BACK TO THE MAIN JAW WIRING PAGE    BACK TO THE OJW-DPOJW COURSE FOR DENTISTS AND ORTHODONTISTS

Back to the Informed Consent for OJW   Back to the AJODO manuscript

SECTIONS OF THE SURVEY BELOW:

1. INVITATION TO TAKE THE SURVEY (THIS PAGE)    2. DEMOGRAPHIC QUESTIONS (1-3) 
3. BACKGROUND OF PATIENTS (4-21)    4. SAFETY OF OJW (21-30) 
5. EFFECTIVENESS AND BENEFITS (31-40)    6. PROBLEMS OF OJW (41-55)
7. CONCLUSIONS (56-73)    8. MISCELLANEOUS (74-77)

SEE THE RESPONSES TO THIS SURVEY
The responses can be also be viewed in HTML, and Excel spreadsheet formats

1.  

Dear Former and Present Orthodontic Jaw Wiring patients who opted-in to be a part of this study:

Thank you for your participation.

If for any reason you have a problem in progressing through the questions email me at: drted35@aol.com or call me at the office: (718) 852-1551.

Questions with an * require you to answer them (ex., Q.1) or else you will be unable to proceed to the next query.

If you find you cannot proceed to the following page after clicking the "Next" button check to see if you have completed ALL the * questions.

This survey allows you to go back to previous question and change them. However, once you have clicked the "Done" button you may no longer recall any of the questions.

If you feel you "messed up" your survey after you clicked on the "Done" button you can request that I resend it to you in order to retake it.

Respondents' instructions for completing the OJW* Questionnaire survey:

This is an ambitious and exhaustive study. There are 78 inquiries. It will take you twenty-thirty minutes to complete.

I plan to present the findings of the study at the 109th meeting of the American Association of Orthodontists in Boston on May 4, 2009.

"Non-responders" who decide to opt back in at a later date will be most welcome. If the survey is marked "Closed" you have only to notify me and I will "Open" it for you.

This survey updates automatically whenever a respondent clicks on the "Done" button, which appears when the last question is answered.

There are seven sections: Demographics (3Qs), Background (17), Safety (11), Effectiveness (10), Problems (15), Conclusions (17) and Miscellaneous (4).

Many of the questions allow you to grade your response on a scale of 0 to 5 in order to allow you to quantify how strongly you feel about your response.
Some simply ask you to choose the response that best describes how you feel.
Some are answerable by yes or no.
Others require you to check off the answers that are applicable to you.
Finally, a few of the questions give you the option to to provide a brief but thoughtful response.

Please be frank. As the French say: "Sonner vrai comme une cloche"...just tell it like it was/is.

An gift of $35 will be my way of thanking you for completing the questionnaire. Toward that end, inquiry 77 requires that you provide your name and current address.

I will publish the results of the study on my web site @ [http://www.drted.com/OJW Questionnaire survey and results.htm], and notify you without delay when I post them.

Thank you again for taking part in this survey to gauge the safety and effectiveness of the OJW approach for weight control in compulsive overeating.

Cordially,
Ted Rothstein, DDS PhD
Dr. Ted Rothstein
June 1, 2008
drted35@aol.com
(718) 852-1551
*OJW patent pending #11/534225


Ground Zero: Why do we eat when we are not hungry?...Answer

 

2. DEMOGRAPHICS

DEMOGRAPHICS/ Background Information of Patient, Safety, Effectiveness, Problems and benefits, Conclusions, Miscellaneous

1. Below is my contact information  Responses to queries 1-3

  
 

2. Are you male or female?

3. What is your age?

   

3. BACKGROUND INFORMATION OF PATIENTS

 
Demographics /BACKGROUND INFORMATION OF PATIENT/ Information of Patient, Safety, Effectiveness, Problems, Conclusions Miscellaneous

4. Weight at start of OJW as you indicated on the Informed Consent you completed. Use the number I provided you with in the invitation to participate in this survey. Responses to queries 4-20
 

 

5. Your BMI (Body Mass Index) at start of OJW as you indicated on the Informed Consent you completed. (This index number is the number provided you in the invitation to participate in this survey.)

 

6. Present Weight

  

7. Present BMI click here or go to [http://nhlbisupport.com/bmi/bmicalc.htm]  

8. Below are listed some common medical problems associated with being overweight. Choose the one(s) that apply to you now.
 

9. Was the risk or fear of surgery an important consideration in choosing OJW?

10. Are you in OJW now?

11. Who did you get to assist you when you got back home? physician, dentist, friend, significant other, etc.?
 

12. Before finding Dr. Rothstein how difficult was it to find an OJW provider?

13. For how many months were you/have you been in OJW?
 

14. How many months ago did you stop OJW?
 

15. Did/Do you feel that Dr. Ted provided you with sufficient information prior to the start of OJW?

16. Was this service valuable to you?

17. Would/Did you recommend it to others?

18. After OJW what method did/would you try/or are trying at present?

19. Did you have Bariatric (gastric-bybass) surgery after OJW?

20. Did you have "lap band” surgery after OJW?
 

4. SAFETY OF OJW  Responses to queries 21-30

Demographics, Background Information of Patient /SAFETY OF OJW/ Effectiveness, Problems, Conclusions, Miscellaneous

21. My choice below represents how I feel about OJW for the control of weight in compulsive overeating.
 

22. Were you harmed by your experience with OJW?
Questions 23-27 ask you to grade the degree of harm to the Teeth, Gums, etc. If you answered "NO" to the above choose "0" for the choices offered in 23-27.

