Web-based versus Paper Administration of Common Ophthalmic Questionnaires

Evaluation of the test-retest and inter-mode comparability of the Impact of Vision Impairment questionnaire in people with chronic eye diseases

PURPOSE

The main objective of this study is to assess the test-retest and inter-administration mode reliability of the Impact of Vision Impairment profile (IVI), a common patient-reported outcome measure (PROM) for people with chronic eye diseases.

METHODS

The IVI was administered to adult patients with stable, chronic eye diseases two to four times per participant (average intervals between administrations 12 to 20 days; maximum two phone interviews, paper administration, electronic administration) by two trained interviewers. Rasch models were fit to the data. Intra-class correlation coefficients (ICCs), mean differences and Cronbach's alpha between test-retest administrations (two phone interviews) and inter-mode comparisons were calculated.

RESULTS

Two hundred-sixteen patients (mean age 67 ± 12 years, 40% male) were included in the study. The IVI met all psychometric requirements of the Rasch model, and the division into the domains of functional items (IVI_F) and emotional items (IVI_E) corresponded to the German validation study. ICCs (all for IVI_F and IVI_E, respectively) for the retest administrations were 0.938 and 0.912, and 0.853 and 0.893 for inter-mode comparisons phone/paper, 0.939 and 0.930 for phone/electronic, and 0.937 and 0.920 for paper/electronic (all p < 0.01). Mean differences (all for IVI_F and IVI_E, respectively) for the retest administrations were 2.8% and 0.7% and ranged from 2.0% to 6.2% and from 0.4 % to 4.9% between administration modes. Cronbach's alpha ranged from 0.886 to 0.944 for retest and inter-mode comparisons.

CONCLUSION

Due to the high test-retest reliability and the almost equally high comparability of different modes of administration of the IVI, the study endorses its use as a robust PROM to capture vision-related quality of life. Our results further support the use of the IVI as an endpoint in clinical trials and may simplify implementing it in both clinical trials or real-world evidence generation by offering multiple administration modes with high reliability.

Interviewer Administration Corresponds to Self-Administration of the Vision Impairment in Low Luminance (VILL) Questionnaire

Purpose

To quantify the impact of the mode of administration (MOA) on scores of the Vision Impairment in Low Luminance (VILL) questionnaire.

Methods

The VILL questionnaire was implemented using different MOAs (paper, interview, electronic), in addition to a demographical survey of adult participants recruited at an outpatient eye clinic, with the initial MOA being either paper or interview. Polytomous Rasch models were used to generate person measure scores for the three subscales of the VILL questionnaire (reading, VILL_R; mobility, VILL_M; and emotional, VILL_E). Measures of agreement among the different MOAs were calculated (self-administered paper/interview, self-administered paper/self-administered electronic, and interview/self-administered electronic). An age-matched analysis was performed to control for the impact of the initial MOA, administration interval, visual acuity, and self-reported hearing difficulties.

Results

We included 309 participants (mean age, 63 ± 14 years; 61% female). Intra-class correlation coefficients were 0.930, 0.919, and 0.799 for paper versus interview assessment; 0.951, 0.959, and 0.916 for paper versus electronic; and 0.967, 0.955, and 0.907 for interview versus electronic assessment (VILL_R, VILL_M, and VILL_E, respectively). Mean differences were 0.35, 0.41, and 1.74 logits; 0.32, 0.18, and 0.68 logits; and 0.08, 0.22, and 0.63 logits, respectively. None of the mentioned factors significantly affected the results (corrected P ≥ 0.11).

Conclusions

Paper, interview, and electronic MOAs of the VILL can be considered equivalent. Reporting across the main MOAs of self-administration (paper) and interviewer-administration was unaffected by better eye visual acuity and self-reported hearing difficulties.

Translational Relevance

The results support use of the VILL questionnaire with flexible modes of administration.

Reliability of Chinese web-based ocular surface disease index questionnaire in dry eye patients: a randomized, crossover study

AIM

To assess the reliability of web-based version of ocular surface disease index in Chinese (C-OSDI) on clinically diagnosed dry eye disease (DE) patients.

METHODS

A total of 254 Chinese participants (51% male, 129/254; mean age: 27.90±9.06y) with DED completed paper- and web-based versions of C-OSDI questionnaires in a randomized crossover design. Ophthalmology examination and DED diagnosis were performed prior to the participants being invited to join the study. Participants were randomly designated to either group A (paper-based first and web-based second) or group B (web-based first and paper-based second). Final data analysis included participants that had successfully completed both versions of the C-OSDI. Demographic characteristics, test-retest reliability, and agreement of individual items, subscales, and total score were evaluated with intraclass correlation coefficients (ICC), Spearman rank correlation, Wilcoxon test and Rasch analysis.

