Document Type : RESEARCH PAPER
Authors
1
Saint Louis University School of Medicine, Saint Louis, MO, USA
2
Burnett School of Medicine at Texas Christian University, Fort Worth, TX, USA
3
Department of Orthopedic Surgery, Saint Louis University Hospital, MO, USA
10.22038/abjs.2024.75361.3492
Abstract
Objectives: While the internet provides accessible medical information, often times it does not cater to
the average patient’s ability to understand medical text at a 6th and 8th grade reading level, per
American Medical Association (AMA)/National Institute of Health (NIH) recommendations. This study
looks to analyze current online materials relating to posterior cruciate ligament (PCL) surgery and their
readability, understandability, and actionability.
Methods: The top 100 Google searchs for “PCL surgery” were compiled. Research papers, procedural protocols,
advertisements, and videos were excluded from the data collection. The readability was examined using 7
algorithms: the Flesch Reading Ease Score, Gunning Fog, Flesch-Kincaid Grade Level, Coleman-Liau Index, SMOG
index, Automated Readability Index and the Linsear Write Formula. Two evaluators assessed Understandability and
Actionability of the results with the Patient Educational Materials Assessment Tool (PEMAT). Outcome measures
included Reading Grade Level, Reader’s age minimum and maximum, Understandability, and Actionability.
Results: Of the 100 results, 16 were excluded based on the exclusion criteria. There was a statistically significant
difference between the readability of the results from all algorithms and the current recommendation by AMA and
NIH. Subgroup analysis demonstrated that there was no difference in readability as it pertained to which page they
appeared on Google search. There was also no difference in readability between individual websites versus
organizational websites (hospital and non-hospital educational websites). Three articles were at the 8th grade
recommended reading level, and all three were from healthcare institutes.
Conclusion: There is a discrepancy in readability between the recommendation of AMA/NIH and online educational
materials regarding PCL surgeries, regardless of where they appear on Google and across different forums. The
understandability and actionability were equally poor. Future research can focus on the readability and validity of
video and social media as they are becoming increasingly popular sources of medical information.
Level of evidence: IV
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