Readability of Trauma-related Patient Education Materials From the American Academy of Orthopaedic Surgeons and Orthopaedic Trauma Association Websites

Diane Ghanem; Oscar Covarrubias; Ridge Maxson; Samir Sabharwal; Babar Shafiq

doi:10.5435/JAAOS-D-23-00449

Readability of Trauma-related Patient Education Materials From the American Academy of Orthopaedic Surgeons and Orthopaedic Trauma Association Websites

J Am Acad Orthop Surg. 2024 Apr 25. doi: 10.5435/JAAOS-D-23-00449. Online ahead of print.

Authors

Diane Ghanem¹, Oscar Covarrubias, Ridge Maxson, Samir Sabharwal, Babar Shafiq

Affiliation

¹ From the Department of Orthopaedic Surgery, The Johns Hopkins Hospital (Ghanem, Sabharwal, and Shafiq), and the School of Medicine, The Johns Hopkins University, Baltimore, MD (Covarrubias, and Maxson).

PMID: 38684136
DOI: 10.5435/JAAOS-D-23-00449

Abstract

Introduction: Web-based resources serve as a fundamental educational platform for orthopaedic trauma patients; however, they are frequently written above the recommended sixth-grade reading level, and previous studies have demonstrated this for the American Academy of Orthopaedic Surgeons (AAOS) web-based articles. In this study, we perform an updated assessment of the readability of AAOS trauma-related educational articles as compared with injury-matched education materials developed by the Orthopaedic Trauma Association (OTA).

Methods: All 46 AAOS trauma-related web-based (https://www.orthoinfo.org/) patient education articles were analyzed for readability. Two independent reviewers used (1) the Flesch-Kincaid Grade Level (FKGL) and (2) the Flesch Reading Ease (FRE) algorithms to calculate the readability level. Mean readability scores were compared across body part categories. A one-sample t-test was done to compare mean FKGL with the recommended sixth-grade readability level and the average American adult reading level. A two-sample t-test was used to compare the readability scores of the AAOS trauma-related articles with those of the OTA.

Results: The average (SD) FKGL and FRE for the AAOS articles were 8.9 (0.74) and 57.2 (5.8), respectively. All articles were written above the sixth-grade reading level. The average readability of the AAOS articles was significantly greater than the recommended sixth-grade reading level (P < 0.001). The average FKGL and FRE for all AAOS articles were significantly higher compared with those of the OTA articles (8.9 ± 0.74 versus 8.1 ± 1.14, P < 0.001 and 57.2 ± 5.8 versus 65.6 ± 6.6, P < 0.001, respectively). Excellent agreement was observed between raters for the FKGL 0.956 (95% confidence interval, 0.922 to 0.975) and FRE 0.993 (95% confidence interval, 0.987 to 0.996).

Discussion: Our findings suggest that after almost a decade, the readability of the AAOS trauma-related articles remains unchanged. The AAOS and OTA trauma patient education materials have high readability levels and may be too difficult for patient comprehension. A need remains to improve the readability of these commonly used trauma education materials.