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PubMed2006

Gluteus tendon rupture is underrecognized by French orthopedic surgeons: results of a mail survey.

OBJECTIVES: To obtain information on the diagnosis and surgical treatment of hip rotator cuff tears by French orthopedic surgeons. METHODS: Survey conducted in 2003 by mailing questionnaires to 459 orthopedic surgeons practicing in France. RESULTS: Of the 84 respondents, 38 (45%) were not aware that tears could occur in the hip rotator cuff and 11 (13%) had never suspected this diagnosis in any of their patients. The 35 (42%) remaining surgeons had experience with at least one case of gluteal tendon repair; among them, 24 (29%) made the diagnosis fortuitously during surgery for another reason (total hip arthroplasty). Only 11 (13%) surgeons had performed surgery to treat gluteal tendon tears that were diagnosed preoperatively (gluteus medius in 20 cases, gluteus maximus in six cases, and gluteus minimus in three cases; total, 29 cases). Of these 29 cases, only 14 were treated by surgical tendon repair (by six [7%] surgeons); the remaining repair procedures were done during total hip arthroplasty. The retrospective data collection procedure and absence of medium-term follow-up data preclude conclusions about the outcomes of surgical treatment. CONCLUSION: Gluteal tendon tears may be underrecognized by orthopedic surgeons in France, who may have limited experience with repairing these lesions. Autopsy and imaging studies have shown gluteal tendon tears in up to 10% of individuals older than 60 years.

Buttocks↗
PubMed2006

Use of tumor necrosis factor inhibitors in rheumatoid arthritis: a national survey of practicing United States rheumatologists.

OBJECTIVES: To determine the prescribing practices, laboratory monitoring protocols, and perceived barriers of United States rheumatologists in prescribing tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA). METHODS: A survey questionnaire was mailed to 1970 rheumatologists who were randomly selected from a national sample of 3008 rheumatologists. A one-page non-response questionnaire was mailed to approximately 200 randomly selected non-responding rheumatologists to assess non-response bias. RESULTS: Two mailings yielded a response rate of 22.3% (428 completed, usable surveys out of 1922 deliverable surveys). Rheumatologists reported using all three agents in patients with moderate RA (82-87%), severe RA (94-96%), and in newly diagnosed and mild RA patients (10-18%). In patients with severe RA who inadequately responded to methotrexate, 91% of rheumatologists reported using a TNF inhibitor with one other disease modifying anti-rheumatic drug. Over 94% of rheumatologists reported switching patients from one TNF inhibitor to a different TNF inhibitor due to inadequate response or side effects. Most rheumatologists (96%) ordered the purified protein derivative test for tuberculosis, with almost 82% conducting this test at baseline. Costs to patients and insurance coverage were perceived as major barriers to prescribing these agents although the perception was slightly lower with infliximab than with adalimumab or etanercept. CONCLUSIONS: The use of TNF inhibitors is not restricted to patients with moderate and severe RA. Rheumatologists are fairly similar in their utilization of the three TNF inhibitors although some variation exists in terms of laboratory practices and perceived barriers regarding the use of these agents.

Adalimumab↗
PubMed2004

Mass mailing and telephone contact were effective in recruiting veterans into an antibiotic treatment randomized clinical trial.

OBJECTIVE: Achieving enrollment goals of randomized clinical trials (RCT) within budgets depends on the timely recruitment of sufficient numbers of participants. We report a comparison of recruitment methods and yields of previously deployed veterans into a large RCT. STUDY DESIGN AND SETTING: A retrospective survey concerning recruitment was administered to staff at 28 sites participating in the VA Cooperative Study #475, "Antibiotic Treatment of Gulf War Veterans' Illnesses" (GWVI). RESULTS: Twenty-one sites reported identifying 31,407 Gulf War Veterans (GWV). Of these, 13.7% were successfully contacted, 3.5% were enrolled, and 1.2% were randomized. Mass mailings and direct telephone calls to GWV identified from a GWV database accounted for 78% of the GWV contacted. The other 22% were contacted by using referrals from medical staff, veterans' groups, media advertisements, and other methods. Data collected prospectively at the Albany Stratton VAMC were similar to data collected retrospectively from other sites. CONCLUSION: These findings demonstrate that in previously deployed GWV with GWVI, 1.2% could be randomized. Although the use of all recruitment methods combined achieved the study recruitment goal, these data demonstrate that mass mailing and direct telephone contacts were effective recruitment methods.

