Item | Domain | Item wording | Item response (score) | ||||
---|---|---|---|---|---|---|---|
Physical Health Subscale | |||||||
 Item 1 | General health | In general, would you say your health is: ...... | Excellent (5) | Very good (4) | Good (3) | Fair (2) | Poor (1) |
 Item 3 | Physical health | In general, how would you rate your physical health? | Excellent (5) | Very good (4) | Good (3) | Fair (2) | Poor (1) |
 Item 6 | Physical function | To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair? | Completely (5) | Mostly (4) | Moderately (3) | A little (2) | Not at all (1) |
 Item 7 | Paina | In the past 7 days, how would you rate your pain on average? | No pain (5) | Score 1–3 (4) | Score 4–6 (3) | Score 7–9 (2) | Worst pain (1) |
 Item 8 | Fatigue | In the past 7 days, how would you rate your fatigue on average? | None (5) | Mild (4) | Moderate (3) | Severe (2) | Very severe (1) |
Mental Health Subscale | |||||||
 Item 2 | Quality of life | In general, would you say your quality of life is: | Excellent (5) | Very good (4) | Good (3) | Fair (2) | Poor (1) |
 Item 4 | Mental health | In general, how would you rate your mental health, including your mood and your ability to think? | Excellent (5) | Very good (4) | Good (3) | Fair (2) | Poor (1) |
 Item 5 | Social discretionary | In general, how would you rate your satisfaction with your social activities and relationships? | Excellent (5) | Very good (4) | Good (3) | Fair (2) | Poor (1) |
 Item 9 | Social roles | In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.) | Excellent (5) | Very good (4) | Good (3) | Fair (2) | Poor (1) |