Letter to the Editor: Editor’s Spotlight/Take 5: Most American Academy of Orthopaedic Surgeons’ Online Patient Education Material Exceeds Average Patient Reading Level
To the editor,
We were pleased to read your recent “Editor’s Spotlight”  in CORR®. Thank you for highlighting the important roles that education and communication play in treating patients.
As you show, better patient education can lead to better clinical outcomes. The problem is often the gap between what a patient hears in an office visit and what he or she ultimately understands.
OrthoInfo, a patient information website from the American Academy of Orthopaedic Surgeons, aims to bridge that gap. The goal of OrthoInfo is to balance content with readability. We aim to be concise, interesting and informative. New and updated articles have more illustrations to enhance the presentation. Many popular articles have been translated into Spanish to reach a broader segment of the population. By providing in-depth information, we can help a patient decide what questions to ask when visiting a doctor and also supplement the information he or she receives during that visit. By necessity, that means we have to present topics in greater detail.
We are concerned about readability. As you point out, OrthoInfo readability scores have come down in the past few years. However, bringing them down much lower would require leaving out important material. Otherwise, articles at a sixth-grade level would be much longer and less attractive to many readers scrolling down a page.
Flesch-Kincaid is a computer formula, nothing more. When you are writing about “pigmented villonodular synovitis,” “adolescent idiopathic scoliosis,” and “autologous chondrocyte implantation” it is difficult to reach a lower grade level based on that formula.
One way we can clearly communicate complex information in a clear and concise manner is by utilizing our multimedia tools. The OrthoInfo website recently added 13 animations of common procedures with simple narration. OrthoInfo has a large collection of videos and slide show tutorials, with more under development.
Taking your example of clubfoot, our new article has 11 pictures. A patient looking at just pictures and captions alone would have a good idea about what a clubfoot is and how it is treated. The pictures are as important as the text.
It is one thing to present a simple four sentence, 65-word explanation as you have done in the “Editor’s Spotlight.” It is quite another to maintain a sixth-grade level in a complete 2000 word article. Most patients who receive a simple explanation will come to the web looking for more detail. The readability of an article is based on the organization, narrative, and flow of the writing. It is much more than a computer score. Having primary and secondary sources of information would be ideal, but with a website containing more than 400 topics that is impracticable.
We appreciate the emphasis you have placed on patient education. These types of articles featured in CORR® and other journals can stimulate practicing surgeons to think about how they can best provide information to their patients.
We thank and commend you for leading the discussion.