Anti-Bacterial Agents↗
PubMed2004

Mode of delivery, but not questionnaire length, affected response in an epidemiological study of eating-disordered behavior.

BACKGROUND AND OBJECTIVES: The effects of questionnaire length and mode of delivery on response rates were examined in an epidemiological study of eating-disordered behavior. METHODS: Short (8 pages) and long (14 pages) questionnaires were posted or hand-delivered to a community sample of 802 women. Nonrespondents who received the first questionnaire by hand delivery received a reminder letter and replacement questionnaire by post; those who received the initial questionnaire by post were further randomized to receive the first reminder by hand delivery or by post, in short or long form. A second reminder letter and questionnaire (in short or long form) were posted to all remaining nonrespondents. RESULTS: The overall response rate was 52.9%. This is a conservative estimate of true response, because in a substantial proportion of cases (12.2%) individuals were no longer resident at the listed address. There was a significant effect of mode of delivery on response, favoring hand delivery, at both the initial mailout and first reminder. There was no effect of questionnaire length on response to the initial mailout, although overall response was significantly higher for the longer form. It was estimated that an overall response of 58.0% would have been achieved had first reminders been hand-delivered to all nonrespondents who received the initial mailout by post. CONCLUSIONS: Delivery of questionnaires by hand may be an effective way to increase response rates in epidemiological research, but little is to be gained by reducing questionnaire length.

Adult↗
PubMed2005

In a mailed physician survey, questionnaire length had a threshold effect on response rate.

OBJECTIVE: To examine the association between questionnaire length and response rate in a mailed survey of generalist physicians randomly selected from the American Medical Association master file. STUDY DESIGN AND SETTING: In a pilot study, otherwise similar questionnaires of 30 different lengths (849 to 1,867 words) were mailed to 192 physicians in April 1999. In the main study, questionnaires of 16 different lengths (564 to 988 words) were mailed to 1,700 physicians between June 1999 and January 2000. RESULTS: In the pilot study, response rate decreased from 60% for questionnaires 849 words in length to 16.7% for questionnaires over 1,800 words in length. Logistic regression revealed an odds ratio of 0.887 (95%CI 0.813, 0.968; p=0.006) for word count, expressed in units of 100 words. In the main study, response rate varied between 51.5% and 71.4%. Logistic regression showed no association between response and word count (OR 0.988; 95%CI 0.896, 1.090; p=0.81). CONCLUSION: There appears to have been a threshold in these studies of approximately 1,000 words. Questionnaires above the threshold had lower response rates than those below it (38.0% vs. 59.4%).

Health Care Surveys↗
PubMed2005

Electronic mail was not better than postal mail for surveying residents and faculty.

OBJECTIVE: To compare response rate, time to response, and data quality of electronic and postal surveys in the setting of postgraduate medical education. STUDY DESIGN AND SETTING: A randomized controlled trial in a university-based internal medicine residency program. We randomized 119 residents and 83 faculty to an electronic versus a postal survey with up to two reminders and measured response rate, time to response, and data quality. RESULTS: For residents, the e-survey resulted in a lower response rate than the postal survey (63.3% versus 79.7%; difference -16.3%, 95% confidence interval (95% CI) -32.3% to -0.4%%; P=.049), but a shorter mean response time, by 3.8 days (95% CI 0.2-7.4; P=.042). For faculty, the e-survey did not result in a significantly lower response rate than the postal survey (85.4% vs. 81.0%; difference 4.4%, 95% CI -11.7 to 20.5%; P=.591), but resulted in a shorter average response time, by 8.4 days (95% CI 4.4 to 12.4; P < 0.001). There were no differences in the quality of data or responses to the survey between the two methods. CONCLUSION: E-surveys were not superior to postal surveys in terms of response rate, but resulted in shorter time to response and equivalent data quality.

