HIP PAIN ONLINE ASSESSMENT Estimated time to complete: 1-2 minutes Did you know that over 20 million people suffer from joint pain? If you are living with hip pain, take this quick hip pain online assessment to determine your next steps to feeling better. My hip pain is causing me difficulty with every day activities like walking, climbing up and going down stairs, getting in or out of a chair.(Required) Yes No My hip feels stiff and limits my ability to move, lift or bend my leg.(Required) Yes No I feel hip pain throughout the day/night even when not being active.(Required) Yes No I am modifying my life-style to try and avoid making my hip pain worse.(Required) Yes No Over-the counter medications are not helping to relieve my hip pain.(Required) Yes No I have been diagnosed with rheumatoid arthritis or osteoarthritis.(Required) Yes No Please provide your date of birth(Required) Month Day Year Resource for questions: orthoinfo.orgHiddenNumber Of "Yes" answers Thank you for taking our hip pain online assessment. Your answers may help you learn how your hip pain is affecting your quality of life. You answered YES to {Number Of “Yes” answers:11} out of 6 hip pain indicator questions. Learn more about Optim’s Joint Center of Excellence . Click Here 1. Hip pain limiting daily activities Your answer: {My hip pain is causing me difficulty with every day activities like walking, climbing up and going down stairs, getting in or out of a chair.:1} 2. Hip stiffness Your answer: {My hip feels stiff and limits my ability to move, lift or bend my leg.:2} 3. Hip pain even when inactive Your answer: {I feel hip pain throughout the day/night even when not being active.:3} 4. Life-style modification due to pain Your answer: {I am modifying my life-style to try and avoid making my hip pain worse.:4} 5. OTC medications are not effective Your answer: {Over-the counter medications are not helping to relieve my hip pain.:5} 6. Diagnosed with rheumatoid arthritis or osteoarthritis Your answer: {I have been diagnosed with rheumatoid arthritis or osteoarthritis.:6} 7. Your DOB Your answer: {Please provide your date of birth:7}
