The Copenhagen Hip and Groin Outcome Score, or HAGOS, is a 37-item patient-reported outcome measure designed for young to middle-aged physically active people with hip and/or groin pain. It includes six separately scored subscales covering pain, symptoms, daily function, sport and recreation, participation in physical activities, and hip/groin-related quality of life. HAGOS can support monitoring and progress tracking, but it does not diagnose a condition or clear someone for sport on its own.

Introduction

Hip and groin pain can affect sprinting, kicking, cutting, change of direction, running, gym training, sport participation, daily activity and confidence with movement.

The Copenhagen Hip and Groin Outcome Score, commonly called HAGOS, is a patient-reported outcome measure developed to assess the client’s own perception of hip and/or groin disability and related problems.

It is commonly used for:

• athletic groin pain
• hip-related pain in active people
• adductor-related groin pain monitoring
• hip and groin rehabilitation tracking
• return-to-running and return-to-sport monitoring
• long-term sport participation tracking
• research and clinical outcome reporting

HAGOS was developed and validated according to COSMIN recommendations for young to middle-aged physically active people with long-standing hip and/or groin pain. It includes six subscales: Pain, Symptoms, Physical Function in Daily Living, Physical Function in Sport and Recreation, Participation in Physical Activities, and hip/groin-related Quality of Life.  

Quick Summary

• Outcome measure: Copenhagen Hip and Groin Outcome Score
• Abbreviation: HAGOS
• Body region: Hip and groin
• Type: Patient-reported outcome measure
• Number of items: 37
• Subscales: Pain, Symptoms, ADL, Sport/Recreation, Participation, Quality of Life
• Score range: 0–100 for each subscale
• Higher score means: Better perceived hip and groin status
• Lower score means: More pain, symptoms, limitation, reduced participation or quality-of-life impact
• Best used for: Physically active people with hip and/or groin symptoms
• Key limitation: HAGOS does not diagnose a hip or groin condition or determine return-to-sport readiness on its own

What Is the Copenhagen Hip and Groin Outcome Score?

The HAGOS is a hip- and groin-specific patient-reported outcome measure.

It was developed to provide a quantitative measure of hip and groin disability across different levels of the International Classification of Functioning framework. The official HAGOS resource describes it as an instrument for assessing the client’s perception of hip and/or groin disability and associated problems.  

HAGOS includes six separately scored subscales:

• Pain
• Symptoms
• Physical Function in Daily Living
• Physical Function in Sport and Recreation
• Participation in Physical Activities
• Hip and/or Groin-Related Quality of Life

The HAGOS is especially relevant when the client is physically active and the assessment needs to capture sport, participation and quality-of-life impact, not only pain.

Why It Is Used

The HAGOS is used because hip and groin symptoms can affect more than pain intensity.

A client may have improving strength or range of motion but still report:

• pain during kicking
• pain during cutting or change of direction
• reduced sprint confidence
• reduced training participation
• symptoms after sport
• difficulty with stretching or long strides
• reduced confidence returning to competition
• frustration with recurrent groin symptoms

The HAGOS may help professionals:

• establish a baseline
• identify which domains are most affected
• monitor symptom and function change over time
• support goal-setting conversations
• track sport and participation impact
• combine client-reported outcomes with physical testing
• improve Measurz reporting quality

The HAGOS should support assessment reasoning and progress tracking. It should not be used as a stand-alone diagnostic or clearance tool.

What It Measures

Pain

The Pain subscale captures hip and/or groin pain related to activity and daily tasks.

It may provide context around:

• pain during sport
• pain during daily movement
• pain during loading
• pain after activity
• pain irritability

Symptoms

The Symptoms subscale captures hip and/or groin symptoms beyond pain.

This may include:

• discomfort
• clicking or noise
• restricted movement
• difficulty stretching
• sudden twinges or stabbing sensations

Physical Function in Daily Living

This subscale captures everyday function.

It may include tasks such as:

• walking
• getting in and out of positions
• basic mobility
• daily activities
• movement confidence

Physical Function in Sport and Recreation

This subscale captures higher-demand sport and recreation activity.

It may include:

• running
• sprinting
• twisting
• kicking
• changing direction
• recreational activity
• gym or field sport demands

Participation in Physical Activities

This subscale captures the degree to which hip or groin symptoms affect participation.

It may provide insight into:

• reduced training involvement
• modified sessions
• avoidance of sport
• limited competition exposure
• reduced recreational participation

Hip and/or Groin-Related Quality of Life

This subscale captures broader personal impact.

