Study Information and Online Consent

Please read the following before proceeding.

Informed Consent
You are being asked to consider participating in a research study that will look at the preferences of power wheelchair users on some of the proposed intelligent power wheelchair systems from research. Please read this form carefully and ask any questions you may have.

Introduction
Mobility is an important aspect of daily living as it allows people to participate in social, leisure and cultural activities, as well as perform tasks necessary for self-care. Without mobility, individuals are at risk for higher rates of depression, reduced quality of life, higher rates of disease, and higher rates of social isolation. As the population ages, mobility is becoming an increasing concern, especially for wheelchair users, as chronic conditions related to aging (such as dementia) can both lead to the need of and limit access to mobility aids.
There have been significant research efforts to reduce the existing barriers to mobility – specifically, through intelligent wheelchair systems. Intelligent wheelchair systems are modified power wheelchairs that provide navigation assistance to the user through features such as collision avoidance. These systems are intended to increase safety when operating a power wheelchair, but few of these systems are available on the market for purchase. This is due to several contributing factors including the limited testing or evaluating of these systems due to safety concerns.
The purpose of this study is to evaluate some of the proposed features from research in the context of doorway navigation through a series of videos and an online survey. The study will gather data and feedback intended for the future development and research.

Eligibility
You are eligible to participate in the study if you:
- are of the age 18 years or older;
- are able to provide consent;
- have 1 or more years of experience operating a power wheelchair; and
- have basic communication skills in English.

What Will Happen During the Study?
You are being asked to complete an online survey that shows videos of examples of the proposed operating modes and asks questions based on them. It is expected that the survey will take approximately an hour to complete.

How Many People Will Take Part in the Study?
Approximately 20 people will complete the survey.

What are the Responsibilities of the Study Participants?
If you decide to participate in this study you will be asked to do the following:
- Carefully read all the information in this consent form.
- Ask any questions you might have about the study by contacting Sang Min Shin (Primary Study Contact) at (416) 820-8394 or sang.shin@mail.utoronto.ca, or about your rights as a participant by contacting the University of Toronto Office of Research Ethics at ethics.review@utoronto.ca  or (416) 946-3273. The Office of Research Ethics is a group of people who oversee the ethical conduct of research studies. They are not part of the study team. Everything that you discuss will be kept confidential.
- Give your consent by checking the “I agree” button at the bottom of this page to be directed to the survey.
- Answer the survey questions to the best of your ability.
- Remember that we want your opinion, so there aren’t any wrong answers!
What are the Risks or Harms of Participating in this Study?
There is some risk associated with the study.
Specifically, as the survey can take up to an hour, you may experience some exhaustion. Please take breaks whenever necessary, but please do not close the tab as your progress cannot be saved.
There is also security risk associated with using SurveyMonkey to collect data because that means that SurveyMonkey will also temporarily have the data. To minimize this risk, upon any completed submission, the data will be manually transferred by research staff as soon as possible to secure University of Toronto servers and password-protected computers that are only accessible by laboratory staff. To further protect your data, your responses will be made anonymous by assigning your responses to a unique code number instead of any identifiable information.

What are the Benefits of Participating in this Study?
There are no direct benefits from taking part in this study. You may learn more about current power wheelchair research. The information you share with us will be used to help build better technologies for supporting power wheelchair users.

Can Participation in this Study End Early?
You can choose to end your participation at any time by closing your browser. Please note that if you have already submitted a response, because your response is anonymous, it will not be possible to delete your data or withdraw from the study at that point.
If you withdraw from the study and wish to share your experience, you are encouraged to contact Sang Min Shin (Primary Study Contact) at (416) 820-8394 or sang.shin@mail.utoronto.ca.

What are the Costs of Participating in this Study?
There are no costs to participate in the survey.

Are Study Participants Paid to Participate in this Study?
There is a 25 CAD compensation for those who voluntarily give their contact information at the end of the survey and request the compensation. However, if you choose to withdraw from the study, you will not receive the compensation as no information or data will have been collected.

