Massage Research Project
Thank you for showing an interest in this research project: Evaluating the effects of massage on stress, anxiety, low mood and depression in Adults with Irritable Bowel Syndrome. These questions will help to see if you meet the criteria. If successful, you'll receive more information on what to do next. Thank you for making the time to fill out this form.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
Pronouns
*
Date of Birth
*
-
Day
-
Month
Year
Date
How long have you experienced Irritable bowel syndrome?
*
Please Select
10-20+ years
5-10 years
1-5 years
Less than a year
Enter the number of days that you typically experience abdominal pain every 10 days: For example, if you enter 4, it means that you get pain 4 out of 10 days
*
How many of these symptoms do you experience?
*
Abdominal pain/cramping - often worse after eating
Bloating, feeling of fullness
Diarrhea/constipation
Wind/flatulence/excessive gas
Digestive Issues
Stress
Anxiety
Low mood/depression
Are you taking any medication for your IBS? Please list if so
*
How long have you been taking this/these for? N/a if not applicable
*
Do you have any other chronic digestive diagnosis/symptoms other then IBS?
*
Crohn's
Inflammatory Bowel Disease
Celiac
Other
No
If you ticked other, Please give more information
*
Do you have any other major health conditions?
*
Chose one of the following for this statement: I found myself getting agitated
*
0 - Did not apply to me at all
1 - Applied to me to some degree, or some of the time
2 - Applied to me to a considerable degree, or a good part of time
3 - Applied to me very much, or most of the time
Chose one of the following for this statement: I found it difficult to relax
*
0 - Did not apply to me at all
1 - Applied to me to some degree, or some of the time
2 - Applied to me to a considerable degree, or a good part of time
3 - Applied to me very much, or most of the time
Chose one of the following for this statement: I felt sad and depressed
*
0 - Did not apply to me at all
1 - Applied to me to some degree, or some of the time
2 - Applied to me to a considerable degree, or a good part of time
3 - Applied to me very much, or most of the time
Can you commit to filling out a questionnaire every week (on some weeks 2 questionnaires) measuring your stress, anxiety, low mood and/or depression and also pain? (in the same format as this form)
*
Please Select
Yes
No
Not sure
Are you available from W/C 21st July - 6th October? The control period is the first 6 weeks with an online questionnaire each week
*
Please Select
Yes
No
Not Sure
Which day would you be available for Massage w/c Sept 1st - 10th Oct? (6 massages all together - it will need to be the same day each week)
*
Please Select
Wednesdays between 2:15pm & 8:15pm
Thursdays between 6:30pm - 8:30pm
Fridays between 11:15am - 6:15pm
None of the above
On your chosen day - What time would work better?
*
Hour Minutes
AM
PM
AM/PM Option
Would you like to mention anything else?
Submit
Should be Empty: