title: Musculoskeletal Health Literacy in Patients With Foot and Ankle Injuries: A Cross-Sectional Survey of Comprehension.
abstract: OBJECTIVE
  Approximately 33% of Americans have inadequate health literacy, which is associated with decreased medical knowledge, increased hospitalization and use of emergency care, and worse control of diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients presenting to the emergency department (ED) with foot and ankle-related complaints, as these individuals may be at increased risk for inferior outcomes.
  
  
  METHODS
  In this cross-sectional study, individuals ≥18 years of age presenting with foot and ankle-related complaints to the ED were invited to participate. Participants completed a demographic survey and the LiMP questionnaire, with scores ≥6 indicative of adequate musculoskeletal literacy. The prevalence of adequate health literacy and the influence of demographic parameters was assessed. P values <.05 were considered significant.
  
  
  RESULTS
  The mean LiMP score was 5 ± 2.06. Limited musculoskeletal health literacy was seen in 32% of participants (18/56). Although gender (male), a current or prior employment in a health care field, and having previously seen a physician for a musculoskeletal complaint correlated with higher literacy rates, these values did not reach statistical significance (P > .05). However, Caucasians and those with higher levels of education (equal to or more than college) were significantly more likely to possess adequate literacy (P = .008, P = .04, respectively).
  
  
  CONCLUSIONS
  Approximately one third of patients presenting to the ED with foot and ankle-related complaints have limited musculoskeletal literacy and may lack the necessary skills required for making informed decisions regarding their care. This is concerning and has tremendous socioeconomic implications, as more than 23 000 people per day require medical care for ankle sprains in the United States, with average treatment costs for this injury in the ED setting estimated at $1498. Identification of those most at risk is thus crucial and will facilitate the development of interventions geared toward those most vulnerable.
  
  
  METHODS
  Prognostic, Level IV study.
authors.affiliation: Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York andrewjrosenbaum@gmail.com.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Rosenbaum
authors.affiliation: Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
authors.forename: Jason
authors.initials: J
authors.lastname: Tartaglione
authors.affiliation: Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Abousayed
authors.affiliation: Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Uhl
authors.affiliation: Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Mulligan
authors.affiliation: Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
authors.forename: Max
authors.initials: M
authors.lastname: Alley
authors.affiliation: Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
authors.forename: John A
authors.initials: JA
authors.lastname: DiPreta
mesh_terms: D000328:Adult; D016512:Ankle Injuries; D032882:Comprehension; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D018409:Foot Injuries; D057220:Health Literacy; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires
keywords: Health Literacy; LiMP; Literacy in Musculoskeletal Problems Questionnaire; Musculoskeletal Health Literacy