Mobility Scooter Usage This questionnaire is for people who use a mobility scooter. This research is investigating why and how people use their mobility scooters as well as how using them affects their everyday life. Please complete it and return it to the freepost address shown at the bottom of the questionnaire. Thank you.
About You and Your Scooter:
1. How long have you regularly used a mobility scooter?______
2. Why did you originally start to use a mobility scooter?
3. For you personally what are the advantages and disadvantages of using a mobility scooter?
4. Please answer the following question by circling the word that best describes how frequently you now walk and how far you travel on foot since you started using your scooter.
I make the same number/ fewer/ more trips by foot since I started using my scooter.
These trips are approximately the same distance/ less far/ further than those I took before I started using my scooter.
5. How often do you use your mobility scooter? (tick the box which describes you best) Every day Most days Once a week A few times a month Monthly Occasionally 7. Think about the trips you make outside your house. Do you use your scooter for: all trips you make most trips you make only a few trips you make
8. How often do you walk 250 yards (1/4 mile) or more? every day most days once a week a few times a month monthly occasionally never
9. Think of a typical trip you make on your scooter. Before you started using your scooter how would you have made the trip? (tick the box that fits best) by bus by train by another forms of public transport by taxi by car by foot other (please specify)______I would not have made the trip
10. Where do you go on your mobility scooter? (tick all that apply) visit friends/family local shops social activities doctor/hospital church other (please specify)______
11. Do you now participate in different activities since you started using your scooter? No Yes If yes, what activities ______About You:
12. I am Male Female
13. I am ______years old
14. My height is ______
15. My weight is ______
16. Before you started to use a mobility scooter did you use a different mobility device to help you get around? (tick all that apply) a cane or walking stick a wheelchair a walking frame a mobility scooter that I hired other______I used no other mobility device
17. Do you currently use an additional mobility device, apart from your mobility scooter, to help you get around? (tick all that apply) a cane or walking stick a wheelchair a walking frame other______I use no other mobility device
About Your Mobility:
18. For health or physical reasons do have any difficulty in walking 800 meters (half a mile)? No Yes No longer do this due to difficulty doing it Could do it but don’t for health reasons 19. Have you changed how frequently you walk 800 meters (half a mile) due to underlying health problems? For example have you cut down from walking everyday to walking 3-4 times a week because you tire more easily?
No Yes – do it more frequently Yes – do it less frequently Yes – don’t do it anymore
20. Have you changed the method that you use to walk 800 meters (half a mile)? For example do you walk more slowly or more carefully, use a different stance or gait, use a walking stick, frame or other aid, take more frequent rest stops
Ye s No
21. For health or physical reasons do you have any difficulty in climbing 10 steps?
No Yes No longer do this due to difficulty doing it Could do it but don’t for health reasons
22. Have you changed how frequently you climb 10 steps due to underlying health problems? For example, do you take the elevator more often whenever possible because of pain in your joints.
No Yes – do it more frequently Yes – do it less frequently Yes – don’t do it anymore
23. Have you changed the method that you use to climb 10 steps? For example do you use the handrail more often, reduce the number of steps you take at a time, walk slowly or more carefully, make frequent rest stops.
Ye s No
24. For health or physical reasons do have any difficulty in getting in or out of a car or bus?
No Yes No longer do this due to difficulty doing it Could do it but don’t for health reasons
25. Have you changed how frequently you get in or out of a car or bus? For example, you decrease the number of car/bus trips you take because it is difficult to get yourself out of the seat.
No Yes – do it more frequently Yes – do it less frequently Yes – don’t do it anymore
26. Have you changed the method that you get in or out of a car or bus? For example, you use the door or seat to steady you, you rely more on your arms to help you, you enter or exit more slowly, you require help from others.
Ye s No We would like to ask you about your quality of life. Please tick one box in each row. There are no right or wrong answers. Please indicate the extent to which you agree or disagree with each of the following statements.
Tick one box in each row. e e e e e e e e e e r r r r r g g g g g a a a A A s s s
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S r e h t i e N I enjoy my life overall I look forward to things Life gets me down I have a lot of physical energy Pain affects my well-being My health restricts me looking after myself or my home I am healthy enough to get out and about My family, friends or neighbours would help me if needed I would like more companionship or contact I have someone who gives me love and affection I’d like more people to enjoy life with I have my children around which is important I am healthy enough to have my independence I can please myself what I do The costs of things compared to my pension/income restricts my life I have a lot of control over the important things in my life e e e e e e e e e e r r r r r g g i. g g g a a a A A s s s
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S r e h t i e N I feel safe where I live The local shops, services and other facilities are good overall I get pleasure from my home I find my neighbourhood friendly I can take life as it comes and make the best of things I feel lucky compared to most people I tend to look on the bright side If my health limits social/leisure activities, then I will compensate and find something else I can do I have enough money to pay for household bills I have enough money to pay for household repairs or help needed in the house I can afford to buy what I want to I cannot afford to do things I would enjoy I have social or leisure activities/hobbies that I enjoy doing I try and stay involved with things I do paid and unpaid work or activities that give me a role in life I have responsibilities to others that restrict my social or leisure activities Religion, belief or philosophy is important to my quality of life Cultural/religious events/festivals are important to my quality of life Thank you for taking the time to complete this questionnaire.
We may like to contact you to complete an additional questionnaire in a years time. Your details will not go onto a mailing list or be used for any other purpose. If you are happy for us to contact you please include your email/postal address here:
Please return this questionnaire to: FAO Roselle Thoreau, FREEPOST University College London
This questionnaire is part of a research project in the Department of Civil, Environmental and Geomatic Engineering at University College London (UCL). This questionnaire is anonymous and no individual is able to be personally identified. All data collected will be treated in accordance with the Data Protection Act 1998.