Chronic Pain and Physical Activity

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Participant Informed Consent

Project Title: Understanding relationships between chronic non-cancer pain, pain-related psychosocial factors, and exercise participation.
Graduate Student Researcher:Miranda Cary, MSc., PhD Candidate, College of Kinesiology, University of Saskatchewan. Phone: (306)966-1075 Email:
Supervisor:Nancy Gyurcsik, PhD, Professor, College of Kinesiology, University of Saskatchewan. Phone: (306)966-1075 Email:
Additional Researchers:
Danielle Brittain, PhD, Associate Professor, School of Human Sciences, University of Northern Colorado. Phone: (970)351-2859. Email:
Being regularly active is an important part of chronic pain management. This study is designed to understand: (a) factors that are related to exercising for adults with chronic pain, and (b) possible changes to those factors related to chronic pain and exercise participation over the one-month (30 days) study period.
Participation in this survey is voluntary. You can decide not to participate at any time by closing your browser, or choosing not to answer any questions you don’t feel comfortable with.
Procedures: In order to understand the factors related to being active, we invite you to take part in three online surveys (the current survey you are about to begin, a second survey in two weeks, and a third survey two weeks after the second survey). Completion of the first survey should take about 30-45 minutes. The second and third surveys will take about 15-20 minutes each to complete.
We will ask you to provide your email address at the beginning of each survey. We will also use your email address to send you up to 3 reminder emails to complete the second and third surveys, if needed. We will also use your email address to match your surveys over time. Finally, if you want to receive a copy of the study results, we will send an electronic copy by August 1, 2017 to the email address that you provide. You will be asked if you want to get a copy of the results at the end of the first survey.
Once our data collection is done, we will remove your email address from our data set and store it in a separate file. This will make sure that the data you provide will not be associated with your email address. Then, once the results are emailed by August 1, 2017, we will destroy the separate file with your email address.
Please note that if your email address contains your name, you may be identified to the researchers. However, we will never identify you as a study participant.
If, for any reason, you want your data removed from our study, you can contact Miranda Cary, by telephone (306-966-1075) or email ( can do this until we are done collecting data from the third survey. After this time, your email will be stored separately from your data. As a result, we will not be able to match your email to your data, making it impossible to remove your data.
There are no known risks to participating in this study. However, as with any online related activity, the risk of breach of confidentiality is possible. As with any survey research, you may experience negative emotions when you are asked to think about your pain and trying to exercise. If you do feel this way, then remember that you can withdraw from the study without negative consequences. Also, you can consider calling your local health authority/region to ask where you can access psychological counselling services.
This survey is hosted by Fluid Survey. See the following for more information on Fluid Survey Data Privacy in Canada.
This research project has been approved on ethical grounds by the University of Saskatchewan Research Ethics Board (BEH 16-381) on November 7, 2016. Any questions regarding your rights as a participant may be addressed to that committee through the Research Ethics Office (306) 966-2975. Out of town participants may call toll free (888) 966-2975.
The data collected will be used as part of a graduate student’s dissertation research in the College of Kinesiology, University of Saskatchewan.
By completing and submitting this survey, your free and informed consent is implied and indicates that you understand the above conditions of participation in this study.
Please print a copy of this form for your records. 

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Thank you very much for participating!