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American Association for Hand Surgery

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Use of Questionnaire-based Research in Hand Surgery
Yuewei Wu-Fienberg, MD, Baylor College of Medicine, Houston, OH and Scott A Mitchell, MD, Baylor College of Medicine, Houston, TX

Introduction
Questionnaire-based research is ubiquitous within the Hand Surgery literature and used to answer a variety of questions including those related to practice patterns, attitudes, preferences, subjective outcomes, and satisfaction. Careful attention to survey audience, question construction, and delivery method are paramount to obtaining meaningful and generalizable results. This study seeks to characterize the methods and scope of questionnaire-based studies in the current Hand Surgery literature.
Methods
We conducted a systematic review of questionnaire-based studies pertaining to the field of Hand Surgery and published between 2010 and 2020 in four major journals read by most Hand Surgeons in the United States, including Journal of Hand Surgery (American Volume), HAND, Plastic and Reconstructive Surgery, and Journal of Bone and Joint Surgery (American Volume). Inclusion criteria included articles related to surgery of the hand, wrist, forearm, and/or elbow, in which questionnaire results represented a primary outcome of the study.
Results
A total of 390 studies were included for analysis, including 201 (51.7%) that used validated instruments, 6 (1.5%) that sought to validate an instrument, 75 (19.2%) that used a combination of validated and non-validated instruments, and 108 (27.6%) that used non-validated instruments. Of studies that used validated instruments, 86% focused on patient-reported outcomes and 14% focused on other patient-centered topics. In contrast, of studies that used non-validated instruments, 46% focused on physician practice patterns, 30% were patient-centered, and 12% focused on education. Among non-validated questionnaires, 74.3% did not report undergoing pre-distribution pilot testing, 36.3% did not present the full text of the survey instrument within the publication or supplemental materials, and 32.7% did not report a response rate.
Conclusions
Survey-based research in common in the Hand Surgery literature and the number of questionnaire-based studies published has up-trended over the past 10 years. While not all research questions can be answered with the use of validated instruments, we have identified several areas for improvement in the design and reporting of studies based on non-validated surveys. These include: the use of pre-distribution pilot testing to assess for question clarity and absence of bias, the inclusion of survey full texts with study publication to improve transparency and critical evaluation, and better reporting on the proportion and characteristics of non-respondents.


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