Miclau Katherine R, Kwong Jeffrey W, Tapp Emma, Mulakaluri Ashley, Shapiro Lauren M
Department of Orthopaedic Surgery, University of California, San Francisco, CA.
Department of Orthopaedic Surgery, University of California, San Francisco, CA.
J Hand Surg Am. 2025 May 9. doi: 10.1016/j.jhsa.2025.03.022.
Patient-reported outcome measures (PROMs) are used to assess patients' outcomes during the treatment of distal radius fractures (DRFs). Limited health literacy is linked to poorer health outcomes. We asked whether limited health literacy is associated with PROM scores in patients with a DRF.
This cross-sectional study enrolled adults ≥18 years of age with an isolated DRF from two urban hospitals within 6 weeks of injury or surgery. Participants completed a demographics survey, brief health literacy screen, and three PROMs: Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity v2.0 Short Form-7a (PROMIS-UE); and Numeric Rating Scale (NRS). Associations between social determinants of health (SDOH) factors (health literacy, income, education, and preferred language) and PROMs were assessed using multivariable linear regressions. Propensity score analyses to control for confounding and postmatching regressions were conducted.
Sixty-five patients participated in this study. In this sample, the mean age was 54 years, 65% were women, 26% had limited health literacy, 46% had public insurance, 18% completed at most a high school education, and 23% preferred a language other than English (PLOE). In multivariable analyses, limited health literacy and PLOE were associated with worse PROMIS-UE, and low income was associated with worse QuickDASH and NRS; associations between health literacy and QuickDASH and NRS were not statistically significant. Propensity score analyses indicated that all SDOH variables had confounding effects on associations between health literacy and PROMs. The postmatching regression analysis demonstrated that PLOE was associated with worse PROMIS-UE, and low income and PLOE with worse QuickDASH and NRS scores; limited health literacy was not significantly associated with any PROMs.
Low income and PLOE were significant predictors of worse PROM scores. After adjusting for other SDOH variables, limited health literacy was not significantly associated with PROM scores. These findings underscore the importance of recognizing and addressing the multiple interconnected SDOH aspects associated with PROM scores.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis IV.
患者报告结局测量指标（PROMs）用于评估桡骨远端骨折（DRF）治疗期间患者的结局。健康素养有限与较差的健康结局相关。我们探讨了健康素养有限是否与DRF患者的PROM分数相关。
这项横断面研究纳入了年龄≥18岁、在受伤或手术后6周内来自两家城市医院的孤立性DRF患者。参与者完成了一项人口统计学调查、简短的健康素养筛查以及三项PROMs：手臂、肩部和手部快速残疾评定量表（QuickDASH）；患者报告结局测量信息系统（PROMIS）上肢v2.0简表-7a（PROMIS-UE）；以及数字评定量表（NRS）。使用多变量线性回归评估健康的社会决定因素（SDOH）因素（健康素养、收入、教育程度和首选语言）与PROMs之间的关联。进行了倾向得分分析以控制混杂因素，并进行了匹配后回归分析。
65名患者参与了本研究。在这个样本中，平均年龄为54岁，65%为女性，26%健康素养有限，46%有公共保险，18%最多完成高中学业，23%首选英语以外的语言（PLOE）。在多变量分析中，健康素养有限和PLOE与更差的PROMIS-UE相关，低收入与更差的QuickDASH和NRS相关；健康素养与QuickDASH和NRS之间的关联无统计学意义。倾向得分分析表明，所有SDOH变量对健康素养与PROMs之间的关联均有混杂效应。匹配后回归分析表明，PLOE与更差的PROMIS-UE相关，低收入和PLOE与更差的QuickDASH和NRS分数相关；健康素养有限与任何PROMs均无显著关联。
低收入和PLOE是PROM分数较差的重要预测因素。在调整其他SDOH变量后，健康素养有限与PROM分数无显著关联。这些发现强调了认识和解决与PROM分数相关的多个相互关联的SDOH方面的重要性。
研究类型/证据水平：预后IV级。
