Live Well With Parkinson's
http://livewellwithparkinsons.com/
1. Do you or your spouse/partner/family member have Parkinson's Disease? *
2. Are you a: *
*If you are a partner/spouse/family member, please respond to the following questions on behalf of the PwP.
3. Are you: *
4. How old are you: *
5. How long have you lived with Parkinson's? *
6. How much assistance do you require with personal care or daily activities? *
No Assistance
Full Assistance
7. Do you take medications for Parkinson's disease? *
8. Which medications do you currently take? *
Select all that apply
Required
9. Are you satisfied with how your medications control your symptoms of Parkinson's? *
Not at all
Excellent Control
10. Do you take your medications at specific times in the day? *
11. Do you experience the "wearing-off" of the effects of medication prior to the next dose? *
("Wearing-off" refers to Parkinson's symptoms that re-emerge or worsen before the next dose of l-dopa is due.)
12. How often do you stick to a medication schedule? *
13. If you have trouble sticking to a schedule, what are the causes? *
Select all that apply
Required
14. Would you be interested in using an electronic form of a medication tool? *
(This tool can help you schedule your medications and your meals customized to your individual lifestyle preferences.)
15. Do you take l-dopa with meals? *
16. Are you aware that eating protein at the same time as taking l-dopa decreases the effectiveness of l-dopa in controlling symptoms? *
17. Are you aware that following a "protein redistribution diet" as part of a lifestyle strategy can improve the effectiveness of l-dopa for symptom control? *
(A "protein redistribution diet" involves eating low protein during the day and high protein in the evening.)
18. Would you consider adopting a protein redistribution diet if you had access to low protein recipes that tasted good and are simple to make? *
19. What kind of foods would you like to see included in recipes?
20. Which health care providers manage your Parkinson's? *
Select all that apply.
Required
21. Where do you currently get information regarding Parkinson's? *
Select all that apply.
Required
22. How do you prefer to access information regarding Parkinson's? *
1 (least preferred)
2
3
4
5 (most preferred)
Books
Internet
Television
Support groups
Parkinson's organizations
Doctor
Smartphone/Tablets
Brochures
Other health care professionals
23. What information about living with Parkinson's would you like to know more about? *
Required
24. Would you use a website that offered practical strategies to living with Parkinson's? *
25. Do you have any additional comments you would like to add?
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