Improving the response rate of patient-reported outcome measures in an Australian tertiary metropolitan hospital

Figures & data

Table 1 Condition-specific PROMs for common operations

PROM	Operation
Disability of the Arm Shoulder and Hand (DASH)^Citation29	All shoulder operations
Oxford Knee Score (OKS)^Citation5	Total knee replacement
	Knee arthroscopy
Oxford Hip Score (OHS)^Citation5	Total hip replacement
Oxford Shoulder Score (OSS)^Citation30	Total shoulder replacement
International Hip Outcome Tool (IHOT)^Citation31	Hip arthroscopy
Western Ontario Rotator Cuff (WORC)^Citation32	Acromioplasty
	Rotator cuff repair
Western Ontario Shoulder Instability Index (WOSI)^Citation33	Labral repair and stabilization Latarjet procedure
Manchester-Oxford Foot Questionnaire (MOXFQ)^Citation34	Forefoot, midfoot and hindfoot procedures
Visual Analog Scale (VAS)^Citation35	Generic wellbeing PROM
EuroQol five dimensions (EQ5D)^Citation36	Generic wellbeing PROM

Table 2 The eight different interventions trialed throughout the study period

	Consult timing	Approached	Instruction sheet	Routine care	Opt in/Opt out	Surgeon assessment	Research desk	Directed to desk
Cohort A	Before	No	No	No	Opt in	No	No	No
Cohort B	After	No	No	No	Opt in	No	No	No
Cohort C	After	Yes	No	No	Opt in	No	No	No
Cohort D	After	Yes	Yes	No	Opt in	No	No	No
Cohort E	After	Yes	Yes	Yes	Opt out	No	No	No
Cohort F	After	Yes	Yes	Yes	Opt out	Yes	No	No
Cohort G	After	Yes	Yes	Yes	Opt out	No	Yes	No
Cohort H	After	Yes	Yes	Yes	Opt out	No	Yes	Yes
Summary
Cohort A	Verbally invited to complete a PROM after seeing their surgeon.
Cohort B	Verbally invited to complete a PROM prior to seeing their surgeon in the waiting room.
Cohort C	Approached and verbally invited to complete a PROM prior to seeing their surgeon.
Cohort D	Approached, given an instruction sheet that explained the research and verbally invited to complete a PROM prior to seeing their surgeon.
Cohort E	Received an instruction sheet, asking to complete a PROM as part of routine care prior to seeing their surgeon
Cohort F	Received an instruction sheet, asking to complete a PROM as part of routine care prior to seeing their surgeon and instructed that the consulting surgeon would be assessing the form.
Cohort G	A registration desk was set up where patients were given an instruction sheet, asked to complete the PROM as part of routine care and return afterwards.
Cohort H	Instructed to line up at the registration desk where they were given an instruction sheet, asked to complete the PROM as part of routine care and return afterwards.

Table 3 Bivariate analysis

Characteristic	N	Mean	SD	P-value
Age				0.002
Not respond	741	56.5	18.11
Respond	1,171	53.81	18.42
Wait time				0.012
Not respond	688	147.63	95.05
Respond	1,144	159.61	100.85

Table 4 Multivariate analysis

Characteristics	Naive logistic regression model				Mixed effect logistic regression model
	OR	Standard error	P-value	95% CI	OR	Standard error	P-value	95% CI
Age	0.99	0.00324	0.002	0.984 - 0.996	0.99	0.00324	0.002	0.984 - 0.996
Sex
Male
Female	1.063	0.1252	0.602	0.844 - 1.339	1.063	0.1252	0.602	0.844 - 1.339
Wait time	1.001	0.0006	0.042	1 - 1.002	1.001	0.0006	0.042	1 - 1.002
Language
Non-English
English	3.839	0.5419	<0.001	2.911 - 5.063	3.839	0.5419	<0.001	2.911 - 5.063
Outcome
Non-op
Pre-op	1.964	0.30,342	<0.001	1.451 - 2.658	1.964	0.30,342	<0.001	1.451 - 2.658
Post-op	1.927	0.29,429	<0.001	1.429 - 2.6	1.927	0.29,429	<0.001	1.429 - 2.6
Pathology
Upper limb
Lower limb	1.198	0.18,126	0.232	0.891 - 1.612	1.198	0.18,126	0.232	0.891 - 1.612
PROM type
Likert scale
Visual Analog scale	1.224	0.21,947	0.261	0.861 - 1.739	1.224	0.21,947	0.261	0.861 - 1.739
Visit type
New
Review	0.649	0.09549	0.003	0.486 - 0.866	0.649	0.09549	0.003	0.486 - 0.866
Cohort
H
G	0.662	0.18,093	0.132	0.388 - 1.131	0.662	0.18,093	0.132	0.388 - 1.131
F	0.241	0.0446	<0.001	0.168 - 0.347	0.241	0.0446	<0.001	0.168 - 0.347
E	0.403	0.09157	<0.001	0.258 - 0.629	0.403	0.09157	<0.001	0.258 - 0.629
D	0.317	0.05405	<0.001	0.227 - 0.442	0.317	0.05405	<0.001	0.227 - 0.442
C	0.115	0.02343	<0.001	0.077 - 0.172	0.115	0.02343	<0.001	0.077 - 0.172
B	0.058	0.01719	<0.001	0.032 - 0.103	0.058	0.01719	<0.001	0.032 - 0.103
A	0.03	0.00806	<0.001	0.018 - 0.051	0.03	0.00806	<0.001	0.018 - 0.051

