Hip Replacement Post-Op QPROM

Thank you for having your hip replacement at Kinvara Private Hospital. Please complete this short questionnaire (known as a Quality Patient-Reported Outcome Measure – QPROM).

The questionnaire should only be completed by patients that have had hip replacement and will only take a few minutes.

Please enable JavaScript in your browser to complete this form.
Name
Date of birth
When did your hip surgery take place?
1. Is anyone helping you fill in this questionnaire?
2. Which statement best describes your living arrangements?
3. Did you experience any of the following problems after your operation?
4. Have you been readmitted to hospital since your hernia operation?
5. Have you had another operation on your hip since your hip replacement surgery?
6. In general, how would you rate your general health?
7. How would you describe the results of your operation?
8. Overall, how are your problems now in the hip on which you had surgery, compared to before your operation?

During the past 4 weeks...

9. How would you describe the pain you usually had from your hip?
10. Have you had any trouble with washing and dressing yourself (all over) because of your hip?
11. Have you had any trouble getting in and out of a car or using public transport because of your hip?
12. Have you been able to put on a pair of socks, stocking or tights?
13. Could you do the household shopping on your own?
14. For how long have you been able to walk before pain from your hip becomes severe?
15. Have you been able to climb a flight of stairs?
16. After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your hip?
17. Have you been limping when walking, because of the hip?
18. Have you had any sudden, severe pain- shooting, stabbing or spasms from the affected hip?
19. How much has the pain from your hip interfered with your usual work (including housework)?
20. Have you been troubled by pain from your hip in bed at night?

By placing a tick in one box in each group below, please indicate which statements best describe your own health state today.

21. Mobility
22. Self-care
23. Usual activities (e.g. work, study, housework, family)
24. Pain / discomfort
25. Anxiety / depression
26. How many times have you seen a physiotherapist since you left hospital?
27. Do you consider yourself to have a disability?