Health literacy; patient reported outcomes; PROMIS; SANE; orthopaedic surgery; Health LiTT


Orthopedics | Sports Medicine


Background: Health literacy may be an important factor in patient health outcomes, however, prior research has primarily focused on primary care patients with research in orthopaedic specific populations lacking.

Questions/purposes: The purpose of this study was to examine the relationship between health literacy and patient reported outcomes in an orthopaedic patient population.

Patients and Methods: 183 patients >18 years of age who presented to our institution’s sports orthopaedic surgery clinic with shoulder or knee complaints were analyzed. The primary outcomes were physical function recorded using Patient-Reported Outcomes Measurement Information System (PROMIS) physical function and Single Assessment Numerical Evaluation (SANE) scores. Health literacy was determined utilizing Health LiTT, a self-administered multimedia touchscreen test based on item response theory that provides a numerical score of 0-100 with a score >50 suggestive of health literacy. In addition, demographic data including age, race, gender, highest level of education, injury location, and surgery status were collected.

Results: Bivariate analysis revealed that low health literacy (Health LiTT score

Conclusions: Our data showed that PROMIS scores are less reliant on health literacy and more dependent on age, employment status, having surgery and low education level achieved. Adaptations to clinical practice may be necessary to better guide these select populations and improve patient-reported physical function. Furthermore, PROMIS measures can be administered successfully to patients regardless of health literacy.

Level of Evidence: Level II

Table1.docx (105 kB)
Demographics by participant status

Table2.docx (91 kB)
Differences in PROMIS scores by demographics

Table3.docx (102 kB)
Factors influencing Health LiTT Scores

Table4.docx (15 kB)
OLS regression model