Directions for Completion of Survey

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1 Directions for Completion of Survey Thank you for participating in this study. Please complete all 6 sections of the questionnaire. The first section gathers demographic information. The remaining 5 sections gather information about your use and opinions of 5 forms of Complementary and Alternative Medicine (CAM). For each form of CAM in this questionnaire, please use the definition provided at the top of each section to base your responses on. The questions for each form of CAM are the same, yet each form is addressed individually. Please note that each page is double sided. For each question, please check all answers that apply and provide your opinions and comments when requested. Please only use the space provided. Based on your response to some questions, you will be directed to skip certain questions please read directions carefully. Completion of the questionnaire will take approximately 20-30min of your time. Thank you for your participation in this study, Sincerely, Heidi Knupp, MScOT Candidate

2 Demographics Please indicate your response to the following questions by marking an X in the appropriate location -- Check all that apply. 1) I am: Female: Male: 2) I am (age in years): ) I have been practicing Occupational Therapy for: 0-1 Year 2-4Years 5-7Years 8-10Years >10Years (please specify) 4) Please indicate your client base of practice: Pediatrics (0-12) Adolescent (13-17) Adult (18-65) Geriatrics (Over 65) 5) Please indicate & specify your scope of practice: Orthotics Palliative Care Musculoskeletal Disorders Hand Therapy Psychiatry Neurology Amputees Developmental Disabilities Cardiology Rheumatology Educator Administration Work Rehab/RTW Researcher 6) Please indicate the setting in which you currently practice: Hospital Extended Care School W.C.B Private Practice Home Care Psychiatric Facility University/Research Centre 7) Please indicate the geographical area you practice in: Urban (town) Rural (country) Metro (city or city centre) 8) Please indicate the Population Size of the demographical location you practice in: Less than 10,000 10,000-99, , ,999 Over 200,000 9) Please identify the accredited Occupational Therapy program you completed and its location:

3 Acupuncture (use of needles) and Acupressure (use of pressure using hands) points are based on the ancient Qi channels or meridians as described above. The goal of Acupuncture is to restore the energy flow to its proper level by stimulating points along the meridians depending on the symptoms suffered and physical location of the illness/ailment 1) I have personally provided Acupuncture and/or Acupressure in my practice as an Occupational Therapist: YES NO If YES please answer Questions #2 & #3 If NO please proceed to Question #4 2) Please specify, based on your case load, the approximate percentage of clients you treat with Acupuncture and/or Acupressure: amount treated/total case load: 3) I have personally provided Acupuncture and/or Acupressure to treat (check all that apply): Symptoms: Pain:. Spasticity: Stiffness: Fatigue: Stress: Medical Conditions: Anxiety: Stress Management: Neurological Disorder (please specify): Musculoskeletal Disorder (please specify): Other Medical Condition (Please specify/provide detail): Other Symptom (Please specify/provide detail): *** Please Continue with Question #6 *** 4) I have not personally provided Acupuncture and/or Acupressure as an OT because (check all that apply): Not Trained: Against regulations of Governing Body: I am not aware of any illnesses/diagnoses which could benefit: I have no interest in the above method: There is not sufficient evidence on the use of the above method: Administrative and/or Logistical reasons (please specify) 5) Under what circumstances would you personally provide Acupuncture and/or Acupressure (please check all that apply)? If I held the proper certifications Colleagues were openly using Included in scope of practice as defined by the Health Professions Act Sufficient Evidence existed I would not (please specify) Continued on next page turn over Turn Over

4 **Whether or not you have personally provided Acupuncture and/or Acupressure as an OT Have you 6) Prescribed or referred a patient to Acupuncture and/or Acupressure: YES NO. If you answered YES, please answer Question #7, if NO proceed to Question #8 7) I have suggested and/or referred a client to Acupuncture and/or Acupressure: Formally (Charted) On a personal note (off the record). ***Please proceed with Question #9*** 8) As you have not referred a patient to Acupuncture and/or Acupressure Under what circumstances would you prescribe and/or refer a patient to Acupuncture and/or Acupressure (please check all that apply)? Patient specifically requested a referral Colleagues were openly providing referrals Patient would be covered by their health plan I would not refer a patient (please specify) Regardless of your current or past provision of, and/or referral to, Acupuncture/Acupressure 9) Do you believe that Acupuncture and/or Acupressure should be included within the scope of practice of Occupational Therapy? Why or Why not? Please explain your answer: Thank you, please continue with the next form of CAM on the Following page

