Readability Analysis of Commonly Cited Patient-Reported Outcome Measures in the Orthopaedic Joint Literature

Area of Science:

• Orthopaedic Surgery
• Health Outcomes Research
• Patient-Reported Outcome Measures

Background:

• Patient-reported outcome measures (PROMs) are essential for evaluating surgical effectiveness and patient quality of life.
• Readability of PROMs is critical for accurate patient completion and data integrity.
• Current guidelines recommend patient materials be at or below a 6th-grade reading level.

Purpose of the Study:

• To evaluate the readability of commonly used PROMs in orthopaedic joint literature.
• To assess compliance with recommended readability standards from the National Institutes of Health and American Medical Association.

Main Methods:

• Thirty-five PROMs were analyzed using the Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index.
• Readability scores were calculated using an online tool.
• Compliance was determined by comparing scores to the 6th-grade reading level threshold (FRES ≥80 or SMOG <7).

Main Results:

• The average FRES was 67 and the average SMOG Index was 8, indicating an 8th- to 9th-grade reading level.
• Only 17% (6 out of 35) of the analyzed PROMs met the 6th-grade readability standard.
• Several widely used PROMs, including the UCLA Activity Score and WOMAC, were among the least readable.

Conclusions:

• The majority of PROMs in orthopaedic joint literature are written above the recommended 6th-grade reading level.
• This low readability may hinder patient comprehension and impact the quality of collected data.
• Revising existing PROMs or developing new, more accessible tools is necessary to improve patient engagement and outcome reporting accuracy.