Musculoskeletal Health Literacy Research Articles

Limited Health Literacy Does Not Adversely Affect Compliance with Postoperative Restrictions, 90-day ED Return, or Opioid Use Following Shoulder Arthroscopy

BackgroundLimited health literacy can negatively impact how patients process medical information, make medical decisions, and navigate the healthcare system. The literature with regards to health literacy and its impact on both postoperative compliance and healthcare utilization remains scant. MethodsWe retrospectively analyzed the records for patients who underwent elective shoulder arthroscopy with a minimum 90-day follow-up at a single academic institution. Demographic data including age, gender, prior ipsilateral shoulder arthroscopy, body mass index (BMI) and age-adjusted Charlson Comorbidity Index (ACCI) were collected. A validated 9-item Literacy in Musculoskeletal Problems (LiMP) questionnaire to assess musculoskeletal health literacy (MHL) was administered preoperatively. Postoperative compliance with therapy and surgeon-directed immobilization restrictions, 90-day return to ED, and the number of opioid prescriptions filled within 3 months postoperatively was recorded. ResultsThere were 252 cases included in this study. Seventy-seven (31%) patients demonstrated adequate MHL (AMHL). On multivariable analysis, limited MHL (LMHL) was not significantly associated with 90-day postoperative ED return, compliance with postoperative surgeon instructions regarding shoulder motion or therapy restrictions, or obtaining ≥ 2 postoperative opioid prescriptions. ConclusionsLMHL is highly prevalent amongst patients undergoing elective shoulder arthroscopy. The lack of association between LMHL and postoperative compliance, 90-day ED return, or filling ≥ 2 postoperative opioid prescriptions suggests that further research is needed to identify more relevant modifiable risk factors that could reduce these negative clinical outcomes and healthcare utilization patterns.

Helpful elements in a brief work-oriented intervention targeting musculoskeletal and mental health literacy.

Musculoskeletal and mental health complaints are common in the general population and frequent reasons for healthcare utilization and work absence. Illness perceptions, coping expectancies, rumination and self-stigma are important factors in the management of these health complaints and factors closely linked to health literacy (HL). The aims of the study were to identify helpful elements in a brief intervention (BI) targeting HL regarding common musculoskeletal and mental health complaints and to identify patient perceptions of how the intervention was helpful and whether it affected their subsequent coping. Three focus group interviews with 14 patients were conducted. Systematic text condensation was used for the analysis, supported by the health literacy skill (HLS) framework to sharpen the focus on intervention elements related to the acquisition and utilization of HLSs. Results revealed the importance of receiving comprehensible health information and guidance, the use of metaphors to create recognizable narratives and the use of practical examples and exercises. Normalizing the experienced health complaints, together with a safe and accommodating clinical environment, facilitated the change process. The BI initiated processes that contributed to acceptance, resilience and empowerment, aiding work-life balance and return to work. The study presents authentic narratives of value for future focus in BI.

Evaluating the Role and Impact of Health Literacy for Patients Undergoing Knee Surgery.

Health literacy is defined as "the capacity to obtain, process, and understand basic medical information and services and the competence to use such information and services to enhance health." Much of the research regarding health literacy in orthopaedic surgery has focused on readability of educational materials. However, the role of health literacy in patient-reported outcomes is somewhat unknown. The purpose of this review was to evaluate the body of literature pertaining to health literacy and knee surgery outcomes. A literature search was performed using keywords and MeSH terms in PubMed/MEDLINE, Scopus, PsycINFO, SPORTDiscus, and Cochrane. Articles written between 1990 and 2021 were evaluated for inclusion. The title and abstract of all studies returned in each database search were screened. In the case that these did not provide sufficient information, the full-text article was reviewed. The initial database search returned a total of 974 articles for review. Eight of these were duplicate results, and one article had been retracted after publication, leaving a total of 965 to be screened for inclusion. Ninety-six articles remained after screening titles and abstracts for relevance. After applying inclusion criteria, six articles remained and were included in this review. It is clear that health literacy impacts patient outcomes in health care and this review suggests that general and musculoskeletal health literacy affect patient expectations, outcomes, and satisfaction before and after knee surgery. However, the peer-reviewed literature on this topic is still deficient in terms of determining effective methods for addressing this barrier to optimal patient care. Research should focus on further elucidation of the relationships among health literacy, readability, and patient education for optimizing patient outcomes and satisfaction across orthopaedic subspecialties.

