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What side hip? (choose one)
1. During the past 4 weeks How would you describe the pain in your hip?
2. During the past 4 weeks Have you been troubled by pain from your hip in bed at night?
3.During the past 4 weeks Have you had any sudden, severe pain- (shooting/stabbing or spasms) from the hip?
4. During the past 4 weeks Have you been limping when walking because of your hip?
5. During the past 4 weeks How long can you walk (with or without stick) before the pain in your hip becomes severe?
6. During the past 4 weeks Have you been able to climb a flight of stairs?
7. During the past 4 weeks Have you been able to put on a pair of socks, stockings or tights?
8. During the past 4 weeks After a meal (sat at a table), how painful is the hip to stand up?
9.During the past 4 weeks Have you had any trouble getting in and out of a car or using public transport because of your hip?
10.During the past 4 weeks Have you had any trouble with washing and drying yourself (all over) because of your hip?
11. During the past 4 weeks Could you do the household shopping on your own?
12. During the past 4 weeks How much has pain from your hip interfered with your usual work (including housework)?