Date of completion

Hip disability and Osteoarthritis Outcome Score (HOOS)

  
Patient's name (or ref
Clinician's name (or ref)
Patient's d.o.b
 

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. If you are unsure about how to answer a question, please give the best answer you can.
 

Symptoms - These questions should be answered thinking of your hip symptoms during the last week.

1. Do you feel grinding, hear clicking or any other type of noise from you hip?
Never Rarely Sometimes Often Always

2. Difficulties spreading legs wide apart
None Mild Moderate Severe Extreme

3. Difficulties to stride out when walking
None Mild Moderate Severe Extreme
 

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.

4. How severe is your hip joint stiffness after first wakening in the morning?
None Mild Moderate Severe Extreme

5. How severe is your hip stiffness after sitting, lying or resting later in the day?
None Mild Moderate Severe Extreme
Subtotal:
 

Pain

1. How often is your hip painful?
Never Monthly Weekly Daily Always

What amount of hip pain have you experienced the last week during the following activities?

2. Straightening your hip fully
None Mild Moderate Severe Extreme

3. Bending your hip fully
None Mild Moderate Severe Extreme

4. Walking on flat surface
None Mild Moderate Severe Extreme

5. Going up or down stairs
None Mild Moderate Severe Extreme

6. At night while in bed
None Mild Moderate Severe Extreme

7. Sitting or lying
None Mild Moderate Severe Extreme

8. Standing upright
None Mild Moderate Severe Extreme

9. Walking on a hard surface (asphalt, concrete, etc)
None Mild Moderate Severe Extreme

10. Walking on an uneven surface
None Mild Moderate Severe Extreme
Subtotal:
 

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.

1. Descending stairs
None Mild Moderate Severe Extreme

2. Ascending stairs
None Mild Moderate Severe Extreme

3. Rising from sitting
None Mild Moderate Severe Extreme

4. Standing
None Mild Moderate Severe Extreme

5. Bending to floor/pick up an object
None Mild Moderate Severe Extreme

6. Walking on flat surface
None Mild Moderate Severe Extreme

7. Getting in/out of car
None Mild Moderate Severe Extreme

8. Going shopping
None Mild Moderate Severe Extreme

9. Putting on socks/stockings
None Mild Moderate Severe Extreme

10. Rising from bed
None Mild Moderate Severe Extreme

11. Taking off socks/stockings
None Mild Moderate Severe Extreme

12. Lying in bed (turning over, maintaining hip position)
None Mild Moderate Severe Extreme

13. Getting in/out of bath
None Mild Moderate Severe Extreme

14. Sitting
None Mild Moderate Severe Extreme

15. Getting on/off toilet
None Mild Moderate Severe Extreme

16. Heavy domestic duties (moving heavy boxes, scrubbing floors, etc)
None Mild Moderate Severe Extreme

17. Light domestic duties (cooking, dusting, etc)
None Mild Moderate Severe Extreme
Subtotal:
 

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.

1. Squatting
None Mild Moderate Severe Extreme

2. Running
None Mild Moderate Severe Extreme

3. Twisting/pivoting on your injured knee
None Mild Moderate Severe Extreme

4. Walking on uneven surface
None Mild Moderate Severe Extreme
Subtotal:
 

Quality of Life

1. How often are you aware of your hip problem?
Never Monthly Weekly Daily Constantly

2. Have you modified your life style to avoid potentially damaging activities to your hip?
Not at all Mildly Moderately Severely Totally

3. How much are you troubled with lack of confidence in your hip?
Not at all Mildly Moderately Severely Extremely

4. In general, how much difficulty do you have with your hip?
None Mild Moderate Severe Extreme
Subtotal:

Thank you very much for completing all the questions in this questionnaire.

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HOOS Hip Survey Score is

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