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Simple Measures Optimize Response to Patient-reported Outcomes Questionnaires in Orthopedics

Key findings

  • Researchers at Massachusetts General Hospital pooled data from 12 studies in which patients who had undergone an upper extremity orthopedic procedure were asked to report their outcomes via questionnaire
  • Across all studies, 49% of patients completed the entire questionnaire (content varied between studies)
  • Female gender, telephone contact by a single researcher and shorter interval between orthopedic procedure and follow-up were independently associated with higher response rates
  • Other potential ways to improve response to outcomes research are to keep questionnaire response time under 12 minutes, refrain from calling on Friday or Saturday and allow patients to complete questionnaires by either telephone or email

Long-term follow-up is important for evaluating outcomes after hand and upper extremity surgery. To spare patients from having to travel to the hospital, an increasing number of follow-up studies rely on questionnaires administered online or over the telephone.

Ritsaart F. Westenberg, MD, a PhD candidate, Neal C. Chen, MD, chief of the Hand and Arm Center in the Department of Orthopaedic Surgery at Massachusetts General Hospital, and colleagues pooled data from 12 studies in which patients who underwent a procedure at their clinic completed follow-up questionnaires. In Clinical Orthopaedics and Related Research, they report factors associated with higher and lower response rates and give tips for improving study participation.

Details of the Analysis

All 12 studies had the same design. Eligible patients were identified retrospectively, then contacted by mail and invited to complete a follow-up questionnaire. Patients who did not respond to the letter within two weeks were contacted by telephone, and those willing to participate could complete the questionnaire by phone or email.

The current analysis included 798 English-speaking adults who had an upper extremity condition treated at Mass General or an affiliated hospital between 2002 and 2017. The median duration of follow-up was 6.6 years.

Primary Outcome: Response Rate

The response rate in the analysis was 49%, defined as the percentage of all 798 patients who completed the entire follow-up questionnaire. (Questionnaire content varied between studies.)

Female gender was independently associated with higher response rates. Longer time from surgery and telephone contacts from multiple researchers were associated with lower response rates.

Secondary Outcomes

The contact rate (percentage of eligible patients reached by mail, telephone or email) was 68%. Higher-income and female gender were associated with higher contact rates, and longer time from surgery was associated with lower contact rates.

The initial participation rate (percentage of patients who were reached and completed at least one component of the questionnaire) was 73%. Telephone contacts from multiple researchers and races other than white, Asian, Black or Latinx were associated with lower participation rates. The latter finding is probably spurious as only four patients reported "other" race.

The completion rate (percentage of participating patients who completed the entire questionnaire) was 98%. Questionnaires with fewer questions (median 36) were more frequently completed than those with higher numbers of questions (median 51).

Other Tips for Outcomes Research

Patients were called by researchers on all days of the week, and over most days there was a relatively even distribution of responses. The exception was that no patient completed a questionnaire by telephone or email on a Friday or Saturday.

59% were completed by telephone and 41% by email. Offering both modalities gives patients the freedom to participate at their convenience and use their preferred method.

The number of questions ranged from 15 to 71, but all questionnaires were designed to require less than 12 minutes to complete. That presumably helps explain the high completion rate.

Learn more about the Hand & Arm Center at Mass General

Refer a patient to the Department of Orthopaedic Surgery at Mass General

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