Home Clean Living Limited health literacy is detrimental for patients undergoing shoulder arthroplasty

Limited health literacy is detrimental for patients undergoing shoulder arthroplasty


August 16, 2022

1 min read


Puzzitiello reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Results showed patients who have difficulty understanding and acting on medical information are at greater risk for decreased preoperative function and pain control as well as prolonged hospitalizations after shoulder arthroplasty.

Richard N. Puzzitiello, MD, and colleagues retrospectively analyzed data on 230 patients who underwent elective inpatient reverse or anatomic shoulder arthroplasty between Jan. 2018 and May 2021. The researchers used the 4-item Brief Health Literacy Screening Tool (BHLST) to determine health literacy of each patient. The four questions included: How confident are you filling out medical forms by yourself; How often do you have someone help you read hospital materials; How often do you have problems learning about your medical conditions because of difficulty understanding written information; How often do you have a problem understanding what is told to you about your medical condition? Limited health literacy (LHL) was defined by a score less than or equal to 17 on the BHLST.

25.2% of patients were classified with limited health literacy, defined by a score less than or equal to 17 on the Brief Health Literacy Screening Tool. Data were derived from Puzzitiello RN, et al. J Shoulder Elbow Surg. 2022;doi:10.1016/j.jse.2022.05.001.

According to the study, outcome measures included preoperative patient-reported outcome scores, range of motion, length of stay (LOS), postoperative inpatient opioid consumption and total inpatient costs.

Among the cohort, 25.2% of patients (n = 58) were classified with LHL. Preoperatively, these patients had higher rates of opioid use and more self-reported allergies, as well as decreased American Shoulder and Elbow Surgeons scores, VAS pain scores, forward elevation and external rotation. After multivariable analysis, researchers found LHL was an independent predictor of a “significantly longer” LOS. Patients with LHL had a mean LOS of 1.84 days, while patients who were not classified with LHL had a mean LOS of 1.57 days. Puzzitiello and colleagues noted no differences between the groups in postoperative inpatient opioid consumption or total inpatient costs.

“LHL is commonplace among patients undergoing elective shoulder arthroplasty and is associated with greater preoperative symptom severity and activity intolerance,” the researchers wrote in the study. “Its association with longer hospitalizations suggests that health literacy is an important factor to consider for postoperative disposition planning,” they concluded.

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