Evaluating the Readability of Patient-Reported Outcome Measures in Pediatric Orthopaedic Registries: Alignment With National Institutes of Health and American Medical Association Standards.

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.