HOOS HIP SURVEY
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INSTRUCTIONS: This survey asks for your view about your hip. This information will help us keep track of how you feel about your hip and how well you are able to do your usual activities. Answer every question by ticking the appropriate box, only one box for each question. If you are uncertain about how to answer a question, please give the best answer you can. SYMPTOMS These questions should be answered thinking of your hip symptoms and difficulties during the last week.
S1. Do you feel grinding, hear clicking or any other type of noise from your hip? NeverRarelySometimesOftenAlways
S2. Difficulties spreading legs wide apart NoneMildModerateSevereExtreme
S3. Difficulties to stride out when walking NoneMildModerateSevereExtreme
STIFFNESS The following questions concern the amount of joint stiffness you have experienced during the last week in your hip. Stiffness is a sensation of restriction or slowness in the ease with which you move your hip joint.
S4. How severe is your hip joint stiffness after first wakening in the morning? NoneMildModerateSevereExtreme
S5. How severe is your hip stiffness after sitting, lying or resting later in the day? NoneMildModerateSevereExtreme
PAIN
P1. How often is your hip painful? NeverWeeklyMonthlyDailyAlways
What amount of hip pain have you experienced the last week during the following activities?
P2. Straightening your hip fully NoneMildModerateSevereExtreme
P3. Bending your hip fully NoneMildModerateSevereExtreme
P4. Walking on a flat surface NoneMildModerateSevereExtreme
P5. Going up or down stairs NoneMildModerateSevereExtreme
P6. At night while in bed NoneMildModerateSevereExtreme
P7. Sitting or lying NoneMildModerateSevereExtreme
P8. Standing upright NoneMildModerateSevereExtreme
P9. Walking on a hard surface (asphalt, concrete, etc.) NoneMildModerateSevereExtreme
P10. Walking on an uneven surface NoneMildModerateSevereExtreme
FUNCTION, DAILY LIVING The following questions concern your physical function. By this we mean your ability to move around and to look after yourself. For each of the following activities please indicate the degree of difficulty you have experienced in the last week due to your hip.
A1. Descending stairs NoneMildModerateSevereExtreme
A2. Ascending stairs NoneMildModerateSevereExtreme
A3. Rising from sitting NoneMildModerateSevereExtreme
A4. Standing NoneMildModerateSevereExtreme
For each of the following activities please indicate the degree of difficulty you have experienced in the last week due to your hip.
A5. Bending to the floor/pick up an object NoneMildModerateSevereExtreme
A6. Walking on a flat surface NoneMildModerateSevereExtreme
A7. Getting in/out of car NoneMildModerateSevereExtreme
A8. Going shopping NoneMildModerateSevereExtreme
A9. Putting on socks/stockings NoneMildModerateSevereExtreme
A10. Rising from bed NoneMildModerateSevereExtreme
A11. Taking off socks/stockings NoneMildModerateSevereExtreme
A12. Lying in bed (turning over, maintaining hip position) NoneMildModerateSevereExtreme
A13. Getting in/out of bath NoneMildModerateSevereExtreme
A14. Sitting NoneMildModerateSevereExtreme
A15. Getting on/off toilet NoneMildModerateSevereExtreme
A16. Heavy domestic duties (moving heavy boxes, scrubbing floors, etc) NoneMildModerateSevereExtreme
A17. Light domestic duties (cooking, dusting, etc) NoneMildModerateSevereExtreme
FUNCTION, SPORTS AND RECREATIONAL ACTIVITIES The following questions concern your physical function when being active on a higher level. The questions should be answered thinking of what degree of difficulty you have experienced during the last week due to your hip.
SP1. Squatting NoneMildModerateSevereExtreme
SP2. Running NoneMildModerateSevereExtreme
SP3. Twisting/pivoting on loaded leg NoneMildModerateSevereExtreme
SP4. Walking on uneven surface NoneMildModerateSevereExtreme
QUALITY OF LIFE
Q1. How often are you aware of your hip problem? NeverWeeklyMonthlyDailyConstantly
Q2. Have you modified your life style to avoid potentially damaging activities to your hip? Not at allMildlyModeratelySeverelyTotally
Q3. How much are you troubled with lack of confidence in your hip? Not at allMildlyModeratelySeverelyExtremely
Q4. In general, how much difficulty do you have with your hip? NoneMildModerateSevereExtreme
Thank you very much for completing all the questions in this questionnaire.
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