title: Designing an Internationally Accessible Web-Based Questionnaire to Discover Risk Factors for Amyotrophic Lateral Sclerosis: A Case-Control Study.
abstract: BACKGROUND
  Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a typical survival of three to five years. Epidemiological studies using paper-based questionnaires in individual countries or continents have failed to find widely accepted risk factors for the disease. The advantages of online versus paper-based questionnaires have been extensively reviewed, but few online epidemiological studies into human neurodegenerative diseases have so far been undertaken.
  
  
  OBJECTIVE
  To design a Web-based questionnaire to identify environmental risk factors for ALS and enable international comparisons of these risk factors.
  
  
  METHODS
  A Web-based epidemiological questionnaire for ALS has been developed based on experience gained from administering a previous continent-wide paper-based questionnaire for this disease. New and modified questions have been added from our previous paper-based questionnaire, from literature searches, and from validated ALS questionnaires supplied by other investigators. New criteria to allow the separation of familial and sporadic ALS cases have been included. The questionnaire addresses many risk factors that have already been proposed for ALS, as well as a number that have not yet been rigorously examined. To encourage participation, responses are collected anonymously and no personally identifiable information is requested. The survey is being translated into a number of languages which will allow many people around the world to read and answer it in their own language.
  
  
  RESULTS
  After the questionnaire had been online for 4 months, it had 379 respondents compared to only 46 respondents for the same initial period using a paper-based questionnaire. The average age of the first 379 web questionnaire respondents was 54 years compared to the average age of 60 years for the first 379 paper questionnaire respondents. The questionnaire is soon to be promoted in a number of countries through ALS associations and disease registries.
  
  
  CONCLUSIONS
  Web-based questionnaires are a time- and resource-efficient method for performing large epidemiological studies of neurodegenerative diseases such as ALS. The ability to compare risk factors between different countries using the same analysis tool will be of particular value for finding robust risk factors that underlie ALS.
authors.affiliation: The University of Sydney, Camperdown NSW, Australia.
authors.forename: Jane Alana
authors.identifier: http://orcid.org/0000-0001-5768-1941
authors.initials: JA
authors.lastname: Parkin Kullmann
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0001-7612-9116
authors.initials: S
authors.lastname: Hayes
authors.forename: Min-Xia
authors.identifier: http://orcid.org/0000-0002-3758-1043
authors.initials: MX
authors.lastname: Wang
authors.forename: Roger
authors.identifier: http://orcid.org/0000-0003-3326-7273
authors.initials: R
authors.lastname: Pamphlett
keywords: amyotrophic lateral sclerosis (ALS); case-control study; epidemiology; international; language translation; motor neuron disease (MND); online; questionnaire; risk factor; web-based