Dry Needling Survey: PATIENT Question Title * 1. Thank you for participating in this survey regarding the impact dry needling has had on your medical care. We appreciate your willingness to help us collect data that will help to improve access to dry needling in patient care in the future.No contact information is required to complete this survey. Results will only be used anonymously even if contact information is provided. Contact information will only be used to allow interested individuals to contribute to activities relevant to a clinicians' utilization of Dry Needling in the United States upon future follow-up. By providing contact information you are authorizing KinetaCore to contact you in regard to Dry Needling. Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number OK Question Title * 2. Are you male or female? Male Female OK Question Title * 3. What is your age? 17 or younger 18-20 21-29 30-39 40-49 50-59 60-69 70+ OK Question Title * 4. What is the highest level of education you have completed or the highest degree you have received? Less than high school degree High school degree or equivalent (e.g., GED) Some college but no degree Associate's degree Bachelor's degree Any Graduate degree OK Question Title * 5. Which of the following categories best describes your employment status? Employed, working full-time Employed, working part-time Not employed, looking for work Not employed, NOT looking for work Retired Disabled, not able to work OK Question Title * 6. What is your ethnicity? (Please select all that apply.) American Indian or Alaskan Native Asian or Pacific Islander Black or African American Hispanic or Latino White / Caucasian Prefer not to answer Other (please specify) OK Question Title * 7. How likely is it that you would recommend Dry Needling to a friend or colleague? NOT AT ALL LIKELY EXTREMELY LIKELY 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 OK Question Title * 8. When did you first receive Dry Needling (DN)? 1990 2003 2017 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 9. How long has it been since you last received Dry Needling from a Physical Therapist? Within the last week Within the last 2 weeks Within the last 4 weeks Within the last 3 months Within the last 6 months Within the last 12 months Over 12 months ago OK Question Title * 10. For how many different problems or symptoms have you received Dry Needling? Note: For one problem you may have received multiple treatment sessions, while different problems would include either treatment in a different body region, or two different episodes of care. One Two Three Four Five More than Five OK Question Title * 11. Approximately how many total sessions of DN have you received? This includes all the different body regions and episodes of care that you have received. 1 2-5 6-10 11-20 20+ OK Question Title * 12. Approximately how many filiments/needles were used, on average, per session by your PT? A session would include treatment that occurred on a single day. 1 2 3 4 5 6 7 8 9 10+ OK Question Title * 13. To which of the following body regions have you received Dry Needling? Select all that apply. Head Region Neck (cervical spine) Chest Region including upper back (thoracic spine) Shoulder Upper arm Hand Low Back (beginning at bottom of rib cage) Hip Thigh (front and back) Foot Elbow Most Frequent Region (please specify) OK Question Title * 14. Do you feel that the Dry Needling benefitted you as part of your care? Please only answer one option. Yes No Variable OK Question Title * 15. How do you view the effects of the inclusion of Dry Needling in your care? Was your recovery time reduced, or DN had no perceptible effect, or it prolonged the length of your rehabilitation? (Please select only one option.) Reduced my recovery time (Improved the rate of recovery) No effect Prolonged my rehabilitation (slowed the rate of recovery) OK Question Title * 16. Based upon your answer to Q15 about whether DN had an effect on your care, please indicate to what extent DN impacted your overall response on a 0-100 scale. 0 = no effect on my care, 100 = every effect on my care was due to the Dry Needling. 0 50 100 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 17. Did you suffer any side effects from receiving Dry Needling? Please check each of the following that apply. The next question will allow you to list the number of occurrences. Soreness for less than 24 hours Soreness for greater than 24 hours Soreness that negatively impacted your function Bruising (concerning, or beyond expected) Infection (directly from filament insertion) Pneumothorax (collapsed lung) I experienced no side effects. Other (please specify) OK Question Title * 18. If you listed any side effects from your Dry Needling, did the side effects you listed prevent you from a positive overall treatment experience? Yes, I had a reduced overall treatment effect due to side effects. No, the side effects were temporary, and overall I improved from my treatment. OK Question Title * 19. Do you feel that your clinician properly educated you with regard to the benefits, risks and possible side effects of Dry Needling? Yes, I was properly educated. I was only educated after I experienced a side effect. No, I was not properly educated. Other (please specify) OK Question Title * 20. To what extent did the inclusion of dry needling impact your overall improvement while participating in physical therapy? (0-100% impact) 0 50 100 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 21. Did your clinician use DN for pain control, to improve your function or both? Please select only one answer. Pain Control Function Both OK Question Title * 22. Would you recommend Dry Needling to friends and family for people with physical impairment and or pain? Yes No Comments welcome: OK Question Title * 23. What type of practitioner performed Dry Needling in your clinical care? Physical Therapist Chiropractor Physician Acupuncturist Other (please specify) OK Question Title * 24. Did a physician or other referral source recommend you to receive Dry Needling as part of your healthcare? Physician No referral Other (please specify) OK Question Title * 25. Did the inclusion of Dry Needling in your medical care change your medication use for pain or functional limitation for which you were receiving treatment? No - no change Yes - increased medication use for my problem (stronger medication or more frequent usage) Yes - reduced medication use for my problem (weaker dose or less frequent usage) Yes - full medication use cessation for my problem (no longer taking medication for my problem) I have not taken medication for what I was treated. Other (please specify) OK Question Title * 26. For each unique problem that you received Dry Needling, after how many treatment sessions did you notice the biggest total change (negative or positive)? Please select one number and include in the comment box which problem treated to which it relates. No change experienced. 1 2 3 4 5 6 7 8 9 10 10+ Problem treated. OK Question Title * 27. Thank you for taking our survey! Would you like to be contacted for any reason? If so, please indicate your preferred method of contact (email, phone, etc). Yes contact me No, do not contact me Preferred method of contact OK DONE