Original article
Predictors of Nonresponse in a Questionnaire-Based Outcome Study of Vocational Rehabilitation Patients

https://doi.org/10.1016/j.apmr.2009.03.014Get rights and content

Abstract

Burrus C, Ballabeni P, Deriaz O, Gobelet C, Luthi F. Predictors of nonresponse in a questionnaire-based outcome study of vocational rehabilitation patients.

Objective

To identify predictors of nonresponse to a self-report study of patients with orthopedic trauma hospitalized for vocational rehabilitation between November 15, 2003, and December 31, 2005. The role of biopsychosocial complexity, assessed using the INTERMED, was of particular interest.

Design

Cohort study. Questionnaires with quality of life, sociodemographic, and job-related questions were given to patients at hospitalization and 1 year after discharge. Sociodemographic data, biopsychosocial complexity, and presence of comorbidity were available at hospitalization (baseline) for all eligible patients. Logistic regression models were used to test a number of baseline variables as potential predictors of nonresponse to the questionnaires at each of the 2 time points.

Setting

Rehabilitation clinic.

Participants

Patients (N=990) hospitalized for vocational rehabilitation over a period of 2 years.

Interventions

Not applicable.

Main Outcome Measure

Nonresponse to the questionnaires was the binary dependent variable.

Results

Patients with high biopsychosocial complexity, foreign native language, or low educational level were less likely to respond at both time points. Younger patients were less likely to respond at 1 year. Those living in a stable partnership were less likely than singles to respond at hospitalization. Sex, psychiatric, and somatic comorbidity and alcoholism were never associated with nonresponse.

Conclusions

We stress the importance of assessing biopsychosocial complexity to predict nonresponse. Furthermore, the factors we found to be predictive of nonresponse are also known to influence treatment outcome and vocational rehabilitation. Therefore, it is important to increase the response rate of the groups of concern in order to reduce selection bias in epidemiologic investigations.

Section snippets

Study Population

The study sample consisted of 990 patients hospitalized between November 15, 2003, and December 31, 2005, after orthopedic trauma, eligible for the OUTCOME study. This is a prospective cohort study of patients enrolled in 2 Swiss rehabilitation clinics after traumatic injury. Clinical and sociodemographic data at hospitalization (baseline) were available for all the 990 eligible patients. A semiconducted interview was organized for every admitted patient during the first 3 days of admission to

Results

Nine hundred ninety patients were eligible for the OUTCOME study and were therefore included in the present investigation. Their mean age ± SD was 42±10.7 years (range, 17–64y). Other characteristics are shown in table 2. The more frequent categories in each of the dichotomous predictors were as follows: men (87%), married or domestic partner (66%), compulsory school (52%), native language other than French or German (54%), complex biopsychosocial case (52%), lack of psychiatric comorbidity

Discussion

Our results suggest that biopsychosocial complexity, language, educational status, and, to a lesser extent, marital status and age may influence nonresponse in a questionnaire-based investigation of vocational rehabilitation study. Sex, psychiatric comorbidity, alcoholism, and somatic comorbidity had no significant effect in this investigation. The effects of biopsychosocial complexity, language, and education were stronger at hospitalization but were still important over 1 year after their

Conclusions

The factors we found to be predictive of nonresponse, particularly low educational level, foreign native language, and high biopsychosocial complexity, are also known to influence treatment outcome and vocational rehabilitation.25, 27, 28, 49, 50 In order to reduce selection bias and limit the risk of misinterpreting results of questionnaire-based studies, an extra effort should be made to improve the likelihood of response by people who are biopsychosocially complex, speak foreign languages,

Acknowledgments

We thank Viviane Dufour, Antoinette Crettenand, and Aaron Russell, PhD, for all the work related to the preparation of the OUTCOME questionnaires, data collection, and data entry. Peter Erhard, PhD, Hanspeter Gmünder, MD, and Nikola Seichert, PhD, collaborated in the design of the OUTCOME project.

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    Supported by Schweizerische Unfallversicherungsanstalt (SUVA) (grant no. 100204).

    A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit on 1 or more of the authors. The Clinique romande de réadaptation belongs to SUVA, the Swiss national accident insurance.

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    Copyright © 2009 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.