Home » Patient Info » Patient Forms » Oxford Hip Score (OHS) Today's Date Clinician's name (or ref) : Patient's name (or ref) : Patient's Date of Birth : Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 Hip side (Right / Left) select one Right Left INSTRUCTIONS: Please answer the following 12 questions. Choose only one answer per question. The value for each answer is indicated to the left of the answer. Total up all of your answers to obtain a total score out of 48points. Answer every question by ticking the appropriate box. If you are unsure about how to answer a question, please give the best answer you can. During the past 4 weeks... 1. How would you describe the pain you usually have in your hip? None Very Mild Mild Moderate Severe 2. How would you describe the pain you usually have in your hip? No nights Only 1 or 2 nights Some nights Most nights Every night 3. Have you had any sudden, severe pain 'shooting', 'stabbing', or 'spasms' from your affected hip? No days Only 1 or 2 days Some days Most days Every day 4. Have you been limping when walking because of your hip? Rarely/never Sometimes or just at first Often, not just at first Most of the time All of the time 5. For how long have you been able to walk before the pain in your hip becomes severe (with or without a walking aid)? No pain for 30 minutes or more 16 to 30 minutes 5 to 15 minutes Around the house only Not at all 6. Have you been able to climb a flight of stairs? Yes,easily With little difficulty With moderate difficulty With extreme difficulty No, impossible 7. Have you been able to put on a pair of socks, stockings or tights? Yes,easily With little difficulty With moderate difficulty With extreme difficulty No, impossible 8. After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your hip? Not at all painful Slightly painful Moderately painful Very painful Unbearable 9. Have you had any trouble getting in and out of a car or using public transportation because of your hip? No trouble at all Very little trouble Moderate trouble Extreme difficulty Impossible to do 10. Have you had any trouble with washing and drying yourself (all over) because of your hip? No trouble at all Very little trouble Moderate trouble Extreme difficult Impossible to do 11. Could you do the household shopping on your own? Yes, easily With little difficulty With moderate difficulty With extreme difficulty No, impossible 12. How much has pain from your hip interfered with your usual work, including housework? Not at all A little bit Moderately Greatly Totally Oxford Hip Outcome Score is To send this data to doctor please click submit
