1. Are you a parent or guardian of a child diagnosed with scoliosis?
Yes
No
2. Do you have scoliosis?
Yes
No
3. How would you describe where you live?
Town (up to 25,000 people)
Suburban Area ( 25,000 - 50,000 people)
Large Urban/Metropolitan Area (more than 50,000 people)
4. Have any of your extended family members been diagnosed with scoliosis?
Yes
No
Unknown
4a. Family members diagnosed
4b. How was your family member treated for their diagnosis?
Single
Married
Living with someone in a marriage-like relationship
Separated
Divorced
Widowed
6. How many people currently live in your home?
1
2
3
4
5
6
7
8
9
10
7. What is your racial/ethnic background?
9. Are your parents currently
Single
Married
Living with someone in a marriage-like relationship
Separated
Divorced
Widowed
10. Have you had treatment for scoliosis?
Yes, observation only (x-rays, doctors' visits)
Yes, bracing only
Yes, bracing then surgery
Yes, observation, bracing and then surgery
Yes, surgery alone
11. What treatment option did you choose initially?
Observation (x-rays, doctors' visits)
Bracing
Surgery
12. What treatment option did you end up with at the completion of treatment?
Observation
Bracing, then surgery
Bracing only
Surgery only
Still receiving treatment
13. About how old were you when you found out you had scoliosis?
Less than 9 years old
9 to 14 years old
More than 14 years old
14. Do you have other medical conditions associated with scoliosis?
Yes
No
14a. Please list other conditions
15. How would you describe your curve when you first found out about your diagnosis?
Mild (less than 20 degrees)
Moderate (20 -30 degrees)
Moderate to Severe (30-50 degrees)
Severe (greater than 50 degrees)
Other
16. How would you describe your curve now?
Mild (less than 20 degrees)
Moderate (20-30 degrees)
Moderate to Severe ( 30-50 degrees)
Severe (greater than 50 degrees)
I had surgery to correct scoliosis
Other
17. How did you feel when you were diagnosed with scoliosis? (choose any that apply)
18. What was memorable about your experience learning about scoliosis and treatment with your doctor?
19. What could have been done differently or better?
20. Did you and your family have input into the decision of how to treat your scoliosis?
21. Would you have liked to have had more information provided to you about the decision?
Yes, more information
No, had just the right amount of information
Other
22. Would you have liked to have had a greater role in the decision about how to treat your scoliosis?
Yes, would have liked a greater role
No, I had just the right role
Other
23. Would you have liked your parent/guardian to have had a greater role in the decision about how to treat your scoliosis?
Yes, my parent/guardian needed a bigger role in decision
No, my parent/guardian had just the right role in decision
Other
24. Who first noticed the curve?
I noticed it myself and let others know
Parent or family member
School screening program
Healthcare exam by regular care provider (pediatrician, primary care provider)
Other
25. What best reflects the role of school screening in your diagnosis?
No role to my knowledge
School screening first brought the curve to my attention
School screening was performed but curve was not noticed
Other
26. What best reflects the role of your primary care provider in your scoliosis diagnosis
No role to my knowledge
Primary care provider/doctor first brought the curve to my attention
Physical exam was performed but curve was not noticed
Other
27. How did you feel about the treatment options offered to you for your scoliosis? (choose all that apply)
28. Was bracing recommended for your scoliosis?
Yes
No (please go to question 41)
29. What is your understanding about how brace treatment works? (you may choose more than one answer)
30. Have you finished brace treatment?
Yes
No
31. I find wearing the brace to be:
Easy
Medium
Difficult
Very difficult
Other
32. It was recommended to wear the brace this many hours per day.
33. In general, I wear/wore the brace
Less than recommended
About what was recommended
More than recommended
Other
34. The long-term effect of wearing the brace is
Negative, affected my self-esteem and happiness
Neutral, no effect
Positive, made me a stronger person
Other
35. The most difficult things about wearing the brace includes (choose all that apply)
36. What would you like to tell parents and children who are starting bracing now?
37. How would you describe your bracing experience?
Easy and successful
Difficult but successful
Intermediate results
Easy but not successful
Difficult and not successful
38. Despite bracing, did you end up needing surgery?
Yes, surgery was recommended
No, no surgery was recommended
39. If surgery was recommended after bracing, how did you feel when surgery was recommended? (choose all that apply)
40. Below is recent data about the result of wearing a brace. Without the brace, 70% of adolescents required spine surgery; and with the brace, 40% of adolescents required spine surgery. Knowing this, would you still have chosen brace treatment?
Yes
No
Other - added comments
41. Given your experiences, is there anything that you would have done differently regarding your scoliosis treatment?
Yes
No
41a. If yes, please explain.
