Readability of Patient-reported Outcome Measures Used in Plastic Surgery

Area of Science:

• Plastic Surgery
• Health Literacy
• Patient-Reported Outcomes

Background:

• Patient-reported outcomes (PROMs) are vital for assessing success in plastic surgery.
• The American Medical Association recommends PROMs be written at a sixth-grade reading level or below.
• This study evaluated the readability of PROMs used in plastic surgery.

Purpose of the Study:

• To assess the readability of patient-reported outcome measures (PROMs) in plastic surgery.
• To determine if PROMs meet the recommended sixth-grade reading level.
• To identify potential barriers to patient comprehension and data accuracy.

Main Methods:

• A literature review identified 43 validated, commonly used plastic surgery PROMs.
• Readability was analyzed using the Simple Measure of Gobbledygook (SMOG) index, Flesch-Kincaid grade level, Coleman-Liau index, and automated readability index.
• PROMs' text and instructions were assessed for word complexity and estimated grade level.

Main Results:

• The mean SMOG index was 8.2 (eighth-grade reading level).
• Other readability indexes ranged from third to sixth grade, potentially underestimating difficulty.
• Only 14% of PROMs met the sixth-grade reading level target; instructions were harder to read than questions.

Conclusions:

• Plastic surgery PROMs, including instructions, generally exceed recommended reading levels.
• This can impede patient comprehension, accurate completion, and the validity/reliability of outcomes data.
• PROMs must be designed for accessibility across all patient literacy levels.