Hoos Hip Survey Page 3
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4Hip dysfunction and Osteoarthritis Outcome Score (HOOS), English version LK 2.0
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For each of the following activities please indicate the degree of difficulty you have
experienced in the last week due to your hip.
A5. Bending to the floor/pick up an object
None
Mild
Moderate
Severe
Extreme
□
□
□
□
□
A6. Walking on a flat surface
Moderate
Severe
Extreme
None
Mild
□
□
□
□
□
A7. Getting in/out of car
Moderate
Severe
Extreme
None
Mild
□
□
□
□
□
A8. Going shopping
Mild
Moderate
Severe
Extreme
None
□
□
□
□
□
A9. Putting on socks/stockings
Moderate
Severe
Extreme
None
Mild
□
□
□
□
□
A10. Rising from bed
Mild
Moderate
Severe
Extreme
None
□
□
□
□
□
A11. Taking off socks/stockings
Moderate
Severe
Extreme
None
Mild
□
□
□
□
□
A12. Lying in bed (turning over, maintaining hip position)
Severe
Extreme
None
Mild
Moderate
□
□
□
□
□
A13. Getting in/out of bath
Moderate
Severe
Extreme
None
Mild
□
□
□
□
□
A14. Sitting
Moderate
Severe
Extreme
None
Mild
□
□
□
□
□
A15. Getting on/off toilet
Moderate
Severe
Extreme
None
Mild
□
□
□
□
□
A16. Heavy domestic duties (moving heavy boxes, scrubbing floors, etc)
Extreme
None
Mild
Moderate
Severe
□
□
□
□
□
A17. Light domestic duties (cooking, dusting, etc)
Extreme
None
Mild
Moderate
Severe
□
□
□
□
□
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Parent category: Medical