Readability of foot and ankle patient-reported outcomes: Alignment with National institutes of health and american medical association standards

Abstract

Patient-reported outcome measures are essential tools for assessing surgical interventions, capturing patient perspectives on functionality, symptoms, and quality of life. However, ensuring that these measures are easily understandable is crucial for accurate patient responses. The National Institutes of Health and American Medical Association recommend that patient materials be written at or below a sixth-grade reading level. This study evaluated the readability of 45 commonly used patient-reported outcome measures in foot and ankle surgery to determine alignment with these guidelines. A readability analysis was conducted using the Flesch Reading Ease Score and the Simple Measure of Gobbledygook Index, with a threshold of a Flesch Reading Ease Score of at least 80 or a Simple Measure of Gobbledygook Index below 7 indicating a sixth-grade or lower reading level. The average readability scores indicated an eighth to ninth-grade reading level, with only 31% of patient-reported outcome measures meeting the readability threshold. Among the least readable measures were the American Orthopaedic Foot and Ankle Society Clinical Rating Scales for various foot and ankle regions and the Ankle Osteoarthritis Scale. These findings suggest that most foot and ankle surgery patient-reported outcome measures are above the recommended readability level, potentially hindering patient comprehension and response accuracy. Improving the readability of patient-reported outcome measures, either by developing new tools or modifying existing ones, may enhance the accessibility and reliability of patient-reported data.