HOOS-JR
Hip disability and Osteoarthritis Outcome Score
Name
*
First Name
Last Name
Email
*
example@example.com
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
If you are completing this form regarding a different date, enter it here (Month, Day, Year)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please indicate which hip this survey is about:
*
Left
Right
VAS: Overall, how bad is your pain (0=no pain, 100 =maximum imaginable pain)
*
Pain - What amount of hip pain have you experienced in the LAST WEEK during the following activities?
*
Rows
None
Mild
Moderate
Severe
Extreme
1. Going up or down stairs
2. Walking on an uneven surface
Function, daily living: Please indicate the degree of difficulty you've experience in the last week due to your hip with the following activities:
*
Rows
None
Mild
Moderate
Severe
Extreme
3. Rising from sitting
4. Bending to floor / pick up an object
5. Lying in bed (turning over, maintaining hip position)
6. Sitting
Raw HOOS-JR Score
Submit
Should be Empty: