Hip Pain Assessment Quiz

This quiz is intended to help you understand more about how knee pain is affecting your life. Once you’ve completed this quiz you may want to make an appointment with your doctor to discuss the results and the surgical and non-surgical options available to help minimize and relieve your pain. If you have any questions, please contact the Center for Advanced Spine & Joint Care at 1-888-MacNeal.

1. Where does it hurt
   • A. Left Hip
   • B. Right Hip
   • C. Both Hips
   
   
2. How often does it hurt
   • A. Every day
   • B. Several days a week
   • C. One day a week
   • D. Less than one day a week
   
   
3. During the past month, how far could you walk comfortably without feeling any soreness or pain in your hip(s)?
   • A. Under half a mile
   • B. Half a mile
   • C. Over a mile
   • D. Over 2 miles
   • E. Over 5 miles
   
   
4. During the past month, how would you describe the unusual pain in your sore hip(s) at rest?
   • A. Very severe
   • B. Severe
   • C. Moderate
   • D. Mild
   • E. None
   
   
5. During the past month, how would you describe the usual pain in your sore hip(s) when you are doing activities?
   • A. Very severe
   • B. Severe
   • C. Moderate
   • D. Mild
   • E. None
   
   
6. During the past month, how often did the pain in your hip(s) make it difficult for you to sleep at night?
   • A. Every night
   • B. Several nights a week
   • C. One night a week
   • D. Less than one night a week
   • E. Never
   
   
7. During the past month, how often have you had severe pain in your hip(s)?
   • A. Every day
   • B. Several days a week
   • C. One day a week
   • D. Less than one day a week
   • E. Never
   
   
8. How would you describe your ability to use your hip(s) during daily activities such as dressing, walking, climbing stairs, household chores, etc?
   • A. Very severely limited
   • B. Severely limited
   • C. Moderately limited
   • D. Mildly limited
   • E. Not limited
   
   
9. During the past month, which of the following resulted in severely difficult pain?
   • A. Climbing stairs
   • B. Descending stairs
   • C. Getting in and out of the car
   • D. Bending down to pick something up off the ground
   
   
10. Considering all the ways you use your hip(s) during recreational or athletic activities (e.g. walking, biking, golfing, aerobics, etc.) how would you describe the function of your hip(s)?
    • A. Very severely limited
    • B. Severely limited
    • C. Moderately limited
    • D. Mildly limited
    • E. Not limited
    
    
11. During the past month, how often were you unable to do your usual work because of your hip pain?
    • A. Every day
    • B. Several days a week
    • C. One day a week
    • D. Less than one day a week
    • E. Never
    
    
12. From this list, please rank the areas in which you would most like to see improvement. “1” for most important, “2” for next most important, etc.
    • __ Pain
    • __ Daily personal and household activities
    • __ Recreational or athletic activities
    • __ Work
    • __ Other

Thanks for completing this quiz. You may now have a better idea about how hip pain is affecting your life. In addition to discussing the results with your doctor, call 1-888-MacNeal to:

Speak to the Joint Care Coordinator.
Schedule an appointment with one of our orthopedic or neurological surgeons.

Tour the Center for Advanced Spine & Joint Care and meet our team.

Learn about attending a free community seminar held at MacNeal Hospital at 2:00 p.m. on the following dates:

• October 14th
• October 27th
• November 11th
• November 24th
• December 9th
• December 22nd