5 Magnetic Therapy: The theory behind magnetic therapy is that magnets emit a magnetic field called a magnetic flux. This magnetic flux taps into and interacts with the body s natural magnetic field, thereby affecting both the nervous and physiological systems. Magnetic therapy is described as Tapping Into the body s meridians, or energy flow. Magnets are strategically placed to activate the meridians and affect several body systems depending on their placement. 1) I have used/provided Magnetic Therapy in my practice as an Occupational Therapist: YES NO If YES please answer Questions #2 & #3 If NO please proceed to Question #4 2) Please specify, based on your case load, the approximate percentage of clients you treat with Magnetic Therapy: amount treated/total case load : 3) I have used/provided Magnetic Therapy to treat (check all that apply): Symptoms: Pain:. Spasticity: Stiffness: Fatigue: Stress: Medical Conditions: Anxiety: Stress Management: Neurological Disorder (please specify): Musculoskeletal Disorder (please specify): Other Medical Condition (Please specify/provide detail): Other Symptom (Please specify/provide detail): *** Please Continue with Question #6 *** 4) I have not used/provided Magnetic Therapy as an OT because (check all that apply): Not Trained: Against regulations of Governing Body: I am not aware of any illnesses/diagnoses which could benefit: I have no interest in the above method: There is not sufficient evidence on the use of the above method: Administrative and/or Logistical reasons (please specify) 5) Under what circumstances would you use Magnetic Therapy in your practice (please check all that apply)? If I held the proper certifications Colleagues were openly using Included in scope of practice as defined by the Health Professions Act Sufficient Evidence existed I would not (please specify) Continued on back turn over Turn Over

6 **Whether or not you have used/provided Magnetic Therapy as an OT Have you 6) Prescribed or referred a patient to Magnetic Therapy: YES NO. If you answered YES, please answer Question #7, if NO proceed to Question #8 7) I have suggested and/or referred a client to Magnetic Therapy: Formally (Charted) On a personal note (off the record). ***Please proceed with Question #9*** 8) As you have not referred a patient to Magnetic Therapy Under what circumstances would you prescribe and/or refer a patient to Magnetic Therapy (please check all that apply)? Patient specifically requested a referral Colleagues were openly providing referrals Patient would be covered by their health plan I would not refer a patient (please specify) Regardless of your current or past use of, and/or referral to, Magnetic Therapy 9) Do you believe that Magnetic Therapy should be included within the scope of practice of Occupational Therapy? Why or Why not? Please explain your answer: Thank you, please continue with the next form of CAM on the Following page

7 Massage originates from the Greek word meaning to knead, and has been defined by Jonas and Leving (1999) as the hand manipulation of body tissues to promote wellness and to reduce stress and pain. (p.383). Reflexology: a therapeutic method that uses manual pressure applied to specific areas, or zones, of the foot that correspond to areas of the body, in order to relieve stress and prevent and treat physical disorder ( Jonas & Leving, 1999, p.583). 1) I have personally provided Massage and/or Reflexology in my practice as an Occupational Therapist: YES NO If YES please answer Questions #2 & #3 If NO please proceed to Question #4 2) Please specify, based on your case load, the approximate percentage of clients you treat with Massage and/or Reflexology: amount treated/total case load : 3) I have personally provided Massage and/or Reflexology to treat (check all that apply): Symptoms: Pain:. Spasticity: Stiffness: Fatigue: Stress: Medical Conditions: Anxiety: Stress Management: Neurological Disorder (please specify): Musculoskeletal Disorder (please specify): Other Medical Condition (Please specify/provide detail): Other Symptom (Please specify/provide detail): ***Please Continue with Question #6 *** 4) I have not personally provided Massage and/or Reflexology as an OT because (check all that apply): Not Trained: Against regulations of Governing Body: I am not aware of any illnesses/diagnoses which could benefit: I have no interest in the above method: There is not sufficient evidence on the use of the above method: Administrative/Logistical reasons (please specify) 5) Under what circumstances would you personally provide Massage and/or Reflexology (please check all that apply)? If I held the proper certifications Colleagues were openly using Included in scope of practice as defined by the Health Professions Act Sufficient Evidence existed I would not (please specify) Continued on back turn over Turn Over

8 **Whether or not you have personally provided Massage and/or Reflexology as an OT Have you 6) Prescribed or referred a patient to Massage and/or Reflexology: YES NO. If you answered YES, please answer Question #7, if NO proceed to Question #8 7) I have suggested and/or referred a client to Massage and/or Reflexology: Formally (Charted) On a personal note (off the record). ***Please proceed with Question #9*** 8) As you have not referred a patient to Massage and/or Reflexology Under what circumstances would you prescribe and/or refer a patient to Massage and/or Reflexology (please check all that apply)? Patient specifically requested a referral Colleagues were openly providing referrals Patient would be covered by their health plan I would not refer a patient (please specify) Regardless of your current or past provision of, and/or referral to, Massage and/or Reflexology 9) Do you believe that Massage and/or Reflexology should be included within the scope of practice of Occupational Therapy? Why or Why not? Please explain your answer: Thank you, please continue with the next form of CAM on the Following page

