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健康调查简表


注意！该文章为贵州三易医疗器械有限公司原创整理编辑，不经过本公司书面同意，不得以任何方式，包括但不限于电子、纸质的方式进行复制、传播及转载。原始发布时间：2026年8月29日。


健康调查简表（SF-36）——概况


健康调查简表（Medical Outcomes Study Short Form 36，SF-36）是一种广泛使用的、通用的、患者自评测量工具，旨在评估普通人群的健康相关生活质量（health-related quality of life，HRQOL）。它是作为医学结局研究（Medical Outcomes Study，一项针对慢性病患者的两年研究）的一部分而开发的（Ware & Sherbourne, 1992）。如今，SF-36是用于测量生活质量的最常用通用工具（de Haan, 2002），适用于14岁及以上人群，施测约需10分钟。SF-36可用于但不限于脑卒中患者。该工具为评估工具，证据审核时间截至2008年8月19日之前。


健康调查简表（SF-36）——的目的


SF-36用于评估普通人群及各类疾病人群（包括脑卒中患者）的健康相关生活质量，可自评、计算机施测或由受过训练的访谈者施测。


健康调查简表（SF-36）——的测试项目与分量表


SF-36包含11个问题、共36个条目，分为8个维度：躯体功能（10个条目）、躯体问题导致的角色限制（4个条目）、身体疼痛（2个条目）、总体健康感知（5个条目）、社会功能（2个条目）、总体心理健康（5个条目）、情绪问题导致的角色限制（3个条目）、活力（4个条目）。前4个维度属躯体成分，后4个维度属心理成分。此外还有1个健康变化问题：受访者被要求将当前健康状况与一年前的健康状况进行比较，此问题独立于8个分量表，不参与评分。


回忆期：标准版为过去4周，急性版为过去1周。


健康调查简表（SF-36）——的施测规则


SF-36可自评、计算机施测或由受过训练的访谈者进行面对面或电话施测，也可通过邮寄问卷调查完成。适用于14岁及以上人群（Ware & Sherbourne, 1992）。可通过网络在线评分（付费，QualityMetric网站）。代理施测在脑卒中患者中不推荐，因为一致性差。


健康调查简表（SF-36）——的评分方法


SF-36不适合生成总体总分，推荐使用加权Likert评分系统。各子量表条目相加得到子量表总分，每个分量表的分数经线性转换为0分（负向健康）至100分（正向健康）。可导出躯体成分总分（PCS）和心理成分总分（MCS），但这些总分需谨慎解释：Hobart等（2002）发现这两个量表仅解释SF-36分数方差的60%。


健康调查简表（SF-36）——的测试时间


平均约10分钟完成（Andreson & Meyers, 2000）。


健康调查简表（SF-36）——需要培训吗？


不需要培训即可施测。


健康调查简表（SF-36）——需要什么样的设备？


仅需问卷和铅笔。


健康调查简表（SF-36）——适合哪些患者群体？


可用于：脑卒中患者，但其在脑卒中人群中的适用性存在争议。


不应用于：不能理解书面或口头语言的患者；严重受损的脑卒中幸存者（需要代理完成）；失语症患者（应使用SAQOL-39）；不应用于记录个体患者变化（仅适用于大群体比较）。


健康调查简表（SF-36）——的心理测量学特性


信度——内部一致性：10项研究中，5项报告优秀内部一致性（除3项研究中的社会功能和1项研究中的总体健康为充分）；2项研究报告充分至优秀的内部一致性；3项研究报告差至优秀的内部一致性。详细数据：Brazier et al.（1992）报告大于0.85（优秀），除社会功能0.73；Jenkinson et al.（1993）报告大于0.80（优秀），除社会功能0.76；Jenkinson et al.（1994）报告0.76-0.90；Brazier et al.（1996）报告大于等于0.80，社会功能0.56、总体健康0.66；Essink-Bot et al.（1997）报告0.76-0.91，均值0.84；Weinberger et al.（1996）报告24个中有17个超过0.80；Hagen et al.（2003）在脑卒中患者中报告良好，除1月活力0.68和3月总体健康0.67；Dorman et al.（1998）在2253例脑卒中患者中报告0.81-0.96（优秀）；McHorney et al.（1994）报告0.65-0.94，中位数0.85；Anderson et al.（1996）报告0.60-0.90。


重测信度：Brazier et al.（1992）报告0.60-0.81；Brazier et al.（1996）报告0.28-0.70（6个月重测期）；Andresen et al.（1999）报告ICC 0.55-0.82；Weinberger et al.（1996）报告r=0.55-0.94；Dorman et al.（1998）在脑卒中患者中报告ICC 0.28-0.80。评分者间信度：无研究检验。