23. In what way(s) did you feel you were harmed by your OJW experience?

My Teeth:
 

24. In what way(s) did you feel you were harmed by your OJW experience?

My Gums:
 

25. In what way(s) did you feel you were harmed by your OJW experience?

My Jaw Joints

26. In what way(s) did you feel you were harmed by your OJW experience?
Please describe:

27. Do you believe you suffered a harm that is permanent?

If yes, answer the next question.
 

28. If you believe you suffered a harm that is permanent? Please explain.

29. Do you think the OJW harmed you in any way after the device was removed?

30. If you believe OJW harmed you in anyway after the device was removed please describe.
 

5. EFFECTIVENESS AND BENEFITS  Responses to queries 31-40

 
Demographics, Background Information of Patient, Safety of OJW /EFFECTIVENESS AND BENEFITS/ Problems, Conclusions, Miscellaneous
 

31. How well did you adhere to OJW regime (5 weeks wired/5 days rest)?

32. Did you lose weight during the OJW?

33. How many pounds did/have you lose/lost during OJW?
 

34. Choose that response(s) that most applies to you regarding OJW.
 

35. If none of the above choices are fitting you can say it in your own words.

36. If you experienced a benefit in what way(s) did you benefit?
 

37. If you experienced a benefit not mentioned above please explain:

38. Did OJW help you to get better control of your eating habits?

39. I now feel sure that vis-a-vis Q21 my choice below represents how I truly feel about OJW for the control of weight in compulsive overeating: (Please do not go back to alter your answer at Q.21)
 

40. I now feel sure that my choice above represents how I truly feel about OJW for the control of weight in compulsive overeating, However, I would like to add:
 

6. PROBLEMS ARISING OUT OF OJW  Responses to queries 41-55


 
Demographics, Background Information of Patient, Safety of OJW, Effectiveness and Benefits /PROBLEMS/ Conclusions, Miscellaneous
 

41. What problem(s) did you have with your OJW? Choose all that apply to you.
 

42. Please respond the degree to which you experienced each of the following:

Re Q's 43-55 a "0" response signifies "not at all".

My social life was impaired.

 

43. My sex life was impaired.

44. I had the support of my significant other.

45. My jaw became stiff and/or painful:

46. My teeth became painful:

47. I gave up on OJW because my jaw joint became stiff and painful:

48. I made a big mistake by choosing OJW:

49. It was a waste of time and money:

50. My speech was impaired:

51. My mouth felt unclean inside:

52. My breathing felt restricted:

53. My friends/family/significant other complained about my breath not being fresh:

54. I gave up because it was too difficult to rewire myself:

55. Regarding the rewiring process, choose the most appropriate response(s)
 
   

7. CONCLUSIONS  Responses to queries 56-73

Demographics, Background Information of Patient, Safety of OJW, Effectiveness and Benefits /Problems /CONCLUSIONS/ Miscellaneous

56. Did you have any experiences related to OJW with special attention to nausea, vomiting or choking?
 

57. If you did have an experience related to OJW with special attention to nausea, vomiting or choking please comment here:
 

58. Given that vomiting could lead to the inspiration of vomit back into your airway leading to effects ranging from choking to death, please state your position(s) from the list below.
 

59. Did you find it helpful to be able to contact previous OJW patients?

60. I might have continued if an easier method to rewire myself was available.

61. I might have continued if there was a provider closer to my home.

62. Do you believe that OJW gave you a "jump start" with your weight loss efforts?

63. Why did you choose the OJW method to begin with? Multiple responses are okay:
 

64. Weight control services should be left to the patient's physician/dietician.

65. I believe OJW is a useful procedure for carefully selected patients.

66. Do you believe that it is the right and responsibility for dental professionals to provide this service to compulsive overeaters?

67. Dental professionals should be encouraged to provide weight control services to their patients:

68. Should OJW be more available/widespread?
 

69. If you did regain the weight you lost did you hold the OJW provider responsible?

70. Do you think OJW should be covered by your insurance company?

71. Why do you think OJW is not covered while the way more costly operations like gastric-bypass are covered?

72. Did OJW help you toward the goal of modifying your behavior as it relates to the amount and type of food you eat at present?

73. What fee, assuming payment all at once, with the cost of all successive visits included, do you think an OJW provider should charge for the service?
 

8. MISCELLANEOUS  Responses to queries 74-77

Demographics, Background Information of Patient, Safety of OJW, Effectiveness and Benefits Problems, Conclusions /MISCELLANEOUS/
 

74. As I said at the start “This is an ambitious survey.” Thank you for taking the time and thought needed to complete it.
Cordially, /Ted Rothstein, DDS, PhD/

Results presented at: http://www.drted.com/OJW Questionnaire survey and results.htm

In the text box below you are invited to add any other possibly helpful comments, suggestions or criticisms.
 

75. Regarding the $35 gift, I am delighted to have take this Questionnaire survey to help Dr. Ted evaluate the safety and effectiveness of Orthodontic Jaw Wiring.

I prefer that you:
 

76. I am delighted to help you in your quest to evaluate the benefits and problems of OJW to help compulsive overeaters regain a modicum of control over their problem.

Send me the honorarium of $35 for completing the survey and sending it back to you.

In the text box below, I have added my Name, Address, City, State and Zip.
 

77.
June 1, 2008
Ted Rothstein, DDS, PhD
Honorary member of the American Association of Orthodontists
Specialist in Cosmetic Orthodontics
Specialist in OJW
35 Remsen St.
Brooklyn, NY 11201
(718) 852-1551
www.drted.com
drted35@aol.com

YOU MAY CONTINUE TO ENTER ANY COMMENTS YOU HAVE IN THIS BOX.
 

Ground Zero: Why do we eat when we are not hungry?...Answer