Assessment of orthopaedic literacy in an urban emergency department

Background: Health literacy is considered the single best predictor of an individual's health status. However, it often is difficult to assess. As such, our group developed the Literacy in Musculoskeletal Problems (LiMP) questionnaire, a musculoskeletal-specific literacy assessment tool. We hypothesized that the degree of inadequate musculoskeletal health literacy would be higher than the rate of inadequate general healthy literacy, as assessed through the Newest Vital Sign (NVS). Methods: Each of the 65 study participants completed a demographic questionnaire, the NVS and the LiMP survey. The NVS and LiMP scores were assessed using contingency table analysis. Categorical outcome variables as a function of demographic parameters also were compared using χ2 tests. Results: More subjects were found to have inadequate musculoskeletal literacy (60%) as compared with general health literacy (48%). Contingency table analysis showed that at LiMP scores of less than 6, the sensitivity and specificity (0.74 and 0.59, respectively) were optimized for predicting limited literacy, as defined by an NVS score of 3 or less. A significantly higher rate of adequate musculoskeletal literacy was observed in Caucasian patients and those who had previously seen a physician for a musculoskeletal complaint. Conclusions: The LiMP's sensitivity and reliability is in line with prior work on disease and specialty-specific literacy, making it a valid and reliable musculoskeletal literacy assessment instrument. It is only with the ability to identify those lacking the skills crucial to making informed decisions regarding their musculoskeletal health that we can accurately target education campaigns, an approach that will ultimately enhance physician-patient interactions and improve clinical outcomes.