Musculoskeletal Literacy in Orthopedics: Associated Factors, Effects on Patient-Physician Communication and Intervention Strategies



1 Montefiore Medical Center - Department of Orthopaedic Surgery, New York, USA

2 Alexandria University - Department of Orthopaedic Surgery, Alexandria, Egypt

3 Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain


Health literacy is defined as the degree to which an individual obtains and processes basic health 
information and services so as to make appropriate and informed health decisions. Limited health 
literacy (LHL), as assessed by various validated instruments, remains prevalent amongst older adult 
patients, non-Caucasian ethnicities, and those of lower socioeconomic backgrounds. Of concern, LHL 
has been associated with decreased medical knowledge, disuse of preventative medical services, 
worse chronic disease control and increased use of emergency services. Within orthopedics 
specifically, LHL has been associated with lower expectations regarding outcomes and ambulation 
following total hip and knee surgery and fewer questions asked regarding diagnosis and treatment in 
the outpatient care setting. In some cases, LHL has been independently correlated with worse patient -
reported outcome measures (PROMs), though this finding may be due in part to the reading level 
required of the PROMs. There is growing evidence that active intervention by the orthopedic provider 
and demonstration of empathy improves patient comprehension of the nature of their musculoskeletal 
complaints, aids informed decision-making and, ultimately, maximizes patient satisfaction. Recognition 
of the associated factors for LHL will ensure improved physician-patient communication through the 
implementation of health literate interventions focused on those most at-risk.
 Level of evidence: III


Main Subjects

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