Questions Covering the Previous 4 Weeks
|
Finding
|
Points
|
|
How would you describe the pain you
usually have from your hip? |
none |
1 |
|
|
very mild |
2 |
|
|
mild |
3 |
|
|
moderate |
4 |
|
|
severe |
5 |
|
Have you had any trouble with
washing and drying yourself (all over) because of your hip? |
no trouble at all |
1 |
|
|
very little trouble |
2 |
|
|
moderate trouble |
3 |
|
|
extreme difficulty |
4 |
|
|
impossible to do |
5 |
|
Have you had any trouble getting in
and out of a car or using public transportation because of your hip? |
no trouble at all |
1 |
|
|
very little trouble |
2 |
|
|
moderate trouble |
3 |
|
|
extreme difficulty |
4 |
|
|
impossible to do |
5 |
|
Have you been able to put on a pair
of socks stockings or tights? |
yes easily |
1 |
|
|
with little difficulty |
2 |
|
|
with moderate difficulty |
3 |
|
|
with extreme difficulty |
4 |
|
|
no impossible |
5 |
|
Could you do the household shopping
on your own? |
yes easily |
1 |
|
|
with little difficulty |
2 |
|
|
with moderate difficulty |
3 |
|
|
with extreme difficulty |
4 |
|
|
no impossible |
5 |
|
For how long have you been able to
walk before pain from your hip becomes severe? (with or without a stick) |
no pain |
1 |
|
|
after walking > 30 minutes |
1 |
|
|
walking 16 – 30 minutes |
2 |
|
|
walking 5 – 15 minutes |
3 |
|
|
around the house only |
4 |
|
|
not at all; pain severe on walking |
5 |
|
Have you been able to climb a flight
stairs? |
yes easily |
1 |
|
|
with little difficulty |
2 |
|
|
with moderate difficulty |
3 |
|
|
with extreme difficulty |
4 |
|
|
no impossible |
5 |
|
After a meal (sat at a table) how
painful has it been for you to stand from a chair because of your hip? |
not at all painful |
1 |
|
|
slightly painful |
2 |
|
|
moderately painful |
3 |
|
|
very painful |
4 |
|
|
unbearable |
5 |
|
Have you been limping when walking
because of your hip? |
never |
1 |
|
|
rarely |
1 |
|
|
sometimes or just at first |
2 |
|
|
often not just at first |
3 |
|
|
most of the time |
4 |
|
|
all of the time |
5 |
|
Have you had any sudden severe pain
– "shooting" "stabbing" or "spasms" – from the affected hip? |
no days |
1 |
|
|
only 1 or 2 days |
2 |
|
|
some days |
3 |
|
|
most days |
4 |
|
|
every day |
5 |
|
How much has pain from your hip
interferred with your usual work (including housework)? |
not at all |
1 |
|
|
a little bit |
2 |
|
|
moderately |
3 |
|
|
greatly |
4 |
|
|
totally |
5 |
|
Have you been troubled by pain from
your hip in bed at night? |
no nights |
1 |
|
|
only 1 or 2 nights |
2 |
|
|
some nights |
3 |
|
|
most nights |
4 |
|
|
every night |
5 |
