THIS SURVEY IS CLOSED: 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. Please return this survey to the investigator upon completion either by emailing it or by mailing it to the respective address below. 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. Carrie Scheberies email address: schebeca@pirates.armstrong.edu mailing address: 437-B Tibet Avenue, Savannah, Ga. 31406 Therapist Evaluation Form Please circle 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 completion, please return this form to the investigator. Thank you. 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. 15. Were you instructed in an exercise program by your physical therapist? Yes No 16. 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 17. How often do you follow your exercise program as recommended by your physical therapist? More than Recommended Exactly as Recommended Less than Recommended Rarely Performed Never Performed N/A 18. Were you given recommendations for ways to conserve energy when performing your activities of daily living? Yes No 19. How useful were these recommendations from your physical therapist? Highly Useful Somewhat Useful Uncertain Not Very Useful Not Useful N/A 20. How often do you utilize these recommendations for conserving energy? More than Recommended Exactly as Recommended Less than Recommended Rarely Performed Never Performed N/A 21. Was an assistive device (such as a cane, walker, wheelchair, scooter,etc.)recommended to you by your physical therapist? Yes No 22. How useful do you feel this assistive device has been for you? Highly Useful Somewhat Useful Uncertain Not Very Useful Not Useful N/A 23. If an assistive device was recommended, how often do you use it? More than Recommended Exactly as Recommended Less than Recommended Rarely Used Never Used N/A 24. 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. tle Knowledge No knowledge N/A Thank you again. Your participation in this study is greatly appreciated.