Readability Analysis of Spanish-Language Patient-Reported Outcome Measures in Orthopaedic Surgery

Patient-reported outcome measures (PROMs) are increasingly used to quantify patient symptomatology when assessing intervention effectiveness as well as to guide patient-centered health-care management and research. Previous studies have analyzed the readability of PROMs used in orthopaedics in the English language; however, the readability of PROMs used in orthopaedics in the Spanish language has not been evaluated. Given the increasing number of Spanish-speaking individuals seeking orthopaedic care in the United States, it is imperative that PROMs are at an adequate reading level for patients to answer appropriately in their native language. This study aimed to assess the readability of publicly available Spanish-language PROMs used in orthopaedics.

Searches of the PubMed, Google Scholar, and Embase databases were conducted to identify publicly available Spanish-language versions of PROMs used in orthopaedics. Additionally, the PROMIS Health Organization was contacted to obtain Spanish-language versions of the PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaires. A total of 42 Spanish-language PROMs were identified and included in this study. The text of each PROM was inserted into multilingual readability software (legible.es), which analyzed the readability of each PROM using the Fernández Huerta and Índice de Legibilidad de Flesch-Szigriszt (INFLESZ) readability formulas. The mean and standard deviation (SD) of the raw readability scores were calculated for the PROMs. The percentage of PROMs at or below the 6th-grade reading level was also calculated.

The mean readability of PROMs using the INFLESZ formula was at a 7th to 10th-grade reading level (mean = 63, SD = 16), and the mean readability using the Fernández Huerta formula was 68 (SD = 15). On average, 57% of the PROMs used in orthopaedics were at or below the INFLESZ 6th-grade readability level.

Approximately half of Spanish-language PROMs used in orthopaedics are written at a reading level that does not meet the National Institutes of Health and the American Medical Association recommendations at or below the 6th-grade level. PROM developers and translators should consider the importance of readability when translating PROMs, to maximize their use and efficacy among orthopaedic patients speaking that language.