Injury acknowledgement by reduction of sports load in world-leading athletics (track and field) athletes varies with their musculoskeletal health literacy and the socioeconomic environment

ObjectiveAlthough injury burden prompts elite athletics (track and field) athletes to engage in injury management, little is known about their health literacy. We investigated musculoskeletal (MS) health literacy in world-leading...

Relation entre l’état musculosquelettique et les mobilités passives (mesures des résultats exprimés par les patients) dans le cadre des douleurs atraumatiques de l’épaule

IntroductionPatient-reported outcome measures (PROMs) are commonly utilized to assess patient-derived orthopaedic health status and function. The prevalence of limited musculoskeletal health literacy (MHL) has been demonstrated to be high within the orthopaedic literature. The purpose of this study was to evaluate the association between MHL and upper extremity-specific PROMs and to determine which patient- and symptom-related factors affect baseline PROMs in patients with atraumatic shoulder pain. HypothesisPatients with limited MHL would demonstrate lower median scores on baseline PROMs compared with those with adequate MHL. Materials and methodsNew patients with atraumatic shoulder pain presenting to an academic practice were administered the Literacy in Musculoskeletal Problems (LiMP), in addition to the American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and Single Assessment Numeric Evaluation (SANE) questionnaires. A detailed physical exam and history was performed by a fellowship-trained shoulder surgeon. Demographic patient data, in addition to prior imaging and orthopaedic treatment, was tabulated. The association between demographics, pain-related variables, and MHL with the ASES, SANE, and QuickDASH scores were examined using Spearman correlation coefficients for continuous variables and Wilcoxon rank-sum tests for categorical variables. Non-parametric analysis of covariance (ANCOVA) was used to examine the independent association of predictor variables with PROMs. ResultsA total of 439 patients met the inclusion criteria and were enrolled. The mean age was 58,8±12.6 years (range, 24–93) with 162 (37 %) being men. Overall, 172 patients (39.2 %) attained a college degree or higher and 183 (41.7 %) were currently employed. MHL was significantly associated with ASES (p=0.03), but not with the QuickDASH (p=0.75) or SANE score (p=0.16). Similarly, age, having been in the medical profession or having previously visited an orthopaedist, was not associated with PROMs, while employment status correlated to the SANE score (p=0.002). Visual Analogue Scale (VAS) pain level demonstrated varying strengths of association with each of the scores (ASES (r=−0.729, p<0.001), QuickDASH (r=0.557, p<0.001), and SANE (r=−0.430, p<0.001)). MHL demonstrated no association with initial patient-derived treatment selection. DiscussionThe SANE and QuickDASH may be administered to patients presenting for atraumatic shoulder pain in the outpatient setting regardless of MHL. Further research should be focused on the utility of the ASES instrument amongst patients with lower educational levels and/or limited MHL. Level of evidenceII; diagnostic.

Digital and Musculoskeletal Health Literacy of Collegiate Student-Athletes

Purpose: To assess the digital health literacy (DHL) and musculoskeletal health literacy (MHL) levels of collegiate student-athletes. Methods: We used a cross-sectional survey to assess collegiate student-athletes (n=160) health literacy using the Digital Health Literacy Instrument (DHLI) and Literacy in Musculoskeletal Problems (LiMP) tool. Data were analyzed using descriptive statistics. Results: The majority of participants shared they accessed the Internet via smart phones and felt the Internet was important and useful to their health. On average, the participants scored a 3.36±0.38 on the DHLI. The LiMP score was 6.29±1.36, and 26.8% (n=15/56) of participants who completed the tool had limited or inadequate MHL. Conclusions: Most student-athletes possess adequate DHL and MHL. The findings directly impact patient education as student-athletes are using their phones to access health related information, which they feel comfortable with, but may not know if the source is trustworthy.