Notes: Cohort A: verbally invited to complete a PROM after seeing their surgeon. Cohort B: verbally invited to complete a PROM prior to seeing their surgeon in the waiting room. Cohort C: approached and verbally invited to complete a PROM prior to seeing their surgeon. Cohort D: approached, given an instruction sheet that explained the research and verbally invited to complete a PROM prior to seeing their surgeon. Cohort E: received an instruction sheet, asking to complete a PROM as part of routine care prior to seeing their surgeon. Cohort F: received an instruction sheet, asking to complete a PROM as part of routine care prior to seeing their surgeon and instructed that the consulting surgeon would be assessing the form. Cohort G: a registration desk was set up where patients were given an instruction sheet, asked to complete the PROM as part of routine care and return afterwards. Cohort H: instructed to line up at the registration desk where they were given an instruction sheet, asked to complete the PROM as part of routine care and return afterwards.

Abbreviation: op, operation.

Table

Characteristic	N	%	95% CI	P-value
Sex				0.866
Male	900	47.07	44.84 - 49.31
Female	1,012	52.93	50.69 - 55.16
Language				<0.001
Non-English	387	20.45	18.7 - 22.33
English	1,505	79.55	77.67 - 81.3
Outcome				<0.001
Non-op	461	44.9	40.41 - 49.48
Pre-op	689	68.8	65.23 - 72.15
Post-op	774	64.21	60.76 - 67.52
Pathology				0.93
Upper limb	609	61.08	57.14 - 64.88
Lower limb	1,315	61.29	58.63 - 63.89
PROM measurement				0.506
Likert scale	1,551	60.86	58.41 - 63.27
Visual Analog Scale	373	62.73	57.7 - 67.51
Visit type				<0.001
New	629	67.57	63.8 - 71.11
Review	1,258	58.35	55.6 - 61.05
PROM filled				0.122
DASH	231	58.44	52.07 - 64.81
IHOT	55	67.27	54.75 - 79.8
MOXFQ	337	64.39	59.27 - 69.51
OHS	279	60.57	54.83 - 66.32
OKS	644	59.47	55.67 - 63.27
OSS	60	66.67	54.63 - 78.7
WORC	246	58.13	51.95 - 64.31
WOSI	72	75	64.92 - 85.08
Cohort				<0.001
A	150	13.33	8.75 - 19.79
B	90	21.11	13.85 - 30.81
C	57	36.94	29.73 - 44.79
D	272	56.25	50.28 - 62.05
E	129	62.79	54.11 - 70.72
F	184	54.89	47.63 - 61.95
G	110	65.45	56.07 - 73.77
H	832	81.01	78.2 - 83.54

Notes: Cohort A: verbally invited to complete a PROM after seeing their surgeon. Cohort B: verbally invited to complete a PROM prior to seeing their surgeon in the waiting room. Cohort C: approached and verbally invited to complete a PROM prior to seeing their surgeon. Cohort D: approached, given an instruction sheet that explained the research and verbally invited to complete a PROM prior to seeing their surgeon. Cohort E: received an instruction sheet, asking to complete a PROM as part of routine care prior to seeing their surgeon. Cohort F: received an instruction sheet, asking to complete a PROM as part of routine care prior to seeing their surgeon and instructed that the consulting surgeon would be assessing the form. Cohort G: a registration desk was set up where patients were given an instruction sheet, asked to complete the PROM as part of routine care and return afterwards. Cohort H: instructed to line up at the registration desk where they were given an instruction sheet, asked to complete the PROM as part of routine care and return afterwards.

