Back pain management feedback questionnaire

We are looking for feedback from our back pain management programme clients to enable us to improve our service. It would be very helpful to us if you could complete this questionnaire with your views on your time with us.

Date:……………………………………………………………………………………..............

Overall how would you rate your experience of the back pain programme?

Excellent □

Very good □

Good □

Average □

Poor □

Please rate between 1 – 5, 5 being very helpful and 1 being no help at all.

It you score a session below 3, please consider leaving a comment as to why to help us improve our sessions.

General

Introduction to Course 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Team Reviews 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Goal Setting 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Friends and family group session 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Friends and family individual session 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Comments:………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……..……………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………

Physiotherapy Sessions

Understanding pain 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Exercise principles 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Anatomy and Physiology 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Tissue healing 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Posture, Core Stability and Lifting 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Management setbacks and flare ups 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Gym Practical Sessions 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Hydrotherapy Sessions 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Any other comments

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Occupational Therapy Sessions

Pacing and Activity Diary 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Sleep 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Seating and Ergonomics 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □Ž

Work and leisure 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Posture in Activities of Daily Living 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Relaxation 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Any other comments

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Psychology Sessions

Stress and Anxiety 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Unhelpful thoughts, Unhelpful Feelings 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Managing and maintaining changes 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Helping others to understand chronic pain 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Any other comments ……………..…..…………………………………………………………………………………… ……………………………………………………………………………………………………… …………………………………… ……………………………………………………………………………………………………… …………………………………… ……………………………………………………………………………………………………… ……………………………………

Other

Dietitian 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Understanding your medication (pain clinic nurse) 1 □ 2 □ 3 □ 4 □ 5 □ Did not attend □

Any other comments ……………..…..…………………………………………………………………………………… ……………………………………………………………………………………………………… …………………………………… ……………………………………………………………………………………………………… ……………………………………

5. Is there anything else you would have liked to have been covered/discussed during your time here………………………………………………………………………………………………… …… ....................................................................................................................... .......................................................................................................................

6. Prior to starting the programme, were you given enough information about what to expect and did you feel prepared to attend the programme? If not, what other information would you find helpful? ............................................................................................................................................... ............................................................................................... .......................................................................................................................

7. Any other comments?..................................................................................... ....................................................................................................................... ....................................................................................................................... .......................................................................................................................