Readability of Patient-reported Outcome Measures Used in Plastic Surgery

Background:. Patient-reported outcomes are essential to understanding success in plastic surgery procedures, many that aim to improve quality of life. Patient-reported outcome measures (PROMs) should be written at or below the sixth-grade reading level recommended by the American Medical Association...

Full description

Saved in:
Bibliographic Details
Main Authors: Zachary Zamore, BA, Chao Long Azad, MD, MPH, Lily Zhu, BS, Chenery Lowe, PhD, ScM, Aviram M. Giladi, MD, MS
Format: Article
Language:English
Published: Wolters Kluwer 2024-12-01
Series:Plastic and Reconstructive Surgery, Global Open
Online Access:http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006351
Tags: Add Tag
No Tags, Be the first to tag this record!
_version_ 1850131022688026624
author Zachary Zamore, BA
Chao Long Azad, MD, MPH
Lily Zhu, BS
Chenery Lowe, PhD, ScM
Aviram M. Giladi, MD, MS
author_facet Zachary Zamore, BA
Chao Long Azad, MD, MPH
Lily Zhu, BS
Chenery Lowe, PhD, ScM
Aviram M. Giladi, MD, MS
author_sort Zachary Zamore, BA
collection DOAJ
description Background:. Patient-reported outcomes are essential to understanding success in plastic surgery procedures, many that aim to improve quality of life. Patient-reported outcome measures (PROMs) should be written at or below the sixth-grade reading level recommended by the American Medical Association. This study aimed to evaluate the readability of plastic surgery PROMs. Methods:. We conducted a literature review to identify validated, commonly used PROMs in plastic surgery. We extracted PROMs’ text and instructions and analyzed readability using different approaches that estimate the grade level required to understand. Our primary outcome was the Simple Measure of Gobbledygook (SMOG) index, which detects word complexity and expects 100% comprehension at the grade level rating assigned. We also included the Flesch-Kincaid grade level, Coleman-Liau index, and automated readability index. Results:. Forty-three PROMs met the inclusion criteria. The mean SMOG index was 8.2 (SD = 1.3), indicating an eighth-grade reading level. Mean reading grade levels measured by the Flesch-Kincaid grade level, Coleman-Liau index, and automated readability index ranged from third to sixth grade, although these may underestimate readability difficulties. Only 6 (14%) PROMs had a SMOG index at or below the sixth-grade level. PROM instructions had significantly higher reading levels than the questions/responses for all readability indexes (P < 0.01). Conclusions:. PROMs used in plastic surgery, including the instructions, exceed the reading level recommended by the American Medical Association. This may limit comprehension and accurate completion and compromise validity and reliability. PROMs should be written and designed to be accessible to patients of all literacy levels.
format Article
id doaj-art-22dcee0cd25d4b04b9da51b31bdc192b
institution OA Journals
issn 2169-7574
language English
publishDate 2024-12-01
publisher Wolters Kluwer
record_format Article
series Plastic and Reconstructive Surgery, Global Open
spelling doaj-art-22dcee0cd25d4b04b9da51b31bdc192b2025-08-20T02:32:32ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742024-12-011212e635110.1097/GOX.0000000000006351202412000-00055Readability of Patient-reported Outcome Measures Used in Plastic SurgeryZachary Zamore, BA0Chao Long Azad, MD, MPH1Lily Zhu, BS2Chenery Lowe, PhD, ScM3Aviram M. Giladi, MD, MS4From the * The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MDFrom the * The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD† Department of Plastic and Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, MD‡ Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MDFrom the * The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MDBackground:. Patient-reported outcomes are essential to understanding success in plastic surgery procedures, many that aim to improve quality of life. Patient-reported outcome measures (PROMs) should be written at or below the sixth-grade reading level recommended by the American Medical Association. This study aimed to evaluate the readability of plastic surgery PROMs. Methods:. We conducted a literature review to identify validated, commonly used PROMs in plastic surgery. We extracted PROMs’ text and instructions and analyzed readability using different approaches that estimate the grade level required to understand. Our primary outcome was the Simple Measure of Gobbledygook (SMOG) index, which detects word complexity and expects 100% comprehension at the grade level rating assigned. We also included the Flesch-Kincaid grade level, Coleman-Liau index, and automated readability index. Results:. Forty-three PROMs met the inclusion criteria. The mean SMOG index was 8.2 (SD = 1.3), indicating an eighth-grade reading level. Mean reading grade levels measured by the Flesch-Kincaid grade level, Coleman-Liau index, and automated readability index ranged from third to sixth grade, although these may underestimate readability difficulties. Only 6 (14%) PROMs had a SMOG index at or below the sixth-grade level. PROM instructions had significantly higher reading levels than the questions/responses for all readability indexes (P < 0.01). Conclusions:. PROMs used in plastic surgery, including the instructions, exceed the reading level recommended by the American Medical Association. This may limit comprehension and accurate completion and compromise validity and reliability. PROMs should be written and designed to be accessible to patients of all literacy levels.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006351
spellingShingle Zachary Zamore, BA
Chao Long Azad, MD, MPH
Lily Zhu, BS
Chenery Lowe, PhD, ScM
Aviram M. Giladi, MD, MS
Readability of Patient-reported Outcome Measures Used in Plastic Surgery
Plastic and Reconstructive Surgery, Global Open
title Readability of Patient-reported Outcome Measures Used in Plastic Surgery
title_full Readability of Patient-reported Outcome Measures Used in Plastic Surgery
title_fullStr Readability of Patient-reported Outcome Measures Used in Plastic Surgery
title_full_unstemmed Readability of Patient-reported Outcome Measures Used in Plastic Surgery
title_short Readability of Patient-reported Outcome Measures Used in Plastic Surgery
title_sort readability of patient reported outcome measures used in plastic surgery
url http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006351
work_keys_str_mv AT zacharyzamoreba readabilityofpatientreportedoutcomemeasuresusedinplasticsurgery
AT chaolongazadmdmph readabilityofpatientreportedoutcomemeasuresusedinplasticsurgery
AT lilyzhubs readabilityofpatientreportedoutcomemeasuresusedinplasticsurgery
AT chenerylowephdscm readabilityofpatientreportedoutcomemeasuresusedinplasticsurgery
AT avirammgiladimdms readabilityofpatientreportedoutcomemeasuresusedinplasticsurgery