Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) as an indicator of health status and health literacy in an urban setting

Objective: The Musculoskeletal Health Questionnaire (MSK-HQ) is a standardized musculoskeletal outcomes measure for the health status of patients with various musculoskeletal conditions. The objective of this study was to investigate the patient reported outcomes using the MSK-HQ in an urban patient population that has a unique set of needs. Specifically, the patient population in the South Bronx, New York has defining demographic and clinical characteristics of low-income, English as a second language, and high rates of obesity. Moreover, patients in this community are at high risk for low rates of health literacy. This study aims to use the MSK-HQ to identify how living in an urban setting impacts patients’ access to affordable and quality care. Methods: Patients (n=83) at the BronxCare Health System Department of Orthopaedics outpatient clinics were surveyed using the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ). The total number of patients were divided into 4 cohorts based on their musculoskeletal condition; spine (n=21), hand and upper extremity (n=29), sports medicine (n=17), and arthroplasty candidates (n=16). The MSK-HQ is a 15-item survey that assesses musculoskeletal disability and levels of physical activity. The minimum score of the questionnaire is 0 and maximum score is 56. A decrease in the total score indicates an decrease in Patient Reported Outcome Measures (PROMs). The patients were individually screened with the questionnaire. Those that declared English as a second language were screened with the aid of a telephone translator. Results: The mean age was 51.6 years old ± 14.1 years. There were 57 (70.37%) females and 24 (29.63%). The mean BMI was 31.0 ± 7.9. There were 12 (14.81%) patients that classified under normal weight conditions, 32 (39.51%) overweight, and 37 (45.68%) obese. The mean Patient Reported Outcome Measures (PROMs) for spine was 22.14, 31.46 for hand, 24.56 for sports, and 26.81 for arthroplasty candidates. The mean score for the patient’s understanding of condition and treatment for spine was 1.9 for spine, 2.36 for hand, 2.38 for sports, and 2.38 for arthroplasty candidates. Sex and the PROMs did not show correlation. There was a correlation between increasing BMI and decreasing PROMs for spine patients. However, there was no significant correlation between BMI and the PROMs of the other musculoskeletal conditions. The spine cohort exhibited the least understanding of their condition and treatment, suggesting a correlation between a patient’s health literacy and his or her overall PROMs. Health literacy did not correlate with English as a second language (ESL). The spine cohort demonstrated the lowest PROMs while the hand cohort had the highest PROMs. Conclusion: This is the first study to make use of the MSK-HQ in an urban setting within the United States. The unique clinical characteristics within this urban population include a mean BMI of obesity, as well as a large percentage of patients with English as a second language and low health literacy. The cohort of individuals that had the worst PROM were those treated for spine conditions, while patients treated for hand and upper extremity conditions had the best PROMs. A possible explanation for this finding is increased BMI within the spine cohort, as well as decrease in patient reported understanding of condition and current treatment. Additionally, as a translator was used for each patient who indicated ESL, there was no correlation found between health literacy, total score and ESL.