RESULTS

Reliability indexes were adequate, Pearson correlation was greater than 0.8 and ICCs range was 0.827 to 0.982; total C-OSDI score was not statistically different between the two versions. The values of mean-squares fit statistics were very low compared to 1, indicating that the responses to the items by the model had a high degree of predictability. While comparing the favorability 72% (182/254) of the participants preferred web-based assessment.

CONCLUSION

Web-based C-OSDI is reliable in assessing DED and correlation with the paper-based version is significant in all subscales and overall total score. Web-based C-OSDI can be administered to assess individuals with DED as participants predominantly favored online assessment.

The 25th Anniversary of Laser Vision Correction in the United States

Laser Vision Correction (LVC) is an elective, self-pay and safe surgical procedure to correct myopia and hyperopia. Since FDA approval 25 years ago, there have been a progression of technological improvements leading to better outcomes and LVC is now one of the safest surgical procedures. With a potential pool of 50 million patients, 6000 trained ophthalmic surgeons regularly treating in over 1000 centers of which 65% are physician owned. Treatments remain low from an earlier peak of 1.4 million to less than 800,000 over last 10 years. The factors preventing patients undergoing surgery have not changed and include the cost of $2000 ± $1000 per eye and fear of laser surgery on their eyes. The latter is overcome by word of mouth referrals and positive social media messaging. In addition, press misinformation and lack of optometrists participating in co-management have not helped grow LVC procedures despite the positive results of the FDA’s Patient Reported Outcomes with LASIK studies known as PROWL. The surgery is quick, and patients can be “in and out” in less than two hours with a rapid recovery, minimal postoperative restrictions and within 24 hours have 20/20 vision. Volume and price drives center and physician profitability with a scheduling capacity of two to four patients’ treatments per hour. Laser vision correction and especially LASIK, remains the treatment of choice for myopic and hyperopic patients wanting to remove their dependency on glasses and contact lenses.

Keratograph 5M As A Useful And Objective Tool For Evaluating The Ocular Surface In Limbal Stem Cell Deficiency

PURPOSE

In limbal stem cell deficiency, both the Ocular Surface Disease Index (OSDI) questionnaire and tear break-up time (BUT) are comparable between traditional methods and the Keratograph 5M. In this study, we aimed to correlate OSDI with Keratograph 5M interviewed OSDI, as well as slit-lamp tear BUT with Keratograph 5M noninvasive tear break-up time (NIKBUT) in limbal stem cell deficiency.

PATIENTS AND METHODS

Thirty-eight limbal stem cell-deficiency patients (76 eyes) from Virgen Macarena-Rocio Hospital (Seville, Spain) underwent this diagnostic test study. All patients completed the traditional OSDI. We measured the BUT, performed a Keratograph 5M analysis of NIKBUT first (employed for the analysis) followed by the average NIKBUT, the level of dryness, and conducted the OSDI questionnaire through an interview. For each pair of tests, we analyzed the means and applied an intraclass correlation coefficient (r), creating a Bland-Altman plot for data dispersion.

RESULTS

Average values were 47.5 points (±25.8), and 47.3 points (±27.5) for traditional OSDI and Keratograph OSDI, respectively (P =0.87); the r value indicates good agreement (0.72). The Bland-Altman plot followed a linear pattern, and the results were similarly distributed. The NIKBUT mean was shorter than the BUT mean (P = 0.007); the r value indicates moderate agreement (0.574). The Bland-Altman plot formed an almost horizontal line, with almost all values between the mean and two standard deviations.

CONCLUSION

Keratograph 5M is useful for the evaluation of the ocular surface in limbal stem cell deficiency. NIKBUT can substitute BUT based on its advantages of being noninvasive, objective, with intraobserver and interobserver repeatability and reliability. The Keratograph 5M OSDI is comparable to the traditional questionnaire.

Feasibility and acceptability of using Wi-Fi access points to provide smoking cessation help at 17 airports and 38 railway stations across China

Supplemental Digital Content is available in the text

Background

The use of mobile phone significantly improved the outcomes of tobacco cessation. However, its feasibility and acceptability were unclear in the Chinese population. This study was to explore the feasibility of using Wi-Fi access points (APs) as a platform to provide smoking cessation help at 17 airports and 38 railway stations across China.

