Hip disability and Osteoarthritis Outcome Score (HOOS) Survey

Hip disability and Osteoarthritis Outcome Score (HOOS) Survey
Name*

First NameLast Name
Date*

MonthDayYear
Date
Affected Hip:

Left hipRight hip
This survey asks for your opinion about your hip and helps us understand how well you are able to complete your usual activities. Answer each 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.
Answer these questions thinking of your hip symptoms and difficulties in 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 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
P1. How often is your hip painful*

NeverMonthlyWeeklyDailyAlways
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

This section describes your ability to move around and to look after yourself. For each of the following activites, 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
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

This section describes your ability to be active on a higher level. For each of the following activities, please indicate the degree of difficulty you have experienced in 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?*

NeverMonthlyWeeklyDailyConstantly
Q2. Have you modified your life style to avoid activities potentially damaging 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
Understanding results

Each subscale will get a score of 0 to 100, with 0 indicating extreme symptoms and 100 indicating no symptoms.
Symptoms sub section
Pain sub section
Function, daily living sub section
Function, sports and recreational activities
Quality of life
Should be Empty: