felt depressed or very nervous all of the time |