Adult↗
PubMed2005

Mail surveys resulted in more reports of substance use than telephone surveys.

OBJECTIVE: To determine to what extent the substance-use information obtained in surveys is affected by method of data collection. STUDY DESIGN AND SETTING: Questions on the use of alcohol and drugs were administered to samples of Minnesota adults assigned to one of two conditions to test the effect of mode of administration (mail and telephone); 816 persons completed the survey, roughly one half by mail and one half by telephone. RESULTS: Those interviewed by telephone revealed more heavy use of alcohol, but the mail sample includes disproportionate numbers of respondents from demographic groups that exhibit less use. Controlling for these differences across modes, as well as the differential use of listed telephone numbers and addresses, reduces the effect of mode on one measure of heavy alcohol use to nonsignificance but yields significant effects of mode on others. Specifically, those in the mail condition reported higher levels of illicit drug use in the last year, alcohol use in the last month, and heavy alcohol use in the last 2 weeks. CONCLUSIONS: The greater, and arguably more accurate, reporting of substance use, coupled with potential cost savings, suggests that researchers should consider using mail surveys for investigating substance use.

Alcohol-Related Disorders↗
PubMed2005

From a postal questionnaire of older men, healthy lifestyle factors reduced the onset of and may have increased recovery from mobility limitation.

BACKGROUND AND OBJECTIVE: We have examined predictors of the onset of and recovery from mobility limitation and the association between lifestyle changes in later life and mobility status. STUDY DESIGN AND SETTING: From a cohort of 7,735 men recruited at ages 40-59 years (1978-1980), 5,075 men completed follow-up postal questionnaires in 1992 (Q92), then aged 52-73 years, and again in 1996 (Q96). Mobility limitation was defined as reported difficulty in any one or more of the following: getting outdoors, walking 400 yards, or climbing stairs. RESULTS: Lifestyle factors (smoking, obesity, physical inactivity, and heavy drinking) and manual worker social class were significantly and independently associated with onset of mobility limitation and with the exception of physical activity remained significant after further adjustment for chronic diseases. Smoking cessation and taking up physical activity in later life are associated with reduced onset of mobility limitation. Among men with mobility limitation at Q92 (n=645), light or moderate levels of physical activity were associated with significantly increased odds of recovery at Q96 (light activity, OR=2.43, 95% CI 1.48, 4.00; moderate activity, OR=2.57, 95% CI 1.31, 5.02). CONCLUSION: Maintaining and adopting a healthy lifestyle in later life reduces the onset of mobility limitation in old age. Maintaining physical activity may improve recovery.

Adult↗
PubMed2005

Concordance between supervised and postal administration of the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) was very high.

BACKGROUND AND OBJECTIVE: There is increasing international interest in using patient-based outcome measures to evaluate interventions. We compared responses to postal administration of Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) with the gold standard of supervised self-completion. STUDY DESIGN AND SETTING: Validation study involving 96 adults, recruited from U.K. general practice, sent the postal questionnaires with an instruction sheet 1 week before supervised self-completion. Responses for those whose quality of life (n=56) or asthma control (n=61) had 'not changed' between postal and supervised completions were compared using paired-sample t-tests, Pearson's correlation coefficient (r), and intraclass correlation coefficient (ICC). RESULTS: For the MiniAQLQ, overall mean scores were similar in both groups: Postal=5.14 (SD=1.42) vs. Supervised=5.17 (SD=1.39), with mean difference of -0.03 (95% CI=-0.14, 0.08; P=.59), with a high degree of correlation (r=.96, P<.001) and concordance (ICC=0.96; 95% CI=0.93, 0.98; P<.001). For the ACQ, overall mean scores (with SD) were also similar in both groups: Postal=1.24 (SD=1.09) vs. Supervised=1.26 (SD=1.10), with mean difference of -0.02 (95% CI=-0.12, 0.08; P=.74), with good correlation (r=.94, P<.01) and concordance (ICC=0.94; 95% CI=0.90, 0.96; P<.01). CONCLUSIONS: Correlation and concordance between supervised and postal administration of the MiniAQLQ and ACQ are very high. Users may confidently choose the mode of administration most appropriate to their needs.

