PPS & Physical Therapy Survey

THIS SURVEY IS CLOSED.
The cover letter and Survey questions will be left online, but please, do not take the survey now. We will place survey results and conclusions as soon as they are available.

Criteria for inclusion in this study are
  1. that you were initially diagnosed with polio years ago,
  2. that you have since been diagnosed with Postpolio Syndrome, and
  3. that you have seen a physical therapist in the last year. Therapist Evaluation Form

    Please click on the degree to which you agree or disagree with each of the statements that follow concerning your physical therapist. This information is confidential and your answers will remain anonymous.

    Upon submission, your responses will be emailed directly to the investigator. I will score these surveys personally and ensure that your answers will be kept confidential.

    Completion of this survey will be regarded as your informed consent.

    Your First_Name & Last_Name:

    Your Email Address:
    Although this information will be kept confidential,your submission will not be accepted without valid a email address

    1. My physical therapist treats me in a friendly manner.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    2. I have some doubts about the abilities of my physical therapist.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    3. My physical therapist seems cold and impersonal.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    4. My physical therapist does his/her best to keep me from worrying.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    5. My physical therapist works with me as carefully as is necessary.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    6. My physical therapist should treat me with more respect.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    7. I have some doubts about the treatment suggested by my physical therapist.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    8. My physical therapist seems very competent and well-trained.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    9. My physical therapist seems to have a genuine interest in me as a person.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    10. My physical therapist leaves me with many unanswered questions about my treatment program.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    11. My physical therapist uses words I do not understand.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    12. I have a great deal of confidence in my physical therapist.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    13. I feel I could tell my physical therapist about very personal problems.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    14. I did not feel free to ask my physical therapist questions.
      Strongly Agree - Agree - Uncertain - Disagree - Strongly Disagree

    Roush, S. E. (1995). The satisfaction of patients with multiple sclerosis regarding services received from physical and occupational therapists. International Journal of Rehabilitation and Health, 1(3), 155-166.
    1. Were you instructed in an exercise program by your physical therapist?
      Yes - No

    2. To what degree do you feel that this exercise program helped you?
      Made Me Much Better - Made Me Better - Uncertain - Made Me Worse - Made Me Much Worse - N/A

    3. How often do you follow your exercise program as recommended by your physical therapist?
      More than Recommended - Exactly Recommended - Less Than Recommended - Rarely Performed - Never Performed - N/A

    4. Were you given recommendations for ways to conserve energy when performing your activities of daily living?
      Yes - No

    5. How useful were these recommendations from your physical therapist?
      Highly Useful - Somewhat Useful - Uncertain - Not Very Useful - Not Useful - N/A

    6. How often do you utilize these recommendations for conserving energy?
      More than Recommended - Exactly Recommended - Less Than Recommended - Rarely Performed - Never Performed - N/A

    7. Was an assistive device (such as a cane, walker, wheelchair, scooter, etc.) recommended to you by your physical therapist?
      Yes - No

    8. How useful do you feel this assistive device has been for you?
      Highly Useful - Somewhat Useful - Uncertain - Not Very Useful - Not Useful - N/A

    9. If an assistive device was recommended, how often do you use it?
      More than Recommended - Exactly Recommended - Less Than Recommended - Rarely Performed - Never Performed - N/A

    10. How knowledgeable was your physical therapist about postpolio syndrome?
      Expert - Good Knowledge - Some Knowledge - Little Knowledge - No Knowledge - N/A

    Thank you again. Your participation in this study is greatly appreciated.
    Carrie Scheberies

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