[vc_row][vc_column width=”2/3″] Step 1 of 8 12% This questionnaire asks how you feel about your health, while you are wearing a brace. This is not a test and there are no right or wrong answers. Please read carefully every question Choose the best answer and mark by clicking in the box Your Name First Last You are a girl a boy AgeDate you started wearing the brace DD slash MM slash YYYY Number of hours per day you wear the brace During the past 3 months...1. The brace made you feel illNeverAlmost neverSometimesMost of the timeAlways2. You were afraid that your back will get worseNeverAlmost neverSometimesMost of the timeAlways During the past 3 months while you were wearing the brace...3. You felt tired when walkingNeverAlmost neverSometimesMost of the timeAlways4. You were able to runNeverAlmost neverSometimesMost of the timeAlways5. You managed to wear the brace without any helpNeverAlmost neverSometimesMost of the timeAlways6. You managed to take out the brace without any helpNeverAlmost neverSometimesMost of the timeAlways7. You couldn’t eat wellNeverAlmost neverSometimesMost of the timeAlways8. You couldn’t sleep wellNeverAlmost neverSometimesMost of the timeAlways9. You couldn’t breathe wellNeverAlmost neverSometimesMost of the timeAlways During the past 3 months...10. The brace made you feel nervousNeverAlmost neverSometimesMost of the timeAlways11. You felt worried because of the braceNeverAlmost neverSometimesMost of the timeAlways12. You felt happyNeverAlmost neverSometimesMost of the timeAlways13. You believed that your life would be better if you were not on braceNeverAlmost neverSometimesMost of the timeAlways14. You believed that brace treatment was beneficialNeverAlmost neverSometimesMost of the timeAlways During the past 1 month...15. You felt proud of yourselfNeverAlmost neverSometimesMost of the timeAlways16. You were satisfied with your bodyNeverAlmost neverSometimesMost of the timeAlways17. You felt strong and full of energyNeverAlmost neverSometimesMost of the timeAlways18. You felt tired and exhausted because of the braceNeverAlmost neverSometimesMost of the timeAlways During the past 1 month, because of the brace...19. You had difficulties with your lessonsNeverAlmost neverSometimesMost of the timeAlways20. You were absent from schoolNeverAlmost neverSometimesMost of the timeAlways21. You found it hard to pay attention in the classroomNeverAlmost neverSometimesMost of the timeAlways During the past 1 month, while you were wearing the brace...22. You had to take medication for painNeverAlmost neverSometimesMost of the timeAlways23. You had pain during the nightNeverAlmost neverSometimesMost of the timeAlways24. You had pain when walkingNeverAlmost neverSometimesMost of the timeAlways25. You had pain when sittingNeverAlmost neverSometimesMost of the timeAlways26. You had pain when climbing stairsNeverAlmost neverSometimesMost of the timeAlways27. You felt pins and needles to your arms or legsNeverAlmost neverSometimesMost of the timeAlways During the past 1 month, because of the brace...28. You couldn’t go out with your friendsNeverAlmost neverSometimesMost of the timeAlways29. Your friends felt compassion for youNeverAlmost neverSometimesMost of the timeAlways30. You felt different from your peersNeverAlmost neverSometimesMost of the timeAlways31. You had problems with your familyNeverAlmost neverSometimesMost of the timeAlways32. You believed that your relationship with your family or your friends would be better if you were not on braceNeverAlmost neverSometimesMost of the timeAlways33. You stayed at home because you were ashamedNeverAlmost neverSometimesMost of the timeAlways34. You worn special clothesNeverAlmost neverSometimesMost of the timeAlwaysThank you! Please submit your responses by clicking submit below. [/vc_column][vc_column width=”1/3″][/vc_column][/vc_row]