Adult↗
PubMed2005

Initial nonresponders had an increased response rate after repeated questionnaire mailings.

BACKGROUND AND OBJECTIVE: There is a growing evidence base on methods to improve response rates in surveys among patients. This study aimed to determine the additional effect of two intensive follow-up procedures compared to a simple follow-up procedure. METHODS: Randomized controlled trial that compared repeated mailing of the questionnaire and a request to explain nonparticipation with a simple reminder card. The study population comprised 955 elderly adults registered with 26 general practitioners in The Netherlands. RESULTS: A total of 530 adults (56%) returned the questionnaire within 3 weeks and a total of 640 (67%) after follow-up. Repeated mailing of the questionnaire had additional effect compared to the simple reminder card in the group of initial nonresponders (relative risk=1.60, 95% confidence interval: 1.11-2.31), but not regarding the overall response rate. A request to explain nonparticipation did not have additional effect. CONCLUSION: Repeated mailing of the questionnaire increased the effectiveness of follow-up among initial nonresponders.

Aged↗
PubMed2006

Postal surveys of physicians gave superior response rates over telephone interviews in a randomized trial.

BACKGROUND AND OBJECTIVES: To compare general practitioner (GP) response to a telephone interview with response to a postal survey with three reminders in a randomized controlled trial. METHODS: GPs were randomly assigned to either a telephone interview or a postal survey. GPs in the telephone group were mailed a letter of invitation and asked to undertake a telephone interview. GPs in the postal group were mailed a letter of invitation and questionnaire. Non-responders were sent up to three reminders, the final by registered post. Response rates were calculated for each group. RESULTS: 416 GPs were randomized to the telephone interview and 451 to the postal survey. Eighty-six in the telephone group and 30 in the postal were ineligible. One hundred thirty-four GPs completed the telephone interview with a response rate of 40.6% (95% confidence interval [CI]: 35.3%, 46.1%). Two hundred fifty-two GPs completed the postal survey with a response rate of 59.9% (95%CI: 55.0%, 64.6%). The difference in response was 19.3% (95%CI: 12.2%, 26.3%). CONCLUSIONS: These results show that postal surveys with three reminders can have superior response rates compared with a telephone interview.

Attitude of Health Personnel↗
PubMed2006

Enclosing a pen with a postal questionnaire can significantly increase the response rate.

BACKGROUND AND OBJECTIVES: It is important to maximize response rates to postal questionnaires. We compared the impact of three low-cost interventions on response rates. METHODS: A 2 x 2 x 2 factorial trial was conducted, nested within TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears). Three interventions were evaluated: (1) enclosing a TOMBOLA-branded pen with the questionnaire (as opposed to no pen); (2) sending the questionnaires by first class post (as opposed to second class); and (3) enclosing a preaddressed return envelope on which there was a second class postage stamp (rather than a freepost business-reply envelope). Nine hundred thirty women, aged 20-59 years, due to receive a TOMBOLA psychosocial questionnaire by post during June-August 2003 were randomized. RESULTS: Enclosing a pen resulted in a statistically significant 7.0% increase in the cumulative proportion of questionnaires returned (from 61.5 to 68.5%; P = .002). The adjusted odds of response was significantly raised (odds ratio [OR] = 1.38, 95% confidence interval [CI] 1.04-1.82). Neither first class post nor providing a stamped envelope had a significant impact on response. There were no interactions between the interventions. CONCLUSIONS: Enclosing a pen with a questionnaire can significantly increase response. This low-cost strategy was effective against a background of "good practice" with regard to the administration of postal questionnaires.

Adult↗
PubMed2004

Recruitment and accrual of women in a placebo-controlled clinical pilot study on manual therapy.

