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HOOS Scoring

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Hip disability and Osteoarthritis Outcome Score (HOOS) Scoring instructions, June 2013
HOOS Scoring 2013
A change in how to manage missing items was introduced in 2013. Previously, 2
missing items were allowed in each subscale. From 2013, at least 50% of the items
should be responded to. This change is reflected in the updated Excel scoring file
formulae available from www.koos.nu. The differences in subscale level are outlined
in the following table:
Number of items needed
for calculation of
subscale score (2013
rule for missing items)
Number of items needed
for calculation of
subscale score (2003 rule
for missing items)
Pain 5 8
Symptoms 3 3
ADL 9 15
Sport/Rec 2 2
QOL 2 2
HOOS Scoring Instructions
Assign the following scores to the boxes:

None Mild Moderate Severe Extreme

0 1 2 3 4

Each subscale score is calculated independently. Calculate the mean score of the
individual items of each subscale and divide by 4 (the highest possible score for a
single answer option). Traditionally in orthopedics, 100 indicate no problems and 0
indicates extreme problems. The normalized score is transformed to meet this
Missing data: If a mark is placed outside a box, the closest box is chosen. If two
boxes are marked, that which indicates the more severe problem is chosen.
As long as at least 50% of the subscale items are answered for each subscale, a
mean score can be calculated. If more than 50% of the subscale items are omitted,
the response is considered invalid and no subscale score should be calculated. For
the subscale Pain, this means that 5 items must be answered; for Symptoms, 3
items; for ADL, 9 items; for Sport/Rec, 2 items; and for QOL, 2 items must be
answered in order to calculate a subscale score. Subscale scores are independent
and can be reported for any number of the individual subscales, i.e. if a particular
subscale is not considered valid (for example, the subscale Sport/Rec 2 weeks after
total hip replacement), the results from the other subscale can be reported at this

Hip disability and Osteoarthritis Outcome Score (HOOS) Scoring instructions, June 2013
HOOS Excel scoring files
Excel spreadsheets with formulae to calculate the five subscale scores are available
from www.koos.nu. If, for any reason, you prefer to use your own spreadsheets, the
Excel formulae are given below.
Excel formulation: When the raw data have been entered in the order the items
occur in the HOOS questionnaires available from www.koos.nu, these Excel
formulations can be copied and pasted directly into an English version of an Excel
spreadsheet to automatically calculate the five subscore scales. Please note that it
has been assumed that the items in the subscale symptoms appear first in the
HOOS Pain: =100-AVERAGE(G2:P2)/4*100
HOOS Symptoms: =100-AVERAGE(B2:F2)/4*100
HOOS ADL: =100-AVERAGE(Q2:AG2)/4*100
HOOS Sport/Rec: =100-AVERAGE(AH2:AK2)/4*100
HOOS QOL: =100-AVERAGE(AL2:AO2)/4*100
HOOS Manual Score calculation
The slightly updated version of the formulae (used from June 2013 in the
spreadsheets available from www.koos.nu) does not need any manual imputation:
Apply the mean of the observed items within the subscale (e.g. HOOS Pain), divide
by 4, and multiply by 100; when this number is then subtracted from 100, you have
the HOOS subscale estimate for that particular cross-sectional assessment of the
individual patient. For manual calculations, please use the formulae provided below
for each subscale:
1. PAIN 100−
™??   ™???   ™ ? ™? × ™?
=  𝐻𝑂𝑂𝑆  𝑃𝑎𝑖𝑛

2. SYMPTOMS 100−
™??   ™?? ?   ™ ? ™ × ™?
=  𝐻𝑂𝑂𝑆  𝑆𝑦𝑚𝑝𝑡𝑜𝑚𝑠

3. ADL 100−
™??   ™???   ™ ? ™? × ™?

4. SPORT/REC 100−
™??   ™???   ™? ? ™? × ™?
=  𝐻𝑂𝑂𝑆  𝑆𝑝𝑜𝑟𝑡/𝑅𝑒𝑐

5. QOL 100−
™??   ™???   ™ ? ™ × ™?

Hip disability and Osteoarthritis Outcome Score (HOOS) Scoring instructions, June 2013
WOMAC - How to score from the HOOS
Assign scores from 0 to 4 to the boxes as shown above. To get original WOMAC
Scores, sum the item scores for each subscale. If you prefer percentage scores
in accordance with the HOOS, use the formula provided below to convert the
original WOMAC scores.

Transformed scale = 100 - actual raw score x 100
Possible raw score range

WOMAC subscores Original score = sum
of the following items
raw score range
Pain P4-P8 20
Stiffness S4-S5 8
Function A1-A17 68
HOOS Profile
To visualize differences in the five different HOOS subscores and change between
different administrations of the HOOS (e.g. pre-treatment to post-treatment), HOOS
Profiles can be plotted, as illustrated below.
pain symptoms ADL sport/recr QOL