It may include:

• frustration
• confidence
• awareness of symptoms
• concerns about recurrence
• lifestyle restriction
• perceived long-term impact

Who It Is Useful For

The HAGOS may be useful for:

• exercise professionals
• rehabilitation practitioners
• strength and conditioning coaches
• performance coaches
• allied health support teams
• movement assessment professionals
• students learning outcome measures
• professionals using Measurz or MAT for structured progress tracking

It may be relevant for clients with:

• athletic groin pain
• adductor-related groin pain
• iliopsoas-related groin symptoms
• pubic-related groin symptoms
• hip-related groin symptoms
• femoroacetabular impingement-related symptoms
• long-standing hip or groin pain
• recurrent sport-related groin symptoms
• reduced confidence with sprinting, kicking or cutting

The original validation population included physically active patients with long-standing hip and/or groin pain, with a mean age of 36 years and age range of 18–63 years.  

When to Use This Outcome Measure

Use the HAGOS when you want to understand how hip or groin symptoms affect the client’s pain, function, sport participation and quality of life.

It may be useful at:

• initial assessment
• onboarding
• reassessment
• groin pain monitoring
• hip pain monitoring
• return-to-running planning
• return-to-sport planning
• in-season athlete monitoring
• discharge or progress review

The HAGOS is especially useful when sport participation and higher-level physical activity matter to the client.

When Not to Use or When to Be Cautious

Use caution when:

• the client is not physically active and sport items are not relevant
• the client cannot complete the questionnaire independently
• language or literacy affects responses
• the wrong language version is used
• multiple body regions are driving limitation
• many items are missing
• the score is being used as a pass/fail decision
• the result is interpreted without physical assessment context

The HAGOS should not be used to:

• diagnose a hip or groin condition
• confirm adductor injury
• confirm hip joint pathology
• determine tissue healing
• explain symptoms on its own
• clear someone for sport
• replace physical assessment
• replace professional judgement

Equipment or Resources Required

• HAGOS questionnaire
• Official scoring guide or validated calculator
• Measurz recording workflow
• Baseline and retest dates
• Client-reported symptom notes
• Optional related physical tests, such as:
  • hip range of motion
  • adductor squeeze test
  • hip adduction strength
  • hip abduction strength
  • FADIR or FABER where appropriate
  • single-leg squat
  • change-of-direction testing
  • running or sprint assessment
  • sport exposure tracking

Administration Protocol / Practice

Setup

Explain the purpose of the questionnaire before the client completes it.

Example wording:

“This questionnaire helps us understand how your hip or groin symptoms are affecting pain, daily function, sport, participation and quality of life. It does not diagnose the condition on its own, but it helps us monitor change over time.”

Format

The HAGOS can be completed:

• on paper
• digitally
• independently
• with assistance
• before a session
• during reassessment
• as part of a Measurz workflow

Client Instructions

Ask the client to:

• answer based on their hip and/or groin problem
• answer based on the stated recall period in the questionnaire
• choose the response that best matches their experience
• answer every item where possible
• avoid overthinking each question
• ask for clarification if they do not understand the wording
• complete the same version at each retest

Completion Method

Record whether the HAGOS was completed:

• independently
• digitally
• on paper
• verbally
• with assistance

This supports repeatability and helps interpret changes over time.

Assistance Rules

If assistance is needed:

• explain instructions without leading the answer
• avoid telling the client which response to choose
• record that assistance was provided
• use the same assistance approach at retest where possible

Missing Item Handling

Do not guess missing responses.

Use the official scoring guidance for the version being used. If too many items are missing for a subscale, record that subscale as incomplete rather than creating an unreliable result.

Scoring Process

Each item is scored, then each subscale is transformed to a 0–100 score.

General scoring direction:

• 100: no hip or groin problems
• 0: extreme hip or groin problems

The six subscales should be interpreted separately rather than combined into one unsupported total score.

Retesting Considerations

Retest at meaningful time points, such as:

• baseline
• after a rehabilitation block
• after return-to-running progression
• after return-to-kicking progression
• during in-season monitoring
• after symptom flare-up
• before return-to-competition decisions
• discharge or progress review

For consistency, record:

• date
• current training exposure
• recent flare-ups
• recent match or competition load
• current running, kicking or cutting exposure
• any changes in training modification

Safety Notes

The HAGOS is a self-report questionnaire, so it does not create physical testing risk.

However, worsening scores may support further assessment when the client reports:

• increasing pain
• reduced participation
• worsening quality of life
• inability to train
• new or changing symptoms
• major confidence reduction

Scoring and Interpretation

The HAGOS has six separate subscale scores.

Each subscale ranges from 0 to 100.