9 Therapeutic Touch (TT): A form of spiritual healing which involves a laying of the hands by the therapist a few inches away from the patient s body. The therapist centers themselves to the patient, and focuses on the patient s energy field. The therapist uses their hands to sense an imbalance in energy and then visualizes the energy becoming balanced and free flowing. Reiki: Similar to Therapeutic Touch, yet the hands are placed directly on the client to promote healing on all levels: physical, mental, emotional and spiritual (Fairbrass, 2000). Defined by Fairbrass (in Novey, 2000), as Rei = universal & Ki = vital force or energy flowing through all that is alive (p.436). 1) I have personally provided Therapeutic Touch (TT) and/or Reiki in my practice as an Occupational Therapist: YES NO If YES please answer Questions #2 & #3 If NO please proceed to Question #4 2) Please specify, based on your case load, the approximate percentage of clients you treat with TT and/or Reiki: amount treated/total case load : 3) I have personally provided TT and/or Reiki to treat (check all that apply): Symptoms: Pain:. Spasticity: Stiffness: Fatigue: Stress: Medical Conditions: Anxiety: Stress Management: Neurological Disorder (please specify): Musculoskeletal Disorder (please specify): Other Medical Condition (Please specify/provide detail): Other Symptom (Please specify/provide detail): *** Please continue with Question #6 *** 4) I have not personally provided TT and/or Reiki as an OT because (check all that apply): Not Trained: Against regulations of Governing Body: I am not aware of any illnesses/diagnoses which could benefit: I have no interest in the above method: There is not sufficient evidence on the use of the above method: Administrative/Logistical reasons (please specify) 5) Under what circumstances would you personally provide TT and/or Reiki (please check all that apply)? If I held the proper certifications Colleagues were openly using Included in scope of practice as defined by the Health Professions Act Sufficient Evidence existed I would not (please specify) Continued on back turn over Turn Over

10 **Whether or not you have personally provided TT and/or Reiki as an OT Have you 6) Prescribed or referred a patient to TT and/or Reiki: YES NO. If you answered YES, please answer Question #7, if NO proceed to Question #8 7) I have suggested and/or referred a client to TT and/or Reiki: Formally (Charted) On a personal note (off the record). ***Please proceed with Question #9*** 8) As you have not referred a patient to TT and/or Reiki Under what circumstances would you prescribe and/or refer a patient to TT and/or Reiki (please check all that apply)? Patient specifically requested a referral Colleagues were openly providing referrals Patient would be covered by their health plan I would not refer a patient (please specify) Regardless of your current or past provision of, or referral to, Therapeutic Touch and/or Reiki 9) Do you believe that TT and/or Reiki should be included within the scope of practice of Occupational Therapy? Why or Why not? Please explain your answer: Thank you, please continue with the next form of CAM on the Following page

11 T ai Chi: A specific form of exercise composed of slow, exact and controlled movements performed in a precise order and composed of over 108 postures and transitions. Its main focus is the incorporation of the body as a whole, recognizing the importance of the spirit in health, the mind-body connections, and the production of energy to achieve overall health. Both the musculoskeletal and nervous systems are activated and exercised (Davis, 2004). 1) I have personally provided T ai Chi as part of my treatment protocol in my practice as an Occupational Therapist: YES NO If YES please answer Questions #2 & #3 If NO please proceed to Question #4 2) Please specify, based on your case load, the approximate percentage of clients you treat with T ai Chi: amount treated/total case load : 3) I have personally provided T ai Chi to treat (check all that apply): Symptoms: Pain:. Spasticity: Stiffness: Fatigue: Stress: Medical Conditions: Anxiety: Stress Management: Neurological Disorder (please specify): Musculoskeletal Disorder (please specify): Other Medical Condition (Please specify/provide detail): Other Symptom (Please specify/provide detail): *** Please continue with Question #6 *** 4) I have not personally provided T ai Chi as an OT because (check all that apply): Not Trained: Against regulations of Governing Body: I am not aware of any illnesses/diagnoses which could benefit: I have no interest in the above method: There is not sufficient evidence on the use of the above method: Administrative/Logistical reasons (please specify) 5) Under what circumstances would you personally provide T ai Chi (please check all that apply)? If I held the proper certifications Colleagues were openly using Included in scope of practice as defined by the Health Professions Act Sufficient Evidence existed I would not (please specify) Continued on back turn over Turn Over

12 **Whether or not you have personally provided T ai Chi as an OT Have you 6) Prescribed or referred a patient to a T ai Chi practitioner and/or group: YES NO. If you answered YES, please answer Question #7, if NO proceed to Question #8 7) I have suggested and/or referred a client to T ai Chi: Formally (Charted) On a personal note (off the record). ***Please proceed with Question #9*** 8) As you have not referred a patient to a T ai Chi practitioner and/or group Under what circumstances would you prescribe and/or refer a patient to a T ai Chi practitioner and/or group (please check all that apply)? Patient specifically requested a referral Colleagues were openly providing referrals Patient would be covered by their health plan I would not refer a patient (please specify) Regardless of your current or past provision of T ai Chi, and/or referral, to T ai Chi 9) Do you believe that T ai Chi should be included within the scope of practice of Occupational Therapy? Why or Why not? Please explain your answer: 10) Any Comments? : Thank you for your time and comments. That completes the questionnaire, your participation is greatly appreciated!!

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