4. 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? (Circle One Number on Each Line) a. Cut down the amount of time you spent on work or other activities b. Accomplished less than you would like c. Were limited in the kind of work or other activities d. Had diffculty performing the work or other activities (for example, it took extra effort) 5. 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)? (Circle One Number on Each Line) a. Cut down the amount of time you spent on work or other activities b. Accomplished less than you would like c. Didn't do work or other activities as carefully as usual Yes (1) No (2) 1 2 1 2 1 2 1 2 Yes (1) No (2) 1 2 1 2 1 2 6. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups? Not at all 1 Slightly 2 Moderately 3 Quite a bit 4 Extremely 5 Short-Form 36-Item Health Survey (SF-36) (continued) 7. How much bodily pain have you had during the past 4 weeks? None 1 Very mild 2 Mild 3 Moderate 4 Severe 5 Very severe 6 38
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