Saturday, March 16, 2013

Patient reported outcomes - how reliable?

Reliability of patient-reported functional outcome in a joint replacement registry

We have long been advocates of patient self-assessment in documenting the comfort and function of shoulders before and after treatment. Our favored instrument is the Simple Shoulder Test because it is short, friendly and has been used extensively in many parts of the word.

These authors used the Western Ontario Osteoarthritis of the Shoulder (WOOS) index, another example of a patient reported outcome measure. 
Their aim was to identify a potential bias in the outcome scores of subgroups in a cohort of patients from the Danish Shoulder Arthroplasty Registry (DSR) and to characterize non-responders.

Their cohort was 787 patients operated in 2008 who were assessed 12 months postoperatively. Non-responders and incomplete responders were sent a reminder by mail. Non-responders to the mail reminder were contacted by telephone. Total WOOS score and WOOS subscales were compared for initial responders (n = 509), responders to the mail reminder (n = 156), and responders after telephone contact (n = 27). 

A mail reminder increased the response rate from 65% (6% incomplete) to 80% (3% incomplete) and telephone contact resulted in a further increase to 82% (2% incomplete). 

They did not find any statistically significant differences in total WOOS score or in any of the WOOS subscales between responders to the original questionnaire, responders to the postal reminder, and responders after telephone contact. However, they did find a trend of worse outcome for non-responders. The response rate was lower in younger patients. 

On this basis the authors recommend the use of reminders in arthroplasty registries using PROMs.

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