Abstract
Purpose
Orthopaedic patient education materials (PEMs) have repeatedly been shown to be well above the recommended reading level by the National Institute of Health and American Medical Association. The purpose of this study is to create a standardized method to improve the readability of PEMs describing spine-related conditions and injuries. It is hypothesized that reducing the usage of complex words (≥ 3 syllables) and reducing sentence length to < 15 words per sentence improves readability of PEMs as measured by all seven readability formulas used.
Methods
OrthoInfo.org was queried for spine-related PEMs. The objective readability of PEMs was evaluated using seven unique readability formulas before and after applying a standardized method to improve readability while preserving critical content. This method involved reducing the use of > 3 syllable words and ensuring sentence length is < 15 words. Paired samples t-tests were conducted to assess relationships with the cut-off for statistical significance set at p < 0.05.
Results
A total of 20 spine-related PEM articles were used in this study. When comparing original PEMs to edited PEMs, significant differences were seen among all seven readability scores and all six numerical descriptive statistics used. Per the Flesch Kincaid Grade level readability formula, one original PEM (5%) versus 15 edited PEMs (75%) met recommendations of a sixth-grade reading level.
Conclusion
The current study shows that using this standardized method significantly improves the readability of spine-related PEMs and significantly increased the likelihood that PEMs will meet recommendations for being at or below the sixth-grade reading level.
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References
OrthoInfo (2022) American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/
Stelzer JW, Wellington IJ, Trudeau MT, Mancini MR, LeVasseur MR, Messina JC, Mazzocca AD (2022) Readability assessment of patient educational materials for shoulder arthroplasty from top academic orthopedic institutions. JSES Int 6:44–48. https://doi.org/10.1016/j.jseint.2021.08.004
Sheppard ED, Hyde Z, Florence MN, McGwin G, Kirchner JS, Ponce BA (2014) Improving the readability of online foot and ankle patient education materials. Foot Ankle Int 35:1282–1286. https://doi.org/10.1177/1071100714550650
Roberts H, Zhang D, Dyer GS (2016) The readability of AAOS patient education materials: evaluating the progress since 2008. J Bone Jt Surg Am 98:e70. https://doi.org/10.2106/JBJS.15.00658
Mehta MP, Swindell HW, Westermann RW, Rosneck JT, Lynch TS (2018) Assessing the readability of online information about hip arthroscopy. Arthroscopy 34:2142–2149. https://doi.org/10.1016/j.arthro.2018.02.039
Badarudeen S, Sabharwal S (2010) Assessing readability of patient education materials: current role in orthopaedics. Clin Orthop Relat Res 468:2572–2580. https://doi.org/10.1007/s11999-010-1380-y
Yi MM, Yi PH, Hussein KI, Cross MB, Della Valle CJ (2017) Readability of patient education materials from the web sites of orthopedic implant manufacturers. J Arthroplasty 32:3568–3572. https://doi.org/10.1016/j.arth.2017.07.003
Kakazu R, Schumaier A, Minoughan C, Grawe B (2018) Poor readability of AOSSM patient education resources and opportunities for improvement. Orthop J Sports Med 6:2325967118805386. https://doi.org/10.1177/2325967118805386
Cotugna N, Vickery CE, Carpenter-Haefele KM (2005) Evaluation of literacy level of patient education pages in health-related journals. J Community Health 30:213–219. https://doi.org/10.1007/s10900-004-1959-x
Weiss BD, Coyne C (1997) Communicating with patients who cannot read. N Engl J Med 337:272–274. https://doi.org/10.1056/NEJM199707243370411
Doak LG, Doak CC, Meade CD (1996) Strategies to improve cancer education materials. Oncol Nurs Forum 23:1305–1312
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K (2011) Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 155:97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005
Friedman DB, Hoffman-Goetz L (2006) A systematic review of readability and comprehension instruments used for print and web-based cancer information. Health Educ Behav 33:352–373. https://doi.org/10.1177/1090198105277329
Baker DW, Parker RM, Williams MV, Clark WS, Nurss J (1997) The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health 87:1027–1030. https://doi.org/10.2105/ajph.87.6.1027
Jackson RH, Davis TC, Bairnsfather LE, George RB, Crouch MA, Gault H (1991) Patient reading ability: an overlooked problem in health care. South Med J 84:1172–1175. https://doi.org/10.1097/00007611-199110000-00004
FLESCH R, (1948) A new readability yardstick. J Appl Psychol 32:221–233. https://doi.org/10.1037/h0057532
Aldridge MD (2004) Writing and designing readable patient education materials. Nephrol Nurs J 31:373–377
Formulas R Automatic Readability Checker (2022). www.readabilityformulas.com
Ley P, Florio T (1996) The use of readability formulas in health care. Psychol Health Med 1:7–26
Dotson VM, Kitner-Triolo MH, Evans MK, Zonderman AB (2009) Effects of race and socioeconomic status on the relative influence of education and literacy on cognitive functioning. J Int Neuropsychol Soc 15:580–589. https://doi.org/10.1017/S1355617709090821
Ryu JH, Yi PH (2016) Readability of spine-related patient education materials from leading orthopedic academic centers. Spine 41:E561–E565. https://doi.org/10.1097/BRS.0000000000001321
Eltorai AEM, Cheatham M, Naqvi SS, Marthi S, Dang V, Palumbo MA, Daniels AH (2016) Is the readability of spine-related patient education material improving? An assessment of subspecialty websites. Spine 41:1041–1048. https://doi.org/10.1097/BRS.0000000000001446
Luciani AM, Foster BK, Hayes D, DelSole EM (2022) Readability of online spine patient education resources. World Neurosurg 162:e640–e644. https://doi.org/10.1016/j.wneu.2022.03.091
Phan A, Jubril A, Menga E, Mesfin A (2021) Readability of the most commonly accessed online patient education materials pertaining to surgical treatments of the spine. World Neurosurg 152:e583–e588. https://doi.org/10.1016/j.wneu.2021.06.010
Eltorai AE, Thomas PN, Yang H, Daniels AH, Born CT (2016) Readability of trauma-related patient education materials from the American Academy of Orthopaedic Surgeons. Trauma Mon 21:e20141. https://doi.org/10.5812/traumamon.20141
Funding
Dr. Steven Defroda receives research support from Arthrex, is an editorial board member for Arthroscopy Journal, and is a speaker for AO North America. Other authors have no relevant financial interests to disclose.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by JB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Baumann, J., Marshall, S., Groneck, A. et al. Readability of spine-related patient education materials: a standard method for improvement. Eur Spine J 32, 3039–3046 (2023). https://doi.org/10.1007/s00586-023-07856-5
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DOI: https://doi.org/10.1007/s00586-023-07856-5