Are Patient-reported Outcome Measures in Orthopaedics Easily Read by Patients?

Abstract

Background Patient-reported outcome measures (PROMs) are commonly used by healthcare providers as means of assessing health-related quality of life and function at any given time. The complexity of PROMs can differ and when combined with varying degrees of adult literacy, error can be introduced if patients fail to understand questions. With an average adult literacy level of 11-year-old students in the United Kingdom, it is unclear to what degree PROMs can be read and understood by most patients (readability); to our knowledge, this has not been evaluated. Questions/purposes We wished to determine the readability of commonly used PROMs in orthopaedic surgery, as assessed by a validated tool that measures the complexity of the language in these surveys. MethodsWe performed a MEDLINE search to identify the most-commonly reported PROMs in orthopaedic research. One hundred twenty-one PROMs were identified and reviewed by 19 attending orthopaedic surgeons at our institution. Fifty-nine were selected as the most commonly used in our department. Of these, 52 (78%) were disease specific and included: 12 (20%) knee, 10 (17%) shoulder, seven (12%) spine, six (10%) hip, five (8%) foot and ankle, four (7%) elbow, three (5%) pelvis, three (5%) hand and wrist, and two (3%) lower limb. The remaining seven (12%) PROMs were general health questionnaires. The Flesch Reading Ease Score is a validated readability tool measuring average sentence length and syllables per word. It is expressed on a scale from 0 to 100 with higher scores indicating easier reading. We extracted the text from each PROM and inserted it in the same online Flesch Reading Ease Score calculator to generate a score. Results The mean readability score was 55 (range, 0-93), corresponding to text best understood by 16-to 18-year-old

Readability of Patient-Reported Outcome Measures in Adult Audiologic Rehabilitation

“…Individuals with low functional health literacy have admitted to having feelings of shame due to their poor reading skills (Parikh, Parker, Nurss, Baker, & Williams, 1996). Additionally, difficulties associated with comprehension are not entirely exclusive to patients with low levels of health literacy (El-Daly, Ibraheim, Rajakulendran, Culpan, & Bates, 2016). Even patients with a proficient level of health literacy may deliberately not seek clarification in order to avoid embarrassment or appearing foolish (El-Daly et al, 2016).…”

Patient-reported measures of quality of life and functional capacity in adhesive capsulitis

“…Orthopedic diseases greatly impact patients' lives, affecting daily activities and consequently QoL. [23][24][25] This study is therefore justified and this health indicator, QoL, needs to be evaluated more often, as already seen in other medical specialties. 1,4,[26][27][28] The simultaneous use of the WHOQOL-BREF and DASH represents an important contribution to the literature because there is a lack of knowledge regarding how these two instruments correlate in relation to this specific disease.…”

Editor's Spotlight/Take 5: Readability of Orthopaedic Patient-reported Outcome Measures: Is There a Fundamental Failure to Communicate?

“…A recent study of orthopaedic patient-reported outcome measures (PROMs) reported that most such materials are written at a level that is incomprehensible to the average adult reader [2]. The problem of hard-tounderstand content is, in fact, even more widespread than that.…”

“…They compared their results against both the Centers for Medicare & Medicaid Service's (CMS) and NIH's recommendations for reading grade levels. Given the reporting to the contrary [2,4], Dr. Ponce's group offer a surprising finding-that the vast majority of PROMs are, in fact, written at an acceptable grade level. However, there are still a small number of PROMs that are beyond the grasp of most patient's reading comprehension.…”

“…Following the explanation of our choice, we present ''Take Five,'' in which the editor goes behind the discovery with a one-on-one interview with an author of the article featured in ''Editor's Spotlight. ' [2,4] showing that orthopaedic patient material often exceeds the reading level of those patients. Why do you think your findings are so different?…”