Hip Outcome Score

Please answer every question with one response that most closely describes to your condition within the past week. If the activity in question is limited by something other than your hip, mark Not Applicable (N/A)

1. Standing for 15 minutes

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

2. Getting into and out of an average car

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

3. Walking up steep hills

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

4. Walking down steep hills

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

5. Going up 1 flight of stairs

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

6. Going down 1 flight of stairs

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

7. Stepping up and down curbs

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

9. Getting into and out of a bath tub

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

10. Walking initially

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

11. Walking for approx. 10 minutes

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

12. Walking 15 minutes or greater

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

13. Twisting/pivoting on involved leg

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

14. Rolling over in bed

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

15. Light to moderate work (standing, walking)

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

16. Heavy Work (push/pulling, climibing, carrying)

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

17. Recreational activities

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

18. Putting on socks and shoes (not scored)

None at all (No-Value)Slight (No-Value)Moderate (No-Value)Extreme (No-Value)Unable to do (No-Value)N/A (No-Value)

19. Sitting for 15minutes (not scored)

None at all (No-Value)Slight (No-Value)Moderate (No-Value)Extreme (No-Value)Unable to do (No-Value)N/A (No-Value)

20. How would you rate your current level of function during your usual activities of daily living from 0 to 100 with 100 being your level of function prior to your hip problem and 0 being the inability to perform any of your usual daily activities?

01000000102030405060708090100

21. Running one mile

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

23. Swinging objects like a golf club

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

25. Starting and stopping quickly

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

26. Cutting/lateral movements

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

27. Low impact activities like fast walking

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

28. Ability to perform activity with your normal technique

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

29. Ability to participate in your desired sport as long as you would like

None at all (4)Slight (3)Moderate (2)Extreme (1)Unable to do (0)N/A (No-Value)

30. How would you rate your current level of function during your sports related activities from 0 to 100 with 100 being your level of function prior to your hip problem and 0 being the inability to perform any of your usual daily activities?

01000000102030405060708090100

31. Overall, how would you rate your current level of function? (not scored)

Normal (No-Value)Nearly normal (No-Value)Abnormal (No-Value)Severely Abnormal (No-Value)