Summary

PRO’s are only worthwhile if they are fully completed by patients. This prospective cohort investigation demonstrated a low overall completion rate (6% to 25%) of paper-based PRO’s in adults with hip, knee, or shoulder pain presenting to a Sports Medicine Orthopaedic Surgeon. Alternative methods of PRO collection must be sought for greater compliance in the future.

Abstract

Objectives:

To determine patient reported outcome (PRO) score collection compliance in Orthopaedic Surgery Sports Medicine practice.

Methods

Three hundred consecutive subjects in one board-certified, Sports Medicine fellowship-trained Orthopaedic Surgeon’s practice were eligible for and enrolled in this IRB-approved prospective observational cohort investigation. The presenting chief complaint of new patient evaluations determined which one of three possible groups (hip, knee, shoulder) in which the subjects were categorized. Patients with more than one joint complaint, established patients, patients less than 18 years of age, non-English speaking patients, patients unable to read, and patients unwilling to participate were excluded. Patients received paper copies of each questionnaire at their initial visit in the waiting room or examination room. Patients were not coerced or given financial incentive to complete scores. All patients received a Short Form-12 (SF-12) and Tegner activity score. Joint-specific scores were also administered (hip: iHOT-12, Hip Outcome Score, Beighton, Patient Activation Measure [PAM]); (knee: International Knee Documentation Committee [IKDC] subjective, Knee injury and Osteoarthritis Outcome Score [KOOS]); (shoulder: American Shoulder and Elbow Surgeons [ASES], and Western Ontario Rotator Cuff [WORC] index [>40 years of age] or Western Ontario Shoulder Instability [WOSI] index [<40 years of age]. The number of completed questions and questionnaires was measured. The percentage of available questions and questionnaires answered was calculated. Correlation analysis (Pearson, Spearman) determined the correlation of the number of questions and questionnaires answered with age. Chi-squared was used to determine the significance of the number of questions and questionnaires answered and gender.

Results

300 subjects enrolled (161 females; 139 males). Subject age was 39.8 +/- 16.3 years. In patients with a chief complaint of hip pain, six individuals (6%) fully completed all 6 questionnaires. In patients with a chief complaint of knee pain, 25 individuals (25%) fully completed all 4 questionnaires. In patients less than and greater than 40 years of age with a chief complaint of shoulder pain, eight (20%) and five (8.5%) individuals fully completed all 4 questionnaires. There was a slight correlation (r= -0.137; p=0.02) with questionnaire completion rate and age (greater age associated with lower questionnaire completion rate). Females completed a significantly greater number (p=0.001) of questions than males (74.6% vs 72.6%).

Conclusions

PRO’s are only worthwhile if they are fully completed by patients. This prospective cohort investigation demonstrated a low overall completion rate (6% to 25%) of paper-based PRO’s in adults with hip, knee, or shoulder pain presenting to a Sports Medicine Orthopaedic Surgeon. Alternative methods of PRO collection (automated, electronic, research assistant administered) must be sought for greater compliance in the future.