The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

"Lost in Translation: The Readability Discrepancy of Online Patient Educational Materials for PCL Surgery"

Document Type : RESEARCH PAPER

Authors
Kuan-Yu Lin 1
Rena G. Wang 1
Saleh Hassan 2
Andi Zhang 1
Scott G. Kaar 3
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 
Keywords
Knee
Patient education materials
PCL surgery
Readability
Understandability
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 4
April 2024
Pages 264-274

  • Receive Date 12 October 2023
  • Revise Date 22 December 2023
  • Accept Date 13 January 2024