Amputation Survey

Helping us to shape our new Amputation Video Information Resource

Thank you for taking the time to complete this survey. The Bone Cancer Research Trust is creating a series of information videos for patients facing, or who have had, an amputation.

Your input will help us with the content of these videos.

There will be an opportunity to be part of a focus group to discuss your experiences in more depth. Please let us know if you would like to be involved later on in the survey and we will be in touch.

Question Title

* 1. How old are you now?

Question Title

* 2. I am..

Male

Female

Prefer not to say

Question Title

* 3. Where do you live?

Outside of the UK

Question Title

* 4. What type of primary bone cancer/ bone tumour were you diagnosed with?

Question Title

* 5. When was your surgery? (DD/MM/YY)

Question Title

* 6. At which hospital was your surgery performed?

Question Title

* 7. Did you have any previous surgery prior to your amputation (in relation to your cancer or the limb you had amputated)?

Yes

Question Title

* 8. If yes, what type of surgery?

Question Title

* 9. Did you have any chemotherapy and/or radiotherapy prior to your amputation?

Yes

Question Title

* 10. If yes, which drugs did you receive and for how long before your surgery?

Question Title

* 11. Could you give us a brief overview of your capabilities BEFORE your amputation surgery i.e. your physical fitness and day-to-day routine?

Question Title

* 12. Which part of your body have you had amputated?

Arm

Leg

Hand

Foot

Digit(s)

Other (please specify)

Question Title

* 13. Please select the level of amputation you have had:

Upper limb (please then select from the following:)

Through shoulder

Above elbow

Through elbow

Below elbow

Hand/finger amputation

Lower limb (please then select from the following:)

Hip disarticulation

External hemipelvectomy

Above knee

Through knee

Below knee

Through ankle

Foot

Toe

Other (please specify)

Question Title

* 14. What were some of the issues you wanted to know about before your surgery?

Question Title

* 15. Which healthcare professionals did you see before your amputation?

An occupational therapist

A rehabilitation consultant

A physiotherapist

A counsellor/ another source of professional psychological support

A prosthetist

Other (please specify)

Question Title

* 16. What were the benefits of having their input(s)?

Question Title

* 17. Which healthcare professionals would you have liked to have seen pre-surgery?

An occupational therapist

A rehabilitation consultant

A physiotherapist

A counsellor/ another source of professional psychological support

A prosthetist

Other (please specify)

Question Title

* 18. What were your main sources of support and information as you prepared for surgery and throughout your recovery?

Question Title

* 19. Retrospectively, what would have helped you at the time of your surgery which was limited/ you did not have access to?

Question Title

* 20. What were some of the issues you wanted to know about after your surgery?

Question Title

* 21. How did you access the information you were given about your surgery and recovery? (select as many as are applicable)

Through my surgeon

Through my prosthetist

Through my Clinical Nurse Specialist

Through my physiotherapist

Through my occupational therapist

Through my own research

Talking to peers

Through charity support

Other (please specify)

Question Title

* 22. Did you receive any peer support before/ after your surgery i.e. a support group, another patient who had undergone an amputation?

Yes

Question Title

* 23. If yes, what would you say the benefits are of peer support pre/ post-surgery?

Question Title

* 24. Following your surgery, did you know what to expect in terms of mobility and rehabilitation?

Question Title

* 25. How were you supported upon returning to work/ school/ caring responsibilities?

Question Title

* 26. How were you supported upon returning to hobbies/ leisure pursuits/ sports (if applicable)?

Question Title

* 27. Would you like to be part of our focus group to further shape the amputation information resource?

Yes

Amputation Survey

Helping us to shape our new Amputation Video Information Resource

Question Title

* 1. How old are you now?

Question Title

* 2. I am..

Question Title

* 3. Where do you live?

Question Title

* 4. What type of primary bone cancer/ bone tumour were you diagnosed with?

Question Title

* 5. When was your surgery? (DD/MM/YY)

Question Title

* 6. At which hospital was your surgery performed?

Question Title

* 7. Did you have any previous surgery prior to your amputation (in relation to your cancer or the limb you had amputated)?

Question Title

* 8. If yes, what type of surgery?

Question Title

* 9. Did you have any chemotherapy and/or radiotherapy prior to your amputation?

Question Title

* 10. If yes, which drugs did you receive and for how long before your surgery?

Question Title

* 11. Could you give us a brief overview of your capabilities BEFORE your amputation surgery i.e. your physical fitness and day-to-day routine?

Question Title

* 12. Which part of your body have you had amputated?

Question Title

* 13. Please select the level of amputation you have had:

Question Title

* 14. What were some of the issues you wanted to know about before your surgery?

Question Title

* 15. Which healthcare professionals did you see before your amputation?

Question Title

* 16. What were the benefits of having their input(s)?

Question Title

* 17. Which healthcare professionals would you have liked to have seen pre-surgery?

Question Title

* 18. What were your main sources of support and information as you prepared for surgery and throughout your recovery?

Question Title

* 19. Retrospectively, what would have helped you at the time of your surgery which was limited/ you did not have access to?

Question Title

* 20. What were some of the issues you wanted to know about after your surgery?

Question Title

* 21. How did you access the information you were given about your surgery and recovery? (select as many as are applicable)

Question Title

* 22. Did you receive any peer support before/ after your surgery i.e. a support group, another patient who had undergone an amputation?

Question Title

* 23. If yes, what would you say the benefits are of peer support pre/ post-surgery?

Question Title

* 24. Following your surgery, did you know what to expect in terms of mobility and rehabilitation?

Question Title

* 25. How were you supported upon returning to work/ school/ caring responsibilities?

Question Title

* 26. How were you supported upon returning to hobbies/ leisure pursuits/ sports (if applicable)?

Question Title

* 27. Would you like to be part of our focus group to further shape the amputation information resource?

Question Title

* 28. If yes, please provide your name and email address here: