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Survey Templates Surveys Crutch Usage Survey

Crutch Usage Survey

Welcome to the Crutch Usage Survey





This questionnaire aims to study crutch usage and any associated side effects.



This questionnaire forms part of the research for a student thesis on improving the comfortableness of the hand/arm area of standard crutch. The results of this study will be kept anonymous and none of the information obtained will be used for financial gain in any respect.



Please only fill out this questionnaire if you have experience of using crutches at least once.



(Duration: 5-8 minutes)



Sex:
Age:
Age when you last used crutches or started using crutches:
Height (Approximate height is fine):
Weight:
How long were you on crutches for?
Please state the reason why you are using or have used crutches:
Were you / Are you using one or two crutches?
How many separate periods have you been required to use crutches?
Are the crutches prescribed or did you buy them yourself?
Please enter the Make
Please enter the Model
Please enter the Price
Custom-made features
Which type of crutches are you using?
Please enter the Make
Please enter the Model
Please enter the Price
When using crutches, how do you rate their comfortableness?
Please tick all the areas of discomfort from crutch use (other than the original injury):
Please comment on the comfort of the crutches
(Cause of the discomfort. Injury during use.
Good/bad points about them – e.g. Shape, grip, braces, foot)
How frequently did you use your crutches during the time when you were meant to use them?
Did you / Do you feel able to carry out your day to do life satisfactorily while using crutches?
In what way were you forced to change your daily routine?
In your opinion, how could crutches be improved?
Do you have any further comments (include any particular needs required with crutches)?
I may wish to contact you regarding your experiences with crutches, please enter your email address or a contact telephone number here
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