Caregiver Literacy in a Pediatric Orthopedic Population: A Cross-Sectional Study

Background: Approximately 33% of Americans have inadequate health literacy, which is associated with increased hospitalization and use of emergency care, poorer control of chronic diseases, infrequent use of preventative measures, and suboptimal treatment outcomes. Aims and Objectives: The purpose of this study was to evaluate the general and musculoskeletal health literacy of the parents or guardians (caregivers) of pediatric patients presenting to a general pediatric orthopedic clinic and identify risk factors for limited health literacy. Study Design: This cross-sectional study obtained a convenience sample of 200 English speaking caregivers of children presenting with musculoskeletal complaints. Caregivers who were taking their children for either first-time or follow-up visits were included in the study. Participants were excluded if they did not meet the aforementioned criteria, had any cognitive impairment, were unable to read English, or were unable to sign their own consent. Setting: The general pediatric orthopedic clinic of a large children’s hospital. Materials and Methods: Caregivers completed a demographic survey, the Literacy in Musculoskeletal Problems questionnaire, and the Newest Vital Sign to measure musculoskeletal and general health literacy, respectively. Statistics: The data was summarized using frequencies and proportions for categorical variables as well as mean and standard deviation for quantitative variables. In the univariate analysis the group comparisons were conducted using the chi-squared test for categorical variables. Multivariable logistic regression was used to model the odds of adequate musculoskeletal health literacy. Results: Limited musculoskeletal health literacy was seen in 46.7% of participants. Inadequate general health literacy was observed in 18.0% of participants. Non-Hispanics (p = 0.0210), those who worked in a health care (p = 0.0055), and those with a level of education of some college or greater (p = &lt;0.0012) were more likely to have adequate musculoskeletal health literacy on multivariable logistic regression. Only at least some college experience correlated with adequate general health literacy (p = 0.003) upon multivariable logistic regression. Conclusion: Almost half of all caregivers who bring their children to a pediatric orthopedic clinic have limited musculoskeletal health literacy and may lack the necessary comprehension required for making informed decisions about their child’s care. Limited musculoskeletal health literacy is more prevalent than limited general health literacy.

The relationship between musculoskeletal health literacy and upper extremity patient-reported outcome measures (PROMs) in the setting of atraumatic shoulder pain

IntroductionPatient-reported outcome measures (PROMs) are commonly utilized to assess patient-derived orthopaedic health status and function. The prevalence of limited musculoskeletal health literacy (MHL) has been demonstrated to be high within the orthopaedic literature. The purpose of this study was to evaluate the association between MHL and upper extremity-specific PROMs and to determine which patient- and symptom-related factors affect baseline PROMs in patients with atraumatic shoulder pain. HypothesisPatients with limited MHL would demonstrate lower median scores on baseline PROMs compared with those with adequate MHL. Materials and methodsNew patients with atraumatic shoulder pain presenting to an academic practice were administered the Literacy in Musculoskeletal Problems (LiMP), in addition to the American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and Single Assessment Numeric Evaluation (SANE) questionnaires. A detailed physical exam and history was performed by a fellowship-trained shoulder surgeon. Demographic patient data, in addition to prior imaging and orthopaedic treatment, was tabulated. The association between demographics, pain-related variables, and MHL with the ASES, SANE, and QuickDASH scores were examined using Spearman correlation coefficients for continuous variables and Wilcoxon rank-sum tests for categorical variables. Non-parametric analysis of covariance (ANCOVA) was used to examine the independent association of predictor variables with PROMs. ResultsA total of 439 patients met the inclusion criteria and were enrolled. The mean age was 58.8±12.6years (range: 24–93) with 162 (37%) being men. Overall, 172 patients (39.2%) attained a college degree or higher and 183 (41.7%) were currently employed. MHL was significantly associated with ASES (p=0.03), but not with the QuickDASH (p=0.75) or SANE score (p=0.16). Similarly, age, having been in the medical profession or having previously visited an orthopaedist were not associated with PROMs, while employment status correlated to the SANE score (p=0.002). Visual Analogue Scale (VAS) pain level demonstrated varying strengths of association with each of the scores [ASES (r=−0.729, p<0.001), QuickDASH (r=0.557, p<0.001), and SANE (r=−0.430, p<0.001)]. MHL demonstrated no association with initial patient-derived treatment selection. DiscussionThe SANE and QuickDASH may be administered to patients presenting for atraumatic shoulder pain in the outpatient setting regardless of MHL. Further research should be focused on the utility of the ASES instrument amongst patients with lower educational levels and/or limited MHL. Level of evidenceII; diagnostic.

