HIP

HIP

Questionnaire concerning hip and/or groin problems
INSTRUCTIONS: This questionnaire asks for your view about your hip and/or groin problem. The questions should be answered considering your hip and/or groin function during the past week.This information will help us keep track of how you feel, and how well you are able to do your usual activities.Answer every question by ticking the appropriate box. Tick only one box for each question. If a question does not pertain to you or you have not experienced it in the past week please make your “best guess” as to which response would be the most accurate.SymptomsThese questions should be answered considering your hip and/or groin symptoms anddifficulties during the past week.
Symptoms

These questions should be answered considering your hip and/or groin symptoms and difficulties during the past week

Symptoms

	Never	Rarely	Sometimes	Often	Always
S1 Do you feel discomfort in your hip and/or groin?
S2 Do you hear clicking or any other type of noise from your hip and/or groin?
S3 Do you have difficulties stretching your legs far out to the side?
S4 Do you have difficulties taking full strides when you walk?
S5 Do you experience sudden twinging/stabbing sensations in your hip and/or groin?

	None	Mild	Moderate	Severe	Extreme
S6 How severe is your hip and/or groin stiffness after first awakening in the morning?
S7 How severe is your hip and/or groin stiffness after sitting, lying or resting later in the day?

	Never	Monthly	Weekly	Daily	Alway
P1 How often is your hip and/or groin painful?
P2 How often do you have pain in areas other than your hip and/or groin that you think may be related to your hip and/or groin problem?

	None	Mild	Moderate	Severe	Extreme
P3 Straightening your hip fully􏰁􏰁􏰁􏰁􏰁
P4 Bending your hip fully
P5 Walking up or down stairs
􏰁􏰁􏰁P6 At night while in bed (pain that disturbs your sleep) 􏰁􏰁􏰁􏰁
􏰁P7 Sitting or lying

	None	Mild	Moderate	Severe	Extreme
P8 Standing upright
P9 Walking on a hard surface (asphalt, concrete, etc.)
P10 Walking on an uneven surface

	None	Mild	Moderate	Severe	Extreme
A1 Walking up stairs
A2 Bending down, e.g. to pick something up from the floor
A3 Getting in/out of car
A4 Lying in bed (turning over or maintaining the same hip position for a long time)
A5 Heavy domestic duties (scrubbing floors, vacuuming, moving heavy boxes etc)

Symptoms

	None	Mild	Moderate	Severe	Extreme
SP1 Squatting
SP2 Running
SP3 Twisting/pivoting on a weight bearing leg
SP4 Walking on an uneven surface
SP5 Running as fast as you can
SP6 Bringing the leg forcefully forward and/or out to the side, such as in kicking, skating etc.
SP7 Sudden explosive movements that involve quick footwork, such as accelerations, decelerations, change of directions etc.
SP8 Situations where the leg is stretched into an outer position

	Always	Often	Sometimes	Rarely	Never
Service QualityPA1 Are you able to participate in your preferred physical activities for as long as you would like?
PA2 Are you able to participate in your preferred physical activities at your normal performance level?
Responsiveness
Friendliness

	Never	Monthly	Weekly	Daily	Constantly
Q1 How often are you aware of your hip and/or groin problem?
􏰁􏰁Q2 Have you modified your life style to avoid activities potentially damaging toyour hip and/or groin?
􏰁Q3 In general, how much difficulty do you have with your hip and/or groin?
Q4 Does your hip and/or groin problem affect your mood in a negative way?Not at all Rarely Sometimes Often All the time􏰁􏰁s
Do you feel restricted due to your hip and/or groin problem?