Higher scores indicate better perceived hip and groin status.

Lower scores indicate greater symptoms, limitation, participation restriction or quality-of-life impact.

Subscales

• Pain: 0–100
• Symptoms: 0–100
• Physical Function in Daily Living: 0–100
• Physical Function in Sport and Recreation: 0–100
• Participation in Physical Activities: 0–100
• Quality of Life: 0–100

What a High Score May Suggest

A higher score may suggest:

• less pain
• fewer symptoms
• better daily function
• better sport and recreation function
• better physical activity participation
• better hip/groin-related quality of life
• improved confidence with activity

What a Low Score May Suggest

A lower score may suggest:

• more pain
• more symptoms
• reduced daily function
• reduced sport or recreation capacity
• reduced training participation
• reduced confidence
• greater quality-of-life impact

What the Score Does Not Prove

A HAGOS score does not prove:

• the diagnosis
• the tissue source of symptoms
• adductor injury
• hip joint pathology
• pubic-related pathology
• readiness to return to sport
• whether imaging is required
• whether one intervention caused the change

How to Explain the Result Safely

Example wording:

“Your HAGOS results show that daily activities are improving, but sport participation and quality of life are still affected. This does not tell us exactly what structure is causing symptoms, but it helps us understand how your hip or groin problem is affecting the activities that matter to you.”

What the Score May Mean in Different Client Populations

General Fitness Clients

For general fitness clients, HAGOS may help show how hip or groin symptoms affect:

• walking
• gym training
• lunging
• squatting
• running
• recreational activity

Interpretation cautions:

• sport participation items may be less relevant
• recent activity can influence responses
• symptoms from the lower back, abdomen or pelvis may affect answers

Sport and Performance Clients

For athletes, HAGOS is especially useful because it includes sport and participation subscales.

It may help monitor:

• sprinting confidence
• kicking tolerance
• cutting and change-of-direction confidence
• training modification
• participation restriction
• quality-of-life impact

Interpretation should include sport-specific testing. A high HAGOS score should not be treated as clearance on its own.

Older Adults

HAGOS was developed for young to middle-aged physically active people, so interpretation in older adults should be cautious.

For older adults, consider:

• whether the sport and participation items are relevant
• whether HOOS may be more appropriate for hip osteoarthritis contexts
• whether comorbidities influence scores
• whether general strength, balance or mobility affects responses

Youth Clients

For youth clients, consider:

• reading level
• comprehension
• parent or guardian assistance
• sport exposure
• whether the measure version is appropriate

If assistance is provided, record it clearly.

Clients With Athletic Groin Pain

HAGOS is highly relevant for athletic groin pain because it captures sport, participation and quality-of-life domains.

Interpretation should include:

• adductor squeeze test
• hip and groin strength testing
• range of motion
• sport-specific symptom behaviour
• training load
• running, kicking and cutting exposure

Clients With Hip-Related Groin Pain

For hip-related groin symptoms, HAGOS may help monitor pain, sport function and participation.

Interpretation should also consider:

• hip range of motion
• symptom provocation tests where appropriate
• strength testing
• sport or occupational demands
• imaging or medical information where available

Clients With Persistent Symptoms

For persistent symptoms, HAGOS can help monitor broader impact beyond pain.

Scores may be influenced by:

• fear of recurrence
• reduced confidence
• modified training
• frustration
• symptom flare-ups
• changes in sport participation

Meaningful Change, MCID, MDC and Responsiveness

Meaningful change helps determine whether a score change is likely to matter.

Key terms:

• MCID / MIC: the smallest change that may be meaningful to clients or professionals, depending on the method used
• MDC: the amount of change likely needed to exceed measurement error
• SEM: the estimated measurement error around a score
• Responsiveness: the ability of the measure to detect change over time

HAGOS Meaningful Change Evidence

In the original HAGOS development and validation study, HAGOS was evaluated for validity, reliability and responsiveness in 101 physically active patients with hip and/or groin pain. Test-retest reliability was substantial, with ICC values reported between 0.82 and 0.91 across subscales.  

High-quality, universally applicable MCID, MDC or SEM values for every HAGOS subscale and every hip/groin population appear limited.

