Worse health literacy linked to greater preoperative symptom severity in shoulder patients
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Results showed patients who have difficulty understanding and acting on medical information are at greater risk for decreased preoperative function and pain control, as well as prolonged hospitalizations, after shoulder arthroplasty.
Richard N. Puzzitiello, MD, and colleagues retrospectively analyzed data on 230 patients who underwent elective inpatient reverse or anatomic shoulder arthroplasty between January 2018 and May 2021. Researchers used the four-item Brief Health Literacy Screening Tool (BHLST) to determine the health literacy of each patient. The four questions included the following:
- How confident are you filling out medical forms by yourself?
- How often do you have someone help you read hospital materials?
- How often do you have problems learning about your medical conditions because of difficulty understanding written information?
- How often do you have a problem understanding what is told to you about your medical condition?
Limited health literacy (LHL) was defined by a score of less than or equal to 17 on the BHLST.
According to the study, outcome measures included preoperative patient-reported outcome scores, range of motion, length of stay (LOS), postoperative inpatient opioid consumption and total inpatient costs.
Among the cohort, 25.2% of patients (n = 58) were classified with LHL. Preoperatively, these patients had higher rates of opioid use and more self-reported allergies, as well as decreased American Shoulder and Elbow Surgeons scores, VAS pain scores, forward elevation and external rotation. After multivariable analysis, researchers found LHL was an independent predictor of a “significantly longer” LOS. Patients with LHL had a mean LOS of 1.84 days, while patients who were not classified with LHL had a mean LOS of 1.57 days. Puzzitiello and colleagues noted no differences between the groups in postoperative inpatient opioid consumption or total inpatient costs.
“LHL is commonplace among patients undergoing elective shoulder arthroplasty and is associated with greater preoperative symptom severity and activity intolerance,” the researchers wrote in the study. “Its association with longer hospitalizations suggests that health literacy is an important factor to consider for postoperative disposition planning,” they concluded.
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