Readability of the Most Commonly Used Patient-Reported Outcome Measures in Hand Surgery

Patient-reported outcome measures (PROMs) assess surgical outcomes and patient perspectives on function, symptoms, and quality of life. The readability of patient-reported outcome measures is crucial for ensuring patients can understand and accurately complete them. The National Institutes of Health and American Medical Association recommend that patient materials be written at or below a sixth-grade reading level. We aimed to evaluate whether PROMs identified in the hand literature meet these recommended reading standards.

We conducted a readability analysis of 22 PROMs referenced in the hand literature. Readability was assessed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) Index. Scores were obtained using an online readability calculator. Patient-reported outcome measures meeting a FRES ≥ 80 or SMOG ˂ 7 were considered at a sixth-grade reading level or lower, per the National Institutes of Health and American Medical Association guidelines.

Across all PROMs, the average FRES was 66 ± 12, and the average SMOG Index was 8 ± 1, corresponding to approximately an eighth- to ninth-grade reading level. Three PROMs met the target readability thresholds: Patient-Reported Outcome Measurement Information System-Physical Function Upper Extremity, Patient Evaluation Measure, and the 6-item Carpal Tunnel Syndrome Symptom Scale. Several PROMs, including the Southampton Dupuytren's Scoring Scheme, Hand Assessment Tool, and Manual Ability Measure 16, demonstrated relatively low readability scores.

Most PROMs mentioned in the hand literature exceeded the recommended sixth-grade reading level, potentially affecting patient comprehension and data accuracy. Although improving readability may enhance patient understanding, altering PROM wording is not straightforward and may require extensive revalidation because changes risk affecting validity and reliability, underscoring the complexity of revising PROMs.

These findings highlight the importance of raising awareness about PROM readability issues. Recognizing these readability challenges may encourage researchers, developers, and journal editors to consider recommended guidelines when proposing, modifying, or evaluating these measures.