Hip anterior resurfacing replacement weinrauch brisbane ...



HOOS HIP SURVEYThis is an internationally standardised hip survey that assists in evaluating your hip function. The questions relate to your hip symptoms and function during the last week. Please answer every question. If you are uncertain, please give the best answer you can.Name FORMTEXT ?????Date FORMTEXT ?????SymptomsThese questions assess your symptoms & stiffnessS1. Do you feel grinding, hear clicking or any other type of noise from your hip? FORMDROPDOWN S2. Do you have difficulties in spreading legs wide apart? FORMDROPDOWN S3. Do you have difficulties to stride out when walking? FORMDROPDOWN S4. How severe is your joint stiffness after first waking in the morning? FORMDROPDOWN S5. How severe is your hip stiffness after sitting, lying or resting later in the day? FORMDROPDOWN PainHow painful are the following activities?P1. How often is your hip joint painful? FORMDROPDOWN P2. Straightening you hip fully? FORMDROPDOWN P3. Bending your hip fully? FORMDROPDOWN P4. Walking on a flat surface? FORMDROPDOWN P5. Going up and down stairs? FORMDROPDOWN P6. At night while in bed? FORMDROPDOWN P7. How painful is sitting or lying? FORMDROPDOWN P8. How painful is standing upright? FORMDROPDOWN P9. How painful is walking on a hard surface? FORMDROPDOWN P10.How painful is walking on an uneven surface? FORMDROPDOWN Function and daily livingHow difficult do you find the following?A1. Descending stairs? FORMDROPDOWN A2. Ascending stairs? FORMDROPDOWN A3. Rising for sitting? FORMDROPDOWN A4. Standing? FORMDROPDOWN A5. Bending to the floor/ picking up an object? FORMDROPDOWN A6. Walking on a flat surface? FORMDROPDOWN A7. Getting in/ out of a car? FORMDROPDOWN A8. Going shopping? FORMDROPDOWN A9. Putting on shoes/ socks? FORMDROPDOWN A10. Rising from bed? FORMDROPDOWN A11. Taking off shoes/ socks? FORMDROPDOWN A12. Lying in bed? FORMDROPDOWN A13. Getting in/ out of bath? FORMDROPDOWN A14. Sitting? FORMDROPDOWN A15. Getting on/ off toilet? FORMDROPDOWN A16. Heavy domestic duties (moving boxes, scrubbing floors etc)? FORMDROPDOWN A17. Light domestic duties (cooking, dusting etc)? FORMDROPDOWN Function, sports and recreational activitiesThe following assess you higher level hip function. How much difficulty to you experience with the following?SP1. Squatting? FORMDROPDOWN SP2. Running? FORMDROPDOWN SP3. Twisting/ pivoting on loaded leg? FORMDROPDOWN SP4. Walking on a uneven surface? FORMDROPDOWN Quality of lifeThe following assess the overall impact your hip is having on your life.Q1. How often are you aware of your hip problem? FORMDROPDOWN Q2. Have you modified your lifestyle to avoid activities potentially damaging your hip? FORMDROPDOWN Q3. How much are you troubled with lack of confidence in your hip? FORMDROPDOWN Q4. In general, how much difficulty do you have with your hip? FORMDROPDOWN Thank you very much for completing this questionnairePlease save the document and email to the office:reception@.aucenter13335000 ................
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