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Evaluating the Readability of Patient-Reported Outcome Measures in Pediatric Orthopaedic Registries: Alignment With
Harjot Uppal1, Daniel Garcia1, George Abdelmalek1
1Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson.
Insights
Most patient-reported outcome measures (PROMs) in pediatric orthopaedics exceed recommended readability levels. This impacts patient understanding and data accuracy for surgical effectiveness. Improving PROM readability is crucial for pediatric care.
Area of Science:
- Orthopaedic Surgery
- Health Outcomes Research
- Patient-Reported Outcomes
Background:
- Patient-reported outcome measures (PROMs) are vital for assessing surgical outcomes and patient quality of life.
- Readability is crucial for accurate PROM completion, with NIH and AMA recommending a sixth-grade reading level.
- Common pediatric orthopaedic PROMs include PODCI, PedsQL, and PROMIS.
Purpose of the Study:
- To evaluate the readability of PROMs used in pediatric orthopaedic surgery registries.
- To determine if these PROMs meet NIH and AMA recommended reading levels.
Main Methods:
- Readability analysis of 59 PROMs from pediatric orthopaedic registries.
- Utilized Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index.
- Compared scores against NIH/AMA guidelines (FRES ≥80 or SMOG <7 for sixth-grade level).
Main Results:
- Average FRES was 69 and SMOG Index was 8, indicating an eighth to ninth-grade reading level.
- Only 4 PROMs met both readability thresholds.
- PODCI and PROMIS instruments were written above the recommended sixth-grade level.
Conclusions:
- The majority of PROMs in pediatric orthopaedics are not written at an accessible reading level.
- This suboptimal readability may hinder patient comprehension and compromise data reliability.
- Efforts to improve PROM readability are necessary for accurate assessment in pediatric orthopaedic care.
Background:
Patient-reported outcome measures (PROMs) are essential tools for assessing surgical effectiveness and capturing patient perspectives on functionality, symptoms, and quality of life. However, readability is critical for ensuring patients can understand and accurately complete them. The National Institutes of Health (NIH) and American Medical Association (AMA) recommend that patient materials be written at or below a sixth-grade reading level. In pediatric orthopaedic surgery, the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Quality of Life Inventory (PedsQL), and Patient-Reported Outcomes Measurement Information System (PROMIS) instruments are among the most commonly utilized PROMs. This study evaluates whether PROMs used in pediatric orthopaedic registries meet NIH and AMA readability standards.
Methods:
A readability analysis was performed on 59 PROMs reported in pediatric orthopaedic registries. PROMs were categorized as validated or not validated for patients under 18 years of age. Primary readability metrics were the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) Index. Scores were obtained using an online calculator and compared against NIH and AMA guidelines. A FRES ≥80 or SMOG <7 was considered reflective of a sixth-grade or lower reading level.
Results:
The average FRES and SMOG Index for all PROMs were 69 ± 14 and 8 ± 1, respectively, corresponding to an eighth to ninth-grade reading level. Only 4 PROMs met both FRES and SMOG readability thresholds: Hospital Anxiety and Depression Scale, Knee Society-Function, Children's Revised Impact of Event Scale, and PedsQL. PROMs such as the International Knee Documentation Committee, Lower Extremity Functional Scale, Single Assessment Numeric Evaluation, University of California Los Angeles Activity Scale, and Kujala Score were among the least readable. Although PedsQL met both readability thresholds, PODCI and PROMIS instruments were written above the recommended sixth-grade reading level.
Conclusions:
Most PROMs used in pediatric orthopaedic surgery are written above the recommended sixth-grade reading level, potentially impacting patient comprehension and the reliability of collected data.
Level Of Evidence:
Level IV-observational study.
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