42. What is your highest level of education?
8th grade or less
High School
Vocational or Technical
College or Associate Degree (including community college)
Graduate or Professional School
Other
43. What is your child's racial/ethnic background
44. How many people are currently living in your household?
1
2
3
4
5
6
7
8
9
10
45. Has your child had treatment for scoliosis?
46. How old was your child when they were diagnosed with scoliosis?
younger than 9 years old
9-14 years old
older than 14 years old
47. Does your child have other medical conditions associated with the scoliosis?
Yes
No
47a. Please describe other conditions
48. How would you describe your child's curve when it was first diagnosed?
Mild (less than 20 degrees)
Moderate (20-30 degrees)
Moderate to Severe (30-50 degrees)
Severe (greater than 50 degrees)
Other
49. How would you describe your child's curve now?
Mild (less than 20 degrees)
Moderate (20-30 degrees)
Moderate to Severe (30-50 degrees)
Severe (greater than 50 degrees)
Child had surgery to correct scoliosis
Other
50. How did you feel when your child was diagnosed with scoliosis? (choose any that apply)
51. What was memorable about your experience learning about scoliosis diagnosis and treatment with your physician?
52. What could have been done differently or better?
53. Did you and your child have input into the decision of how to treat your child's scoliosis?
54. What treatment options were presented to you? (choose all that apply)
54a. If other, please elaborate on other treatment option(s) that was/were presented to you.
55. Would you have liked more information provided to you about the decision to treat the scoliosis
Yes, more information
No, had just the right amount of information
Other
56. As a parent, would you have liked to have had a greater role in the decision about how to treat your child's scoliosis?
Yes, would have liked greater role
No, I had just the right role
Other
57. As a parent, would you have liked your child to have had a greater role in the decision about how to treat his/her scoliosis?
Yes, child needed a bigger role in decision
No, child had right role in decision
Other
58. Who first noticed the curve?
My child
Parent or family member
School screening program
Healthcare exam by regular care provider (pediatrician, primary care provider)
Other
59. What best reflects the role of school screening in your child's diagnosis
No role to my knowledge
School screening first brought the curve to my attention
School screening was performed but curve was not noticed
Other
60. What best reflects the role of your primary care provider in your child's scoliosis diagnosis
No role to my knowledge
Primary care provider/doctor first brought the curve to my attention
Physical exam was performed but curve was not noticed
Other
61. How did you feel about the treatment options offered for scoliosis treatments? (choose all that apply)
62. Was your child offered bracing
Yes
No (please go to question 74)
63. What is your understanding of brace treatment? (choose all that apply)
64. Has your child finished brace treatment?
Yes
No
65. For my child, wearing the brace was:
Easy
Medium
Difficult
Very difficult
Other
66. My child wears/wore the brace:
Less than was recommended
About what was recommended
More than recommended
Other
67. For my child, the long-term effect of wearing the brace was:
Negative, affected my child's self esteem
Neutral, no effect
Positive, made my child a stronger person
Other
68. The most difficult things about wearing the brace includes (choose any that apply)
69. What would you like to tell parents and children who are starting bracing now?
70. How would you describe your bracing experience?
Easy and successful
Difficult but successful
Intermediate results
Easy but not successful
Difficult and not successful
71. Despite bracing, did your child end up needing surgery?
Yes, surgery recommended
No, no surgery recommended
72. How did you feel when surgery was recommended? (Choose all that apply)
73. Below is recent data about the result of wearing a brace. Without the brace, 70% of adolescents required spine surgery; and with the brace, 40% of adolescents required spine surgery. Knowing this, would you still have chosen brace treatment?
Yes
No
Other
74. Given your experience, is there anything that you would have done differently regarding your child's scoliosis treatment?
Yes
No
75. My child's current treatment is..
Observation (includes completed bracing)
Bracing, then surgery
Bracing only
Surgery only
76. Please share some of the challenges that you face with your child's current treatment.
Male
Female
Prefer not to say
78. Which factors were important in making a decision on the treatment plan? (Lifestyle, financial, etc.)
79. Please elaborate on the specific challenge that you faced while making the decision
80. Does the image below about the effect of brace wear appeal to you?
Yes
No
81. Does the image below about the effect of brace wear appeal to you?
Yes
No
82. Does the image below about the effect of brace wear appeal to you?
Yes
No
83. Does the image below about the effect of brace wear appeal to you?
Yes
No
84. Does this image about the effect of brace wear appeal to you?
Yes
No
85. Does the image below about the effect of brace wear appeal to you?
Yes
No
86. Of images in questions 80-85, which one is your favorite image?
Question 80
Question 81
Question 82
Question 83
Question 84
Question 85
87. New research studies show that bracing even when worn full-time is not always successful to prevent surgery for scoliosis. Think about what percentage of success would make bracing worthwhile for you. For Instance, I would only go through bracing if:
Bracing reduced the risk of surgery from 100% to 0%
Bracing reduced the risk of surgery from 100% to 20%
Bracing reduced the risk of surgery from 80% to 40%
Bracing reduced the risk of surgery from 50% to 30%
Insert your own percentage from __% to __%
87a. Bracing reduced the risk of needing surgery from
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