Exit this survey

1. Welcome to Discovering The Power In Me!

Thank you for agreeing to participate in the Discovering The Power In Me pilot program in Australia. The pilot program is a collaboration between: The Pacific Institute, who developed the program Spinal Cord Injury Australia (SCIA), The Australian Quadriplegic Association (AQA), Spinal Injuries Association (SIA) who are delivering the program and the University of Western Sydney who are conducting the evaluation.

You are invited to take part in a research study to about the ‘Discovering The Power In Me’ (DPM) pilot program being undertaken by Spinal Cord Injuries Australia, Australian Quadriplegia Association Victoria, Spinal Injuries Australia. The study is being conducted by Dr Kathryn Nicholson Perry, University of Western Sydney.

What does the study involve and how much time will it take?

If you agree to participate in this study, you would take part in three online surveys (which take approximately 20 minutes to complete). This would include completing the survey when you first express an interest in taking part in DPM, immediately before you take part in DPM,immediately after you take part in DPM and a final survey approximately one month after completing DPM.

Will the study benefit me?

The study is not expected to benefit you directly, although it will help those who are running the DPM program to find out more about the potential benefits of it and how best to run the DPM program in future.

Will the study involve any discomfort for me?

We do not anticipate any specific discomfort related to participating in the study, except that associated with giving up your time to take part.

How is the study being paid for?

The study is being paid for partly through a donation from the Spinal Cord Injury Network (an organisation that supports the fast-tracking of safe treatments for spinal cord injury and disease) and partly by grant from the University of Western Sydney School of Psychology to Dr Kathryn Nicholson Perry.

Will anyone else know the results? How will the results be disseminated?

All information that is collected in the course of this study will be completely confidential, and will not be revealed to others. The responses of all participants will be combined together and presented as a report to those running the DPM and results of this study will be reported at conferences or in journals, but not in any way that could identify you.

Can I withdraw from the study?

You are not obliged to participate and, if you do participate, you can withdraw at any time until data collection is completed. Your decision will not affect your relationship with the researchers or the University of Western Sydney in any way. Participation in this study is entirely voluntary.

What if I require further information?

When you have read this information, we would be happy to answer any questions that you have about participating. If you would like to know more at any stage, please feel free to contact Rio Yamaguchi (r.yamaguchi@uws.edu.au) or Dr Kathryn Nicholson Perry (k.nicholsonperry@uws.edu.au) on 02 9772 6781.

What if I have a complaint?

This study has been approved by the University of Western Sydney Human Research Ethics Committee. The Approval number is H9292. If you have any complaints or reservations about the ethical conduct of this research, you may contact the Ethics Committee through the Office of Research Services on Tel 02 4736 0883 Fax 02 4736 0013 or email

I consent to participate in the research project named above.

I acknowledge that:

I have read the participant information sheet and have been given the opportunity to discuss the information and my involvement in the project with the researcher(s).

The procedures required for the project and the time involved have been explained to me, and any questions I have about the project have　been answered to my satisfaction.

I am aware of and consent to the procedures involved in the study, including any inconvenience, risk, discomfort or side effect, and of their implications.

I understand that my involvement is confidential and that the information gained during the study may be published by no information about me will be used in any way that reveals my identity.

I freely choose to participate in this study, and understand that I can withdraw from the study at any time, without affecting my relationship with the researcher(s) now or in the future.

Question Title

* 1. I hereby consent to participate in this research study

( Privacy & Cookie Notice

T