The Hip Outcome Scale (Used with permission of Gunderson Lutheran Sportsmedicine).
| Hip Outcome Scale (HOS) Activities of Daily Living Subscale | ||||||
|---|---|---|---|---|---|---|
| Please answer every question with one response that most clearly describes your condition within the past week. If the activity in question is limited by something other than your hip, mark not applicable (N/A). | ||||||
| No difficulty at all | Slight difficulty | Moderate difficulty | Extreme difficulty | Unable to do | N/A | |
| Standing for 15 minutes | ||||||
| Getting into and out of an average car | ||||||
| Putting on socks and shoes | ||||||
| Walking up steep hills | ||||||
| Walking down steep hills | ||||||
| Going up 1 flight of stairs | ||||||
| Going down 1 flight of stairs | ||||||
| Stepping up and down curbs | ||||||
| Deep Squatting | ||||||
| Getting into and out of a bath tub | ||||||
| Sitting for 15 minutes | ||||||
| Walking initially | ||||||
| Walking approximately 10 minutes | ||||||
| Walking 15 minutes or greater | ||||||
| Because of your hip how much difficulty do you have with: | ||||||
| No difficulty at all | Slight difficulty | Moderate difficulty | Extreme difficulty | Unable to do | N/A | |
| Twisting/ pivoting on involved leg | ||||||
| Rolling over in bed | ||||||
| Light to moderate work (standing, walking) | ||||||
| Heavy work (push/pulling, climbing, carrying) | ||||||
| Recreational activities | ||||||
| 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? | ||||||
| __ ____ _____.0% | ||||||
| HOS - Sports Subscale | ||||||
| Because of your hip how much difficulty do you have with: | ||||||
| No difficulty at all | Slight difficulty | Moderate difficulty | Extreme difficulty | Unable to do | N/A | |
| Running one mile | ||||||
| Jumping | ||||||
| Swinging objects like a golf club | ||||||
| Landing | ||||||
| Starting and stopping quickly | ||||||
| Cutting / lateral movements | ||||||
| Low impact activities like fast walking | ||||||
| Ability to perform activity with your normal technique | ||||||
| Ability to participate in your desired sport as long as your would like | ||||||
| How would you rate your current level of function during your usual 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? | ||||||
| __ ____ _____.0% | ||||||
| Overall, how would you rate your current level of function? | ||||||
| Normal Nearly normal Abnormal Severely Abnormal | ||||||