Screening Questions for Counterspiral Program
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Consent
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Personal Information
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General Questions
Screening Questions for Counterspiral Trial
This is a research-eligibility screening. Completing it is voluntary and does not automatically enroll you in the study. Personal information you provide is handled under the Counterspiral Privacy Policy. If eligible and you enroll, the more specific commitments in the Informed Consent and Participant Agreements Packet - which you will be asked to read and sign - will apply. Screening data of applicants who do not enroll is destroyed or de-identified within twelve (12) months unless you opt in to be contacted about future studies
I understand and consent to the screening.
Opt-in to be contacted for future studies.
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Personal information:
Name
Date Of Birth
Gender
Male
Female
Others
Are you currently pregnant?
Yes
No
Race/Ethnicity
Height/Weight
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General Questions
Q.1 Our exercises are designed to retrain deep muscular and skeletal systems, not just stretch or strengthen them superficially. This requires consistency and awareness over time. On a scale of 1–5, how motivated are you to improve your posture, flexibility, and body mechanics through regular, virtually guided training sessions?
Not committed
Slightly committed
Moderately committed
Committed
Fully committed
Q.2 The Counterspiral system follows a progressive, year-long structure, where each stage builds on precise movement foundations. How committed are you to following a structured, progressive program that requires consistency over a year?
Not committed
Slightly committed
Moderately committed
Committed
Fully committed
Q.3 Many individuals experience chronic stiffness, back pain, or limited mobility that affects their daily lives. This program aims to address these challenges through gradual, precise movements. Real improvement will require patience, focus, and consistency over time. How important is it for you to reduce pain and improve your long-term physical well-being at this stage?
Not important
Slightly important
Moderately important
Important
Very Important
Q.4 Participation in the trial requires one hour-long video session as well as at least 6 20-minute sessions of self-guided training per week, which can typically be completed in short sessions and combined with other activities. How likely are you to meet these requirements?
Not likely
Slightly likely
Moderately likely
Likely
Very likely
Q.5 The program focuses on gradual improvement and long-term functional change, rather than short-term results. Progress is achieved through consistency, body awareness, and active engagement with each online session. The program is delivered online through secure platforms for non-local participants, while the local cohort attends in person. Would you be comfortable with this format?
Yes
No
Q.6 How confident and comfortable are you with using a virtual video platform to attend scheduled sessions consistently and follow the exercises on your own?
Not at all
Slightly
Moderately
Quite a lot
Very much
Q.7 Our movement methodology requires a controlled environment to ensure accuracy and safety. Ideally, you will need a clear wall (1.5–2 meters) and at least 3 meters of open space in front of it to move freely. This space allows you to move freely and position your phone or camera at an appropriate distance for proper viewing and recording. Do you have access to a suitable location?
Yes
No
Q.8 The Counterspiral system demands steady progress, even when life gets busy. Maintaining consistency is essential for visible, long-term change, as the program builds on each stage of training to gradually retrain movement and balance. How disciplined are you in following health or exercise routines that require weekly or daily commitment despite personal or work obligations?
Not disciplined
Slightly disciplined
Moderately disciplined
Disciplined
Very disciplined
Q.9 Participation in the trial entails training your feet with new movements that may take time to learn. Changes may take several months or more to appear. How likely are you to complete the full year-long program from start to finish, even if you don’t see immediate results?
Not likely
Slightly likely
Moderately likely
Likely
Very likely
Q.10 Many of our exercises involve unfamiliar and precise movement sequences, which may initially challenge conventional ideas of balance and coordination. How open are you to learning unconventional, specialised exercises that may feel unusual at first but are designed to improve long-term strength, mobility, and balance?
Not open
Slightly open
Moderately open
Open
Very open
Q.11 Understanding your current activity level helps us tailor our guidance and set appropriate expectations. The Counterspiral system is suitable for all experience levels but differs from typical fitness programs, focusing on precision, control, and long-term alignment rather than speed or endurance. Do you currently attend a gym, fitness class, or follow any regular movement or exercise routine?
Yes
No
Q.12 How consistently do you currently engage in this activity or movement routine?
Never
Rarely
Sometimes
Consistently
Very consistently
Q.13 Participation in the trial may result in sore feet and muscles; cracked, chipped, or discoloured toenails; calluses, blisters, or cracked skin; etc. How likely are you to complete the full program despite such minor or temporary physical inconveniences?
Not likely
Slightly likely
Moderately likely
Likely
Very likely
Q.14 Participation in the extended program entails not merely stretching muscles and learning specific movements (as in many other programs), but rather the physical realignment of bones to enable new movements. How likely are you to participate in the trial given these long-term goals?
Not likely
Slightly likely
Moderately likely
Likely
Very likely
Q.15 Longer-term participation in the extended program may result in permanent changes to the appearance of your feet and to the appearance of your walk. How likely are you to participate in the trial given these possible consequences?
Not likely
Slightly likely
Moderately likely
Likely
Very likely
Q.16 This program is designed for individuals seeking meaningful change through sustained effort, not quick fixes. Progress may feel subtle before it becomes visible. How confident are you in your ability to stay engaged through all stages of the program, even when progress is slow or physically demanding?
Not committed
Somewhat uncommitted
Neutral
Committed
Fully committed
Please answer Yes or No to each item
A. Has a doctor ever told you that you have a heart condition, or that you should only do physical activity recommended by a doctor?
Yes
No
B. Do you ever experience dizziness or loss of balance, or have you ever lost consciousness?
Yes
No
C. Have you fallen in the past 12 months, or do you have a condition (including significant vision impairment, vestibular disorder, or BPPV) that makes you afraid of falling?
Yes
No
D. Are you currently taking medication for blood pressure, a heart condition, blood thinners (anticoagulants), or sedatives?
Yes
No
E. Have you had surgery, a fracture, or a significant injury to your lower body in the past 6 months?
Yes
No
F. Has a doctor ever told you not to exercise, or to do only certain kinds of exercise?
Yes
No
G. Is there any other physical, medical, or other reason why you should not participate in regular exercise without medical clearance?
Yes
No
What is your primary goal?
Rehab/Injury recovery/Pain relief
Athletic Performance/Movement
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