. Author manuscript; available in PMC: 2014 Nov 1.

Published in final edited form as: J Burn Care Res. 2013 Nov-Dec;34(6):10.1097/BCR.0b013e3182839ae9. doi: 10.1097/BCR.0b013e3182839ae9

Table 1.

Exercise training following burn injury questionnaire

Exercise Training Following Burn Injury Questionnaire
1 What is your occupation? Occupational Therapist Physical Therapist Medical Doctor Nurse Other (please specify bellow)
2 In your daily practice do you treat adult, pediatric burns or both? Adult Pediatric Both
3 How many years of burn rehabilitation experience do you have? 1 2–5 6–10 11–15 16 or more
4 Do you provide PT/OT services after patient discharge? Yes No
5 What determines the duration of outpatient therapy? Physical Prescription PT/OT evaluation Both A and B Other (please specify below)
6 Do you prescribe a written home exercise program upon patient discharge? Yes No
7 Does the home exercise program include cardiopulmonary/strength/endurance exercises? Yes No
8 If Yes, what do you base the aerobic exercise on when prescribing aerobic exercise intensity? (If you answered ‘No” above then choose N/A) N/A Heart Rate VO2 max General PT/OT guidelines Other (please specify below)
9 Does your home exercise program include resistive exercises (weight, machines, etc.)? Yes No
10 If yes, what do you base the amount of workout weights on? (If you answered ‘No”, choose “N/A”) N/A Manual Muscle Testing Dynamometer (e.g. Blodex Cybex) RMs Other (please specify below)
11 Do you have an onsite/in-house structured outpatient exercise program that goes beyond the traditional burn rehabilitation program and focuses on cardio/strength/endurance? Yes No
12 If you answered “yes” above please describe your program very briefly in the space below (If you answered ‘No”, just write “N/A”)
13 What baseline assessments do you utilize to determine the current status of a patient prior to initiating a cardiopulmonary & strength exercise program? Please choose all that apply. ROM Lean Body Mass Manual Muscle Testing Endurance (VO2 max) Quality of life Other (please specify below)
14 What is the frequency of contact between you (therapist) and the patients in such programs? Please choose all that apply. Daily Weekly Monthly Annually As goals are achieved Other (please specify below)