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Hip Outcome Score

The document is a hip outcome score survey that asks patients to rate their ability to perform various daily activities and sports activities on a scale from no difficulty to unable to do. It includes questions about standing, walking, stairs, squatting, sitting and activities like running and jumping. It asks patients to rate their current function level as a percentage and describe their overall function.

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Lily Ann D. Bautista
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65 views2 pages

Hip Outcome Score

The document is a hip outcome score survey that asks patients to rate their ability to perform various daily activities and sports activities on a scale from no difficulty to unable to do. It includes questions about standing, walking, stairs, squatting, sitting and activities like running and jumping. It asks patients to rate their current function level as a percentage and describe their overall function.

Uploaded by

Lily Ann D. Bautista
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Hip Outcome Score

Please answer every score with one response that most closely describes your condition within the past week.

ADL Subscale

No
Slight Moderate Extreme Unable
Difficulty
Difficulty Difficulty Difficulty to Do
at All
1. Standing for 15 min.

2. Getting into and out of an average car

3. Putting on socks and shoes

4. Walking up steep hills

5. Walking down steep hills

6. Going up 1 flight of stairs

7. Going down 1 flight of stairs

8. Stepping up and down curbs

9. Deep squatting

10. Getting into and out of a bathtub

11. Sitting for 15 min.

12. Walking initially

13. Walking for approximately 10 minutes

14. Walking for 15 minutes or more

No
Because of your hip, how much trouble do you have Slight Moderate Extreme Unable
Difficulty
with the following? Difficulty Difficulty Difficulty to Do
at All
15. Twisting/pivoting on involved leg

16. Rolling over in bed

17. Light to moderate work (standing, walking)

18. Heavy work (pushing/pulling, climbing, carrying)

19. Recreational activities

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

□□□ .0%
Sports Subscale

No
Because of your hip, how much difficulty do you have Slight Moderate Extreme Unable
Difficulty
with the following? Difficulty Difficulty Difficulty to Do
at All
21. Running 1 mile

22. Jumping

23. Swinging objects like a golf club

24. Landing

25. Starting and stopping quickly

26. Cutting/lateral movements

27. Low impact activities like fast walking

28. Ability to perform activity with your normal technique


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

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 before your hip problem and 0 being the inability to perform any of your usual daily activities?

□□□ .0%

31. How would you rate your current level of function?

Normal Nearly Normal Abnormal Severely abnormal

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