What are the risk factors associated with limited musculoskeletal health literacy in shoulder arthroplasty patients?

Low health literacy is both pervasive in the United States and a substantial barrier to satisfactory patient care and the appropriate utilization of healthcare resources. This prospective study aims to evaluate the factors that contribute to limited musculoskeletal literacy in patients who undergo shoulder arthroplasty. Ninety patients undergoing shoulder replacement surgery completed demographics and Literacy in Musculoskeletal Problems (LiMP) surveys. Scores of less than six were considered indicative of limited musculoskeletal literacy. The overall percentage of participants with limited musculoskeletal literacy was 38.8%. Multivariable logistic regression analysis with multiple imputation modeling demonstrated a significant positive relationship between patient income and adequate LiMP scores (p=0.009) with an odds ratio of 1.15 (CI: 1.04; 1.28) while level of education (p=0.173) and patient ethnicity (p=0.830) among other patient characteristics did not have a significant relationship with LiMP scores. In patients undergoing shoulder replacement surgery, low income was the only variable found to be predictive of limited musculoskeletal health literacy scores. Therefore, when discussing the risks and benefits of shoulder arthroplasty, orthopaedic surgeons should be cognizant of the possibility that any given patient may not meet the threshold of adequate musculoskeletal literacy.

Musculoskeletal Health Literacy is Associated With Outcome and Satisfaction of Total Knee Arthroplasty

BackgroundThe purpose of this study was to investigate if there is an association between musculoskeletal health literacy with outcome and satisfaction after total knee arthroplasty (TKA). MethodsA cross-sectional study was performed at our tertiary center to include patients between one and six years postoperatively after primary TKA. Patients were provided a survey including basic demographics, validated musculoskeletal health literacy scale (Literacy in Musculoskeletal Problems), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and TKA satisfaction (whether they would choose to undergo the same operation again). Patients were categorized as either low or normal health literacy based on number of questions (cutoff 6 out of 9) answered correctly on the Literacy in Musculoskeletal Problems. Statistical analysis included multivariate regression with significance at P < .05. ResultsFour hundred fifty-three individuals fully completed the survey of eligible participants. Two hundred ninety-six individuals (65.3%) had normal health literacy, and one hundred fifty-seven individuals (34.7%) had low health literacy. Average WOMAC (/96) was 18.0 ± 19.7 in the low and 12.1 ± 15.4 in the normal health literacy groups. Patients with low health literacy had significantly higher WOMAC (worse function) than those with normal health literacy (P = .001). Patients with normal musculoskeletal health literacy were significantly more likely to undergo the same operation again (P = .01, odds ratio 2.163). ConclusionThis study shows that patients with low musculoskeletal health literacy have worse outcome scores and are less likely to be satisfied with their TKA. By identifying these patients preoperatively, emphasis can be placed on enhancing procedure expectations and understanding to improve outcome measures and overall satisfaction.

Association Between Baseline PROMIS Scores, Patient-Provider Communication Factors, and Musculoskeletal Health Literacy on Patient and Surgeon Expectations in Foot and Ankle Surgery.

