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ijs8UIgdmDH39a9ZxtDjzo8tmWtJGQJho

Consent

My name is Kyle Leister, and I am a Certified Orthotist/Prosthetist and PhD student at Syracuse University. I am part of a research group and we are interested in learning more about the mental health and mobility status of adults with amputation during three specific phases during the COVID-19 pandemic: Phase 1: initial onset of COVID-19; Phase 2: self-quarantine phase (no contact); Phase 3: post quarantine phase (limited contact). You will be asked to answer a few general questions about yourself, your health history, your employment and living situation, and prosthesis before and after isolation, and general questions about anxiety, depression, mobility, and stress. You will not be asked to provide your name, email, phone number, or address. This will take approximately 25-30 min of your time.

I am inviting you to participate in a research study. Involvement in the study is voluntary. This means you can choose whether to participate and that you may withdraw from the study at any time without penalty. You qualify to participate in this study if you are 18 years of age or older, reside in the US, utilize a prosthesis, and you can read and write in English.

Whenever one works with the internet, there is always the risk of compromising privacy, confidentiality, and/or anonymity. Your confidentiality will be maintained to the degree permitted by the technology being used. It is important for you to understand that no guarantees can be made regarding the interception of data sent via the internet by third parties.

If you have any questions, concerns, or complaints about the research, please contact Tiago Barreira at exscihbml@syr.edu

I am 18 years of age or older, and I wish to participate in this research study.

By continuing, I agree to participate in this research study.

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