Advertisement

Late response to patient-reported outcome questionnaires after surgery was associated with worse outcome

Published:November 30, 2012DOI:https://doi.org/10.1016/j.jclinepi.2012.09.001

      Abstract

      Objectives

      Nonresponse to patient-reported outcome (PRO) questionnaires after surgery might bias the results. Our aim was to gauge the potential impact of nonresponse bias by comparing the outcomes of early and late responders.

      Study Design and Setting

      This study compares 59,565 early and 20,735 late responders who underwent a hip or knee replacement, hernia repair, or varicose vein (VV) surgery. The association between timeliness of response and three outcomes (the mean postoperative disease-specific PRO and generic PRO scores and the proportion reporting a fair or poor result) was examined by regression analysis.

      Results

      Late responders were slightly more likely to be young, nonwhite, deprived, and have a more severe preoperative condition with poorer quality of life. Late response was associated with a slightly poorer outcome in all four procedures although not statistically significant (P < 0.05) for VV surgery. Adjusting for preoperative characteristics reduced the strength of the associations, but they remained statistically significant.

      Conclusion

      As nonresponse to PRO questionnaires introduces slight bias, differences in response rates between hospitals should be taken into account when making comparisons so as to avoid overestimating the performance of those with lower response rates and failing to detect poor performing hospitals.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Epidemiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Little R.J.A.
        Modelling the drop-out mechanism in repeated-measures studies.
        J Am Stat Assoc. 1995; 90: 1112-1121
        • Kristman V.
        • Manno M.
        • Cote P.
        Loss to follow-up in cohort studies: how much is too much?.
        Eur J Epidemiol. 2004; 19: 751-760
        • Armstrong B.K.
        • White E.
        • Saracci R.
        Principles of exposure measurement in epidemiology.
        Oxford University Press, Oxford, UK1992
        • Wood A.M.
        • White I.R.
        • Hotopf M.
        Using number of failed contact attempts to adjust for non-ignorable non-response.
        J R Stat Soc A. 2006; 169: 525-542
        • Sheikh K.
        • Mattingly S.
        Investigating non-response bias in mail surveys.
        J Epidemiol Community Health. 1981; 35: 293-296
        • Emberton M.
        • Black N.
        Impact of non-response and of late-response by patients in a multi-centre surgical outcome audit.
        Int J Qual Health Care. 1995; 7: 47-55
        • Gasquet I.
        • Falissard B.
        • Ravaud P.
        Impact of reminders and method of questionnaire distribution on patient response to mail-back satisfaction survey.
        J Clin Epidemiol. 2001; 54: 1174-1180
        • Perneger T.V.
        • Chamot E.
        • Bovier P.A.
        Nonresponse bias in a survey of patient perceptions of hospital care.
        Med Care. 2005; 43: 374-380
        • Kim J.
        • Lonner J.H.
        • Nelson C.L.
        • Lotke P.A.
        Response bias: effect on outcomes evaluation by mail surveys after total knee arthroplasty.
        J Bone Joint Surg Am. 2004; 86A: 15-21
      1. NHS Information Centre for Health & Social Care. Patient reported outcome measures. Available at http://www.ic.nhs.uk/services/patient-reported-outcomes-measures-proms. (accessed October 4, 2012).

        • Hutchings A.
        • Neuburger J.
        • Grosse Frie K.
        • Black N.
        • van der Meulen J.
        Factors associated with non-response in routine use of patient reported outcome measures after elective surgery in England.
        Health Qual Life Outcomes. 2012; 10: 34
        • Department of Communities and Local Government
        The English Indices of Deprivation.
        Communities and Local Government Publications, London, UK2007
        • Chard J.
        • Kuczawski M.
        • Black N.
        • van der Meulen J.
        Outcomes of elective surgery undertaken in independent sector treatment centres and NHS providers in England: the patient outcomes in surgery audit.
        BMJ. 2011; 343: d6404
        10.1136/bmj.d6404
        • Dawson J.
        • Fitzpatrick R.
        • Carr A.
        • Murray D.
        Questionnaire on the perceptions of patients about total hip replacement.
        J Bone Joint Surg Br. 1996; 78: 185-190
        • Dawson J.
        • Fitzpatrick R.
        • Murray D.
        • Carr A.
        Questionnaire on the perceptions of patients about total knee replacement.
        J Bone Joint Surg Br. 1998; 80: 63-69
        • Garratt A.M.
        • MacDonald L.M.
        • Ruta D.A.
        • Russell I.T.
        • Buckingham J.K.
        • Krukowski Z.H.
        Towards measurement of outcome for patients with varicose veins.
        Qual Health Care. 1993; 2: 5-10
        • EuroQol Group
        EuroQol—a new facility for the measurement of health-related quality of life.
        Health Policy. 1990; 16: 199-208
        • Dolan P.
        Modelling valuations for EuroQol health states.
        Med Care. 1997; 35: 1095-1108
        • Royston P.
        Multiple imputation of missing values: update.
        Stat J. 2005; 5: 1-14
        • Sterne J.A.C.
        • White I.R.
        • Carlin J.B.
        • Spratt M.
        • Royston P.
        • Kenward M.G.
        • et al.
        Multiple imputation for missing data in epidemiological and clinical research; potentials and pitfalls.
        BMJ. 2009; 338: b2393
        • StataCorp
        Stata statistical software: release 11.
        StataCorp LP, College Station, TX2009
        • Rolfson O.
        • Kärrholm J.
        • Dahlberg L.E.
        • Garellick G.
        Patient-reported outcomes in the Swedish Hip Arthroplasty Register: results of a nationwide prospective observational study.
        J Bone Joint Surg Br. 2011; 93: 867-875
        • Browne J.P.
        • van der Meulen J.H.
        • Lewsey J.D.
        • Lamping D.L.
        • Black N.
        Mathematical coupling may account for the association between baseline severity and minimally important difference value.
        J Clin Epidemiol. 2010; 63: 865-874