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BOLSTA® EC Registered: Medical Device Class 1 |
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BOLSTA® Support cushion To all owners of the BOLSTA®support cushion: Arabesque Commercial SA, has pleasure in inviting you - as an owner of the BOLSTA® Support Cushion - to take part in a clinical study. We would be most grateful for your assistance, and, in this way, we hope to be of further service to you in the future. If you agree, please complete the following questions and return the form to us: 1.Have you had a specific back problem diagnosed by your doctor by clinical examination, scan and/or X-ray? YES ___ NO ___ (e.g. osteoporosis, rheumatoid arthritis, scoliosis, or trauma) 2.
If yes, what condition?
__________________________________________________ 3. If you suffer from back pain, is the pain felt in the upper, mid, or lower back? _________ 4. Do you take painkillers for back pain on a regular basis? YES ___ NO ___ 5.
What expectation did you have when you started
to use your BOLSTA®
? 6. Have your expectations been met? YES ___ NO ___ 7.
What benefit has BOLSTA®
given
you? 8. How many hours per week do you use your BOLSTA® ? __________________ Hours 9.
In what situations have you found your BOLSTA®
most helpful? Answers to the following questions are not essential but they would be useful and greatly appreciated. We hope that you will agree to complete these also: 10. What is your age? ______________ years 11. Are you male/female? MALE ___ FEMALE ____ 12. Have you had to stop work due to back pain? YES ___ NO ___ 13. And, if so, for how long? ______________________________________________
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BOLSTA® |