Oxford hip score evaluation.

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Patient Details

First name:

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Height:

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Weight:

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Oxford Hip Score

Pre-operation
Post-operation

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Date of surgery:

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Operation performed:

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Please answer the following 12 multiple choice questions.

During the past 4 weeks......

1. How would you describe the pain you usually have in your hip?​

None
Very mild
Mild
Moderate
Severe

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2. Have you been troubled by pain from your hip in bed at night?​

No nights
Only 1 or 2 nights
Some nights
Most nights
Every night

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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
Everyday

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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

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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

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6. Have you been able to climb a flight of stairs?​

Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible

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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

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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

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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

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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 difficulty
Impossible to do

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11. Could you do the household shopping on your own?​

Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible

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12. How much has pain from your hip interfered with your usual work, including housework?​

Not at all
A little bit
Moderately
Greatly
Totally

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​Hip Affected:

Left
Right

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