Abridged version of questionnaire
Part 1
This questionnaire includes questions about eight body regions:
Neck Wrist / Hand
Shoulders Elbow
Upper back Knee
Lower back Ankle / foot
Some of these body parts overlap so you will need to decide for yourself which part you have experienced discomfort (if any).
You only need to fill in the section that applies to you. For example, if you only experience neck discomfort, fill in the section for neck only.
If you experience discomfort in more than one region, you will need to complete the questionnaire for each body region.
N.B. The term “Discomfort” includes pain, ache, difficulty with movement and numbness. In this questionnaire, please only respond to work related discomfort.
Have you experienced discomfort in any of the following body regions while working as an optometrist in the last 12 months? (You may check more than 1 box)
neck
shoulder
upper back
lower back
elbow
wrist / hand
knee
ankle/foot
I have not experienced discomfort in any of the nominated body regions over the last 12 months
Part 2
1. Have you ever been hospitalised because of neck discomfort?
No Yes
2. Have you ever had to change jobs or duties because of neck discomfort?
No Yes
3. What is the total time length that you have had neck discomfort during the last 12 months?
0 day 1-7 days
8-30 days
More than 30 days, but not everyday Everyday
4. Has your neck discomfort prevented you from performing certain tasks?
a. Work-related activities?
No Yes b. Leisure or Home activities?
No Yes
5. What is the approximate length of time that neck discomfort has prevented you from doing normal tasks (at home or at work) during the last 12 months?
0 days
1-7 days 8-30 days
More than 30 days
6. Have you been seen by a doctor, physiotherapist, chiropractor or other health care provider because of neck discomfort?
No Yes
7. Have you had neck discomfort at any time during the last 7 days?
No Yes
8. The following list describes tasks at work which could contribute to work related discomfort. Have any of these factors contributed to your neck discomfort? (You may check more than one box) Performing repetitive tasks
Examining a large number of patients per day Insufficient rest breaks during the workday Working in awkward and cramped positions
Working in the same position for long periods (e.g. standing, bent over, sitting) Bending or twisting your back in an awkward way
Working near or at your physical limits Reaching or working away from your body Continuing to work while injured or hurt Lifting or moving dependant patients
Carrying, lifting or moving heavy objects or equipment Work scheduling (overtime, length of workday) None of these factors apply to me
9. Do any specific work tasks or ophthalmic techniques increase your neck discomfort?
No Yes
If yes, please specify:
10. Have you been able to modify your work or your work space to decrease your discomfort?
No Yes
If yes, please specify:
Part 3
We would like to now ask you some questions about yourself and your work as an optometrist:
Gender Male Female
Age 21-30 31-40 41-50 51-60 61-70 71+
Are you right-handed or left-handed? ... Right handed Left handed
What mode of practice best describes your work as an optometrist?
Self employed
Full-time or part-time employee Locum
How many years have you been practicing as an optometrist?
<5 years 5-10 years 10-15 years >15 years
What tasks do you usually perform at work? (please check all that are appropriate) Frame Selection
Dispensing/Repairs Eye examinations Administration Other (please specify):
On average how many hours per week do you work as an optometrist? (Include all tasks such as administrative, dispensing etc)
<10 hours 10-19 hours 20-29 hours 30-39 hours 40+ hours
On average, how many eye examinations do you conduct per day?
0-5 6-10 11-15 16+