Readability analysis of AAOS and ASSH shoulder and elbow patient education online content: A 9-year follow-up study

Given the progressive spread of medical misinformation, access to understandable educational content from trusted sources has become increasingly more crucial for patients. Online patient education materials, particularly from specialty organizations, have been criticized for being too complex for the average reader. It is advised that this information be at or below the 6th-grade reading level. This study is a 9-year follow-up to an analysis conducted in 2013 which evaluated the overall readability of educational articles from the American Academy of Orthopaedic Surgeons (AAOS) and American Society for Surgery of the Hand (ASSH) websites related to shoulder and elbow conditions. In the current investigation, 74 shoulder and elbow articles were assessed using the same methodology, which included analyzing the number of years since their last update, word count, percentage of passive sentences, Flesch Reading Ease score, Flesch-Kincaid grade level, Simple Measure of Gobbledygook (SMOG) grade, and New Dale-Chall grade level. No articles from either site were at or below the recommended 6th-grade reading level. Those from the AAOS were longer than those from the ASSH (P < .001). The articles had a mean Flesch Reading Ease score of 53.8 vs. 58 (P = .01), Flesch-Kincaid grade level of 9.6 vs. 9.4, SMOG grade of 8.9 vs. 8.6, and New Dale-Chall grade of 10.5 vs. 10.1 for the AAOS and ASSH sites, respectively. Although no significant differences in the readability measures were noted between the 2013 and current AAOS articles, the current ASSH content had a significantly higher Flesch Reading Ease score (P = .01) and significantly lower Flesch-Kincaid (P = .04), SMOG (P = .03), and New Dale-Chall (P = .03) grade levels, than their 2013 counterparts. Although improvements have been made in the shoulder and elbow articles from the ASSH, there remains a need to further improve the readability of AAOS and ASSH online materials to better ensure adequate patient education.