HOOS - Scott Faucett, MD

Hip disability and Osteoarthritis Outcome Score (HOOS)

Clinician's name (or ref)

Patient's name (or ref)

Patient's d.o.b

INSTRUCTIONS: This survey asks for your view about your hip. This information will help us keep track of how you feel about your hip and how well you are able to do your usual activities.

Answer every question by ticking the appropriate box. If you are unsure about how to answer a question, please give the best answer you can.


Symptoms - These questions should be answered thinking of your hip symptoms during the last week.
S1. Do you feel grinding, hear clicking or any other type of noise from you hip?
	Never	Rarely	Sometimes	Often	Always

S2. Difficulties spreading legs wide apart
	None		Mild		Moderate		Severe		Extreme

S3. Difficulties to stride out when walking
	None		Mild		Moderate		Severe		Extreme


Stiffness - The following questions concern the amount of joint stiffness you have experienced during the last week in your hip. 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?
	None	Mild	Moderate	Severe	Extreme

S5. How severe is your hip stiffness after sitting, lying or resting later in the day?
	None		Mild		Moderate		Severe		Extreme

Subtotal:

Pain
P1. How often is your hip painful?
	Never	Monthly	Weekly	Daily	Always

What amount of hip pain have you experienced the last week during the following activities?
P2. Straightening your hip fully
	None	Mild	Moderate	Severe	Extreme

P3. Bending your hip fully
	None		Mild		Moderate		Severe		Extreme

P4. Walking on flat surface
	None		Mild		Moderate		Severe		Extreme

P5. Going up or down stairs
	None		Mild		Moderate		Severe		Extreme

P6. At night while in bed
	None		Mild		Moderate		Severe		Extreme

P7. Sitting or lying
	None		Mild		Moderate		Severe		Extreme

P8. Standing upright
	None		Mild		Moderate		Severe		Extreme

P9. Walking on a hard surface (asphalt, concrete, etc)
	None		Mild		Moderate		Severe		Extreme

P10. Walking on an uneven surface
	None		Mild		Moderate		Severe		Extreme

Subtotal:


Function, daily living - The following questions concern your physical function. By this we mean your ability to move around and to look after yourself. For each of the following activities please indicate the degree of difficulty you have experienced in the last week due to your hip.
Al. Descending stairs
	None	Mild	Moderate	Severe	Extreme

A2. Ascending stairs
	None		Mild		Moderate		Severe		Extreme

A3. Rising from sitting
	None		Mild		Moderate		Severe		Extreme

A4. Standing
	None		Mild		Moderate		Severe		Extreme

A5. Bending to floor/pick up an object
	None		Mild		Moderate		Severe		Extreme

A6. Walking on flat surface
	None		Mild		Moderate		Severe		Extreme

A7. Getting in/out of car
	None		Mild		Moderate		Severe		Extreme

A8. Going shopping
	None		Mild		Moderate		Severe		Extreme

A9. Putting on socks/stockings
	None		Mild		Moderate		Severe		Extreme

A10. Rising from bed
	None		Mild		Moderate		Severe		Extreme

A11. Taking off socks/stockings
	None		Mild		Moderate		Severe		Extreme

A12. Lying in bed (turning over, maintaining hip position)
	None		Mild		Moderate		Severe		Extreme

A13. Getting in/out of bath
	None		Mild		Moderate		Severe		Extreme

A14. Sitting
	None		Mild		Moderate		Severe		Extreme

A15. Getting on/off toilet
	None		Mild		Moderate		Severe		Extreme

A16. Heavy domestic duties (moving heavy boxes, scrubbing floors, etc)
	None		Mild		Moderate		Severe		Extreme

A17. Light domestic duties (cooking, dusting, etc)
	None		Mild		Moderate		Severe		Extreme

Subtotal:


Function, sports and recreational activities - The following questions concern your physical function when being active on a higher level. The questions should be answered thinking of what degree of difficulty you have experienced during the last week due to your hip.
SP1. Squatting
	None	Mild	Moderate	Severe	Extreme

SP2. Running
	None		Mild		Moderate		Severe		Extreme

SP3. Twisting/pivoting on your injured knee
	None		Mild		Moderate		Severe		Extreme

SP4. Walking on uneven surface
	None		Mild		Moderate		Severe		Extreme

Subtotal:


Quality of Life
Q1. How often are you aware of your hip problem?
	Never	Monthly	Weekly	Daily	Constantly

Q2. Have you modified your life style to avoid potentially damaging activities to your hip?
	Not at all		Mildly		Moderately		Severely		Totally

Q3. How much are you troubled with lack of confidence in your hip?
	Not at all		Mildly		Moderately		Severely		Extremely

Q4. In general, how much difficulty do you have with your hip?
	None		Mild		Moderate		Severe		Extreme

Subtotal:

Thank you very much for completing all the questions in this questionnaire.


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The HOOS Hip Survey Score is

Reference for Score: Klassbo M, Larsson E, Mannevik E. Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol. 2003;32(1):46-51. Link