Various factors may affect differences between patient and surgeon expectations. This study aimed to assess associations between patient-reported physical and mental status, patient-surgeon communication, and musculoskeletal health literacy with differences in patient and surgeon expectations of foot and ankle surgery. Two hundred two patients scheduled to undergo foot or ankle surgery at an academic hospital were enrolled. Preoperatively, patients and surgeons completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey. Patients also completed Patient-Reported Outcomes Measurement Information System (PROMIS) scores in Physical Function, Pain Interference, Pain Intensity, Depression, and Global Health. Patient-surgeon communication and musculoskeletal health literacy were assessed via the modified Patients' Perceived Involvement in Care Scale (PICS) and Literacy in Musculoskeletal Problems (LiMP) questionnaire, respectively. Greater differences in patient and surgeon overall expectations scores were associated with worse scores in Physical Function (P = .003), Pain Interference (P = .001), Pain Intensity (P = .009), Global Physical Health (P < .001), and Depression (P = .009). A greater difference in the number of expectations between patients and surgeons was associated with all of the above (P ≤ .003) and with worse Global Mental Health (P = .003). Patient perceptions of higher surgeons' partnership building were associated with a greater number of patient than surgeon expectations (P = .017). There were no associations found between musculoskeletal health literacy and differences in expectations. Worse baseline patient physical and mental status and higher patient perceptions of provider partnership building were associated with higher patient than surgeon expectations. It may be beneficial for surgeons to set more realistic expectations with patients who have greater disability and in those whom they have stronger partnerships with. Further studies are warranted to understand how modifications in patient and surgeon interactions and patient health literacy affect agreement in expectations of foot and ankle surgery. Level II, prospective comparative series.

Associations Between Baseline PROMIS Scores, Patient-Provider Communication Factors, and Musculoskeletal Health Literacy on Differences in Patients’ and Surgeons’ Expectations in Foot and Ankle Surgery

Category:OtherIntroduction/Purpose:Aligning patient and surgeon expectations is important, as it allows for informed and shared decision- making and may improve postoperative satisfaction. Patient-provider communication factors have been found to affect differences between patient and surgeon expectations of total knee arthroplasty. Patients with limited health literacy have been found to ask fewer questions and spend less time with their surgeons, and to perceive themselves to have a more passive decision-making role in hand surgery clinic visits. Understanding how these factors affect differences in expectations of foot and ankle surgery is important in order to increase patient-surgeon agreement. This study aimed to assess associations between patient-reported physical and mental status, patient-surgeon communication factors, and musculoskeletal health literacy with differences between patient and surgeon expectations of foot and ankle surgery.Methods:Two hundred two patients scheduled to undergo foot or ankle surgery by one of seven fellowship-trained foot and ankle surgeons at an academic hospital were enrolled. Preoperatively, patients and surgeons completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey independently. Patients also completed Patient-Reported Outcomes Measurement Information System (PROMIS) scores in Physical Function, Pain Interference, Pain Intensity, Depression, and Global Health. Patient involvement in care, provider partnership building, and provider information giving were assessed with the modified Patients’ Perceived Involvement in Care Scale (PICS). Musculoskeletal health literacy was assessed with the Literacy in Musculoskeletal Problems (LiMP) questionnaire. A score >= 6 reflects adequate musculoskeletal literacy and a score < 6 reflects limited musculoskeletal literacy. Associations between scores and differences between patient and surgeon expectations were assessed with Pearson Correlation coefficients. Associations between musculoskeletal health literacy and differences were assessed with Student’s t-tests and Mann Whitney U tests.Results:Greater differences in patient and surgeon overall expectations scores were associated with worse PROMIS scores in Physical Function (p = 0.003), Pain Interference (p = 0.001), Pain Intensity (p = 0.009), Global Physical Health (p < 0.001), and Depression (p = 0.009). A greater difference in the number of expectations between patients and surgeons was associated with all of the above (p <= 0.003) and with worse Global Mental Health (p = 0.003). Patient perceptions of higher surgeons’ partnership building were associated with a greater number of patient than surgeon expectations (r = 0.170, p = 0.017) (Table 1). There were no associations found between LiMP scores or adequate/limited musculoskeletal literacy and differences in expectations (p >= 0.155).Conclusion:Worse baseline patient physical and mental status and higher patient perceptions of provider partnership building were associated with greater patient to surgeon differences in expectations of foot and ankle surgery. It may be beneficial for surgeons to set more realistic expectations with patients who have greater disability and in those whom they have stronger partnerships with in order to increase agreement in expectations. Further studies are warranted to understand how modifications in patient and surgeon interactions affect agreement in their expectations of foot and ankle surgery, and whether musculoskeletal literacy affects these interactions.

