Readability of Orthopaedic Patient-reported Outcome Measures: Is There a Fundamental Failure to Communicate?

Pérez, Jorge Luis González; Mosher, Zachary A.; Watson, Shawna L.; Sheppard, Evan; Brabston, Eugene W.; McGwin, Gerald; Ponce, Brent A.

doi:10.1007/s11999-017-5339-0

Cited by 40 publications

(41 citation statements)

References 99 publications

(41 reference statements)

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“…orthopedics, oncological surgery) and represent a cutting edge opportunity for pain physicians to influence rational evidence-based pain care. [23][24][25][26][27] A scoping review characterized 21 publications where PROMIS measures were used in the perioperative setting. The authors applauded the utility of PROMIS measures to provide standardized, accurate and efficiently captured patient constructs.…”

Section: Quality Of Recovery Score (Qor) -Qor-9 Qor-15 Qor-40mentioning

confidence: 99%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Abola

Bennett‐Guerrero

Kent

et al. 2018

Anesthesia &Amp; Analgesia

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Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2-3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future study that consistently applies PROMs in an ERP will define the role these measures will have evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with traditional measures of health care quality after surgery provides an opportunity to improve clinical care.

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Section: Quality Of Recovery Score (Qor) -Qor-9 Qor-15 Qor-40mentioning

confidence: 99%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Abola

Bennett‐Guerrero

Kent

et al. 2018

Anesthesia &Amp; Analgesia

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“…The readability of patient-oriented materials has been a common subject in recent orthopedic literature,5, 7, 11, 19, 25 and most studies have found that very few online documents are written at an appropriate level 2, 6, 31, 32, 35. Although print material may be accessed less frequently than online material, a Pew survey found that nearly 60% of people who initially learn about their diagnoses online eventually see a clinician 8 .…”

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confidence: 99%

Readability assessment of American Shoulder and Elbow Surgeons patient brochures with suggestions for improvement

et al. 2018

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BackgroundMany Americans have limited literacy skills, and the National Institutes of Health (NIH) suggests patient educational material be written below the 8th grade level. Many orthopedic organizations provide print material for patients, but whether these documents are written at an appropriate reading level is not clear. This study assessed the readability of patient education brochures provided by the American Shoulder and Elbow Surgeons (ASES).Materials and MethodsIn May 2017, 6 ASES patient education brochures were analyzed using readability software. The reading level was calculated for each brochure using 9 different tests. The mean reading level for each article was compared with the NIH-recommended 8th grade level using 2-tailed, 1-sample t tests assuming unequal variances.ResultsFor each of the 9 tests, the mean reading level was higher than the NIH-recommended 8th grade (test, grade level): Automated Readability Index, 14.1 (P < .05); Coleman-Liau, 14.2 (P < .05); New Dale-Chall, 13.2 (P < .05); Flesch-Kincaid, 13.7 (P < .05); FORCAST, 11.8 (P < .05); Fry, 15.8 (P < .05); Gunning Fog, 16.5 (P < .05); Raygor Estimate, 15.4 (P < .05); and Simple Measure of Gobbledygook (SMOG), 15.1 (P < .05).ConclusionsThe ASES patient education brochures are written well above the NIH-recommended 8th grade reading level. These findings are similar to other investigations concerning orthopedic patient education material. Supplementary brochures and websites could be a useful source of information, particularly for patients who are deterred from asking questions in the office. Printed material designed for patient education should be edited to a more reasonable reading level. Further review of patient education materials is warranted.

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“…15,16 Recent studies in other healthcare fields, including medical oncology and orthopedics, have measured readability scores with widely ranging results. 17,18 Within otolaryngology, prior readability studies of PROMs have analyzed those used for audiology and dysphagia only. 1,19,20 No prior studies have evaluated H&N PROMs.…”

Section: Introductionmentioning

confidence: 99%

Readability of Patient‐Reported Outcome Measures for Head and Neck Oncology

et al. 2020

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Objectives/Hypothesis: Patient-reported outcome measures (PROMs) are communication tools to help patients convey their disease experience to medical providers and guide management decisions. However, the utility of healthcare outcome measures is dependent on patient literacy and readability of PROMs. If written for a more advanced literacy level, they can misestimate symptoms and add significant barriers to care, especially in the underserved. However, readability of head and neck (H&N) oncology PROMs has not been assessed. The aim of this study was to evaluate the readability of H&N oncology PROMs to assess whether they meet recommended readability levels. Study Design: Bibliometric review. Methods: Three readability measures: Gunning Fog, Simple Measure of Gobbledygook, and FORCAST were used to evaluate the readability level of commonly used H&N PROMs. PROMs with sixth grade readability level or lower were considered to meet the recommendations of health literacy experts. Results: Eight H&N oncology PROMs were reviewed. None of H&N PROMs met health literacy experts' and National Institutes of Health recommended reading levels. Gunning Fog consistently estimated easiest readability and FORCAST the most difficult. Conclusions: PROMs are important clinical tools that drive patient-centric care in H&N oncology. All H&N PROMs are written above recommended reading levels and do not meet suggested standards. Future PROMs should be written with easier readability to accurately convey patients' H&N oncology disease experiences.

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Readability of Orthopaedic Patient-reported Outcome Measures: Is There a Fundamental Failure to Communicate?

Abstract: Fears of widely incomprehensible PROMs may be unfounded. Future research to identify the most appropriate readability algorithm for use in the healthcare sector, and revalidation of PROMs after readability-improving edits is warranted.

Cited by 40 publications

References 99 publications

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Readability assessment of American Shoulder and Elbow Surgeons patient brochures with suggestions for improvement

Readability of Patient‐Reported Outcome Measures for Head and Neck Oncology

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