The code block below illustrates how one might use # and // as comments in your logic and calculations.

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Required format:

nDCaTgkhtf37hRpHyyCjXgYdCLWAVfr5xLVzh6X3Xo9Fvsf6mNjMiKPeo6S68PXUadBLB2CqP3G49A8FMZZtAUcLKUNozyJPY6Gphb

Adaptive Provider Survey

Please complete the survey below.

Thank you!

Is the majority of your practice spent taking care of pediatric patients or adult patients?

* must provide value

Pediatric

Adult

Both/even split

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What is your gender?

* must provide value

Male

Female

Non-binary

Prefer not to answer

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What is your current age?

* must provide value

What is your ethnicity? (select all that apply)

* must provide value

Asian or Southwest Asian

Black or African American

Hawaiian or Pacific Islander

Hispanic or Latino

Middle Eastern/North African

White

Other

Prefer not to answer

How many years have you been in practice (after completing training)?

* must provide value

<5 years

5-10 years

10-20 years

>20 years

I am still in training

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Did you pursue any form of fellowship training? (check all that apply)

* must provide value

Sports Medicine

Pediatrics

Spine

Neuromuscular

Hand

Shoulder/Elbow

Foot/Ankle

Other

Did not complete fellowship

Not applicable for my specialty

If other, please specify:

* must provide value

Did you pursue any other structured training post-residency (traveling fellowship etc)?

* must provide value

Yes

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If other, please specify:

* must provide value

What is your current practice setting? (Check all that apply)

* must provide value

Academic

Private/Community

County/public

Military

Other

In which geographic location do you practice?

* must provide value

West

Midwest

South

Northeast

Other

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What percentage of your patient population consists of patients who are living with long-term physical disabilities?

* must provide value

<10%

10-25%

25-50%

50-75%

>75%

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What percentage of your patient population consists of patients who are living with long-term developmental disabilities?

* must provide value

< 10%

10-25%

25-50%

50-75%

>75%

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What percentage of your patient population consists of patients who are living with long-term blindness or visual impairment?

* must provide value

< 10%

10-25%

25-50%

50-75%

>75%

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Is your current clinical setting accessible for patients living with disabilities?

* must provide value

Yes

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How comfortable are you treating patients with physical disabilities?

* must provide value

Extremely comfortable

Comfortable

Neutral

Uncomfortable

Extremely uncomfortable

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How comfortable are you treating patients with developmental disabilities?

* must provide value

Extremely comfortable

Comfortable

Neutral

Uncomfortable

Extremely uncomfortable

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How comfortable are you treating patients with visual disabilities?

* must provide value

Extremely comfortable

Comfortable

Neutral

Uncomfortable

Extremely uncomfortable

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Based on your clinical experience, how comfortable are you discussing healthcare recommendations with patients who have long-term disabilities?

* must provide value

Extremely comfortable

Comfortable

Neutral

Uncomfortable

Extremely uncomfortable

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Based on your clinical experience, how comfortable are you discussing healthcare recommendations with families of patients who have long-term disabilities?

* must provide value

Extremely comfortable

Comfortable

Neutral

Uncomfortable

Extremely uncomfortable

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Based on your clinical experience, when considering a pediatric patient with a physical disability, which of the following is most important for overall well-being?

* must provide value

Inclusion in school with peers who are typically developing

Spending time with friends/peers outside of school

Participation in physical activity outside of school

Participation in other extra-curriculars outside of school (clubs, boy/girl-scouts etc)

Participation in academic enrichment outside of school (tutors etc)

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Based on your clinical experience, when considering a pediatric patient with a physical disability, which of the following is least important for overall well-being?

* must provide value

Inclusion in school with peers who are typically developing

Spending time with friends/peers outside of school

Participation in physical activity outside of school

Participation in other extra-curriculars outside of school (clubs, boy/girl-scouts etc)

Participation in academic enrichment outside of school (tutors etc)

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Have you ever attended a Special Olympics event?

* must provide value

Yes No

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Have you ever attended an Adaptive Sports event?

* must provide value

Yes No

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Complete the following statement: Participation in Adaptive Sports for Patients with physical disabilities leads to...

* must provide value

Better health outcomes for patients

Worse health outcomes for patients

No/minimal difference for patients

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If you had a patient who had a physical disability and wanted to participate in sports, how comfortable would you feel about counseling them on the risks?

* must provide value

Extremely comfortable

Comfortable

Neutral

Uncomfortable

Extremely uncomfortable

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If you had a patient who was typically developing who wanted to participate in sports, how comfortable would you feel about counseling them on the risks?

* must provide value

Extremely comfortable

Comfortable

Neutral

Uncomfortable

Extremely uncomfortable

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If you had a patient who had a physical disability who presented with a sports injury, how comfortable would you feel about counseling them?

* must provide value

Extremely comfortable

Comfortable

Neutral

Uncomfortable

Extremely uncomfortable

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If you had a patient who was typically developing who presented with a sports injury, how comfortable would you feel about counseling them?

* must provide value

Extremely comfortable

Comfortable

Neutral

Uncomfortable

Extremely uncomfortable

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For patients who have physical disabilities who want to participate in sports, how important do you think it is to have trained medical support at sporting events?

* must provide value

Extremely important

Important

Neutral

Unimportant

Extremely unimportant

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For patients who have typically developing who want to participate in sports, how important do you think it is to have trained medical support at sporting events?

* must provide value

Extremely important

Important

Neutral

Unimportant

Extremely unimportant

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When considering a patient with physical disabilities, what is the most important safety consideration while participating in sports?

* must provide value

Appropriate type of wheelchair

Appropriate size/fit of wheelchair

Seatbelt/strapping for wheelchair

Baseline physical coordination

Medical Support presence at event

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When considering a patient with physical disabilities, what is the least important safety consideration while participating in sports?

* must provide value

Appropriate type of wheelchair

Appropriate size/fit of wheelchair

Seatbelt/strapping for wheelchair

Baseline physical coordination

Medical Support presence at event

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If you feel comfortable disclosing, do you identify as a person with a disability or chronic illness?

Yes

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If you feel comfortable disclosing, do you identify as a person who has a loved one or family member with a disability or chronic illness?

Yes

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