Readability Analysis of Commonly Cited Patient-Reported Outcome Measures in the Orthopaedic Joint Literature
Bibliographic record
Abstract
Background: Patient-reported outcome measures (PROMs) are vital for assessing surgical effectiveness and capturing patient perspectives on function, symptoms, and quality of life. To ensure patients can accurately complete these tools, readability is essential. The National Institutes of Health and American Medical Association recommend patient materials be written at or below a 6th-grade reading level. This study evaluated the readability of commonly cited PROMs in the orthopaedic joint literature to assess compliance with these standards. Methods: Thirty-five PROMs were analyzed using 2 validated readability metrics: the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) Index. A FRES ≥80 or SMOG <7 indicated 6th-grade readability. Scores were calculated using an online readability calculator and compared to National Institutes of Health and American Medical Association guidelines. Results: The average FRES was 67 (range, 21-90), and the average SMOG Index was 8 (range, 6-12), indicating an overall 8th- to 9th-grade reading level. Only 6 PROMs (17%) met the readability threshold. Among the least readable were the University of California, Los Angeles Activity Score, Modified Cincinnati Knee Rating System, Hamilton Depression Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, Kujala Score, International Knee Documentation Committee score, and Tampa Scale of Kinesiophobia. Conclusions: Most PROMs commonly cited in the orthopaedic joint literature are written above the recommended 6th-grade level, which may compromise patient understanding and data quality. Improving readability through revision or development of new tools may enhance patient accessibility and the accuracy of reported outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.029 | 0.171 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.026 | 0.012 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".