Readability of Patient-Reported Outcome Measures for Persons with Aphasia

The relationship between positive health outcomes in persons with aphasia (PWA) and personcentered care is highlighted by personally relevant information obtained directly from the PWA. Such is often facilitated via patient reported outcome measures (PROMs). In order to provide accurate responses to PROMs, PWAs must to read, comprehend, formulate and generate answers to a variety of questions. PROMs designed for other clinical populations assessed/treated by speech-language pathologists have been found to be largely unreadable. Despite the significant role of PROMs in assessment and management of aphasia, no study to date has examined the readability of these measures. Four readability formulae were applied to identified PROMs for PWAs. These formulae estimate readability in terms of reading grade level and provide additional, quantitative information regarding textual elements such as syllable, word, and sentence length, complexity, and frequency. Fourteen PROMs were identified, per review of extant literature. A Macintosh-based readability software program was used to perform readability analyses. Additional metrics of clinical utility were applied to the selected measures via the Clinical Utility Scale. Results indicate that, on average, PROMs designed for PWAs are written at an eighth-grade reading level which is discordant with fourth-to-sixth reading grade level recommendations set forth by health literacy experts. Scores derived from the Clinical Utility Scale highlight the disconnect among measures that are easy to implement but are unreadable. Further analysis indicates that syllable-, word-, and sentence-level complexities can also impact the difficulty of analyzed texts. Results of the present study are consistent with prior PROM analyses performed across a variety of clinical populations assessed/treated by speech-language pathologists. Clinical implications and limitations of the present study are discussed as well as directions for further research