Enclosing a pen reduced time to response to questionnaire mailings.

OBJECTIVES: To assess the effectiveness of including a pen in postal questionnaires on response rate, necessity of reminders, time to response, and completeness of response to the primary outcome question (POQ). STUDY DESIGN AND SETTING: A two-arm randomized controlled trial (RCT) embedded within the screening of older women for prevention of fracture trial (SCOOP). Women, aged 70-75 years, were randomized to receive a pen with their questionnaire (n = 3,826) or to receive the questionnaire alone (n = 3,829). The results were combined with another embedded RCT in a meta-analysis. RESULTS: A response rate of 92.4% was observed in the pen group compared with 91.3% in the control group (odds ratio [OR] = 1.16; 95% confidence interval [CI]: 0.98, 1.37; P = 0.08). There was a difference in reminders required (OR = 0.88; 95% CI: 0.79, 0.98; P = 0.02), time to response (hazard ratio = 1.06; 95% CI: 1.01, 1.11; P = 0.01) and some difference in the completeness of response to the POQ (OR = 1.18; 95% CI: 1.00, 1.39; P = 0.05). The pooled OR from the meta-analysis for response rate was 1.21 (95% CI: 1.05, 1.39; P = 0.01). CONCLUSION: Inclusion of a pen with postal questionnaires potentially has a positive impact on response rates and the number of reminders required. There may be some reduction in time to response. Studies of different participant groups are needed to test the effectiveness over more diverse populations.

Clinical tool to identify patients who are most likely to achieve long-term improvement in physical function after total hip arthroplasty.

OBJECTIVE: To develop a clinical risk prediction tool to identify patients most likely to experience long-term clinically meaningful functional improvement following total hip arthroplasty (THA). METHODS: We studied 282 patients from 2 health districts in England (Portsmouth and North Staffordshire) who were ≥45 years of age and undergoing THA for primary osteoarthritis. Baseline data on age, sex, comorbidity, body mass index (BMI), functional status (Short Form 36 [SF-36]), and preoperative radiographic severity were collected by interview and examination. The outcome was a clinically significant (30-point) improvement in SF-36 physical function score assessed ~8 years after THA. Logistic regression modeling was used to identify predictors of functional improvement. RESULTS: Improvement in physical function was less likely in patients with better preoperative functioning (odds ratio [OR] 0.73 [95% confidence interval (95% CI) 0.60, 0.89]), older people (OR 0.94 [95% CI 0.90, 0.98]), women (OR 0.37 [95% CI 0.19, 0.72]), those with a previous hip injury (OR 0.14 [95% CI 0.03, 0.74]), and those with a greater number of painful joint sites (OR 0.61 [95% CI 0.46, 0.80]). Patients with worse radiographic grades were most likely to improve (OR 2.15 [95% CI 1.17, 3.93]). We found no influence of BMI or patient comorbidity on functional outcome. Predictors of good outcomes were the same as those of bad outcomes, acting in the opposite direction. A clinical risk prediction tool was developed to identify patients who are most likely to receive functional improvement following THA. CONCLUSION: This prediction tool has the potential to inform health care professionals and patients about functional improvement following THA (as distinct from driving rationing or commissioning decisions regarding who should have surgery); it requires introduction into clinical practice under research conditions to investigate its impact on decisions made by patients and clinicians.

Long-term outcome following total hip arthroplasty: a controlled longitudinal study.

OBJECTIVE: To assess long-term outcome and predictors of prognosis following total hip arthroplasty (THA) for osteoarthritis (OA). METHODS: We studied 282 patients from 2 English health districts approximately 8 years after THA, along with 295 controls selected from the general population. Baseline data were collected by interview and examination, on sex, age, comorbidity, body mass index (BMI), and Short Form 36 (SF-36) functional status, and preoperative radiographic severity of OA was graded. Functional status was reassessed at followup by postal questionnaire. Predictors of change in physical functioning were analyzed by linear regression. RESULTS: Over followup, cases who had THA reported a median improvement of 10 points in SF-36 score for physical functioning, whereas in controls there was a median deterioration of 10 points (P < 0.0001). Mental health improved by a median of 12 points in both cases and controls. Change in physical functioning was significantly worse in women and at older ages among both cases and controls. In cases, Croft grade 5 OA was associated with a physical functioning score improvement 19.4 points (95% confidence interval 7.7, 31.2) greater than the improvement in grades 0-3, but BMI was unrelated to change in physical functioning. CONCLUSION: Improvements in physical functioning following THA for OA are sustained in the long term and are more frequent in patients with more severe radiographic features preoperatively. We found no indication that patients who are overweight benefit less from THA, but further evidence is needed on the prognostic influence of more severe obesity.

Rheumatology telephone helplines: patient and health professionals' requirements.

OBJECTIVES: The aim of this study was to ascertain patients' and health professionals' requirements from a rheumatology helpline and how such a service should be delivered. METHODS: Self-completed questionnaires were administered to both users of rheumatology helplines, patients and health professionals (HPs), and providers of rheumatology services at five UK NHS trusts. Additional data were sought from experts in the field. Information was elicited on access to the service, preferred waiting time for response to a call, acceptability of an answerphone and choice of HP responding. Quantitative data were analysed using percentages and Chi-squared tests. Open questions were analysed as free text responses, and organized into clusters of themes. RESULTS: A total of 607 questionnaires were returned, 523 from users (411 patients, 112 health professionals) and 84 from providers. There were no significant differences across the five Trusts. The top six reasons for patients contacting the helpline were: advice on changes in condition, drug information, understanding symptoms, blood results, information on diagnosis, and appointment queries. All groups recommended a return call on the same day and were happy to leave an answerphone message. HP users requested additional access via e-mail and fax. Rheumatology practitioners were deemed the most appropriate personnel to staff a helpline. CONCLUSIONS: The findings of this study have contributed a valuable insight into the essential components of a rheumatology helpline service from a user and provider perspective. These data will add to existing recommendations for the management of a rheumatology helpline service and ultimately contribute to a proposal for national guidelines.