A Last-Ditch Effort and Personalized Surgeon Letter Improves PROMs Follow-Up Rate in Sports Medicine Patients: A Crossover Randomized Controlled Trial

J Knee Surg. 2021 Jan;34(2):130-136. doi: 10.1055/s-0039-1694057. Epub 2019 Aug 7.


Patient-reported outcomes measures (PROMs) are important for the advancement of orthopaedic surgeries. The primary difficulty while collecting PROMs is obtaining adequate follow-up rates. Therefore, it is important to find methods to improve follow-up, especially in patients who have failed to respond to initial attempts. We hypothesized that PROMs follow-up could be effectively increased by sending a salvage-effort personalized surgeon letter to sports medicine patients who failed to respond to initial (centralized electronic, mail, and/or phone contacts) PROMs collection 1 year after surgery. Patients who failed to respond to 1-year follow-up of postoperative PROMs collection at our outpatient sports medicine surgery center were included. Patients were randomized into an intervention or control group. Patients in the intervention group were mailed PROMs form and an Institutional Review Board-approved letter that was personalized with surgical information, surgeon picture, and surgeon signature. Control group was mailed the same letter a month later. Chi-squared analysis was conducted at 5 weeks. Out of 843 surgeries, our initial 1-year PROMs follow-up rate was 65%, which allowed for 292 patients to be eligible for our study. After exclusions, 281 patients (randomized to 140 control group and 141 intervention group) were included in our study. We found a 20% response rate in the intervention group with 28 patients returning PROMs as compared with a 1.4% rate in the control group with two patients returning PROMs. The odds ratio was 17.1 (95% confidence interval: 4-73.3; p < 0.0001). A salvage-effort personalized surgeon letter is an efficient and relatively cost-effective method to increase PROMs follow-up rate, which means that a personalized surgeon letter can reach and engage patients who would otherwise be considered lost to follow-up, allowing for better outcomes monitoring after surgery.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aftercare*
  • Correspondence as Topic*
  • Cross-Over Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures*
  • Reminder Systems*
  • Sports Medicine*