Uppal Harjot, Garcia Daniel, Abdelmalek George, Attia Peter, Sahai Nikhil, Sinha Kumar, Hwang Ki, McGinniss Andrew, Chu Alice, Emami Arash
Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson.
Rutgers New Jersey Medical School, Newark, NJ.
J Pediatr Orthop. 2025 Jul 11. doi: 10.1097/BPO.0000000000003042.
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.
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.
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.
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 IV-observational study.
患者报告结局测量（PROMs）是评估手术效果以及了解患者对功能、症状和生活质量看法的重要工具。然而，可读性对于确保患者能够理解并准确完成这些测量至关重要。美国国立卫生研究院（NIH）和美国医学协会（AMA）建议患者材料的编写应达到或低于六年级阅读水平。在小儿骨科手术中，小儿骨科结局数据收集工具（PODCI）、小儿生活质量量表（PedsQL）和患者报告结局测量信息系统（PROMIS）工具是最常用的PROMs。本研究评估小儿骨科登记处使用的PROMs是否符合NIH和AMA的可读性标准。
对小儿骨科登记处报告的59种PROMs进行可读性分析。PROMs被分类为针对18岁以下患者经过验证或未经验证的。主要可读性指标是弗莱什易读性分数（FRES）和雾度简易测量指标（SMOG）。使用在线计算器获得分数，并与NIH和AMA指南进行比较。FRES≥80或SMOG<7被认为反映了六年级或更低的阅读水平。
所有PROMs的平均FRES和SMOG指标分别为69±14和8±1，相当于八年级到九年级的阅读水平。只有4种PROMs同时满足FRES和SMOG可读性阈值：医院焦虑抑郁量表、膝关节协会功能量表、儿童事件影响量表修订版和PedsQL。国际膝关节文献委员会、下肢功能量表、单项评估数值评定、加利福尼亚大学洛杉矶分校活动量表和库贾拉评分等PROMs的可读性最差。虽然PedsQL满足了两个可读性阈值，但PODCI和PROMIS工具的编写高于推荐的六年级阅读水平。
小儿骨科手术中使用的大多数PROMs的编写高于推荐的六年级阅读水平，这可能会影响患者的理解以及所收集数据的可靠性。
IV级观察性研究。
