Health literacy in an orthopedic trauma patient population: A cross-sectional survey of patient comprehension

Objectives: The aim of this study was to evaluate the level of comprehension in an orthopedic trauma patient population regarding injury, surgery, and postoperative instructions and to determine if educational background is associated with inadequate comprehension. Design: This involved a prospective observational cohort. Setting: The study was conducted at an Academic Level 1 trauma center. Patients: From April to June 2011, 248 orthopedic trauma patients with an operatively fixed isolated fracture were found to be eligible for inclusion. One hundred forty-six eligible questionnaires were collected (58.9% response rate). Intervention: The patients were administered a questionnaire during their first postoperative visit before being seen by a physician. The questionnaire included demographic information and questions regarding (1) which bone was fractured; (2) the type of implanted fixation; (3) weight-bearing status; (4) expected recovery time; and (5) need for deep vein thrombosis (DVT) prophylaxis. Multivariable logistic regression analyses were used to examine the association between educational level and questions regarding surgical procedure and discharge instructions. Results: The overall mean score of all the patients on the patient comprehension portion was 2.54 ± 1.27 correct responses out of 5. Only 47.9% of patients knew the bone they fractured, and 18.5% knew their expected healing time. Of the patients, 66.4% knew the type of implanted fixation, and 45.2% knew their weight-bearing status. The patients (74.0%) knew their DVT prophylaxis medication(s). The mean score for patients in the group ≤ HS (high-school education or less) was 2.26, whereas the mean score for patients in the group > HS (more than high-school education) was 3.00 (P = 0.0009). The patients in the group > HS were 2.54 times more likely to know the bone they fractured (P = 0.01), 3.82 times more likely to know the recovery time (P = 0.004), and 2.79 times more likely to know their DVT prophylaxis medication(s) than patients in the group ≤ HS. Conclusions: Orthopedic trauma patients demonstrated limited comprehension of their injuries, surgeries, and postoperative instructions. Patients with lower educational levels did significantly worse on the questionnaire than those with higher educational levels. The results of the study highlight a lack of comprehension within this patient population and suggest that an increased focus on patient communication by orthopedic providers may be necessary. Level Of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.