Hip Pain Index

Hip Pain Disability Questionnaire

This questionnaire has been designed to give your health care provider information as to how your hip pain has affected your ability to manage in every day life. Please answer every section and mark only one box which best applies to you at this moment.

I can tolerate the pain I have without having to use pain medicationThe pain is bad but I manage without take pain medicationPain medication gives me complete relief from painPain medication gives me moderate relief from painPain medication gives me very little relief from painPain medication has no effect on the pain and I do not use it

I can take care of myself normally without causing an increase in my painI can look after myself normally but it causes an increase in my painIt is painful to take care of myself and that requires me to be slow and carefulI need some help but I manage most of my personal careI need help every day in most aspects of self-careI do not get dressed by myself, I wash with difficulty and stay in bed

I can lift heavy weights without increasing my painI can lift heavy weights but it does increase my painPain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, for example on a tablePain prevents me from lifting heavy weights but I can manage light to medium weights if they are conveniently positionedI can lift only very light weightsI cannot lift or carry anything at all

Pain does not prevent me from walking any distancePain prevents me from walking more than 1 milePain prevents me from walking more than 1/2 milePain prevents me from walking more than 1/4 mileI can only walk using a cane or crutchesI am in bed most of the time and have to crawl to the toilet

I can sit on any chair as long as I likeI can only sit in my favorite chair as long as I likePain prevents me from sitting more than 1 ourPain prevents me from sitting more than 1/2 hourPain prevents me from sitting more than 10 minutesPain prevents me from sitting at all

I can stand as long as I like without increasing my painI can stand as long as I want but it increases my painPain prevents me from standing for more than 1 hourPain prevents me from standing for more than 1/2 hourPain prevents me from standing for more than 10 minutesPain prevents me from standing at all

Pain does not prevent me from sleeping wellI can sleep well only using medicationEven when I take medication, I have less than 6 hours of sleepEven when I take medication, I have less than 4 hours of sleepEven when I take medication I have less than 2 hours of sleepPain prevents me from sleeping at all

My sex life is normal and causes no increase in painMy sex life is normal and causes some increase in my painMy sex life is nearly normal but is very painfulMy sex life is severely restricted by my painMy sex life is nearly absent because of my painPain prevents any se life at allN/A

My social life is normal and does not increase my painMy social life is normal but increases my painMy pain has no effect on my social life apart from limiting my energetic interests, for example dancingPain has restricted my social life and I do not go out as oftenPain has restricted my social life to homeI have no social life because of my pain

I can travel anywhere without increasing my painI can travel anywhere but it increases my painMy pain is bad but I manage journeys over 2 hoursMy pain restricts me to journes of less than 1 hourMy pain restricts me to short necessary journeys less than 30 minutesMy pain prevents me from traveling except to my medical appointments or to the hospital

Low Back Pain Index

Hip pain is often closely related to the low back. This questionnaire will give your provider information about how your low back condition affects your hip and everyday life. Please answer every section by marking the one statement that applies to you. If two or more statements in one section apply, please mark the one statement that most closely describes your problem.

The pain comes and goes and is very mildThe pain is mild and does not vary muchThe pain comes and goes and is moderateThe pain is moderate and does not vary muchThe pain comes and goes and is very severeThe pain is very severe and does not vary much

I get no back pain in bedI get back pain in bed but it does not prevent me from sleeping wellBecause of my back pain my normal sleep is reduced by less than 25%Because of my back pain my normal sleep is reduced by less than 50%Because of my back pain my normal sleep is reduced by less than 75%Back pain prevents me from sleeping at all

I can sit in any chair as long as I likeI can only sit in my favorite chair as long as I likePain prevents me from sitting more than 1 hourPain prevents me from sitting more than 1/2 hourPain prevents me from sitting more than 10 minutesI avoid sitting because it increases pain immediately

I can stand as long as I want without painI have some pain while standing but its does not increase with timeI cannot stand for longer than 1 hour without increasing painI cannot stand for longer than 1/2 hour without increasing painI cannot stand for longer than 10 minutes without increasing painI avoid standing because it increases pain immediately

I have no low back pain while walkingI have some pain while walking but it does not increase with distanceI cannot walk more than 1 mile without increasing painI cannot walk more than 1/2 mile without increasing painI cannot walk more than 1/4 mile without increasing painI cannot walk at all without increasing pain

I do not have to change my way of washing or dressing in order to avoid painI do not normally change my way of washing or dressing even though it causes some painWashing and dressing increases the pain but I manage not to change my way of doing itWashing and dressing increases the pain and I find it necessary to change my way of doing itBecause of the pain I am unable to do some washing and dressing without helpBecause of the pain I am unable to do any washing and dressing without help

I can lift heavy weights without extra painI can lift heavy weights but it causes extra painPain prevents me from lifting heavy weights off the floorPain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned (e.g. on a table)Pain prevents me from lifting heavy weights off the floor, but I can manage light to medium weights if they are conveniently positionedI can only lift very light weights

I get not pain while travelingI get some pain while traveling but none of my usual forms of travel make it worseI get some extra pain while traveling but it does not cause me to seek alternate forms of travelI get extra pain while traveling which causes me to seek alternate forms of travelPain restricts all forms of travel except that done while lying downPain restricts all from of travel

My social life is normal and gives me no extra painMy social life is normal but increases the degree of painPain has no significant affect on my social life apart from limiting my more energetic interests (e.g. dancing, etc.)Pain has restricted my social life and I do not go out very oftenPain has restricted my social life to my homeI have hardly any social life because of the pain

My pain pain is rapidly getting betterMy pain fluctuates but overall is definitely getting betterMy pain seems to be getting better but improvement is slowMy pain is neither getting better nor worseMy pain is gradually worseningMy pain is rapidly worsening