title: The comparison of paper- and web-based questionnaires in patients with hand and upper extremity illness.
abstract: BACKGROUND
  Questionnaires are often used to quantify the subjective aspects of illness such as disability, coping strategies, or symptoms of depression. Most questionnaires were validated in a paper-based format, but direct entry into a computer is becoming commonplace. The aim of this study was to assess differences in outcome of questionnaires pertinent to hand and upper extremity illness when they were administered in a computer or paper format.
  
  
  METHODS
  Ninety-nine patients completed both paper and web versions of the short forms of the Disabilities of Arm, Shoulder, and Hand; the Pain Catastrophizing Scale; the Short Health Anxiety Index (SHAI-6); the Patient Health Questionnaire Depression Scale; and a pain scale and the Pain Self-Efficacy Questionnaire sequentially during a single visit. We alternated starting with the paper or the web version after every five patients.
  
  
  RESULTS
  The cohort consisted of 46 females and 53 males with a mean age of 49 years. There were significant differences in SHAI-6 and the pain scale, but not in the other measures. The intraclass correlation was high.
  
  
  CONCLUSIONS
  The use of these questionnaires in electronic format is valid provided that the small differences we observed are not important to the primary study question. In our opinion, for most studies, the advantages of using an electronic format outweigh the small additional variation that might be introduced in the measures in an electronic format.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Arjan G J
authors.initials: AG
authors.lastname: Bot
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Chaitanya S
authors.initials: CS
authors.lastname: Mudgal
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: David
authors.initials: D
authors.lastname: Ring
keywords: Paper; Questionnaires; Validation; Web