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Readability of Online Patient Resources for Hand and Upper Extremity Procedures
Julia A. Cook, BS; Sarah E. Sasor, MD; Sunil S. Tholpady, MD PhD; Michael W. Chu, MD
Indiana University, Indianapolis, IN
Introduction: Patient education is essential to establish a therapeutic alliance, patient satisfaction, and clinical outcomes. As patient satisfaction becomes increasingly linked to medical reimbursement, patient education will have financial implications as well. The National Institute of Health and the American Medical Association recommend that all patient resources be written at a sixth grade reading level. However, online resources are often written at a higher recommended reading level. The purpose of this study is to assess readability of online material for hand and upper extremity procedures found on academic plastic surgery and orthopedic surgery websites.
Materials and Methods: An internet search was performed of all academic hospitals that had both plastic surgery and orthopedic surgery training programs. Average word and syllable count was performed for each procedure. Readability analyses were conducted using the Flesch-Kincaid Reading Ease, Flesch-Kincaid Grade Level, SMOG Index, Gunning-Fog Score, Automated Readability Index, and Coleman-Liau Index. A two-tailed z-test was used to compare scores and statistical significance was set at p < 0.05.
Results: Seventy-six programs were identified; 42 had educational material. The overall average readability for all information was at the 11.92 grade reading level. Orthopedic surgery education materials had a statistically higher average grade reading level of 12.12 ± 0.91 than plastic surgery (11.78 ± 1.19, p < 0.001). Carpal tunnel release was the most commonly described procedure for both plastic and orthopedic surgery sites (98% and 93%, respectively). Information regarding De Quervain’s tenosynovitis surgical treatment had the highest grade reading level for all plastic surgery procedures (13.45 ± 0.75); hand arthritis surgical treatment had the highest grade reading level for all orthopedic surgery procedures (12.82 ± 0.94). Ganglion cyst excision had the lowest grade level for both plastic surgery and orthopedic surgery (10.15 ± 0.67 and 11.01 ± 0.97, respectively; p = 0.12). There were no differences in text complexity between geographic regions.
Conclusion: Online resources for hand and upper extremity procedures are more complex than the recommended sixth grade reading levels. The complexity of written patient resources represents an obstacle to online patient education. Future efforts to address written patient education materials would benefit patients seeking medical information for hand surgery.
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