效度——预测效度：总体健康感知最能预测死亡（最低四分位数死亡率是最高四分位数的3倍）；基线躯体功能、躯体角色限制和疼痛最能预测住院；疼痛、总体健康和活力最能预测医生就诊；心理健康子量表与抑郁严重程度强烈相关；术前PCS评分是冠状动脉旁路移植术（CABG）术后6个月死亡率的显著预测因子（OR=1.39）。


聚合效度：SF-36躯体健康子量表与日常生活活动指数充分相关；SF-36社会功能与Nottingham健康量表的社会隔离充分相关；SF-36总体健康与EuroQol总体HRQOL评分充分相关；SF-36躯体疼痛与所有EuroQol领域充分相关；角色功能-情绪与EuroQol心理领域充分相关；SF-36躯体健康与老年抑郁量表之间优秀相关；活力子量表与Nottingham健康量表能量子量表优秀相关；躯体疼痛与EuroQol疼痛领域优秀相关。


已知组效度：SF-36评分可区分慢性躯体疾病患者与健康年龄匹配对照、大于75岁与小于75岁个体、不同环境组别（全科对医院门诊）、偏头痛患者与对照、不同就诊频次组、脑卒中患者与年龄性别匹配对照。


地板/天花板效应：8项研究中，6项报告SF-36有显著地板和天花板效应，1项报告仅显著天花板效应，1项报告仅显著地板效应。详细数据：Lai et al.（2003）报告躯体功能地板效应37%-100%，社会功能天花板效应60%；Anderson et al.（1996）报告地板效应无超过7%者，天花板效应为躯体角色限制53%、身体疼痛43%、社会功能67%、情绪角色限制72%；Brazier et al.（1996）报告躯体角色限制和情绪角色限制地板效应大于25%；Hobart et al.（2002）报告躯体角色限制地板效应59.1%、情绪角色限制63.1%、社会功能29.9%、身体疼痛25.6%；O'Mahoney et al.（1998）报告地板效应为躯体角色限制54%、情绪角色限制35%、社会功能17%、躯体功能18%，天花板效应为躯体角色限制16%、情绪角色限制51%、社会功能18%、身体疼痛25%；Weinberger et al.（1996）报告地板效应为躯体角色限制43.8%-53.2%、情绪角色限制25.0%-34.0%，天花板效应为社会功能27.8%-31.5%、躯体角色限制14.6%-14.7%、情绪角色限制36.2%-52.8%；Walters et al.（2001）报告地板效应为躯体角色限制30.9%-60%、情绪角色限制25.6%-50.4%，天花板效应为躯体角色限制11.7%-38.6%、情绪角色限制32.2%-53.2%；Andresen et al.（1999）报告地板效应为躯体功能26.8%、躯体角色限制29.5%，天花板效应为社会功能36.1%、情绪角色限制49.5%、身体疼痛21.6%。


敏感度/变化检测能力：3项研究中，1项报告大变化检测能力，1项报告中等至大变化检测能力（除社会功能和心理健康维度效应量小），1项报告小到大变化检测能力。据知无研究检验SF-36在脑卒中患者中的变化检测能力。


健康调查简表（SF-36）——的版本


SF-36版本1.0（1992年，Ware & Sherbourne）：原始版本。


SF-36版本2.0（1996年，SF-36v2）：修正了原始版本中发现的缺陷，变更包括措辞修改（如将downhearted and blue改为downhearted and depressed），被认为是SF-36的国际版本（Andresen & Meyers, 2000）；回应类别数量和格式标准化；角色功能条目现在有5个回应级别而非2个；早期测试报告为积极（Jenkinson et al., 1999）。


SF-12（Ware, Kosinski, & Keller, 1996）：简化版，用于大规模调查，完成时间不超过5分钟，可自评、访谈、电话或计算机施测；SF-12v2与SF-36v2对应。


SF-8（QualityMetric, Inc.）：8条目通用评估，每个SF-36维度用1个问题测量，完成时间约1-2分钟，已翻译验证用于30多个国家。


SF-6D（Brazier et al., 1998; 2002）：基于偏好的评分系统，使用SF-36的6个子量表，允许从SF-36/SF-36v2计算效用值，将8个维度减至6个（省略总体健康感知，合并躯体和情绪角色限制）。


语言版本：SF-36有多种语言版本。IQOLA项目（1991年启动）有14个国家参与（澳大利亚、比利时、加拿大、丹麦、法国、德国、意大利、日本、荷兰、挪威、西班牙、瑞典、英国、美国），额外翻译用于40多个国家（包括中国、日本、韩国等），超过500篇使用SF-36翻译或英语改编版的出版物。


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