Westenberg Ritsaart F, Nierich Juliette, Lans Jonathan, Garg Rohit, Eberlin Kyle R, Chen Neal C
R. F. Westenberg, J. Nierich, J. Lans, R. Garg, N. C. Chen, Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts, General Hospital, Harvard Medical School, Boston, USA.
K. R. Eberlin, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical, School, Boston, USA.
Clin Orthop Relat Res. 2020 Dec;478(12):2889-2898. doi: 10.1097/CORR.0000000000001319.
Long-term follow-up studies are an important tool in the evaluation of orthopaedic illness and its treatment options. However, a patient's participation in a follow-up study may be affected by several factors, leading to variability in response rates and the risk of selection bias.
QUESTIONS/PURPOSES: (1) What is the average response rate in hand surgery questionnaire studies? (2) What factors are associated with higher and lower response rates to research questionnaires? (3) What factors are associated with higher and lower contact, initial participation, and completion rates?
We included 798 adult patients who were enrolled in one of 12 questionnaire follow-up studies in the hand and upper extremity service of our institution. All included studies evaluated patient-reported outcomes for the surgical treatment of upper extremity conditions using questionnaires and all used the same enrollment design. Patients were invited by letter to ask if they would be willing to participate, and we informed them that they would be contacted by telephone at least three times if they did not respond to the letter. Patients were contacted at a median of 6.6 years (interquartile range [IQR] 3.7 to 11) after surgery. The successful response rate was 49% (390 of 798 patients). We manually reviewed records to collect data on patient characteristics, and we performed bivariate analysis and multivariable logistic regression analysis to identify factors associated with the contact rate (percentage of patients reached by either mail, phone, or email), initial response rate (percentage of reached patients who initiated participation), completion rate (percentage of patients who initiated participation and completed the entire follow-up questionnaire), and our primary outcome successful response rate (percentage of patients who were contacted and who completed the entire questionnaire).
The average response rate in hand surgery questionnaire studies was 49% (390 of 798 patients). In the multivariable analysis, enrollment of women (odds ratio 1.43 [95% confidence interval 1.03 to 1.97]; p = 0.031) was independently associated with higher response rates. On the contrary, a longer follow-up time from surgery (OR 0.95; 95% CI 0.92 to 0.99]; p = 0.015) and multiple researchers contacting patients (OR 0.51 [95% CI 0.37 to 0.71]; p < 0.001) were independently associated with lower response rates. The contact rate was higher for women (OR 1.46 [95% CI 1.03 to 2.06]; p = 0.034) and patients with higher income (OR 1.000007 [95% CI 1.000001 to 1.000013]; p = 0.019). The contact rate was lower in patients with a longer follow-up time from surgery (OR 0.93 [95% CI 0.90 to 0.97]; p = 0.001). The initial participation rate was lower when patients were contacted by multiple researchers (OR: 0.34 [95% CI 0.23 to 0.52]; p < 0.001). Studies with a lower number of questions (36; IQR 22 to 46) were completed more frequently than studies with a higher number of questions (51; IQR 39 to 67; p = 0.044).
Studies assessing long-term outcomes that have a large proportion of men and longer follow-up time tend to have lower response rates. When performing a follow-up study, it seems beneficial to have one researcher contact the patients and use a shorter questionnaire. Results of this study can help clarify the response rates in hand surgery follow-up questionnaire studies and help with the planning of future follow-up studies.
Level II, prognostic study.
长期随访研究是评估骨科疾病及其治疗方案的重要工具。然而，患者参与随访研究可能会受到多种因素的影响，从而导致应答率的差异和选择偏倚的风险。
问题/目的：（1）手外科问卷调查研究的平均应答率是多少？（2）与研究问卷较高和较低应答率相关的因素有哪些？（3）与较高和较低的联系率、初始参与率和完成率相关的因素有哪些？
我们纳入了798名成年患者，他们参与了我们机构手和上肢服务部门的12项问卷随访研究中的一项。所有纳入的研究均使用问卷评估上肢疾病手术治疗的患者报告结局，并且都采用相同的入组设计。通过信件邀请患者询问他们是否愿意参与，并且告知他们如果未回复信件，将至少通过电话联系他们三次。患者在术后中位时间6.6年（四分位间距[IQR]3.7至11年）被联系。成功应答率为49%（798名患者中的390名）。我们人工审查记录以收集患者特征数据，并进行双变量分析和多变量逻辑回归分析，以确定与联系率（通过邮件、电话或电子邮件联系到的患者百分比）、初始应答率（开始参与的被联系患者百分比）、完成率（开始参与并完成整个随访问卷的患者百分比）以及我们的主要结局成功应答率（被联系且完成整个问卷的患者百分比）相关的因素。
手外科问卷调查研究的平均应答率为49%（798名患者中的390名）。在多变量分析中，女性入组（比值比1.43[95%置信区间1.03至1.97]；p = 0.031）与较高的应答率独立相关。相反，术后随访时间较长（OR 0.95；95% CI 0.92至0.99]；p = 0.015）和多名研究人员联系患者（OR 0.51[95% CI 0.37至0.71]；p < 0.001）与较低的应答率独立相关。女性（OR 1.46[95% CI 1.03至2.06]；p = 0.034）和收入较高的患者（OR 1.000007[95% CI 1.000001至1.000013]；p = 0.019）的联系率较高。术后随访时间较长的患者联系率较低（OR 0.93[95% CI 0.90至0.97]；p = 0.001）。当由多名研究人员联系患者时，初始参与率较低（OR：0.34[95% CI 0.23至0.52]；p < 0.001）。问题数量较少（36个；IQR 22至46个）的研究比问题数量较多（51个；IQR 39至67个；p = 0.044）的研究完成得更频繁。
评估长期结局且男性比例较大和随访时间较长的研究往往应答率较低。在进行随访研究时，由一名研究人员联系患者并使用较短的问卷似乎是有益的。本研究结果有助于阐明手外科随访问卷调查研究中的应答率，并有助于未来随访研究的规划。
II级，预后研究。
