Prosthetic Sock Attributes and Preferences Survey About You This survey is for research purposes only and is being conducted by students at UCLA. Data will be anonymized and aggregated. At the end of the survey, there is an option to enter a raffle to receive a $25 Amazon gift card. Please answer honestly. Your help is greatly appreciated, thank you! Question Title * 1. Do you currently use a lower-limb prosthesis? Yes No Question Title * 2. How often do you wear your prosthesis? Never Sometimes (during activities) Daily Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 3. How many years have passed since your amputation? Less than 1 year 1-3 years 4-6 years 7-10 years More than 10 years Prefer not to say Question Title * 4. Who is your primary payer for prosthetic care? VA Medicare Medicaid Private insurance Self Other (please specify) Question Title * 5. Do you receive reimbursement for your prosthetic sock? Yes No Other (please specify) Question Title * 6. How often do you adjust sock ply during the day? Never - I put on my socks once and leave it on for the whole day. Sometimes - Every 3-4hours Hourly, or even less than that Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 7. On a 0-10 scale, if 0 represents the most uncomfortable socket fit you can imagine, and 10 represents the most comfortable socket fit, how would you score the comfort of the socket fit of your artificial limb: 0 - Most uncomfortable 1 2 3 4 5 6 7 8 9 10 - Most comfortable At the moment? At the moment? 0 - Most uncomfortable At the moment? 1 At the moment? 2 At the moment? 3 At the moment? 4 At the moment? 5 At the moment? 6 At the moment? 7 At the moment? 8 At the moment? 9 At the moment? 10 - Most comfortable At best, over the last 7 days? At best, over the last 7 days? 0 - Most uncomfortable At best, over the last 7 days? 1 At best, over the last 7 days? 2 At best, over the last 7 days? 3 At best, over the last 7 days? 4 At best, over the last 7 days? 5 At best, over the last 7 days? 6 At best, over the last 7 days? 7 At best, over the last 7 days? 8 At best, over the last 7 days? 9 At best, over the last 7 days? 10 - Most comfortable At worst, over the last 7 days? At worst, over the last 7 days? 0 - Most uncomfortable At worst, over the last 7 days? 1 At worst, over the last 7 days? 2 At worst, over the last 7 days? 3 At worst, over the last 7 days? 4 At worst, over the last 7 days? 5 At worst, over the last 7 days? 6 At worst, over the last 7 days? 7 At worst, over the last 7 days? 8 At worst, over the last 7 days? 9 At worst, over the last 7 days? 10 - Most comfortable On average, over the last 7 days? On average, over the last 7 days? 0 - Most uncomfortable On average, over the last 7 days? 1 On average, over the last 7 days? 2 On average, over the last 7 days? 3 On average, over the last 7 days? 4 On average, over the last 7 days? 5 On average, over the last 7 days? 6 On average, over the last 7 days? 7 On average, over the last 7 days? 8 On average, over the last 7 days? 9 On average, over the last 7 days? 10 - Most comfortable Question Title * 8. What typically triggers a change in fit, resulting in you having to take off your prosthesis? Select all that apply. Activity Time of day Swelling Heat Food Other (please specify) Question Title * 9. Do you ever feel discomfort while wearing your prosthesis? Yes No Question Title * 10. What do you usually do when discomfort arises and you can’t see a prosthetist? Adjust sock Remove prosthesis Apply padding Ignore Other (please specify) Next