Patient perception of Achilles tendon rupture treatment

The optimal treatment of Achilles tendon ruptures (ATRs) is a subject of some debate amongst orthopedic surgeons. Many patients’ understanding of Achilles injuries is limited and may be more informed by popular culture than anything objective. We sought to assess patient perceptions of ATRs using a proprietary questionnaire and correlate that with demographic information and the health literacy of the patient. Patients presenting with an Achilles tendon injury were asked to fill out a demographic form, the Literacy in Musculoskeletal Problems (LiMP) survey, to assess musculoskeletal health literacy, and a 22-question survey on ATRs designed to assess patient knowledge and perception of ATRs. Seventy percent of patients responded that surgery with or without other modalities is the most appropriate treatment for ATRs, while only 20% of patients responded that nonoperative treatment is most appropriate. Perceptions of treatment were not associated with demographic data or LiMP scores and appear to be biased to some degree towards surgery. In a setting in which the optimal treatment has not been fully worked out by surgeons, it is difficult to tell what influence patient perceptions may have on treatment, although it is possible these patient perceptions may cause surgeons to be more surgically aggressive.

Determinants of caregiver satisfaction in pediatric orthopedics.

This study investigates determinants of pediatric orthopedic surgery patients' parent or guardian (caregiver) satisfaction with the physician in an outpatient office setting. This was a cross-sectional survey study of 200 English-speaking caregivers of pediatric patients that checked into the pediatric orthopedic clinic at the authors' institution from 1 March 2017 to 1 November 2018. Questionnaires given in clinic include the Newest Vital Sign and The Literacy in Musculoskeletal Problems survey to measure general and musculoskeletal health literacy, respectively, demographic information, expected/estimated wait time, Consultation and Relational Empathy Measure, and Consumer Assessment of Healthcare Providers and Systems Clinician and Group. After multivariate regression, only perceived physician empathy as measured by the Consultation and Relational Empathy Measure score was significantly correlated with caregiver satisfaction (P < 0.0001), accounting for 56% of the variability of caregiver satisfaction scores. The odds of a satisfaction score of at least 9 out of 10 were 21% higher for every unit increase of the Consultation and Relational Empathy Measure score [odds ratio = 1.21 (P < 0.0001)]. After logistic regression, the caregiver's gender was also correlated with patient satisfaction and the odds of a patient satisfaction score ≥9 for males was less than 1/4th that of females [odds ratio = 0.16 (P = 0.040)]. The most important determinant of caregiver satisfaction with the physician in an outpatient pediatric orthopedic setting is perceived physician empathy. This accounts for the majority of the caregiver's satisfaction. This is the first study to determine this relationship in pediatric orthopedic surgery.

Evaluation of General and Musculoskeletal Health Literacy Disparities in Pediatric Sports Injury Patient and Guardian Populations

Increased participation of adolescents in organized sports has led to an increase in pediatric sports injury. Limited health literacy puts patients at risk for worse outcomes through decreased compliance. We aim to evaluate the extent of health literacy disparities in pediatric sports medicine populations. Patients aged 10 to 17 years and their consenting guardians visiting clinic for treatment of a sports-related injury completed a unique questionnaire including self-reported health literacy measures and direct assessment of knowledge regarding care for musculoskeletal injuries. Statistical analysis based on socioeconomic factors and demographics was performed using t tests. A total of 268 patient surveys (14.37±1.94 y) and 251 guardian surveys (43.62±9.08 y) were collected. In self-reported general health literacy scores for guardians, all categories except ethnicity played a statistically significant role, with higher health literacy scores associated with higher education, use of English as the primary language at home, private insurance, and female guardians (P<0.001, <0.001, <0.001, 0.011). In contrast, age was the only factor affecting scores in the patient population (P=0.015). Among self-reported musculoskeletal health literacy and directly measured musculoskeletal literacy scores, there were significant differences in groups by age, primary language, and level of education (P=0.020, 0.003). Significant disparities in general and musculoskeletal health literacy exist within pediatric sports medicine populations, most notably between guardian groups. Improving disparities in health literacy for these populations may best be aimed at guardians, using medical education through verbal/written instruction in multiple languages. Level IV.

