FICS Research TWG22 Participant Consent
PURPOSE: International Federation of Sports Chiropractic (FICS) provides a delegation of chiropractors at The World Games (TWG2017) event. Any accredited individual is welcome to receive chiropractic care at no charge. The goal of this study is three-fold.
- To calculate the utilization rate of persons seeking voluntary chiropractic care at this event
- To calculate the injury incidence per activity at the chiropractic care center at this event
- To determine the injury rate of anatomical region of treatment at the chiropractic care center at this event
PROCEDURE: Participants voluntarily seeking chiropractic care at the treatment center will be greeting by the primary investigator, provided information on consent to being part of the study, assigned a random identification number and logged into the data base on a numerical basis. We will collect some personal information from you. You will then be introduced to one of the FICS delegation and they will conduct a history, physical examination and discuss a treatment plan with you. You will then receive the appropriate treatment for you condition and this will be recorded. This is expected to take approximately 20-30 minutes. The study will take place at TWG2022 event in designated treatment centers.
RISKS/DISCOMFORT: As we are collecting treatment information from you, there is a small risk that this information may be seen by others not involved in this project.
BENEFITS: While there is no benefit to you personally, the information we collect may help lead to better interventions at future World Games events.
CONFIDENTIALITY OF RECORDS: The documentation of your involvement is strictly confidential. You will provide some basic demographic information; however, your records will only show a numerical identifier. Your name will never be available to anyone other than the researcher. Any publication arising from this study will not include information that allows identifying individuals.
VOLUNTARY PARTICIPATION: This is voluntary participation. You may opt out of consent at any time and your information will not be used in the study. You will be provided a copy of this form to keep for your records.
QUESTIONS REGARDING THIS RESEARCH PROJECT: If you have any questions about the study, please contact Brian Nook at +1 408 944 6055 or brian.nook@palmer.edu. If you have questions about your rights as a research study participant, please contact Palmer’s Institutional Review Board through Dr. Ron Firth at +1
Statement of Consent
I, ________________________________________, have read and understand the above information and all of my questions have been addressed. I freely and voluntarily consent to participate in this research study and understand that I may withdraw from the study without penalty at any time.
Signature of Participant: ___________________________________Date: ______________
Name of Witness:_______________________________________________________________
Signature of Witness: ____________________________________Date: _________________