The compensation process will go as follows:
1. The primary research contact will send an email to arrange the compensation transfer (i.e. mail-in check or e-transfer).
2. Compensation will be sent out.
3. Once the delivery of compensation has been confirmed either via email or mail services, the primary research contact will follow-up with you to receive confirmation that the compensation has been received.

Do the Investigators Have any Conflicts of Interest?
There are no conflicts of interest for any of the investigators in this study.
What are the Rights of Participants in a Research Study?
All participants in a research study have the following rights:
- You have the right to have this form and all information concerning this study explained to you and if you wish translated into your preferred language.
- Participating in this study is your choice (voluntary). You have the right to refuse to participate, or to stop participating in this study at any time without having to provide a reason.
- You have the right to receive all significant information that could help you make a decision about participating in this study. You also have the right to ask questions about this study and your rights as a research participant, and to have them answered to your satisfaction, before you make any decision. If you have any questions about this study you may contact Sang Min Shin (Primary Study Contact) at (416) 820-8394 or sang.shin@mail.utoronto.ca. If you have questions about your rights as a research participant or about any ethical issues relating to this study, you can contact the University of Toronto Office of Research Ethics at ethics.review@utoronto.ca  or (416) 946-3273. The Office of Research Ethics is a group of people who oversee the ethical conduct of research studies. They are not part of the study team. Everything that you discuss will be kept confidential.
- By  agreeing to participate in this survey, you do not give up any of your legal rights.
- You have the right to receive a copy of this consent form before participating in this study. If you would like a copy, please contact Sang Min Shin (Primary Study Contact) at (416) 820-8394 or sang.shin@mail.utoronto.ca.
- You have the right to be told about any new information that might reasonably affect your willingness to continue to participate in this study as soon as the information becomes available to the study staff. This may include new information about the risks and benefits of being a participant in this study.
- Any of your personal information (information about you and your health that identifies you as an individual) collected or obtained, whether you choose to participate or not, will be kept confidential and protected to the fullest extent of the law.  All personal information collected will be kept in a secure location. The study staff and the Toronto Rehabilitation Institute Research Ethics Board will have access to your personal information for purposes associated with the study but will only be allowed to access your records under the supervision of the Principal Investigator and will be obligated to protect your privacy and not disclose your personal information. None of your personal information will be given to anyone without your permission unless required by law. When the results of this study are published, your identity will not be disclosed. The data for this study will be retained for seven years after the study publication.
- You have the right to be informed of the results of this study once the entire study is complete. If you would like to receive information regarding the results of this study, please contact Sang Min Shin (Primary Study Contact) at (416) 820-8394 or sang.shin@mail.utoronto.ca.
Primary Study Contact
Sang Min Shin
Master of Applied Science Candidate, University of Toronto
Intelligent Assistive Technology and Systems Lab
Institute of Biomaterials and Biomedical Engineering | University of Toronto
Toronto Rehabilitation Institute - University Health Network
www.iatsl.org
Email: sang.shin@mail.utoronto.ca
Phone: (416) 820-8394

Research Supervisor
Alex Mihailidis, Ph.D P.Eng.
Scientific Director, AGE-WELL Network of Centres of Excellence
Barbara G. Stymiest Research Chair in Rehabilitation Technology, Toronto Rehab Institute-UHN / University of Toronto
Professor, Department of Occupational Science & Occupational Therapy / Institute of Biomaterials & Biomedical Engineering, University of Toronto
Email: alex.mihailidis@utoronto.ca
Phone: (416) 946-8565

Participant
By checking the “I Agree” button below, I confirm that:
- This research study has been fully explained to me and all of my questions have been answered to my satisfaction;
- I understand the requirements of participating in this research study;
- I have been informed of the risks and benefits, if any, of participating in this research study;
- I have been informed of the rights of research participants; and
- I have read all of this form and agree to participate.

Question Title

* 1. I agree and give my consent to participate in this survey.

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