Prevalence and Risk Factors of Limited Musculoskeletal Health Literacy in the Outpatient Setting: A Logistic Regression Model.

The purpose of this study was to determine the risk factors of limited musculoskeletal health literacy (MHL) in a general population of orthopaedic patients. Patients presenting to either a foot or ankle surgeon or hand or wrist surgeon were given the Literacy in Musculoskeletal Problems (LiMP) questionnaire, a nine-item survey for assessing "limited" MHL (LiMP score < 6). After confirming group homogeneity, the two populations were analyzed together to determine factors significantly correlated with and predictive of limited MHL. Overall, 231 patients were included in the analysis. Average LiMP score was 5.4 ± 1.8, and 49% of participants had "limited" MHL. Chi-square analysis revealed that being non-Caucasian, using cigarettes, and having a less than college-level education were associated with a higher prevalence of "limited" MHL (P < 0.05). Logistic regression revealed that being of non-Caucasian race (P = 0.04) or having less than college-level education (P = 0.03) were significant independent predictors of "limited" MHL, with adjusted relative risks of 1.37 and 1.40, respectively. In this study, the patients at the greatest risk of limited MHL are often at the risk of many other complications. These results should be used as a groundwork to craft directives aimed at improving MHL and outcomes in these patients.

Patient Perceptions of Achilles Tendon Rupture

Category: Sports Introduction/Purpose: The optimal treatment of Achilles tendon ruptures (ATRs) is a subject of some debate amongst orthopaedic surgeons. However, patient perceptions of ATRs are unclear. Many patients understanding of Achilles injuries is limited and may be more informed by popular culture than anything objective. Many patients may assume that an ATR necessitates surgical treatment or that surgical treatment is “better” because that is how professional athletes are often treated. These ideas may be related to a patient’s health literacy. We sought to assess patient perceptions of ATRs using a proprietary questionnaire and correlate that with health literacy and the education level of the patient. Methods: Patients presenting to an academic orthopaedic foot and ankle clinic with a complaint of Achilles tendon injury were asked to fill out a demographic form, the LiMP (Literacy in Musculoskeletal Problems) survey to assess musculoskeletal health literacy, and a 22 question survey on ATRs designed to assess patients knowledge and perception of ATRs that was modelled after a similar survey done for meniscal injuries. Results: Twenty-nine patients were surveyed with a mean age of 45 years. 62% of respondents noted that they had little knowledge of the Achilles, with the remaining 38% saying that their knowledge of the Achilles was moderate to considerable. 14% of those surveyed were employed in healthcare. The mean LiMP score was 4.91 (out of 9, mean in general population in another study was 4.68). 70% of patients replied that surgery alone or in combination with physical therapy was the most appropriate treatment for an ATR. Only 11% of patients responded that physical therapy with some immobilization was sufficient. Conclusion: Patient perception of ATR treatment appears to be biased to some degree towards surgery. In an educated patient group that scored well in terms of health literacy, a majority of patients felt that surgical treatment was most appropriate. In a setting in which the optimal treatment has not been fully worked out by surgeons, it is difficult to tell what influence patient perceptions may have on treatment, although it is possible these patient perceptions may cause surgeons to be more surgically aggressive.