Abbreviations: op, operation; Disability of the Arm Shoulder and Hand (DASH); Oxford Knee Score (OKS); Oxford Hip Score (OHS); Oxford Hip Score (OHS); Oxford Shoulder Score (OSS); International Hip Outcome Tool (IHOT); Western Ontario Rotator Cuff (WORC); Western Ontario Shoulder Instability Index (WOSI); Manchester-Oxford Foot Questionnaire (MOXFQ); Visual Analog Scale (VAS); EuroQol five dimensions (EQ5D).

Table 5 List of languages spoken by patients

List of languages	Number
English	2,180
Vietnamese	80
Macedonian	45
Greek	40
Italian	27
Arabic (including Lebanese)	25
Spanish	23
Croatian	21
Persian (excluding Dari)	18
Cantonese	17
Mandarin	13
Tamil	11
Dinka	10
Serbian	7
Serbo-Croatian/Yugoslavian	7
Turkish	7
Burmese	6
Dari	6
Bosnian	5
French	5
Maltese	5
Polish	5
Punjabi	4
Karen	3
Portuguese	3
Albanian	2
Hakka	2
Hindi	2
Pashto	2
Samoan	2
Slovene	2
Somali	2
Tigrinya	2
Urdu	2
African Languages	1
Assyrian Neo-Aramaic	1
Auslan	1
Azeri	1
Chaldean Neo-Aramaic	1
Eastern Anmatyerr	1
Hazaraghi	1
Hungarian	1
Lao	1
Nepali	1
Oromo	1
Romanian	1
Sinhalese	1
Slovak	1
Swahili	1
Telugu	1
Thai	1
Tibetan	1
Tigre	1

Figure 1 Response rates for all eight cohorts.Notes: Cohort A: verbally invited to complete a PROM after seeing their surgeon. Cohort B: verbally invited to complete a PROM prior to seeing their surgeon in the waiting room. Cohort C: approached and verbally invited to complete a PROM prior to seeing their surgeon. Cohort D: approached, given an instruction sheet that explained the research and verbally invited to complete a PROM prior to seeing their surgeon. Cohort E: received an instruction sheet, asking to complete a PROM as part of routine care prior to seeing their surgeon. Cohort F: received an instruction sheet, asking to complete a PROM as part of routine care prior to seeing their surgeon and instructed that the consulting surgeon would be assessing the form. Cohort G: a registration desk was set up where patients were given an instruction sheet, asked to complete the PROM as part of routine care and return afterwards. Cohort H: instructed to line up at the registration desk where they were given an instruction sheet, asked to complete the PROM as part of routine care and return afterwards.

Figure 2 Gender age distribution.

Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602–608. doi:10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L8773720

 PubMed Web of Science ®Google Scholar

Murray DW, Fitzpatrick R, Rogers K, et al. The use of the Oxford hip and knee scores. J Bone Jt Surg. 2007;89(8):1010–1014. doi:10.1302/0301-620X.89B8.19424

 Web of Science ®Google Scholar

Dawson J, Rogers K, Fitzpatrick R, Carr A. The Oxford shoulder score revisited. Arch Orthop Trauma Surg. 2009;129(1):119–123. doi:10.1007/s00402-007-0549-718183410

 PubMed Web of Science ®Google Scholar

Mohtadi NGH, Griffin DR, Pedersen ME, et al. The Development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the international Hip Outcome Tool (iHOT-33). Arthroscopy. 2012;28(5):595–605. quiz 606-10.e1. doi:10.1016/j.arthro.2012.03.01322542433

 PubMed Web of Science ®Google Scholar

Wessel RN, Lim TE, Van Mameren H, De Bie RA. Validation of the western ontario rotator cuff index in patients with arthroscopic rotator cuff repair : A study protocol. BMC Musculoskelet Disord. 2011;12(1):64. doi:10.1186/1471-2474-12-6421453470

 PubMed Web of Science ®Google Scholar

Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med. 1998;26(6):764–772. doi:10.1177/036354659802600605019850776

 PubMed Web of Science ®Google Scholar

Morley D, Jenkinson C, Doll H, et al. The Manchester – Oxford Foot Questionnaire (MOXFQ) development and validation of a summary index score. Bone Joint Res. 2013;2(4):66–69. doi:10.1302/2046-3758.24.200014723673374

 PubMed Web of Science ®Google Scholar

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF). Arthritis Care Res. 2011;63(Suppl.11):240–252. doi:10.1002/acr.20543

 PubMed Web of Science ®Google Scholar

Devlin N, Shah K, Feng Y. Valuing health-related quality of life : an EQ-5D-5L value set for England. Health Econ 2018;27(1):7-22. doi:10.1002/hec.3564.

 Google Scholar