Intended for healthcare professionals

Information In Practice

Patient non-compliance with paper diaries

BMJ 2002; 324 doi: (Published 18 May 2002) Cite this as: BMJ 2002;324:1193
  1. Arthur A Stone, professor and vice-chair (,
  2. Saul Shiffman, chief science officerb,
  3. Joseph E Schwartz, associate professora,
  4. Joan E Broderick, assistant professora,
  5. Michael R Hufford, director of scientific affairsb
  1. a Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY, 11794-8790, USA
  2. b invivodata, Pittsburgh, PA, 15203, USA
  1. Correspondence to: A A Stone
  • Accepted 24 January 2002

Doctors often ask patients to recall recent health experiences, such as pain, fatigue, and quality of life.1 Research has shown, however, that recall is unreliable and rife with inaccuracies and biases.2 Recognition of recall's shortcomings has led to the use of diaries, which are intended to capture experiences close to the time of occurrence, thus limiting recall bias and producing more accurate data.3

The rationale for using diaries would be undermined if patients failed to complete diaries according to protocol. In this study we used a newly developed paper diary that could objectively record when patients made diary entries in order to compare patients' reported and actual compliance with diary keeping. For comparison, we also used an electronic diary designed to enhance compliance in order to assess what compliance rates might be achieved.

Methods and results

We recruited 80 adults with chronic pain (pain for ≥3 hours a day and rated ≥4 on a 10 point scale) and assigned 40 to keeping a paper …

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