Oxford Score - Hip
Please answer the questions as they relate to the past four (4) weeks
Hip
*
Left
Right
Name
*
First Name
Last Name
How would you describe the pain you usually have from your hip?
*
None
Very mild
Mild
Moderate
Severe
Have you had any trouble washing and drying yourself all over because of your hip?
*
No trouble at all
Very little trouble
Moderate trouble
Extreme difficulty
Impossible to do
Have you had any trouble getting in and out of a car or using public transport because of your hip?
*
No trouble at all
Very little trouble
Moderate trouble
Extreme difficulty
Impossible to do
Have you been able to put on a pair of socks, stockings or tights?
*
Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible
Could you do the household shopping on your own?
*
Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible
How long have you been able to walk before pain in your hip becomes too severe? With or without a stick
*
No pain/more than 30 mins
16 - 30 mins
5 - 15 mins
Around the house only
Not at all, pain severe when walking
Have you been able to climb a flight of stairs?
*
Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible
After a meal at a table, how painful has it been for you to stand up from a chair because of your hip?
*
Not painful at all
Slightly painful
Moderately painful
Very painful
Unbearable
Have you been limping when walking because of your hip?
*
Rarely/never
Sometimes or just at first
Often, not just at first
Most of the time
All the time
Have you had any sudden, severe pain (shooting, stabbing or spasm) from the affected hip?
*
No days
Only 1 - 2 days
Some days
Most days
Every day
How much has pain from your hip interfered with your usual work? Including housework
*
Not at all
A little bit
Moderately
Greatly
Totally
Have you been troubled by pain from your hip in bed at night?
*
No nights
Only 1 - 2 nights
Some nights
Most nights
Every night
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