Comparison of Paper and Computer-Based Questionnaire Modes for Measuring Health Outcomes in Patients Undergoing Total Hip Arthroplasty

Shervin, Nina; Dorrwachter, Janet; Bragdon, Charles R.; Shervin, David; Zurakowski, David; Malchau, Henrik
February 2011
Journal of Bone & Joint Surgery, American Volume;2/2/2011, Vol. 93-A Issue 3, p285
Academic Journal
Background: Health status questionnaires are important, especially with the growing interest in outcome studies. However, these questionnaires continue to be administered in their original paper format. We hypothesized that total hip arthroplasty outcome data derived with computer-based questionnaires do not differ significantly from those derived with established paper-based formats. Methods: From January 2006 to January 2007, the clinic schedules of four attending arthroplasty surgeons were screened weekly to identify patients who could potentially be included in the study. Charts were reviewed for subjects who were scheduled for or had received primary total hip arthroplasty. Patients were recruited during their office visit or when they attended a preoperative educational class, and five health status questionnaires (the Harris hip score, WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index], SF-36 [Short Form-36], EQ-5D [EuroQol-5D], and UCLA [University of California at Los Angeles] activity score) were administered in three formats: paper, touch screen, and web-based. Repeated-measures analysis of variance and Pearson correlations were used to compare the questionnaire modes for the Harris hip score (normally distributed data), and the Friedman test and Spearman correlations were used to compare the modes for the other health status scores (non-normally distributed data). The study was designed with 90% power for detecting 10% differences between modes in the entire series of sixty-one patients and with 82% and 87% power in preoperative and postoperative subgroups, respectively. Results: The mean age was sixty-three years, with thirty-seven male and twenty-four female patients in the study. Forty- seven hips (77%) had osteoarthritis as the primary diagnosis. No significant differences were detected, for any of the five health outcome systems, among the paper, touch screen, and web-based modes, and there were highly significant correlations among all questionnaire modes in the entire series of patients and in the preoperative and postoperative subgroups (p < 0.001). Conclusions: The scores obtained with the paper, touch screen, and web-based modes of the five questionnaires demonstrated excellent agreement. Thus, touch screen and web-based formats can be used to collect and track patient outcome data. Use of electronic formats of these questionnaires will facilitate a more efficient and reliable data collection process.


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