OBJECTIVE: To investigate the accrual rates and recruitment processes among 3 Midwestern sites during a pilot study on manual therapy for chronic pelvic pain. DESIGN: Multisite pilot study for a randomized, placebo-controlled clinical trial. SETTING: Three chiropractic institutions in or near major metropolitan cities in the Midwestern United States. SUBJECTS: Thirty-nine women aged 18 to 45 with chronic pelvic pain of at least 6 months duration, diagnosed by a board certified gynecologist. MAIN OUTCOME MEASURES: The method of recruitment was collected for each individual who responded to an advertisement and completed an interviewer-administered telephone screen. Participants who were willing and eligible after 3 baseline visits were entered into a randomized clinical trial. The number of responses and accrual rates were determined for the overall study, each of the 3 treatment sites, and each of the 5 recruitment efforts. RESULTS: In this study, 355 women were screened over the telephone and 39 were randomized, making the rate of randomization approximately 10%. The most effective recruitment methods leading to randomization were direct mail (38%) and radio advertisements (34%). However, success of the recruitment process differed by site. CONCLUSIONS: Based on the accrual of this multisite pilot study, a full-scale trial would not be feasible using this study's parameters. However, useful information was gained on recruitment effectiveness, eligibility criteria, and screening protocols among the 3 metropolitan sites.

Adolescent↗
PubMed2006

A randomized trial to assess the impact of direct reporting of DXA scan results to patients on quality of osteoporosis care.

Consecutive patients identified as having osteoporosis on screening dual-energy X-ray absorptiometry (DXA) scans were randomized to: (1) a patient activation intervention consisting of mailing patients their DXA scan results supplemented by a call from a nurse educator or (2) usual care. Three months after the DXA scan, patients were contacted to assess: (1) use of antiresorptive therapy, (2) osteoporosis specific knowledge, and (3) satisfaction with their osteoporosis-related care. A total of 1,035 consecutive patients were screened to identify 422 eligible patients. Of these, 56 patients met inclusion criteria and were subsequently randomized. At follow-up, use of antiresorptive agents was numerically more common in the intervention arm (62%) than the control arm (54%), but this difference was not statistically significant (p=0.58). Patients in the intervention group were more likely to report being notified of their DXA results in a timely fashion (p=0.03), but osteoporosis-specific knowledge was similar.

Absorptiometry, Photon↗
PubMed2005

The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research.

This article describes the development and validation of the S-LANSS score, a self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. The S-LANSS aims to identify pain of predominantly neuropathic origin, as distinct from nociceptive pain, without the need for clinical examination. Two hundred patients with chronic pain were asked to complete the S-LANSS unaided. A researcher then administered the S-LANSS scale and the Neuropathic Pain Scale (NPS) in interview format. An independent clinician determined the pain type (neuropathic versus nociceptive) and rated his or her certainty about diagnosis. The S-LANSS scale was also incorporated into a chronic pain questionnaire that was sent to 160 community patients and 150 newly referred patients waiting for pain clinic assessment. The S-LANSS scale correctly identified 75% of pain types when self-completed and 80% when used in interview format. Sensitivity for self-completed S-LANSS scores ranged from 74% to 78%, depending on the cutoff score. There were significant associations between NPS items and total score with S-LANSS score. In the postal survey, completed questionnaires were returned by 57% of patients (n = 174). Internal consistency and convergent validity of the survey S-LANSS scores were confirmed. The findings support the S-LANSS scale as a valid and reliable self-report instrument for identifying neuropathic pain and it is also acceptable for use in postal survey research. Establishing valid measures of symptoms and signs in neuropathic pain will allow standardized comparisons with other investigational measures. This might lead to new insights into the relationship between pathophysiologic mechanisms and clinical manifestations of pain.

Chronic Disease↗
PubMed2005

Antibiotic prescribing for upper respiratory tract infection: the importance of diagnostic uncertainty.

