title: Health Literacy in Patients Seeking Orthopaedic Care: Results of the Literacy in Musculoskeletal Problems (LIMP) Project.
abstract: BACKGROUND
  Health literacy is the most important predictor of an individual's health status, with more frequent hospitalizations, worse control of chronic conditions, and suboptimal treatment outcomes associated with limited literacy. Despite this, little is known about musculoskeletal health literacy. As such, this study utilized a musculoskeletal specific literacy survey (the LiMP questionnaire) to evaluate the level of comprehension in patients presenting to the emergency department with musculoskeletal complaints, with an emphasis on their understanding of anatomy, terminology, diagnosis and treatment of musculoskeletal conditions. The relationship between musculoskeletal specific and general health literacy was also assessed, in addition to the risk factors for limited musculoskeletal comprehension.
  
  
  METHODS
  In this cross-sectional study, each of the 248 participants completed a demographic survey, the LiMP questionnaire, and the Newest Vital Sign (NVS), a general health literacy assessment tool. A x(2) analysis was used to compare results from the LiMP questionnaire and NVS, and to evaluate the relationship between musculoskeletal health literacy and demographic parameters.
  
  
  RESULTS
  The mean LiMP score was 4.68 ± 1.78 out of a possible nine points. Questions regarding musculoskeletal conditions were answered correctly by 47.4% of respondents. Questions regarding diagnosis and treatment were answered correctly by 31.2% of respondents. Questions regarding anatomy and terminology were answered correctly by 65.3% of respondents. Limited musculoskeletal literacy, defined as LiMP questionnaire scores of <6, was observed in 69% of subjects. Inadequate general health literacy, defined as NVS scores <4, was observed in 48% of subjects. This difference was statistically significant (p<0.001). Those who identified themselves as Caucasian and having an education level of ≥ college were significantly more likely to have adequate musculoskeletal literacy (p=0.001, p<0.001, respectively).
  
  
  CONCLUSIONS
  The prevalence of limited musculoskeletal literacy is greater than that of limited general health literacy, with minorities and those with lower education levels most at risk. These findings are consistent with other disease and specialty specific literacy studies. Although such insight will assist providers in accurately targeting education and outreach campaigns, it remains imperative that additional research be performed to determine if limited literacy correlates with increased complications and worse outcomes in those with musculoskeletal conditions.
  
  
  METHODS
  Level IV. The authors have no relevant financial disclosures or conflicts of interest with regard to this manuscript. No funding was received.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Rosenbaum
authors.forename: Denis
authors.initials: D
authors.lastname: Pauze
authors.forename: Daniel
authors.initials: D
authors.lastname: Pauze
authors.forename: Nancy
authors.initials: N
authors.lastname: Robak
authors.forename: Ralph
authors.initials: R
authors.lastname: Zade
authors.forename: Michael
authors.initials: M
authors.lastname: Mulligan
authors.forename: Richard L
authors.initials: RL
authors.lastname: Uhl
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004522:Educational Status; D004636:Emergency Service, Hospital; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D057226:Information Seeking Behavior; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000601:surgery*; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D015995:Prevalence; D011634:Public Health; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult