From: Quality of life and patient satisfaction in bracing treatment of adolescent idiopathic scoliosis
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 with an x | |
 Example | |
  • During the last week, you were in a good mood for studying | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the times | |
  • Always | |
 Please tell us a few things about yourself: | |
  You are a boy/a girl (cross out what is NOT correct) | |
  How old are you? ......... years. | |
  You are wearing the brace since ………. months/years. | |
  You are wearing the brace for ….. hours/day | |
  Date …………………………… | |
During the first 3 months | |
 1. The brace made you feel ill | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 2. You were afraid that your back will get worse | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
During the past 3Â months while you were wearing the brace... | |
 3. You felt tired when walking | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 4. You were able to run | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 5. You managed to wear the brace without any help | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 6. You managed to take off the brace without any help | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 7. You could not eat well | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 8. You could not sleep well | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 9. You could not breathe well | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
During the past 3 months… | |
 10. The brace made you feel nervous | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 11. You felt worried because of the brace | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 12. You felt happy | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 13. You believed that your life would be better if you were not on brace | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 14. You believed that brace treatment was beneficial | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
During the past 1Â month... | |
 15. You felt proud of yourself | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 16. You were satisfied with your body | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
During the past 1Â month | |
 17. You felt strong and full of energy | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 18. You felt tired and exhausted because of the brace | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
During the past 1Â month, because of the brace... | |
 19. You had difficulties with your lessons | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 20. You were absent from school | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 21. You found it hard to pay attention in the classroom | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
During the past 1Â month, while you were wearing the brace... | |
 22. You had to take medication for pain | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 23. You had pain during the night | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 24. You had pain when walking | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 25. You had pain when sitting | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 26. You had pain when climbing stairs | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 27. You felt pins and needles in your arms or legs | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
During the past 1Â month, because of the brace... | |
 28. You could not go out with your friends | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 29. Your friends felt compassion for you | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 30. You felt different from your peers | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 31. You had problems with your family | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 32. You believed that your relationship with your family or your friends would be better if you were not on brace | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 33. You stayed at home because you were ashamed | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always | |
 34. You wore special clothes | |
  • Never | |
  • Almost never | |
  • Sometimes | |
  • Most of the time | |
  • Always |