This means meaningful change should be interpreted by combining:

• baseline comparison
• repeated testing
• subscale pattern
• client-reported change
• sport exposure
• symptom response
• related physical testing
• training participation

Practical Interpretation

When interpreting HAGOS change:

• compare each subscale to baseline
• avoid relying on one subscale alone
• look for consistent improvement across relevant domains
• consider whether activity exposure has increased
• interpret sport and participation changes alongside actual training load
• combine score change with pain, strength, ROM and sport-specific tests

When Values Are Uncertain

Reported meaningful change values may vary by:

• condition
• sport
• language version
• scoring method
• baseline severity
• follow-up timeframe
• intervention type

Where no matching MCID, MDC or SEM value exists, interpretation should rely more heavily on:

• repeated measurement
• client goals
• symptom change
• function change
• training participation
• related physical assessment findings
• professional judgement

Normative Data, Reference Values or Comparative Data

Broad general-population HAGOS normative data appear limited because HAGOS was developed mainly for young to middle-aged physically active people with hip and/or groin pain.

However, sport-specific comparative data are available.

A 2021 study in professional male football investigated normal values for hip/groin strength and self-reported hip and groin function using HAGOS across a season. The study aimed to identify normal values and seasonal changes in professional football players, making it useful as a sport-specific comparison context rather than a universal benchmark.  

Practical comparison guidance:

• Use the client’s own baseline as the primary comparison.
• Compare subscales separately rather than using one total score.
• Interpret sport and participation scores in relation to actual training exposure.
• Use professional athlete values only for similar athletic populations.
• Avoid applying football-specific values to general population clients.
• Combine HAGOS scores with physical tests and goals.

Comparison values should be interpreted with caution because scores may differ by:

• sport
• sex
• age
• training level
• injury history
• current participation
• symptom duration
• season phase
• cultural or language version

Reliability and Validity

The original HAGOS study was developed according to COSMIN recommendations and evaluated validity, reliability and responsiveness in young to middle-aged physically active people with long-standing hip and/or groin pain.  

Key reported measurement findings include:

• six separately scored subscales
• substantial test-retest reliability
• ICC values reported from 0.82 to 0.91
• evaluation of validity and responsiveness in a physically active hip/groin pain population

A Dutch validation study reported that HAGOS was developed to assess disease-specific consequences in young to middle-aged physically active hip and/or groin patients, and evaluated validity and reliability of the Dutch version in people with hip pathology.  

A 2022 validation study using modern test theory in Danish, Norwegian and English-speaking male football players further examined HAGOS measurement properties in athletic populations.  

Reliability and validity are stronger when:

• the correct version is used
• the same language version is repeated
• all relevant items are completed
• subscales are interpreted separately
• the client is similar to the validation population
• retesting occurs at meaningful time points
• results are interpreted alongside physical and sport-specific assessment

Interpret cautiously when:

• many items are missing
• the client has not attempted sport or training
• the client is outside the intended population
• symptoms involve multiple regions
• the score is used without activity exposure context
• the score is used as a stand-alone return-to-sport decision

Common Errors and Limitations

Common errors include:

• treating HAGOS as a diagnosis
• using one subscale as a clearance measure
• combining subscales into an unsupported total score
• ignoring missing items
• not recording the language or version used
• comparing scores without considering training exposure
• using professional athlete comparisons for non-athletes
• over-interpreting small changes
• ignoring participation and quality-of-life domains
• failing to pair HAGOS with physical testing

Limitations include:

• developed mainly for young to middle-aged physically active people
• less directly applicable to sedentary or older adult populations
• self-report can be influenced by expectations, mood and recent activity
• sport items may be misleading if the client has not returned to sport
• broad normative data are limited
• MCID, MDC and SEM values may not be available for every population
• does not identify the exact cause of hip or groin symptoms

Practical Applications

The HAGOS may help professionals:

• document baseline hip/groin status
• identify whether pain, sport, participation or quality of life are most affected
• monitor athletic groin pain over time
• track return-to-running and return-to-sport progress
• support training modification discussions
• improve client education
• communicate progress with coaches or support teams
• strengthen Measurz reports

For athletes, HAGOS can help identify whether participation and sport confidence are still limited even when pain has improved.

For general fitness clients, HAGOS can help track how hip or groin symptoms affect training, walking, running and daily activity.

For persistent symptoms, it can show whether the condition is affecting confidence, lifestyle and activity choices.

