title: Hip and knee replacement patients prefer pen-and-paper questionnaires: Implications for future patient-reported outcome measure studies.
abstract: OBJECTIVE
  Electronic forms of data collection have gained interest in recent years. In orthopaedics, little is known about patient preference regarding pen-and-paper or electronic questionnaires. We aimed to determine whether patients undergoing total hip (THR) or total knee replacement (TKR) prefer pen-and-paper or electronic questionnaires and to identify variables that predict preference for electronic questionnaires.
  
  
  METHODS
  We asked patients who participated in a multi-centre cohort study investigating improvement in health-related quality of life (HRQoL) after THR and TKR using pen-and-paper questionnaires, which mode of questionnaire they preferred. Patient age, gender, highest completed level of schooling, body mass index (BMI), comorbidities, indication for joint replacement and pre-operative HRQoL were compared between the groups preferring different modes of questionnaire. We then performed logistic regression analyses to investigate which variables independently predicted preference of electronic questionnaires.
  
  
  RESULTS
  A total of 565 THR patients and 387 TKR patients completed the preference question. Of the THR patients, 81.8% (95% confidence interval (CI) 78.4 to 84.7) preferred pen-and-paper questionnaires to electronic questionnaires, as did 86.8% (95% CI 83.1 to 89.8) of TKR patients. Younger age, male gender, higher completed level of schooling and higher BMI independently predicted preference of electronic questionnaires in THR patients. Younger age and higher completed level of schooling independently predicted preference of electronic questionnaires in TKR patients.
  
  
  CONCLUSIONS
  The majority of THR and TKR patients prefer pen-and-paper questionnaires. Patients who preferred electronic questionnaires differed from patients who preferred pen-and-paper questionnaires. Restricting the mode of patient-reported outcome measures to electronic questionnaires might introduce selection bias. Cite this article: Bone Joint Res 2013;2:238-44.
authors.affiliation: Leiden University Medical Center, Departmentof Orthopaedic Surgery, Albinusdreef 2, PO Box9600, Postzone J-11-S, 2300RC Leiden, the Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Keurentjes
authors.forename: M
authors.initials: M
authors.lastname: Fiocco
authors.forename: C
authors.initials: C
authors.lastname: So-Osman
authors.forename: R
authors.initials: R
authors.lastname: Ostenk
authors.forename: A W M M
authors.initials: AW
authors.lastname: Koopman-Van Gemert
authors.forename: R G
authors.initials: RG
authors.lastname: Pöll
authors.forename: R G H H
authors.initials: RG
authors.lastname: Nelissen
keywords: Health-related quality of life; PROM; Patient-reported outcome measure; Questionnaire mode; Total hip replacement; Total knee replacement