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H.1898-0421 Parkinson's Treatment

You are about to fill in a short survey which will help determine your suitability to this research project. Please be aware that all data you provide us with will be held in accordance with the data protection policy outlined on our website. For further information please visit https://www.healthcareopinions.co.uk/privacy-policy/

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What is your name, contact number and email address?
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Please tell us your age.
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Are you...
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What is your working status?  
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If applicable, what is your occupation? 
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Are your details currently registered with us? If you haven't, please do so here http://https://www.healthcareopinions.co.uk/
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Where did you hear about this research participation opportunity?
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Have you, or anyone in your household, ever been employed by any of the following?

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Have you been diagnosed with Parkinson’s disease?

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How long has it been since you/ they were diagnosed with Parkinson’s Disease?

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Are you/ they currently participating, or planning to participate, in a clinical trial research study?

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When is the end date of the clinical research study?

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What medication(s) do you/ they currently take as part of your / their treatment for Parkinson’s disease?
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Please tell us how frequently you/ they take these medications...
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Please tell us how long you/ they have been taking these medications...
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Do you/ they experience “off time” during the day/night? Off time is when you feel your current medication is suddenly losing its efficacy, you feel your symptoms (such as tremor, rigidity, or bradykinesia) are coming back and are no longer controlled by your medications.

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Please estimate how much “off time” you/ they have during an average day? Be sure to include any morning stiffness before you/ they take your/their  medication.

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Are you/ they currently diagnosed as currently having any of the following symptoms/ conditions?

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Do you/ they have any other neurological deficits not directly stemming from Parkinson’s disease (e.g., hemiparesis) or disabilities that significantly restrict your/ their movement, vision and/or hearing?
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While on your/ their medication, how often in the past month have you/ they...

​​​​​​Had difficulty using or dialing a telephone?

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While on your/ their medication, how often in the past month have you/ they...

Had difficulty standing or walking?

While on your/ their medication, in the past months  how often have you/ they...

Had difficulty cutting up your/ their food?

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While on your/ their medication, what level of assistance do you/ they typically require for...

Dressing yourself

While on your/ their medication, what level of assistance do you/ they typically require for... 

Sitting and standing from a chair or couch?

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Does a caregiver, such as a partner, spouse, friend, or family member assist you with any of your daily activities?

 

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Please describe how your caregiver assists you in your daily activities...