Please answer every question with one response that most closely describes to your condition within the past week. If the activity in question is limited by something other than your hip, mark not applicable (N/A).

Activity of Daily Living Scale

Because of your hip how much difficulty do you have with:



















      
How would you rate your current level of function during your usual activities of daily living from 0 to 100 with 100 being your level of function prior to your hip problem and 0 being the inability to perform any of your usual daily activities?


Sports Scale

Because of your hip how much difficulty do you have with:











      
How would you rate your current level of function during your sports related activities from 0 to 100 with 100 being your level of function prior to your hip problem and 0 being the inability to perform any of your usual daily activities?