1 sf-8. 2 wlq 1.in the past 2 weeks, how much of the time did your physical health or emotional...

1

1. Overall, how would you rate your health during the past 4 weeks?

Excellent Very good Good Fair Poor Very poor

2. During the past 4 weeks, how much did physical health problems limit your usual physical activities (such as walking or climbing stairs)?

Not at all Very little Somewhat Quite a lot Could not do

physical activities

3. During the past 4 weeks, how much difficulty did you have doing your daily work, both at home and away from home, because of your physical health?

None at all A little bit Some Quite a lot Could not do daily work

4. How much bodily pain have you had during the past 4 weeks?

None Very mild Mild Moderate Severe Very Severe

5. During the past 4 weeks, how much energy did you have? Very much Quite a lot Some A little None

6. During the past 4 weeks, how much did your physical health or emotional problems limit your usual social activities with family or friends?


social activities

7. During the past 4 weeks, how much have you been bothered by emotional problems (such as feeling anxious, depressed or irritable)?

Not at all Slightly Moderately Quite a lot Extremely

8. During the past 4 weeks, how much did personal or emotional problems keep you from doing your usual work, school or other daily activities?


daily activities

SF-8

2

WLQ

1. In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following? (Mark one box on each line a. through e.)

All of the Time (100%)

Most of the Time

Some of the Time (About 50%)

A Slight Bit of

the Time

None of the Time

(0%)

Does Not

Apply to My Job

a. work the required number of hours

1 2 3 4 5 0

b. get going easily at the beginning of the workday

1 2 3 4 5 0

c. start on your job as soon as you arrived at work

1 2 3 4 5 0

d. do your work without stopping to take breaks or rests

1 2 3 4 5 0

e. stick to a routine or schedule 1 2 3 4 5 0

These questions ask you to rate the amount of time you had difficulty handling certain parts of your job. Please read and answer every question. Then choose a response.

Mark the “Does Not Apply to My Job” box only if the question describes something that is not part of your job. If you have more than one job, report on your main job only.

Please do not duplicate, distribute or use without complying with the guidelines of use outlined by the developers in the Gold Book.

Time limitations

3

WLQ

All of the Time

(100%)

Most of the Time


A Slight Bit of the

Time

None of the Time

(0%)

Does Not Apply to My Job

a. walk or move around different work locations (for example, go to meetings) . . . . . . . . . .

1 2 3 4 5 0

b. lift, carry, or move objects at work weighing more than 10 lbs. . . . . . . . . . . .

1 2 3 4 5 0

sit, stand, or stay in one position for longer than 15 minutes while working . . . . . . . . . . . . . .

1 2 3 4 5 0

d.repeat the same motions over and over again while working . . . . . . . . . . . . . .

1 2 3 4 5 0

e.bend, twist, or reach while working . . . . . . . . . . . . . .

1 2 3 4 5 0

f.use hand-held tools or equipment (for example, a phone, pen, keyboard, computer mouse, drill, hairdryer, or sander) . . . . .

1 2 3 4 5 0

These questions ask you to rate the amount of time you were able to handle certain parts of your job without difficulty.

2. In the past 2 weeks, how much of the time were you ABLE TO DO the following without difficulty caused by physical health or emotional problems?


Physical limitations

4

These questions ask about difficulties you may have had at work.

3. In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following?

(Mark one box on each line a. through f.)

All of the Time

(100%)

Most of the Time


A Slight Bit of the

Time

None of the Time

(0%)


a. keep your mind on your work . . . . . . . . . . . . . . . . .

1 2 3 4 5 0

b. think clearly when working . . . . . . . . . . . . . .

1 2 3 4 5 0

c. do work carefully . . . . . . . 1 2 3 4 5 0

d. concentrate on your work . . . . . . . . . . . . . . . .

1 2 3 4 5 0

e. work without losing your train of thought . . . . . . . . .

1 2 3 4 5 0

f. easily read or use your eyes when working . . . . . .

1 2 3 4 5 0

WLQ


Mental limitations

5

WLQ

The next questions ask about difficulties in relation to the people you came in contact with while working. These may include employers, supervisors, coworkers, clients, customers, or the public.

4. In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following?

(Mark one box on each line a. through c.)

All of the Time

(100%)

Most of the Time


A Slight Bit of the

Time

None of the Time

(0%)


a. speak with people in-person, in meetings or on the phone . . . . . . . . . . . . .

1 2 3 4 5 0

b. control your temper around people when working . . . .

1 2 3 4 5 0

c. help other people to get work done . . . . . . . . . . . . .

1 2 3 4 5 0

These questions ask about how things went at work overall. 5. In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following?

(Mark one box on each line a. through e.)

All of the Time

(100%)

Most of the Time


A Slight Bit of the

Time

None of the Time

(0%)


a. handle the workload . . . . . 1 2 3 4 5 0

b. work fast enough . . . . . . . 1 2 3 4 5 0

c finish work on time . . . . . . 1 2 3 4 5 0

d. do your work without making mistakes. . . . . . . .

1 2 3 4 5 0

e. feel you’ve done what you are capable of doing. . . . .

1 2 3 4 5 0


Interpersonal limitations

Output limitations

6

Average Before and After SF-8 Scale Score Results:

sample

49.4% 49.6% 50.5% 50.0% 51.3% 51.1%52.6% 53.3%

49.7% 50.6% 50.6% 51.1%49.2%

51.3%49.0% 49.9%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

First Last First Last First Last First Last First Last First Last First Last First Last

GeneralHealth

PhysicalFunctioning

RolePhysical

Bodily Pain Vitality SocialFunctioning

MentalHealth

RoleEmotional

Perce

nt of

SF-8

Scale

Scor

es

7

Average Before and After SF-8 Summary Score Results : sample

52.2% 51.8%49.4%

51.7%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

First Last First Last

Physical Component Summary Mental Component Summary

Perce

nt of

SF-8

Summ

ary Sc

ores

http://www.sf-36.org/demos/SF-8.htmlBest: 58.6, 59.3

Worst: 19.5, 17.9

http://www.sf-36.org/demos/SF-8.html

8

WLQ Survey Results: sample

8.8%

6.9%

9.4% 9.4%9.6%

7.9%

5.5% 5.4%

8.3%

7.4%

0%

2%

4%

6%

8%

10%

12%

First Last First Last First Last First Last First Last

Physical Demands*Time ManagementMental/Interpersonal

Demands*

Output DemandsOverall WLQ Score*

Per

cen

t o

f Im

pai

rmen

t

* P-Value Significance ≤ 0.05

1 sf-8. 2 wlq 1.in the past 2 weeks, how much of the time did your physical health or emotional...

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