Methods

This study was divided into two stages: platform development and population survey. In the first stage, a survey platform was developed and incorporated into Wi-Fi service at airports and railway stations, which could provide survey content as a pop-up window when participants tried to access the Wi-Fi service. In the second stage, a population survey was conducted to explore the intention to receive tobacco cessation support.

Results

A total of 20,199 users participated and 13,628 users submitted the survey, with a response rate of 67.47%. The smoking rate was 30.9%. A total of 86.58% of smoking participants and 2.44% of non-smoking participants wished to receive tobacco cessation support, respectively. The multivariate analysis showed intention to receive support did not differ in age, gender, and heaviness of smoking (P > 0.05).

Conclusion

Providing tobacco cessation support via Wi-Fi APs is feasible and efficient, and smokers have high intention to receive tobacco cessation support. It is suggested hospitals, academia, information technology industries, and government agencies must work together to provide tobacco cessation support via mHealth.

Orthokeratology and Contact Lens Quality of Life Questionnaire (OCL-QoL)

OBJECTIVES

To develop a quality of life (QoL) instrument for patients fitted with Orthokeratology (OrthoK) and other modalities of contact lenses.

METHODS

A 45-item pilot questionnaire was developed from an extensive literature review, focus groups, and interviews. Subsequently, 234 participants fitted with contact lenses (OrthoK, soft lenses, and gas permeable lenses) or spectacles completed the pilot questionnaire. Rasch analysis was used to assess the psychometric properties in terms of person separation, item fit statistics, category threshold ordering, differential item functioning (DIF), and targeting. A subset of participants completed the final questionnaire twice (1 week apart) and the repeatability assessed (within-subject standard deviation). The Spearman rank-order correlation coefficient between the questionnaire score and binocular visual acuity was calculated to assess construct validity.

RESULTS

Inspection of category probability curves suggested that one category was underused and the response options were collapsed. Furthermore, Rasch analyses indicated 22 items misfitted the model and were removed. The final questionnaire contained 23 items with a person separation of 2.18, item fit statistics within the range 0.83 to 1.15, targeting 1.05 logits, and no significant DIF (<0.8 logits). The repeatability (Sr) was 4.21 and there was no correlation between questionnaire scores and binocular visual acuity (rs=0.03, P=0.65).

CONCLUSIONS

The Orthokeratology and Contact Lens Quality of Life Questionnaire demonstrated excellent psychometric properties and is capable of measuring vision-related QoL in patients fitted with various forms of contact lenses including OrthoK lenses. The tool is scored on a 0 to 100 interval level scale with higher scores indicating better QoL.

Sending family history questionnaires to patients before a colonoscopy improves genetic counseling for hereditary colorectal cancer

OBJECTIVES

To investigate whether sending a family history questionnaire to patients prior to undergoing colonoscopy results in an increased availability of family history and better genetic counseling.

METHODS

A questionnaire was mailed to patients before they underwent outpatient colonoscopy at a university hospital in 2013. These patients' additional characteristics and referral for genetic evaluation were retrieved from the electronic medical records. Patients undergoing inpatient coloboscopy, with confirmed hereditary colorectal cancer (CRC) or inflammatory bowel disease were excluded. All study patients from 2010 to 2013 were matched with the database of the genetics department to determine who consulted a geneticist.

RESULTS

A total of 6163 patients underwent colonoscopy from 2010 to 2013. Of 1421 who underwent colonoscopy in 2013, 53 (3.7%) consulted a geneticist, while 75 (1.6%) of 4742 patients undergoing colonoscopy between 2010 and 2012 did so (P < 0.01). A total of 974 patients undergoing colonoscopy in 2013 were included to evaluate the completed questionnaire. Of these, 282 (29.0%) completed the questionnaire. Family history was not recorded in the electronic medical records of 393 (40.3%). In 129 (32.8%), family history was obtained from the completed questionnaire. In 2013, 49 (60.5%) out of 81 patients referred for genetic counseling were referred based on their family history. Eight (9.9%) patients were referred based on the completed questionnaire.

CONCLUSION

Screening for hereditary CRC in a population undergoing outpatient colonoscopy with a questionnaire sent by mail resulted in an increased availability of family histories and genetic counseling.

