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

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.
 

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

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

 
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


 
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.