A Mokken analysis of the literacy in musculoskeletal problems questionnaire

BackgroundLimited health literacy is known to impact on medication adherence, hospital readmission and potentially poorer health outcomes. The literature on the health literacy of those with musculoskeletal conditions suggests greater functional limitations and increased pain levels. There are a number of measures of health literacy. One that specifically relates to musculoskeletal complaints is the Literacy in Musculoskeletal Problems (LiMP) questionnaire. The LiMP contains 9 multiple choice items that cover anatomy, musculoskeletal conditions and the diagnosis of musculoskeletal complaints. The aim of the study was to evaluate the dimensionality and internal structure of the LiMP in patients attending for osteopathy care at a student-led clinic, as a potential measure of musculoskeletal health literacy.MethodThree hundred and sixty-one (n = 361) new patients attending the Victoria University Osteopathy Clinic completed the LiMP and a demographic and health information questionnaire prior to their initial consultation. Mokken scale analysis, a nonparametric item response theory approach, was used to evaluate the dimensionality and structure of the LiMP in this population, to ascertain whether the questionnaire was measuring a single latent construct – musculoskeletal health literacy. McDonald’s omega and Cronbach’s alpha were calculated as the reliability estimations. The relationship between the LiMP and a single item screen of health literacy was also undertaken.ResultsThe 9 items on the LiMP did not form a Mokken scale and the reliability estimations were below an acceptable level (alpha and omega <0.45). LiMP items 5 and 8 were more likely to be answered correctly by those with higher health literacy (p < 0.05), however the effect sizes were small (<0.20).ConclusionCalculation of a total score for the LiMP, as advocated by the original authors, is not supported based on data in the present study. Further research is required to explore the relationship of the LiMP items to demographic and clinical data, and to other broader measures of health literacy. Further research may also develop a health literacy measure that is specific to patients seeking manual therapy care for musculoskeletal complaints.

Does musculoskeletal health literacy differ between urban and rural orthopaedic patients?

Background: Many patients lack the necessary skills needed to make informed decisions regarding their health. This critical skill set, broadly defined as health literacy, is influenced by various demographic factors including age, gender, ethnicity, education, and socioeconomic status. Patients seeking care for musculoskeletal ailments are afflicted by low health literacy, with several studies identifying higher rates of inadequate musculoskeletal health literacy than general health literacy. This study aimed to evaluate and compare the prevalence of limited musculoskeletal health literacy in patients seeking orthopaedic care in both urban and rural environments, looking at the geographical distribution in a single state. Methods: Validated health literacy assessment instruments and demographic surveys were administered to patients seeking musculoskeletal care in two emergency departments (one rural, one urban). Patients were eligible to participate if they had a single musculoskeletal complaint, were at least 18 yr old, and spoke English. Results: There were 55 participants in the rural emergency department (ED), and 65 in the urban ED. Adequate general health literacy was found in 62% of rural and 52% of urban patients, while 44% of rural and 43% of urban patients had adequate musculoskeletal health literacy. There was no significant difference in the prevalence of adequate health literacy between the two populations, but both cohorts had significantly worse rates of musculoskeletal health literacy as compared to general health literacy (P&lt;0.05). Conclusions: This study confirms that there is a greater prevalence of limited musculoskeletal health literacy as compared to general health literacy, and that this transcends geographic boundaries.

Musculoskeletal Health Literacy in Patients With Foot and Ankle Injuries: A Cross-Sectional Survey of Comprehension.

Approximately 33% of Americans have inadequate health literacy, which is associated with decreased medical knowledge, increased hospitalization and use of emergency care, and worse control of diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients presenting to the emergency department (ED) with foot and ankle-related complaints, as these individuals may be at increased risk for inferior outcomes. In this cross-sectional study, individuals ≥18 years of age presenting with foot and ankle-related complaints to the ED were invited to participate. Participants completed a demographic survey and the LiMP questionnaire, with scores ≥6 indicative of adequate musculoskeletal literacy. The prevalence of adequate health literacy and the influence of demographic parameters was assessed. P values <.05 were considered significant. The mean LiMP score was 5 ± 2.06. Limited musculoskeletal health literacy was seen in 32% of participants (18/56). Although gender (male), a current or prior employment in a health care field, and having previously seen a physician for a musculoskeletal complaint correlated with higher literacy rates, these values did not reach statistical significance (P > .05). However, Caucasians and those with higher levels of education (equal to or more than college) were significantly more likely to possess adequate literacy (P = .008, P = .04, respectively). Approximately one third of patients presenting to the ED with foot and ankle-related complaints have limited musculoskeletal literacy and may lack the necessary skills required for making informed decisions regarding their care. This is concerning and has tremendous socioeconomic implications, as more than 23 000 people per day require medical care for ankle sprains in the United States, with average treatment costs for this injury in the ED setting estimated at $1498. Identification of those most at risk is thus crucial and will facilitate the development of interventions geared toward those most vulnerable. Prognostic, Level IV study.