For Measurz users, HAGOS is most useful when combined with objective measures such as:

• adductor squeeze test
• hip adduction strength
• hip abduction strength
• hip range of motion
• single-leg squat
• change-of-direction testing
• running or sprint exposure
• pain with sport-specific tasks

How to Record This in Measurz

Record:

• outcome measure name: Copenhagen Hip and Groin Outcome Score / HAGOS
• version used
• language/version used
• date completed
• completion method: paper, digital, interview or assisted
• condition or presentation being tracked
• side involved: left, right or bilateral
• Pain subscale score
• Symptoms subscale score
• ADL subscale score
• Sport/Recreation subscale score
• Participation subscale score
• Quality of Life subscale score
• score range: 0–100
• direction of scoring: higher score indicates better status
• missing items, if any
• assistance provided, if any
• current pain score, if relevant
• current symptoms
• current sport or training exposure
• key functional limitations
• participation goals
• confidence notes
• baseline comparison
• meaningful change comparison where supported
• related physical assessment findings
• interpretation notes
• retest date
• referral or further assessment notes where appropriate

Record whether the main limitation appears to be:

• pain dominant
• symptom dominant
• daily function limitation
• sport/recreation limitation
• participation limitation
• quality-of-life limitation
• mixed presentation
• unclear due to incomplete responses

This improves:

• repeatability
• communication
• client education
• assessment reasoning
• monitoring over time
• team consistency
• reporting quality

Related Outcome Measures / Internal Links

• Hip Disability and Osteoarthritis Outcome Score / HOOS
• Lower Extremity Functional Scale / LEFS
• Knee Injury and Osteoarthritis Outcome Score / KOOS
• Lysholm Knee Scoring Scale
• Foot and Ankle Outcome Score / FAOS
• Foot & Ankle Disability Index / FADI
• Pain Self-Efficacy Questionnaire / PSEQ
• Tampa Scale for Kinesiophobia / TSK
• Fear-Avoidance Beliefs Questionnaire / FABQ

FAQs

What does the HAGOS measure?

The HAGOS measures self-reported hip and groin pain, symptoms, daily function, sport and recreation function, participation in physical activities, and hip/groin-related quality of life.

How many items are in the HAGOS?

The HAGOS has 37 items across six subscales.

How is the HAGOS scored?

Each subscale is converted to a 0–100 score. A higher score indicates better perceived hip and groin status.

Is there one total HAGOS score?

HAGOS is usually interpreted using six separate subscale scores rather than one combined total score.

Does HAGOS diagnose groin pain?

No. HAGOS does not diagnose adductor, hip joint, pubic or iliopsoas-related groin pain. It measures the client’s perceived symptoms, function, participation and quality-of-life impact.

Who is HAGOS best suited for?

HAGOS was designed for young to middle-aged physically active people with hip and/or groin pain, so it is especially relevant for active and athletic populations.

Can HAGOS be used for return-to-sport decisions?

HAGOS can support return-to-sport reasoning, especially the Sport/Recreation and Participation subscales, but it should not be the only clearance measure.

How often should HAGOS be repeated?

It can be repeated at baseline, reassessment, after a training or rehabilitation phase, during in-season monitoring and at key return-to-activity milestones.

Key Takeaways

• HAGOS is a hip and groin patient-reported outcome measure.
• It was designed for young to middle-aged physically active people with hip and/or groin pain.
• It includes six subscales: Pain, Symptoms, ADL, Sport/Recreation, Participation and Quality of Life.
• Each subscale is scored from 0 to 100.
• Higher scores indicate better perceived hip and groin status.
• HAGOS does not diagnose a condition or clear a client for sport.
• Reliability and validity are strongest when used in populations similar to the validation group.
• Measurz should record each subscale, version, language, completion method, sport exposure, baseline comparison, related findings and retest plan.

References

Bourne, M. N., Williams, M., Jackson, J., Williams, K. L., Timmins, R. G., Pizzari, T., & Opar, D. A. (2020). Preseason hip/groin strength and HAGOS scores are associated with subsequent injury in professional male soccer players. Journal of Orthopaedic & Sports Physical Therapy, 50(5), 234–242. https://doi.org/10.2519/jospt.2020.9022

Christensen, K. B., et al. (2022). Validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory across different cultures and languages: A cross-sectional study of 452 male football players with groin pain. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2021-104412

Giezen, H., Stevens, M., van den Akker-Scheek, I., & Reininga, I. H. F. (2017). Validity and reliability of the Dutch version of the Copenhagen Hip and Groin Outcome Score (HAGOS-NL) in patients with hip pathology. PLOS ONE, 12(10), e0186064. https://doi.org/10.1371/journal.pone.0186064

Thorborg, K., Hölmich, P., Christensen, R., Petersen, J., & Roos, E. M. (2011). The Copenhagen Hip and Groin Outcome Score (HAGOS): Development and validation according to the COSMIN checklist. British Journal of Sports Medicine, 45(6), 478–491. https://doi.org/10.1136/bjsm.2010.080937

Walden, M., et al. (2021). Do hip and groin muscle strength and symptoms change throughout a football season in professional male football players? Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2021.03.008