Lower Limb Therapy Quiz
Please complete this quiz to help us understand your lower limb therapy needs and readiness.
What is your primary reason for seeking lower limb therapy?
*
Injury recovery
Post-surgery rehabilitation
Chronic pain management
Improving mobility
Other
Which of the following symptoms do you currently experience in your lower limbs? (Select all that apply)
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Pain
Swelling
Numbness
Weakness
Stiffness
Instability
Other
On a scale of 1 to 10, how would you rate your current lower limb pain?
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No pain
1
2
3
4
5
6
7
8
9
Worst pain
10
1 is No pain, 10 is Worst pain
How mobile are you currently?
*
Fully mobile
Mobile with assistance (cane, walker, etc.)
Limited mobility (short distances only)
Primarily wheelchair-bound
Which activities are currently most difficult for you due to your lower limb condition? (Select all that apply)
*
Walking
Climbing stairs
Standing for long periods
Running
Getting in/out of chairs
Other
Briefly describe your main therapy goal.
*
Have you previously participated in lower limb therapy?
*
Yes, recently
Yes, but a long time ago
No
How confident do you feel about starting or continuing lower limb therapy?
*
1
2
3
4
5
What kind of support do you have at home to assist with your therapy?
*
Family or friends available to help
Professional caregiver
No regular support
Please share any concerns or questions you have about lower limb therapy.
Submit
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