Increasing the Accessibility of the PFDI-20 by Evaluating its Readability and Understandability

Objectives: To evaluate the overall readability and understandability of the pelvic floor disability index (PFDI-20) in order to assess its accessibility to patients.

Methods: Readability analysis was conducted with validated accessibility tools, including two Flesch-Kincaid readability tests: The Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Score (FKGS). Understandability was assessed using the Patient Education and Materials Assessment Tool (PEMAT).

Results: The mean FRES reading level for the PFDI-20 was 50 (college-freshman reading level). Ninety percent of questions were written above the recommended sixth-grade reading level, while 35% of questions were written at a college graduate level or above. The mean FKGS was 9.9., though 40% of questions were above 10. Only two of the 20 questions in the screening tool had both the recommended FRES and FKGS scores for readability. Lastly, the PEMAT understandability score was 46%, which is below the 70% acceptability threshold.

Conclusions: Because the PFDI-20 is one of the most used screening tools for pelvic floor disorders, it is important that the questionnaire be easily understandable and readable for patients. Currently, the PFDI-20 does not align with public health readability or understandability standards, making the tool less accessible and not as useful to many patients. Developing more appropriate and targeted patient screening tools for pelvic floor discomfort may improve patient understanding and promote more accurate screening.