Male Sex, Decreased Activity Level, and Higher BMI Associated With Lower Completion of Patient-Reported Outcome Measures Following ACL Reconstruction

Abstract

Background:Patient-reported outcome (PRO) surveys have become increasingly important in both improving patient care and assessing outcomes.Purpose/Hypothesis:The purpose of this study was to evaluate which variables are associated with compliance with completing PRO surveys in patients who have undergone anterior cruciate ligament reconstruction (ACLR). The authors hypothesized that older patient age and longer time since ACLR would be associated with lower completion rates of PRO surveys preoperatively and at postoperative time points.Study Design:Case series; Level of evidence, 4.Methods:All patients who underwent ACLR by a sports medicine fellowship–trained orthopaedic surgeon at a single institution and were electronically assigned PRO surveys through a data collection system preoperatively between December 2013 and March 2015 were included. Postoperatively, PRO surveys were sent to patients’ email addresses at 6, 12, and 24 months. Demographics, history, and operative and postoperative information were evaluated for an association with survey completion rates.Results:A total of 256 patients met the inclusion criteria. There were 140 (54.7%) male and 116 (45.3%) female patients, with an overall mean age of 28.6 ± 11.9 years. Only 19 (7.4%) patients completed all preoperative and postoperative surveys at all time points. Less than half of the patients (n = 104; 40.6%) completed both the preoperative survey and at least 1 postoperative survey. There was a steady decrease in the completion rate of PRO surveys postoperatively over time (Pearson r = –0.995, P = .005). Male patients had significantly worse compliance with completing PRO surveys preoperatively and at a minimum of 1 time point postoperatively (P = .044). Patients who did not identify as athletes or report frequent exercise (≥3 times/wk) had significantly worse compliance with completing any PRO surveys (P = .046). Lower body mass index was associated with greater odds of compliance with completing the preoperative survey and 24-month postoperative survey (odds ratio, 0.902; P = .029).Conclusion:An inverse relationship was found between the surgery-to-survey period and percentage of those completing PRO surveys, with poor overall compliance. Male sex and not self-identifying as an athlete or performing frequent physical exercise were associated with lower completion rates of PRO surveys, while lower body mass index was associated with a greater rate of completion.

Preoperative Factors Associated with 2-Year Postoperative Survey Completion in Knee Surgery Patients

“…Cotter et al reported similar findings of lower survey completion among patients with lower activity levels after anterior cruciate ligament reconstruction. 19 The reasons for this association are unknown, but it seems probable that more active patients have higher energy levels.…”

Compliance with Electronic Patient Reported Outcome Measure System Data Collection Is 51% Two-years After Shoulder Arthroscopy

“…One study of anterior cruciate ligament reconstruction included 313 patients, while another in shoulder arthroscopy included 143 patients. 14 , 15 The current study included 225 patients, and we must consider the possibility of type II error due to the study being underpowered.…”

“…The most cited demographics for PROM noncompletion following elective orthopaedic procedures are male sex, younger age, and non-White race. 5 , 14 , 16 , 17 , 18 , 19 Although these are commonly cited, a recent study analyzing 9 factors concluded no single patient characteristic can accurately predict loss to follow-up. 20 This study failed to replicate the results of previous orthopaedic studies; however, one publication specific to shoulder arthroscopy did not find differences in PROM compliance, according to patient age or gender.…”

Patient-reported outcome measures can advance population health, but is access to instruments and use equitable?

“…Social determinants ranging from the structure and systems level (e.g., federal or state regulations), community level (e.g., policies or built environment), institutional level (e.g., schools or healthcare administration), interpersonal level (e.g., support systems), to the individual level (e.g., health behaviors or beliefs) are interconnected and impact the health achievement of individuals ( 9 ). Although individual characteristics such as sex, BMI, or age are associated with PROM completion ( 10 , 11 ), no study has simultaneously evaluated upstream system-level factors and individual-factors associated with PROM completion. In this paper, we performed an observational study with a retrospective chart review to examine individual (parent/child), and clinic factors associated with parental completion of a locally developed PROM, the Early Healthy Lifestyles (EHL) questionnaire, at Geisinger pediatric care clinics between 2016 and 2020.…”