Validation of an online questionnaire for identifying people at risk of familial and hereditary colorectal cancer

We developed and validated an online questionnaire to document familial cancer history, in order to facilitate the detection of persons with a familial or hereditary colorectal cancer (CRC) risk. The development of the self-administered online questionnaire for the assessment of familial and hereditary CRC risk was based on nationwide criteria for referral to genetic specialists due to a Lynch syndrome suspicion, as well as existing criteria for surveillance colonoscopies because of an increased risk of familial CRC. The questionnaire was validated at a private colonoscopy center. Patients scheduled for colonoscopy were enrolled (n = 150). Performance of the questionnaire was assessed by comparing referrals based on questionnaire data against referral decisions based on full pedigree data. In a second validation phase, referrals based on questionnaire data were compared with referrals based on data collected in a telephone interview. We also calculated inter-observer agreement in referral decisions. In the first validation phase, the questionnaire had a sensitivity of 90 % (95 % CI 55–98 %) at a specificity of 98 % (95 % CI 87–100 %) in identifying persons qualifying for referral. In the second validation phase, sensitivity was 100 % (95 % CI 63–100) at a specificity of 97 % (95 % CI 91–99 %). In both validation phases an inter-observer agreement of 100 % in referral decisions was achieved. The online questionnaire has a high sensitivity and specificity in identifying persons qualifying for referral because of suspected Lynch syndrome or familial CRC. Implementation of this tool in colonoscopy clinics can facilitate the detection of patients with hereditary or familial CRC.

Mode of administration does not cause bias in patient-reported outcome results: a meta-analysis

PURPOSE

Technological advances in recent decades have led to the availability of new modes to administer patient-reported outcomes (PROs). To aid selecting optimal modes of administration (MOA), we undertook a systematic review to determine whether differences in bias (both size and direction) exist among modes.

METHODS

We searched five electronic databases from 2004 (date of last comprehensive review on this topic) to April 2014, cross-referenced and searched reference lists. Studies that compared two or more MOA for a health-related PRO measure in adult samples were included. Two reviewers independently applied inclusion and quality criteria and extracted findings. Meta-analyses and meta-regressions were conducted using random-effects models.

RESULTS

Of 5100 papers screened, 222 were considered potentially relevant and 56 met eligibility criteria. No evidence of bias was found for: (1) paper versus electronic self-complete; and (2) self-complete versus assisted MOA. Heterogeneity for paper versus electronic comparison was explained by type of construct (i.e. physical vs. psychological). Heterogeneity for self-completion versus assisted modes was in part explained by setting (clinic vs. home); the largest bias was introduced when assisted completion occurred in the clinic and follow-up was by self-completion (either electronic or paper) in the home.

CONCLUSIONS

Self-complete paper and electronic MOA can be used interchangeably for research in clinic and home settings. Self-completion and assisted completion produce equivalent scores overall, although heterogeneity may be induced by setting. These results support the use of mixed MOAs within a research study, which may be a useful strategy for reducing missing PRO data.

Patient-reported outcome assessment after total joint replacement: comparison of questionnaire completion times on paper and tablet computer

INTRODUCTION

Patient-reported outcome (PRO) assessment is becoming increasingly important after joint replacement surgery. However, PRO data collection, questionnaire handling, and data processing are time consuming and costly process. The aim of our study was to evaluate the efficiency of PRO assessment using tablet computers compared with traditional paper questionnaires in a total hip or knee arthroplasty (THR or TKR) population.

MATERIALS AND METHODS

We recruited 100 patients from outpatient clinics attending for routine follow-up 2 months, 1 year, or 5 years after THR or TKR. Fifty patients completed the Western Ontario and McMaster Universities (WOMAC) osteoarthritis score and Forgotten Joint Score-12 (FJS-12) questionnaires on paper, and 50 patients completed these on a tablet computer. Questionnaire completion was timed for each PRO assessment and for manual data entry of the paper questionnaires into the database. The t test, Mann-Whitney U test, Fisher's exact test, and Wilcoxon test were used for statistical analysis.

RESULTS

The mean age of the patients was 67.0 years (standard deviation 10.3 years), with no significant difference between the two groups. Median time for WOMAC questionnaire completion (including data entry for the paper questionnaires) was 197 s for the paper version and 117 s for the tablet version (p < 0.001). Median times for completion of FJS-12 were comparable for paper and tablet versions (32 vs. 37 s). We did not find a significant correlation between age and time for questionnaire completion.

CONCLUSION

Electronic PRO data collection can substantially decrease time, logistics, and effort associated with questionnaire completion in daily clinical practice. It is also acceptable for use in an older arthroplasty population.