Form Coding Instructions

INSTRUCTIONS: This survey asks for your view about your hip. This information will help us keep track of how well you are able to perform different activities. Answer every question by ticking the appropriate box, only one box for each question. If you are unsure about how to answer a question, please give the best answer you can so that you answer all the questions

Source: Charite - Universitatsmedizin Berlin

Form Context

The following questions concern your level of function in performing usual daily activities and higher level activities. For each of the following activities, please indicate the degree of difficulty you have experienced in the last week due to your hip problem

Source: Charite - Universitatsmedizin Berlin

88780-2 Descending stairs

Observation ID in Form

1

Fully-Specified Name

Component
Degree of difficulty experienced due to your hip while descending stairs in the last W
Property
Find
Time
1W
System
^Patient
Scale
Ord
Method
HOOS

Long Common Name

Degree of difficulty experienced due to your hip while descending stairs in the last week [HOOS]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.64
Last Updated
Version 2.64 (ADD)
Order vs. Observation
Observation

Normative Answer List LL4051-0

AnswerCodeScoreAnswer ID
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value)0LA137-2
Mild1LA6752-5
Moderate Copyright http://snomed.info/sct ID:6736007 Moderate (severity modifier) (qualifier value)2LA6751-7
Severe3LA6750-9
Extreme4LA11912-5

Member of these Panels

LOINCLong Common Name
98945-9Hip disability and osteoarthritis outcome score - physical function shortform panel [HOOS-PS]
72092-0Hip Dysfunction and Osteoarthritis Outcome Score [HOOS]

88777-8 Getting in/out of bath or shower

Observation ID in Form

2

Fully-Specified Name

Component
Degree of difficulty experienced due to your hip while getting in or out of bath in the last W
Property
Find
Time
1W
System
^Patient
Scale
Ord
Method
HOOS

Long Common Name

Degree of difficulty experienced due to your hip while getting in or out of bath in the last week [HOOS]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.64
Last Updated
Version 2.64 (ADD)
Order vs. Observation
Observation

Normative Answer List LL4051-0

AnswerCodeScoreAnswer ID
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value)0LA137-2
Mild1LA6752-5
Moderate Copyright http://snomed.info/sct ID:6736007 Moderate (severity modifier) (qualifier value)2LA6751-7
Severe3LA6750-9
Extreme4LA11912-5

Member of these Panels

LOINCLong Common Name
98945-9Hip disability and osteoarthritis outcome score - physical function shortform panel [HOOS-PS]
72092-0Hip Dysfunction and Osteoarthritis Outcome Score [HOOS]

88762-0 Sitting

Observation ID in Form

3

Fully-Specified Name

Component
Degree of difficulty experienced due to your hip while sitting or lying during the last W
Property
Find
Time
1W
System
^Patient
Scale
Ord
Method
HOOS

Long Common Name

Degree of difficulty experienced due to your hip while sitting or lying during the last week [HOOS]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.64
Last Updated
Version 2.72 (NAM)
Order vs. Observation
Observation

Normative Answer List LL4051-0

AnswerCodeScoreAnswer ID
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value)0LA137-2
Mild1LA6752-5
Moderate Copyright http://snomed.info/sct ID:6736007 Moderate (severity modifier) (qualifier value)2LA6751-7
Severe3LA6750-9
Extreme4LA11912-5

Member of these Panels

LOINCLong Common Name
98945-9Hip disability and osteoarthritis outcome score - physical function shortform panel [HOOS-PS]
72092-0Hip Dysfunction and Osteoarthritis Outcome Score [HOOS]

88749-7 Running

Observation ID in Form

4

Fully-Specified Name

Component
Degree of difficulty experienced due to your hip while running during the last W
Property
Find
Time
1W
System
^Patient
Scale
Ord
Method
HOOS

Long Common Name

Degree of difficulty experienced due to your hip while running during the last week [HOOS]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.64
Last Updated
Version 2.64 (ADD)
Order vs. Observation
Observation

Normative Answer List LL4051-0

AnswerCodeScoreAnswer ID
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value)0LA137-2
Mild1LA6752-5
Moderate Copyright http://snomed.info/sct ID:6736007 Moderate (severity modifier) (qualifier value)2LA6751-7
Severe3LA6750-9
Extreme4LA11912-5

Member of these Panels

LOINCLong Common Name
98945-9Hip disability and osteoarthritis outcome score - physical function shortform panel [HOOS-PS]
72092-0Hip Dysfunction and Osteoarthritis Outcome Score [HOOS]

88748-9 Twisting/pivoting on your loaded leg

Observation ID in Form

5

Fully-Specified Name

Component
Degree of difficulty experienced due to your hip while twisting or pivoting on loaded leg during the last W
Property
Find
Time
1W
System
^Patient
Scale
Ord
Method
HOOS

Long Common Name

Degree of difficulty experienced due to your hip while twisting or pivoting on loaded leg during the last week [HOOS]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.64
Last Updated
Version 2.64 (ADD)
Order vs. Observation
Observation

Normative Answer List LL4051-0

AnswerCodeScoreAnswer ID
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value)0LA137-2
Mild1LA6752-5
Moderate Copyright http://snomed.info/sct ID:6736007 Moderate (severity modifier) (qualifier value)2LA6751-7
Severe3LA6750-9
Extreme4LA11912-5

Member of these Panels

LOINCLong Common Name
98945-9Hip disability and osteoarthritis outcome score - physical function shortform panel [HOOS-PS]
72092-0Hip Dysfunction and Osteoarthritis Outcome Score [HOOS]

98946-7 Total score [HOOS-PS]

Term Description

Items are coded from 0 to 4, none to extreme respectively. The HOOS-PS questionnaire is scored by summing the raw response (range 0-20) and then using a nomogram to convert the raw score to a true interval score (0-100). HOOS-PS can be scored in two directions, best to worst and worst to best. http://www.koos.nu

Fully-Specified Name

Component
Total score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
HOOS-PS

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
98945-9Hip disability and osteoarthritis outcome score - physical function shortform panel [HOOS-PS]

Example Units

UnitSource
{score}Example UCUM Units