TY - JOUR
T1 - The relationship between musculoskeletal health literacy and upper extremity patient-reported outcome measures (PROMs) in the setting of atraumatic shoulder pain
AU - Gruson, Konrad
AU - Mahmoud, Shady
AU - Zhu, Nina
AU - Lo, Yungtai
AU - Gruson, Hiroko T.
AU - Schwartz, Brittany
N1 - Publisher Copyright:
© 2021 Elsevier Masson SAS
PY - 2022/9
Y1 - 2022/9
N2 - Introduction: Patient-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. Hypothesis: Patients with limited MHL would demonstrate lower median scores on baseline PROMs compared with those with adequate MHL. Materials and methods: New 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. Results: A 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 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. Discussion: The 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 evidence: II; diagnostic.
AB - Introduction: Patient-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. Hypothesis: Patients with limited MHL would demonstrate lower median scores on baseline PROMs compared with those with adequate MHL. Materials and methods: New 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. Results: A 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 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. Discussion: The 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 evidence: II; diagnostic.
KW - Atraumatic shoulder pain
KW - Health disparities
KW - Musculoskeletal health literacy
KW - Patient-centered care
KW - Patient-reported outcome measures
KW - QuickDASH
KW - Single Assessment Numeric Evaluation
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U2 - 10.1016/j.otsr.2021.103165
DO - 10.1016/j.otsr.2021.103165
M3 - Article
C2 - 34871797
AN - SCOPUS:85124665735
SN - 1877-0568
VL - 108
JO - Orthopaedics and Traumatology: Surgery and Research
JF - Orthopaedics and Traumatology: Surgery and Research
IS - 5
M1 - 103165
ER -