OBJECTIVES: Antibiotic misuse for viral upper respiratory tract infections (URI) in children is a significant problem. We determined the influence on antibiotic prescribing of clinical features that may increase concern about possible bacterial infection (age, appearance, fever) in children with URI. STUDY DESIGN: We created 16 scenarios of children with URI and distributed them by mail survey to 540 pediatricians and family practitioners in Ontario, Canada. The association of patient clinical features, parental pressure, and physician characteristics with antibiotic prescribing was determined through the use of logistic regression analysis. RESULTS: A total of 257 physicians responded (48%). Poor appearance (OR, 6.50; 95% CI, 5.06 to 3.84), fever above 38.5 degrees C (OR, 1.48; 95% CI, 1.21 to 1.82), and age older than 2 years (OR, 2.27; 95% CI, 1.85 to 2.78) were associated with prescribing, whereas parental pressure was not. Physician characteristics associated with antibiotic use were family practitioner (OR, 1.54; 95% CI, 1.22 to 1.96), increasing number of patients seen per week (OR, 1.05; 95% CI, 1.01 to 1.08 for every 20-patient increase), and increasing physician age (OR, 1.17; 95% CI, 1.11 to 1.24, 5-year increments). CONCLUSIONS: Clinical factors, which may lead physicians to be concerned about possible bacterial infection in children, are associated with antibiotic use for pediatric URI.

Anti-Bacterial Agents↗
PubMed2004

Urinary 1-hydroxypyrene and mutagenicity in bus drivers and mail carriers exposed to urban air pollution in Denmark.

BACKGROUND: Previous studies in Denmark have shown that bus drivers and tramway employees were at an increased risk for developing several types of cancer and that bus drives from central Copenhagen have high levels of biomarkers of DNA damage. AIMS: The present study evaluates 1-hydroxypyrene concentrations and mutagenic activity in urine as biomarkers of exposure in non-smoking bus drivers in city and rural areas on a work day and a day off and in non-smoking mail carriers working outdoors (in the streets) and indoors (in the office). METHODS: Twenty-four hour urine samples were collected on a working day and a day off from 60 non-smoking bus drivers in city and rural areas and from 88 non-smoking mail carriers working outdoors (in the streets) and indoors (in the office). The concentration of 1-hydroxypyrene was measured by means of HPLC and the mutagenic activity was assessed by the Ames assay with Salmonella tester strain YG1021 and S9 mix. The N-acetyltransferase (NAT2) phenotype was used as a biomarker for susceptibility to mutagenic/carcinogenic compounds. RESULTS: Bus drivers excreted more 1-hydroxypyrene in urine than did mail carriers. The differences were slightly smaller when NAT2 phenotype, cooking at home, exposure to vehicle exhaust, and performing physical exercise after work were included. The NAT2 slow acetylators had 29% (1.29 [CI: 1.15-1.98]) higher 1-hydroxypyrene concentrations in urine than the fast acetylators. Male bus drivers had 0.92 revertants/mol creatinine [CI: 0.37-1.47] and female bus drivers 1.90 revertants/mol creatinine [CI: 1.01-2.79] higher mutagenic activity in urine than mail carriers. CONCLUSION: The present study indicates that bus drivers are more exposed to polycyclic aromatic hydrocarbons (PAH) and mutagens than mail carriers. Mail carriers who worked outdoors had higher urinary concentration of 1-hydroxypyrene, a marker of exposure to PAH, than those working indoors. The individual levels of urinary mutagenic activity were not correlated to excretion of 1-hydroxypyrene. This might be due to the fact that the most potent mutagenic compounds in diesel exhaust are not PAH but dinitro-pyrenes. Among bus drivers, fast NAT2 acetylators had higher mutagenic activity in urine than slow NAT2 acetylators and female bus drivers had higher mutagenic activity than male bus drivers.

Adult↗
PubMed2004

Response patterns to a postal survey using a cervical screening register as the sampling frame.

This study compared different types of respondent to a postal survey. A random sample of women aged 20-64 years (n = 4057) was selected from a population-based cervical screening register to examine their information experience during the screening programme. The initial response rate was 57%, and this increased to 81% after one reminder. Respondents were older (P < 0.0001) than non-respondents, but both groups were comparable with regard to attendance history for cervical screening (respondents 89.3%; non-respondents 89.1%) and normal smear test results (respondents 84.0%; non-respondents 81.4%). Early and late respondents were similar in age. Compared with late respondents, early respondents were more likely to live in highly affluent (P < 0.0001) and rural areas (P = 0.026). They were also more likely to be non-attenders (P < 0.0001), but they were less likely to have had inadequate smear results (P = 0.030) than late respondents. These results suggest that consideration should be given to factors other than sociodemographic differences when examining response patterns to postal surveys.

Adult↗